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No Time to Waste in Battle to Regulate E-cigarettes

Apr 28, 2015, 8:53 AM, Posted by Joe Marx

The CDC just released alarming data on the new rise of electronic cigarette use among U.S. teens. Unless the FDA acts now, it may get worse with each passing day which is a gamble we can't take.

If the health debate coalescing around e-cigarettes feels familiar, there’s good reason. The uncertainty and questions about this relatively new—and unregulated—product harken back to an age when it was chic for Hollywood stars to blow smoke at the screen, and cigarette brands were plastered all over race cars.  

The tobacco industry knew just what to do to entice young people, and this formula hooked millions upon millions of them and locked in a lifetime of smoking—tragically shortening lives in countless cases.

Even today, just over 50 years since the Surgeon General’s first landmark report on Smoking and Health, tobacco addiction causes a host of cancers and other illnesses. Smoking is still the leading preventable cause of death in the U.S., killing 480,000 people annually and costing over $325 billion in medical expenditures and lost productivity.

E-cigarette graphic

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“Tobacco Just Doesn’t Fit In:” CVS Exec Gives Story Behind the Story

Oct 22, 2014, 4:01 PM, Posted by Catherine Arnst

CVS Employee Unpacking Shopping Basket Stop Tobacco Signs in Back

Along with the start of CVS Health, the sale of cigarettes and tobacco products at CVS/pharmacy ends today. By eliminating cigarettes and tobacco products from sale in our stores, we can make a difference in the health of all Americans.”—CVS Health CEO Larry Merlo

On October 20, The Campaign for Tobacco-Free Kids launched a national campaign calling on America’s retailers to stop selling tobacco products, and a new mobile-friendly website—www.ShopTobaccoFree.org—that has an interactive map that allows consumers to search for the nearest tobacco-free retailers. The website currently features more than 20 retail chains with more than 13,000 separate store locations—chief among them CVS Health.

On September 3, CVS ended sales of tobacco products at all of its 7,700 stores, a month ahead of its previously targeted date of October 1. It is the first, and so far the only, national pharmacy chain to take this step. The company also changed its corporate name to CVS Health in order to reinforce its broader commitment to the health of its customers.

RWJF applauds CVS’s actions wholeheartedly—indeed, we collaborated with CVS on the initial announcement back in February that it would end the sale of tobacco products. So we asked CVS Health executive VP and chief medical officer Troy Brennan MD, to tell us the story behind the story. Just how do you get a publicly traded company to sacrifice some $2 billion in annual sales?

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New Campaign for Tobacco-Free Kids Website Helps Consumers Shop Tobacco-Free

Oct 20, 2014, 1:08 PM

Parents know how difficult it can be to find kid-friendly supermarket checkout counters without candy or magazines. Now a new mobile-friendly website from the Campaign for Tobacco-Free Kids offers parents a way to find retailers who don’t sell tobacco. Public health experts applaud its debut:  

  • Tobacco companies spend more than 90 percent of their annual $8.8 billion marketing budget at the point-of-sale in stores, and this marketing has been shown to increase youth tobacco use.
  • Every day, more than 2,800 U.S. kids try their first cigarette. That’s more than one million kids who take their first puff each year.
  • 5.6 million children alive today will die prematurely from smoking unless current trends are reversed.
  • An estimated 375,000 U.S. retail stores sell tobacco products. That sends a terrible message to kids that tobacco use is normal, acceptable and appealing.

The new website includes an interactive map that shows the locations of Tobacco-Free Retailers across the country. All CVS Pharmacies have just gone tobacco-free and other retailers who don’t sell tobacco include Wegmans and Target. As part of a new national campaign, stores that are tobacco-free can also display stickers from Tobacco-Free Kids.

>>Bonus Links:

This commentary originally appeared on the RWJF New Public Health blog.

With Classes Well Underway, It’s a Good Time for Colleges and Universities to Think about their Campus Tobacco Policies

Sep 10, 2014, 1:26 PM

Just a few weeks ago the Bloomberg School of Public Health at Johns Hopkins University announced that it had launched the Tobacco-Free Campus Initiative, which prohibits the use of any tobacco product—not just cigarettes—in all buildings, facilities and vehicles. The initiative also forbids e-cigarettes and discourages the use of tobacco products on all outdoor campus grounds. Organizers of the initiative say that deterring the use of tobacco in all forms is crucial to protect the health of the students and workforce of the campus community.

“By keeping out all tobacco products, the initiative ensures that the School doesn’t unintentionally encourage or reinforce tobacco addiction among students, faculty and staff,” according to a statement released by the school.

However, the rest of the university won’t be taking the same steps, at least for now. In 1991, all Johns Hopkins campuses followed the example first set by the School of Public Health in becoming smoke-free, said Dennis O’Shea, a spokesman for the university, adding that the “school could follow the new initiative, but no decision has been made.”

