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More Vaper Insights Drawn from the FDA PATH Survey, 2013-14


Following are additional insights into smoking and vaping from my Nicotine & Tobacco Research study (abstract here), coauthored by my economist colleague Dr. Nantaporn Plurphanswat.  Earlier blog notes on this analysis of the 2013-14 FDA-funded Population Assessment of Tobacco and Health (PATH) Survey are here. Flavors and Nicotine Flavors are important to vapers, but the PATH questionnaire inquired about flavoring only by grouping them: “menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets.”  Nevertheless, we report that flavors “were consumed by 7 out of 10 current users.  Never-smokers were significantly more likely to use them than current and former smokers (84% vs. 67% and 69%), and they were significantly less likely to use liquid containing nicotine (69% vs. 93% and 88%).  Notably, …5.2% of current smokers, 7.8% of former smokers, and 25.9% of never-smokers used e-cigarettes that contained flavor, but no nicotine.” Buying E-Cigarettes We found that “The majority of users bought e-cigarettes in person (81%).  Former smokers were significantly more likely to buy them from the internet than current and never-smokers (21% vs. 10.3% and 13.0%).  Never-smokers were the least likely to buy their own e-cigarettes.  Two-thirds of former smokers purchased their e-cigarettes in a smoke shop or vape shop, which was significantly higher than current or never-smokers (55% and 45%).” Reasons for Vaping The PATH Survey asked vapers why they used e-cigarettes.  The top five reasons among former smokers who vaped were: 1.     “less harmful to me” (94%), 2.     “less harmful to persons around me,” (88%) 3.     “help to quit smoking,” (86%) 4.     “don’t smell” (80%) 5.     “use when/where smoking not allowed” (78%). Current smokers who vaped listed the same top five reasons in slightly different order.  Understandably, #5 moved to the #2 slot.  Notably, “E-cigarette use by other people (‘important to me’ or ‘in the media or other public figures’) and appealing advertising were the least popular reasons for use among all groups.” Perceptions of Nicotine and E-Cigarette Harm Regardless of smoking status, most vapers were misinformed about nicotine: 84% of never smokers believed that nicotine causes most cancers, as did 77% of current smokers and 66% of former smokers.  There was better news with respect to relative risk of vaping versus smoking: “The majority of users thought that e-cigarettes were less harmful than cigarettes. Ninety-four percent of former smokers thought that e-cigarettes were less harmful, which was significantly higher than either current or never-smokers (78% and 77%).” This is meaningful, as a 2015 National Cancer Institute survey showed that only 26% of U.S. adults believed that e-cigarettes were less harmful than traditional cigarettes (discussed here).  The PATH results show that, despite a tsunami of misinformation from government agencies and health organizations, e-cigarette users are much better informed than the general public about differential risks of vaping and smoking.  Original author: Brad Rodu
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NY Wrongheadedly Bans Indoor Vaping


Saying that e-cigarettes “carry long-term risks to the health of users and those around them,” New York Governor Andrew Cuomo signed into law on October 23 a bill that bans indoor vaping.   The governor got his facts wrong.  While e-cigarette usage rates have boomed over the past five years, there is no evidence that they have any significant short-, medium- or long-term health effects.  Andrew Stuttaford in the National Review (here) labeled Cuomo’s action “an unscientific war,” citing the Royal College of Physicians’ 2016 report (here)(emphasis in original).  The case for e-cigarettes can be summed up by four key recommendations from the RCP report: ·       E-cigarettes are marketed as consumer products and are proving much more popular than NRT [nicotine replacement therapy] as a substitute and competitor for tobacco cigarettes.  ·       E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking. ·       … the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco. ·       …in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking Ignoring clear evidence of vapor’s relative safety and widespread use in smoking cessation, politicians and public health officials in New York and elsewhere support the deadly cigarette status quo. Beyond science issues, vaping bans have little impact on consumer behavior.  E-cigarette vapor dissipates quickly, so while bans may stifle e-cigarette use in public settings, enthusiasts know that they can continue vaping indoors; if they are discreet, no one will know. The biggest flaw in vaping bans is the false implication – if not the explicit false claim – that vapor is as dangerous as smoke.  In the war on vaping by Governor Cuomo and others, such deception misleads American tobacco users and denies them use of proven harm reduction aids. That is the denial, not the promotion, of public health. Original author: Brad Rodu
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NIAAA Promotes Alcohol Industry Public Relations Program; Violates Ethical Standards by Appearing in Anheuser-Busch Promotional Video

