Altria Considering Investing In Marijuana

Marlboro Man Might Pitch Pot

Altria Group Inc., which owns Philip Morris USA, is the latest big company to show interest in marijuana. Late Monday, Canadian medical marijuana company Cronos Group Inc. confirmed talks with Altria about a possible investment.

Altria, based in Richmond, Virginia, is one of the largest cigarette makers in the United States. The company said it had no comment on Cronos’ announcement.

Altria joins beverage makers like Molson Coors, Constellation Brands and Heineken that already have announced moves in the cannabis space. Other big companies like Coca-Cola, Pepsi, Anheuser-Busch and Guinness brewer Diageo haven’t acted yet, but have said they’re watching closely as the market for marijuana and its extracts evolves.

Shares of Toronto-based Cronos Group rose 6 percent Tuesday to close at $10.74. Altria shares fell 2 percent to $54.40.

The cannabis market is expected to rapidly grow as legalization expands in the U.S. and social norms change. On Tuesday, conservative Utah became the latest state to legalize marijuana use for medical purposes.

quit smoking campaign

Consumers are expected to spend $57 billion per year worldwide on legal cannabis by 2027, according to Arcview Market Research, a cannabis-focused investment firm. In North America, that spending is expected to grow from $9.2 billion in 2017 to $47.3 billion in 2027.

Cigarette and beverage makers, in particular, want a stake in a market that could eat into demand for their traditional products. For example, a 2017 U.S. government survey showed daily marijuana use was exceeding daily cigarette use among high school students.

“We think that this is another very aligned category that’s going to develop very fast and very large and it simply presents another opportunity for growth,” Constellation Brands CEO Rob Sands said in a recent conference call with investors. In August, Constellation, which owns Corona beer and Manischewitz wine, invested $4 billion in exchange for a 38 percent stake in Canadian marijuana grower Canopy Growth.

Canada legalized recreational marijuana use this year, and it will allow food and drinks containing cannabis sometime next year. In the U.S., marijuana still is illegal at the federal level, but 10 states and the District of Columbia have legalized recreational marijuana for adults. Colorado and Washington were first in 2012 and Michigan is the latest after voters approved the idea last month.

A farm bill before Congress could also legalize industrial hemp at the federal level, which would further open the market for food, beverage and other companies. Like marijuana, hemp comes from the cannabis plant but it contains less than 0.3 percent of THC, the compound that gives pot its high. But it does contain cannabidiol, or CBD, which some claim has calming and healing influences. Earlier this summer, the U.S. government approved an anti-seizure drug that contains marijuana-derived CBD. In some states, consumers can already buy CBD-infused cooking oils, drinks and gummies.

“You can’t name a big, national-scale chain that isn’t involved already or secretly getting involved,” said Ryan Stroud, the co-founder and COO of Xanthic Beverages, an Oregon-based maker of beverages infused with CBD from evergreen bark. “They realize it’s a race and they don’t want to be left behind.”

While some companies are quietly researching cannabis-infused products, others are making their intentions clear. Earlier this year, Tilray Inc., a medical marijuana company in British Columbia, became the first cannabis business to trade on a major U.S. stock exchange. Its market value is quickly approaching $10 billion.

Molson Coors has set up a joint venture called Truss with Hexo Corp., another Canadian marijuana company. It says it will reveal more, including what sorts of products it will offer, early next year. And in California marijuana dispensaries, Heineken subsidiary Lagunitas is already selling sparkling water infused with CBD and its psychoactive cousin, THC.

Big corporations could help the cannabis market by funding research, standardizing products and providing distribution, said Giadha Aguirre De Carcer, the CEO of New Frontier Data, a cannabis research group. Right now, for example, there is no agreement on the dosage of CBD that should go into drinks or the rules for labeling.

“There is a lack of visibility in this space when it comes to consumer products,” she said.

But Stroud says the appearance of multinational corporations on the scene is chilling for many mom-and-pop marijuana growers, who won’t be able to make the transition from the counterculture to the corner office.

“A lot of people are still smoking grandpa’s joint. That’s about to change,” he said.

Several other companies around the world are pushing into the marijuana sector.

Corona beer owner Constellation Brands has said it would pour some $4bn (£3.1bn) into Canada’s top cannabis producer, Canopy Growth, in a deal marking the largest investment in the industry to date.

Tobacco firm Imperial Brands is investing in UK biotech company Oxford Cannabinoid Technologies, while a recent media report said Coca-Cola was in talks with a Canadian producer Aurora Cannabis about developing marijuana-infused beverages.

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FDA To Regulate Flavors, Menthol In Tobacco Products

FDA Commissioner Proposes New Steps To Protect Youth

By Scott Gottlieb, M.D., FDA Commissioner 

As a physician who cared for hospitalized cancer patients, I saw first-hand the devastation that smoking-related diseases had wrought on the lives of patients and their families, and dedicated myself to helping ease this suffering.

As a cancer survivor myself, I understand too well the uncertainty, grief and struggle that accompanies a cancer diagnosis.

And 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.

When I pledged last year to reduce addiction to nicotine, I was driven by the fact that, in the U.S., tobacco use remains the leading cause of preventable death and disease. Combustible cigarettes cause the overwhelming majority of tobacco-related disease. When used as intended, they are responsible for the death of half of all long-term users.

smoking and teenagers

Today, I’m pursuing actions aimed at addressing the disturbing trend of youth nicotine use and continuing to advance the historic declines we’ve achieved in recent years in the rates of combustible cigarette use among kids.

When I first announced our comprehensive tobacco framework plan in July 2017, I recognized my opportunity – an almost unprecedented opportunity – to use the tools that the FDA had been given in the Family Smoking Prevention and Tobacco Control Act to bring about meaningful, lasting change to dramatically alter this cycle of disease and death.

I envisioned a world in which cigarettes lose their addictive potential through reduced nicotine levels. I envisioned a regulatory paradigm that focused on nicotine and evaluated the diverse nicotine delivery mechanisms along a continuum of risk. On one end, there are combustible tobacco products. At the other end, there are medicinal nicotine products sold as gums and patches. And there is an array of products in between.

I saw the opportunity to advance new technologies like electronic nicotine delivery systems (ENDS) as an alternative to cigarettes for adults who still seek access to satisfying levels of nicotine, without all the deadly effects of combustion.

I believed then – and I continue to believe – that we must recognize the potential for innovative, less harmful products that can efficiently deliver satisfying levels of nicotine to adults who want them.

But as I said at that time, as I said at my confirmation hearing, as I said in my first remarks to the professional staff of the FDA three days after being confirmed as the FDA’s Commissioner in May of 2017, and as I’ve said dozens of times in the months that followed: any policy accommodation to advance the innovations that could present an alternative to smoking – particularly as it relates to e-cigarettes – cannot, and will not, come at the expense of addicting a generation of children to nicotine through these same delivery vehicles.

Today, I’m announcing proposals to help reverse these trends, with the unwavering support of HHS Secretary Alex Azar, who shares my deep commitment to protecting the health of our nation’s children. Today, we advance our efforts to combat youth access and appeal with a policy framework that firmly and directly addresses the core of the epidemic – flavors.

The data show that kids using e-cigarettes are more likely to try combustible cigarettes later. The policies I’m outlining now strive to strike a careful public health balance between our imperative to enable the opportunities to transition to non-combustible products to be available for adults; and our solemn mandate to make nicotine products less accessible and less appealing to children.The data make unmistakably clear that, if we’re to break the cycle of addiction to nicotine, preventing youth initiation on nicotine is a paramount imperative.

Almost all adult smokers started smoking when they were kids. Nearly 90 percent started smoking before the age of 18, and 95 percent by age 21.

