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Rassegna Stampa Scientifica Giugno 2022
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Orticaria indotta da citisina: un caso clinico durante un trattamento per smettere di fumare
La notizia è relativa al recente articolo pubblicato sulla rivista Acta Biomedica (Acta Biomed 2022; Vol. 93, Supplement 1: e2022073) accessibile attraverso il link: https://pubmed.ncbi.nlm.nih.gov/35731167/
La citisina il più antico farmaco per smettere di fumare, utilizzata da oltre 50 anni nell’Europa dell’est e in Asia, è generalmente ben tollerata ed efficace. Gli eventi avversi riportati negli studi sono in genere disturbi gastrointestinali e del sonno, non gravi e autolimitanti. E’ stato recentemente pubblicato per la prima volta un caso sospetto di orticaria, in una donna di 48 anni in cura per tabagismo presso l'Unità di Medicina delle Dipendenze, Dipartimento di Medicina Interna, Azienda Ospedaliera di Verona, Italia1. Il protocollo terapeutico utilizzato per la cessazione dal fumo era quello standard che prevede l’aumento gradualmente delle capsule di citisina assunte giornalmente. La paziente ha sospeso la citisina, è stata trattata per i primi tre giorni con betametasone (1 mg/die) e ha mostrato segni di guarigione dopo una settimana.
Brain lesions disrupting addiction map to a common human brain circuit
Nature Medicine (2022)
Published: 13 June 2022
Juho Joutsa, Khaled Moussawi, Shan H. Siddiqi, Amir Abdolahi, William Drew, Alexander L. Cohen, Thomas J. Ross, Harshawardhan U. Deshpande, Henry Z. Wang, Joel Bruss, Elliot A. Stein, Nora D. Volkow, Jordan H. Grafman, Edwin van Wijngaarden, Aaron D. Boes & Michael D. Fox
https://www.nature.com/articles/s41591-022-01834-y
https://www.nature.com/articles/s41591-022-01834-y.pdf
A smoke-free generation: New Zealand's tobacco ban
The Lancet
VOLUME 399, ISSUE 10339, P1930-1931, MAY 21, 2022
Chris McCall
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00925-4/fulltext
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2900925-4
Note: Open Access upon registration.
"Despite the current no-tobacco advertising policies, both PMI’s [Philip Morris International's] and Altria’s corporate image campaigns have run extensively in major news outlets (in both physical and digital formats), including the New York Times and Washington Post… They feature high-ranking corporate executives advocating for company-sponsored research coupled with claims that these companies are aligned with public health objectives. Message placement in prominent news outlets suggests a deliberate attempt to position their sponsored content alongside news reporting while helping to ensure message exposure among an influential audience… The extent to which these ‘corporate promotion’ ads have infiltrated major news outlets is concerning, raising questions about how objective media outlets should treat sponsored industry content."
Ad watch
Tobacco industry advertising: efforts to shift public perception of big tobacco with paid media in the USA
Tobacco Control Published Online First: 16 May 2022.
Robin Koval, Nicole Dorrler, Barbara Schillo
https://tobaccocontrol.bmj.com/content/early/2022/05/08/tobaccocontrol-2021-057189
"Our study demonstrates majority support for regulations controlling e-cigarettes in Australia. Parents generally favoured wide-ranging restrictions that could reduce adolescent e-cigarette use. Almost all parents support a ban on marketing and advertising of e-cigarettes to teenagers thus recognising the reach and influence of product appeal, placement and price on this age group. Australian governments have an opportunity to help prevent more widespread e-cigarette use and protect the health of adolescents by limiting their exposure to e-cigarette promotions."
Parents support strong restrictions controlling e-cigarette use in Australia: findings from a national survey
Tobacco Control Published Online First: 17 May 2022.
Mary-Anne Measey, Vikram Palit, Monsurul Hoq, Moya Vandeleur, Anthea Rhodes
https://tobaccocontrol.bmj.com/content/early/2022/05/16/tobaccocontrol-2021-057074
Also:
Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source
https://tobaccocontrol.bmj.com/content/early/2022/05/12/tobaccocontrol-2021-056986
Place-based inequities in cigarette smoking across the USA
https://tobaccocontrol.bmj.com/content/early/2022/05/17/tobaccocontrol-2022-057293
"Due to the low return of saliva samples, validated prolonged abstinence rates in the intention-to-treat analysis were low (39 of 571 (6.8%) versus 25 of 569 (4.4%) in the e-cigarette and NRT [nicotine replacement therapy] arms, respectively) and did not differ significantly between the two study arms… In summary, in the unadjusted primary analysis there was insufficient evidence to confidently demonstrate that e-cigarettes are more effective than NRT in helping pregnant women to stop smoking. The effects of e-cigarettes appear to have been masked by e-cigarette use in the NRT arm. When abstinent participants using non-allocated products were excluded, e-cigarettes were markedly more effective than patches in all abstinence outcomes. "
Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial
Nature Medicine (2022)
Published: 16 May 2022
Peter Hajek, Dunja Przulj, Francesca Pesola, Chris Griffiths, Robert Walton, Hayden McRobbie, Tim Coleman, Sarah Lewis, Rachel Whitemore, Miranda Clark, Michael Ussher, Lesley Sinclair, Emily Seager, Sue Cooper, Linda Bauld, Felix Naughton, Peter Sasieni, Isaac Manyonda & Katie Myers Smith
https://www.nature.com/articles/s41591-022-01808-0
https://www.nature.com/articles/s41591-022-01808-0.pdf
Note: Open Access.
