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E-Cigarette Use Among Middle and High School Students Has Doubled

WASHINGTON, D.C. — New data released today by the Centers for Disease Control and Prevention (CDC) show an alarming increase in e-cigarette use among middle school and high school students in the U.S.  From 2011-2012, the number of students in grades 6-12 reporting having ever used an e-cigarette doubled from 3.3 percent to 6.8 percent.  Recent use of e-cigarettes among 6-12 year olds increased from 1.1 percent to 2.1 percent.
These troubling numbers highlight the urgent need for the Obama Administration to move forward with regulating e-cigarettes, cigars and other tobacco products.  None of these products are currently under the authority of the Food and Drug Administration (FDA).  E-cigarettes are sold in dozens of flavors that appeal to kids, including cotton candy, bubble gum, Atomic Fireball, and orange cream soda.  Because e-cigarettes are a relatively new tobacco product, most states do not have laws prohibiting the sale of e-cigarettes to kids.  One recent study estimated that there are over 250 different e-cigarette brands for sale today, over half of which offered fruit and candy flavors.  The three major cigarette companies now also sell e-cigarette products.
“Using an e-cigarette can begin kids on a lifelong addiction to nicotine and tobacco products,”   said Paul G. Billings, Senior Vice President for Advocacy and Education.  “These data show the urgent need for oversight of these products.  The Obama Administration must halt its delay and the FDA must propose meaningful regulation of these product to protect to the public health.”
The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), which became law in 2009, gave FDA immediate authority over cigarettes and smokeless tobacco products.  The Tobacco Control Act also gave FDA the ability to then assert authority or “deem” jurisdiction over all other tobacco products, including cigars, e-cigarettes, hookah and pipe tobacco – the next generation of tobacco products that are being used to target kids.  So far, the Obama Administration and FDA have failed to move forward with asserting that authority.
The CDC study also shows that while e-cigarette use is most common among youth who use traditional cigarettes, a significant percent of youth are only using e-cigarettes, especially among younger age groups.  Among middle school students who have ever used an e-cigarette, 20.3 percent said they never smoked a traditional cigarette, compared to 7.2 percent among high school students.
“With flavors like bubble gum and cotton candy, e-cigarettes are very clearly being made and marketed in ways that appeal to children,” said Billings.
According to an initial study conducted by the FDA in 2009, toxic chemicals and carcinogens were found.  Two other initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a carcinogen) coming from the secondhand smoke emissions from e-cigarettes.

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About the American Lung Association
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Democratic Senators Pounce on E-Cigarettes After CDC Study Shows Teen Use Spike

By 
Five Democratic U.S. senators condemned tobacco-free electronic cigarettes as a gateway to cancer-causing tobacco ones, and promised to do something about it Thursday after the release of a government study showing a sharp uptick in the percentage of teens who tried one of the vapor-producing devices in 2012.
From 2011 to 2012 the percentage of high school students who had ever tried an electronic cigarette doubled from 4.7 percent to 10 percent, according to data released by the Centers for Disease Control and Prevention in its annual National Youth Tobacco Survey.
[RELATED: U.S. News Talks With the CDC’s Anti-Smoking Director About E-Cigs]
More than 92 percent of high school students who reported trying an electronic cigarette had also smoked a tobacco cigarette, but it’s unclear which they sampled first. Just 2.8 percent of high school students reported smoking an electronic cigarette in the past month, an increase from 1.5 percent in 2011. By contrast, in 2011 the CDC found 18.1 percent of high school students smoked a conventional cigarette in the past month. The 2012 data for tobacco cigarettes is not yet available.
Electronic cigarettes are touted as a healthy alternative to their foul-smelling cousins and their popularity is booming. Immediately after the CDC release, however, several senators characterized the companies behind the boom as unethical predators.
Sen. Richard Blumenthal, D-Conn., was particularly vitriolic in his attack, citing the various flavors of nicotine-laced liquid offered by e-cigarette vendors as evidence of the companies’ “very clear intent of creating a new generation of smokers.”
“Without question,” Blumenthal said in a press release, “tobacco companies are using the same despicable tactics with e-cigarettes that they used in previous decades with traditional cigarettes to lure youth down a path of nicotine addiction and eventual death.”
Senate Majority Whip Dick Durbin, D-Ill., described the uptick as “a call to action.”
[STUDY: One in Five U.S. Smokers Has Tried an ‘E-Cigarette’]
“This scientific report provides conclusive evidence,” Durbin said, “that the use of e-cigarettes among our nation’s kids is both on the rise and closely linked to the deadly use of cigarettes.”
Sen. Tom Harkin, D-Iowa, denounced companies’ “unproven claims that [electronic cigarettes] are a safe alternative to conventional cigarettes or can help smokers quit – underscoring the urgent need for greater research into these products.”
Sen. Tom Carper, D-Del., said “these products still pose serious dangers for kids and adults alike, despite their perceived image as safer alternatives to cigarettes. Regardless of the vehicle, smoking and nicotine use cost our country greatly, in terms of both health care dollars and lives lost. ”
Sen. Ed Markey, D-Mass., claimed “e-cigarettes are a gateway to tobacco use by children and teens and should not be marketed to youth.”
But advocates of electronic cigarettes say there’s no evidence they cause any health problems and say there’s nothing particularly exceptional about teen experimentation with the devices.
“Real public health practitioners and policymakers should not allow experimentation by youth to cloud their judgment about the great health benefits experienced by adult smokers who switch to e-cigarettes,” said Greg Conley, legislative director of the Consumer Advocates for Smoke-free Alternatives Association, in a statement provided to U.S. News.
Not all states ban the sale of the devices to minors, Conley pointed out. CASAA supports new state laws to restrict their sale to adults, but also wants adults e-cigarette smokers to be left alone.
 

