Category Archives: News roundups
HHS: Significant Improvement on Leading Health Indicators that Influence Reduction in Preventable Disease and Death
A new report from the U.S. Department of Health and Human Services (HHS), Healthy People 2020, finds that the country’s health is importing in more than half—14 of 26—of the critical measures known to have a major influence in reducing preventable disease and death. The Leading Health Indicators include categories such as access to care; maternal and child health; tobacco use; nutrition; and physical activity. “The Leading Health Indicators are intended to motivate action to improve the health of the whole population,” said Howard Koh, MD, Assistant Secretary for Health, in a release. “Today’s LHI Progress Report shows that we are doing just that.” Among the indicators that been met or are improving:
- Fewer adults smoking cigarettes
- Fewer children exposed to secondhand smoke
- More adults meeting physical activity targets
- Fewer adolescents using alcohol or illicit drugs
Read more on HHS.
Study: Americans Twice as Likely to Get Food Poisoning from Restaurants than at Home
Americans are twice as likely to get food poisoning from food at a restaurant than they are from food at home, according to a new study from the nonprofit Center for Science in the Public Interest (CSPI). The organization analyzed “solved” outbreaks over a ten-year period, finding that 1,610 outbreaks in restaurants sickened more than 28,000 people while 893 outbreaks linked to private homes sickened approximately 13,000 people. The study also determined that of the 104 outbreaks linked to milk, about 70 percent were caused by raw milk—meaning that while less than one percent of consumers drink raw milk, they account for 70 percent of the illnesses caused by milk-borne outbreaks. The researchers also expressed concern over the 42 percent drop in reported outbreaks from 2011 to 2012. "Underreporting of outbreaks has reached epidemic proportions," said CSPI food safety director Caroline Smith DeWaal. "Yet the details gleaned from outbreak investigations provide essential information so public health officials can shape food safety policy and make science-based recommendations to consumers. Despite the improvements in food safety policy in the past decade, far too many Americans still are getting sick, being hospitalized, or even dying due to contaminated food." Read more on food safety.
Study: Antipsychotic Medications for Foster Care Youth Remain High
Use of antipsychotic medications for unlabeled indications such as treatment for attention-deficit hyperactivity disorder (ADHD) is increasing among youth in foster care, according to a new study in the Journal of Adolescent Psychopharmacology. Researchers from the University of Maryland, Morgan State University and the Johns Hopkins Medical Institutions analyzed data on 266,590 youth ages 2-17 years and continuously enrolled in a mid-Atlantic state Medicaid program in 2006, finding that approximately one-third of the ADHD-diagnosed foster care youth included in the assessment received atypical antipsychotics. This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry," said Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology, and President, Child Mind Institute, in a release. "Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight. The highlight of Burcu et al.'s paper for any reader should be the simple but necessary recommendations for antipsychotic prescribing and monitoring in these populations." Read more on prescription drugs.
CDC Identifies Rare U.S. Case of Lassa Fever
A severe viral disease common in West Africa has been confirmed in a person returning to the United States from the region, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Minnesota Department of Health (MDH). The patient was admitted to a Minnesota hospital for Lassa fever on March 31, with the CDC confirming diagnosis on April 3 and the patient now recovering and in stable condition. The last case of Lassa fever in the United States, of which there have been seven confirmed and all related to travel, was in Pennsylvania in 2010. The virus is not transmitted through direct contact with a sick person’s blood of bodily fluids and cannot by transmitted by casual contact; there are up to 300,000 cases and 5,000 deaths each year in West Africa. “This imported case is a reminder that we are all connected by international travel. A disease anywhere can appear anywhere else in the world within hours,” said CDC Director Tom Frieden, MD, MPH. Read more on infectious disease.
Public Health Officials in Developing Countries Use Social Marketing to Promote Health Behaviors
Public health officials in developing countries are successfully using social marketing strategies to educate people about the importance of behaviors related to water and sanitation, according to a new study in the journal Social Science & Medicine. In a systematic review of 32 studies, researchers led by W. Douglas Evans, PhD, a professor of prevention and community health at Milken Institute School of Public Health at the George Washington University, looked at how public health officials utilized social marketing tools such as door-to-door visits and public education campaigns for school children to promote behaviors such as regular hand washing and water purification. Read more on global health.