Related coverage:
E-cigarettes ‘as safe as nicotine patches’ for pregnant smokers trying to quit
Vaping may be an effective way to quit smoking during pregnancy
"We did not find a significant difference in the cardiovascular risk of exclusive e-cigarette use compared with nonuse of cigarettes and e-cigarettes, although analyses were limited by a small number of CVD [cardiovascular disease] events in e-cigarette users. Dual use of cigarettes and e-cigarettes was associated with a significantly increased risk of CVD compared with nonuse. The cardiovascular risk of dual use did not differ from the risk among those exclusively smoking cigarettes."
Letter
E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019
Circulation. 2022;0
Originally published 6 May 2022
Jonathan B. Berlowitz, Wubin Xie, Alyssa F. Harlow, Naomi M. Hamburg, Michael J. Blaha, Aruni Bhatnagar, Emelia J. Benjamin and Andrew C. Stokes
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057369
https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.121.057369
Note: Open Access.
"We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014–2018… EC [E-cigarette] use was low in most countries. “Dual use” was common among current smokers and the quit ratio was higher among ECs users… Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals."
Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014–2018 Estimates From Global Adult Tobacco Surveys
Nicotine & Tobacco Research, ntab269.
Published: 21 May 2022
Chandrashekhar T Sreeramareddy, Anusha Manoharan
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntab269/6590320
"Following JUUL’s removal of mint in November 2019, JUUL’s market share dropped from over 66% in Florida and the United States to 37.1% (Florida) and 55.1% (United States). In January 2020, the second leading brands were Puff Bar (15.0%) in Florida and Vuse (18.1%) in the United States. Mint market share decreased and share of all other flavor categories increased, particularly menthol and concept. Total ENDS sales increased in Florida but decreased in the United States. Average prices of ENDS devices decreased. Conclusions: While JUUL’s actions led to a decline in its sales, Puff Bar emerged and menthol and concept flavors experienced growth."
JUUL’s 2019 Removal of Mint-Flavored Pods and Changes to the Retail Environment of Electronic Nicotine Delivery Systems in Florida and the United States
Nicotine & Tobacco Research, ntac128.
Published: 15 May 2022
Jennifer Gaber, Doris G Gammon, Youn Ok Lee, James Nonnemaker, Brittany Young, Annice Kim, Lauren Porter
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac128/6586051
Also:
Adolescents’ understanding of smoking and vaping risk language: Cognitive interviews to inform scale development
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac127/6585952
Secondhand tobacco smoke and functional impairments in older adults living in the community
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac131/6586052
A randomized pilot of a tailored smoking cessation quitline intervention for individuals who smoke and vape
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac129/6586250
"How we define “current use” of tobacco and nicotine delivery products changes our estimates of how individuals transition to, between, and from different patterns of use. We show that the robustness of transition estimates to whether or not non-established users are included as current users and to different frequency-of-use threshold depends in part on whether low-frequency users are categorized as non-current users or as a distinct category. Our results emphasize the importance of intentional definitions of product use that reflect the larger goals of public health and tobacco control."
The impact of current tobacco product use definitions on estimates of transitions between cigarette and ENDS use
Nicotine & Tobacco Research, ntac132.
Published: 19 May 2022
Andrew F Brouwer, David T Levy, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Luz María Sanchez-Romero, Ritesh Mistry, Rafael Meza
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac132/6589520
Also:
The unhealthy association between smoking, vaping, and other drug use
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac130/6588418
Note: Open Access.
"The hardening hypothesis suggests that tobacco control activities influence an individual’s ability to quit, and those who find it challenging to quit are those who remain smokers. Reviews and papers have attempted to demystify this hypothesis, and the debate continues. Adding to the continuing discussions, a recently-published umbrella and systematic review by Harris et al. (2022) strongly opposed the existence of the hardening hypothesis, after conducting a wide-ranging qualitative synthesis of the evidence pertinent to various hardening constructs and indicators. However, several key methodological issues may have ushered a deficient—or worse, unqualified—interpretation of the evidence base."
Correspondence
The Hardening Hypothesis – Further Testing is Still Required
Nicotine & Tobacco Research, ntac125.
Published: 13 May 2022
Isabella Steffensen, Red Thaddeus D Miguel, Julien Carlone
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac125/6585632
Referenced N&TR study:
Smokers increasingly motivated and able to quit as smoking prevalence falls: umbrella and systematic review of evidence relevant to the 'hardening hypothesis', considering transcendence of manufactured doubt
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac055/6542043
Note: Open Access.
"Ever/current [Hungarian] HTP [heated tobacco product] users presented misperceptions about the harms of HTPs, e-cigarettes, and NRT. They underestimated the potential health benefits of NRT and had distorted harm perceptions about HTPs and e-cigarettes. Public education about the relative harms of different nicotine and tobacco products is urgently needed."
Perceived harm of heated tobacco products, e-cigarettes, and nicotine replacement therapy compared with conventional cigarettes among ever and current heated tobacco users
Addict Behav Rep. 2022 May 16;15:100432. eCollection 2022 Jun.
Melinda Pénzes, Tamás Joó, Róbert Urbán
https://www.sciencedirect.com/science/article/pii/S235285322200027X
Note: Open Access.
