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Vaping isn’t working at cessation; it is working at hooking our teens

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When electronic cigarettes first came on the market, we hoped they might help reduce the tremendous harm caused by tobacco cigarettes. If smokers inhaled a vapor containing nicotine, flavorings and other additives rather than the multitude of cancer-causing chemicals in tobacco smoke, there might be some benefit.

While some adults have used e-cigarettes to wean themselves from tobacco, research indicates that e-cigarettes are really just another nicotine delivery device with its own unique hazards that addict users to nicotine. This is especially concerning for teens and young adults who are using e-cigarettes with alarming frequency.

One recent study did suggest that e-cigarettes helped adults stop smoking. However, those who quit tobacco continued to consume e-cigarettes and nicotine a year later. More common appears to be the experience of smokers studied by Dr. Russell Bowler, a professor of medicine at National Jewish Health. He found that most of the tobacco smokers who started using e-cigarettes in hopes of quitting tobacco continued to smoke tobacco at similar or higher levels five years later. Former smokers who began using e-cigarettes were more than 16 times as likely to resume tobacco smoking.

Additional research at National Jewish Health has shown that, while less harmful than tobacco smoke, e-cigarette vapor itself is harmful. It injures cells lining the airways and blood vessels in the lungs, and increases susceptibility to respiratory viruses.

E-cigarette use, or vaping, by teens and young adults is especially worrisome. After decades of decline, the consumption of tobacco products has taken a U-turn and begun a precipitous climb. Vaping among middle and high school students increased 900 percent from 2011 to 2015 and nearly doubled in just the last year.

Today, one in 20 middle schoolers and one in five high school students use e-cigarettes. College students and young adults vape at similar or even greater rates.

Research has shown that youth who try an e-cigarette are more likely to begin smoking tobacco. The Surgeon General and the Food and Drug Administration have both called e-cigarette use by teens and young adults a serious public health threat.

Nicotine in e-cigarettes poses unique threats to young users’ health. Adolescence is an important period of brain development when learning capacity, decision making, working memory, reward processing and emotional regulation all grow and mature. Nicotine use during adolescence profoundly alters this process, priming the brain for future addictions and increasing the risk of mood disorders, intellectual problems and impulsiveness.

E-cigarettes have become immensely popular, fueled by flavors and marketing targeted at young people. Peer pressure to vape is bearing down on those who don’t. Many don’t even realize they are vaping nicotine and mistakenly believe they are inhaling simple water vapor. Teenage brains are especially susceptible to nicotine’s addictive and rewarding effects, yet many fail to recognize the threat e-cigarettes pose to long-term mental and physical health.

After decades of fighting to reduce harm from tobacco, it is astounding that a new generation faces a renewed threat from tobacco. We must help young people avoid nicotine and quit e-cigarettes. Teens can call the Colorado QuitLine (1-800-QUIT-NOW), which recently lowered the age of eligibility for services to 12.

As the operator of the Colorado and many other state quitlines for 17 years, National Jewish Health has extensive experience treating nicotine addiction with personalized plans to avoid nicotine, navigate peer pressure and manage nicotine withdrawal. At the same time, the FDA must tighten regulation of e-cigarettes and follow through on promises to close down manufacturers who don’t meaningfully limit youth access to e-cigarettes.

JUUL, the dominant company in the market, must follow through on its action plan to cease marketing to youth and limit their access to its products.

We urge Colorado legislators to pass the recently introduced bill to raise the age for legal purchase of e-cigarettes.

Together, we can protect our youth from the dangers of e-cigarettes and vaping.

Dr. Michael Salem is president and CEO of National Jewish Health. Thomas Ylioja, PhD, is an assistant professor of medicine and clinical director of health initiatives at National Jewish Health.

Brian Donohue column: Tobacco 21: Addressing the right problem the wrong way

Nearly 95 percent of adults who smoke started before age 21, so we applaud our state legislators for wanting to reduce the use of tobacco, including e-cigarettes, for those younger than 21. However, the proposed bill as it is drafted will not provide the public policy results legislators are looking for and will not have support from the American Cancer Society Cancer Action Network (ACS CAN).

It is important to closely evaluate each proposed Tobacco 21 bill as the tobacco industry has a history of using age of sale laws to weaken restrictions on sales to youth, penalize youth, create carve-outs for certain products, and to interfere with other effective tobacco control policies.

