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AP: House bill aims for less e-cigarette regulation

WASHINGTON — House Republicans are pushing to ease proposed government regulations for companies that sell e-cigarettes and other new tobacco products, a move that Democrats charge could lead to unsafe products on the market.

A spending bill approved by a House subcommittee Thursday would prevent the Food and Drug Administration from requiring pre-market reviews of e-cigarettes that already are on the market.

As part of a broader rule regulating e-cigarettes for the first time, the agency has proposed that e-cigarette brands marketed since February 2007 undergo those pre-market reviews retroactively once the final rule is approved. Companies would have to submit the applications within two years of the final rule, and then the FDA would ensure that the product is “appropriate for the protection of the public health.” If not, the agency could take it off the market.

In addition to e-cigarettes, the FDA rules and the House legislation would apply to other unregulated tobacco products such as cigars, hookahs, nicotine gels, waterpipe tobacco and dissolvable tobacco products. The FDA already regulates cigarettes, smokeless tobacco and roll-your-own tobacco products.

Republicans said the pre-market review would be a lengthy and expensive process that could drive companies out of business. Alabama Republican Rep. Robert Aderholt, who sponsored the bill, said the provision is just a technical change that would keep the newer products under FDA oversight but allow them to be regulated in the same way as older tobacco products. The legislation would not affect the FDA’s proposal to ban the sales of the products to minors and would still allow certain product standards.

Public health groups said the legislation would hamper the FDA’s ability to prevent tobacco companies from marketing the new products to kids, and Democrats said before the panel’s vote that the change would reduce regulation on the industry at the same time that e-cigarette use is skyrocketing.

The bill “is nothing short of a giveaway to the tobacco industry,” said New York Rep. Nita Lowey, the top Democrat on the Appropriations Committee.

FDA’s proposed rules, expected to be finalized in the coming months, are aimed at eventually taming the fast-growing e-cigarette industry.

E-cigarettes are plastic or metal tubes, usually the size of a cigarette, that heat a liquid nicotine solution instead of burning tobacco. That creates vapor the user inhales.

The nicotine-infused vapor of e-cigarettes looks like smoke but doesn’t contain all of the chemicals, tar or odor of regular cigarettes. Some smokers use e-cigarettes as a way to quit smoking tobacco, or to cut down. However, there’s not much scientific evidence showing e-cigarettes help smokers quit or smoke less, and it’s unclear how safe they are.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the House language could keep products on the market that appear to be targeted to children, like cigars and e-cigarettes in a variety of candy and fruit flavors.

Gregory Conley, president of the American Vaping Association, said the FDA regulations could hurt small businesses.

“This proposal does not remove the FDA’s ability to regulate vapor products,” Conley said. “The FDA will still have the full authority to make science-based regulatory decisions on the manufacturing, marketing and sale of these products.”

The FDA would not comment on the legislation, but FDA spokesman Michael Felberbaum said the rules are important consumer protections.

“When finalized, the rule will represent a significant first step in the agency’s ability to effectively regulate tobacco products and, as we learn more about these products, the agency will have additional opportunities over the long term to make a positive difference in the public health burden of tobacco use in this country,” Felberbaum said.

