Decrease Seen In Cigarette Consumption, Increase In Alternatives

Gone are the days of “Mad Men” and big tobacco. Smoking cigarettes doesn’t quite have the cultural significance it had in the past in the U.S., with public health advocates promoting the benefits of quitting smoking. However, a study found that there’s been a shift in the tobacco products that are used in the country. The Centers for Disease Control and Prevention (CDC) recently reported that there has been a decrease in cigarette consumption, but increases in other types of smoked tobacco. Over the past 11 years, there has been a decline in the consumption of cigarettes. In particular, from 2010 to 2011, there was a 2.5 percent decrease. On the other hand, from 2010 to 2011, there has been an uptick in the use of pipe tobacco (482 percent) and large cigars (233 percent).

“While consumption patterns of traditional cigarettes have continued to decline, when we take into account these alternative cigarette like products, we’re seeing a lack of change in the overall consumption of burned tobacco that is being inhaled,” explained study author Terry Pechacek, associate director for science with the CDC Office on Smoking and Health in Atlanta, in a New York Times article. The CDC believes that the increase could possibly be due to loopholes in tax structure and the classification system. For example, tobacco companies added weight to small cigars so that they could be classified as large cigars, allowing the company to save on taxes.

The New York Times also reports that the Government Accountability Office has advised changing federal tobacco excise taxes to prohibit differential taxation. Companies like Altria Group have stated that they would not be supportive of instituting a tax system of more than one level. “Altria and its tobacco operating companies believe that little cigars and roll your own tobacco should pay the same tax as cigarettes, as Congress intended,” David Sylvia, a spokesman for Altria, wrote in an email to Bloomberg. “The companies support legislation at both the state and federal level to ensure that taxes on little cigars and roll your own are taxed the same as cigarettes.”

The study, published in a recent edition of the Morbidity and Mortality Weekly Report, included data from the Treasury Department who had calculated consumption for all types of smoked tobacco products. The researchers found that, due to differences in taxes for pipe tobacco and roll-your-own tobacco as opposed to cigarettes, there was an increase in sales for pipe tobacco. Pipe tobacco is seen as a cheaper option than manufactured cigarettes. “The disparity in tax treatment of tobacco products is undercutting our ability to effectively reduce tobacco use and save lives,” remarked Chris Hansen, president of the American Cancer Society Cancer Action Network, in a statement to USA Today. “More smokers who might otherwise quit are now resorting to other types of tobacco products, including cigars and pipe tobacco, because of lower taxes resulting in overall lower costs.

The CDC’s findings are consistent with a Government Accountability Office report issued in April that found the same disparities in consumption of smoked tobacco products.” According to USA Today, while cigarettes are sold for $4 to $5 per pack, little cigars are sold for approximately $1.40 a pack. “This report demonstrates that the tobacco industry is as resourceful, and as predatory, as ever,” Thomas Glynn, director of international cancer control at the American Cancer Society, told USA Today. “It also provides us with some insight into the tobacco industry’s future plans.

When manufactured cigarettes may, at some point in the future, no longer be their primary source of income, they will look to other ways — such as cigars, roll-your-own, various forms of smokeless tobacco — of maintaining their customer’s nicotine dependence.” The researchers find the little cigars worrisome, as they are available in a number of flavors, like grape and chocolate, which can be appealing to children and teens. “They look like cigarettes,” commented Michael Tynan, co-author of the CDC report, in the USA Today article. “They smoke like cigarettes. They taste better than a cigarette, because they have flavors. They are cheaper than cigarettes, because of the tax issues. But they are just as deadly.

They contain the same toxic chemicals.” Studies have also found that new smokers consist of many young people and almost all smokers start the habit before they are 20 years of age. “The rise in cigar smoking, which other studies show is a growing problem among youth and young adults, is cause for alarm,” noted Tim McAfee, director of CDC’s Office on Smoking and Health, in a prepared statement. “The Surgeon General’s Report released this past March shows that getting young people to either quit smoking or never start smoking is the key to ending the tobacco epidemic, because 99 percent of all smokers start before they’re 26 years old.” According to the CDC, tobacco use can lead to heart disease, various forms of cancer, lung disease, and other chronic health conditions. In terms of health care costs, cigarette use has led to $193 billion in costs annually. redOrbit (http://s.tt/1jQB5)

Grisly warnings on cigarette packs in UAE from tomorrow

One of four images will occupy half the space on both sides of the pack. A third of the remaining space will display written warnings. "This policy has been proven effective in countries that have applied this measure," said Dr Wedad Al Maidoor, head of the tobacco control committee at the Ministry of Health. "Young smokers will seriously start to think about the dangers of smoking and either stop or cut down the number of cigarettes they are smoking." The graphics will also prevent tobacco companies from using packaging to advertise their product, Dr Al Maidoor said.

