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Most youth who use smokeless tobacco are smokers, too

By Anne Harding, Reuters
NEW YORK (Reuters Health) – Most young people in the U.S. who use newer smokeless tobacco products are smoking cigarettes too, according to new research.
“These findings are troubling, but not surprising, as tobacco companies spend huge sums to market smokeless tobacco in ways that entice kids to start and encourage dual use of cigarettes and smokeless tobacco,” Vince Willmore, vice president of communications at the Campaign for Tobacco-Free Kids, a Washington, D.C.-based advocacy organization, told Reuters Health in an email.
“From 1998 to 2011, total marketing expenditures for smokeless tobacco increased by 210 percent – from $145.5 million to $451.7 million a year, according to the Federal Trade Commission,” he added.
Swedish-style “snus,” introduced to the U.S. in 2006, and dissolvable tobacco products, introduced in 2008, are arguably less harmful than conventional chewing tobacco because they contain fewer nitrosamines, and have been promoted as safer alternatives.
But public health experts have been concerned that these products could serve as a “gateway drug” to use of conventional smokeless tobacco and to cigarette smoking.
To better understand the prevalence of smokeless tobacco use among young people, Dr. Gregory Connolly of the Harvard School of Public Health in Boston and his colleagues looked at data from the 2011 National Youth Tobacco Survey, which included nearly 19,000 sixth- to 12th-graders from across the country.
Overall, the researchers found, 5.6 percent of young people reported using any type of smokeless tobacco. Five percent used chewing tobacco, snuff or dip, just under two percent used snus and 0.3 percent used dissolvable products.
Among young people who were current smokeless tobacco users, about 72 percent reported smoking cigarettes too, while almost 81 percent of young people who used only snus or dissolvables were also smoking cigarettes.
Just 40 percent of smokeless tobacco users said they had plans to quit using tobacco, according to findings published in Pediatrics.
“We found higher current use than we expected. It’s just not experimentation, it looks like it’s taken hold among adolescents,” Connolly told Reuters Health.
“The most distressing finding was that this is not resulting in children or in young adolescents switching from smoking to these new products that may or may not be safer when used alone. They’re using both in very high numbers.”
Little information had been available on trends in the use of novel smokeless tobacco products, so studies like this one are important, Dr. Neal Benowitz, who has studied the health effects of smokeless tobacco at the University of California, San Francisco, told Reuters Health.
“To me the fact that 72 percent of users concurrently smoke cigarettes is a serious issue,” he said. “These would be safer alternatives only if people used them exclusively, and as soon as you’re talking about dual use you virtually negate any reduction of harm.”
Benowitz, who was not involved in the current research, noted that studies have shown use of smokeless tobacco among U.S. youth can indeed be a gateway to cigarette smoking.
“The most disturbing finding is that a huge percentage of youth smokeless tobacco users also smoke cigarettes,” Willmore said.
“This indicates that smokeless tobacco compounds the problem of overall tobacco use in the United States, rather than helping to solve it as some tobacco companies claim.”
RJ Reynolds, which makes Camel Snus and dissolvable tobacco products including Camel Orbs, Sticks and Strips, did not respond to a request for comment by press time.
“The tobacco industry is facing the 21st century with a whole new strategy, and that is to bring in new products that they claim to be safer,” Connolly told Reuters Health.
He pointed out that under the Family Smoking Prevention and Tobacco Control Act, passed in 2009, the U.S. Food and Drug Administration is charged with regulating tobacco products, including smokeless tobacco.
“When we look at this data I think it is very disturbing to realize that the law has not kept them out, and at least in this data set they’re gaining traction among young people,” Connolly said.
SOURCE: http://bit.ly/13INoAt Pediatrics

