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New York Times: U.S. Smoking Rate Declines, but Poor Remain at Higher Risk

By SABRINA TAVERNISE

WASHINGTON — Smoking, the leading cause of preventable death in the United States, continued to decline last year, federal health authorities reported Thursday, with the share of American adults who smoke dropping to 16.8 percent, down from 17.8 percent in 2013.

Smoking has been one of the brightest public health successes of recent history. Nearly half of all Americans smoked in the 1960s, but a broad push against the habit, starting with the surgeon general’s warning in 1964, helped bring rates down. The rate has dropped by about a fifth since 2005, when it was 21 percent.

But the national numbers mask deep trouble spots within the American population. About 43 percent of less educated Americans smoked in 2014, compared with just 5 percent of those with a graduate degree. About a third of Americans insured by Medicaid, the health insurance program for the poor, smoked, compared with 13 percent of Americans with private insurance.

The figures, reported by the Centers for Disease Control and Prevention, underscored the extent to which smoking in America has become a problem of the poor. Nearly six million Americans covered by Medicaid smoke, as well as almost nine million uninsured Americans, or about a third of the uninsured population.

Smoking-related diseases accounted for more than 15 percent of annual Medicaid spending from 2006 to 2010, or about $39 billion a year, according to the American Lung Association.

“Disparities are the single most important issue in smoking,” said Kenneth E. Warner, a professor of public health at the University of Michigan School of Public Health.

Dr. Warner added: “The people who are politically influential believe the smoking problem has been solved. It’s not in their neighborhoods. Their friends don’t smoke. Those who still smoke are the poor, the disenfranchised, the mentally ill. That’s who we need to focus on.”

On Thursday, the federal government appeared to take aim at that problem by proposing a rule that would prohibit smoking in public housing nationwide.

Nationally, success of the antismoking campaign has been striking. Progress among the poor and less educated, however, has been far slower.

About 43 percent of people with only a high school equivalency diploma smoke, virtually unchanged from 2005. In comparison, smoking declined by about 26 percent among people with college degrees, to 8 percent from 11 percent. For people with a high school diploma only, smoking declined by about 12 percent, to 22 percent.

Smoking among people who live at or above the poverty line declined by about 26 percent, to 15 percent from about 21 percent in 2005. Those below the poverty line declined by about 12 percent, to 26 percent from 30 percent, the report found.

American Indians and Alaskan Natives had the highest smoking rate, about 29 percent, followed by Americans of more than one race, about 28 percent of whom smoked.

Whites and blacks smoked at about the same rate in 2014 — about 18 percent — while Hispanics had a much lower rate, 11 percent.

http://mobile.nytimes.com/2015/11/13/health/us-smoking-rate-cdc-report.html?_r=0

The Washington Post: Who still smokes in the United States — in seven simple charts