"With their packaging, they are fooling the customer into thinking [smoking] is something that is cool and nice - that it is a part of your life," she said. "Now this will be taken very seriously. The graphic cannot be removed or peeled off - it's part of the packaging." According to Dr Al Maidoor, the UAE is the first country in the GCC to introduce this policy. However the process was not easy, she said. "Tobacco companies were very resistant, and they are still resistant in the other GCC countries," she said.

"They are giving the message that no matter what you do, people will still smoke. But that is not true and we've seen how these policies can work." Future plans include having completely plain packaging - where nothing but the graphic image will be in colour and the brand name will be significantly smaller. "The human brain is more attracted to the colour than the pictures, but by having plain packaging more focus will be placed on the image," she said.

The Ministry of Health is still in talks with the Ministry of Finance to increase the taxation on cigarettes, a move that was first announced in 2010. "The Ministry of Finance said they need more time," Dr Al Maidoor said. "First they want to control smuggling and then raise the tax. They're approaching it step by step." The lobbying of tobacco companies remains a major challenge, she added, but said officials are determined to make the new system work.

Heavy Smoking May Be a Genetic Thing

Patients who start smoking at a younger age appear to have a genetic susceptibility to heavy smoking as adults, researchers found. In a meta-analysis, smokers who started at age 16 or younger and had at least one mutation in a nonsynonymous single-nucleotide polymorphism in CHRNA5 -- rs16969968 -- had a significantly greater risk for heavy smoking in adulthood than those who started smoking later (OR 1.45, 95% CI 1.36 to 1.55, P=0.01), according to Laura Bierut, MD, of Washington University School of Medicine in St. Louis, Mo., and colleagues.

"The finding of a stronger genetic risk in early-onset smokers supports public health interventions to reduce adolescent smoking," they wrote in the Aug. 6 issue of Archives of General Psychiatry. The results are supported by earlier studies in animal models showing that "the developing adolescent brain [is] particularly vulnerable to addictive effects of nicotine and by human studies suggesting that adolescent neurodevelopment is a particularly vulnerable period for the development of addiction," the authors explained.

The researchers analyzed a sample of 33,348 ever-smokers from 43 studies and stratified participants into early-onset -- those who started smoking at 16 or younger -- and late-onset smokers or those who started after age 16. Additionally, participants had presence of the rs16969968 genotype, or an analogous SNP called rs1051730, measured against heavy and light smoking status. The analogous gene was included, the authors wrote, because it provided "statistically equivalent results and there is biological evidence that rs16969968 alters receptor function."

"An unresolved issue is whether rs16969968 plays a role in the heightened susceptibility to nicotine dependence in early-onset smokers," they added. Heavy smoking status was defined as more than 20 cigarettes per day, while light smoking was defined as 10 or fewer cigarettes per day, with moderate smoking status excluded from the analysis. They found that the overall risk for heavy smoking in participants who initiated smoking early was significant at an odds ratio of 2.63 (95% CI 2.49 to 2.78, P

Smoking during pregnancy causes respiratory problems in offspring

Another impact of maternal smoking on offspring has emerged. A new study evaluated the incidence of bronchiolitis (inflammation of the smaller breathing tubes in the lungs) in infants born to mothers who smoked during their pregnancy. Researchers affiliated with Harvard Medical School, Baylor College of Medicine, the University of Louisville, and the University of Pittsburgh published their findings online in the journal Pediatrics.

The researchers designed a study to identify factors associated with continuous positive airway pressure (CPAP) and/or intubation for children with bronchiolitis. They conducted a 16-center, prospective study of hospitalized children aged less than two years with bronchiolitis. For three consecutive years from November 1 2007 until March 2010, the investigators collected clinical data and a nasopharyngeal aspirate from the children. They oversampled children from the intensive care unit (ICU); samples of nasopharyngeal aspirate were tested by polymerase chain reaction for 18 pathogens.

The study group was comprised of 2,207 children; 379 (17%) were admitted to the ICU, and 161 (42%) of those children required continuous positive airway pressure (CPAP) and/or intubation; 59 (37%) required CPAP, 64 (40%) required intubation, and 38 (23%) required both. The median age of the subjects was four months; 59% were male; 61% were Caucasian, 24% were black, and 36% were Hispanic. In addition to collecting clinical information, the researchers conducted interviews to obtain patient demographics, medical histories, environmental histories, and acute illness details. The parents were asked if the mother of the child smoked cigarettes during the pregnancy.