'Cowboys get cancer, too,' says speaker at smokeless tobacco summit in Missoula

By Alice Miller
For nine months, James Capps didn’t have a bite of food. He had to pour nutrition drinks into a feeding tube to get nourishment while he underwent and recovered from treatment for oral cancer.
Smokeless tobacco is dangerous, and Capps’ story is the testament.
Capps is featured in a short video and advertising campaign in Oklahoma that shares his story. After the video’s first week on television, the number of people requesting tobacco-cessation aids jumped 300 percent.
Capps said he loves his new role as an advocate and hopes his story gives people the push they need to quit.
“You don’t need that crutch to be someone you want to be,” he said. “You should do it without tobacco.”
Capps traveled to Missoula from his hometown of Atoka, Okla., to receive the Cliff Niles Creative Media Award during the seventh National Smokeless and Spit Tobacco Summit, held at the University of Montana this week.
The summit, held every other year, focuses on prevention and research about smokeless tobacco. Hundreds of people from around the country are attending the summit, which features more than 70 presentations.
UM’s College of Health Professions and Biomedical Sciences hosted the event and received $32,250 from the National Association of Chronic Disease to plan the summit, which is the only national conference of its kind.
Smoking takes center stage when people talk about tobacco use, said Patricia Nichols, an independent consultant for Montana’s Tobacco Use Prevention Program and co-chairperson of the summit’s smokeless advisory board.
However, smokeless tobacco is just as dangerous. It causes cancer and contributes to cardiovascular disease, Nichols said.
“We want people to know that this isn’t a safe habit, even if your grandpa did it,” she said.
Smokeless tobacco use tends to be more common in rural areas because it allows manual laborers to get the kick tobacco provides without tying up their hands, she said.
And smokeless tobacco requires people to spit.
“Which is a lot easier in rural locations,” she said.
***
Tobacco companies are constantly putting new products on the market, she said, and the rise in smoke-free public spaces and businesses equates to a resurgence in use of smokeless tobacco products.
As with other tobacco products, companies are targeting the younger generation, because they need more people to replace those who have quit or died, Nichols said.
One way Montana is fighting back against tobacco company advertising to younger people is through a tobacco-free rodeo program.
In 2010, the Montana High School Rodeo Association agreed to the Montana Tobacco Use Prevention Program’s request for the organization to adopt a more stringent tobacco-free policy, said Crissie Hansen, a prevention specialist out of Dillon.
Most parents, rodeo workers and fans abide by the policy, which prohibits tobacco use by anyone during rodeo events.
“We really have not had any friction on it,” Hansen said in response to a question about community feedback on the policy during a presentation Tuesday at the summit.
In addition to the policy, about 200 rodeo athletes have taken a pledge not to use tobacco. Athletes must sign the pledge if they want to participate in the reACT rodeo series and have a chance at end-of-season prizes. reACT is a student-based program advocating against tobacco use.
The rodeo program is a way for health workers to reach kids where they play – venues where tobacco companies have traditionally excelled, said Alison Reidmohr, a health educator with the Montana Tobacco Use Prevention Program.
Changing how kids look at tobacco and its use helps alleviate peer pressure to do something that has been associated with the rodeo scene, she said, adding some athletes are sharing their personal stories through commercials.
***
Capps, the Oklahoman who’s speaking out against smokeless tobacco, said he knows well the pressure cowboys feel to use tobacco.
Capps was hooked by the time he was 15, and he began dipping because that’s what every good Oklahoma cowboy did.
“So I thought dipping snuff was the way to fit in,” he said.
Girls thought it was nasty.
“Well, we’d just get another girlfriend,” he said.
Thirty years after he began dipping snuff, Capps got oral cancer at the base of his tongue. Because doctors couldn’t get to the tumor surgically, they put a port in his neck and pumped chemotherapy drugs directly to the tumor – 24 hours a day, seven days a week for seven weeks.
He received radiation therapy five days a week over the same time. Now, he has difficultly speaking, suffers from dry mouth and must wash down every bite of food with water.
The risks of getting cancer were there for him to see.
“I believe everybody knows there’s that chance,” he said. “But the key thing is this: It will never happen to me.”
Today, Capps knows differently.
“Now I know cowboys get cancer, too,” he said.
http://missoulian.com/news/local/cowboys-get-cancer-too-says-speaker-at-smokeless-tobacco-summit/article_5445e1e2-ff04-11e2-b71d-0019bb2963f4.html