By Brady Dennis
Cigarette smoking among U.S. adults has fallen to the lowest rate in generations, according to data released Thursday by the Centers for Disease Control and Prevention. That’s good news, considering that smoking still accounts for about 480,000 deaths annually in the United States, along with an estimated $300 billion in health costs and lost productivity.
But the CDC numbers also offer an interesting glimpse at the 17 percent of adults who continue to light up. People in the Midwest, for instance, smoke more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.
Here are seven charts, based on CDC data, that detail the current landscape of smoking in the United States:
1) Half a century ago, more than two of every five adults were smokers. But that has fallen steadily over time. From 2005 to 2014, the adult smoking rate declined from 20.9 percent to 16.8 percent. Public health officials are hoping to to drive that rate below 12 percent by 2020.
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2) Cigarette smoking has fallen sharply among 18- to 24-year-olds. In fact, the percentage of smokers in that age group dropped by nearly a third over the past decade, CDC data show,  the sharpest decline of any group. But that striking change might be attributable, at least in part, to the growing popularity of e-cigarettes, hookahs and other “non-cigarette tobacco products,” CDC officials said.
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3) People with lower levels of education tend to smoke at higher rates. The new data also show that smoking among people with graduate and undergraduate degrees has fallen more sharply over the past decade than among most other groups.
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4) Smoking among multiracial people and those classified as American Indian or Alaska Natives (AI/AN) far outpaces that of other ethnic groups. Notably, Asians continue to have the lowest rate of smokers and, along with Hispanics, have cut their smoking rates steeply over the past decade. CDC officials said the disparities across ethnic groups, which are consistent with previous research, might partly be due to cultural differences related to the acceptability of tobacco use.
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5) Midwesterners still smoke at higher rates than anyone else in the country. This was true a decade ago. But Thursday’s data show that while other regions have cut smoking rates by 20 percent or more since 2005, the Midwest’s dropped only 14.4 percent.
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6) U.S. adults who are uninsured or on Medicaid smoke at rates more than double that of people who have Medicare or private insurance. There could be many factors at play here. But health officials said one contributing factor is likely the “variations in tobacco-cessation treatment coverage and access to evidence-based cessation treatments” across different insurance types.
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7) The number of heavy smokers seems to be declining. Between 2005 and 2014, the number of daily smokers dropped from 36.4 million to 30.7 million. Those daily smokers also reported smoking fewer cigarettes over time, from an average of 16.7 a day in 2005 to 13.8 a day in 2014. The number of people smoking more than 30 cigarettes a day fell by almost half.
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https://www.washingtonpost.com/news/to-your-health/wp/2015/11/12/smoking-among-u-s-adults-has-fallen-to-historic-lows-these-7-charts-show-who-still-lights-up-the-most/

States Most Impacted by Tobacco Do Least to Reduce Smoking’s Toll

From Parnership for Drug-Free Kids
States most impacted by tobacco use often do the least to reduce the toll of smoking, according to an analysis by USA Today. Kentucky, Tennessee, Missouri, West Virginia and Mississippi are doing the worst job in terms of tobacco control, the newspaper found.
USA Today found big tobacco-growing states, including Kentucky, Georgia and Tennessee, have the poorest and sickest residents, but spend less than one-fifth of the federal government’s recommended minimum for tobacco education and enforcement.
States hardest hit by tobacco use are the least likely to restrict smoking in restaurants and workplaces, the analysis found. These states impose penalties of $100 or less on businesses that sell tobacco to children, compared with $10,000 in states with the most aggressive enforcement.
Tobacco taxes in states with the most smokers are 60 cents or less, compared with $4.35 in New York and $3.75 in Rhode Island, the newspaper found.
USA Today created two scores for states. States’ “impact score” combined youth and adult smoking rates with public perception about the risks of smoking. States’ “aggressiveness score” combined cigarette taxes, smoking bans, how state spending compares with federal recommendations, ad restrictions, and penalties on cigarette sales to young people.
The states that scored high on aggressiveness and low on tobacco impact included Hawaii, New York and Utah. States scoring low on aggressiveness and high on tobacco impact included Kentucky, Tennessee, Missouri, West Virginia and Mississippi.
According to Brian King, a Deputy Director in the Centers for Disease Control and Prevention’s Office of Smoking and Health, the most effective ways to reduce smoking are to regulate it, increase cigarette taxes, run powerful anti-tobacco campaigns and adequately fund tobacco control efforts. He notes that government anti-smoking efforts are “outgunned” by the tobacco industry, which spends about $1 million an hour advertising tobacco.
http://www.drugfree.org/join-together/states-impacted-tobacco-least-reduce-smokings-toll/