Hopkins is not the only college deliberating. While there are a few states that require state campuses to adopt smoke-free policies most campuses voluntarily adopt them, according to Cynthia Hallett, the executive director of Americans for Non-Smokers Rights (ANR). According to ANR, there are a little more than 4,000 colleges and universities in the United States, and as of July 2014 there were 1,372 smoke-free campuses in the United States, of which 938 are 100 percent tobacco-free and 176 prohibit the use of e-cigarettes anywhere on campus. That’s up from 446 smoke-free campuses in 2010; reporting on tobacco-free campuses began in 2012, when there were 608.

Credit some of that change to the Tobacco-Free College Campus Initiative (TFCCI) of the U.S. Department of Health and Human Services (HHS), launched two years ago to promote and support the adoption and implementation of tobacco-free policies at colleges and universities. TFCCI is a partnership of HHS, the American College Health Association and the University of Michigan, with sponsorship from the American Legacy Foundation.

While support for making campuses smoke- and even tobacco-free is growing, it’s hardly a slam dunk, especially when the move requires students to vote. Universities say opposition can come from foreign students who are sometimes more likely to smoke than their U.S. counterparts or contract employees who don’t want to be barred from smoking on campus. It can even come from the media. Two years ago, when UCLA announced its campus-wide tobacco free policy, the Los Angeles Times published an editorial titled “A Smoke Free UC Goes too Far” which said that “[s]moking is a detestable, dangerous habit—but it's also a legal one, and there is plenty to say in defense of allowing adults to make bad decisions if they're not breaking the law or harming others.”

Hoping to get the initiatives to pick up steam, TFCCI has launched challenges aimed at getting more campuses—and their students, faculty and employees—to give up their smokes.

>>Bonus Links:

This commentary originally appeared on the RWJF New Public Health blog.

No More Tobacco Behind the Counter at CVS

Sep 3, 2014, 2:40 PM, Posted by Jeff Meade

CVS Tobacco Stopping Starts Here in Store Sign

You can pick up a prescription. You can get your blood pressure checked. You can buy a bottle of pain reliever, a package of bandages, a tube of toothpaste.

Here's what you can't do at CVS: buy cigarettes or any other tobacco product.

Last February, CVS (now CVS Health) announced its decision to remove all tobacco products from its 7,700 pharmacies nationwide. One month ahead of the deadline the company set for itself, CVS has declared all of its stores free of tobacco products.

Back when CVS made its announcement, RWJF President and CEO Risa Lavizzo-Mourey, MD, praised the pharmacy chain’s decision to go tobacco-free, saying, “In eliminating the sale of tobacco products, CVS recognizes that pharmacies and pharmacists are responsible for far more than filling prescriptions and selling sundries; they have become a key partner for better health in neighborhoods across the nation.”

At the time, some raised questions about the business impact of that decision, Lavizzo-Mourey acknowledged in a related blog post on the professional social networking site LinkedIn. In snuffing out tobacco sales, she noted, CVS stands to lose about $2 million in revenue. That’s a big hit in the short term, but it could also be a smart move in the long run, many analysts say, as the chain seeks to grow its in-store clinic program and partner with traditional health care providers.

Regardless of business considerations, the decision by CVS to stop selling tobacco in its stores is also the right thing to do for the nation’s health, Lavizzo-Mourey noted in her LinkedIn post. “In today’s interconnected world, corporate policies must take into consideration far more than short term revenues—the health and wellness of a company’s employees, customers, and community are also key determinants of the well-being of its business.”

Read coverage of this week’s announcement:

Are E-Cigs a Gateway to Smoking for Teens?

Aug 21, 2014, 3:44 PM, Posted by Sheree Crute

Vaping Electronic Cigarette

As you step through the door of Beyond Vape, you are enveloped in the warm scent of vanilla, tinged with butterscotch. The sleek glass counters and display cases are reminiscent of a high-end cigar shop, but there are no tobacco leaves on hand here. This popular, high-end “vaping” parlor, on one of Williamsburg Brooklyn’s more popular streets, is one of seven the company owns on the East and West Coasts.

Vaping—or inhaling richly flavored, heated vapor through a slender, battery-powered tube—is the latest trend in “smoking,” without actually lighting a traditional cigarette. Cindy Hsu, the store’s manager, explains that some of her customers “vape" without even adding liquid nicotine to the tube’s cylinder. “They prefer to just enjoy the extensive menu of flavors such as mocha mint, kiwi strawberry and pineapple.”