1 in 20 School-Aged Kids Use Smokeless Tobacco

Susan E. Matthews, Everyday Health Staff Writer
Approximately 1 in 20 school-aged U.S. kids use smokeless tobacco products such as dip, chewing tobacco or snuff, a new study found. While smokeless products are often promoted by tobacco companies as “healthier” options, the study also found that teens who use them are not replacing traditional tobacco with smokeless tobacco, but instead are using both.
Since young people aren’t switching products and are instead combining them, any potential health benefits associated with switching to smokeless brands are lost. In fact, by using both types of products, young adults may actually be increasing their risks for tobacco-associated illnesses.
And in a blow to the idea that transitioning to smokeless products might help teens quit tobacco, the survey showed that less than half — 40.1 percent — of smokeless tobacco users intended to quit.
Researchers from the Harvard School of Public Health used data from the 2011 National Youth Tobacco Survey, which included more than 18,000 students in grades 6 through 12 who were asked about their use of a variety of tobacco products over the previous 30 days. Of the surveyed students, 5.6 percent used smokeless tobacco products, and 72.1 percent of these students also used conventional tobacco products including cigarettes, cigars, and water pipes.
In recent years, several novel forms of smokeless tobacco have come onto the market, such as snus, which is moist snuff, and dissolvable tobacco. Of the students using smokeless tobacco, 5 percent used traditional products, while 1.9 percent used snus, and 0.3 percent used the dissolvable tobacco. Compared to traditional smokeless tobacco and cigarettes, these products contain fewer carcinogenic nitrosamines, and may pose less health risk. As a result, tobacco companies have promoted them as a better tobacco alternative.
Males in the survey more likely to use smokeless tobacco products than females (9 percent versus 2 percent), and students over 18 were also more likely to use them than students aged 9 to 11 (10.8 percent compared to 2.2 percent). Smokeless tobacco use has stayed relatively consistent, at around 5 percent, while cigarette use has declined over the past decade, the researchers noted.
“Promotion of snus or dissolvable tobacco products at a population level may not have benefits and might even cause harm from dual use with combustible and/or conventional smokeless tobacco products,” the researcher wrote in the study, published in Pediatrics. Student who reported noticing warning labels on the products were actually more likely to use tobacco, suggesting that these warning aren’t effective, according to researchers.
The American Academy of Pediatrics has called for further regulation of novel tobacco. The study authors suggested more effective warning labels on smokeless products, and that physicians take more initiative in bringing up the harms of smokeless tobacco in consultations with young adults.
Based on the survey results, the researchers concluded that peer pressure was the most likely influence on smokeless tobacco use. If a close friend used these products, an individual was almost 10 times more likely to also use them, the study found.
Another study out today in Pediatrics found that children of smokers were 3.2 times more likely to smoke than children of non-smokers, even if the smoking parent had quit before the child was born. For children over age 11, smoking prevalence ranged from 23 to 29 percent of children whose parents had once smoked, compared to 8 percent of children of parents who had never smoked. The researchers, from Purdue University and Pennsylvania State University, suggested the study supported the idea of genetic predisposition towards smoking.
http://www.everydayhealth.com/stop-smoking/1-in-20-school-aged-kids-use-smokeless-tobacco-7884.aspx