KX News: Less Students Smoking Cigarettes, More Students Smoking E-Cigarettes

By Alicia Ewen
North Dakota kids smoke cigarettes less than they used to…far less.
But they are dabbling in some other risky behaviors.
The state asked high school students across the state about their habits. It found that fewer kids smoke.
In fact, 80% of kids said they hadn’t smoked or used smokeless tobacco in the previous month.
Only 3% of high school students say they smoke cigarettes daily.
For the first time though electronic cigarette use was surveyed.
22% of students surveyed say they tried an e-cigarette in the month before they took the survey…
“That’s another misconception, that kids think they are safer than traditional smoking but really there are still chemicals in these vaping products that will harm your body. There hasn’t been as much research done on them as we should have so I’ll be really excited to see what comes out in the next couple of years about these vaping products,” says Hannah Rexine, CHS student and member of the tobacco policy board.
Rexine is the only youth member on the state tobacco policy board. She’s a senior at Century High School in Bismarck.
http://www.kxnet.com/story/30467318/less-students-smoking-cigarettes-more-students-smoking-e-cigarettes

Bismarck Tribune: E-cigarettes more popular than tobacco among teens, survey finds

By Amy R. Sisk, Bismarck Tribune
Although tobacco use is down among North Dakota’s teenagers, nearly double the number of youngsters are using e-cigarettes, according to a survey of students.
The 2015 Youth Risk Behavior Survey shows that 12 percent of high school students statewide reported smoking at least once in the month before the survey. That’s down from 22 percent in 2005.
Meanwhile, 22 percent of students report having used an e-cigarette in the past month.
The statistics come from a survey overseen by the U.S. Centers for Disease Control and Prevention given to middle school and high school students in every state. In North Dakota, the Department of Public Instruction and the Department of Health administer it to 10,000 high school students.
The prevalence of e-cigarettes marks an area of concern for school and health officials who spoke Monday at a news conference at the state Capitol in Bismarck. E-cigarettes convert nicotine liquid into aerosols that are inhaled, said Jeanne Prom, director of the North Dakota Center for Tobacco Prevention and Control Policy.
Hannah Rexine, a senior at Century High School, said she and her friends became aware of the vaping devices two or three years ago when they began to grow in popularity.
“E-cigarettes are becoming more popular because kids think they are more safe than an actual cigarette,” she said.
Rexine, who sits on the board of directors for the tobacco prevention center, said not enough research has been done to verify that claim.
Prom said using nicotine at a young age causes lasting harm to the brain.
“Nicotine is one of the most highly addictive drugs,” she said. “A curious experiment with an e-cigarette could lead kids into an addiction into any form of nicotine.”
Teens often buy e-cigarettes off the Internet or from friends and don’t know the nicotine content, Rexine said.
E-cigarettes come in a variety of flavors. Some believe the product can help them quit smoking.
“It’s all these rumors going around,” Rexine said.
The Students Against Destructive Decisions group at Century has educated freshmen during orientation each of the past two years about the risks associated with e-cigarettes.
The state and local governments have also jumped on board to combat the popularity of the vaping devices.
Prom said the 2015 North Dakota Legislature passed a bill prohibiting youth from using e-cigarettes and vendors from selling them to minors. Bismarck also approved an ordinance that requires stores selling the products to have a tobacco license and place the items behind the counter.
Though the percentage of teens smoking traditional cigarettes has dropped, Prom said there’s still work to do.
She said 42 percent of the state’s K-12 students attend a school that has a comprehensive policy banning tobacco. She aims to bring that number up to 100 percent by working with county public health units and school districts. Money from North Dakota’s settlement with tobacco companies in the 1990s is funding that effort.
In addition to cigarette use, the survey asks about a number of issues affecting teens, including suicide, drinking, drug use and diet.
State Superintendent Kirsten Baesler outlined efforts to address mental health issues.
The percentage of North Dakota high school students who report having attempted suicide in the past year is 9 percent. The number of students who felt sad or hopeless daily for two or more weeks in the past year is climbing from 20 percent in 2005 to 27 percent this year, according to the survey.
“We need to work to change those numbers,” Baesler said.
She said DPI is preparing training for teachers to identify early signs of mental health issues. She said the 2015 Legislature passed a bill requiring such training annually for high school and middle school administrators, teachers and instructional staff.
She said another new law requires that new teachers receive mental health training before they receive their teaching license.
http://bismarcktribune.com/news/local/education/e-cigarettes-more-popular-than-tobacco-among-teens-survey-finds/article_513c5759-69a0-5f26-8452-d296bca6b03f.html