New Study Provides More Evidence for FDA to Ban Menthol Cigarettes

Statement of Matthew L. Myers
President, Campaign for Tobacco-Free Kids
WASHINGTON, DC – Menthol cigarettes are much more likely to be used by youth and young adult smokers than older smokers and are undermining efforts to reduce smoking in the United States, according to a new study published today in the journal Tobacco Control.  The study also found that menthol smoking rates have increased among young adults and remained constant among youth and older adults, while non-menthol smoking has decreased among all three groups.
These findings indicate that “the presence of menthol cigarettes in the marketplace is slowing progress in the reduction of population smoking prevalence,” the study concludes.
This study adds to the powerful scientific evidence that menthol cigarettes have a profound adverse impact on public health in the United States, resulting in more smoking and more death and disease from tobacco use.  It underscores why the U.S. Food and Drug Administration (FDA) must act quickly to ban menthol cigarettes.
In July, the FDA began a regulatory process by inviting public comment to inform its decisions regarding menthol cigarettes.  There is more than adequate scientific evidence for the FDA to quickly develop a formal rule banning menthol cigarettes.
The new study adds to the evidence contained in the FDA’s 153-page report on the health impact of menthol cigarettes released in July.  That report found that menthol cigarettes lead to 1) increased smoking initiation among youth and young adults; 2) greater addiction; and 3) decreased success in quitting smoking. “These findings, combined with the evidence indicating that menthol’s cooling and anesthetic properties can reduce the harshness of cigarette smoke and the evidence indicating that menthol cigarettes are marketed as a smoother alternative to nonmenthol cigarettes, make it likely that menthol cigarettes pose a public health risk above that seen with nonmenthol cigarettes,” the FDA’s report concluded.
The FDA’s report independently affirmed the findings of the agency’s Tobacco Products Scientific Advisory Committee, which in March 2011 issued a report that concluded, “Removal of menthol cigarettes from the marketplace would benefit public health in the United States.”
The new study estimated menthol and non-menthol cigarette use during 2004-2010 using data from the federal government’s annual National Survey on Drug Use and Health.  Its key findings include:
·         Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7 percent) and 18-25 years olds (45 percent) than among older age groups.
·         From 2004 to 2010, menthol smoking rates increased among young adults and remained constant among youth.  In contrast, smoking rates for non-menthol cigarettes decreased for both age groups.
·         Use of Camel menthol and Marlboro menthol cigarettes increased during the study period, especially among youth and young adults.
The study was led by Gary Giovino, PhD, professor and chair of the University at Buffalo Department of Community Health and Health Behaviors.  It was funded by Legacy, (http://www.legacyforhealth.org/), a leading public health non-profit whose primary mission is to reduce tobacco use.
Tobacco use is the number one cause of preventable death in the United States, killing more than 400,000 people and costing $96 billion in health care bills each year.  The new study makes it even more clear that banning menthol cigarettes is a critical step in reducing tobacco’s devastating toll on our nation.
The University at Buffalo – State University of New York press release on the study can be read at http://www.buffalo.edu/news/releases/2013/08/033.html.
 