"We analyzed data from Wave 3 (Sept-Dec 2019) and Wave 5 (Sept-Dec 2020) of a 2-year, 5-wave longitudinal study of young adults across six US metropolitan areas… Of W3 cigarette non-users (n=1693), 5.0% (n=85) initiated cigarettes at W5; predictors of initiation included younger age, lower perceived smoking risk, lifetime cigarette and e-cigarette use, and W3 e-cigarette use. Of W3 e-cigarette non-users (n=1522), 6.3% (n=96) initiated e-cigarettes at W5; predictors included younger age, less news exposure, lifetime cigarette and e-cigarette use, and W3 cigarette use. Conclusions: These findings underscore the need to address cigarette and e-cigarette co-use and related risk perceptions in prevention and cessation interventions."
Changes in cigarette and e-cigarette use among US young adults from before to during the COVID-19 pandemic: News exposure and risk perceptions as potential predictors
Tob Prev Cessat. 2022 May 6;8:18. eCollection 2022.
Breesa Bennett, Katelyn F Romm, Carla J Berg
Note: Open Access.
"In 2020, the prevalence of middle and high school students reporting “no” or “little” harm (vs. “some” or “a lot”) was 20.1% for e-cigarettes, 17.4% for hookahs, 14.6% for cigars, 13.5% for smokeless tobacco, and 11.0% for cigarettes. During 2016–2020, perceptions of “no” or “little” harm decreased for e-cigarettes, increased for cigarettes and smokeless tobacco, and exhibited nonlinear changes for hookahs. Discussion: Most youth are aware of tobacco product harms, but opportunities exist to educate youth about the harms of nondaily tobacco product use."
Tobacco Product Harm Perceptions Among US Middle and High School Students, 2016-2020
J Adolesc Health. 2022 May 19;S1054-139X(22)00386-X. Online ahead of print.
Emily Glidden, Nikki A Hawkins, Ahmed Jamal, Teresa W Wang
https://www.jahonline.org/article/S1054-139X(22)00386-X/fulltext
"The implementation of CEASE [Clinical effort against secondhand smoke exposure] in practices was influenced by the adaptability and complexity of the intervention, the needs of patients and their families, the resources available to practices to support the implementation of CEASE, other competing priorities at the practices, the cultures of practices, and clinicians' and office staffs' knowledge and beliefs about family-centered tobacco control."
A Qualitative Study of Factors Influencing Implementation of Tobacco Control in Pediatric Practices
J Smok Cessat. 2022 May 5;2022:4156982. eCollection 2022.
Emara Nabi-Burza, Jonathan P Winickoff, Jeremy E Drehmer, Maurice P Zeegers, Bethany Hipple Walters
https://www.hindawi.com/journals/josc/2022/4156982/
https://downloads.hindawi.com/journals/josc/2022/4156982.pdf
Note: Open Access.
"In the French context, the new plain packaging of tobacco products probably had an impact on smokers’ perception of tobacco by increasing the embarrassment they felt when they took out their pack of cigarettes in plain sight. It also influenced the motivation to quit smoking, and more generally, it could contribute to the denormalization of tobacco."
Plain packaging on tobacco products in France: Effectiveness on smokers’ attitudes one year after implementation
Tob. Induc. Dis. 2022;20(April):35
Anne Pasquereau, Romain Guignard, Raphaël Andler, Karine Gallopel-Morvan, Viêt Nguyen-Thanh
http://www.tobaccoinduceddiseases.org/pdf-146600-74381?filename=Plain%20packaging%20on.pdf
Note: Open Access.
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Rassegna Stampa Scientifica Maggio 2022
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Impact of Canada’s menthol cigarette ban on quitting among menthol smokers: pooled analysis of pre–post evaluation from the ITC Project and the Ontario Menthol Ban Study and projections of impact in the USA
Tobacco Control Published Online First: 28 April 2022.
Geoffrey T Fong, Janet Chung-Hall, Gang Meng, Lorraine V Craig, Mary E Thompson, Anne C K Quah, K Michael Cummings, Andrew Hyland, Richard J O'Connor, David T Levy, Cristine D Delnevo, Ollie Ganz, Thomas Eissenberg, Eric K Soule, Robert Schwartz, Joanna E Cohen, Michael O Chaiton
https://tobaccocontrol.bmj.com/content/early/2022/04/27/tobaccocontrol-2021-057227
Also:
Vaping and anime: a growing area of concern
https://tobaccocontrol.bmj.com/content/early/2022/04/25/tobaccocontrol-2021-057195
Note: Open Access.
"In conclusion, this review indicates that e-cigarette products with ice hybrid flavours or synthetic coolants may be appealing, widely marketed, preferred among young people and possess possible toxicological concerns. To inform regulation of e-cigarettes with ice flavours and non-menthol coolants, research is needed to address evidence gaps on the epidemiology, toxicology, health effects, addiction potential and influence on smoking cessation of the evolving product class."
Ice flavours and non-menthol synthetic cooling agents in e-cigarette products: a review
Tobacco Control Published Online First: 28 April 2022.
Adam M Leventhal, Alayna P Tackett, Lauren Whitted, Sven Eric Jordt, Sairam V Jabba
https://tobaccocontrol.bmj.com/content/early/2022/04/27/tobaccocontrol-2021-057073
Related BMJ Open report:
Measuring young adult appeal for menthol and non-menthol cigarettes: protocol of a clinical trial using both laboratory and intensive longitudinal methods (PRISM)
https://bmjopen.bmj.com/content/12/4/e058823.long
Note: Open Access.
"Of the sampled 558 960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of −3.2 (95% CI, −3.5 to −2.8; P < .001)… In this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019."
Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019
JAMA. 2022;327(16):1566-1576.
