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Drinking, Bingeing and Toking More Popular Than Smoking Among Teens in 2014


Teen smoking deservedly gets a great deal of attention from the media and public policymakers, but one government survey shows that teens consume alcohol and marijuana at far higher rates than cigarettes.The National Surveys on Drug Use and Health (NSDUH), which I discussed last week (here), provide intriguing insights into use of licit and illicit products.At left are 2014 NSDUH estimates of the numbers – and percentages by age – of Americans using cigarettes, smokeless tobacco, alcohol and marijuana in the past month. (Binge drinking is defined as consuming five or more drinks within two hours)  There were nearly 56 million smokers, 8.6 million smokeless tobacco users, 22.5 million marijuana users and a whopping 140 million drinkers.  There were actually more binge drinkers (61 million) than smokers.  The following table shows the number of teens (12-17 years) and young adults (18-20 years) who used these substances in 2014..nobr br { display: none } td { text-align: center} Numbers (millions) of Teens and Young Adults Who Were Past-Month Smokers, Smokeless Users, Drinkers, Binge Drinkers and Marijuana Users in 2014Teens (12-17 yrs)Young Adults (18-20 yrsTotalSmokers1.233.244.47Smokeless Users0.500.661.16Drinkers2.805.888.68Binge Drinkers1.533.745.27Marijuana Users1.852.774.62There were some 1.2 million past-month smokers under 18, and about half a million underage smokeless users.  These numbers pale in comparison to those for alcohol.  There were 2.8 million drinkers under 18, and another 5.9 million between 18 and 20.  There were more underage binge drinkers (1.5 million) and marijuana users (1.85 million) than smokers.  The totals for marijuana, drinking and binge drinking are all greater than smoking.Teenage smoking must be prevented, but teen abuse of alcohol and marijuana also requires attention.Original author: Brad Rodu
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FDA’s proposed smokeless tobacco nitrosamine regulation: innumeracy and junk science (part 3)

by Carl V Phillips

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FDA’s proposed smokeless tobacco nitrosamine regulation: innumeracy and junk science (part 2)

by Carl V Phillips

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U.S. Can’t Decide How Many Adults Use Smokeless – 8.1 Million or 5.1 Million?


Federal officials routinely obfuscate on the subject of smokeless tobacco, and particularly on the number of smokeless users in the U.S. The newest numbers are reported by Dr. Rachel Lipari and Mr. Struther Van Horn of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). They say, “In 2014, an estimated 8.7 million people aged 12 or older used smokeless tobacco in the past month.” (available here)  Their finding is based on data from the National Survey on Drug Use and Health (NSDUH). That number included teens (Age 12-17 years).  When including only adults (18 and older), the NSDUH estimate is 8.1 million in 2014, which contrasts with a 2015 CDC-supported National Health Interview Survey (NHIS) adults-only estimate of 5.1 million. The 59% higher NSDUH number probably results from the use of different definitions.  NSDUH collects information on past-30 day use, whereas current users in NHIS is every day or some days. The primary conclusion in the Lipari/Van Horn report is that “Smokeless tobacco is not a healthy alternative to cigarette smoking.”  This is a non sequitur, as the NSDUH survey includes no information on health.  The government inconsistency also extends to smoking numbers, as I discussed previously (here, hereand here).  The NSDUH estimate of adult U.S. smokers for 2014 was 55.8 million, about 40% higher than the NHIS estimate of 40 million for that year. It is time for federal officials to acknowledge the gross inconsistency of the government’s tobacco use estimates. In all likelihood, the higher NSDUH estimates, which reflect the fact that Americans use tobacco products more irregularly than every day or some days, are closer to reality than those based on the NHIS. Original author: Brad Rodu
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Time for the Government of Sweden to get behind snus and tobacco harm reduction

One of the more puzzling things about snus is the reluctance of Sweden’s government to claim credit for what is by any standards an extraordinary public health achievement. So here I write to the relevant ministers requesting that they acknowledge Sweden’s success, show some leadership and promote the concept of tobacco harm reduction.  The challenge to the EU prohibition of snus brought by Swedish Match and New Nicotine Alliance provides an opportunity for the Government of Sweden to change its approach.  I wrote the following heartfelt plea, attaching the letter that 18 comrades sent sent to the European Commission: Lifting the unjustified European Union ban on oral tobacco or “snus” in the light of ongoing legal action hoping it might encourage a more constructive pro-health, pro-trade, post-enlightenment approach. 