ACS CAN has been working to advance effective Tobacco 21 legislation across the nation for several years. What we have learned from these debates is that the legislative focus needs to be on the sale — not the purchase — of tobacco and e-cigarette products. We have also seen that penalizing and fining youth who purchase tobacco and e-cigarettes has proven not to be an effective way to reduce consumption. Therefore, as this bill is drafted, it will not have support from ACS CAN.

The Tobacco 21 legislation needs to address three critical areas of concern in order to have the greatest impact: focus on the sale of tobacco and e-cigarettes rather than the purchase, require licensing for all retailers that sell tobacco and e-cigarette products, and fund prevention and cessation programs to help reduce youth tobacco use.

This bill retains penalties for youth who purchase, use, and possess tobacco and e-cigarette products. We have learned from working Tobacco 21 bills across the states that laws that focus on the purchaser rather than the seller fail to reduce youth consumption. Virginia’s current law unfairly penalizes youth, many of whom became addicted at an early age due to tobacco industry marketing campaigns. This takes the spotlight off Big Tobacco and retailers and shifts it onto the victims — our youth.

Not licensing retailers makes enforcement and holding retailers accountable next to impossible. For Tobacco 21 laws to be effective, there must be strict enforcement to ensure a high rate of compliance. We recommend the proposed bill be amended to require retailers to be licensed, designate an enforcement agency, identify a dedicated funding source for enforcement, require annual unannounced compliance checks, increase fines and penalties including license suspension and revocation for retailers found out of compliance, provide for citizen complaints of violations, require appropriate signage at retail stores, and, lastly, provide retailer education.

Our final concern is that many young people who smoke are already addicted. Some research suggests that penalizing youth could deter them from seeking support for cessation. Promoting and increasing funding for tobacco prevention and cessation resources for teens interested in quitting would be a more beneficial alternative to fines and punishment.

Without the amendments outlined above, this bill will prove to be ineffective, feel-good legislation that allows the tobacco and e-cigarette industries to support this measure while presenting themselves as good corporate citizens who are doing the right thing.

We urge lawmakers to oppose this bill as drafted and work to seize this opportunity to pass meaningful legislation that has proven to effectively reduce youth consumption of all tobacco and e-cigarette products. ACS CAN stands ready to work with legislators on amendments needed to make this bill an effective vehicle for protecting our young people from a lifelong addiction to tobacco and e-cigarette products.

E-cigarettes use among youth at epidemic levels

“The latest Florida Youth Tobacco Survey, which tracks indicators of tobacco use and exposure to secondhand smoke among middle and high school students, shows that one in four high school students currently use electronic vaping.  Florida is significantly above the national average.

People do not become addicted to tobacco or to cigarettes. They become addicted to nicotine, which is in tobacco and in electronic cigarettes. Nicotine is an insecticide, and is highly addictive.

Today there are significantly more children inhaling nicotine than 20 years ago. Nicotine adversely affects the brains of children, which are not fully developed. Nicotine addiction leads to a costly, slow and painful death. It kills 480,000 Americans each year.

Any assumption that vaping is safer than smoking has been dispelled by many studies including one at the University of Miami School of Medicine. Vaping is not safe, and there is no safe level of exposure to secondhand smoke.

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The Surgeon General recently declared “e-cigarette use among youth an epidemic.”

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Legislators in Florida (state and local) have done nothing to stop the vaping epidemic, but they can do many things. For example, the state legislature can define electronic nicotine delivery systems (ENDS), which includes electronic cigarettes, as tobacco.

Currently, vape shops in Florida are unregulated and do not require a license to sell ENDS. Requiring vape shops to have licenses to operate and taxing ENDS as cigarettes are taxed will be more popular than raising property taxes.

Since 2016 six states have raised the legal age to purchase tobacco to 21, and so have 370 cities and counties across America. None are in Florida.

The Florida Legislature and local governments must raise the legal age to purchase tobacco to 21. Nearly all tobacco product use, and addiction, begins during youth and young adulthood. Tobacco use among teenagers has been cut in half in communities where the legal age is now 21.

Raising the access age to 21 would be beneficial to elected officials as it is an extremely popular measure. In a statewide poll of likely voters, 69 percent favored raising the legal age to 21 if it were a ballot initiative. This overwhelming popular support is consistent with numerous other polls conducted across America.

Opponents may argue the state will lose tobacco tax revenue. This argument lacks vision because Florida pays out more than twice the money it collects in tobacco tax to pay for Medicaid claims due to tobacco-related illnesses and does not account for the immeasurable human suffering caused by drug addiction.

Healthy laws need to be enacted to protect young people from this deadly epidemic. If the state legislature will not act, then cities and counties must act to end the ENDS epidemic.”