Significant factors for the prediction of CPAP/intubation were: age less than two months (4.3-fold increased risk), maternal smoking during pregnancy (1.4-fold increased risk), birth weight less than 5 pounds (1.7-fold increased risk), breathing difficulty began less than one day before admission (1.6-fold increased risk), presence of apnea (cessation of breathing; 4.8-fold increased risk), inadequate oral intake (2.5-fold increased risk), severe retractions (11.1-fold increased risk), and room air oxygen saturation less than 85% (3.3-fold increased risk).

The authors concluded that they had identified several demographic, historical, and clinical factors that predicted the use of CPAP and/or intubation, including children born to mothers who smoked during pregnancy. They also identified a unique subgroup of children who required mechanical respiratory support less than one day after respiratory symptoms began.

Centerville bans smoke shops

Smoke shops have joined taverns and tattoo parlors in the banned category in Centerville. In a 3-2 vote, the City Council on Tuesday added a definition of tobacco specialty businesses to the municipal zoning code, then voted to prohibit those stores from every type of zone. The speciality businesses are defined under state law as those that make more than 35 percent of their annual gross receipts from the sale of tobacco products.

Council members Ken Averett and Lawrence Wright voted for the zoning ordinance prohibiting smoke shops, while John Higginson and Sherri Lindstrom voted against it. Because of the deadlock, Mayor Ronald Russell cast the tie-breaking vote. Council member Justin Allen was not at the meeting. Higginson, who said he doesn’t smoke and wishes no one did, said his vote was based on "people’s right to open a store." Cigarettes and other types of tobacco will still be available at convenience stores and other outlets in Centerville. And the ban does not affect the city’s only existing specialty store, the Smoke Shop, at 356 N. Market Place Drive.

"We’re not taking away somebody’s right to smoke," Wright said. The council action was prompted by HB95S1, a bill passed earlier this year by the Utah Legislature that requires new smoke shops to get a city business license to operate and restricts where they can operate. Under the law, a retail tobacco specialty business cannot be within 1,000 feet of a community location — a school, child care facility, church, library, public park or playground, youth center and public arcade — or within 600 feet of property zoned or used for agriculture or residential use.

Those limitations significantly reduce the area where a smoke shop could go, according to Cory Snyder, community development director. In addition, HB95S1 allows a city to enact more restrictive requirements, and Centerville Planning Commission members last month unanimously recommended a ban. A report on the reasons for the recommendation notes that the city’s general plan "desires a tax base of ‘high quality’ business uses." In addition, the commission also found that "other similar or problematic uses, such as taverns, privates clubs, tattoo parlors, are also not ‘permitted uses’ of any zoning district," the report says.

Charges filed against naturopaths for marijuana authorizations at Hempfest

The state Department of Health has charged two naturopaths with unprofessional conduct for operating an “assembly line” practice of authorizing medical marijuana at last year’s Hempfest. The charges, filed Tuesday, appear to be the first disciplinary action taken against a state medical professional for a medical marijuana authorization, said Tim Church, a DOH spokesman.

The two naturopaths, Carolyn Lee Bearss and Dimitrios Jimmy Magiasis were featured in a Seattle Times story last August in which a reporter received a medical marijuana authorization for $150 at a Hempfest tent. Bearss recommended marijuana as treatment for the reporter’s lower-back pain without seeing medical records after an appointment that lasted 11 minutes. The naturopaths were independent contractors for a company owned by 4Evergreen Group, one of the largest regional clinics specializing in medical marijuana authorizations.

During Hempfest, the two naturopaths saw a combined 216 patients and recommended marijuana for 214 of them, according to the DOH charges against Bearss and Magiasis. The charges accuse the naturopaths of stretching the definition of “intractable pain” – one of the qualifying conditions under the state medical cannabis law — and of failing to explore other treatment options, as also required.

“This assembly line type of practice failed to meet the standard of care because individualized treatment options were not adequately rendered to the patient,” according to the charges. The state medical marijuana law protects medical professionals from criminal or disciplinary charges if they follow a set of rules, including completing an exam and documenting other ways used to treat “the terminal or debilitating medical condition” other than marijuana.

Pa. town tax collector dealt marijuana

A 21-year-old central Pennsylvania tax collector has been relieved of his duties after police say he sold marijuana to an undercover officer. Carlisle tax collector George Hicks disputes the allegations, saying he uses marijuana for medical reasons.

Hicks was arrested Tuesday on two felony charges of possession with intent to deliver and released on bail. Cumberland County prosecutors say Hicks twice sold drugs to an undercover officer. Police say they have video and audio evidence to support the charges.

District Attorney David Freed says the sales took place in an office a few doors from where Hicks worked as tax collector. A judge granted an injunction temporarily relieving Hicks of his duties. The borough is taking over his duties.