Depression, Anxiety Linked to Poor Diabetes Management
Depression and anxiety can be significant impediments to proper management of diabetes, according to a new study in the journal BioMed Central. Researchers from The University of Texas School of Public Health examined 500 Mexican-American adults from the Cameron County Hispanic Cohort in Brownsville, Texas, each of whom had been diagnosed diabetes and were taking medication for diabetes. Each t was interviewed about symptoms of depression and anxiety, and researchers also took measurements for body mass index (BMI), waist circumference, physical activity, fasting glucose and average blood sugar levels over time. “Unfortunately, greater depression and anxiety are associated with higher BMI and greater waist circumference, both indicators of obesity, as well as engaging in less physical activity and having less favorable indicators of glycemic control,” said Darla Kendzor, PhD, principal investigator and assistant professor at the School of Public Health Dallas Regional Campus, part of The University of Texas Health Science Center at Houston. Eighty one percent of Mexican-Americans are obese or overweight nationwide, with a nationwide diabetes rate of 16.3 that climbs to 30 percent for those who live along the U.S.-Mexico border. Read more on obesity.
CDC: Calls to Poison Centers for E-Cigarettes Has Jumped Dramatically Since 2010
Calls to poison centers involving e-cigarette liquids containing nicotine jumped from just one per month in September 2010 to 215 per month in February 2014, according to a new U.S. Centers for Disease Control and Prevention (CDC) study in the Morbidity and Mortality Weekly Report. There was no similar increase for conventional cigarettes. The study found that 51.1 percent of the e-cigarette calls involved children under age 5 and about 42 percent involved people ages 20 and older. “This report raises another red flag about e-cigarettes—the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, MD, MPH, in a release. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.” Read more on the FDA.
HHS Draft Report Would Strengthen Innovative Health IT, Help Patients
The U.S. Department of Health and Human Services (HHS) has released a draft report that includes a proposed strategy for a health information technology (health IT) framework to help promote product innovation while also ensuring patent protections and avoiding regulatory duplication. The congressionally mandated report was developed by the U.S. Food and Drug Administration in consultation with HHS’ Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC). “The diverse and rapidly developing industry of health information technology requires a thoughtful, flexible approach,” said HHS Secretary Kathleen Sebelius. “This proposed strategy is designed to promote innovation and provide technology to consumers and health care providers while maintaining patient safety.” Improved health IT could help lead to greater prevention of medical errors; reductions in unnecessary tests; increased patient engagement; and faster identifications of and response to public health threats and emergencies. Read more on technology.
Study: Fewer Cases of Smoking on TV Screens May Be Tied to Overall Drop in U.S. Smoking Rates
Fewer scenes of cigarette use in prime-time television shows may be linked to an overall reduction in the U.S. smoking rate, according to a new study in the journal Tobacco Control. Analyzing 1,800 hours of popular U.S. prime-time dramas broadcast between 1955 and 2010, researchers from the Annenberg Public Policy Center at the University of Pennsylvania in Philadelphia determined that scenes involving cigarette use on such shows fell from nearly five scenes per hour of programming (excluding commercials) in 1961 to about 0.3 scenes per hour in 2010. Based on this data they concluded that one less depiction of smoking per hour over two years of prime-time programming was associated with an overall drop of almost two packs of cigarettes, or 38.5 cigarettes, a year for every adult. The new findings support previous research showing that seeing other people smoke prompts cigarette cravings in adult smokers. Read more on tobacco.
