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Cincinnati raises minimum age to buy tobacco to 21

In a 5-3 vote, Cincinnati City Council voted to increase the minimum legal sales age for tobacco products, including e-cigarettes and vape products, to 21.  One Councilmember was absent.  Tamaya Dennard, the councilmember who sponsored the legislation, made clear that this ordinance would not criminalize 18-20 year olds for smoking or obtaining tobacco products.  “The disease and illness that smoking causes are 100 percent preventable.  Without a doubt, this ordinance will help curb the rate of unnecessary and preventable health issues in our area,” said Dennard.

Normal Enacts Tobacco 21 Ordinance

Normal has raised the minimum age to buy tobacco and vaping products from 18 to 21.

The town joins the ranks of 26 other Illinois communities with similar laws, including Peoria and Washington. The change goes into effect Dec. 1.

The unanimous council vote Monday night follows a meet-and-greet last month with representatives of the Illinois State University chapter of the Tobacco 21 coalition.

Council members commended students’ work advocating for the change, citing their own connections to the issue.

“I’m pleased to see people in that age group standing up and saying, ‘We want this, and we want this now,'” said council member Chemberly Cummings. “This was something that kind of hit home personally, knowing those who have passed away from lung disease, from prolonged tobacco usage.”

“I think we all had a similar experience that night,” said council member R.C. McBride, who is also GLT’s general manager. “It was interesting as you talked to (the students), most all of them had gotten involved because they knew someone who’d had lung cancer or something.”

“Smoking is what killed my father,” McBride continued. “So a lot of us sadly have that in common.”

Speaking on the group’s behalf at Monday night’s council meeting, Patricia Fountain of Normal said while communities with similar laws have seen reduced tobacco use among high schoolers, the rising popularity of e-cigarettes threatens to undo that progress.

Fountain cited a recent statement from FDA Commissioner Scott Gottlieb calling youth e-cigarette use and nicotine addiction an “epidemic.” The statement accompanied the publication of data from the FDA and the Centers for Disease Control and Prevention’s 2018 National Youth Tobacco Survey, showing that e-cigarette use among high schoolers jumped 78 percent between 2017 and 2018.

Normal resident Charles Sila said while preventing people from taking up smoking is a worthy goal, an ordinance goes too far, restricting the choices of legal adults.

“At age 18, most citizens can buy a house and sign a binding mortgage, or buy a car and sign a binding note without anyone’s permission,” he said. “Essentially treating some citizens as grade school students is totally unfair.”

Council member Kevin McCarthy said with tobacco and other drugs, it’s not necessarily about choice.

“We know what the cigarette industry does is put things in cigarettes that makes them addicting,” he said. “Once kids start, it’s very difficult to get off. It’s not just laziness, it’s not just social pressure, but it is a matter of the chemicals that are put in the cigarettes as well. So I think it’s important that we give them every fighting chance and keep that out of their hands as long as we can.”

Under the ordinance, vendors caught selling tobacco and vaping products to those under 21 face a $50 fine on the first offense and a $500 fine for repeat offenses.

. . .

Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018

Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018

Authors:  Karen A. Cullen, PhD1; Bridget K. Ambrose, PhD1; Andrea S. Gentzke, PhD2; Benjamin J. Apelberg, PhD1; Ahmed Jamal, MBBS2; Brian A. King, PhD2 (View author affiliations)

Electronic cigarettes (e-cigarettes) are battery-powered devices that provide nicotine and other additives to the user in the form of an aerosol (1). E-cigarettes entered the U.S. marketplace in 2007 (1), and by 2014, e-cigarettes were the most commonly used tobacco product among U.S. youths (2). Data from the 2011–2018 National Youth Tobacco Survey (NYTS), a cross-sectional, voluntary, school-based, self-administered, pencil-and-paper survey of U.S. middle and high school students, were analyzed to determine the prevalence of current use (≥1 day in past 30 days) of e-cigarettes,* current use of any tobacco product, frequency of (number of days during the preceding 30 days) e-cigarette use, and current use (any time during preceding 30 days) of any flavored e-cigarettes among U.S. middle school (grades 6–8) and high school (grades 9–12) students. Logistic regression (2011–2018) and t-tests (2017–2018) were performed to determine statistically significant differences (p<0.05).

Among high school students, current e-cigarette use increased from 1.5% (220,000 students) in 2011 to 20.8% (3.05 million students) in 2018 (p<0.001) (Figure). During 2017–2018, current e-cigarette use increased by 78% (from 11.7% to 20.8%, p<0.001). The proportion of current e-cigarette users who reported use on ≥20 of the past 30 days increased from 20.0% in 2017 to 27.7% in 2018 (p = 0.008). Among high school students, during 2017–2018, current use of any flavored e-cigarettes increased among current e-cigarette users (from 60.9% to 67.8%, p = 0.02); current use of menthol- or mint-flavored e-cigarettes increased among all current e-cigarette users (from 42.3% to 51.2%, p = 0.04) and current exclusive e-cigarette users (from 21.4% to 38.1%, p = 0.002).