In what I believe is a clear ethics code violation, senior employees of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have appeared in an Anheuser-Busch InBev promotional video that is designed primarily to serve the company's public relations interests.The video was brought to light in an article by Miriam Shuchman at Wired which was published last Thursday. In the video, Anheuser-Busch InBev boasts to the public about its "Smart Drinking Goals" program, which is purportedly designed to reduce "hazardous" drinking. Several Anheuser-Busch executives-- including its CEO, Chief "Health" Officer, and Chief Legal and Financial Officer--appear in the video, boasting about how wonderful this program is and implying how great a company Anheuser-Busch is for funding this program and how much it cares about the public's health.But the Anheuser-Busch executives aren't the only ones who appear in this promotional, public relations video.Shockingly, this Anheuser-Busch PR effort (i.e., public relations effort) is also endorsed and promoted by senior officials of the Executive Branch of the United States government. And even worse, those senior officials are the Director and the Director of Global Alcohol Research of the NIAAA!The Director of Global Alcohol Research at NIAAA provides a glowing endorsement of the program, describing it as "wonderful" (see 0:27-0:34 in the video). The Director of NIAAA also endorses the program, asserting that it will "go far in moving the field forward" (see 3:17-3:26).Brilliantly, Anheuser-Busch intersperses promotional statements from its own executives with promotional statements from the NIAAA officials, thus creating a clear endorsement of the program by the NIAAA itself, which is a public relations coup for the company.The true purpose of the video is revealed at 3:42, when an Anheuser-Busch Global Advisory Council reveals the company's aspiration: "We're no longer a neighborhood's beer or a country's beer. We're in fact a corporation representing the world."The video is clearly marketing Budweiser and other beers produced by Anheuser-Busch. As the company acknowledges, they are running this international program because they don't just want to be a neighborhood's beer or a country's beer; they want to be the world's beer.There's nothing wrong with that aspiration. In fact, were I a shareholder, I would be very pleased with this amazing public relations ploy. I would be more than thrilled that the company was able to get the leadership of NIAAA to endorse this effort to make Anheuser-Busch the world's beer. However, there is something very wrong with NIAAA officials appearing in this promotional video and endorsing this marketing ploy.The Rest of the StoryThe rest of the story is that the Director of NIAAA and the Director of Global Research at NIAAA are essentially endorsing a public relations effort of the world's largest beer company by appearing in a promotional video whose true purpose is to expand Budweiser sales so that it becomes the world's beer.This is entirely inappropriate, as the NIAAA has no business aiding Anheuser-Busch in its marketing efforts. Nor does the NIAAA have any business endorsing a public relations effort, or any other program, of this alcohol company.Not only does the appearance of the Director of the NIAAA in this video undermine the public health mission of the National Institutes of Health, but in my view, it is a clear ethics violation.According to Title 5, Chapter 45, Part 5501 of the Code of Federal Regulations--a section known as the Supplemental Standards of Ethical Conduct for Employees of the Department of Health and Human Services--no employee of the NIH may:"Engage in any employment or self-employed business activity that involves the sale or promotion of products or services of a substantially affected organization or a health care provider or insurer, except for the purpose of commercializing invention rights obtained by the employee pursuant to Executive Order 10096, 15 U.S.C. 3710d, or implementing regulations." [Section 5501.109 - Prohibited outside activities applicable to employees of the National Institutes of Health - at (c)(1)(iii)].The appearance of the NIH Director and the NIH Director of Global Research in this Anheuser-Busch InBev promotional video violates this standard because it involves the promotion of a product or service of Anheuser-Busch, which is a substantially affected organization because its profits may be directly impacted by an activity of the NIAAA (namely, the agency's research on the health benefits or risks of alcohol use).In his defense, the NIAAA director told Wired: "It always surprises me when people are critical of us even talking to industry."If NIAAA was merely talking to industry, it wouldn't be a problem. But appearing in an Anheuser-Busch promotional video is not merely talking to industry. It is actually promoting and endorsing a company product or service. By doing so, the NIAAA has participated in a marketing ploy of the company. Essentially, NIAAA is helping Anheuser-Busch to market beer and achieve its goal of becoming the world's beer.In my view, NIAAA has been corrupted by the alcohol industry because it is acting as essentially a marketing branch for Anheuser-Busch. With the promotion of Anheuser-Busch's interests that NIAAA is providing, the company hardly needs its own marketing division. It can simply call the director of NIAAA it's de facto Director of Marketing and Public Relations. The alcohol industry couldn't have a better friend in a higher place.Original author: Michael Siegel
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A Sensible Tobacco Tax Plan to Benefit Smokers & States

