Quitting Rates are Up, Electronic Cigarettes May be Helping

As reported by KQED:

Electronic cigarettes may be a helpful tool for those who are looking to quit smoking, according to a recent study. This complicates the public health narrative around this new tobacco product, which have grown in popularity in the U.S. over the past decade.

E-cigarettes are relatively new to the market, and their rapid popularity has caused public health agencies to grapple to create regulations and messaging around a technology with unclear health implications. This study, published in the journal BMJ, puts some weight behind the idea the e-cigarettes can have a positive health impact on those who are trying to kick cigarettes.

The e-cigarette uses a coil to heat a nicotine solution so it can be inhaled as vapor. This process can allow users to get their nicotine fix while leaving behind the carcinogens associated with breathing in smoke. Trading in a regular cigarette for an electronic option could have significant health implications considering smoking cigarettes remains the leading cause of preventable death in the U.S. …

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New Bay Area tobacco bans include non-tobacco products

VapingRestrictive new anti-tobacco ordinances are spreading across the San Francisco Bay Area like a cigarette-sparked wildfire. Northern California cities already have some of the toughest anti-smoking laws in the nation, but a raft of new laws and proposals take aim at “flavored” tobacco products such as menthol cigarettes and fruity mini-cigars.

Health officials argue that these flavored products are particularly appealing to teens, and that their bans are designed to keep young people from picking up an unquestionably dangerous habit. They also argue that the purveyors of menthol cigarettes, for example, target minority communities, and lead to ongoing health problems there.

The ordinances, however, share one trait that has advocates for tobacco “harm reduction” concerned. They make no distinction between combustible tobacco products – i.e., cigarettes, cigarillos, pipe tobacco and cigars – and smokeless products such as e-cigarettes and snus (Swedish-style spit-less tobacco that one places on one’s upper lip).

Tobacco “harm reduction” is a public health strategy designed to reduce the harmful effects of cigarette smoking by encouraging smokers to switch to far-less dangerous – not safe, but less dangerous – types of tobacco-related products. For instance, Public Health England, the United Kingdom’s main public-health agency, argues that vaping is 95 percent safer than cigarette smoking and therefore is a potentially beneficial alternative to smoking.

“About 40 percent of former and current adult smokers predict that removing their ability to choose flavors would make them less likely to remain abstinent or attempt to quit,” wrote Carrie Wade, the R Street Institute’s director of harm-reduction policy, in a recent Washington Examiner column. “While the vast majority of quit attempts are of the ‘cold turkey’ variety, e-cigarettes beat out both nicotine replacement therapies like the patch or nicotine gum and prescribed drugs like Chantix and Zyban.”

Vape liquids are not actually tobacco but mostly contain nicotine. They almost always are flavored. Many adult e-cigarette users prefer vaping with flavored liquids than vaping with those that have a tobacco flavor. These local bans on flavors, by the way, follow a recent statewide law that taxes vaping liquids at the same rate as cigarettes. The California Board of Equalization is currently working out the details of that taxation edict.

Wade described the essence of tobacco harm-reduction policy: make it easier for smokers to switch to smoking alternatives that cause fewer health-related problems. It might be ideal, health-wise if every smoker simply went “cold turkey,” but that’s not likely to happen, so harm-reduction advocates see vaping as a reasonable alternative. They see efforts to limit access to liquids and to boost taxes on them as policies that work against this harm-reduction approach.

Even California’s official Tobacco Education and Research Oversight Committee explained, in a public meeting earlier this year, that insufficient numbers of smokers participate in medically approved nicotine-replacement therapies. The committee, however, made no effort to distinguish between degrees of harm, and one member depicted vaping as just another form of smoking. In Bay Area cities and elsewhere, public-health officials argue that vaping is still dangerous – and they argue (despite contrary evidence) that it serves as a gateway for teens to actual smoking.

As a result of the new rules, it will become increasingly difficult for nicotine-addicted northern Californians to purchase and use vaping products. That’s particularly true as neighboring counties and cities embrace similar bans. Supporters of these bans admit that it is one of their goals to have such ordinances spread from one community to another, thus making it more difficult for people to simply go to a neighboring city to grab some vape juice.

Some proposals have become law, such as one in the Marin County city of Novato. Others are under consideration. The Contra Costa County Board of Supervisors is now considering a ban after one of its committees recently approved a new proposal. Likewise, officials in San Francisco and Oakland have also introduced flavor bans.