Parental smoking tied to kids' risk of lighting up

By Andrew M. Seaman
NEW YORK (Reuters Health) – Children born to parents with a history of cigarette smoking are more likely to light up than kids of people who never smoked, according to a new U.S. study.
Despite falling smoking rates across age groups, researchers found that children raised by current or even former smokers were about three times more likely to be smokers themselves during their teenage years than kids raised by parents who never smoked.
“Things are getting better, but we can see it’s best among the consistent non-smoking households,” said Mike Vuolo, the study’s lead author from Purdue University in West Lafayette, Indiana.
Previous research has produced similar results, but the new study was based on 23 years of data on the smoking patterns of the parents in the study – 214 people who were ninth grade students in 1988 – to see whether their habits from adolescence onward were tied to their children’s risk of smoking.
For example, Vuolo and his colleague, who published their findings in Pediatrics, were able to compare the children of never-smokers and people who had smoked consistently since high school.
They had data on 314 children of the original group of teens. In 2011, the kids of the second generation – all at least 11 years old – were asked if they had smoked cigarettes within the last year. Sixteen percent said yes.
Among the children of parents who had never smoked, about 8 percent reported smoking cigarettes during the past year.
That compared to between 23 percent and 29 percent of the children of current or former smokers.
The researchers also looked at the parents’ “trajectories” of smoking for clues about the parental influence on the children’s behavior.
They found that 23 percent of kids whose parents had smoked as adolescents but quit or reduced their smoking as young adults were smokers themselves.
Among kids whose parents had smoked little or not at all in high school but started smoking in adulthood, 29 percent were smokers.
And 25 percent of children whose parents had smoked consistently since high school were smokers.
In addition, children who said they had smoked during the last year were more likely to be older, to display more symptoms of depression and to have low grades and low self-esteem. They were also more likely to feel distant from their parents and to have an older sibling who smoked.
While the study can’t prove that parental smoking caused the children to adopt the habit, Dr. Jonathan Winickoff, who has studied teen smoking behavior but wasn’t involved in the new research, said the new results support past findings.
“I think the first confirmatory result is that if you are a parent who smokes, your teenage child has a three-fold increased risk of smoking,” Winickoff, an associate professor in Harvard Medical School’s Department of Pediatrics in Boston, said.
He added that there are several theories on why children of smokers may be at an increased risk of picking up the habit, including modeling their parents’ behaviors, easy access to cigarettes and being “primed” for an addiction through second-hand smoke exposure.
He cautioned, however, that the new study can’t determine whether a child’s risk of becoming a smoker falls if the parents stop smoking early-on, such as in their early adult years, because the group that contained those early quitters also included some current light smokers.
“They can’t say – based on these data – whether earlier parental quitting is associated with less smoking in their kids,” he said.
The researchers also warn that their findings may not apply to all smokers, because only 15 percent of the people included in their survey had a bachelor’s degree or more education and most had their first child at a fairly young age.
Vuolo added that they don’t know whether these smoking rates in the second generation are an improvement over the past because they’re only looking at one point in time. Going forward, they will be able to look at smoking rates over time as they collect more data.
“We’re going to be able to answer that question,” he said.
http://kfgo.com/news/articles/2013/aug/05/parental-smoking-tied-to-kids-risk-of-lighting-up/

R.J. Reynolds Pulling Back on Dissolvable Tobacco Products

WINSTON-SALEM, N.C. – R.J. Reynolds Tobacco Co. is cutting back on the marketing and sales of its dissolvable tobacco products after more than four and a half years in test markets.
According to a report by the Winston-Salem Journal, Camel Orbs, Camel Sticks and Camel Strips will remain in limited distribution at point-of-sale sites in Denver and Charlotte, N.C., as well as on the age-verified website www.cameldissolvables.com.
“At this time, there are no plans for any marketing beyond these channels,” said Richard Smith, spokesman for Reynolds. “We’ve found in our conversations with adult tobacco consumers that while there’s strong interest in the category, a different product form may present a better option over the long term. Though for now, Camel Sticks, Strips and Orbs will remain available while we continue to gather learnings.”
Dissolvable tobacco products have garnered criticism from organizations such as the Campaign for Tobacco-Free Kids, which believe that they will appeal to children due to their flavoring and packaging. Reynolds offered these products in child-resistant packaging, but some analysts have speculated that the difficulty in opening them may have had a detrimental effect, according to the report.
Others speculated that the market for dissolvables may already prefer other products. “My thought would be that the market for spit-less, non-combustible tobacco is probably already taken up by snus,” John Spangler, a professor of family and community medicine at Wake Forest School of Medicine, told the news outlet. Reynolds took just two and a half years to move Camel Snus from test markets to national distribution after its April 2006 debut.
Reynolds initially offered its dissolvables for sale in Columbus, Ohio; Portland, Ore.; and Indianapolis before moving them to Denver and Charlotte. The company did not dictate retail prices, but suggested that they sell at a comparable price to a tin of Camel Snus, or between $4 and $4.50.
http://www.csnews.com/top-story-supplier_news-r.j._reynolds_pulling_back_on_dissolvable_tobacco_products-64184.html

NC law takes effect banning e-cigarettes to minors

MITCH WEISS
Associated Press
CHARLOTTE, NC (AP) — At North Carolina smoke shops and other retailers, the warning signs are going up.
A law banning the sale of e-cigarettes to minors takes effect Thursday.
Retailers now face the same misdemeanor charge if they sell e-cigarettes to a minor as they already did for other tobacco products. Penalties can be as high as a $1,000 fine.
So retailers say they’ll be careful.
E-cigarettes are battery-powered devices that heat a liquid nicotine solution, creating vapor that users inhale. Some are made to look like a real cigarette with a tiny light on the tip that glows.
Devotees tout them as a way to break addiction to real cigarettes.
But public health officials say the safety of e-cigarettes and their effectiveness in helping people quit regular smokes haven’t been fully studied.
http://www.wwaytv3.com/2013/07/31/nc-law-takes-effect-banning-e-cigarettes-to-minors