Most tobacco taxes aim to punish tobacco consumers and companies.  My University of Louisville economics colleague Dr. Nantaporn Plurphanswat and I offer a rational tobacco tax plan (here) to benefit tobacco users and state governments.  It’s supported by 16 tobacco research and economic policy experts from across the nation, and it’s co-sponsored by the Pegasus Institute.  Watch my interview with Nick Storm of Spectrum News here, or click on the image above.Original author: Brad Rodu
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FDA wants to reduce nicotine in cigarettes – what could possibly go wrong (and right)?


October 25th, 2017

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New Vaping Insights Based on FDA’s PATH Survey 2013-2014



Analyzing data from the baseline 2013-14 FDA-funded Population Assessment of Tobacco and Health (PATH) Study, my economist colleague Dr. Nantaporn Plurphanswat and I have produced a comprehensive study of e-cigarette use in the United States.  The research appears in the journal Nicotine & Tobacco Research (abstract here). The standard vaping definition has two components: participants must have regularly vapedAND now vape every day or some days.  Using this definition, we estimate that there were 5.5 million current e-cigarette users (2.4% of the U.S. population), of which 2.3 million used them daily and 3.2 million used them some days. However, there are 7.4 million participants who have NOT “regularly vaped” but report that they use e-cigs every day or some days.  It is important to count them too, and to distinguish them from current users, so we call them “e-cigarette triers,” the vast majority of whom (95%) use them some days.  The total of current users and triers is 12.9 million (or about 5.6% of the population). (In a recent blog entry (here) I estimated that there were 8.9 million U.S. vapers in 2014, based on the National Health Interview Survey [NHIS].  The fact that the NHIS does not collect data on “regular” vaping likely accounts for the difference with our new PATH-based 12.9 million estimate.) The figure above shows that the vast majority of every day current vapers were either current smokers (47%) or former smokers (46%).  In contrast, most some day vapers and all e-cigarette triers were current smokers, and the percentage of never smokers was higher in these groups (discussed below).  PATH also collected more detailed cigarette smoking information than did NHIS.  In our new article we note that we use a similar “…classification strategy…for estimates of cigarette smoking. The number of current smokers in PATH was 41.5 million, and 80% were daily smokers, which is consistent with the 2014 NHIS.  However, there were also 7.1 million cigarette triers, who are distinguished by being every day or some day smokers who had not consumed 100 cigarettes in their lifetime.  Triers do not fit the traditional definition of current smokers, so we have included them as a subset of ‘never-smokers’ for comparison with NHIS surveys, where they would have been classified as never-smokers by answering ‘no’ to the 100-cigarette question and not being asked about every or some day smoking. This is an indication that a substantial number of American smokers may have been misclassified as never-smokers in previous national surveys.”These details illuminate critical characteristics of both vapers and smokers.  For example, as shown the chart at left, the vast majority of vapers who “never smoked” according to the NHIS definition are actually current or former cigarette triers.  Only a small fraction (7-11%) have never tried cigarettes.  This finding refutes the common claim that vaping attracts never smokers. Other vaping insights gleaned from the PATH survey will be discussed in a future post. Original author: Brad Rodu
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Is Australia falling behind on tobacco policy?