Underage tobacco sales reported at record lows

By MICHAEL FELBERBAUM
AP Tobacco Writer
RICHMOND, Va. (AP) — New statistics show that the sale of tobacco to minors in the U.S. were held near all-time lows last year under a federal-state inspection program intended to curb underage usage.
The violation rate of tobacco sales to underage youth at retailers nationwide has fallen from about 40 percent in 1997 to 9.1 percent in the last fiscal year, according to a Substance Abuse and Mental Health Administration report released Tuesday. The rate, which reached an all-time low of 8.5 percent in 2011, is based on the results of random, unannounced inspections conducted at stores to see whether they’d sell tobacco products to a customer under the age of 18.
A U.S. Surgeon General’s report issued last year found that more needs to be done to prevent young Americans from using tobacco, including stricter smoking bans and higher taxes on tobacco products. According to that report, almost one in five high school-aged children smokes. That’s down from earlier decades, but the rate of decline has slowed. It also said that more than 80 percent of smokers begin by age 18 and 99 percent of adult smokers in the U.S. start by age 26.
The inspection program, named for late U.S. Rep. Mike Synar of Oklahoma, is a federal mandate requiring each state to document that the rate of tobacco sales to minors is no more than 20 percent at the risk losing millions in federal funds for alcohol and other drug abuse prevention and treatment services.
Frances Harding, director of the federal agency’s Center for Substance Abuse, said that while the program has made “remarkable strides,” far more needs to be done to curb underage tobacco use.
In the last fiscal year, 33 states and Washington, D.C., reported a retailer violation rate below 10 percent, according to the Tuesday report. It was the seventh time that no state was found to be out of compliance. Maine reported the lowest rate of 1.8 percent, and Oregon reported the highest rate at 17.9 percent.
The latest federal data shows that about 14 percent of minors reported buying their own cigarettes in stores in 2011, down from 19 percent a decade earlier, suggesting that children may instead be getting their cigarettes and tobacco products from places other than convenience stores or gas stations.
http://minnesota.publicradio.org/display/web/2013/08/27/health/underage-tobacco-sales-reported-at-record-lows

Doctors can help prevent teen smoking, panel says

Kim Painter, Special for USA TODAY
Children and teens may hear about the dangers of smoking from parents, teachers and friends, but they may be less likely to take up the deadly habit if they hear the message from at least one more important person: their doctor.
That’s the conclusion of an influential panel publishing new recommendations today in two medical journals, the Annals of Internal Medicineand Pediatrics. In a number of studies, kids were less likely to try smoking if they got some kind of counseling or education from their doctors or other health care providers, says the U.S. Preventive Services Task Force.
“We didn’t recommend any particular intervention, because a variety of things seem to help,” says panel member David Grossman, a pediatrician and researcher at the Group Health Research Institute and the University of Washington-Seattle. “The important thing is that the message is coming from a physician and that’s an important voice … even to kids.”
The report says “even very minimal interventions,” such as a doctor’s office mailing a series of prevention guides to parents and kids, could make a difference.
Stopping kids from ever smoking could have a huge health impact, the panel says: Smoking kills about 443,000 people a year in the United States, and 90% of smokers start before age 18.
The American Academy of Pediatrics already urges doctors to talk to parents, children and teens about smoking.
But the task force, the academy and other experts also say that broader strategies — enlisting families, communities, mass media and lawmakers — are needed to chip away at smoking initiation rates. As of 2011, about 18% of high school students and 4% of middle school students were smokers, according to the federal Centers for Disease Control and Prevention (CDC).
While those numbers have been falling, the fact that nearly one in five teens still leave high school as smokers is unacceptable, says Michael Steinberg, an internist who directs a tobacco dependence program at Robert Wood Johnson University Hospital, New Brunswick, N.J.
“We need to do everything we can to reduce a young person’s opportunity to try their first cigarette or to go from experimenting to becoming addicted,” he says.
In an opinion piece published alongside the task force’s report in the Annals, Steinberg endorses one increasingly proposed strategy: raising the legal age to buy cigarettes to 21. A proposal to do that is under discussion in New York City, and several states and counties have already raised the age from 18 to 19, over the protests of smokers’ rights advocates and some retailers. The small town of Needham, Mass., was the first to raise the age to 21, with a phased-in plan that started in 2005, and some other Massachusetts towns are following suit, says Jonathan Winickoff, a Harvard Medical School pediatrician who spearheads anti-smoking efforts for the pediatrics academy.
Raising the age to 21 could cut teen smoking rates dramatically, largely because younger teens often get cigarettes from older teens and young adults, Winickoff says. “And if you make it to 21 without smoking, your chances of ever becoming a smoker drop to about 2%,” he says.
Some of the steepest drops in teen smoking have occurred since the federal government started requiring states to beef up enforcement of existing under-18 sales bans, says the federal Substance Abuse and Mental Health Services Administration. The share of retailers caught selling to minors dropped from 40% in 1997 to 8.5% in 2011, the agency says. Numbers for 2012 will be released Tuesday.
• Parents, educators and others who want to talk children and teens about smoking can get help from the CDC at www.cdc.gov/tobacco/youth/
• Teens who want help can go to teen.smokefree.gov, a government website with information on text and app-based tools, or Tobacco-Free Teens, a free app in Apple iTunes stores developed by researchers at MD Anderson Cancer Center in Houston.
http://www.usatoday.com/story/news/nation/2013/08/26/teen-smoking-doctors/2687711/

