Tobacco use

Study: Americans with lower incomes more likely to have respiratory illnesses

Despite improvements in air quality and other advances, Americans with low incomes more often have asthma, lung disease and related illnesses, a new study has found (Source: “Poor Americans More Likely to Have Respiratory Problems, Study Finds,” New York Times, May 28).

In recent decades, air quality has improved in the United States, smoking rates have plummeted and government safety regulations have reduced exposure to workplace pollutants. But rich and poor Americans have not benefited equally, scientists reported in a paper on Friday.

While wealthier Americans have quit smoking in droves, tobacco use remains frequent among the poor. Asthma has become more prevalent among all children, but it has increased more drastically in low-income communities. And Americans with lower incomes continue to have more chronic lung disease than the wealthy.

The analysis, which was published in JAMA Internal Medicine, included data from national health surveys conducted by the Centers for Disease Control and Prevention periodically from 1959 to 2018. The study did not examine disparities in respiratory health by race or ethnicity, though it assessed both income-based and education-based differences in lung health.

Before the 1980s, smoking rates did not vary much by income, and they only slightly varied by education level: 62% of the wealthiest adults and 56% of the poorest were either current or former smokers. But that has changed drastically. By the survey period 2017-18, current and former smoking rates among the wealthiest dropped by nearly half to 34% — while rates among the poorest inched up to 57.9%.


Ban on menthol cigarettes, long marketed to Black Americans, gains momentum

Banning menthol cigarettes appears to be gaining political momentum at the federal, state and local levels (Source: “Menthol Cigarettes Kill Many Black People. A Ban May Finally Be Near.,” New York Times, March 22).

Black smokers smoke less but die of heart attacks, strokes and other causes linked to tobacco use at higher rates than white smokers do, according to the Centers for Disease Control and Prevention. And 85% of Black smokers use Newport, Kool and other menthol brands that are aggressively marketed to Black Americans and are easier to become addicted to and harder to quit than plain tobacco, according to the Food and Drug Administration (FDA).

There is also now growing momentum in Congress to enact a ban. In states and municipalities across the country, Black public health activists have been organizing support and getting new laws passed at the state and local level. Public opposition among white parents to all flavored e-cigarettes, including menthol, has brought new resources to the issue. And the FDA is under a court order to respond to a citizens’ petition to ban menthol by April 29.


Ohio cigarette tax revenue up as more Ohioans appear to be smoking during the pandemic

Cigarette tax revenue in Ohio has been significantly higher than expected through September, a troubling sign that Ohioans are smoking and using other tobacco products more during the pandemic (Source: “‘Troubling trend’: Ohioans appear to be smoking more amid pandemic stress,” Dayton Daily News, Oct. 20).

Cigarette excise tax revenue was $16.1 million (21.8%) above what the state had anticipated for September and $23.5 million (13.6%) above estimate for the first quarter of the state fiscal year.

The Ohio Office of Budget and Management said in its monthly budget report that the "substantial overage is likely related to heightened consumption during the continuing pandemic.”

“It’s a very troubling trend because Ohio already has very high rates of tobacco use and it’s a major cause of our poor health outcomes in Ohio,” said Amy Bush Stevens, vice president of Health Policy Institute of Ohio.

Smoking is the No. 1 cause of preventable deaths. About 20.5% of adults smoked cigarettes in Ohio in 2018, according to the Centers for Disease Control and Prevention, placing the state as the 11th highest smoking rate in the country.

The coronavirus pandemic is a higher risk time for smokers. Smoking impairs lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases. The CDC states being a current or former cigarette smoker increases risk of severe illness from COVID-19.


CDC: Teen e-cigarette use drops

The number of high school students regularly using e-cigarettes dropped significantly over the past year, after several years of soaring use, according to a new government survey of teenagers (Source: “E-Cigarette Use Falls Sharply Among Teenagers, C.D.C. Finds,” New York Times, Sept. 9).

The encouraging public health news was tempered by evidence that many high school users were taking advantage of a regulatory loophole to get access to flavored products.

But the CDC data suggested that even greater progress may have been stymied by the growing popularity of a new product — disposable e-cigarettes, which, under a loophole in federal regulations, are still allowed to be sold in youth-friendly flavors.

The shifting trends were captured by the 2020 National Youth Tobacco Survey, an annual look at teen use of tobacco-related products, administered by the Centers for Disease Control and Prevention.


Smokers, vapers may be at greater risk for COVID-19, experts warn

Because the coronavirus attacks the lungs, experts are warning that those who smoke or vape are at greater risk for COVID-19 complications (Source: “Smokers and Vapers May Be at Greater Risk for Covid-19,” New York Times, April 9, 2020).

”Quitting during this pandemic could not only save your life, but by preventing the need for your treatment in a hospital, you might also save someone else’s life,” said Dr. Jonathan Winickoff, director of pediatric research at the Tobacco Research and Treatment Center at Massachusetts General Hospital.

Studies already amply show that cigarette smoking weakens the immune system and compromises lung function. Research into the health effects of vaping is limited because the devices are relatively new, but studies suggest that e-cigarettes may cause inflammation in the airways and lungs.

Warnings about smoking use and COVID are an especially important consideration in Ohio. The state ranks in the bottom quartile for adult smoking and children living in a household with a smoker, according to HPIO’s 2019 Health Value Dashboard. Analysis of the rankings found that tobacco use and secondhand smoke exposure contribute to many of Ohio’s greatest health challenges, including infant mortality, cardiovascular disease, cancer and asthma.