Only about 1 percent of cigarette smokers begin at age 26 or older. When I announced the FDA’s Comprehensive Plan for Tobacco and Nicotine Regulation in July 2017, I made clear my concerns about kids’ use of e-cigarettes, especially those products marketed with obviously kid-appealing flavors. At the time, however, the trends in youth use appeared to be changing in the right direction – reported e-cigarette use among high school students, which peaked at 16.0 percent in 2015, had decreased to 11.3 percent in 2016 and held steady in 2017. What I did not predict was that, in 2018, youth use of e-cigarettes and other ENDS products would become an epidemic.

Today, the FDA and the Centers for Disease Control and Prevention are publishing data from the 2018 National Youth Tobacco Survey (NYTS). The data from this nationally representative survey, conducted of middle and high school students, show astonishing increases in kids’ use of e-cigarettes and other ENDS, reversing years of favorable trends in our nation’s fight to prevent youth addiction to tobacco products. These data shock my conscience: from 2017 to 2018, there was a 78 percent increase in current e-cigarette use among high school students and a 48 percent increase among middle school students. The total number of middle and high school students currently using e-cigarettes rose to 3.6 million — that’s 1.5 million more students using these products than the previous year. Additionally, more than a quarter (27.7 percent) of high school current e-cigarette users are using the product regularly (on 20 or more days in the past month). More than two-thirds (67.8 percent) are using flavored e-cigarettes. Both these numbers have risen significantly since 2017.

These increases must stop. And the bottom line is this: I will not allow a generation of children to become addicted to nicotine through e-cigarettes. We won’t let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build. We’ll take whatever action is necessary to stop these trends from continuing.

Over the past months, the FDA has worked aggressively to address youth use of e-cigarettes.

We deployed a range of our regulatory tools. We launched a multi-pronged Youth Tobacco Prevention Plan. We escalated enforcement against retailers who illegally sell ENDS products to minors. We partnered with the Federal Trade Commission to target e-liquid manufacturers whose products used misleading, kid-appealing imagery that mimicked juice boxes, lollipops and other foods. We worked with eBay to remove listings for these products on their websites. We launched innovative campaigns, including “The Real Cost” Youth E-Cigarette Prevention Campaign, to educate teens about the consequences of addiction to e-cigarettes.

teen smoking and vaping

Although we continue to believe that non-combustible tobacco products may provide an important opportunity to migrate adult smokers away from more harmful forms of nicotine delivery, these opportunities couldn’t come at the expense of addicting a generation of kids to nicotine. I told the manufacturers of e-cigarettes that the youth use of their products was an existential threat to this innovation. In short, over the past year we weren’t sitting still. And we weren’t quiet about our concerns. And yet these deeply disturbing trends continued to build.

In September, after receiving the raw data from the NYTS survey, I took additional action. I called on manufacturers to step up, to take voluntary actions to prevent youth access to these products and to take meaningful steps to curb their youth appeal. Some manufacturers have already responded to these requests and pledged to take some meaningful voluntary steps to curb youth access and appeal to their products. I also said that the FDA would be re-evaluating our own policy approach and that all options would be considered. Given the startling and disturbing youth use rates in the 2018 NYTS data being released today, it’s clear that we must do more – specifically, several policy changes to target what appear to be the central problems – youth appeal and youth access to flavored tobacco products.

Some of these changes would involve revisiting the FDA’s compliance policy, issued in 2017, which extended the dates by which manufacturers of deemed tobacco products that were on the market as of Aug. 8, 2016, were expected to submit premarket applications to the FDA for review (after receipt of an application, the FDA reviews the application and determines if the product meets the applicable statutory standard to be marketed). Under that policy of enforcement discretion, the premarket application compliance date for newly regulated combustible tobacco products, including certain cigars and pipe tobacco, was extended to August 2021. The premarket application compliance date for newly regulated non-combustible tobacco products was extended to August 2022. This applied to most ENDS or e-cigarettes.

Today, I’m directing the FDA’s Center for Tobacco Products (CTP) to revisit this compliance policy as it applies to deemed ENDS products that are flavored, including all flavors other than tobacco, mint and menthol. The changes I seek would protect kids by having all flavored ENDS products (other than tobacco, mint and menthol flavors or non-flavored products) sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification.

These changes will not include mint- and menthol-flavored ENDS. This reflects a careful balancing of public health considerations. Among all ENDS users, data suggests that mint- and menthol-flavored ENDS are more popular with adults than with kids. One nationally representative survey showed that, among ENDS users aged 12-17 years old, 20 percent used mint- and menthol-flavored ENDS while, among adult ENDS users, 41 percent used mint- and menthol-flavored ENDS. Any approach to mint- and menthol-flavored ENDS must acknowledge the possibility that the availability of these flavors in ENDS may be important to adult smokers seeking to transition away from cigarettes. Moreover, I recognize that combustible cigarettes are still sold in menthol flavor, including in convenience stores. I don’t want to create a situation where the combustible products have features that make them more attractive than the non-combustible products. Or a situation where those who currently use menthol-flavored cigarettes might find it less attractive to switch completely to an e-cigarette. This is a difficult compromise that I’m trying to strike, recognizing the public health risk posed by cigarettes still being available in menthol flavor.

But at the same time, I’m deeply concerned about the availability of menthol-flavored cigarettes. I believe these menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes. The menthol serves to mask some of the unattractive features of smoking that might otherwise discourage a child from smoking. Moreover, I believe that menthol products disproportionately and adversely affect underserved communities. And as a matter of public health, they exacerbate troubling disparities in health related to race and socioeconomic status that are a major concern of mine. Although I’m not proposing revisions to the compliance policy for the mint- and menthol flavors in e-cigarettes at this time, we need to address the impact that menthol in cigarettes has on the public health.

I’m also aware that there are potentially important distinctions even between mint- and menthol-flavored e-cigarette products. I’m particularly concerned about mint-flavored products, based on evidence showing its relative popularity, compared to menthol, among kids. So, I want to be clear that, in light of these concerns, if evidence shows that kids’ use of mint or menthol e-cigarettes isn’t declining, I’ll revisit this aspect of the current compliance policy.

In addition, I’m directing CTP to revisit the compliance policy for all flavored ENDS products (other than tobacco, mint and menthol flavors or non-flavored products) that are sold online without additional, heightened age-verification and other restrictions in place. As part of that effort, I’m directing CTP to publish additional information regarding best practices for online sales. My aim is to have these best practices available soon, so sites can quickly adopt them to help prevent youth access to these flavored products. Of course, no tobacco products, including non-flavored ENDS products or those with tobacco, mint and menthol flavors, should be sold to kids. For this reason we’ll continue to enforce the law whenever we see online sales of these products to minors and will closely monitor online sales of mint and menthol ENDS products.

If youth trends don’t move in the right direction, we will revisit all of these issues.

I hope I’ll soon see manufacturers of ENDS products preparing, with the FDA input as appropriate, premarket tobacco product applications (PMTAs) to demonstrate that their products meet the public health standard in the Tobacco Control Act. In the coming months, CTP plans to issue additional policies and procedures to further make sure that the process for reviewing these applications is efficient, science-based and transparent. We’ll also explore how to create a process to accelerate the development and review of products with features that can make it far less likely that kids can access an e-cigarette.

Other considerations of our policy framework would apply to traditional forms of combustible tobacco products.

I noted that the popularity of menthol cigarettes with youth is especially troubling. In fact, youth smokers are more likely to use menthol cigarettes than any other age group. More than half (54 percent) of youth smokers ages 12-17 use menthol cigarettes, compared to less than one-third of smokers ages 35 and older. Prevalence of menthol use is even higher among African-American youth, with data showing that seven out of 10 African-American youth smokers select menthol cigarettes.

And, unlike menthol-flavored ENDS, there’s no evidence to suggest that menthol-flavored cigarettes may play a role in harm reduction for adult smokers.

We will advance a Notice of Proposed Rulemaking that would seek to ban menthol in combustible tobacco products, including cigarettes and cigars, informed by the comments on our Advanced Notice of Proposed Rulemaking (ANPRM).