April 26, 2022
Beth Han, Nora D. Volkow, Carlos Blanco, Douglas Tipperman, Emily B. Einstein, Wilson M. Compton
https://jamanetwork.com/journals/jama/fullarticle/2791406
Related coverage:
Smoking rates fall among Americans with depression, substance use disorders
https://www.upi.com/Health_News/2022/04/27/smoking-depression-substance-use/2241651068404/
"Approximately 1% of pregnant women reported past 30-day exclusive e-cigarette use and 3.2% used e-cigarettes and one other tobacco product. Compared to no tobacco use, past 30-day e-cigarette use (exclusive or use with another tobacco product) during pregnancy was not associated with increased odds of an adverse pregnancy or birth outcome in bivariate or multivariable models… Conclusions: E-cigarette use during pregnancy is rare. Understanding the positive and negative impacts of pre-natal e-cigarette use on women’s health may guide public health messaging campaigns."
Birth Outcomes Associated with E-Cigarette and Non-E-Cigarette Tobacco Product Use During Pregnancy: An Examination of PATH Data Waves 1 – 5
Nicotine & Tobacco Research, ntac111.
Published: 26 April 2022
Amy Cohn, Hoda Elmasry, Robert C Wild, Amanda L Johnson, Haneen Abudayyeh, Allison Kurti, Victoria H Coleman-Cowger
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac111/6574582
"Results from this study provide initial insights into the extent to which required nicotine warning statements appear in ENDS [electronic nicotine delivery systems] ads in the study sample across traditional (e.g., magazines, television, radio) and digital (e.g., online/mobile ads) advertising mediums. Following the August 10, 2018 effective date, we observed a substantial increase in the presence of the required FDA warning statement on the ENDS ads in this sample. However, a notable number of ads in the study lacked the required warning and warnings did not always include the required formatting displays."
Presence of nicotine warning statement on US electronic nicotine delivery systems (ENDS) advertisements six months before and after the August 10, 2018 effective date
Nicotine & Tobacco Research, ntac104.
Published: 29 April 2022
Lauren Czaplicki, Kristy Marynak, Dannielle Kelley, Meghan Moran, Sarah Trigger, Ryan David Kennedy
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac104/6576195
"We found high rates of e-cigarette ever use (29%) and current use (13%) among study participants. There was high exposure to e-cigarette advertising and promotion in social media, with a majority of participants (84%) reported ever seeing e-cigarette adverts or promotions on Facebook, Instagram, YouTube, and others. Both high rates of e-cigarette use and exposure to social media advertising are associated. Participants reported ever seeing adverts and promotions were 2.91 times and 2.82 times more likely ever to use and currently use e-cigarettes, respectively, after controlling for socioeconomic factors, region, and cigarette smoking status."
Is Exposure to Social Media Advertising and Promotion Associated with E-cigarette Use? Evidence from Indonesia
Asian Pac J Cancer Prev. 2022 Apr 1;23(4):1257-1262.
Widya Ratna Wulan, Dian Kusuma, Nurjanah Nurjanah, Aprianti Aprianti, Abdillah Ahsan
http://journal.waocp.org/article_90059.html
http://journal.waocp.org/article_90059_b62d9e1456dba0b0bc46e82651231ea0.pdf
Also:
Cigarette Consumption and Nutrient Intake in Indonesia: Study of Cigarette-Consuming Households
http://journal.waocp.org/article_90066.html
http://journal.waocp.org/article_90066_1a899637ec3d23e9f65ab845147af2d9.pdf
Note: Open Access.
"The annual cessation rate increased 29% using NHIS [National Health Interview Survey] data (from 4.2% in 2008-2013 to 5.4% in 2014-2019) and 33% with NSDUH [National Survey on Drug Use and Health] data (4.2% to 5.6%). The cessation rate increase accounts for 60% of a smoking prevalence decline in the most recent period exceeding the 1990-2013 predicted trend. The remaining 40% owes to declining smoking initiation. With current initiation and cessation rates, smoking prevalence should fall to 8.3% in 2030 and eventually reach a steady state of 3.53%... This [cessation rate] increase suggests that the Healthy People 2030 goal of 5% adult smoking prevalence, while ambitious, is attainable."
Monitoring the Increase in the U.S. Smoking Cessation Rate and its Implication for Future Smoking Prevalence
Nicotine & Tobacco Research, ntac115.
Published: 29 April 2022
David Méndez, Thuy T T Le, Kenneth E Warner
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac115/6576151
Note: Open Access.
Also:
A Daily Assessment Study of Smoking Cessation After a Head and Neck Cancer Diagnosis
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac114/6576149
"We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries… 51.1% of current tobacco smokers and 27.1% of exclusive EC [e-cigarette] or HTP [heated tobacco product] users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%)… Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit."
How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries
BMJ Open. 2022 Apr 29;12(4):e059068.
Marie Line El Asmar, Anthony A Laverty, Constantine I Vardavas, Filippos T Filippidis
https://bmjopen.bmj.com/content/12/4/e059068
Also:
Cross-sectional survey on cigarette smoking in Chinese high-income areas
https://bmjopen.bmj.com/content/12/4/e056209
Note: Open Access.
"After adjustment for secular trends, there was a significant increase from the pre-pandemic to pandemic period in the prevalence of use of traditional remote support by past-year smokers in a quit attempt (odds ratio[OR]=2.18[95% confidence interval 1.42-3.33]); specifically telephone support (OR=7.16[2.19-23.45]) and websites (OR=2.39[1.41-4.08]). There was also an increase in the prevalence of use of prescription medication (OR=1.47[1.08-2.00]); specifically varenicline (OR=1.66[1.09-2.52]). There were no significant changes in prevalence of use of other cessation aids after adjustment for secular trends."