Among middle school students, current e-cigarette use increased from 0.6% in 2011 (60,000 students) to 4.9% (570,000 students) in 2018 (p<0.001) (Figure). During 2017–2018, current e-cigarette use increased by 48% (from 3.3% to 4.9%, p = 0.001); the proportion of current e-cigarette users who reported use on ≥20 days of the past 30 days did not significantly change (from 12.9% to 16.2%, p = 0.26).

Current use of any tobacco product among high school students was 24.2% (3.69 million students) in 2011 and 27.1% (4.04 million students) in 2018 (p>0.05) (Figure). Current use of any tobacco product among middle school students was 7.5% (870,000 students) in 2011 and 7.2% (840,000 students) in 2018 (p>0.05). During 2017–2018, overall tobacco product use increased by 38% among high school students (from 19.6% to 27.1%, p<0.001) and by 29% among middle school students (from 5.6% to 7.2%, p = 0.008).

Current e-cigarette use increased considerably among U.S. middle and high school students during 2017–2018, reversing a decline observed in recent years and increasing overall tobacco product use (3). Moreover, during 2017–2018, frequent e-cigarette use increased among high school students. Although e-cigarettes have the potential to benefit adult smokers if used as a complete substitute for combustible tobacco smoking, the use of any form of tobacco product among youths, including e-cigarettes, is unsafe (1). The Surgeon General has concluded that e-cigarette use among youths and young adults is of public health concern; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain (1).

The rise in e-cigarette use during 2017–2018 is likely because of the recent popularity of e-cigarettes shaped like a USB flash drive, such as JUUL; these products can be used discreetly, have a high nicotine content, and come in flavors that appeal to youths (4). In September 2018, the Food and Drug Administration (FDA) issued more than 1,300 warning letters and civil money penalty fines to retailers who illegally sold e-cigarette products to minors, the majority of which were blu, JUUL, Logic, MarkTen XL, and Vuse; this was the largest coordinated enforcement effort in FDA’s history (5). Sustained implementation of proven population-based strategies, in coordination with the regulation of tobacco products by FDA, is key to reducing all forms of tobacco product use and initiation, including e-cigarettes, among U.S. youths (1).

Results from 2018 National Youth Tobacco Survey show dramatic increase in e-cigarette use among youth over past year

FDA News Release:

Today, the U.S. Food and Drug Administration and U.S. Centers for Disease Control and Prevention (CDC) released new findings from the National Youth Tobacco Survey (NYTS) showing that more than 3.6 million middle and high school students were current (past 30 day) e-cigarette users in 2018, a dramatic increase of more than 1.5 million students since last year. According to the results published in today’s Morbidity and Mortality Weekly Report (which will be made public at 1 p.m. ET), youth who use e-cigarettes also are using them more frequently and using flavored products more often than last year. The sharp rise in e-cigarette use has resulted in an increase in overall youth tobacco product use, reversing a decline seen in recent years, and is prompting a series of steps by the FDA to curb youth use trends.

“These new data show that America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation in nicotine addiction,” said HHS Secretary Alex Azar. “By one measure, the rate of youth e-cigarette use almost doubled in the last year, which confirms the need for FDA’s ongoing policy proposals and enforcement actions. HHS’s work will continue to balance the need to prevent youth use of e-cigarettes with ensuring they are available as an off-ramp for adults who are trying to quit combustible cigarettes.”

According to the findings, the number of U.S. high school students who reported being current e-cigarette users increased 78 percent between 2017 and 2018 to 3.05 million (or 20.8 percent). Numbers among middle school students rose 48 percent to 570,000 (or 4.9 percent). The study authors suggest the rise in e-cigarette use in the last year is likely due to the recent popularity of certain types of e-cigarettes, such as JUUL. These products include ones that are cartridge-based, can be used discreetly because of their resemblance to slim USB flash drives, have a high nicotine content and come in appealing fruit and candy flavors. The increased popularity of e-cigarettes among youth raises a number of other health concerns: risk of addiction to nicotine early on in life; potential harm from nicotine exposure to the developing adolescent brain; and exposure to chemicals associated with adverse health effects. In addition, research shows that, compared with non-users, youth who use e-cigarettes are more likely to transition to conventional cigarettes ‒ risking a lifetime of addiction to smoking and resulting smoking-attributable disease.