Finally, to ensure that we’re taking a comprehensive approach, we must evaluate our regulatory approach to flavored cigars. Flavors are added to cigars and other tobacco products for various reasons, such as reducing the harshness, bitterness and astringency of tobacco products during inhalation and to soothe irritation during use. Research shows that, compared to adults (25 or older) who smoke cigars, a higher proportion of youth who smoke cigars use flavored cigars.

These data also indicate that eliminating flavors from cigars would likely help prevent cigar initiation by young people. Accordingly, I am also outlining policy goals to address the presence of flavors in cigars – including those that were subject to the compliance policy for newly deemed products, and those that were “grandfathered.”

Specifically, I propose a policy through appropriate means to ban flavors in cigars.

The bottom line is that these efforts to address flavors and protect youth would dramatically impact the ability of American kids to access tobacco products that we know are both appealing and addicting. This policy framework reflects a re-doubling of the FDA’s efforts to protect kids from all nicotine-containing products. They also reflect a very careful public health balance that we’re trying to achieve. A balance between closing the on-ramp for kids to become addicted to nicotine through combustible and non-combustible products, while maintaining access to potentially less harmful forms of nicotine delivery through ENDS for adult smokers seeking to transition away from combustible tobacco products.

This policy framework is an important step toward reversing the epidemic that is underway and that is confirmed by the data from the NYTS. I could take more aggressive steps. I could propose eliminating any application enforcement discretion to any currently marketed ENDS product, which would result in the removal of ALL such products from the marketplace. At this time, I am not proposing this route, as I don’t want to foreclose opportunities for currently addicted adult smokers.

We’ve already seen some positive steps announced voluntarily by manufacturers. Responsible manufacturers certainly don’t need to wait for the FDA to finalize these policies to act. The FDA continues to take aggressive action to protect the public health, especially among kids at risk of nicotine addiction and tobacco use. As part of our Comprehensive Plan, in addition to issuing the ANPRMs to hear the public’s input on the role of flavors in tobacco products, and on cigars, we also issued an ANPRM on lowering nicotine in cigarettes.

We’ll continue to base our actions on the best available science. And when it comes to protecting our youth, we’ll continue to actively pursue a wide range of prevention and enforcement actions. We’ll leave no stone unturned. This is one of our highest priorities.

The tobacco marketplace has changed dramatically in the past year when it comes to youth use of ENDS. And the vision for public health achievements from reduced use of combustible products and reduced nicotine addiction is at risk.

But with implementation of the forceful and far-reaching actions that are outlined today, and with the commitment of tobacco manufacturers to take additional, voluntary actions to reduce youth access to their products, we can reverse these trends.

Here are additional details regarding the policy framework that I seek to advance:

  1. Flavored ENDS products that are not sold in an age-restricted, in-person location.
    • Have all flavored ENDS products (other than tobacco, mint and menthol flavors or non-flavored products) sold in age-restricted, in-person locations. All ENDS products, including e-liquids, cartridge-based systems and cigalikes, in flavors except tobacco, mint and menthol, would be included. For instance, the proposed policy would apply to flavors such as cherry, vanilla, crème, tropical, melon and others.
    • To advance this goal, the FDA is revisiting the compliance policy on PMTA authorization for such flavored products sold in physical locations where people under the age of 18 are permitted.
    • The FDA is not revisiting the compliance policy with respect to ENDS products sold exclusively in age-restricted locations – for instance, a stand-alone tobacco retailer (such as a vape shop) that adequately prevents persons under the age of 18 from entering the store at any time; or, a section of an establishment that adequately prevents entry of persons under the age of 18 and the flavored ENDS products are not visible or accessible to persons under the age of 18 at any time.
    • At this time, ENDS products with tobacco, mint or menthol flavors, as well as any non-flavored ENDS products, sold in any location, would not be included in any policy revisions. This distinction among flavors seeks to maintain access for adult users of these products, including adults who live in rural areas and may not have access to an age-restricted location, while evidence of their impacts continues to develop. It also recognizes that combustible cigarettes are currently available in menthol in retail locations that are not age-restricted. This approach is informed by the potential public health benefit for adult cigarette smokers who may use these ENDS products as part of a transition away from smoking.
    • The FDA, however, will not ignore data regarding the popularity of mint- and menthol-flavored ENDS among kids. We will continue to use all available surveillance resources to monitor the rates and use patterns among youth and adults for these products, and we will reconsider our policies with respect to these products, if appropriate.
  2. Flavored ENDS products (other than tobacco, mint and menthol flavors or non-flavored products) that are sold online.
    • In addition, we will seek to curtail the sale of applicable flavored ENDS products that are sold online without heightened age verification processes.
    • The FDA will be working to identify these heightened measures for age verification and other restrictions to prevent youth access via online sales. These best practices would be available soon, so sites can quickly adopt them.
    • Because no tobacco products should be sold to kids (including non-flavored ENDS products or those with tobacco, mint and menthol flavors), the FDA will continue to enforce the law whenever we see online sales of these products to minors and will closely monitor online sales of mint and menthol ENDS products.
  3. Flavored cigars.
    • Research shows that, compared to adults (25 or older) who smoke cigars, a higher proportion of youth who smoke cigars use flavored cigars. This data also indicates that eliminating flavors from cigars would likely help prevent cigar initiation by young people.
    • Given these public health concerns, I believe flavored cigars should no longer be subject to the extended compliance date for premarket authorization — regardless of the location in which the products are sold.
    • The FDA’s proposal to revisit the compliance policy for flavored cigars that are new tobacco products does not apply to the entire product category, as some products were considered “grandfathered.” Accordingly, the FDA intends to propose a product standard that would ban flavors in all cigars.
    • In July, the comment period for our ANPRM on flavors in tobacco products closed. The FDA has expedited review and analysis of these comments, and we intend to proceed with developing a proposed regulation. As included in the most recent Unified Agenda, the FDA intends to prioritize the issuance of this proposed rule.
  4. ENDS products that are marketed to kids.
    • The FDA will pursue the removal from the market of those ENDS products that are marketed to children and/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.
  5. Menthol in combustible tobacco products.
    • Informed by the comments from our ANPRM, the FDA will advance a Notice of Proposed Rulemaking that would seek to ban menthol in combustible tobacco products, including cigarettes and cigars.
    • The FDA started this process several years ago with an ANPRM. That ANPRM issued alongside the FDA’s preliminary scientific evaluation, which suggested menthol use is likely associated with increased smoking initiation by youth and young adults.
    • Now, armed with the additional years of data, comments from the public – and with the perspective of our Comprehensive Plan and its implementation – the FDA will accelerate the proposed rulemaking process to ensure that our policies on flavored tobacco products protect public health across the continuum of risk.

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.

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Juul Headquarters Raided By Regulators

Sales, Marketing Practices Scrutinized

By Jan Hoffman, New York Times

The Food and Drug Administration conducted a surprise inspection of the headquarters of the e-cigarette maker Juul Labs last Friday, carting away more than a thousand documents it said were related to the company’s sales and marketing practices.

The move, announced on Tuesday, was seen as an attempt to ratchet up pressure on the company, which controls 72 percent of the e-cigarette market in the United States and whose products have become popular in high schools. The F.D.A. said it was particularly interested in whether Juul deliberately targeted minors as consumers.

“The new and highly disturbing data we have on youth use demonstrates plainly that e-cigarettes are creating an epidemic of regular nicotine use among teens,” the F.D.A. said in a statement. “It is vital that we take action to understand and address the particular appeal of, and ease of access to, these products among kids.”

F.D.A. officials described the surprise inspection as a follow-up to a request the agency made for Juul’s research and marketing data in April. Kevin Burns, Juul’s chief executive officer, said the company had already handed over more than 50,000 pages of internal documents to the F.D.A. in response to that request.

“We want to be part of the solution in preventing underage use, and we believe it will take industry and regulators working together to restrict youth access,” he said.