Sources: Office for National Statistics (UK). Smoking habits in the UK and its constituent countries, 2016.  Australian Institute of Health and Welfare, National Drug Strategy Household Survey, 2016.

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“Deception or Evasion” by FDA CTP & National Cancer Institute Regarding Smokeless Tobacco?


“A majority of adults do not think smokeless tobacco is less harmful than cigarettes,” according to a study by the FDA Center for Tobacco Products and the Tobacco Control Research Branch of National Cancer Institute (abstract here).  Sheri P. Feirman and colleagues analyzed responses to a question in the Health Information National Trends Survey (HINTS), 2012, 2014, and 2015: “Do you believe that some smokeless tobacco products, such as chewing tobacco and snuff, are less harmful than cigarettes?”  Do You Believe that Some Smokeless Tobacco Products…Are Less Harmful Than Cigarettes?201220142015Yes9.4%12.0%10.9%No73.5%72.1%66.8%Don’t Know17.1%15.9%22.2% Simply put, only 9 to 12% of Americans correctly believe that smokeless tobacco is less harmful than cigarettes. In a PubMed Commons commentary on this study, David Sweanor and I note: “The article failed to specify that the correct answer [to the question] is:  ‘Yes, smokeless tobacco products are less harmful than cigarettes.’  The article instead focuses on the majority of participants who inaccurately answered ‘No’ or ‘Don’t Know,’ which demonstrates the misperception fostered by an effective ‘quarantine’ of truthful risk information by federal agencies (Kozlowski and Sweanor, 2016). “Decades of epidemiologic studies have documented that the health risks of smokeless tobacco use are, at most, 2% those of smoking (Rodu and Godshall, 2006; Rodu, 2011; Fisher 2017; Royal College of Physicians, 2002; Lee and Hamling, 2009).  Unlike cigarettes, smokeless tobacco does not cause lung cancer, heart and circulatory diseases or emphysema.  The Royal College of Physicians concluded in 2002: ‘As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10–1,000 times less hazardous than smoking, depending on the product.’” (Royal College of Physicians, 2002) ”Low risks from smokeless tobacco use extend to mouth cancer.  A 2002 review documented that men in the U.S. who use moist snuff and chewing tobacco have minimal to no risk for mouth cancer (Rodu and Cole, 2002), and a recent federal study found no excess deaths from the disease among American men who use moist snuff or chewing tobacco (Wyss, 2016). “As one of us recently wrote, ‘Deception or evasion about major differences in product risks is not supported by public health ethics, health communication or consumer practices.  Public health agencies have an obligation to correct the current dramatic level of consumer misinformation on relative risks that they have fostered.’ (Kozlowski and Sweanor, 2018).” The FDA and NCI must be more forthcoming with the American public.Original author: Brad Rodu
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My Response to an Invitation to Consult for the Foundation for a Smoke-Free World