As new federal vape rules go into effect, experts warn of potential loophole

The U.S. government on Thursday began enforcing restrictions on flavored electronic cigarettes aimed at curbing underage vaping, but experts warn that some young people have already moved on to a newer kind of vape that isn’t covered by the flavor ban (Source: “FDA crackdown on vaping flavors has blind spot: disposables,” Associated Press, Feb. 6, 2020).

These disposable e-cigarettes are sold under brands like Puff Bar, Stig and Fogg in flavors such as pink lemonade, blueberry ice and tropical mango.

The Food and Drug Administration’s crackdown narrowly targets reusable vaping devices like Juul, the brand that helped trigger the teen vaping craze in the U.S. Under the new policy, only menthol and tobacco flavors are allowed for those devices. Critics of the FDA policy fear teens will simply switch to the cheaper disposables, which are widely available at convenience stores and gas stations.

The FDA confirmed that the flavor restriction won’t apply to “self-contained, disposable products,” but only to rechargeable ones that use pods or cartridges prefilled with a nicotine solution.


FDA to restrict most e-cigarette flavors

The Food and Drug Administration on Thursday announced restrictions on the sale and manufacturing of all flavors of e-cigarette pods except tobacco and menthol (Source: “FDA to enact scaled-back e-cigarette flavor ban,” Modern Healthcare, Jan. 2, 2020).

FDA Commissioner Dr. Stephen Hahn said the policy was intended to limit youth e-cigarette use but maximize the potential benefit to adults trying to quit smoking combustible cigarettes. The flavor restrictions do not apply to tank vaping systems found at vape shops that HHS officials said are more often used by adults.

The Trump administration in September indicated it wanted to ban all e-cigarette flavors besides tobacco. Campaign for Tobacco-Free Kids President Matthew Myers said the exceptions were concessions to the vaping industry and vape shops that had furiously lobbied to water down the flavor ban.

"By leaving menthol flavored e-cigarettes widely available and completely exempting liquid flavored products, this policy will not stop the youth e-cigarette epidemic," the group said in a statement.

HHS officials justified leaving menthol-flavored e-cigarette pods on the market by pointing to the 2019 Monitoring the Future survey, which showed less than 1% of frequent youth e-cigarette users surveyed in the 10th grade most often used the classic tobacco flavor, compared to 4.8% who preferred menthol. Mint was the most popular flavor at 52.1%.


Congress approves raising age for tobacco, e-cigarettes to 21

The U.S. House and Senate have now passed a provision that would ban the sale of tobacco and e-cigarettes to anyone under 21 (Source: “Congress Approves Raising Age to 21 for E-Cigarette and Tobacco Sales,” New York Times, Dec. 19, 2019).

The rule comes at a time when Congress and the Trump administration are facing public pressure to reduce the soaring rates of teenage vaping. President Trump has spoken in favor of increasing the age limit, and is expected to sign the measure into law as part of the overall spending package.

Nineteen states, including Ohio, and more than 500 cities and towns have already raised the age to 21. Setting it as a national age limit is viewed as an effort to appease those who are calling for a full ban on e-cigarettes or a flavor ban to prevent addicting a new generation to nicotine.

While many lawmakers and public health experts welcomed a higher age limit for sales of cigarette items, others argue that tougher enforcement of sales laws, as well as higher taxes on products, are also needed to deter teenage use.

Doctors and public health experts have long been concerned about the effects of nicotine on the teenage brain. The National Academy of Medicine has estimated that 90% of adult smokers first start the habit before turning 19, when developing brains are most vulnerable to nicotine addiction. In a 2015 study, the academy reported that banning legal access to those under 21 would spur a 12% reduction in tobacco use by the time current teenagers became adults; with the biggest impact among 15-to-17-year olds.


Tough anti-vaping laws could have unintended public health consequences, experts warn

As new restrictions at the local, state and federal level are poised to wipe out thousands of fruit-, candy- and dessert-flavored vapes that have attracted teens, experts who study tobacco policy fear the scattershot approach of the clampdown could have damaging, unintended consequences, including driving adults who vape back to cigarette smoking, which remains the nation’s leading preventable cause of death (Source: “Clampdown on vaping could send users back toward cigarettes,” Associated Press via ABC News, Oct. 5, 2019).

“This could take us from potentially the single biggest improvement in public health in the United States toward a public health disaster in which cigarettes continue to be the dominant nicotine product,” said Jonathan Foulds, an addiction researcher and tobacco specialist at Penn State University.

The policy debate underscores the challenge of finding the right regulatory scheme for e-cigarettes, products for which there is little high-quality research.

More than 30 countries prohibit vaping products. In contrast, the United Kingdom has fully embraced them as a public health tool, urging doctors to promote them to help smokers quit. The U.S. FDA has been struggling to find the right approach since it gained authority over e-cigarettes in 2016.

Further complicating the picture is the fact that no e-cigarette brand has yet been shown to help smokers quit in rigorous studies. But large-scale surveys suggest smokers who use e-cigarettes daily are up to six times more likely to quit than those who don’t use them.


Teen vaping use continues to climb, new national study finds

About 25% of high school seniors surveyed this year said they vaped nicotine in the previous month, up from about 21% the year before (Source: “Teen vaping of nicotine jumped again this year, survey finds,” Associated Press, Sept. 18, 2019).

The University of Michigan study was published online Wednesday by the New England Journal of Medicine. Researchers surveyed more than 42,000 students across the country in grades 8, 10 and 12.

The study also found cigarette smoking declined in high school seniors, from about 8% to 6%. The researchers have not reported how many students said they vaped marijuana.

A government survey released last week showed similar trends.