In recent months, the F.D.A. has increasingly expressed alarm over the prevalence of vaping among youths in high school and even middle school, which its commissioner, Dr. Scott Gottlieb, said had reached “epidemic proportions.”

The number of high-school students who used e-cigarettes in the past 30 days has risen roughly 75 percent since last year to about three million, according to preliminary unpublished data, confirmed by the F.D.A. Dr. Gottlieb has repeatedly noted that the candy-like names and flavors of many vaping liquids seem intended to attract younger users.

teen smoking and vaping

A RAND Corporation study of 2,039 Californians from ages 16 to 20 beginning in 2015 through 2017, released Tuesday, offered new evidence for concern about teenage vaping. Published in the journal Nicotine and Tobacco Research, the report said that as teenagers who used e-cigarettes grew older, many began smoking traditional cigarettes, which are more dangerous, as well.

By the end of the study period, over half of e-cigarette users were also smoking cigarettes.

In another report released on Tuesday and published in the journal JAMA, the Centers for Disease Control and Prevention highlighted the dominance of Juul in the e-cigarette market. The C.D.C. noted that Juul Labs’ sales soared from 2.2 million devices in 2016 to 16.2 million devices last year. The C.D.C.’s figures only included those from retail stores, not the internet, which is also a major source of sales.

Other recent studies have also pointed out that teenagers are increasingly using vaping devices for marijuana consumption.

Many adult consumers of e-cigarettes say the devices have helped them move away from smoking traditional cigarettes, or quit entirely. But a growing number of teenagers who have never smoked are also turning to e-cigarettes, believing that they are relatively harmless products.

But though e-cigarettes do not have the carcinogens that come from burning tobacco, they, especially Juul, can have strong concentrations of nicotine, which is highly addictive, and detrimental to the developing adolescent brain.

In September the F.D.A. announced a flurry of fines and warning letters that it had sent to convenience stores for selling e-cigarettes to underaged customers. (It is illegal to sell the devices to anyone under 18.) The agency said it would also go after online sales, pointing out that bulk purchases were possible red-light indicators that a buyer might then resell devices to minors.

The agency has given Juul and four other e-cigarette manufacturers a 60-day deadline to produce plans showing how they will limit access to teenagers. Recently, it started its own multimillion-dollar campaign of posters for high school bathrooms and public service announcements on popular websites to warn teens of the dangers of vaping nicotine.

Read The Full Story About Juul and The FDA

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Tobacco Kills When Used As Intended

Tobacco Kills Millions Every Year

Tobacco is the only legal drug that kills many of its users when used exactly as intended by manufacturers. WHO has estimated that tobacco use (smoking and smokeless) is currently responsible for the death of about six million people across the world each year with many of these deaths occurring prematurely. This total includes about 600,000 people are also estimated to die from the effects of second-hand smoke. Although often associated with ill-health, disability and death from noncommunicable chronic diseases, tobacco smoking is also associated with an increased risk of death from communicable diseases.

Under a UN mandate to address four noncommunicable diseases (NCDs), the World Health Assembly established in 2013 a global voluntary tobacco target to help reduce prevent premature avoidable mortality from NCDs. The agreed global tobacco target is a 30 percent relative reduction in prevalence of current tobacco use in persons aged 15+ years.

smoking rates and trends global

The setting of this target not only provides a context for the development of policies and programs of actions to attain the target, it also provides an opportunity for policy makers to monitor progress towards achievement of the target over time.

To address the global burden of tobacco, the World Health Assembly in 2003 unanimously adopted the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). In force since 2005, the main objective of the WHO FCTC is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. Ratified by 180 Parties as at March 2015, the WHO FCTC currently covers about 90 percent of the world’s population. It is a legally binding treaty which commits Parties to the Convention to develop and implement a series of evidence-based tobacco control measures to regulate tobacco industry marketing activities and sales reach, reduce the demand for tobacco, and provide agricultural alternatives for those involved in growing and producing tobacco.

To assist countries to fulfil their WHO FCTC obligations, in 2008 WHO introduced a package of six evidence-based tobacco control demand reduction measures that are proven to reduce tobacco use. These measures known as the MPOWER package measures reflect one or more provisions of the WHO FCTC. MPOWER refers to M: Monitoring tobacco use and prevention policies; P: Protecting people from tobacco smoke; O: Offering help to quit tobacco use; W: Warning about the dangers of tobacco; E: Enforcing bans on tobacco advertising, promotion and sponsorship, and R: Raising taxes on tobacco.

The ability to monitor change in any indicator rests on the availability of data to measure the indicator adequately over time. The NCD tobacco target refers to tobacco use which includes both tobacco smoking and smokeless tobacco. The quality and quantity of data on tobacco smoking is enough to allow for an attempt to draw trends in tobacco smoking by country. Smokeless tobacco data, although improving rapidly, are still too scant to allow for derivation of meaningful underlying trends for many countries. For this reason, the work presented in this report focuses only on tobacco smoking.

After a careful analysis of data quality and completeness of data availability, WHO aims to undertake a similar exercise for smokeless tobacco, most likely only for a limited number of countries.

To generate the trends, WHO worked with a team of epidemiologists and biostatisticians from the University of Newcastle (Australia) and University of Tokyo to generate the underlying trend in tobacco smoking. The trend is based on fitting a Bayesian meta-regression using a negative binomial model. A full description of the method used has been published in The Lancet.

The data for the analysis were obtained from the following WHO databases: WHO FCTC Implementation Database, WHO Comprehensive Information Systems for Tobacco Control, WHO Infobase and from other sources.

The resulting trend lines are projections not predictions of future attainment. A projection indicates a likely endpoint if the country maintains its tobacco control efforts at the same level that it has implemented to date. Obviously the impact of recent interventions or new interventions that are undertaken as a result of the projection will most likely alter the expected endpoint. Countries like Ireland or Vietnam who have reported taking strong tobacco control measures will not capture the impact of their efforts until completing a new survey. The success or otherwise of these actions will only be reflected in the trends once the surveys are completed.

quit smoking campaign

This report contains country specific estimates for four indicators: current and daily tobacco smoking and current and daily cigarette smoking, for males and females for the years 2000, 2005, 2010, 2015, 2020 and 2025.

It also contains information on age-specific prevalence estimates by sex for current tobacco smoking for 2000, 2010 and 2025, as well a short history of recent surveys undertaken by the country. The report also provides an assessment of the next survey due for the country based on the WHO advice to undertake a survey at least once every five years (acknowledging that some countries undertake surveys on a more regular basis).

If the 194 WHO Member States collectively achieved a 30% reduction from the 2010 level of 22.1%, they would be expected to reach a prevalence level of 15.4% in 2025. At this stage, it is projected that the prevalence level in 2025 will be 18.9%, or 3.5 percentage points above the target. This would represent a 14% relative reduction overall.

Read the full report about tobacco consumption trends

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Countries That Smoke The Most Tobacco

European Nations Consume The Most Tobacco

By Oliver Smith, The Telegraph

To mark World No Tobacco Day, we’ve mapped the planet according to cigarette consumption.

As with alcohol consumption, Eastern European nations dominate – with a couple of exceptions. Andorra tops the table, compiled by Tobacco Atlas, with an estimated 6,398 legally-sold machine-made and roll-your-own cigarettes consumed per person per year. However, the country is a haven for duty-free shopping, which may well be skewing those figures. Next up is another of Europe’s littlest nations, Luxembourg.

lung cancer and smoking

Belarus, the country that consumes the most alcohol per capita, comes third, followed by Macedonia and Albania. Belgium, Czech Republic, Jordan, Russia and Syria complete the top 10.