Below is my response to an invitation to consult for the Foundation for a Smoke-Free World, funded by Philip Morris International:Unfortunately, I will not be able to consult or play any advisory role on this project. Since Philip Morris International (PMI) continues to aggressively market cigarettes internationally and to aggressively fight public health efforts to reduce tobacco use, this is just not a project that I can participate in as a public health practitioner. PMI cannot be sincere in its intention to establish a smoke-free world when it continues to aggressively lobby against public health efforts to reduce tobacco use.Original author: Michael Siegel
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Note to readers: look for me at @TheDaily_Vaper

by Carl V Phillips

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Mythic Tobacco Endgames



A new $1.2 million campaign to promote tobacco prohibition on college campuses was announced on September 19 (here).  As I have noted, the federal government annually spends hundreds of millions of dollars in support of academic anti-tobacco research (here).  This time, the money is coming from pharmacy giant CVS’s Health Foundation as part of a five-year, $50 million campaign.  CVS collaborators include the misnamed Truth Initiative (see hereand here) and the American Cancer Society, whose numerous prohibitionist exploits are reported in this blog (here, here, here, here, here, here, here, here, here, here). Campaign awards to several Texas schools were reported in a Houston Chronicle article (here) that included illustrations offering and refuting four tobacco “myths”.  In this effort, the paper (or the campaign) repeated fantastical claims that are often made by prohibitionists. Myth #1: “Almost no one smokes any more [sic].”  A myth, by definition, is a widely held view, so this attempt fails from the start. The latest data from the CDC, for 2016, shows 38 million smokers in the United States – a substantial and highly visible group of people, all in need of effective quit-smoking tools and support. Myth #2: “e-Cigarettes, hookahs and cigars are safe alternatives.”  Again, few people hold this view (here).  Scientists, the industry and public health officials agree that no form of tobacco use is perfectly “safe.”  Eminent authorities like Britain’s Royal College of Physicians, however, have pronounced that vaping “is unlikely to exceed 5% of the harm from smoking tobacco.” (here)  Furthermore, FDA data shows that smoking one or two cigars a day have almost no health risks (hereand here). Myth #3: “Infrequent, social smoking is harmless.”  This is creating a myth when one doesn’t exist. Myth #4: “Smoking outside eliminates secondhand smoke dangers.”  Myths convey false information.  This statement is entirely true. Ironically, some viewers of the online Chronicle article are shown an advertisement for Nicorette gum, reproduced here.  While pharmaceutical nicotine has a known 93% quit-smoking failure rate (here), this ad touts one day of success – an extraordinarily low bar for cessation. Original author: Brad Rodu
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2016 CDC Data Shows E-Cigarette Use Declines Again



Some 7.8 million American adults used e-cigarettes in 2016, according to data from the 2016 National Health Interview Survey, the source for CDC national smoking estimates.  That is about half a million fewer than a year earlier, and 1.1 million fewer than in 2014, the first year NHIS surveyed for vaping.  As the CDC reported a month ago (here), the 2016 data indicates 3.2% adult prevalence – 3.9% (about 4.5 million) for men, and 2.6%, (about 3.3 million) for women.   The 2.62 million former smokers who are current vapers comprised an increasing percentage of all vapers, from 22% in 2014, to almost 34% in 2016.  This is more evidence that smokers are using e-cigarettes to quit their habit.  As the following chart shows, 87% of former smokers currently using e-cigarettes quit in the last 5 years, suggesting that e-cigarettes played a significant role.  Meanwhile, 13% of former-smoker current-vapers quit over 6 years ago.  The CDC admits that relapse among former smokers is common (here), so health advocates should applaud these former-smokers’ choice of e-cigarettes over far more dangerous cigarettes. As noted previously (here), the 2.6 million former smokers represent more than mere anecdotal evidence; their documented experience ought to carry substantial weight with government policymakers.  In view of the important positive health implications of switching to smoke-free products, the number of former smokers ought to be growing faster.  Unfortunately, the sustained war on all smoke-free products is likely suppressing broader transition away from cigarettes.Original author: Brad Rodu
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Guest post: BAT executive on disruption of the tobacco industry

On June 12th, I published a blog, Pariahs, predators or players? The tobacco industry and the end of smoking, in which I tried to guess how tobacco companies are thinking about the future from my vantage point on the sidelines.  But I also asked if any industry figures would like to offer an informed insider’s view and offered a right of reply. Well, to my surprise one executive did reply.  David O’Reilly is BAT’s Group Scientific and R&D Director, and here is his perspective.