Providence vs. Big Tobacco

By , Mayor of Providence, RI

In January of 2012, I was pleased to sign two local ordinances designed to limit the ability of the tobacco industry to harm Providence’s young people. Together, these laws banned the sale of flavored tobacco products in the City of Providence, as well as sales involving the redemption of coupons and multi-pack discounts that are designed to circumvent state pricing restrictions.
Tobacco use poses a major public health threat for our young people. Nearly all tobacco use begins in childhood and adolescence — in fact, according to a 2012 Surgeon General report, approximately 88 percent of regular smokers begin by age 18. Each day, over 3,800 people under 18 smoke their first cigarette. According to the Campaign for Tobacco Free Kids, an estimated 23,000 children currently under the age of 18 could die prematurely from a smoking-related illness.
In Providence, we’re fighting back.
Fruit and candy flavored tobacco products appeal to young people who wrongly think that these products are less harmful than traditional cigarettes. The FDA banned most fruit and candy flavored cigarettes in September of 2009, and our ordinance closes the loophole that allows the tobacco industry to sell other fruit and candy flavored tobacco products, like cigars, chewing tobacco and other emerging tobacco-based products, here in the City of Providence.
Similarly, research has shown that the single most effective deterrent to smoking — particularly for young people — is the cost of a pack of cigarettes. According to the American Lung Association, a 10 percent increase in the price of cigarettes reduces youth consumption by approximately seven percent. But in Rhode Island and elsewhere, the tobacco industry circumvents state minimum price laws through creative “buy-two-get-one-free” gimmicks. Our ordinance closes this loophole too.
Predictably, big tobacco has challenged us in court. In December of 2012, the U.S. District Court rejected the tobacco industry’s arguments, siding with the city in our efforts to protect vulnerable, young people from the dangers of the tobacco industry. The tobacco industry has appealed this decision to the U.S. Court of Appeals for the First Circuit.
I encourage you to learn more about the harmful effects of smoking and what you can do to support our efforts by visiting here.
Smoking is the leading cause of preventable death in the United States. Policymakers have no excuse for not taking this issue on, and I’m proud that Providence is working with a wide variety of stakeholders — our City Council, community groups, advocacy organizations and public health campaigns — to stand up for our young people.
http://www.huffingtonpost.com/angel-taveras/providence-anti-tobacco-laws_b_3786575.html