San Francisco Supervisor Malia Cohen’s public statements focus on the sale of mentholated tobacco products. She explains that 80 percent of African-American smokers use menthol products. Nevertheless, her proposal includes all flavored tobacco, which includes vaping liquids. Oakland Councilmember Annie Campbell Washington, who led a 2016 campaign to increase soda taxes in the city, has introduced a similar measure that includes vapor products in the flavoring ban.

Novato’s ordinance, which goes into effect January 2018, requires that all residential leases in the city include a clause calling it a “material breach of the agreement for tenant or any other person subject to the control of the tenant … to violate any law regulating smoking while anywhere on the property.” In other words, tenants can be evicted from their apartments not only if caught smoking – but if they or their guests are caught vaping.

The Contra Costa County health department justifies its proposal by stating that e-cigarettes contain nicotine, which is addictive, and includes various chemicals known to cause cancer and lung problems. But harm-reduction advocates don’t claim that vaping is totally safe, only that it is far safer than cigarette smoking.

Given the political bent of Bay Area cities and counties, it seems likely that most if not all of these proposals will eventually become law. The question remains whether in their zeal to improve the public’s health, these officials are embracing policies that will make actual smoking-related health improvements that much harder to attain.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

This piece was originally published by CalWatchdog.com

Should CA Tax E-Cigarettes the Same as the Real Thing?

e-cigaretteThe claims that e-cigarettes are just as much of a health hazard as regular cigarettes and must be heavily taxed has touched off a fight in the public health community. A faction of public health officials has sided with e-cigarette companies and their assertion that e-cigarettes are much less dangerous than cigarettes and can in fact help people break the smoking habit.

The issue is coming to the fore in California because of voters’ passage of Proposition 56 last month. It will increase the state tax on a pack of cigarettes from 87 cents to $2.87 and mandates an “equivalent” increase in taxes on e-cigarettes, which allow users to heat nicotine fluid and inhale nicotine vapor without the tars they ingest when smoking regular cigarettes.

It’s not clear yet what “equivalent” means. State officials are still formulating the levies. But the Associated Press reports e-cigarette makers and distributors believe they will face a huge increase in state taxes that will raise the cost of vaping devices and liquids by more than 60 percent. If that happens, according to the American Vaping Association, it will be cheaper to smoke regular, more dangerous cigarettes in California than to “vape” — even though state taxes on regular cigarettes are going far higher as well.

In the United States, public health authorities, medical doctors and academics are broadly split on e-cigarettes. Some believe that e-cigarettes are so much less harmful that their use by conventional smokers should be encouraged. Some argue that there isn’t nearly enough hard research with which to draw conclusions about the relative healthiness of vaping. And some argue that e-cigarettes’ popularity threatens to undo the huge progress that has been made in reducing nicotine consumption in America over the last 50 years and should be heavily taxed and regulated for that reason alone.

Britain sees vaping as public health tool

These divided views aren’t the norm elsewhere. In California, state health officials issued a 2015 report blasting the emergence of vaping as a common habit, especially among the young. This report may be a factor in state officials’ consideration of heavy taxes for e-cigarettes.

Conversely, in the United Kingdom, physicians have been recommending that vaping be used by cigarette smokers because a massive government study found it is 95 percent healthier and has been a valuable tool for individuals trying to break their conventional smoking habits. These conclusions were released in a 2015 report by Public Health England.

Given that millions of Americans have died of lung cancer caused by smoking cigarettes, this would seem to make the case for vaping’s utility in fighting regular smoking. But many authorities are unpersuaded. Perhaps the most prominent critic of the notion of vaping as a public health tool is Stanton Glantz, a professor of tobacco control at the University of California, San Francisco.

In a 2015 interview with Rolling Stone magazine, Glantz dismissed claims about vaping’s promise with a profanity. He acknowledges that e-cigarettes are healthier than regular cigarettes but sharply questions the British research. “I’ll eat my shoe if that 95 percent figure turns out to be correct five years from now,” he told the magazine.

Glantz says the big picture must not be ignored: “Are there people who have totally made the switch or quit completely because of these? Yes, I believe there are. Terrific. But most are what we call dual users — those who smoke both, often to smoke in places where they can no longer smoke cigarettes. If you’re talking about a smoker using these to inhale more dangerous chemicals, well, that has a net negative effect on public health.”

Proposition 56 takes effect on April 1. It is unclear if state officials will issue a draft proposal on how to tax e-cigarettes and seek public comment or decide rates without such input. The text of the 24-page ballot measure is silent on how the rules should be crafted.