Study: Fertility Drugs Not Tied to Increased Risk of Breast Cancer
Fertility drugs are not linked to an increased risk of breast cancer, according to a new long-term study in the journal Cancer Epidemiology, Biomarkers & Prevention. Researchers analyzed records for 9,892 U.S. women who were followed for 30 years after having been evaluated for infertility between 1965 and 1988, finding that about 38 percent of them were exposed to the fertility drug clomiphene and about 10 percent were exposed to drugs known as gonadotropins. There were 749 breast cancers diagnosed during the three decades, but women who were exposed to either drug were just as likely as the women who hadn’t been exposed to fertility drugs to develop breast cancer. The study did note an increased risk of breast cancer for the small group of women exposed to the highest doses of clomiphene. "It's reassuring that if women desire pregnancy and unfortunately have infertility that they can undergo treatment without modification of their overall risk for cancer later," said Kurt Barnhart, MD, president of the Society for Reproductive Endocrinology and Infertility, to Reuters Health. He was not involved in the study. Read more on cancer.
Study: CDC’s Salt Recommendations Are Too Low
The U.S. Centers for Disease Control and Prevention’s (CDC) salt guidelines are too low, according to a new study in the American Journal of Hypertension. Researchers reviewed 25 previous studies, concluding that both too much and too little salt can be harmful. They concluded that the safest intake range was between 2,645 and 4,945 mg of salt a day, although the CDC recommends less than 2,300 mg of salt per day for healthy people under age 50, and less than 1,500 mg per day for most people over age 50. "For most people, there is no reason to change their dietary habits concerning salt, as most people eat what appears to be the safest amount," said review author Niels Graudal, MD, a senior consultant at Copenhagen University Hospital in Denmark, according to HealthDay. Read more on nutrition.
HUD to Provide Disaster Assistance to Washington State Mudslide Victims
Having officially been given a major disaster declaration yesterday, Snohomish County and the Sauk-Suiattle, Stillaguamish and Tulalip Indian Reservations in Washington state will now received federal disaster assistance from the U.S. Department of Housing and Urban Development (HUD) to help recover from the flooding and mudslides that began on March 22. Among the assistance:
- Offering the State of Washington and other entitlement communities the ability to re-allocate existing federal resources toward disaster relief
- Granting immediate foreclosure relief
- Making mortgage insurance available
- Making insurance available for both mortgages and home rehabilitation
- Offering Section 108 loan guarantee assistance
- Information on housing providers and HUD programs
"Families who may have been forced from their homes need to know that help is available to begin the rebuilding process,” said HUD Secretary Shaun Donovan in a release. "Whether it's foreclosure relief for FHA-insured families or helping these counties to recover, HUD stands ready to help in any way we can." Read more on disasters.
Mistrust, Perceived Discrimination Affect Young Adult Latinos’ Satisfaction with Health Care
Mistrust of the medical community and perceived discrimination can affect how satisfied young adult Latinos are with their health care, which in turn can influence health outcomes, affect participation in health care programs under the Affordable Care Act and contribute to disparities in health care access, according to a new study in The Journal of Rural Health. Researchers surveyed 387 young adult Latinos, ages 18-25, finding that approximately 73 percent were moderately or very satisfied with their health care, but among those who were not, medical mistrust and perceived discrimination were found to be factors. The researchers recommend improving “cultural competency” among health care providers—from the doctors to the receptionists to the lab technicians—to help ensure Latinos are treated with respect and dignity, and also that a bilingual/bicultural workforce may be more effective at building trust. “Trust is huge; it allows patients to disclose concerns and be honest,” said study co-author S. Marie Harvey, associate dean and professor of public health at Oregon State University in a release. Read more on health disparities.
FDA Approves First Sublingual Home Treatment for Hay Fever
The U.S. Food and Drug Administration (FDA) has approved the first sublingual—or under the tongue—allergen extract for use in the United States. Designed to treat hay fever with or without conjunctivitis that results from exposure to certain grass pollens in people ages 10-65, the first dose is administered in a health care providers office so that the patient can be observed for any adverse reactions, but can then be taken at home. Approximately 30 million Americans and 500 million people worldwide are affected by hay fever, also known as allergic rhinitis, which can cause repetitive sneezing; nasal itching; runny nose; nasal congestion; and itchy and watery eyes. “While there is no cure for grass pollen allergies, they can be managed through treatment and avoiding exposure to the pollen,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, in a release. “The approval of Oralair provides an alternative to allergy shots that must be given in a health care provider’s office.” Read more on the FDA.