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FDA’s proposed smokeless tobacco nitrosamine regulation: innumeracy and junk science (part 1)

by Carl V Phillips

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Smoking May Harm Mental Health


Research has documented a strong link between smoking and various mental health disorders, including anxiety, depression, schizophrenia and bipolar disorder.  The CDC advises that about 20% of American adults had some form of mental illness in 2009-2011, and the smoking rate for that group was 36%, in contrast to 21% for all others (here). There is certainly an association, but there are four distinct possibilities with respect to causality: ·       Mental health problems cause people to smoke. ·       Smoking causes mental health problems. ·       Both pathways exist. ·       Neither pathway exists. My economist colleague Dr. Nantaporn Plurphanswat is the lead author of an innovative analysis that identifies a potential causal pathway for mental illness and smoking; the work appears in the American Journal of Health Behavior (abstract here).  Our co-author is University of Illinois professor Dr. Robert Kaestner.  We used data from people in almost all states participating in the federal Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2010.  BRFSS collected information on smoking and asked participants “…for how many days during the past 30 days was your mental health [which includes stress, depression, and problems with emotions] not good?” Recognizing that traditional approaches cannot identify a causal pathway between smoking and mental illness, Drs. Plurphanswat and Kaestner employed an instrumental variable approach, in which variation in smoking at the state level is strongly associated with cigarette excise taxes, but the excise taxes are completely unrelated to outcomes like mental health.  The IV analysis provides information on whether smoking leads to mental health problems, or vice versa. Our results indicate that smoking may harm mental health: it is significantly associated with 14 or more days of poor mental health.  Most of the effect due to smoking is from large increases in the number of mentally unhealthy days and not by small increases among many smokers.  The BRFSS data cannot tell us whether smoking is a form of self-medication practiced by those who suffer from specific mental health disorders.  However, our analysis confirms that smoking may contribute to anxiety, depression and emotional distress.  Thus, policies that reduce smoking may have a positive spill-over effect in improving mental health.   Original author: Brad Rodu
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A critical review of an Australian anti-vaping polemic


John Maynard Keynes: “when the facts change, I change my mind. What do you do sir?”

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Time to stop measuring risk as “fraction of risk from smoking”?

by Carl V Phillips

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Avoiding bureaucratic destruction of the US vaping market – proposals for a new approach by FDA


June 18th, 2017

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American Lung Association in Wisconsin is Lying About Health Effects of Smoking