This article was originally published by CalWatchdog.com

High-Visibility Tobacco Tax Initiative Receiving Lots of Attention, Money

SmokingSACRAMENTO – There’s broad agreement that the 17 initiatives on the statewide ballot on November 8 cover some of the most significant public-policy issues to come before voters in more than a decade. For instance, voters will have a chance to legalize marijuana, outlaw the death penalty, put an end to the state’s virtual ban on bilingual education, approve a broad gun-control package and reduce prison sentences for some non-violent felons.

But two months before the election, one of the highest-visibility measures also is fairly narrow in scope. Proposition 56 would raise California’s relatively low tobacco tax (relative to other states) by $2 a cigarette pack – and increase taxes by an equivalent amount on all other tobacco products (cigars, chewing tobacco, etc.). It also would significantly increase taxes on electronic cigarettes and vaping products. It has high visibility right now because of a series of advertisements opponents are running on radio stations across the state.

Supporters pitch the measure as a means primarily to boost public health. “An increase in the tobacco tax is an appropriate way to decrease tobacco use and mitigate the costs of health care treatment and improve existing programs providing for quality health care and access to health care services for families and children. It will save lives and save state and local government money in the future,” according to the initiative’s findings.

Gov. Jerry Brown recently signed into law a package of anti-tobacco bills that, among other things, raise the smoking age to 21. Studies of addiction show that teens who begin smoking are more likely to continue this dangerous habit throughout their lives. Backers of this initiative argue that raising the prices of cigarettes is another main way to dissuade people from smoking. And they point to the costs to the health system imposed by smokers.

But the measure’s opponents are focused increasingly on the spending aspects of the proposal. According to the official ballot argument against the measure, “Prop. 56 allocates just 13 percent of new tobacco tax money to treat smokers or stop kids from starting. If we are going to tax smokers another $1.4 billion per year, more should be dedicated to treating them and keeping kids from starting. Instead, most of the $1.4 billion in new taxes goes to health insurance companies and other wealthy special interests, instead of where it is needed.”

An analysis by the non-partisan Legislative Analyst’s Office confirms that only a small percentage of the estimated $1.4 billion in new revenues are earmarked to such programs. The main priority of the new funds, based on the LAO analysis, is to “replace revenues lost due to lower consumption resulting from the excise tax increase.” That reinforces the odd conundrum faced by California and other states. They use tax and regulatory policies to promote public health by reducing smoking, but then struggle to find funds to pay for ongoing programs as the number of smokers – and therefore the number of tobacco-taxpayers – keeps falling.

The initiative then earmarks some funds to law enforcement, to University of California physician training, to the state auditor and to administration. But 82 percent of the remaining funds go to “increasing the level of payment” for health care related to Medi-Cal, the state’s health-care program for low-income people. Prop. 56 opponents therefore argue it’s designed mainly to benefit health-insurance companies and other interest groups – and includes few limits on how they spend the money they receive.

Furthermore, the initiative bypasses educational-funding requirements under Proposition 98, the 1988 initiative that now requires approximately 43 percent of state general-fund revenues to be directed to the public-school system. As the LAOexplained, “Proposition 56 amends the state Constitution to exempt the measure’s revenues and spending from the state’s constitutional spending limit. (This constitutional exemption is similar to ones already in place for prior, voter-approved increases in tobacco taxes.) This measure also exempts revenues from minimum funding requirements for education required under Proposition 98.”

It’s not unusual for a major tax hike measure to ignite controversies over how the new revenues will be spent. But there’s a serious question about whether this initiative will meet its health-improvement goals given the way the tax hammers a common product used by people to quit smoking.

In a research paper co-authored with my R Street Institute colleague Cameron Smith, we note the measure boosts excise taxes on vaping by 320 percent. The key, stated goal of the tobacco tax increase is to dissuade people from buying cigarettes. By the same logic then, the massive boost in taxes on e-cigarettes seems designed to dissuade people from using them.

Yet as Public Health England explained: “The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes.” That government health agency urges public-health officials to promote vaping as a way to improve public health. Some U.S. studies come to similar conclusions.

Proposition 56 backers argue that vaping hasn’t been proven safe and the devices haven’t been around long enough to know long-term health effects. They also fear teens will begin vaping and then move on to combustible cigarettes, which everyone agrees are dangerous. And they point to a recent University of Southern California study suggesting teens who vape are six times more likely to begin smoking cigarettes than teens who don’t vape.

In reality, the study seems mainly to reflect “the difference between teens inclined to experiment and teens not so inclined,” according to a public-health expert we quoted. Furthermore, the e-cigarette industry doesn’t claim vaping is safe – they say it is a safer alternative to cigarette smoking. Research suggests they are about 95 percent safer.