http://www.cbsnews.com/news/house-bill-aims-for-less-e-cigarette-regulation/

Reuters: Half of deaths from 12 common cancers directly linked to cigarette use

By Lisa Rapaport / Reuters Media

Roughly half of deaths from 12 smoking-related cancers may be linked directly to cigarette use, a U.S. study estimates.
While the largest proportion of deaths associated with smoking were for cancers of the lung, bronchus, trachea and larynx, about half of fatalities from tumors of the oral cavity, esophagus and bladder were also tied to cigarettes, the study found.
“The bottom line is that while we’ve made a lot of progress against the tobacco epidemic in the United States, there’s still much work to do,” lead study author Rebecca Siegel, a researcher at the American Cancer Society in Atlanta, said by email.
Siegel and colleagues estimated that out of 345,962 cancer deaths in 2011 among U.S. adults 35 and older, 167,805 were associated with smoking.
To estimate the proportion of cancer deaths attributable to smoking, the researchers used a standard formula to calculate the fraction of cases of specific cancer types that would not have occurred if there were no smoking.
Then they analyzed data from national surveys and in-person interviews asking people about their health history and tobacco habits. They adjusted their estimates to account for age, race, education level and alcohol use.
Based on smoking habits in the population and the proportion of cancer cases attributable to smoking, the researchers estimated that 125,799 lung, bronchus and trachea cancer deaths, representing 80 percent of the total, were linked to smoking. So were 50 percent of deaths from esophagus tumors and 45 percent of deaths from bladder malignancies.
The researchers also credit smoking with 17 percent of kidney cancer deaths, 20 percent of stomach cancer deaths, 22 percent of cervical cancer deaths and 24 percent of liver and bile duct cancer deaths in 2011.
One limitation of the study is that the survey and interview participants were generally more educated and less racially diverse than the U.S. population as a whole, the researchers acknowledge in JAMA Internal Medicine.
It’s also possible, however, that they underestimated cancer deaths tied to smoking because they didn’t have data on second-hand smoke exposure, which may cause an additional 5 percent of lung cancer deaths, or on use of cigars, pipes, or smokeless tobacco.
“While smoking prevalence continues to slowly decline, the use of alternative tobacco products is on the rise,” Siegel said.
Use of combustible forms of tobacco other than cigarettes, such as cigars and hookahs, doubled from the equivalent of 15.2 billion cigarettes in 2000 to the equivalent of 33.8 billion cigarettes in 2011, Siegel said.
“Although we can’t know exactly how many people are not starting to smoke cigarettes because they are using other tobacco products, e-cigarettes are now the most common form of tobacco use among high school students,” Siegel said.
Evidence doesn’t suggest that people who use alternative tobacco products are more likely to quit smoking or avoid starting on cigarettes, Dr. Michael Ong, author of a tobacco cessation editorial accompanying the study, said by email.
If there’s an upside to alternatives, though, it may be seen in the declining proportion of lung cancer deaths attributable to cigarettes, said Ong, a researcher at the University of California, Los Angeles and the Veterans Affairs Greater Los Angeles HealthCare System.
“But most of all lung cancer deaths are still attributable to smoking, and lung cancer makes up the largest cause of cancer-related mortality,” he said.
In an indication of the uphill battle smoking cessation can be, another study also published in JAMA Internal Medicine found that clinicians simply asking patients to quit and advising them of the lung cancer risks isn’t enough motivation to make it more likely that patients successfully quit.
Researchers followed more than 3,000 smokers for one year after lung cancer screenings to see if the amount of cessation support they received from clinicians might influence their odds of quitting.
The smokers who received assistance such as referrals to counseling or prescriptions for smoking-cessation drugs were 40 percent more likely to quit, while those who received follow-up care to monitor their progress were 46 percent more likely to stop smoking.
“Smokers face physical, environmental and social barriers to quitting,” lead study author Elyse Park, a researcher at Massachusetts General Hospital in Boston, said by email. “Primary care providers can assist smokers, particularly smokers with a heavy smoking history, to boost their confidence and obtain the counseling and medication support that can help them improve their odds of successful quitting.”
http://www.inforum.com/news/3766802-half-deaths-12-common-cancers-directly-linked-cigarette-use

Star Tribune: Mpls. considers restrictions on flavored tobacco products

By Eric Roper Star Tribune

The sale of flavored cigars in convenience stores could soon come to an end in Minneapolis, where city officials are mulling the state’s first ban on the products at most traditional locations to curb youth tobacco use.

Anti-smoking advocates and small retailers squared off at a packed City Council hearing Monday over a proposal that would restrict sales of flavored tobacco products from more than 300 allowed locations to just under two dozen specialty tobacco shops. Similar bans have been enacted in New York City and Providence, R.I.

A council committee delayed a vote on the proposal, which targets flavored cigars, smokeless tobacco, shisha for hookahs and e-cigarette juice — but excludes menthol flavors. It would also set a minimum price on all cigars at $2.60 — echoing measures passed in Bloomington, St. Paul, Maplewood and Brooklyn Center.

Supporters said low-cost flavored cigars, sold under brands like White Owl and Swisher Sweets, are especially harmful because they entice young people to start smoking. A recent study of 530 underage youth in north Minneapolis found that more than half of the 313 who had used tobacco reported at one point smoking a cigar or cigarillo.

“Luring people to an addictive product with cheap prices and candy flavors before they’re old enough to know better doesn’t … give kids much choice,” testified Latrisha Vetaw of Northpoint Health and Wellness Center. Some of the non-tobacco flavors mentioned in the ordinance include chocolate, honey and vanilla, as well as fruits, herbs and candy.

City records show that 362 businesses are currently authorized to sell tobacco products in Minneapolis, though about a quarter of them are bars that largely sell cigarettes. The proposal would limit flavored tobacco sales to approximately 21 “tobacco products shops,” which generate 90 percent of their revenue from tobacco-related sales. It also clarifies that customers must be 18 to enter those stores.