It used to be that the tobacco industry lied to the public in order to downplay the severe health effects of cigarette smoking. Today, it is the Wisconsin branch of the American Lung Association (ALA) that is lying about the risks of smoking.According to the director of tobacco control and public policy for the ALA in Wisconsin: "there’s still a perception that e-cigarettes are less harmful than regular cigarettes and so for some kids who never would have tried smoking cigarettes they get the idea this might be a safer alternative."Clearly, the ALA is telling the public that kids are actually mistaken and that e-cigarettes are no less harmful than regular cigarettes. Of course, this also means that cigarettes are no more dangerous than e-cigarettes. The Rest of the StoryThe truth is that e-cigarettes are much safer than regular cigarettes. Dr. Stan Glantz - a highly respected, long-time scientist in the anti-tobacco movement - has stated unequivocally that e-cigarettes are safer than regular cigarettes and that if a smoker switches to e-cigarettes exclusively, they will experience an improvement in their health. Dr. Glantz may quibble with some of us who support harm reduction in terms of the exact magnitude of the risk differential, but there is no credible scientific doubt that vaping is safer than smoking.Even the cigarette companies are not lying to the public about this point. In fact, they readily admit that their cigarettes are much more dangerous than regular cigarettes and they are even making efforts to market e-cigarettes as a less hazardous alternative.So why is the American Lung Association picking up where the historical fraud and deception of the tobacco industry ended?Like the ALA, I do not want youth to be taking up vaping. However, unlike the ALA, I don't condone lying to our nation's youth in order to try to deter them from vaping. Especially since the ultimate effect of downplaying the health hazards of smoking is that it will produce less deterrence to youth smoking. If kids think that smoking is only as bad as inhaling cherry vapes and blowing a few vape rings, then their appreciation of the serious health hazards of smoking will be undermined, which of course will lead to more kids smoking.As Alan Selk said eloquently in his comment to the article in which the ALA was quoted:"Donna Wininsky's statement that there is still a perception that e-cigarettes are less harmful than regular statements is a pretty bizarre statement, considering that e-cigarettes are in fact significantly less harmful then regular cigarettes. All the real evidence points to that fact. It has also been shown that about 80% of kids who are using e-cigs are not using nicotine. They are simply playing with the vapor. A great majority of the youth who are using nicotine are using it as a substitute (and a much less harmful one) for smoking. ... ""As far as health goes there is only one number that matters, and that is how many people are inhaling smoke from cigarettes. Those numbers are at historic lows among youth and adults. There is good evidence that the reason for the drop is because people are switching to low risk alternatives. That is a very positive news. (in the UK, where e-cigs are endorsed by the health establishment as a viable harm reduction tool, and people are generally better informed as to the relative risk of smoking verses vaping, 50% of people who take up vaping end up completely quitting cigarettes).""I would like to know why, instead of encouraging people to switch to a far less harmful alternative to cigarettes, the American Lung Association of Wisconsin is misinforming the people of Wisconsin on the relative risk of vaping verses smoking. They are in fact killing people with there misinformation campaign." The ALA is not only wrong in its assessment of the relative health effects of vaping compared to smoking, but it is also wrong in suggesting that e-cigarette use among youth in Wisconsin is a problem because it leads to cigarette use. The evidence from Wisconsin suggests exactly the opposite. According to the state's Youth Tobacco Survey, while e-cigarette use among high school students in Wisconsin continued to increase substantially from 7.9% in 2014 to 13.3% in 2016, smoking prevalence declined by 24%, from 10.7% to 8.1%. These data are not consistent with the assertion that e-cigarettes are serving as a gateway to smoking among Wisconsin youth. In fact, they suggest the opposite. As Alan Selk correctly argues, e-cigarettes appear to be serving as a deterrent to smoking as a culture of vaping replaces, rather than reinforces, a culture of smoking.Original author: Michael Siegel
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EU Snus Ban Costs More Lives


A new report from the Swedish Snus Commission underscores the accelerating human toll of the European Union’s unconscionable ban on smokeless tobacco: “…among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.”  Sweden is the only EU nation in which sales of snus are legal. In 2009, epidemiologist Phil Cole and I, analyzing data from the World Health Organization and the International Agency for Research on Cancer, reported in the Scandinavian Journal of Public Healththat 274,000 smoking-attributable deaths would be avoided if men throughout the EU had the smoking prevalence of men in Sweden (here).  Four years later, I updated that figure to 291,000 (here).        The Snus Commission report, available here, was produced by a distinguished group of Swedes.  The commission’s chairman is Anders Milton, a physician and former President and Chairman of the Swedish Medical Association, President of the Swedish Confederation of Professional Associations from 1993 to 2001, and President of the Swedish Red Cross from 2002 to 2005.  His collaborators are Christina Bellander, a journalist who previously headed business development at Swedish TV4 and was a Board Member of New Wave Group AB, Mittmedia AB and the Swedish Educational Broadcasting Company; Göran Johnsson, a former member of the Social Democratic Party’s Executive Committee, Board Member of Volvo AB and Chairman of Swedish national television broadcaster SVT from 2011 to 2014; and Karl Olov Fagerström, a WHO-recognized nicotine and tobacco researcher who has authored 150 articles in peer reviewed journals. The casualty list from the indefensible and immoral EU snus ban continues to grow. Original author: Brad Rodu
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New CDC Data Should Put to Rest the Contention that E-Cigarettes are a Gateway to Youth Smoking