California has the second-lowest smoking rate in the nation at around 12 percent. Only Utah has a lower percentage of smokers. So Proposition 56 doesn’t effect a broad swath of the public – but it is a contentious measure given questions about where the tax dollars will go and about its heavy-handed treatment toward vaping. Compared to many of the other initiatives on the ballot, this one might seem simple, but it’s about far more than whether the state government should boost taxes on a pack of cigarettes by two dollars.

Steven Greenhut is Western region director for the R Street Institute. He is based in Sacramento. Write to him at sgreenhut@rstreet.org.

This piece was originally published by CalWatchdog.com

Game Changer: World’s Leading Medical Group Backs E-Cigarettes

e-cigaretteOne of the world’s most prestigious medical organizations has delivered a groundbreaking 200-page report that supports e-cigarettes as a tool to quit smoking and demolishes several vaping myths in the process.

The Royal College of Physicians (RCP), the most respected medical institution in the United Kingdom, concluded e-cigarettes are 95 percent safer than regular cigarettes and are likely to be hugely beneficial to public health.

Titled “Nicotine without smoke: tobacco harm reduction,” the report is one of the most comprehensive ever published examining e-cigarettes and could be a game changer for health officials and politicians all over the world. The RCP’s seminal 1962 report, which demonstrated the link between smoking, lung disease and bronchitis spurred the U.S. Surgeon General to publish the historic 1964 “Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States.”

The RCP’s new report tears apart scare stories, including the ever-more popular idea that vaping is somehow a gateway to smoking. “To date, there is no evidence that any of these processes is occurring to any significant degree in the UK,” said the report’s authors. (RELATED: CDC Admits, No ‘Concrete’ Evidence E-Cigarettes Are Gateway To Smoking)

The authors are emphatic there is no evidence e-cigarette use has in any way “renormalized” smoking. “None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people.”

One of the most damaging myths about e-cigarettes that caught fire in 2015 was e-cigarettes don’t actually help smokers quit. (RELATED: Study Claiming E-Cigarettes Make Quitting Harder Exposed As ‘Unscientific Hatchet Job’)

Contrary to the claims of some public health activists in the U.S., the RCP is clear: e-cigarettes can help smokers kick their habit for good. “Among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking.” (RELATED: Study Finds E-Cigarettes Raise Chances Of Quitting, ‘Can Save Lives’)

The RCP does not claim vaping is totally safe, as vapers inhale nicotine and flavorings. But they conclude any risk to vapers is likely to be “very small, and substantially smaller than that arising from tobacco smoking.”

Concurring with a previous report by Public Health England, RCP believes the health risks to vapers is unlikely to reach more than five percent of the risks associated with smoking. The report also warns overzealous policymakers to resist the temptation to regulate e-cigarettes in a way that would stifle innovation or discourage use.

“This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK,” said Professor John Britton, chair of the RCP’s Tobacco Advisory Group. “Smokers should be reassured that these products can help them quit all tobacco use forever,” he added.

Those most applauding the study’s conclusions are e-cig groups who have been fighting an onslaught of attacks from politicians and dubious public health researchers. (RELATED: Read The Stunning Correction This Scientist Dropped On Her Own Anti-E-Cig Study)

“When the RCP told the truth about cigarettes in 1962, it took two years for the U.S. government to play catch up and release its own report. It should not take two months, let alone two years, for American public health authorities to correct their past misstatements about vaping. The FDA and CDC must seriously consider the RCP’s guidance before moving forward on any new regulations or public campaigns about smoke-free nicotine products,” said Gregory Conley, president of the American Vaping Association.

“For those in mainstream tobacco control, the question for them is, how can you dismiss this report out of hand? The authors are credible experts without financial conflicts of interest in tobacco or vapor products. At some point, these groups will have to realize that the science has long outpaced their rhetoric,” Conley added.

Cancer charities added their voices to the chorus of praise for the RCP’s report. “This important report is an accurate summary of the latest scientific evidence on e-cigarettes and will help dispel the increasingly common misconception that they’re as harmful as smoking. They’re not,” said Cancer Research UK’s director of prevention Alison Cox.

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Originally published by the Daily Caller News Foundation

FDA Regulations Could Wipe Out 99 Percent Of E-Cigarette Industry

e-cigaretteThe e-cigarette industry could be all but wiped out thanks to regulations coming down the pipeline from the Food and Drug Administration.

Most damaging of all, e-cigarette makers will have to retroactively submit marketing applications for all their products, with the costs running into the millions.

Manufacturers of e-cigarettes could also be banned from advertising the reduced risk from substituting smoking for vaping unless they can convince the FDA otherwise.