New Report Analyzes Link Between Metro Areas and Overall Health
People who live in compact, connected metropolitan regions are more likely to see their incomes rise, have lower household costs, have more transportation options and live longer, safer and healthier lives, according to Measuring Sprawl 2014, a new report from Smart Growth America and the University of Utah’s Metropolitan Research Center. The report looks at 221 major U.S. metropolitan areas, ranking them based on how sprawling or compact they are as well as examining how sprawl relates to factors such as economic mobility; the cost of housing and transportation; life expectancy; obesity; chronic disease and safety. “Smart growth strategies are about making life better for everyone in a community,” said Geoff Anderson, President and CEO of Smart Growth America. “If policymakers are looking for ways to lower costs for their constituents, improve public health and support their broader economy, they need to be thinking about how to improve their development.” Read more on community health.
NHTSA: Rear Cameras for All New Cars by May 2018
All new vehicles under 10,000 pounds will be required to have rear visibility technology—or rear cameras—by May 2018, according to a new rule issued by the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA). According to NHTSA, the technology significantly reduces injuries and fatalities due to backover incidents; there are an average of 210 deaths and 15,000 injuries each year caused by such incidents, with children under age 5 accounting for 31 percent and adults ages 70 and older accounting for 26 percent. "Safety is our highest priority, and we are committed to protecting the most vulnerable victims of backover accidents — our children and seniors," said U.S. Transportation Secretary Anthony Foxx. "As a father, I can only imagine how heart wrenching these types of accidents can be for families, but we hope that today's rule will serve as a significant step toward reducing these tragic accidents." Read more on injury prevention.
Study: Diet of Fruit, Vegetables Linked to Reduced Risk of Death
Diets heavy on fruits and vegetables can reduce the risk of death at any age by as much as 42 percent, according to a new study in the Journal of Epidemiology and Community Health. Using data on the eating habits of more than 65,000 people in England from 2011 to 2013, researchers determined that the risk of death was reduced by 36 percent with five to seven portions, 29 percent with three to five portions and 14 percent with one to three portions. More specifically, they also determined that eating seven or more portions of fruits and vegetables reduced the risk of death from heart disease by 31 percent and the risk of death from cancer by 25 percent. "We all know that eating fruit and vegetables is healthy, but the size of the effect is staggering," study author Oyinlola Oyebode, at the department of epidemiology and public health of University College London, in a release. "Vegetables have a larger effect than fruit, but fruit still makes a real difference. If you're happy to snack on carrots or other vegetables, then that is a great choice but if you fancy something sweeter, a banana or any fruit will also do you good.” Read more on nutrition.
Affordable Care Act Expected to Hit Goal of Coverage for 7 Million
Despite a glitch-filled rollout of HealthCare.gov that allowed few people to enroll over the first month, the Affordable Care Act and its online portals appear to be on track to meet the original goal of enrolling 7 million people by its deadline of yesterday, March 31, according to Obama administration officials. More than 6 million had signed up for health care coverage as of last week and the run up to the deadline saw a surge that should put the total over 7 million. The administration also recently announced an extension of the enrollment deadline for Americans who had attempted to sign up for coverage but were impeded by technological problems. Read more on the Affordable Care Act.
Study Finds Many Older Adults Often Not Prepared for Disasters
A recent University of Iowa study finds that, compared to younger adults, older adults are more vulnerable when natural disasters, hit yet most U.S. adults ages 50 and older may not be prepared for a serious flood, earthquake, tornado, or other natural disaster. The report is based on a 2010 survey that was part of the Health and Retirement Study, which collects social, economic, and health information on adults age 50 and older in the United States. The survey did not include older adults living in nursing homes or other institutional settings. Among the findings:
- Only about one-third of the 1,304 adults interviewed said they had participated in an educational program or read information on how to prepare for a disaster.
- Fewer than 25 percent had an emergency plan in place, although the same percentage lived alone.