NPR: Poll: Most Americans Support FDA Regulation Of E-Cigarettes

Poll: "Do you believe e-cigarettes should be regulated by the FDA like tobacco products?"
A majority of Americans say electronic cigarettes should be regulated by the Food and Drug Administration the same way the agency handles cigarettes containing tobacco, according to results from the latest NPR-Truven Health Analytics Health Poll.
Overall, 57 percent of people said the FDA should regulate e-cigarettes like tobacco products. The proportion of people in favor of regulation rose with age and education. Nearly, two-thirds of people with college degrees or graduate degrees supported regulation compared with 48 percent with high school diplomas or less.
The Food and Drug Administration proposed regulations for e-cigarettes in April 2014. Since then the agency has collected comments and held workshops on the public health issues raised by the products.
The agency sent its e-cigarette regulations to the White House on Oct. 19 for a required review, agency spokesman Michael Felberbaum tells Shots. The Office of Management and Budget has to pore over major regulations before they can be into effect.
Some of the key parts of the proposal included a ban on the sale of e-cigarettes to minors, a requirement that the products carry warnings they contain nicotine and disclosure of ingredients by manufacturers.
How much the FDA may have changed the regulations since they were first proposed isn’t clear because the agency doesn’t publicly release what it sends to the White House for sign-off. The White House can further tweak the rules, too.
We may find out fairly soon, though. There is a 90-day timetable for OMB review. The White House can extend the review to allow for more back and forth on the rules.
In the meantime, plenty of Americans have tried e-cigarettes. The NPR-Truven Health poll found that a quarter of respondents had vaped at least once. About a quarter of the respondents said they are current tobacco users.
E-Cigarette Use vs. Tobacco Use
What’s drawing people to e-cigarettes? The most common reasons given from those who have tried them were: to help stop smoking cigarettes (27 percent), as a healthier alternative to tobacco (26 percent) and curiosity (24 percent).
Among people who have tried e-cigarettes, half continue to use them. But 40 percent of current vapers said they have concerns about the health effects.
What was your primary reason for trying e-cigarettes?
“Electronic cigarettes have exploded in popularity in just a few short years, but we still know very little about the health risks associated with the technology,” said Dr. Michael Taylor, chief medical officer at Truven Health Analytics. “With our data showing a 50 percent adoption rate among those who have tried e-cigarettes, it’s reasonable to expect that usage will continue to grow, even as traditional cigarette smoking declines. This is clearly an area that will require a great deal more research.”
More than 3,000 people were surveyed about e-cigarettes during the first half of August. The responses came from households contacted by cellphone, land line and the Internet. The margin of error is plus or minus 1.8 percentage points.
You can find the questions and full results of the latest poll here. For previous polls, click here.
http://www.npr.org/sections/health-shots/2015/10/27/452244929/poll-most-americans-support-fda-regulation-of-e-cigarettes

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

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

CNN: Raise smoking age to 21 and regulate e-cigs, pediatricians urge

By Jen Christensen and Joseph Netto

(CNN) Most people who smoke started in their teens. While the number of kids trying tobacco for the first time has declined since the 1970s, there are still new smokers every year and kids’ doctors want to do something about it.

The American Academy of Pediatrics (AAP) came out with a strong new policy statement that urges policymakers to raise the minimum age people could buy nicotine products, be they cigarettes or e-cigarettes, to 21.

The public health benefits of barring people under age 21 from buying these products could be tremendous, including “4.2 million fewer years of life lost” among the next generation of American adults, according to a report released in March by the Institute of Medicine.