In 2009, e-cigarettes came under the purview of the FDA and may face many of the restrictions placed on the tobacco industry, such as issuing health warnings and stopping sales to minors.

The e-cig industry is still relatively young, with the first e-cigarette invented in China in 2007. Despite there being close to 20 million Americans regularly using e-cigarettes, the FDA’s regulations could bankrupt the vast majority of producers.

Speaking to The Hill, Jan Verleur, co-founder and CEO of VMR Products, said as much as 99 percent of the industry could be wiped out. “This makes it so any product released after the grandfather date would require premarket approval,” said Verleur.

He added that ”the process could cost us half a million to million dollars,” per individual product. With more than 500 e-cigarette products, VMR Products would have to pay five times the company’s revenue.

His comments echo those of the president of the American Vaping Association Greg Conley who told the L.A. Times Monday that 99 percent of the small businesses in the industry could close their doors.

There is as of yet no fixed date for when the rules come into force. The FDA has said it will give companies two years to submit their applications and they will be able to sell the products under review during that time.

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Originally published by the Daily Caller News Foundation

CA Senate Passes Bill to Raise Legal Smoking Age to 21

cigarette smoking ashesAdding another bill to its reputation as a trend-setting Legislature, Sacramento has taken a big step toward raising the statewide smoking age to 21. By an overwhelming tally of 26 to 8, the state Senate voted to prohibit sales of tobacco products to those aged 18-20.

By the numbers

According to the bill’s supporters, the ban would be instrumental in dramatically reducing not only teen smoking but smoking in general. “Sen. Ed Hernandez, D-West Covina, said he introduced the bill, SB151, out of concern that an estimated 90 percent of tobacco users start before age 21,” the Los Angeles Times reported.

That statistic emerged from a recent Institute of Medicine study making the rounds in policy circles. Researchers suggestedthat “teen smoking could be curbed by 12 percent if the age limit was raised to 21,” as LAist noted, “making it harder for minors to find somebody to buy cigarettes for them.” In real numbers, the study concluded, the age-21 limit would ensure “more than 200,000 fewer premature deaths nationally for those born between 2000 and 2019.”

Although critics have pointed out that people older than 18 are adults eligible to be drafted and bound to signed contracts, the Times observed, momentum has gathered to raise the legal smoking age for reasons unrelated to consistency in the treatment of individual rights and responsibilities.

Tobacco-related illness has long represented a significant chunk of aggregate health care costs. For policymakers, that problem grows more serious the more those costs are shifted onto government and taxpayers. “Tobacco-related disease killed 34,000 Californians in 2009 and cost the state $18.1 billion in medical expenses, according to studies by UC San Francisco,” according to the Times.

A developing trend

Trendsetting_Teens_Now_Smoking_E-Cigs-c84599d4735c853b900185fa0a93e9ebSome evidence of the policy’s likely impact has accumulated in states where the smoking age was previously hiked. “Although most states set the minimum age at 18, Alabama, Alaska, New Jersey and Utah set it at 19, and some localities have set it at 21,” according to The Washington Post. “Higher age limits seem to correspond with lower smoke rates in these states; Utah and New Jersey also have among the lowest smoking rates in the country, No. 1 and No. 5, per Gallup, while Alaska has the most improved, and Alabama is somewhat of an outlier in the South, as it’s not among the states with the highest smoking rates, like its neighbors Mississippi and Louisiana.”

California could be the first state to deny tobacco to under-21s. But other western states could swiftly follow suit. According to KPPC, “Legislatures in Oregon and Washington are considering similar bills and lawmakers in Hawaii have passed a bill and sent it to the governor.” Among the localities setting the legal age at 21, Hawaii County has been joined by New York City.

Next, vaping

Traditional tobacco products were not the only ones on the state Senate’s chopping block. SB140, introduced by state Sen. Mark Leno, D-San Francisco, also passed handily, on a 24-12 vote.

As the San Francisco Chronicle reported, that bill “would include e-cigarettes in the definition of tobacco products in order to prohibit the devices from being used at workplaces, schools and public places, just as tobacco products are under the state’s Smoke Free Act. SB140 would also make it a misdemeanor to provide e-cigarettes to minors.”

The tandem advance of the state Senate’s anti-smoking and anti-vaping bills raised the prospect that the two approaches would converge in the near future, raising the vaping age to 21. “California bans the sale of e-cigarettes to anyone under 18,” the Chronicle observed, “but Leno said young teens still have access to them and they are becoming increasingly popular among middle and high school students.” If Hernandez’s bill were to pass before Leno’s, vaping would automatically be restricted in the same manner as traditional cigarette smoking.

Originally published by CalWatchdog.com