Most U.S. youth exposed to tobacco advertising in stores

ATLANTA, July 31 (UPI) — U.S. researchers at the Centers for Disease Control and Prevention say a lot of kids continue to see tobacco ads and be influenced by them.
Dr. Shanta Dube, lead health scientist for surveillance in the Epidemiology Branch, Office on Smoking and Health at the Centers for Disease Control and Prevention in Atlanta, and colleagues examined the proportion of adolescents exposed to pro-tobacco advertising and assessed the association between this exposure and susceptibility to smoking.
The researchers used data from the 2011 National Youth Tobacco Survey to calculate the proportion of susceptible middle-school and high-school students exposed to pro-tobacco advertisements via stores, magazines and the Internet. Susceptibility to smoking cigarettes was defined as “never smoked but open to trying cigarettes,” Dube said.
In 2011, 81.5 percent of middle-school students and 87 percent of high-school students were exposed to tobacco advertisements in stores; 48 percent of middle-school students and 54 percent of high-school students were exposed to such advertising in magazines.
Exposure to tobacco advertisements on the Internet was similar at about 40 percent for both middle-school and high-school students.
Of those surveyed, 22 percent of middle-school students and 24 percent of high-school students were susceptible to trying cigarettes.
Exposure to magazine advertising declined from 71.8 percent in 2000 to 46 percent in 2009 among susceptible middle-school students; but exposure increased to 55 percent in 2011. Tobacco advertising seen through the Internet among susceptible high-school students increased from 26 percent in 2000 to 45 percent in 2011.
The study was published in the Journal of Adolescent Health.
Read more: http://www.upi.com/Health_News/2013/07/31/Most-US-youth-exposed-to-tobacco-advertising-in-stores/UPI-26521375321062/#ixzz2ajGPXhMN

Law banning smoking in restaurants turns 10

 / Featured Stories, Fulton News
For many of us, it seems like a lifetime ago when we were asked if we wanted to be seated at the smoking or non-smoking section in our local restaurant.
For Zachary and Matthew Metott, it was an actual lifetime ago. The Metott boys turn 10 years old this year and have never known a world where smoking was allowed in New York state restaurants. July 24th is the 10th anniversary of the Expanded Clean Indoor Air Act, most commonly known for prohibiting smoking in bars and restaurants.
The 2003 state law banned smoking in almost all workplaces, bars, restaurants, bowling facilities, taverns and bingo halls and protected millions of New Yorkers from daily exposure to second-hand smoke and the illnesses it causes.
When the Metott boys were asked their thoughts on having smoking and non-smoking sections in restaurants Matthew replied, “That’s just weird!” Zachary added “I’d wonder why they were doing that.”
Zachary and Matthew met at Vona’s Restaurant to talk with the Tobacco Free Network of Oswego County about this milestone. Vona’s was one of the first Oswego restaurants to go smoke-free, making the decision before New York even passed the Expanded Clean Indoor Air Act. The boys also had strong opinions on being exposed to smoke in restaurants.
“We wouldn’t want to go there to enjoy time with our family because it would hurt us or make our little sisters sick,” said Zachary.
A recent survey of bars and restaurants in Oswego County revealed that compliance with the law 10 years later is excellent. In fact, there was a 100 percent compliance rate at the time of the unannounced survey. Despite the success of this law and the countless lives that have been saved, smoking remains the leading cause of preventable death and kills more than 25,000 New Yorkers every year.
The U.S. Surgeon General characterizes youth smoking as a pediatric epidemic, and states that the evidence is clear that tobacco marketing causes youth to start smoking, and most start before they reach the age of 18.
“Smoking is still a problem in Oswego County and New York state as whole, particularly among teens,” said Abby Jenkins, Program Coordinator of the Tobacco Free Network of Oswego County. “Zachary and Matthew have never known a time when smoking was allowed in restaurants. Maybe the next generation of 10 year olds will never know a time when they were inundated with tobacco marketing.”
For more information about efforts to reduce smoking and protect youth from tobacco marketing, visit www.tobaccofreenys.org.
http://valleynewsonline.com/blog/2013/07/27/law-banning-smoking-in-restaurants-turns-10/