Setting a new minimum age nationwide, that study estimated, would result in nearly a quarter-million fewer premature deaths and 50,000 fewer deaths from lung cancer among people born between 2000 and 2019. Teenagers, especially those between ages 15 and 17, are most vulnerable to becoming addicted at a time when their brains are still developing.

The study, conducted at the request of the U.S. Food and Drug Administration, studied the predicted benefits of raising the minimum legal age for buying tobacco products — currently 18 in most states — to 19, 21, and 25 years. The greatest health benefits would actually come from raising the legal age even higher to 25, at which point the report estimates the prevalence of smokers among today’s teens, when they become adults, would decline by 16%.

The number of people who would not smoke if the age limit was raised to 21 is still significant. It’s estimated smoking rates would fall to 12%.

Even though fewer teenagers are using tobacco than ever before, more than half of current smokers say they started smoking before they were 18, studies show. And the number of teens who tried e-cigarettes and hookahs tripled in one year. The AAP policy statement urges the U.S. Federal Food and Drug Administration to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products.

Chris Hansen of the American Cancer Society’s Cancer Action Network praised the study when it came out in March, saying “powerful interventions are needed to keep youth from lifelong addictions to these deadly products.”

The American Academy of Pediatrics issued a statement calling the report “a crucial contribution to the debate on tobacco access for young people.”

“There is no safe way to use tobacco,” said Dr. Sandra G. Hassink, the academy’s president.

The FDA cannot raise the age limit nationwide. The minimum age in four states is 19, and in several local jurisdictions including New York City have raised the legal age to 21.

Historically, the tobacco industry has called for “responsible” consumption of tobacco products.

Companies should create more child-resistant packaging to keep curious kids from drinking the liquid nicotine used in e-cigarettes, the AAP policy statement also said. In 2014, there were more than 3,000 e-cigarette calls to U.S. poison centers. As little as half a teaspoon can kill an average-size toddler, according to the AAP. Liquid nicotine is extremely toxic when ingested on its own.

“Tobacco is unique among consumer products in that it severely injures and kills when used exactly as intended,” states the AAP policy statement. “Protecting children from tobacco products is one of the most important things that a society can do to protect children’s health.”

http://www.cnn.com/2015/10/26/health/raise-minimum-smoking-age/

Patient-centered care helps patients overcome mental illness and tobacco use

By Chizimuzo Okoli, Contributing columnist, Lexington Herald-Leader

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

http://www.kentucky.com/2015/10/24/4103534/patient-centered-care-helps-patients.html

The Hill: FDA sends e-cigarette regs to White House for review

By Lydia Wheeler
The Food and Drug Administration (FDA) has sent its final rule to regulate additional tobacco products, including electronic cigarettes and cigars, for White House review.
The rule, which was first proposed more than a year ago, was sent to the White House Office of Management and Budget’s Office of Information and Regulatory Affairs on Monday, but it could be weeks before the rule is actually released.
FDA spokesman Michael Felberbaum said the Office of Management and Budget is required to review all significant regulatory actions and has 90 calendar days to do so.
“However, this timeframe can be extended to allow for additional interagency discussion,” he said. “At this time, the FDA cannot provide any further comment until the final rule is published.”
The American Lung Association is hoping for an expedited review.
“We remain deeply troubled that it’s taken 18 months from the time the proposal was released to now,” said Erika Sward, the group’s assistant vice president of national advocacy. “We need to move forward in protecting kids and public heath.”
Sward said the lung association is hoping the final rule will give FDA the authority to truly regulate all tobacco products. Under the proposed rule, she said, there was a loophole for certain “premium” cigars.
“There’s no such thing as a safe tobacco product and certainly not a safe cigar,” she said. “FDA needs to have the basic authority over all tobacco products to make sure kids aren’t buying them and warning labels are required.”
http://thehill.com/regulation/pending-regs/257920-fdas-tobacco-deeming-rule-under-final-review