The 20 countries that smoke the most

  1. Andorra
  2. Luxembourg
  3. Belarus
  4. Macedonia
  5. Albania
  6. Belgium
  7. Czech Republic
  8. Jordan
  9. Russia
  10. Syria
  11. Slovenia
  12. Greece
  13. Hungary
  14. China
  15. Lebanon
  16. Armenia
  17. Mongolia
  18. Cyprus
  19. Austria
  20. Georgia

Jordan, Syria and China are the most tobacco-dependent non-European countries. Few regular visitors to Greecewill be surprised to see it at 12th. Other popular summer holiday destinations not far from the smokers’ summit include Austria (19th), Turkey (24th) and Croatia (35th).

Britons, conversely, consume far fewer cigarettes – just 827.66 per adult per year – placing it 79th on the list. The US is slightly higher, at 68th.

Residents of Brunei should be proud of the fact that they smoke the least of all those countries to feature in the Tobacco Atlas list. India, Ecuador, Peru, Ghana, and Antigua and Barbuda are also near the bottom of the table.

smoke cigar and cancer

There also appears to be a clear relationship between wealth and tobacco consumption. Many of the world’s poorest countries can be found in the lower reaches of the rankings. Those with no data appear in grey on the map above. The data does not take into account tobacco sold illegally. 

The 20 countries that smoke the least

  1. Brunei
  2. Guinea-Bissau
  3. Mauritania
  4. Ghana
  5. Antigua and Barbuda
  6. India
  7. Swaziland
  8. Ecuador
  9. Rwanda
  10. Peru
  11. Guatemala
  12. Ethiopia
  13. Niger
  14. Zimbabwe
  15. Democratic Republic of Congo
  16. Eritrea
  17. Haiti
  18. Zambia
  19. Togo
  20. Dominica

Six facts about global smoking

  1. Globally, 942 million men and 175 million women ages 15 or older are current smokers.
  2. Tobacco kills more than half of those who regularly use it and has a two trillion-dollar economic cost to society each year.
  3. In many countries, farmers clear forested land that is agriculturally marginal to grow tobacco—often by burning —and/or harvest wood for curing. Typically, the land is quickly abandoned and becomes unusable, often leading to desertification.
  4. Three quarters of male daily smokers live in countries with medium or high-HDI (Human Development Index), whereas half of female daily smokers live in very high-HDI countries.
  5. The number of smokers is declining only in very-high HDI countries; in the rest of the world, the number of smokers is increasing.
  6. More than 6 million people per year die from tobacco use across the globe, and in 2016 alone, second hand smoke caused 884,000 deaths.

Read The Full Story About Tobacco Consumption By Country

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Lung Cancer Rising Among Younger Women

Lung Cancer Dropping Among Young Men

In a reversal of historical patterns, lung cancer is now more common among young U.S. women than men, a new study finds.

The good news, researchers found, is that over the past two decades, lung cancer rates among 35- to 54-year-old Americans have dropped across the board.

But the decline has been steeper among men so that now, incidence of the disease is higher in white and Hispanic women born since the mid-1960s.

advertising smoking

Among blacks and Asian-Americans, meanwhile, women have caught up with men, according to findings published in the May 24 issue of the New England Journal of Medicine.

The question now is why, said lead researcher Dr. Ahmedin Jemal of the American Cancer Society.

“The higher incidence among women is not fully explained by smoking,” he said.

About 85 percent of lung cancer cases in the United States are related to smoking, according to Jemal. So it’s logical to think that smoking habits would account for shifting patterns in lung cancer.

It’s true, Jemal said, that American women and men have become increasingly similar in their smoking rates. But men still typically smoke more cigarettes per day. And among Hispanic Americans, he said, smoking remains more common among men than women.

Jemal could only guess about why the lung cancer rate has fallen to a greater degree among men. One possibility, he said, is that female smokers who quit have a slower decrease in their lung cancer risk compared male smokers.

He noted that women and men tend to differ in the types of lung cancer they develop. A form called adenocarcinoma is more common in women — and the risk of that lung cancer typically dips at a slower rate among former smokers, compared with other forms of the disease.

smoking tobacco and mental illness

Some research has suggested women might be more biologically vulnerable to the damaging effects of cigarette smoke. But so far, Jemal said, studies have come to mixed conclusions.

Regardless of the explanation, he said, the message for smokers is clear: Quit as soon as you can.

“Smokers should know that those who quit — especially by age 40 — can largely avoid lung cancer,” Jemal said.

And while this study focused on younger adults, he added, it’s never too late to quit smoking. Even people who kick the habit at relatively older ages can lower their disease risks and add years to their life expectancy.

The findings are based on cases of invasive lung cancer diagnosed in Americans ages 30 to 54 between 1995 and 2014.

In general, the study found, the incidence of the disease dipped over time. But men saw a sharper decrease, so that the traditional male-female pattern flipped.

For example, among Americans born in the mid-1960s, the annual rate of lung cancer at the ages of 45 to 49 was about 25 cases for every 100,000 women. That compared with 23 cases for every 100,000 men.

The pattern was a turnaround from what was seen among Americans born around 1950. In that group, the rate of lung cancer among men in their late 40s was about one-quarter higher, compared with women.

“We don’t know why this change has taken place,” said Dr. Norman Edelman, senior scientific adviser for the American Lung Association, which was not involved in the study.

But it will be important to figure it out, according to Edelman. “Anything you can learn about lung cancer could eventually help us better treat or prevent the disease,” he said.

For smokers — or kids who are tempted to start — Edelman said this study highlights a crucial point: Lung cancer can arise at a young age.

“Sometimes young people are immune to messages about long-term health risks that will happen in their 60s,” he said. “If they know this can happen at age 40, that could be a very powerful message.”

Edelman also stressed that many smokers need five or more tries before they successfully quit. But, he said, help is out there, and smokers should keep trying until they find that tactic that works.

In general, Edelman said, a combination of medication and some form of support program is most effective.

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Electronic Cigarettes Targeting Kids

Juul Now A Public Health Threat

Introduced in 2015, Juul electronic cigarettes have quickly skyrocketed in popularity among teens and college students across the United States, according to widespread news reports. Educators and students report an alarming level of Juul use in middle and high schools, making this an urgent public health problem.

JUUL Labs produces the JUUL device and JUULpods, which are inserted into the JUUL device. In appearance, the JUUL device looks quite similar to a USB flash drive, and can in fact be charged in the USB port of a computer. According to JUUL Labs, all JUULpods contain flavorings and 0.7mL e-liquid with 5% nicotine by weight, which they claim to be the equivalent amount of nicotine as a pack of cigarettes, or 200 puffs. JUULpods come in five flavors: Cool Mint, Crème Brulee, Fruit Medley, Virginia Tobacco, Mango, as well as three additional limited edition flavors: Cool Cucumber, Classic Tobacco, and Classic Menthol. Other companies manufacture “JUUL-compatible” pods in additional flavors; for example, the website Eonsmoke sells JUUL-compatible pods in Blueberry, Silky Strawberry, Mango, Cool Mint, Watermelon, Tobacco, and Caffé Latte flavors. There are also companies that produce JUUL “wraps” or “skins,” decals that wrap around the JUUL device and allow JUUL users to customize their device with unique colors and patterns (and may be an appealing way for younger users to disguise their device).

According to data from Wells Fargo, JUUL’s popularity has grown dramatically in the last year, with unit sales increasing more than 600 percent in 2017. In mid-2016, dollar sales share for JUUL products was less than 5 percent, the lowest compared to products sold by the main companies in Nielsen-tracked channels. But by the end of 2017, JUUL sales had surpassed all other companies’ products (see adjacent graph). As a result, JUUL is now more popular than the e-cigarette brands manufactured by the major tobacco companies (blu, Vuse, and MarkTen).

More recently, JUUL has updated its marketing code with the purported goal of limiting youth exposure to its advertising. Its current marketing materials focus primarily on its popular flavors and on messaging that encourages smokers to “make the satisfying switch.”

teen smoking and vaping

E-cigarettes are a diverse group of products containing a heating element that produces an aerosol from a liquid that users can inhale via a mouthpiece, and include a range of devices such as “cig-a-likes,” vape tank systems, and vape mods.  Millions of Americans use e-cigarettes, and e-cigarette use is generally greatest among young adults and decreases with age.  Use varies substantially across demographic groups, including age, gender, race, and ethnicity.  For example, among youth and adults, use is typically greater among males than females.