Letter to the Editor: North Dakota should take lesson from Minnesota on cigarette tax

Minnesota just raised its cigarette tax by $1.60 per pack, leaving me in envy of our neighbor’s efforts to help people quit smoking.
High cigarette prices and noticeable price hikes like Minnesota’s recent increase prevent young people from getting hooked and help current smokers to kick the habit. That’s good. One in three who try cigarettes get addicted and a majority of those who smoke want to quit. A high tobacco tax is an effective health policy; kudos to Minnesota’s elected leadership for recognizing that and investing in this prevention strategy.
By contrast, North Dakota ranks as one of the “best” states for cheap tobacco. North Dakota’s tobacco tax is outrageously low at a mere $0.44 per pack — the 46th lowest cigarette tax in the nation. Across the river, Minnesota’s cigarette tax is the sixth highest at $2.83 per pack. Is “cheap tobacco” the policy North Dakota wants for its children? From my perspective as a public health advocate and mom, no. North Dakota needs to take action to significantly increase the price of tobacco here. It’d be the first time since 1993.
I love North Dakota, but not the current price of our cigarettes. In addition to its tobacco tax, sometimes I also envy Minnesota for its trees — when the wind blows and we have few to stop it. But we’re proactive and plant trees for the immediate and long-term benefits they provide. For the same reasons, raise North Dakota’s tobacco tax — and the sooner the better.
Valerie Schoepf,
Bismarck
http://www.thedickinsonpress.com/event/article/id/70212/group/Opinion/
http://bismarcktribune.com/news/opinion/mailbag/envying-sister-state-s-high-tax/article_df913772-ee8a-11e2-ad6c-0019bb2963f4.html
http://www.inforum.com/event/article/id/406373/

R.I. Governor Chafee vetoes e-cigarette ban for those under 18

BY PHILIP MARCELO, KATHERINE GREGG AND RANDAL EDGAR
PROVIDENCE — Governor Chafee has vetoed legislation prohibiting anyone under the age of 18 from purchasing e-cigarettes and other “vapor products” that heat liquid nicotine into a smokable vapor.
The American Cancer Society, the American Heart Association, the American Lung Association, and other health advocacy groups, had called on Chafee to veto the measure.
They said the bill represented a “stalking horse” for tobacco and e-cigarette companies that want to exempt the growing industry from the regulations and taxes imposed on traditional tobacco-based products.
They also warned that federal regulators are still studying the potential health risks of the relatively new technology .
Introduced by Senate Majority Leader Dominick Ruggerio, D-North Providence, the bill would have defined e-cigarettes and other related products as “vapor products.”
Nine states, including Vermont and New Hampshire, have simply included them in their definition of “tobacco products.”
R.J. Reynolds Tobacco, which is set to roll out its own e-cigarette line, VUSE, later this year, had strongly advocated for the bill and dozens like it in other states.
In his veto message, Chafee said, “The sale of electronic cigarettes to children should be prohibited, but it is counter-productive to prohibit sales to children while simultaneously exempting electronic cigarettes from laws concerning regulation, enforcement, licensing or taxation.
“As a matter of public policy, electronic cigarette laws should mirror tobacco product laws, not circumvent them,” Chafee said.
Other bills vetoed by Chafee on Wednesday would have let municipalities raise taxes on low-income, government-subsidized housing, and increased required public-reporting by the state’s quasi-public agencies.
Chafee did not heed all calls for a veto.
For example, he rejected pleas from the state’s auto insurers to veto a bill telling them when they can — and cannot — declare a damaged vehicle a total loss, that was a priority of the state’s politically connected auto-body shop industry. (Leading the industry’s fight again this year was the sister/law partner of the former senior deputy majority leader in the House.)
Sponsored by Rep. Arthur Corvese, D-North Providence, the new law prohibits an insurer from declaring a motor vehicle a total loss if the cost to restore the vehicle is less than 75 percent of its “fair market value” before it was damaged. The only exception would be if the owner gives the OK to say the vehicle is totaled.
http://www.providencejournal.com/breaking-news/content/20130717-r.i.-governor-chafee-vetoes-e-cigarette-ban-for-those-under-18.ece