The uptick in e-cigarette use has led overall tobacco product use to increase by 38 percent among high school students (to 27.1 percent) and by 29 percent among middle school students (to 7.2 percent) in the last year, reversing the positive decline seen over the last few years.

Additionally, the survey also shows that high school students who reported being current e-cigarette users also reported using the product more frequently. In the last year, the proportion of those using the product more regularly (on 20 or more of the past 30 days) increased from 20 percent to 27.7 percent, an alarming one-year rise. The 2018 NYTS also found that among high school e-cigarette users, there was a significant increase in current flavored e-cigarette use within the past year, from 60.9 percent to 67.8 percent. Research shows youth and young adults identify flavors as a primary reason for e-cigarette use. Additionally, there is evidence from the Population Assessment of Tobacco and Health (PATH) Study indicating youth who first tried a flavored tobacco product have a higher likelihood of current tobacco use compared to those who first tried an unflavored product.

“We’ve been aware of these data for several months and are pursuing a robust set of new policies to address this epidemic level of e-cigarette use by kids. This spike in use threatens to stall or reverse the substantial public health gains we’ve made by reducing tobacco use overall, and especially among children. It’s clear we have a problem with access to, and appeal of these products to kids, and we’re committed to utilizing the full range of our regulatory authorities to directly target the places kids are getting these products and address the role flavors and marketing are playing in youth initiation,” said FDA Commissioner Scott Gottlieb, M.D. “We still believe that non-combustible forms of nicotine delivery, such as e-cigarettes, may be less harmful alternatives for currently addicted adult smokers who still seek nicotine. And we want to keep this option open for adults as the evidence develops to inform their use by adult smokers. But as we’ve said before, we will not allow that opportunity to come at the expense of addicting a whole new generation of kids to nicotine. We must close the on-ramp of nicotine addiction for kids even if it risks narrowing the off-ramp from smoking for adults. These are the hard tradeoffs we must take to keep these products out of the hands of kids and confront this troubling epidemic.”

NYTS is a cross-sectional, voluntary, school-based, self-administered, pencil-and-paper survey of U.S. middle and high school students. The data for the 2018 NYTS were collected from March to May 2018. The alarming rise in use and the threat of a new generation of young people becoming addicted to nicotine prompted the FDA and CDC to release these data earlier than usual so as to encourage e-cigarette companies and retailers, state, county and local health departments, public health organizations, and parents and educators to act immediately to curtail this crisis. The FDA and CDC plan to release the remaining data on usage rates of other tobacco products in early 2019.

“The markedly accelerating rate of e-cigarette use among U.S. youth within the past year is a cause for grave concern,” said CDC Director Robert R. Redfield, M.D. “E-cigarette use is unsafe among youth, and it’s critical that we implement proven strategies to protect our Nation’s youth from this preventable health risk.”

Tailoring social media, digital resources and web content for parents, teachers, coaches, and other youth influencers, CDC provides states and communities with accurate, actionable, and up-to-date science and information about the risks of e-cigarettes to young people. For example, CDC has a number of online resourcesexplaining the risks of e-cigarettes for youth and ways to prevent youth from using e-cigarettes or to help them stop.

In addition to the steps the FDA is announcing today, the agency has taken a series of actions over the past several months to target the illegal sales of e-cigarettes to youth, as well as to target companies engaged in kid-friendly marketing that increases the appeal of these products to youth. In particular, the FDA recently announced a series of critical enforcement actions that included issuing more than 1,300 warning letters and fines to retailers who illegally sold JUUL and other e-cigarette products to minors during a nationwide, undercover blitz of brick-and-mortar and online stores this summer–the largest coordinated enforcement effort in the FDA’s history. Moving forward, the FDA is indefinitely stepping up enforcement actions with a sustained campaign to monitor, penalize and prevent e-cigarette sales to minors in retail locations, including manufacturers’ internet storefronts. The agency is exploring action under both its civil and criminal enforcement tools to target potentially violative sales and marketing practices by manufacturers as well as retailers.

The agency also issued letters in September to five major e-cigarette manufacturers that produce JUUL, Vuse, MarkTen, blu e-cigs and Logic, which, combined, comprise more than 97 percent of the market share for closed-system e-cigarette products. These letters asked the companies to submit to the FDA within 60 days plans describing how each firm will address the widespread youth access and use of its products. The FDA recently met with these companies to discuss not only the potential steps they would take to restrict youth access to, and appeal of, these products, but also the measures they think the FDA and other policy-makers can take to reverse the trends in youth use of e-cigarettes.