Legislators aim to bar e-cigarette sales to minors

By Chris Bergeron/Daily News staff
NATICK — Appearing on the Late Show, sassy actress Katherine Heigl puffed an electronic cigarette as she told David Letterman it had helped her kick a smoking habit and live healthier since becoming a mother.
Rather than applauding, Tami Gouveia, executive director of Tobacco Free Mass, is cheering a new bill to prohibit sale of e-cigarettes and other “nicotine-delivery devices’’ to anyone under 18 in Massachusetts.
Gouveia supports the bill filed last week by Rep. Jeffrey Sanchez, D-Jamaica Plain, because she’s concerned such devices when glamorized by celebrities, like Jenny McCarthy and Johnny Depp, encourage minors to smoke.
“We regard them as an initiation pathway to using cigarettes. It’s dangerous to think of e-cigarettes as less dangerous than regular cigarettes. That’s what the industry wants us to think,’’ she said.
Sanchez’ bill “prohibits sale of nicotine delivery products … to anyone under 18″ and restricts retailers and manufacturers from providing samples of such products” except in tobacco stores and smoking bars.’’
Sanchez said he wrote his bill because current state laws “are silent on the availability of e-cigarettes to minors.’’
“Right now, my 7-year-old daughter could walk in and buy them at several locations and nobody would say anything. We want to make such products inaccessible to children. … We need to keep our children from becoming a new generation of nicotine addicts,’’ he said.
E-cigarettes and related products are currently sold under the name Smoke To Live: The Electronic Cigarette from a kiosk in the Natick Mall and can be purchased at several area tobacconists, package stores and from on-line sites.
Dvora Lieberman, regional manager for Smoke To Live, which operates in Massachusetts and three other states, said company policy prohibits sales to anyone under 18.
“If someone looks underage, we instruct our vendors to ask for IDs,’’ she said in a telephone interview. “If you’re going smoke cigarettes, e-cigarettes are better but they’re still addictive. It’s still a stimulant.’’
Lieberman said e-cigarettes can “definitely’’ help smokers quit traditional cigarettes which have many more harmful chemicals and they also provide “the option of reducing nicotine all the way down to zero if you want to quit.’’
She said e-cigarettes are also less harmful because they don’t burn and damage skin tissue and reduce the unpleasant tastes, smells and coughing associated with conventional cigarettes.
Speaking from her Framingham office, Gouveia expressed support for Sanchez’ bill’s prohibition of using e-cigarettes in places where smoking is outlawed, such as the workplace and high school campuses.
Several MetroWest legislators expressed support for the bill, citing the importance of discouraging nicotine use among minors.
After speaking with Sanchez, Sen. Karen Spilka, D-Ashland, described the bill as a “commonsense’’ measure to protect minors’ health.
“It’s important not to get these devices into children’s hands. Kids could think they’re better than cigarettes. The bottom line is nicotine is a poison that causes cancer,’’ she said.
While nicotine delivery devices are often marketed as safer alternatives to smoking, Spilka said further research is necessary to determine their impact on users’ health and the chemical composition of the “vapors’’ they release.
“We need to be wary and understand the consequences of these devices,’’ she said.
State Rep. Chris Walsh, D-Framingham, said the bill’s premise of keeping such devices out of minors’ hands makes good sense.
He said he was troubled by an advertising slogan for a brand of e-cigarettes that promised to help users “re-gain your freedom from smoking.’’
“Since nicotine is a habit-forming drug, promoting it by saying it’ll help get you off nicotine seems disingenuous,’’ said Walsh.
Walsh said, however, he wants to learn more about what carcinogens are delivered through such devices.
Two other area state representatives, Carolyn C. Dykema and Alice Hanlon Peisch, expressed support for Sanchez’ bill.
Dykema, D-Holliston, said she’d “just signed on to co-sponsor’’ Sanchez’s bill because of concerns nicotine delivery devices could be used to consume other illegal drugs including marijuana and some opioids including heroin.
She said she’s looking forward to a public hearing because research about the advertised benefits of such devices is “inconclusive.’’
Peisch, D-Wellesley, said she’d likely support efforts to restrict minors’ access to such devices and their use on school grounds. While Sanchez’ bill doesn’t recommend taxing such devices like conventional tobacco products, she said additional costs could further discourage minors from purchasing them.
Senator Richard T. Moore, D-Uxbridge, cited an American Cancer Society study that said e-cigarettes might encourage people to smoke and added “more research is needed to see if the tobacco tax should be broadened to include electronic cigarettes.’’
And Sheriff Peter Koutoujian called “banning electronic cigarettes for children under 18 the right thing to do.’’
“Electronic cigarettes glamorize an unhealthy and addictive habit, not to mention that these are actual nicotine delivery devices,’’ he said. “That’s pretty much a one-two punch for children, setting them up to think smoking is cool then working in a chemical dependence. … Electronic cigarettes pose one more temptation for the younger teenagers that we don’t need out there.”
http://www.metrowestdailynews.com/features/x606655175/Legislators-aim-to-bar-e-cigarette-sales-to-minors?zc_p=1

