Tobacco use

Graphic of the week

AlcoholTobaccoTrend_HighSchool_Standalone

Analysis from HPIO late last year found that the most notable change in tobacco use in recent years has been the shift away from combustible cigarettes and toward e-cigarettes among teens and young adults (see graphic above). By 2019, only 4.9% of Ohio high school students reported that they had smoked a cigarette in the past 30 days, while e-cigarettes surpassed alcohol and became the most commonly used drug among teens. Similarly, the percent of 18-24-year-olds reporting e-cigarette use jumped 77% from 2016 to 2020, making this the group of adults with the highest rate of e-cigarette use in 2020 (19%).

Learn more in HPIO’s fact sheet, Tobacco, Alcohol and Health Series: Health Impacts of Excessive Alcohol Use in Ohio.

 


Study: Smoking rates double in underserved communities

Patients in underserved communities smoke at a rate double that of the general U.S. population, according to a new study (Source: “Smoking rate in underserved communities double that of general population, study says,” Medical Economics, March 7).
 
The American Cancer Society study, which was published in the journal Cancer, found that the prevalence of smoking among adults served at federally qualified health centers was 28.1%, compared to 14% reported for the general U.S. population.
 
Among other major findings in the study are that Black adults who smoked had more than two times the odds of reporting substance use disorders.
 
“Our study underscores the importance of understanding the association and increased risk of mental health conditions and substance use disorders among adults from underserved communities who smoke while also addressing socioeconomic risk factors to achieve better health outcomes,” said study author Dr. Sue C. Lin of the Health Resources and Services Administration within the U.S. Department of Health and Human Services. “The study further highlights the significance of tailored smoking cessation treatments for individuals from underserved communities that will support cancer prevention care.”


Cigarettes sales up last year for first time in two decades

For the first time in two decades, cigarette sales increased last year during the COVID-19 pandemic, as tobacco companies also beefed up spending to promote their products (Source: “Cigarette sales went up last year for the first time in 20 years,” National Public Radio, Oct. 27).

The Federal Trade Commission, in its annual Cigarette Report, said that manufacturers sold 203.7 billion cigarettes in 2020, up from 202.9 billion in 2019 — an increase of 0.4%.

The cigarette companies, the report said, increased advertising and promotion to $7.84 billion in 2020 from $7.624 billion the previous year, concentrating the bulk of their spending in "price discounts paid to cigarette retailers in order to reduce the price of cigarettes to customers," the FTC said.


FDA approves e-cigarette product for first time

Federal health regulators Tuesday for the first time authorized the legal marketing of an electronic cigarette, saying the product from RJ Reynolds could help addicted adult smokers (Source: “FDA authorizes an e-cigarette for first time, citing benefit for smokers,” The Hill, Oct. 12).

The Food and Drug Administration said the company's refillable Vuse Solo closed device and tobacco-flavored e-liquid pods could benefit addicted adult smokers who switch by reducing their exposure to harmful chemicals.

The first-of-its-kind authorization comes amid an effort by the FDA to regulate the massive vaping industry and determine which products are allowed to stay on the market. 

It signals the agency may look more favorably on tobacco-flavored products than the fruity ones that are most popular among teenagers, even though some feature extremely high nicotine content.


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.