The agency also launched “The Real Cost” Youth E-Cigarette Prevention Campaign. This new, comprehensive effort targets nearly 10.7 million youth, aged 12-17, who have used e-cigarettes or are open to trying them. The new campaign features hard-hitting advertising on digital and social media sites popular among teens, as well as posters with e-cigarette prevention messages in high schools across the nation. The FDA also recently announced a public hearing, to be held Dec. 5, to discuss efforts to eliminate youth e-cigarette use, with a focus on the potential role of drug therapies to support cessation among youth, and the issues impacting the development of such therapies for children.

As part of the agency’s comprehensive plan on tobacco product and nicotine regulation, the FDA also issued an advance notice of proposed rulemaking in March to seek public comment on the role that flavors in tobacco products, including e-cigarettes, play in attracting youth. Additionally, the agency plans to explore additional restrictions on the sale and promotion of e-cigarettes to further reduce youth exposure and access to these appealing products.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

High school e-cigarette use has jumped nearly 80%. Now, the FDA wants new regulations

(CNN)Vaping increased nearly 80% among high schoolers and 50% among middle schoolers since last year, prompting the US Food and Drug Administration to propose new measures against flavored nicotine products that have propelled the rise, the agency announcedThursday.

“These data shock my conscience,” FDA Commissioner Dr. Scott Gottlieb said in a statement, proposing to strengthen the agency’s policies against flavored e-cigarette products. These proposals could ultimately prompt their removal from shelves and websites that are accessible to minors.
The proposed changes do not include mint, menthol and tobacco flavors, however. Gottlieb said he wanted to leave the door open for adults who might use these products to quit smoking cigarettes. But that should not mean fueling an “epidemic” of new kids becoming addicted, he added.
“We will not allow that opportunity to come at the expense of addicting a whole new generation of kids to nicotine,” Gottlieb said.
Despite these exceptions for e-cigarette flavors, Gottlieb proposed additional bans on regular menthol cigarettes and flavored cigars.
He also proposed tightening the reins on products that are marketed or “appealing to youth.”
“This could include using popular children’s cartoon or animated characters, or names of products favored by kids like brands of candy or soda,” the announcement said.
Consumers and health experts have been locked in a contentious debate about vaping: While some see it as a smoking cessation tool for adults, others say there’s no good evidence to support this.
“We’re committed to utilizing the full range of our regulatory authorities to directly target the places kids are getting these products and address the role flavors and marketing are playing,” Gottlieb said.
“We will leave no stone unturned,” he said. “This is one of our highest priorities.”

‘Spike in use’

One in five high schoolers has vaped in the past month, according to the new numbers announced by the FDA and released in conjunction with the US Centers for Disease Control and Prevention.
“As a father of three young children, I hear daily from parents and teachers worried about the epidemic use of electronic cigarettes and nicotine addiction among kids,” Gottlieb said.
Health experts worry these products could put kids’ developing brains at risk, get them hooked on nicotine early in life, and be a gateway to smoking and other drugs.
“The data show that kids using e-cigarettes are going to be more likely to try combustible cigarettes later,” Gottlieb said. “This is a large pool of future risk.”
The new statistics also show that students who vape are doing so more frequently than last year, and they are using flavored liquids more often, according to the FDA. More than a quarter of current users vaped at least 20 of the last 30 days, and over two-thirds had used flavored products.
“Flavors are a major reason they use these products in the first place,” Health and Human Services Secretary Alex Azar said in a statement Thursday.
“Flavors increase the likelihood of kids progressing from experimentation to regular use, and a portion of them will go on to use combustible tobacco products, with the huge added dangers of tobacco-related disease.”
The new numbers come from a school-based survey, conducted from March to May, which revealed that the number of current users in middle and high school — meaning those who have vaped in the past 30 days — increased 48% and 78% from last year, respectively.
In other words, the number of current vapers in middle and high school has jumped by roughly 1.5 million since last year, now totaling 3.6 million kids, Gottlieb said.
The “alarming” surge in adolescent e-cigarette use prompted health officials to release these numbers “earlier than usual” in hopes of spurring immediate action, according to the FDA.
“Not only are we seeing a staggering increase in the number of high schoolers who use e-cigarettes, we’re seeing that more and more of them have moved beyond experimentation and are using e-cigarettes almost daily,” Dr. Colleen A. Kraft, president of the American Academy of Pediatrics, said in an emailed statement.
The rapid spread of e-cigarettes — which work by heating a liquid containing nicotine until it vaporizes — was flagged in a 2016 report by the US Surgeon General that cited a 900% increase in e-cigarette use by high school students from 2011 to 2015. E-cigarette use declined for the first time in 2016 but held steady — under 12% — the following year. Now, that number is 20.8%.
“This spike in use threatens to stall or reverse the substantial public health gains we’ve made by reducing tobacco use overall, and especially among children,” Gottlieb said.