Juul sales have grown dramatically and now make up more than half of the e-cigarette market. According to the most recent data from Wells Fargo, JUUL sales currently represent 68 percent of the market share. 

Several factors have contributed to Juul’s rising popularity with teens:

  • Juul e-cigarettes are sleek, high tech and easy to hide. They look just like USB flash drives and can be charged in the USB port of a computer. They don’t look like a traditional tobacco product. A Juul is small enough to fit in a closed hand;
  • Juul comes in sweet flavors that appeal to youth, including mango, fruit medley, crème brulee, cool mint and cool cucumber. Research has shown that flavors play a key role in youth use of tobacco products, including e-cigarettes; and
  • Juul appears to deliver nicotine more quickly, more effectively and at higher doses than other e-cigarettes, increasing users’ risk of addiction. The manufacturer claims each Juul cartridge of nicotine liquid (called a “Juul pod”) contains as much nicotine as a pack of cigarettes (about 200 puffs). However, research has found that many Juul users don’t know the product always contains nicotine, and many teens call use of the product “juuling,” indicating they may not realize it is an e-cigarette or tobacco product.

According to the National Youth Tobacco Survey, 11.7 percent of high school students and 3.3 percent of middle school students—over 2.1 million youth—were current e-cigarette users in 2017. However, a study from Truth Initiative found that a quarter of youth and young adult JUUL users don’t refer to JUUL use as “e-cigarette use” or “vaping,” but rather as “JUULing.” Therefore, it is possible that existing surveys may not be capturing the full spectrum of youth e-cigarette use. News articles, letters from school officials, and anecdotal evidence indicate that JUUL has gained popularity among youth and young adults across the country, from middle schools to college campuses. A 2018 study found that nearly one-fifth of youth (ages 12-17) surveyed reported having seen JUUL used in their school.

While smoking cigarettes among high school students has dropped, vaping nicotine continues to increase–in some states more than others. For example, according to the 2017 Healthy Kids Colorado Survey, only 7 percent of high school students currently smoke cigarettes, while 27 percent said they vape nicotine. The statewide school survey shows 87 percent of Colorado high school students think cigarette smoking is risky, but only 50 percent think those risks apply to vaping nicotine.

teen vaping

The availability of flavors may also contribute to JUUL’s popularity among youth. A national survey found that that 81 percent of youth aged 12-17 who had ever used e-cigarettes had used a flavored e-cigarette the first time they tried the product, and that 85.3 percent of current youth e-cigarette users had used a flavored e-cigarette in the past month. Moreover, 81.5 percent of current youth e-cigarette users said they used e-cigarettes “because they come in flavors I like.”

The number of youth using e-cigarettes, including JUUL, is alarming and raises serious concerns that E-cigarettes could be an entryway to nicotine addiction and use of regular cigarettes for some kids. Though there is insufficient research on the long-term effects of using e-cigarettes in general, and certainly not specific to JUUL, the use of such products still raises concerns because they contain nicotine. The company claims that the nicotine in JUUL is from “nicotine salts found in leaf tobacco, rather than freebase nicotine,” which they claim “accommodate cigarette-like strength nicotine levels.” 12 The health impact of that specific form of nicotine is yet unknown.

Juul is putting kids at risk of nicotine addiction and threatens to undermine decades of progress in reducing youth tobacco use:

The alarming increase in youth use of Juul requires strong and immediate action by the Food and Drug Administration to protect kids. The FDA is responsible for regulating tobacco products, including e-cigarettes, and the FDA must take action to address the skyrocketing youth use of Juul.

A congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine takes a comprehensive look at evidence on the human health effects of e-cigarettes. Although the research base is limited given the relatively short time e-cigarettes have been used, the committee that conducted the study identified and examined over 800 peer-reviewed scientific studies, reaching dozens of conclusions about a range of health impacts.

Whether e-cigarettes have an overall positive or negative impact on public health is currently unknown, the report says. More and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed to answer that question with clarity.

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

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Tobacco-Free Kids Campaign Celebrates 20 Years

Tobacco Addiction A Key Marketing Strategy

Tobacco use is the world’s leading cause of preventable death, according to the World Health Organization. Increasingly, the burden of tobacco use is greatest in low- and middle-income countries that have been targeted by the tobacco industry with its deadly products and deceptive marketing practices. The result: A global tobacco epidemic of preventable death, disease and economic harm to countries and families.

smoking cigar and cancer

 

  • There are more than one billion smokers in the world.
  • Globally, 21% of adults are current smokers (men 35%; women 6%).
  • More than 80% of the world’s smokers live in low- and middle-income countries.
    • 29% of men in high-income countries, 37% in middle-income countries, and 24% of men in low-income countries are smokers.
    • 18% of women in high-income countries, 4% in middle-income, and 3% of women in low- income countries smoke.
  • Globally, the number of youth aged 13-15 years who smoke cigarettes is estimated to be around 25 million, with almost 13 million using smokeless tobacco products.2
  • Cigarette smoking and use of other tobacco products is increasing in many low- and middle-income countries due to population growth and tobacco industry marketing.

teen smoking statistics

 

The Campaign for Tobacco-Free Kids has fought to protect children and save lives from the top cause of preventable death: tobacco use. Our vision is a future free of the death and disease caused by tobacco. Tobacco has killed enough.

We are the leading advocacy organization working to reduce tobacco use and its deadly consequences in the United States and around the world. Through strategic communications and policy advocacy campaigns, we promote the adoption of proven solutions that are most effective at reducing tobacco use and save the most lives.

We are passionate and experienced public health advocates with a more than 20-year track record of leading and supporting successful policy advocacy campaigns:

  • In the United States, we work at the national, state and local levels.
  • Around the world, we are active in low- and middle-income countries facing the greatest threat from tobacco.
  • In addition to our work fighting tobacco use, our Global Health Advocacy Incubator applies our broad range of advocacy experience to supporting organizations working to address other critical public health challenges.

teen vaping

We’re making progress against tobacco

  • In the U.S., our work has helped drive smoking rates to record lows.
  • Around the world, we’re helping to turn the tide of a global tobacco epidemic that would otherwise kill one billion people this century.

The battle against tobacco is far from over

  • Tobacco still kills nearly half a million Americans and more than 7 million people worldwide each year.
  • The tobacco industry relentlessly peddles its deadly products, targeting kids and other vulnerable populations.

Our remarkable progress shows that we can win the fight against tobacco. The Campaign for Tobacco-Free Kids is unyielding in our resolve and committed to finishing the job.

Since 1996, the campaign has contributed to:

  • 70% decrease in youth smoking
  • 39% decrease in adult smoking
  • 185 million Americans protected from secondhand smoke
  • Millions of lives saved by reducing cancer, heart disease and other tobacco-related conditions

As part of the Bloomberg Initiative to Reduce Tobacco Use, we have helped:

  • Pass new tobacco control laws in 59 countries since 2007
  • Save 30 million lives in low- and middle-income countries
  • Reverse the steep growth in cigarette sales worldwide
lung cancer and smoking tobacco

TOBACCO IS STILL THE #1 CAUSE OF PREVENTABLE DEATH AND IS RESPONSIBLE FOR ONE IN TEN DEATHS AROUND THE WORLD.