New data released moments ago by the Centers for Disease Control and Prevention (CDC) should put to rest the contention that electronic cigarettes are a gateway to smoking among youth. These new data show that the prevalence of smoking among high school students was cut in half in just five years - from 2011 to 2016 - at the same time as the use of e-cigarettes among these very same students increased dramatically from 1.5% to a peak of 16.0% in 2015.There is more good news from the CDC. Not only has youth smoking declined at an unprecedented pace in the last five years, but for the first time, the prevalence of youth use of e-cigarettes has also declined, dropping from 16.0% in 2015 to 11.3% in 2016 (among high school students). Use of cigarettes among high school students continued to fall between 2015 and 2016, dropping from 9.3% to 8.0%.The Rest of the StoryThis is great news because it reveals that smoking is truly becoming unpopular among youth. The rate of decline in youth smoking is unprecedented. This despite the rapid rise in e-cigarette experimentation. These data are simply not consistent with the hypothesis that vaping is going to re-normalize smoking and that e-cigarettes are a gateway to youth smoking.The drop in e-cigarette use is also reassuring because it suggests that vaping is largely a social phenomenon that involves experimentation and that the addictive potential of these products is quite low. It also suggests that the popularity of youth vaping has peaked and that concerns about vaping taking over and leading to nicotine addiction among a huge proportion of youth are not warranted.If anything, the real concern at this point is whether the decline in e-cigarette use might actually slow the unprecedented declines we have seen in youth smoking.Original author: Michael Siegel
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Pariahs, predators or players? The tobacco industry and the end of smoking


June 12th, 2017

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The Swedish Miracle Continues


 A special report on tobacco and e-cigarettes published by Eurobarometer, the official polling organization of the 28-nation European Union (here), underscores the remarkable success of what researchers call “The Swedish Experience”. According to the report, the prevalence of smoking in Sweden is just 7%, with no other EU country even remotely close.  UK prevalence is 17%, while only Denmark, the Netherlands, Belgium and Ireland are below 20%.  The prevalence of daily smoking in Sweden is a bare 5%, as shown in the chart at left (credit to Lars Ramstrom from Sweden), and the prevalence of former smoking is 41%, the EU’s highest by far.  Eurobarometer provides an array of impressive statistics: “In all but one country, at least eight in ten (80%) of smokers consume tobacco products daily. The exception is Sweden, where only just over half (52%) give this response. In turn, over a fifth (21%) of smokers in Sweden are irregular smokers, consuming listed tobacco products less than monthly.  In all other countries, very few respondents give this answer.” There is only one explanation for Sweden’s remarkable number: the popularity of snus, the sales of which are prohibited in all other EU nations.  The new report reveals that 20% of Swedes use snus daily.  The only other countries with daily smokeless use are Denmark (1%), home of Oliver Twist chewing tobacco pellets, and Finland (2%). The Eurobarometer report should pressure the EU to end its snus ban.  Swedish Match has filed a complaint with the European Court of Justice to compel EU action.  For more on “the worst regulation in the EU,” see Clive Bates’ excellent commentaries, such as this (here). Original author: Brad Rodu
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Chewers and Dippers: Get the Facts on Smokeless from CASAA


Smokeless tobacco users in the U.S. are constantly under attack for their “bad habit”.  Public health officials and organizations deliberately misinform consumers about smokeless health risks, generating undue pressure to quit from friends and families. The truth about smokeless has been hard to come by. Chewers and dippers can watch my informative video interview with Mudjug’s Darcy Compton (here), or they can read or listen to my book, For Smokers Only, How Smokeless Tobacco Can Save Your Life.  Now, there’s another option: a downloadable pamphlet from Consumer Advocates for Smoke-free Alternatives Association (CASAA) titled, “Smokeless Tobacco: Separating Fact from Myth” (available here).  Save it as a pdf and print copies to share. CASAA is a non-profit organization “dedicated to ensuring the availability of reduced harm alternatives to smoking and to providing smokers and non-smokers alike with honest information about those alternatives so that they can make informed choices… We believe that consumers are best served by ensuring diversity in the marketplace and by being provided with truthful and accurate information so that they can make informed decisions regarding their health and lifestyle choices.” CASAA’s 200,000 members are active in tobacco legislation, litigation and regulation.  The group maintains an archive of thousands of testimonials from former smokers who found safer cigarette substitutes (here).  Everyone who cares about smokers, smokeless users and truthful information should become a member here. Original author: Brad Rodu
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Letter to European Commissioner for Better Regulation on the worst regulation in the EU – the snus ban

Eighteen of us have just written a detailed letter to Mr Frans Timmerman, the EU’s Commissioner for Better Regulation (amongst other things) drawing his attention to one of the worst regulations in the EU, the ban on oral tobacco, better known as snus. This ban is now facing challenge in the Court of Justice of the European Union (case C 151/17) by a producer, Swedish Match, and the consumer group, New Nicotine Alliance (see NNA background on the case).