Prevalence of use and real-world effectiveness of smoking cessation aids during the Covid-19 pandemic: a representative study of smokers in England
Addiction. 2022 May 2. Online ahead of print.
Sarah E Jackson, Sharon Cox, Lion Shahab, Jamie Brown
https://onlinelibrary.wiley.com/doi/10.1111/add.15903
Also:
Identifying Prospective Subpopulations of Combustible and Electronic Cigarette Dual Users in the United States via Finite Mixture Modeling
https://onlinelibrary.wiley.com/doi/10.1111/add.15906
"The results indicate that higher cigarette prices and taxes were associated with a decrease in smoking prevalence and an increased likelihood of quitting smoking. Cigarette tax and price increases produced the most powerful impact on the smoking prevalence of 18- to 24-year-olds. The estimates also show that males tended to be more price-sensitive than females… Cigarette price and tax changes were likely to have a smaller effect on individuals with annual income under $25,000 relative to individuals with higher income levels."
The association between smoking behaviors and prices and taxes per cigarette pack in the United States from 2000 through 2019
BMC Public Health. 2022 Apr 28;22(1):856.
Thuy T T Le, Mohammed A Jaffri
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13242-5
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-022-13242-5.pdf
Note: Open Access.
"Considering the average PAAS [primary aromatic amines] content and estimated CBs [cigarette butts] littered worldwide every year, freshly smoked CBs can theoretically emit 2.9 tons of ∑PAAs into the environment annually. Considering other chemicals that may also be released into the environment via CBs (beside PAAs), we can consider CBs as a critical source of toxic compounds into the environment and water bodies."
Aromatic amines contents of cigarette butts: Fresh and aged cigarette butts vs unsmoked cigarette
Chemosphere. 2022 Apr 27;134735. Online ahead of print.
Sina Dobaradaran, Xenia A M Mutke, Torsten C Schmidt, Philipp Swiderski, Gabriel E De-la-Torre, Maik A Jochmann
E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019
Circulation
Originally published 6 May 2022
Jonathan B. Berlowitz, Wubin Xie, Alyssa F. Harlow, Naomi M. Hamburg, Michael J. Blaha, Aruni Bhatnagar, Emelia J. Benjamin and Andrew C. Stokes
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057369
https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.121.057369
Note: Open Access.
Related PR:
No health benefits among adults who used both e-cigarettes and traditional cigarettes
"3830 English videos were included in the supervised machine learning. The most common video theme was ‘product review’ (48.9%), followed by ‘instruction’ (eg, ‘how to’ use/modify e-cigarettes; 17.3%); diverse e-cigarette products were featured; ‘vape enthusiasts’ most frequently posted e-cigarette videos (54.0%), followed by retailers (20.3%); 43.2% of videos had discount/sales of e-cigarettes; and the most common sales strategy was external links for purchasing (34.1%). ‘Vape trick’ was the least common theme but had the highest engagement (eg, >2 million views)… Discussion Our findings indicate that on YouTube videos accessible to youth, a variety of e-cigarette products are featured through diverse videos themes, with discount/sales. The findings highlight the need to regulate the promotion of e-cigarettes on social media platforms."
Understanding e-cigarette content and promotion on YouTube through machine learning
Tobacco Control Published Online First: 03 May 2022.
Grace Kong, Alex Sebastian Schott, Juhan Lee, Hassan Dashtian, Dhiraj Murthy
https://tobaccocontrol.bmj.com/content/early/2022/05/02/tobaccocontrol-2021-057243
"Significant lung disease (EVALI) has occurred in adolescents and not all cases are linked to vitamin E acetate. Finally, extrapolating research on adults to adolescents raises the possibility that e-cigarette use is linked to pre-symptomatic cardiovascular dysfunction and may have a significant health impact during adulthood. The combination of this evidence, from pre-clinical to population-based longitudinal studies, conclusively demonstrates that e-cigarettes are not safe for youth."
Health effects of electronic cigarettes
Curr Probl Pediatr Adolesc Health Care. 2022 May 4;101202. Online ahead of print.
Judith Groner
https://www.sciencedirect.com/science/article/abs/pii/S1538544222000712
Also:
E-cigarette disparities: Who are the targets?
https://www.sciencedirect.com/science/article/abs/pii/S1538544222000700
"Participants [young adults aged 18-25 years old in Los Angeles, California] reported pairing nicotine vaping with caffeinated beverages like coffee, pop/soda, tea, and after every meal (like patterns of combustible cigarette use). Participants also reported vaping nicotine as a tool to avoid binge eating and increase concentration while studying. Reports of vaping effecting (sic) appetite and eating behaviors also emerged. Vaping nicotine to suppress appetite and/or achieve weight loss was often reported in conjunction with an eating disorder. Participants reported learning about weight-motivated vaping from peers or deducing from cigarette effects and their own experiences with nicotine. Others mentioned controlling food cravings by vaping a similar e-liquid flavor."
A chocolate cake or a chocolate vape? Young adults describe their relationship with food and weight in the context of nicotine vaping
Appetite. 2022 May 5;175:106075. Online ahead of print.