- Almost one-third reported being disabled or in fair or poor health.
“Our analysis underscores that older adults living at home often have special needs and situations that put their health and safety at risk in the face of natural disasters,” said Tala Al-Rousan, MD, the study’s primary author and a graduate student in epidemiology at the UI College of Public Health. “The oldest respondents, 80- to 90-year-olds, were significantly less prepared than 65- to 79-year-olds.”
>>NewPublicHealth will be on the ground at the 2014 Preparedness Coverage this week. Follow our coverage here.
Healthy Foods Can Increase Concession Stand Sales A new small study by researchers at the University of Iowa found that adding healthy foods to a football game concession stand appears to increase sales. The researchers asked a college club to add healthy foods such as apples and string cheese to its concession stand menu open during football season, as well as put healthier ingredients into other items including nachos and popcorn. Sales rose four percent over the previous year, and the healthier foods making up almost ten percent of sales. The study was published in the Journal of Public Health. Read more on nutrition.
Study: Gastric-Bypass Surgery Linked to Remission of Type 2 Diabetes
People who undergo gastric-bypass surgery to deal with their weight are more likely to see their type 2 diabetes go into remission without medication that are people who undergo a sleeve gastrectomy, according to a new study in the New England Journal of Medicine. "One-third [of patients] in the gastric bypass group had remission of diabetes—meaning they had normal blood sugar control—and a quarter of the people in the sleeve gastrectomy group had remission of type 2 diabetes," said study co-author Sangeeta Kashyap, MD, an endocrinologist at the Cleveland Clinic's Endocrinology & Metabolism Institute, according to HealthDay. "These effects are real, and they're persistent for at least three years. Essentially, these patients have had a vacation from diabetes for three years." The study included 150 people with type 2 diabetes, with an average age of 49 and two-thirds female. Read more on obesity.
CDC: 1 in 68 U.S. Children on Autism Spectrum
The U.S. Centers for Disease Control and Prevention (CDC) has significantly increased its estimates of the number of U.S. children with an autism spectrum disorder (ASD). According to a new surveillance summary report, approximately 1 in 68 children—or 14.7 per 1,000 eight-year-olds—are on the spectrum. The new estimate is about 30 percent higher than previous CDC estimates. The report also found that ASD continue to be five times more common among boys than girls; more common among white children than Black of Hispanic children; and that most children are still not diagnosed until after age 4, despite the fact that ASD can be diagnosed as early as age 2. “The number of children identified with autism continues to increase and the characteristics of these children have changed over time,” said Coleen A. Boyle, PhD, MS, director of CDC’s National Center on Birth Defects and Developmental Disabilities, in a release. “While progress has been made, there is an urgent need to continue the search for answers and provide help now for people living with autism.” Read more on pediatrics.
New Cancer Cases Dropped Slightly from 2009 to 2010
Rates of new cancer cases dropped slightly for both men and women in the United States from 2009 to 2010, according to the new U.S. Centers for Disease Control and Prevention report, Invasive Cancer Incidence—United States, 2010. The report saw the incidence rate drop to 446 per 100,000 persons from 459 per 100,000 persons. Rates varied by state, from a high of 511 to a low of 380. The rate was higher for men than it was for women, with the highest rate of all among black Americans. Read more on cancer.
HHS Releases New Security Risk Assessment Tool for Small-to-Medium-Sized Health Care Organizations
The U.S. Department of Health and Human Services (HHS) has released a new security risk assessment (SRA) tool to help health care providers in small-to-medium sized offices conduct risk assessments of their organizations. A collaborative effort of the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR), the tool enables the organizations to conduct and document a thorough risk assessment at their own pace by allowing them to assess the information security risks under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. The SRA tool’s website contains a User Guide and Tutorial video to help providers begin using the tool. Videos on risk analysis and contingency planning are available at the website to provide further context. The tool is available for both Windows and operating systems and iOS iPads. Read more on technology.