In All Flavors, Cigars Draw In Young Smokers

By SABRINA TAVERNISE
BALTIMORE — At Everest Greenish Grocery, a brightly lit store on a faded corner of this city, nothing is more popular than a chocolate-flavored little cigar. They are displayed just above the Hershey bars along with their colorful cigarillo cousins — white grape, strawberry, pineapple and Da Bomb Blueberry. And they were completely sold out by 9 one recent evening, snapped up by young people dropping by for a snack or stopping in during a night of bar hopping.
“Sorry, no more chocolate,” the night clerk, Qudrad Bari, apologetically told a young woman holding a fruit drink.
In 2009, Congress passed a landmark law intended to eliminate an important gateway to smoking for young people by banning virtually all the flavors in cigarettes that advocates said tempted them. Health experts predicted that the change would lead to deep reductions in youth smoking. But the law was silent on flavors in cigars and a number of other tobacco products, instead giving the Food and Drug Administration broad discretion to decide whether to regulate them.
Four years later, the agency has yet to assert that authority. And a rainbow of cheap flavored cigars and cigarillos, including some that look like cigarettes, line the shelves of convenience stores and gas stations, often right next to the candy. F.D.A. officials say they intend to regulate cigars and other tobacco products, but they do not say how or when. Smoking opponents contend that the agency’s delay is threatening recent progress in reducing smoking among young people.
Cigarette sales are down by a third over the past decade, according to federal data, but critics of the agency say the gains are being offset by the rise of cheaper alternatives like cigars, whose sales have doubled over the same period and whose flavored varieties are smoked overwhelmingly by young people. Loose tobacco and cigars expanded to 10 percent of all tobacco sold in the United States in 2011, up from just 3 percent in 2000, federal data show.
“The 20th century was the cigarette century, and we worked very hard to address that,” said Gregory N. Connolly, the director of the Center for Global Tobacco Control at the Harvard School of Public Health. “Now the 21st century is about multiple tobacco products. They’re cheap. They’re flavored. And some of them you can use anywhere.”
The F.D.A. is now wrestling with how to exercise its authority over an array of other tobacco products. In recent weeks, for example, it sent warning letters to several companies that it says are disguising roll-your-own tobacco as pipe tobacco, a practice that industry analysts say has become a common way to avoid federal taxes and F.D.A. regulation.
“The giant has finally awoken and hopefully will do its job,” said Ron Bernstein, the chief executive of Liggett Vector Brands, a cigarette producer that is worried about unfair competition from cigar makers and others.
Mitchell Zeller, 55, a public interest lawyer who became the director of the F.D.A.’s Center for Tobacco Products this spring, acknowledged in an interview that the emergence of new tobacco products meant a new look was needed.
“What we’ve seen in the past 10 years is this remarkable transformation of the marketplace,” Mr. Zeller said. “There are products being sold today — unregulated products — that literally did not exist 10 years ago.”
But new rules have to be grounded in scientific evidence, he said, and written to withstand legal challenges. The tobacco industry won a recent court fight against graphic images on cigarette labels.
As for the criticism that the agency has been slow to act, Mr. Zeller said, “Message received.”
But the F.D.A.’s careful approach exasperates smoking opponents.
“We shouldn’t need 40 years of study to figure out that chocolate- and grape-flavored cigars are being smoked by young people,” said Matthew L. Myers, the president of the Campaign for Tobacco-Free Kids. Traditional handmade cigars were seen as a luxury for older men, but much of the recent growth has been in products sold in convenience stores to low-income customers. Flavored cigars now represent more than half of all convenience store and gas station cigar sales, up nearly 40 percent since 2008, according to Nielsen market data analyzed by Cristine Delnevo, a tobacco researcher at Rutgers University.
A three-pack of Good Times flavored cigarillos at Everest costs 99 cents, an alluring price for the store’s clientele: young, poor African-Americans.