Afton Kechter, Rachel Carmen Ceasar, Kelsey A Simpson, Sara J Schiff, Genevieve F Dunton, Ricky N Bluthenthal, Jessica L Barrington-Trimis
https://www.sciencedirect.com/science/article/abs/pii/S0195666322001660
"After the introduction of new plain packaging [in France], the proportion of smokers who felt embarrassed taking out their pack of cigarettes in plain sight because of its appearance doubled in 2017 (11.9%, 95% CI: 10.2-13.9 vs 5.9%, 95% CI: 4.4-7.8 in 2016, p<0.001) and continued to increase in 2018 (15.5%, 95% CI: 13.7-17.5, p<0.01). In 2018, women were more embarrassed than men (OR=2.0; 95% CI: 1.5-2.6, p<0.001). In 2018, 26.8% (95% CI: 24.6-29.1) of smokers said the appearance of a pack of cigarettes motivated them to quit, and 22.5% (95% CI: 18.3-27.2) ex-smokers cited it as having motivated them to quit. Smokers who were embarrassed by displaying their pack were more likely to be motivated to quit because of the pack's appearance."
Plain packaging on tobacco products in France: Effectiveness on smokers' attitudes one year after implementation
Tob Induc Dis. 2022 Apr 7;20:35. eCollection 2022.
Anne Pasquereau, Romain Guignard, Raphaël Andler, Karine Gallopel-Morvan, Viêt Nguyen-Thanh
http://www.tobaccoinduceddiseases.org/pdf-146600-74381?filename=Plain%20packaging%20on.pdf
Also:
Stigmatizing attitudes about lung cancer among individuals who smoke cigarettes
http://www.tobaccoinduceddiseases.org/pdf-146907-75360?filename=Stigmatizing%20attitudes.pdf
Content and trend analysis of user-generated nicotine sickness tweets: A retrospective infoveillance study
http://www.tobaccoinduceddiseases.org/pdf-145941-73102?filename=Content%20and%20trend.pdf
Note: Open Access.
"Almost two-thirds of [1874] respondents thought it would be ‘a good thing’ if there came a time when it was no longer legal to sell cigarettes in shops in Australia and only 16.7% thought it would be ‘a bad thing’. After the concept of a phase-out was defined as removing a product from the Australian market over a set period, such as 5 years, but still allowing purchases online from overseas companies, 50.7% indicated support for such a phase-out and 61.8% thought it should happen within 10 years. Support was greater for specific measures such as licensing tobacco retailers (75.3%) and restricting sales to places children cannot enter (76.3%)."
Public support for policies to phase out the retail sale of cigarettes in Australia: results from a nationally representative survey
Tobacco Control Published Online First: 03 May 2022.
Emily Brennan, Elizaveta Ilchenko, Michelle Scollo, Sarah J Durkin, Melanie A Wakefield
https://tobaccocontrol.bmj.com/content/early/2022/05/02/tobaccocontrol-2021-057122
Also:
Ex ante evaluation of the impact of tobacco control policy measures aimed at the point of sale in the Netherlands
https://tobaccocontrol.bmj.com/content/early/2022/05/04/tobaccocontrol-2021-057205
Note: Netherlands paper Open Access.
"Key themes from the employer interviews included: the local environment played an important role in implementation of tobacco control EBIs [evidence-based interventions]; tobacco control was perceived as important but not a priority; and tobacco control decisions were driven by worksite culture. Key themes from the employee focus groups included: perceived employer support for tobacco cessation was limited although there was interest from employees; employees who currently used tobacco were stigmatized for their behavior; and incentives and coaching were considered ideal tobacco control EBIs."
Worksite tobacco control - a qualitative study on perspectives from employers and employees at small worksites
BMC Public Health. 2022 May 6;22(1):904.
Christine M Kava, Raymond A Ruiz, Jeffrey R Harris, Peggy A Hannon
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13346-y
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-022-13346-y.pdf
Note: Open Access.
"Data from a 4-year cohort of the Population Assessment of Tobacco and Health (PATH) study was used, including 7,512 smokers at Wave 1 who had smoking status data at Wave 4… Older smokers were more likely to report 12-month cigarette and tobacco abstinence and the effect of age on abstinence differed by smoking frequency/intensity. Smoking cessation interventions need to be age-specific and consider smoking frequency… Younger smokers may need more targeted cessation interventions to successfully quit."
Short and Long-Term Cigarette and Tobacco Abstinence among Daily and Non-Daily Older Smokers
Nicotine & Tobacco Research, ntac116.
Published: 03 May 2022
Jaqueline C Avila, Carla J Berg, Jason Robinson, Jasjit S Ahluwalia
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac116/6578513
Also:
Measuring nicotine dependence among adolescent and young adult cigarillo users
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac117/6581064
"Average mouth-level nicotine estimates from cigarettes smoked during the hotel stays indicate participants puffed VLNC [very low nicotine content] cigarettes with greater intensity than NNC [normal nicotine content] cigarettes in each respective 24-hour period. However, this effect diminished over time (p<0.001). Specifically, VLNC puffing intensity was 40.0% (95% CI: 29.9, 53.0) greater than NNC puffing intensity in the first period, and 16.1% (95% CI: 6.9, 26.0) greater in the fourth period. Conclusion: Average puffing intensity per cigarette was elevated with exclusive VLNC cigarette use, but the extent of this effect declined across four days."
Early Changes in Puffing Intensity When Exclusively Using Open-Label Very Low Nicotine Content Cigarettes
Nicotine & Tobacco Research, ntac118.