  • 100 million people died from tobacco use in the 20th century. If current trends continue one billion people will die from tobacco use in the 21st century.
  • Tobacco use kills up to half of all lifetime users. On average, smokers lose 15 years of life.
  • Tobacco kills more than 7 million people each year. By 2030, the number of tobacco-related deaths will increase to 8 million each year.
  • Smoking is estimated to cause about 1.4 trillion USD in economic damage each year.
  • Health care costs associated with tobacco-related illnesses are extremely high. Economic costs associated with smoking represent 1.8% of global GDP, and smoking-attributable health expenditure represents 5.7% of total health spending.
    • In the United States, annual tobacco-related health care costs amount to 170 billion USD; in China, 28.9 billion; in Vietnam, 0.6 billion USD; in Brazil, 5.8 billion USD.9
  • Tobacco-related illnesses and premature mortality impose high productivity costs to the economy because of sick workers and those who die prematurely during their working years. Lost economic opportunities in highly-populated low- and middle-income countries will be particularly severe as tobacco use is high and growing in those areas.
    • Global indirect costs of smoking are estimated to be about 1 trillion USD, nearly two thirds of which are due to premature mortality.
    • In Ukraine, the productivity loss due to premature smoking-related mortality is at least 3 billion USD annually.
  • Tobacco production damages the environment:
    • Tobacco plants are especially vulnerable to many pests and diseases, prompting farmers to apply large quantities of chemicals and pesticides that harm human health and the environment.
    • Clearing of land for cultivation and large amounts of wood needed for curing tobacco cause massive deforestation at a rate of about 200,000 hectares per year.
  • Tobacco kills over 480,000 people in the U.S. and over 7 million worldwide each year.
  • 5.6 million kids alive today in the U.S. will ultimately die from smoking — unless we act now to prevent it.
  • In the U.S. alone, tobacco companies spend $9.1 billion a year — $1 million every hour — to market their deadly products.

COST-EFFECTIVE SOLUTIONS CAN REDUCE TOBACCO USE AND SAVE LIVES.

  • Raise the price of tobacco products;
  • Make all workplaces and public places smoke-free;
  • Require graphic health warnings on tobacco products;
  • Conduct tough anti-smoking ad campaigns;
  • Invest in programs that prevent kids from smoking and help smokers quit;
  • Raise the tobacco sale age to 21; and
  • End the tobacco industry’s harmful manufacturing and marketing practices.
 Read More About Tobacco-Free Kids
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Studies Linking Vaping To Health Impacts

Vaping Helps Adults Quit Nicotine, While Helping Kids Start Habit

By Erin Brodwin, Business Insider

Smoking kills. No other habit has been so strongly tied to death.

In addition to inhaling burned tobacco and tar, smokers breathe in toxic metals like cadmium and beryllium, as well as metallic elements like nickel and chromium — all of which accumulate naturally in the leaves of the tobacco plant.

It’s no surprise, then, that much of the available evidence suggests that vaping, which involves puffing on vaporized liquid nicotine instead of inhaling burned tobacco, is at least somewhat healthier. Reaching for a vape pen instead of a conventional cigarette might also be helpful for quitting smoking, though the evidence is somewhat limited.

teen smoking and vaping

We don’t have a ton of research on how vaping affects the body and brain. But a handful of studies published this year have begun to illuminate some of the potential health effects of e-cigs.

Vaping is linked with twice the risk of a heart attack, while smoking is linked with triple the risk.

One of the most worrisome outcomes of that research is a study linking daily vaping to a significantly higher risk of heart attacks.

It is the very first study to show a long-term health impact of e-cigarettes.

The analysis, presented on Saturday at the annual meeting of the nonprofit Society for Research on Nicotine and Tobacco, suggests that people who vape every day may double their risk of having a heart attack compared with people who do not vape or smoke. In comparison, daily cigarette smoking potentially triples the risk.

But the people most at risk are “dual users,” or people who use both devices, according toStanton Glantz, the lead author on the presentation and a professor of medicine at the University of California, San Francisco as well as its director of the Center for Tobacco Control Research and Education. People who smoked and vaped every day faced five times the risk of a heart attack as those who took up neither habit, Glantz told Business Insider.

Dual users make up a significant proportion of overall vapers, Glantz said.

“E-cigarettes are widely promoted as a smoking cessation aid but for some, they actually make it harder to quit, so most people end up doing both,” Glantz said. “This is the dominant use.”

lung cancer and smoking tobacco

Still, the study has a number of limitations, most notably the fact that it could not conclude that vaping (or even smoking, for that matter) caused heart attacks — only that the two were linked. Also, only the study’s abstract has been peer-reviewed; the full paper is still awaiting publication. Glantz said one of the reasons they decided to make the abstract public was to get the word out about the findings as soon as possible.

“We’re the first people to show a long term impact of e-cigarettes, and given that it’s consistent with what we know biologically about how vaping affects the heart, we wanted to get this out there,” Glantz said.

To arrive at his findings, Glantz looked at national survey data on 70,000 Americans which asked people about their use of e-cigarettes and regular cigarettes. It also asked if they’d ever suffered a heart attack. After controlling for factors that could muddle their results, like hypertension, the researchers found that people who vaped every day were twice as likely to have suffered a heart attack compared with people who didn’t vape or smoke at all. Daily smokers were three times as likely as non-smokers to have suffered a heart attack.

Other studies in animals and cells have suggested that vaping could stiffen the heart and blood vessels, potentially creating an increased risk of heart disease and heart attacks, but this was the first to line up those limited findings with actual health impacts in humans.

The study isn’t the first to suggest that e-cigarettes may come with some important risks.

Some of the same toxic metals that can be found in cigarettes are also found in e-cigs.

In 2015, a group of researchers from medical schools across the globe decided to find out just what was inside the vapors that e-cig users were inhaling.

After recruiting 56 daily e-cig users in Baltimore and testing their devices in a lab at the Bloomberg School of Public Health, researchers found that, trapped deep in the aerosol particles that vapers breathe, lurk some of the same toxic metals and metallic elements found in conventional cigarettes, including cadmium and nickel.

They also found unsafe levels of several other dangerous substances such as arsenic, chromium, and manganese. They published their findings earlier this week in the journal Environmental Health Perspectives.

“These heating coils, as currently made, seem to be leaking toxic metals — which then get into the aerosols that vapers inhale,” Ana Maria Rule, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health who led the study, said in a statement.

Despite these findings, it remains unclear what inhaling these levels of substances does. Still, consistently inhaling high levels of these metals has been tied to health problems in the lungs, liver, immune system, heart, and brain, as well as some cancers, according to the US Department of Labor’s Occupational Health and Safety Administration.

“We’ve established with this study that there are exposures to these metals, which is the first step, but we need also to determine the actual health effects,” Rule said.

The largest report on the health effects of vaping found that e-cigs could help adults quit smoking — but may encourage teens to start.

A large recent report on the health effects of vaping from the National Academies of Sciences, Engineering, and Medicine found that e-cigarettes may be helpful for adults looking to quit smoking. One of the reasons may be that vaping not only exposes people to fewer of the cancer-causing substances in conventional cigarettes but may also be less addictive.

But while adults sometimes use e-cigs as a tool to quit smoking, young people may end up using them to start, the authors of the newest report concluded.

As a result, “e-cigarettes cannot be simply categorized as either beneficial or harmful,”David Eaton, a vice provost at the University of Washington at Seattle who led the committee that wrote the report, said in a statement.

Eaton said that in certain circumstances, such as when teens use them and become addicted to nicotine, e-cigarettes “adverse effects clearly warrant concern.” But in other cases, like when adults turn to e-cigs to quit smoking, “they offer an opportunity to reduce smoking-related illness.”

Read The Full Story About The Health Effects Of Vaping

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Vaping Contributing To Smoking, Addiction Among Teens

Report Fails To Call Vaping Safe

By Sheila Kaplan, New York Times

A national panel of public health experts concluded in a report released on Tuesday that vaping with e-cigarettes that contain nicotine can be addictive and that teenagers who use the devices may be put at higher risk of switching to traditional smoking.