Flu Vaccine Reduces Risk of Child’s Flu-Related ICU Hospitalization by 74 Percent
Receiving a flu vaccine dramatically reduces a child’s risk of flu-related intensive care hospitalization, according to a new study in the Journal of Infectious Diseases. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) analyzed the medical records of 216 children age 6 months through 17 years admitted to 21 pediatric intensive care units (PICUs) in the United States during the 2010-2011 and 2011-2012 flu seasons, finding that the a flu vaccination reduces the risk of being admitted to a PICU by 74 percent. “These study results underscore the importance of an annual flu vaccination, which can keep your child from ending up in the intensive care unit,” said Alicia Fry, MD, a medical officer in CDC’s Influenza Division. “It is extremely important that all children—especially children at high risk of flu complications—are protected from what can be a life-threatening illness." Kids younger than 5 and those with chronic medical conditions such as asthma, diabetes or developmental delays are at especially high risk of serious flu complications. Read more on influenza.
CDC Releases Expansive Salmonella Report for Researchers
The U.S. Centers for Disease Control and Prevention (CDC) has released an expansive, first-of-its kind report charting the past four decades of laboratory-confirmed surveillance data on 32 Salmonella serotypes. An Atlas of Salmonella in the United States, 1968-2011, includes data and analysis by age, sex, season and geography down to the county level. The report is available both online and in a downloadable format. Salmonella causes an estimated 1.2 million illnesses, 23,000 hospitalizations and 450 deaths each year in the United States. “We hope these data allow researchers and others to assess what has happened and to think more about how we can reduce Salmonella infections in the future,” said Robert Tauxe, MD, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “The more we understand Salmonella, the more we can make progress in fighting it all along the farm to table chain.” Read more on research.
GlaxoSmithKline Recalling Alli Non-Prescription Weight-Loss Drug Amid Reports of Tampering
GlaxoSmithKline is working with the U.S. Food and Drug Administration in recalling all supplies of its non-prescription weight-loss drug Alli in the United States and Puerto Rico, after reports that some bottles had been tampered with and may not contain authentic Alli. The drug comes in a turquoise-blue capsule, but the company has received inquiries from consumers in seven U.S. states about bottles containing a range of tablets and capsules of various shapes and colors. Read more on safety.
Study: ‘White Coat Effect’ on Blood Pressure is Real
The “White Coat Effect” is real, according to a new study in the British Journal of General Practice. The effect, wherein a person’s blood pressure is higher when taken by a doctor than when taken by a nurse, has long been assumed, but this is the first study to confirm it. The study analyzed the results of more than 1,000 people who had their blood pressure taken by both a physician and a nurse, finding the results of the physician-administered tests were noticeably higher. "Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” said Christopher Clark, MD, of the University of Exeter Medical School, in a release. “The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects.” Clark also noted that researchers should also take these findings into account when performing studies on topics such as hypertension. Read more on heart health.
Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs, according to a new study in the Journal of Clinical Oncology. In a survey of 1,502 patients, researchers determined that 9 percent of whites, 15 percent of blacks, 17 percent of English-speaking Latinas and 10 percent of Spanish-speaking Latinas reported medical-related debt four years post diagnosis. The study said the findings should “motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.” Read more on health disparities.
Lawsuit Challenges New York City’s Ban on E-Cigarettes
A “smoker’s rights” group called New York City Citizens Lobbying Against Smoker Harassment has filed a legal challenge to the city’s ban on electronic cigarettes—or e-cigarettes—in restaurants, parks and certain other public places. The group contends that since e-cigarettes do not contain tobacco or produce smoke, they should not be subject to New York City’s Smoke-Free Air Act. The city council expanding regulations to include e-cigarettes last year and the U.S. Food and Drug Administration has announced its intention to propose government regulations over their use. In the lawsuit, the group wrote that "E-Cig regulation is, even in the Council's words, at best, tangentially related to the subject of smoking, in much the same way that toy water guns are at best tangentially related to authentic firearms.” However, city council spokeswoman Robin Levine said by email to Reuters that "Our legislation ensures the goals of the Smoke-Free Air Act are not undermined and protects the public against these unregulated substances.” Read more on tobacco.