Published: 07 May 2022
Cassidy M White, Clifford Watson, Roberto Bravo Cardenas, Phuong Ngac, Liza Valentin-Blasini, Benjamin C Blount, Joseph S Koopmeiners, Rachel L Denlinger-Apte, Lauren R Pacek, Neal L Benowitz, Dorothy K Hatsukami, Eric C Donny, Matthew J Carpenter, Tracy T Smith
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac118/6582320
"The prevalence of current use across all TNP [tobacco and/or nicotine-containing products] in the general adult population was 18.5% (95% confidence interval 17.2-19.5%), with 17.5% (16.4-18.6%) for cigarette smoking and 1.8% (1.4-2.2%) for IQOS use. With regard to the distribution of patterns of use in the IQOS user survey, the majority (63.4% [61.2-65.6%]) were exclusive users of IQOS, followed by 20.6% (18.7-22.5%) of individuals who reported dual use of IQOS and cigarettes. Conclusions: In Japan, cigarette smoking remains the most prevalent way of consuming TNP; however, IQOS is being adopted by a growing number of adult Japanese smokers."
Prevalence and patterns of tobacco and/or nicotine product use in Japan (2017) after the launch of a heated tobacco product ( IQOS ®): a cross-sectional study
F1000Res. 2021 Jun 25;10:504. eCollection 2021.
Esther F Afolalu, Peter Langer, Karina Fischer, Steve Roulet, Pierpaolo Magnani
Competing interests: All authors are/were employees of Philip Morris International. Philip Morris International is the sole source of funding and sponsor of this research. IQOS is manufactured by Philip Morris Products S.A.
https://f1000research.com/articles/10-504/v2
Note: Open Access tobacco industry research.
"The COVID-19 pandemic was not associated with an increase in the number of women attending smoking cessation clinics, (2020-2021 n=46 [40.8%] of 110); compared to (2019-2020 n=44 [30.9%] of 142 referred pregnant women pre-pandemic) p=0.061. Eighty-two women utilised NRT [nicotine replacement therapy] to help them stop smoking and the frequency of NRT use did not change during the pandemic (2019-2020 n=39, 2020-2021 n=43; p=0.420)."
The impact of COVID-19 on smoking cessation in pregnancy
J Perinat Med. 2022 May 10. Online ahead of print.
Nadja Bednarczuk, Emma E Williams, Gareth Absalom, Judith Olaitan-Salami, Anne Greenough
https://www.degruyter.com/document/doi/10.1515/jpm-2022-0178/html
https://www.degruyter.com/document/doi/10.1515/jpm-2022-0178/pdf
Note: Open Access.
"Androgenetic alopecia is thought to be caused by twin factors of heredity and androgens. Other factors such as environmental factors are also regarded as important, and smoking is believed to be one of them. This review shows that smoking may have a significant role to play in androgenetic alopecia. There is also some evidence to support a relation between amount of smoking and severity of baldness and also age of onset of AGA. There are a number of plausible mechanisms through which smoking could affect hair loss. The dermatologist should therefore advise patients of AGA to stop smoking."
Role of Smoking in Androgenetic Alopecia: A Systematic Review
Int J Trichology. Mar-Apr 2022;14(2):41-48. Epub 2022 Apr 4.
Yatra Kavadya, Venkataram Mysore
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9069908/
Note: Open Access.
Tobacco industry is “talking trash” on environmental harms of production, say WHO and watchdog
BMJ 2022;377:o1211 (Published 13 May 2022)
Luke Taylor
https://www.bmj.com/content/377/bmj.o1211
"Cigarette filters are composed of more than 15,000 fibres strands which can be detached in a MF [microfiber] size range or eventually get fragmented into lower sizes. This MF can be introduced to the trophic chain and can be easily ingested by a wide range of organism including human. Therefore, a new form of pollution from cigarettes is added to the environment with proven damage to ecosystems and therefore to humans. This pollution cannot be ignored and should be treated by the scientific and social communities as an important MP [microplastics] source that harms our planet and its biodiversity."
Tobacco as a Source of Microplastics. Tobacco and Environment: World No Tobacco Day 2022
Arch Bronconeumol. 2022 May 2;S0300-2896(22)00327-1. Online ahead of print.
José Ignacio de Granda-Orive, Segismundo Solano-Reina, Carlos A Jiménez-Ruiz
https://www.sciencedirect.com/science/article/pii/S0300289622003271
Note: Open Access.
"Addiction, chemicals, negative health symptoms and effects, and cigarette comparison themes were associated with higher PME [perceived message effectiveness], as were graphic images and warning symbols. Industry targeting, environmental impact, flavour themes, images of food and people’s faces were associated with lower PME, as were hashtags, statistics and first-person language or the word ‘teen’. Most elements were not associated with appeal, but ads with a flavour theme were associated with increased vaping appeal."
Perceived effectiveness of objective elements of vaping prevention messages among adolescents
Tobacco Control Published Online First: 09 May 2022.
Marcella H Boynton, Nora Sanzo, Whitney Brothers, Alex Kresovich, Erin L Sutfin, Paschal Sheeran, Seth M Noar
https://tobaccocontrol.bmj.com/content/early/2022/05/08/tobaccocontrol-2021-057151
Note: Open Access.
Related PR:
Effective anti-vaping advertisements can have the greatest impact on teens
"In 47 lower-middle, upper-middle and high-income countries from 2015 to 2018, ~1 in 12 (8.6%) adolescents reported vaping in the past 30 days, but prevalence of frequent vaping was low (1 in 60; 1.7%). A higher tobacco tax was associated with higher adolescent vaping."