Tasty flavors are one thing, but there’s another popular incentive to vape: the claim that vaping can help you stop smoking. Another neighborhood shop, Brooklyn Vaper, advertises its wares with a video explaining that vaping is a “greener, cheaper alternative to help you quit smoking effortlessly... while vaping in 40 flavors.”

Is that true? Can vaping or pre-packaged e-cigarettes help smokers quit?

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Helping the Homeless Quit Smoking: Q&A with Michael Businelle and Darla Kendzor, The University of Texas School of Public Health

Jul 30, 2014, 3:25 PM


Not surprisingly, a recent study in the American Journal of Public Health found that homeless smokers struggle with quitting more than economically disadvantaged smokers who have their own housing. The study compared homeless smokers receiving treatment at a shelter-based smoking cessation clinic to people enrolled in a smoking cessation program at a Dallas, Texas, safety-net hospital.

“On average, homeless people reported that they found themselves around about 40 smokers every day, while the group getting cessation care at the hospital reported that they were more likely to be around three to four smokers every day,” said Michael S. Businelle, PhD, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health Dallas Regional Campus, and the lead author of the study. “Imagine if you had an alcohol problem and were trying to quit drinking—it would be almost impossible to quit if you were surrounded by 40 people drinking every day. That is the situation homeless folks have to overcome when they try to quit smoking.”

Businelle said research shows that about 75 percent of homeless people smoke and that smoking is a leading cause of death in this population. And although homeless smokers are just as likely to try to quit smoking as are other smokers, they are far less successful at quitting, according to Businelle’s work. He said tailored smoking cessation programs are needed for homeless people, including smoke-free zones in shelters.

NewPublicHealth recently spoke with Businelle and his wife, Darla Kendzor, PhD, who is a co-author of the recent study on smoking and the homeless, as well as an assistant professor at The University of Texas.

NPH: Why did you embark on the study?

Michael Businelle: The smoking prevalence in this population is so high and homeless people are not enrolled in clinical trials so we don’t know what will work best for them. We’ve developed, over the last 50 years, really good treatments for the general population of smokers, but there are very few treatments that have been tested in homeless populations.

Darla Kendzor: And cancer and cardiovascular disease, which are in large part due to tobacco smoking, are the leading causes of death among homeless adults. So quitting smoking would make a big difference for them. 

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‘It Makes You Want to Smoke’

May 29, 2014, 11:57 AM

Citylab—formerly Atlantic Citiesreported recently on an architectural award bestowed by Residential Architect on the Corinthian Gardens Smokers Shelter, a 275-square-foot structure in Des Moines, Iowa. It was created by local architectural firm ASK Studio for smokers who live in a nearby apartment building. “This project serves as a reminder that smokers aren’t extinct by quietly celebrating an activity that has gone from banal to banned,” reads the description on the publication’s online portal.

“It’s the sort of structure that has the feel of a private clubhouse for the tobacco-initiated,” according to award juror Cary Bernstein, whose comments were published by Residential Architect. “It makes you want to smoke so you can be in it.”

Wisely, the materials used to construct the shelter are nonflammable. Smokers get benches to sit on while they smoke and lighting for security after dark.

Corinthian Gardens is hardly the only such smoking shelter in the United States. An online search finds several companies that make the shelters, although none seem as glitzy as the one in Des Moines. And late last year a judge in Great Falls, Montana, ruled that smoking shelters that also house gambling machines don’t violate the city’s Clean Indoor Air Act.

So far, it seems, the shelters are legal so long as they adhere to rules governing smoking in the state or city they’re in, such as being built the requisite distance away from a building to avoid blowing second hand smoke at non-smokers. But tobacco- control advocates worry that the shelters, especially the recent award winner, can hurt the goals of completely eradicating smoking as a social norm—especially when 19 percent of U.S. adults still smoke.

“The fact that people are being protected from the elements is fine, we support the design perspective, but we worry about anything that normalizes or glamorizes smoking,” said Robin Koval, president and CEO of tobacco control advocacy group Legacy.

“We don’t’ hate smokers, we love smokers, what we hate is tobacco,” said Koval, “and so you have to call the structure what it is: a waiting room for the cancer ward because one out of two people who use it will die of tobacco-related diseases. To us that’s really the issue.”

This commentary originally appeared on the RWJF New Public Health blog.

Why Thirdhand Smoke Looks to Be a First-Rate Problem

May 19, 2014, 1:50 PM

Data on thirdhand smoke—tobacco smoke left on surfaces, walls and floors—was first published in 2009. The data has raised significant concerns that the smoke can linger for months or longer, as well as combine with indoor air compounds to possibly form new carcinogens. In the last few months researchers from the California Thirdhand Smoke Consortium, funded by the University of California’s Tobacco-Related Disease Research Program (TDRP), have been presenting and publishing data that indicates that thirdhand smoke is linked to serious health risks in animals and humans—though more research is needed to better measure thirdhand smoke constituents and their health impact.