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Advertising code at fault over e-cigarette public health ad ban


This year’s Stoptober campaign encourages smokers to try vaping – bravo!

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Sunday Science Lesson: Debunking the claim that only 16,000 smokers switched to vaping (England, 2014)

by Carl V Phillips

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Antidote to NEJM Formaldehype Arrives at Last


In January 2015, R. Paul Jensen and colleagues created global headlines with a defective e-cigarette experiment (here).  They claimed in the New England Journal of Medicine that vapor contains “hidden” formaldehyde at far higher levels than cigarettes (here).  Their measurements required overheating or “dry-puffing” e-cigarette liquid, a process that produces such harsh (not hidden) oral sensations that the vapor is intolerable to normal consumers.  As Churchill said, “A lie gets halfway around the world before the truth has a chance to get its pants on.”  The Jensen mischaracterization caused considerable damage, as it encouraged smokers to believe that vaping is more dangerous than smoking.  Last week, the formaldehyde fallacy was laid bare.  Dr. Konstantinos Farsalinos and colleagues reproduced the Jensen experiment and found that “The high levels of formaldehyde emissions that were reported in [the Jensen] study were caused by unrealistic use conditions that create the unpleasant taste of dry puffs to e-cigarette users and are thus avoided.” Their work appears in Food and Chemical Toxicology (abstract here).  Farsalinos’ group painstakingly reproduced the earlier experiment, using the same now-outdated vaping equipment that was prone to dry puffs.  First, they had experienced vapers identify at what settings the “burning” taste of a dry puff was detected: 4.2 volts, 8.0 watts.  They then used Jensen’s methods to measure formaldehyde at various voltage-power settings, seen in the chart (above) adapted from their publication. Vapers detected dry puffs when the formaldehyde level was 100 micrograms (per 10 puffs).  Given that a microgram is one-millionth of a gram, Jensen’s formaldehyde level wasn’t hidden at all; at 380 micrograms, it was much higher than vapers could tolerate.  At lower, normal vaping power, formaldehyde was only 20 micrograms, or two-thirds that of cigarettes. Farsalinos cautions the scientific community: “blindly testing e-cigarettes in the laboratory setting without evaluating realistic use is a serious omission that can result in misleading conclusions about the risk to consumers compared to smoking;” and such conclusions can wrongly imply “that there is little to be gained by switching to e-cigarettes.” In response to the Jensen article in 2015, Clive Bates and Konstantinos Farsalinos published a letter in Addiction calling for its retraction (here); the demand was ignored.  The current publication is a much-needed antidote to Jensen’s seriously flawed and misleading findings. Original author: Brad Rodu
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What is Tobacco Harm Reduction?

by Carl V Phillips

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Do Smokers Quit After Hospital Cessation Trials? Don’t Count on It, or Them