On a recent evening, Mr. Bari, a native of Pakistan, was in a generous mood. He had just broken his Ramadan fast with sweet tea and was helping a customer with the last 30 cents needed for a pack of Newports. But he said flavored cigars were actually more popular in his store than cigarettes. Sometimes people pay for them with spare change.
Jay Jackson, a 19-year-old nursing assistant in hospital scrubs, rarely has the $6.50 for a pack of cigarettes, which she also smokes, but can usually come up with a dollar for the kind of cigar she likes. Flavors improve the taste of cigars that are otherwise so harsh they make her light headed, she said, paying Mr. Bari for two — chocolate and cherry.
Mr. Bari said he remembered only strawberry, vanilla and chocolate when he first arrived 10 years ago. “Now look at this,” he said, motioning toward the cigar shelf disapprovingly. Some companies are producing small filtered cigars that look like cigarettes in brown wrappers, avoiding the federal taxes and F.D.A. regulation required for cigarettes. Mr. Bernstein, the cigarette producer, contended that such cigars made up much of the recent increase in cigar sales. A typical pack of 20 costs about $2, compared with about $6 for a pack of cigarettes.
Tobacco in cigars is cured by a different method than tobacco in cigarettes. And cigars come in a wrapper made of tobacco, while cigarettes are wrapped in paper. Smaller cigars popular among young people tend to be inhaled more, making the health risks similar to cigarettes.
Nationally, about one in six 18- to 24-year-olds smoke cigars, federal research shows, compared with only 2 percent of people over 65. More than half of the younger users smoke flavored cigars, with the highest rates among the poorest and least educated.
Those are familiar circumstances in certain parts of Baltimore, where life expectancy for men can be as low as 63 years, a level last seen for all American men in the 1940s. The smoking rate here is double the national one — a pattern that Devin Miles, a high school junior who started smoking cigarettes when he was 10, said was obvious at his school.
“Everybody smokes, even the teachers,” he said.
Cigar producers say they are bracing for F.D.A. action, even as sales have flattened in the last few years, dampened by new taxes. But they question a flavor ban, pointing out that the F.D.A. has yet to prohibit the most common flavor, menthol, in cigarettes and that chewing tobacco still comes in flavors.
“We continue to ask the question, ‘What’s the rationale?’ ” said Joe Augustus, a spokesman for Swisher International, a cigar producer. Flavors have existed “since the beginning of time,” he said, and are popular with “the guys who are cutting your lawn and fixing your car.”
There is also evidence that cigar purchases are related to marijuana use. In a survey of 5,000 middle and high school students in Massachusetts in 2003, researchers found that about a fifth were using cigar wrappers to smoke marijuana.
Mr. Bari, the night clerk, said many of his customers used the wrappers for marijuana. “It’s the younger generation,” he said. “Your sister’s crying, your daughter’s crying, you don’t care.”
One customer, Torri Stevens, a 19-year-old who said she worked at a strip club in Washington, said she sometimes smoked as many as 12 blunts a day, a name for marijuana in a cigar wrapper that is associated with Phillies Blunt, a cigar brand.
Black youths were the one group that registered a rise in cigar smoking nationally. Twelve percent of black high school students smoked cigars in 2011, compared with 7 percent in 2009, the C.D.C. said.
Maryland, where the legal age to buy cigarettes is 18, did its own survey and found that cigar smoking had increased across the entire high school population. It is now one of at least six states where cigar smoking among youths now equals or surpasses cigarette smoking, according to the C.D.C.
Alarmed officials started a public education campaign. A Web site, TheCigarTrap.com, shows an ice cream truck adorned with a giant lit cigar and children running after it.
On a recent night at Everest Greenish Grocery, Mr. Bari sold cigars to patrons of a nearby transvestite bar and people who were just leaving work.
Trayvon Henderson, 19, was still wearing his McDonald’s uniform when he stopped in for a chocolate cigarillo. Cigars are stylish, he said, and some of his favorite rappers smoke them.
“If they take away the flavor, it would be a problem,” he said, cigarillo in hand. “I’d probably stop smoking them. Or maybe I’d go back to cigarettes.”
http://www.nytimes.com/2013/08/18/health/in-all-flavors-cigars-draw-in-young-smokers.html?pagewanted=1&_r=0