Consortium researchers published the first animal study on thirdhand smoke in January in the journal PLOS One, finding that mice exposed to thirdhand smoke developed a range of medical conditions, including liver damage and hyperactivity. Research published last year, as well as presented at the annual meeting of the American Chemical Society a few weeks ago, finds that thirdhand smoke likely causes damage to human DNA.

And last month several of the Consortium scholars presented their findings at a tobacco conference n California.

“The potential health risks of what we call thirdhand smoke are only now being studied. This is a new frontier,” said Georg Matt, a Consortium member and psychology professor of at San Diego State University who focuses on policies to protect nonsmokers. “We don’t yet know the degree of risk, but we are already finding that indoor smoking leaves a nearly indelible imprint. We need to find out what risk this pollution poses.”

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Big Cities Health Coalition, Other Groups Push FDA to Expand Its Proposed Regulations on E-Cigarettes

May 5, 2014, 2:14 PM

A growing number of public health groups are urging the U.S. Food and Drug Administration (FDA) to go well beyond the new rules the agency proposed last month to expand its authority over tobacco, including e-cigarettes. Late last week the Big Cities Health Coalition, made up of twenty of the largest cities in the United States—including Boston, New York City, Chicago and Los Angeles—held a briefing in Washington, D.C. to address what they see as significant gaps in the recently released FDA tobacco regulations. The Coalition is a project of the National Association of County and City Health Officials (NACCHO). “What began as a sliver of the tobacco market is now predicted to eclipse traditional tobacco sales by mid-century,” said the Coalition in a letter to the agency last week.

The letter and Washington, D.C., briefing highlighted  concerns about regulating e-cigarettes that the current FDA rules do not address:

  • E-cigarettes are being marketed in ways that appeal to youth and could undermine existing tobacco regulations
  • E-cigarette manufacturers are making unsubstantiated claims regarding health and safety
  • E-cigarettes do not carry health warning labels

Marketing to children was a key concern during the Coalition’s briefing. “The FDA should aggressively limit access to minors and not allow marketing to them or flavorings,” said Barbara Ferrer, MPH, PhD, executive director of the Boston Public Health Commission. All of the commissioners at the briefing voiced a need to regulate flavorings, which can include flavors such as—bubble gum and watermelon—and which the commissioners say are a direct enticement for young people.

“Bubble gum is not a flavor that’s aimed at you or me,” said Mary Bassett, MD, MPH, Commissioner of the New York City Department of Health and Mental Hygiene.

Many of the Coalition member cities have already proposed or enacted laws regarding e-cigarettes that are stricter than the ones proposed by last month by the FDA. A sampling of city regulations regarding e-cigarettes includes:

  • Boston — E-cigarettes are not permitted in the workplace; sales are not permitted to anyone under 18; and neither cigarette smoking nor e-cigarette “vaping” are permitted in the city’s public parks.
  • New York City — Bans the sale of e-cigarettes to anyone under 21, and as of August 2014 “vaping” will not be permitted anywhere cigarette smoking is not allowed.
  • Chicago — Requires retailers to obtain tobacco licenses in order to sell e-cigarettes, prohibits sales of e-cigarettes within 500 feet of schools, requires e-cigarettes to be sold behind store counters and prohibits use of e-cigarettes wherever smoking is prohibited.
  • Los Angeles — E-cigarettes cannot be used in public buildings, in parks, at beaches and at other locations where cigarette and tobacco smoking is prohibited. Sales are not allowed to people under 18.

“City health commissioners and mayors are playing and will continue to play critical roles in regulating tobacco products, including e-cigarettes,” said Vince Willmore, vice president for communications at the Campaign for Tobacco-Free Kids in Washington, D.C. “Overall, the main things public health advocates can do is to comment on the FDA rule and urge that it be finalized as quickly as possible; push for action in their own states and communities to regulate e-cigarettes as tobacco products; and continue to focus attention on the problems posed by e-cigarettes.”

The FDA has proposed a 75-day comment period rather than the usual 90-day period, pointed out Robin Koval, president and CEO of Legacy. Last week the organization released a new report on e-cigarettes that looked at the rise of e-cigarette use among youth, as well as the entry of the major tobacco companies into the e-cigarette market.

Koval said she would like to see the FDA commit to a specific time frame for sending its proposed rules to Congress once the comment period is over because “there isn’t’ any time to lose in getting the regulations out...these markets are building growth aggressively.”

>>Bonus Link: Read about a new study in The New York Times, which found that e-cigarettes can become hot enough to release some carcinogens found in conventional cigarettes.

This commentary originally appeared on the RWJF New Public Health blog.