Convenience store owners at Monday’s hearing challenged the necessity of the change, noting that it is already illegal for them to sell tobacco to minors. City records show that out of more than 350 undercover compliance checks each year, only about 6 to 7 percent result in violations for selling to a minor.

They also said that restricting tobacco sales threatens one of their core revenue streams. “Forty percent of our sales in the convenience store industry comes from tobacco. … That’s the industry average: 40 percent,” said Steve Williams, owner of Bobby and Steve’s Auto World, which has several locations. “So we’re affecting the viability of a lot of convenience stores.”

Ahmad Al-Hawari, who owns four convenience stores around the city, said while flavored cigars account for less than 5 percent of their business, the change could result in lost customers.

“A customer will walk or drive to a smoke shop, buy his flavored tobacco as he wishes … and then he’s going to buy cigarettes and pop from there,” Al-Hawari said. “He’s not going to go back to the convenience store.”

The federal government banned all flavored cigarettes except for menthol in 2009, but did not apply the same restrictions to cigars. Cigars may also be sold individually, versus in packs like cigarettes, making a common price about 99 cents each, according to a city staff report.

Paul Pentel, an internist at Hennepin County Medical Center, said their low cost also makes cigars an appealing option for adults who already smoke.

“In my clinic, I am very alarmed by the number of patients I see who have switched to cheap cigars because of the cost of cigarettes,” Pentel said. “For these patients, cheap cigars are a missed opportunity to quit smoking.”

New York City banned the sale of flavored tobacco products in 2009, except for at a handful of tobacco bars. A ban in Providence, R.I., went into effect in 2013. The state of Maine has also enacted a ban on small, flavored cigars.

Four Minnesota cities have already established minimum cigar prices. The minimum is $2.10 in St. Paul and Brooklyn Center, and $2.60 in Bloomington and Maplewood, city staff said.

Council Member Blong Yang, a cosponsor of the ordinance change, said he was drawn to the issue after seeing in the recent study from Breathe Free North, a program of Northpoint, that children have too much access to flavored tobacco. It also appears to be disproportionately affecting minority communities, he said.

“Every single convenience store that you go to it seems has all this stuff right in front of people, basically,” Yang said. “And it’s screaming for people to buy it because it’s there.”

The council’s health, environment and community engagement committee is expected to vote on the measure in two weeks, with a final vote before the full council possible in July.

http://www.startribune.com/minneapolis-mulls-restrictions-on-flavored-tobacco-products/306572261/

U.S. News: Nevada Republican Gov. Brian Sandoval secures unlikely win with approval of big tax increase

By MICHELLE RINDELS, Associated Press

CARSON CITY, Nev. (AP) — Nevada’s Republican governor, Brian Sandoval, secured an unlikely victory Monday when the conservative state Legislature approved a huge tax increase at his urging as part of a plan to boost education spending.

The $1.1 billion package raises taxes on businesses and cigarettes, and it makes permanent a $500 million bundle of temporary payroll and sales taxes.

Sandoval’s win comes on the last day of the legislative session, and the proposal’s fate had been in doubt until late Sunday when several skeptical Republicans in the state Assembly pledged support.

The plan had faced vocal resistance for months, led by anti-tax conservatives emboldened by election victories in November that increased their majorities in both chambers.

Many critics noted that Nevada voters had overwhelmingly rejected a similar business tax plan and said the lawmakers shouldn’t go against their wishes.

Sen. Don Gustavson said legislators “should be ashamed of themselves to force through the largest tax increase in Nevada’s history that includes the type of tax that voters did not support.”

“And you wonder why our constituents distrust politicians?” he added.

Gustavson and Sens. Pete Goicoechea and James Settelmeyer, all rural Republicans, were the only opposition in the Senate, which passed the tax plan 18-3 Monday.

That vote came after the Assembly passed the plan 30-10 Sunday night after heavy-hitting business groups lined up behind it.

The tax increase will allow Sandoval to pump millions of dollars into programs for poor students and children learning English. The state has lagged behind others for years in education rankings and on school funding, but it has consistently rejected efforts to raise revenue.

Republican Sen. Scott Hammond had been among the skeptics, but he said his concerns about accountability had been eased, in part by the passage of his bill allowing students to use public funds at private schools.

“I can assure you that there have been significant reforms. We have one of the best, if not the best, school choice reform programs now in the nation,” Hammond said. “For that reason, I can support this.”

Elements of the plan include:

— A hike in the business license fee. The fee for corporations would rise from the existing $200 a year to $500, while the fee for the rest of the business entities would remain at $200.