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Democrats press FDA to proceed with destruction of the vaping market – we respond



June 1st, 2017

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CDC Bemoans the Fact that the Public Has an Accurate Understanding of Secondhand Vaping Risks

In an article published in the journal Preventing Chronic Disease, researchers from the Centers for Disease Control and Prevention (CDC) report the results of a national survey of U.S. adults to assess their opinion regarding the harmfulness of exposure to "secondhand" vaping (i.e., exposure to the air in a place where vaping is taking place).The results of the study were as follows: "Overall, 5.3% of adults responded that secondhand EVP exposure caused “no harm” to children, 39.9% responded “little harm” or “some harm,” 21.5% responded “a lot of harm,” and 33.3% responded “don’t know.”"The article concludes: "Current cigarette smokers and EVP users had greater odds of reporting that exposure to secondhand EVP aerosol causes “no harm” or “little harm” or “some harm” to children compared with never cigarette smokers and never EVP users. However, scientific evidence indicates that EVP aerosol exhaled into the air potentially exposes nonusers to aerosolized nicotine and other harmful and potentially harmful substances, including heavy metals, ultrafine particulates, and volatile organic compounds."It appears that CDC has concluded that the correct answer to the question is "a lot of harm" and that answers of "no harm," "little harm," or even "some harm" are incorrect. Therefore, more education is needed to inform the public of the "harms" (apparently, the substantial harms) of secondhand vaping. The basis of the CDC's contention that secondhand vaping is very harmful is that "this aerosol is not as safe as clean air" and that it "is not harmless and that it can contain harmful and potentially harmful chemicals, including nicotine." The Rest of the StoryApparently, the CDC has forgotten one of the major principles of environmental health, which is that the dose of exposure to a chemical is critical in assessing its health impact. Just because e-cigarette aerosol has been found to contain nicotine and some other chemicals does not mean that it is substantially harmful. What matters is the actual exposure, which is dependent upon the levels of these chemicals in ambient air under actual (real-life) conditions and the duration of exposure. To date, there is no evidence that there is any substantial exposure to harmful chemicals in real-life situations that most adults and children encounter. On the contrary, there is evidence that secondhand "vapor" dissipates rapidly and that exposure to nicotine and other chemicals is very low.While I agree that public education about the risks of vaping is needed, I believe that "public education" implies giving people the actual facts, not making things up or exaggerating harms that are not known to exist.Here, the CDC is clearly suggesting that we mislead the public by trying to convince them that secondhand vaping is a significant public health hazard when in fact the evidence suggests the opposite.The worst that the CDC can document about secondhand "EVP" is that it is "not as safe as clean air" and that it is "not harmless." That is hardly a ringing endorsement of EVP representing a substantial public health problem or of EVP being very harmful.Moreover, people who state that they "do not know" the hazards cannot be viewed as being ignorant, as the CDC would have us believe, because there is not a huge body of literature on this topic and the exact risks have not yet been quantified. But there is certainly no evidence at present that secondhand vaping is harmful. Therefore, we cannot say that people who believe that EVP is "not harmful" are wrong.Clearly, the CDC is not interested in the actual scientific facts. They are simply interested in scaring people about the harms of secondhand vapor - harms that have not been shown to exist. The CDC is engaging in an unwarranted scare campaign against e-cigarettes and apparently is trying to demonize these products because, for some reason, it doesn't like them.The unfortunate part of this is not merely that the CDC is violating principles of public health by deceiving the public and by making claims that are not substantiated by scientific evidence. The CDC's statements are also a tangible threat to the public's health. By deceiving people about the risks of e-cigarettes, CDC is actually undermining the public's appreciation of the hazards of smoking and the tremendous difference in risk between the use of combustible tobacco products and the use of tobacco-free, smoke-free, non-combusted products. This could lead to smokers deciding not to quit because there is no point to vaping if it is just as harmful as smoking. It could also lead to former smokers returning to smoking for the same reason.In this era of the government relying upon and disseminating "alternative facts," it is especially inappropriate for the CDC to be waging a campaign of deception about the health effects of vaping and secondhand vaping.Original author: Michael Siegel
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San Francisco, CA - Local Alert - Help us stop the flavor ban!

(Update - 05.20.17)

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