Cigarette Taxes Linked to Binge Drinking

By Elbert Chu, Associate Producer, MedPage Today
Cigarette tax hikes were associated with a drop in the number of binge drinking bouts among male smokers and the amount of alcohol consumed when they did drink, investigators found.
Compared with male smokers who were not hit with any cigarette tax increases, those who were binged seven fewer times a year — a 22% drop — and drank 11% less — roughly a third of a drink — per “episode,” according to a study published online inAlcoholism: Clinical and Experimental Research.
Excessive drinking costs the U.S. about $234 billion each year, noted Sherry A. McKee, PhD, of Yale University School of Medicine and colleagues.
“We were surprised at the strength of the associations between increases in cigarette taxes and reductions in alcohol consumption,” McKee told MedPage Todayin an interview. She and her co-authors noted that to their knowledge, “no prior study has considered the potential for crossover association of cigarette taxation on drinking outcomes using a longitudinal, epidemiological U.S. sample.”
The researchers dug into prospective surveys of 21,473 U.S. alcohol drinkers from theNational Epidemiological Survey on Alcohol and Related Conditions. Two data sets provided the before-and-after cigarette tax increases. One set from 2001 and 2002, and another from 2004 and 2005.
Among the sample, 51% lived in the 31 states that increased cigarette taxes. Increases ranged from seven cents to $1.60 (mean = 61 cents, SD= 42 cents, median = 40 cents).
The investigators also accounted for alcohol prices, education, marriage status, and ethnicity. They further stratified their sample by age, drinking level, sex, and income.
The survey asked respondents about their drinking habits in the previous 12 months on a scale that ranged from “every day” to “never in the last year,” and how many drinks in consumed in each bout. Drinking was classified as “hazardous” when men reported downing more than 14 drinks per session, or women seven drinks. Also labeled as a “hazardous” drinker was anyone who binged at least once in the year they were surveyed.
Only people who said they smoked daily were included as smokers. Smokers who were also hazardous drinkers were more likely male, younger, and less likely to be married, compared with other drinkers.
Women drinkers showed no associated response to increased cigarette taxes. McKee attributed the difference between the sexes to higher rates of male drinkers in the U.S. population. “Eight percent of the population meets the criteria for alcohol use disorder. Out of that, five percent are men and three percent are women,” she told MedPage Today.
In young adults ages 18 to 29, increased cigarette taxes reduced the frequency of binge drinking (b= -0.19, P= 0.02). A similar effect was seen among smokers 50 and older (b = -0.23,P=0.04). Non-smokers showed no changes in their drinking habits.
“Nicotine acts with specific receptors in the brain unrelated to alcohol but have non-nicotine compounds that induce triggers and cues unrelated to nicotine receptors,” said Gregory N. Connolly, DMD, MPH, faculty director for the Center for Global Tobacco Control at the Harvard School of Public Health. “So the researchers may have found something big.
“We do know the opposite is true. Alcohol and the social acceptance of smoking in the bar induces relapse. The bar or pub has become the nicotine classroom for the young,” Connolly continued.
The primary limitation of the study was the reliance on people to accurately recall and record their drinking habits. In addition, the timing of the tax increases was not consistent across all states, nor does the data account for online or bulk purchases of alcohol that could be exempt from taxes.
“Absolute magnitude of increases in cigarette taxes was in the direction expected (greater increases in tax were associated with less heavy and less frequent drinking); however, the pattern of results was unchanged,” the authors wrote. It is unclear whether there’s any upper limit to the effect of increased taxes and associated drinking reductions, McKee said.
To be sure, there are other avenues for future research on other associated behaviors mentioned in the study like the rates of sex crimes and drunk driving among youth.
Although there are attempts to develop a safer cigarette underway, “smoking is the number one leading cause of morbidity in the U.S., and alcohol is the number three preventable cause of morbidity,” McKee said. “This study suggests that there are positive spillover effects to enacting these tax policies. If you can change one, you’re likely to change the other behaviour.”
Smokers are more likely to drink too much alcohol, particularly more vulnerable young men. With both behaviors so closely linked, what are the most effective strategies you use with your patients to curb binge drinking? Let us know by Adding Your Knowledge below. — Sanjay Gupta, MD
http://www.medpagetoday.com/theguptaguide/publichealth/40918

New cigarette tax saves lives in Minnesota

By: Lindsay Aijala, Two Harbors, Lake County News Chronicle
I’m writing in support of the $1.60 increase in the cigarette tax, which was included in the tax bill passed in the recently completed legislative session. The $1.60 per pack increase means that 47,000 Minnesota kids will never become addicted to cigarettes and have to face the life-long health problems that result from the addiction. My family and I have lived in Lake County for most of my life and I have noticed how cigarettes are getting into the hands of high school students and even middle school students. This increase could help the youth in our county from becoming lifelong users.
Thanks to this increase, youth smoking will decrease by 16 percent and save 5,700 Minnesotans from premature, smoking-related deaths. This increase in the cost of a pack of cigarettes is important because tobacco is still a big problem in Minnesota. Smoking costs our state $3 billion a year. The number of deaths in Minnesota caused by smoking is more than alcohol, homicide, car accidents, AIDS, illegal drugs, and suicides combined. This increase has contributed toward my efforts to help others improve their health, including many family and friends.
http://www.twoharborsmn.com/event/article/id/25323/group/Opinion/#sthash.1CHRwcRX.dpuf