— A hike in the payroll tax. Sandoval’s plan raises the state’s existing modified business tax from 1.17 percent to 1.475 percent of wages beyond the first $200,000 a company pays out each year and sets the rate at 2 percent of those wages for the mining industry and financial institutions. Companies would still get to deduct health care premiums for employees from the calculation.

— A “Commerce Tax” on gross revenue. Industry-specific tax rates will apply to businesses with more than $4 million in Nevada revenue each year. Businesses can count 50 percent of their commerce tax bill as a credit against their modified business tax bill — a provision that’s intended as a perk to those who employ people. The commerce tax aims to capture more money from capital-intensive businesses such as mines and those that do business in Nevada but aren’t based here.

— A flexible payroll tax rate. The plan allows the state to lower the modified business tax rate if revenues from the new commerce tax and MBT rate bring in more revenue than projected.

— An extension of “sunset taxes.” More than $500 million of the plan comes from making a set of expiring payroll and sales taxes permanent.

— Cigarette taxes. The bill raises a tax on cigarette packs by $1, which is expected to generate about $100 million over two years.

http://www.usnews.com/news/politics/articles/2015/06/01/nevada-gop-governor-secures-unlikely-win-with-tax-increase

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

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

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

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

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

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

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

What can be done?

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

Here are five quick tips for smokers trying to quit:

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

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

References:

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

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

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

By Patrick Springer

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

Opinion: E-cigarettes: Doctors' View: E-cigarette, tobacco smoke enough alike to warrant regulation

By Terry Clark, Mary J. Boylan and Joseph Bianco

What are e-cigarettes? Have you ever seen one? Do you know how they work? Are they as bad for your health as traditional cigarettes?

It is fair to say that three or four years ago these were new questions and we did not know the answers. But now we do, and it is certainly time for you to know — and for our St. Louis County Board of Commissioners to know as they consider a vote to help protect citizens of our county from the “invisible” harm caused by these gadgets if being used indoors.

Details about e-cigarettes and their health effects are well-described in a recent report from the California Department of Health, and even more recent good information on e-cigarettes can be found in the News Tribune’s “Our View” editorial on Friday, headlined, “County up next in quest for clear air.”

E-cigarettes is a good news/bad news story. Are they less toxic than traditional cigarettes? Likely. Are they really safe to use? Not likely.

First, how do they work? With no tobacco or cigarette paper to burn, there’s no smoke. They really are electronic gadgets with several sections, one with a small battery, one with a small amount of fluid usually containing some nicotine as well as flavoring and other chemicals, and a high-temperature chamber that converts the liquid into an aerosol or fog to be inhaled by the user (an action called vaping) and then exhaled where it is readily inhaled by those around the user.

What is in this aerosol emitted by the e-cigarette? At least 10 chemicals known to cause cancer, birth defects or other reproductive harm, including nicotine, formaldehyde, heavy metals and volatile organic compounds, according to the report. It’s not what you or your favorite teenager should be exposed to.

Nicotine, a key ingredient in the aerosol, is highly addictive. Of course, that is why so many users of traditional cigarettes said for years that they could quit whenever they wanted but usually never could.

We should all wonder why the three major tobacco companies purchased start-up e-cigarette companies. What do they know that we do not? One thing is this: Kids who start using purportedly safer e-cigarettes often switch and become traditional smokers or, even worse, dual smokers who use both e-cigs and traditional tobacco cigarettes. They are then addicted to nicotine for decades. Is that what the big tobacco companies are banking on?

Our elected county leaders soon will vote on this simple question: Should e-cigarette use indoors be regulated as a public health hazard just like traditional tobacco smoke? That is, no smoking in indoor places such as worksites, bars, restaurants, stores, arenas, etc.

The city of Duluth and many other communities in Minnesota already have answered this question in the affirmative: Yes, e-cigarette aerosol and tobacco smoke have enough in common to warrant being regulated in the same way under the Minnesota Clean Air Act.

In short, keep them outside.

Terry Clark and Mary J. Boylan are doctors from Duluth. Joseph Bianco is a doctor from Ely.

http://www.duluthnewstribune.com/opinion/columns/3742094-e-cigarettes-doctors-view-e-cigarette-tobacco-smoke-enough-alike-warrant

Reuters Health: Youth who receive tobacco coupons may be more susceptible to smoking

BY KATHRYN DOYLE

(Reuters Health) – Middle and high school students exposed to tobacco coupons were more likely to find smoking “cool” and less likely to feel confident in quitting if they already smoked, according to recent U.S. survey data.