Is Juul the Startup World’s Greatest Long Con?

“It was 25 years ago that executives at Philip Morris and six other American cigarette companies testified before Congress that nicotine was not addictive. Even under oath, the tobacco giants continued their decadeslong practice of gaslighting the public about the negative effects of cigarettes, which were once actually marketed by doctors. The image of seven CEOs being sworn in to answer for their companies’ misdeeds has endured as a powerful visual shorthand for modern corporate villainy. As the lethal effects of cigarettes were drilled into the minds of young would-be smokers by middle school counselors and aggressive ad campaigns, smoking entered an ongoing decline in usage. Big Tobacco had been felled.

Or so it seemed. In late December a Virginia-based conglomerate called Altria bought a 35 percent stake in the San Francisco startup Juul Labs for almost $13 billion. Juul is a maker of e-cigarettes and says its goal is to help adults quit smoking. Altria is the rebranded version of Philip Morris, whose entire corporate directive is to get adults to keep smoking. Juul says its wild popularity among teens is an unfortunate accident. Philip Morris once wrote an internal memo that said, “Today’s teenager is tomorrow’s potential regular customer.”

This seems like a horrible corporate mismatch, unless you see it for what it is: the pairing of two scheming businesses deftly executing a long con. In the decades since Big Tobacco took so many PR lumps that its biggest player had to change its name, tech has emerged as the sector most likely to sell people a bill of goods. Phones that were supposed to make us more efficient have made us less so. Social networks that were supposed to bring us all together have repeatedly driven us apart. By joining forces with its professed enemy, Juul is skipping a bit ahead in the Silicon Valley startup timeline, which generally follows a three-step track: (1) Don’t be evil; (2) be evil sometimes, but only when it’s in service of a greater societal good; (3) actually, being evil is fine.

 

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Minnesota kids are being tricked (and addicted) by flavored tobacco products

Minneapolis (10/30/18) – This Halloween, Minnesotans for a Smoke-Free Generation is reminding parents, teachers and community leaders that many tobacco products aimed at youth closely resemble popular Halloween candies. The tobacco industry blatantly continues to use kid-friendly menthol, candy and fruit flavors to attract the next generation of smokers. These products include wild cherry cigars, Bubble Gang watermelon e-liquid, peach cigarillos, and Mint JUULpods – to name a few.

“The tobacco industry has not stopped their tricks to hook young tobacco users on their addictive and deadly products,” said Molly Moilanen, Director of Public Affairs at ClearWay MinnesotaSM and Co-Chair of Minnesotans for a Smoke-Free Generation. “Big tobacco knows that 95 percent of addicted smokers start before age 21 and that’s why we continue to see thousands of flavored nicotine and tobacco products flood our schools, stores and homes. In the face of a youth nicotine addiction epidemic, lawmakers must do more to protect our kids.”

The U.S. Food and Drug Administration in 2009 banned the use of most flavoring agents, except menthol, in cigarettes. However, that ban does not include other tobacco products such as little cigars and cigarillos, or emerging products like e-cigarettes. Internal documents from the tobacco industry show that tobacco companies know that young people are attracted to fruit, candy and alcohol flavors in tobacco products. Research also has found that most kids start smoking by using flavored tobacco products.

Flavored tobacco products have helped contribute to the first increase in youth tobacco use in 17 years in Minnesota. The 2017 Minnesota Youth Tobacco Survey found that more than 60 percent of youth tobacco users reported using flavored products in the past 30 days, and almost 40 percent of Minnesota high-school students have tried e-cigarettes, which come in candy and other kid-friendly flavors.

Flavored products mask the harshness of tobacco, but are just as addictive and dangerous as other products. Nicotine damages the developing adolescent brain whether it’s delivered in a cigarette, cigarillo, e-cigarette or other tobacco product.

Federal and state health officials are sounding the alarm on rising rates of youth nicotine and tobacco addiction. In a recent health advisory, the Minnesota Department of Health called youth nicotine addiction a major health concern because nicotine harms the developing adolescent brain and primes youth for addiction to cigarettes and other substances. Separately, the FDA recently said youth e-cigarette use is an epidemic and the agency is considering actions against e-cigarette manufacturers and retailers.

The 2017 Minnesota Youth Tobacco Survey found that youth tobacco use has risen for the first time in 17 years in Minnesota. The increase is due to a sharp rise in e-cigarette use and by the tobacco industry’s marketing, including kid-friendly flavors, prolific advertising, easy access and stealthy new products.

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