Do smokers lie about quitting?  A new study analyzes smokers’ self-reports of their smoking habits six months after their participation in quit-smoking clinical trials. Several years ago, researchers recruited sick smokers at a group of hospitals – the Consortium of Hospitals Advancing Research on Tobacco, or CHART – and conducted federally-supported smoking cessation trials.  Now Taneisha Scheuermann et al. in the journal Addiction (abstract here) examine the post-trial results, focusing on levels of cotinine, a nicotine breakdown product, in trial participants’ saliva. Hospitals in six cities provided 5,827 smoking patients with a variety of quit-smoking interventions.  Six months later, 4,206 of those subjects completed a survey, with 1,708 reporting that they had not smoked in the past seven days.  Nearly 10% of them reported using pharmaceutical nicotine, e-cigarettes or other tobacco harm reduction products in the past seven days; those subjects were among the 530 excluded from the Scheuermann analysis.  Self-described non-smokers were offered $50 to $100 in exchange for saliva samples, but only 923 participants responded; of those, 822 supplied usable samples. Scheuermann used a standard saliva cotinine cutoff of 10 nanograms per milliliter: participants below this level were considered to be not smoking, while those at or above were still smoking. Of the 822 participants who reported 7-day abstinence, 347 (42.2%) were dissembling, as their saliva cotinine levels indicated they were smoking.  That so many individuals failed to quit evidences a fact that tobacco prohibitionists often ignore: The vast majority of smokers are unable or unwilling to quit.  The 475 verified quitters constituted roughly 8% of the 5,827 patients who started the trials – a percentage that is consistent with the quit rate among the general population.  Also note that these smokers were recruited during a hospitalization, when their focus on health issues might have increased their motivation to quit. Treating smokers as social outcasts may influence their decision to lie about the results of their quit attempts. The CHART study was supported from 2009 to 2014 by five NIH grants costing taxpayers $15.5 million.      Original author: Brad Rodu
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The War on Nicotine begins

by Carl V Phillips

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Center for Tobacco Products is Lying to the Public About Youth Tobacco Use


This month, the FDA's Center for Tobacco Products (CTP) updated a chart purporting to show trends in youth tobacco use over the past 5 years.Here are the facts (i.e., the "true" facts) displayed in the chart:1. Youth cigarette use (among high school students) dropped by a huge amount from 2011 to 2016.2. Cigar use dropped substantially from 2011 to 2016.3. Pipe use dropped substantially from 2011 to 2016.4. Smokeless tobacco use dropped slightly from 2011 to 2016.5. Hookah use was essentially the same in 2011 and 2016.Given those facts, here is the key question:What happened to overall use of tobacco among high school students during the time period 2011-2016?It doesn't take any fancy math or statistics to figure out that overall tobacco use among high school students must have declined substantially from 2011 to 2016. Since youth cigarette use dropped by a huge amount, cigar use dropped substantially, pipe used dropped substantially, smokeless tobacco use didn't change  much, and hookah use didn't change much, it stands to reason that overall tobacco use went down substantially. There is no way that youth tobacco use went up or even stayed the same from 2011 to 2016 because it dropped substantially for three categories of use but didn't change much in the other two categories.The Rest of the StoryBut that is not what the Center for Tobacco Products chose to tell the public. Here is what the Center for Tobacco Products titled the chart:The CTP chose to tell the public that there was no significant decline in overall tobacco use over the past 5 years. However, as I showed above, that is simply not true. Youth tobacco use declined substantially.So how does CTP justify this dishonesty?It plays a trick on the public. It classifies e-cigarette use as a form of tobacco use and includes e-cigarette use in the totals for overall tobacco use. Since there was a huge increase in e-cigarette use from 2011 to 2016, CTP is able to completely undermine the fact that there was a dramatic drop in youth smoking, cigar use, and pipe use by adding youth who experimented with e-cigarettes. This is dishonest and inaccurate because e-cigarette use is not a form of tobacco use. The truth is -- and CTP knows this -- that e-cigarettes do not contain tobacco. In fact, the whole point of e-cigarettes is that they are an alternative to using tobacco. The rest of the story is that the Center for Tobacco Products is lying to the public. This is unfortunate because it risks losing the public's trust. It is also unfortunate because this deception could have deleterious public health effects, as misinforming people to think that e-cigarettes contain tobacco may dissuade many smokers from quitting and may even induce many ex-smokers to return to smoking. On top of all of this, it is - in my view- unethical to lie to the public, even if the aim were to discourage us from engaging in a potentially harmful behavior. I think the public deserves to know the truth. Someone has to start telling them the rest of the story. Note: Thanks to Clive Bates for alerting me to the deceptive headline in this dishonest communication. Original author: Michael Siegel
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