Some kids may encounter the coupons for free or discounted tobacco products passively, via direct mail campaigns aimed at their parents, but the coupons are also often sent by email and are readily available on the Internet.

“In previous studies, my collaborators and I found that exposure to cigarette coupons predicts smoking progression in youth and young adults and reduces likelihood of cessation among general adult smokers from the U.S. upper Midwest,” said the study’s author, Dr. Kelvin Choi of the National Institute on Minority Health and Health Disparities in Bethesda, Maryland.

This new national sample of middle and high school students who were included in the current analysis can be generalized to youth across the United States, Choi told Reuters Health in a statement.

Choi’s opinions do not necessarily reflect those of the National Institutes of Health, Department of Health and Human Services, or the United States Government, the statement added.

Using the National Youth Tobacco Survey 2012, Choi examined questionnaire responses from more than 24,000 middle and high school students, who reported if and where they had received coupons from a tobacco company over the past 30 days.

Almost 10 percent said they were current smokers, 16 percent were experimenters and almost 75 percent were non-smokers.

Thirteen percent of the students had received tobacco coupons over the previous month, most often digitally – by text message, Internet or social networks – and sometimes by paper mail or on tobacco packages themselves.

In the survey, kids who had been exposed to these coupons in any form were less likely to disagree with positive statements about cigarette smoking, such as that it helps young people fit in and have more friends. They were also less likely to agree with negative statements, such as that all tobacco products are dangerous.

The kids who were exposed to the coupons but had never smoked gave survey responses that suggested they were more susceptible to trying smoking, and those who were smokers gave responses suggesting they were less confident in their ability to quit.

Among those who experimented with cigarettes, kids who saw the coupons were more likely to purchase cigarettes over the next month, as reported in Tobacco Control.

“It is well-established that a wide variety of psychosocial factors are associated with smoking and are likely on the causal pathway to smoking,” said Dr. Jennifer O’Loughlin of the department of social and preventive medicine at the University of Montreal in Canada, who was not part of the new study.

“Note that one of the determinants of tobacco use is pricing,” O’Loughlin told Reuters Health by email. “Coupons directly reduce the price and may be a powerful incentive for tobacco use.”

But with a study of only one point in time, like this one, it is difficult to determine which came first, the coupons or the smoking, she said.

Without a long-term study randomizing kids to receive these coupons, it will be difficult to establish that the coupons cause kids to smoke, and therefore difficult to hold coupon distributors responsible, she said.

“In kids especially (who may be particularly vulnerable to advertising and promotion), it is vital to combat anything that contributes to the social norm that tobacco smoking is OK,” O’Loughlin said.

Since kids can download coupons from the Internet easily, they may easily do so without their parents’ knowledge, she said.

“We found that cigarette companies say on their websites that they do not target anyone under the age of 21 with direct mail materials, although their compliance with this self-regulation is unknown,” Choi said. “Interested youth could also potentially bypass the age-verification on cigarette company websites using someone else’s or inaccurate identification.”

On the Internet and in social network channels, it is much harder, if not impossible, to enforce stringent age-verification, he said. “Plus, as we found in a previous study, individuals give coupons to others if they don’t use them,” he said.

http://www.reuters.com/article/2015/05/06/us-adolescent-smoking-coupons-idUSKBN0NR25Q20150506

Press Release: Heitkamp Announces Significant Federal Funding for Tobacco Prevention

WASHINGTON, D.C. – U.S. Senator Heidi Heitkamp today announced nearly $914,000 in federal funding to support statewide efforts to prevent tobacco use.

These funds, awarded to the North Dakota Department of Health, will be used to support its Tobacco Prevention and Control program, which includes information for schools and health care providers, programs to help North Dakotans quit smoking, data collection and trainings.

“Over the past several decades, the devastating health effects caused by tobacco use have become more and more clear,” said Heitkamp. “As North Dakota’s Attorney General in the 1990s, I led the charge to hold tobacco companies responsible for what their products were doing to North Dakotans, so I understand the importance of investing in tobacco prevention efforts and providing resources to help folks quit smoking. These funds will help the North Dakota Department of Health continue its great work to stop tobacco use and help make sure the next generation of North Dakotans are tobacco-free.”

While Attorney General, Heitkamp helped to broker an agreement between 46 states and the tobacco industry, which forced the tobacco industry to tell the truth about smoking and health. The settlement resulted in the award of about $336 million to North Dakota taxpayers to date and was one of the largest civil settlements in U.S. history.

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

By: Theresa Knox

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And the result?

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

And the most celebrated result?

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

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