Whether teenage use of e-cigarettes may lead to conventional smoking has been intensely debated in the United States and elsewhere. While the industry argues that vaping is not a stepping stone to conventional cigarettes or addiction, some anti-smoking advocates contend that young people become hooked on nicotine, and are enticed to cancer-causing tobacco-based cigarettes over time.

The new report by the National Academies of Sciences, Engineering and Medicine is the most comprehensive analysis of existing research on e-cigarettes. It concluded the devices are safer than traditional smoking products and that they do help smokers quit, citing conclusive proof that switching can reduce smokers’ exposure to deadly tar, numerous dangerous chemicals and other carcinogens.

teen smoking e-cigarette

But it stopped short of declaring e-cigarettes as safe, noting that there are no long-term scientific studies of the devices’ addictive potential or their effects on the heart, lungs or on reproduction.

The panel found evidence among studies it reviewed that vaping may prompt teenagers or young adults to try regular cigarettes, putting them at higher risk for addiction, but that any significant linkage between e-cigarettes and long-term smoking has not been established. It said it was unable to determine whether young people were just trying cigarettes or becoming habitual smokers.

“When it got down to answering the questions about what the impacts on health are, there is still a lot to be learned,” said David Eaton, of the University of Washington, who led the committee that reviewed existing research and issued the report. “E-cigarettes cannot be simply categorized as either beneficial or harmful.”

The report was commissioned in 2016, after the F.D.A. gained the authority to regulate tobacco products that had previously been outside its jurisdiction, such as e-cigarettes, cigars and other goods.

Mitch Zeller, head of the agency’s tobacco division, said the committee was assigned to assess the existing science, and to point out where research gaps suggest more study was needed. The report will aid the agency in its review of applications for lower-risk tobacco products and the potential harm or benefits those pose to individuals and the public.

On Wednesday, an F.D.A. advisory panel will review an application from Philip Morris International for iQOS, an electronic device that unlike e-cigarettes, contains tobacco in a stick that the company says heats it but does not burn it. It releases nicotine vapor the company says is less hazardous than smoke. If approved, it would be the first company allowed by the government to claim its product is less harmful than cigarettes.

lung cancer and smoking tobacco

Also this week, on Friday, the agency’s new nicotine steering committee will hold a public hearing on over-the-counter therapeutic products, among them gums, patches and lozenges, designed to help smokers quit.

Cessation was one area where the committee’s report did give the booming e-cigarette industry some good news. It pointed out the benefits for smokers of tobacco-based cigarettes who are trying to quit. and. But people who continue to smoke cigarettes, alternating with e-cigarettes, do not gain the same health benefits, the committee said. That’s especially important given that most adults who vape also still smoke or use other tobacco products.

While there is no evidence at this time that e-cigarettes or their components cause cancer, the committee recommended more long-term research. Some e-cigarettes do contain chemicals and metals whose long-term effects — including on pregnancy — also require additional research, the committee said.

Smoking rates among adults and teenagers have declined significantly over the last few decades. In 2015, the last year for which the Centers for Disease Control and Prevention has statistics, about 37 million Americans, 15 percent of adults aged 18 and older, smoked cigarettes. The number has declined from nearly 21 percent of every 100 adults in 2005; and 42 percent in 1965.

healthcare costs and smoking

With that decline, the e-cigarette industry has emerged as a potential substitute and Big Tobacco has been among the device developers enjoying new profits from the tobacco alternatives. Bonnie Herzog, a well-known Wells Fargo tobacco analyst, predicted the industry will grow about 15 percent to $5.1 billion in retail sales in the United States, in 2018. Of that, she noted that $1.6 billion will be spent on the pre-filled cartridges sold mostly by the big tobacco companies, and $3.5 billion on open vapor systems; the liquid refill products, most of which are sold at vape shops.

The vaping industry, as well as traditional tobacco companies, are also gearing up for a lengthy fight with the F.D.A. over the campaign by the agency’s commissioner, Dr. Scott Gottlieb, to slash levels of nicotine in traditional cigarettes to nonaddictive or minimally addictive levels.

Dr. Gottlieb is expected to issue an initial proposal, calling for public comment on lower nicotine levels, in the near future.

The new report reflects the complexity of the issues surrounding e-cigarettes and the balancing act tobacco regulators face over the pros and cons of the many alternatives to conventional cigarettes. The notion of e-cigarettes as a gateway to conventional cigarettes for youths has been a sticking point.

Adam Leventhal, a professor of preventive medicine at the University of Southern California, and an author of the report, said his group did an exhaustive literature search, reviewing all studies on youths and e-cigarette use from around the world. Of those, they found 10 studies that they deemed strong enough to address the question. But these studies did not show that using e-cigarettes caused teens to move on to tobacco, only that the use of e-cigarettes was associated with later smoking of at least one traditional cigarette. The report noted that more than 11 percent of all high school students had used e-cigarettes within the past month, a total of nearly 1.7 million youths.

“The evidence was substantial that this association was consistent across a number of research methodologies, age ranges, locations, and research groups in and outside the U.S.,” Mr. Leventhal said.

More intriguing was the report’s finding of moderate evidence that youths who use e-cigarettes before trying tobacco, are more likely to become more frequent and intense smokers.

Critics have long contended that the flavored liquids for the devices are luring adolescents to the habit, at a time when nicotine is especially hazardous for their brain development. Three of the top-selling flavors at e-liquid.com, a large online retailer, include “Unicorn Milk” (strawberries and cream), “TNT” (strawberry, apple and peach) and “I Love Donuts” (blueberries and pastry).

The authors of the new report cite conclusive evidence that vaping can be addictive, and that exposure to nicotine from e-cigarettes is highly variable, depends on the characteristics of the device, as well as how it is used. They also cited conclusive proof that in addition to nicotine, most e-cigarettes also contain and emit numerous potentially toxic substances.

In terms of second hand vapor, the committee said there was conclusive evidence that e-cigarette use increases airborne concentrations of particulate matter and nicotine indoors.

The report concluded that much of the current research on e-cigarettes is lacking by scientific standards and that many important areas have not yet been studied. Dr. Eaton, in an interview, said that the authors did not distinguish between industry-funded, and independent research.

Many of the existing studies were also flawed, either in methodology or because of industry-financed bias. In addition, the levels of nicotine and other chemicals, including metals, vary in e-cigarettes from brand to brand, which has complicated some research findings.

Mr. Zeller praised the report and stressed its strong findings that youths who start on e-cigarettes are more likely to become heavier users of tobacco.

“And for kids who initiate on e-cigarettes, there’s a great chance of intensive use of cigarettes. As the regulator, we’ve got to factor all that in,” Mr. Zeller said.

In July, the F.D.A. delayed the deadline at least four years for e-cigarette companies to submit applications for currently marketed products to demonstrate that their public health benefit warrants agency approval. The agency did not delay other aspects of its tobacco control work, including requirements for mandatory age and photo-ID checks to prevent illegal sales to minors and the banning of free samples.

Public health advocates who objected to the July delay, said this report gave them further concern.

“What the report demonstrates is that despite the popularity of e-cigarettes, little is known about their overall health effects, and there is wide variability from product to product,” said Matthew L. Myers, President of Campaign for Tobacco-Free Kids. “That makes the case even stronger for F.D.A. regulation. This report makes very real the concern that e-cigarettes may well increase the use of combustive tobacco products.’’

The vaping industry was cautiously optimistic about the influence of the report. Gregory Conley, president of the American Vaping Association, a nonprofit that advocates for vapor products, said it was good news. He said the findings were consistent with those reached by the Royal College of Physicians and other institutions in Britain that have issued reports indicating e-cigarettes are less dangerous than traditional smoking and help with cessation.

“The committee’s findings also fall in line with F.D.A. Director Scott Gottlieb’s nicotine strategy, a key element of which involves adult smokers switching to lower risk products,” he said. “In the wake of this report, it is more apparent than ever that true leadership is needed in public health to ensure that adult smokers have access to truthful information about the benefits of switching to smoke-free products.”

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