Association between the implementation of tobacco control policies and adolescent vaping in 44 lower-middle, upper-middle, and high-income countries
Addiction
First published: 11 May 2022
Gary C. K. Chan,Coral Gartner,Carmen Lim,Tianze Sun,Wayne Hall,Jason Connor,Daniel Stjepanović, Janni Leung
https://onlinelibrary.wiley.com/doi/10.1111/add.15892
Related PR:
New study finds global adolescent vaping is low
https://medicalxpress.com/news/2022-05-global-adolescent-vaping.html
"Younger adolescents 12-15 years had lower tobacco use compared to 16-17 year olds and less stable classes. In the 16-17 year group, there were five unique trajectories of cigarette smoking, including a Persistent High Frequency class. Four e-cigarette use trajectories were identified; but not a persistent use class. Shared predictors of class membership for cigarettes and e-cigarettes included mental health problems, other tobacco use, marijuana use, and poorer academic achievement… Conclusions: There was no evidence that initiation with e-cigarettes as the first product tried was associated with cigarette progression (nor cigarettes as first product and e-cigarette progression)."
Predictors of e-cigarette and cigarette use trajectory classes from early adolescence to emerging adulthood across four years (2013-2017) of the PATH Study
Nicotine & Tobacco Research, ntac119.
Published: 11 May 2022
Cassandra A Stanton, Zhiqun Tang, Eva Sharma, Elizabeth Seaman, Lisa D Gardner, Marushka L Silveira, Dorothy Hatsukami, Hannah R Day, K Michael Cummings, Maciej L Goniewicz, Jean Limpert, Colm Everard, Maansi Bansal-Travers, Bridget Ambrose, Heather L Kimmel, Nicolette Borek, Wilson M Compton, Andrew J Hyland, Jennifer L Pearson
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac119/6584494
Note: Open Access.
"Before instituting a ban on all non-tobacco e-cigarette flavors (which might have unintended consequences) or a cap on nicotine concentration or limiting ease of access to e-cigarettes for adult smokers, we believe that alternative approaches should be carefully considered to avoid negative ramifications of policy decisions, especially if e-cigarettes have the potential to reduce cigarette related mortality."
Correspondence
Response to: Appropriate policy implications of the fact that high content and flavored e-cigarettes have higher abuse liability
Nicotine & Tobacco Research, ntac120.
Published: 10 May 2022
Mari S Gades, BA, Dorothy K Hatsukami
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac120/6583153
Related N&TR Correspondence & Referenced Study:
Appropriate Policy Implications of the Fact That High Content and Flavored E-Cigarettes Have Higher Abuse Liability
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac089/6562583
The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac073/6550857
Note: Correspondence Open Access, study available upon request.
"This study used ITS [interrupted time series] analysis to examine the impact of vaping introduction on smoking in six high-income jurisdictions [in four Canadian provinces, United Kingdom and Australia] that have adopted varied regulatory approaches to vaping. Our findings showed that in most, but not all, settings where policies enable substitution of cigarettes with e-cigarettes, vaping introduction has accelerated the rate of decline in smoking, whereas in settings that restrict the uptake of e-cigarettes or do not permit the use of nicotine in e-cigarettes, vaping introduction has slowed the secular rate of decline in smoking."
Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis
BMJ Open 2022;12:e058324.
Online issue publication May 02, 2022
Daphne C Wu, Beverley M Essue, Prabhat Jha
https://bmjopen.bmj.com/content/12/5/e058324
https://bmjopen.bmj.com/content/bmjopen/12/5/e058324.full.pdf
Note: Open Access.
"In the UK, the regulatory authorities, the Royal Colleges, and learned societies (with the exception of the Royal College of Paediatrics and Child Health), are immobilised. They are ignoring the tactics of a resurgent industry that seems to be targeting children and younger people, increasing their exposure to nicotine (nicotine alone has significant toxicity, including to the fetus) and several other inhalants of unknown toxicity. The tobacco industry has a record of duplicitous suppression of data; yet, with their promotion of ENDS [electronic nicotine delivery systems] they are regaining ground they previously lost with tobacco cigarettes. At the least, ENDS should be subject to the same legislation as tobacco, and those who supply them to under-age children should be subject to stringent penalties."
Comment
E-cigarette company tactics in sports advertising
The Lancet Respiratory Medicine
Published: May 11, 2022
Stephen Fowler, Jayesh Bhatt, Sarah Brown, Louise Fleming, Sarah Mayell, Ian Sinha, Andrew Bush
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00166-7/fulltext
"Perceived stress predicted e-cigarette progression and continuation among current users among a diverse cohort of youth and young adults in Texas; perceived stress did not predict e-cigarette initiation among never users. Two study hypotheses (i.e., progression; continuation) were supported while one hypothesis (i.e., initiation) was not supported."
Perceived stress and E-cigarette use during emerging adulthood: A longitudinal examination of initiation, progression, and continuation
Prev Med. 2022 May 11;107080. Online ahead of print.
Dale S Mantey, Stephanie I Clendennen, Aslesha Sumbe, Anna V Wilkinson, Melissa B Harrell
https://www.sciencedirect.com/science/article/abs/pii/S0091743522001281
"The ecological data underscore that menthol in cigarettes continues to stall progress in reducing cigarette smoking, and menthol capsules have likely played a role in overall usage trends. Given its documented public health harms and high rates of use among marginalised populations,10 eliminating menthol as a characterising flavour from the cigarette market remains a priority. Moreover, menthol bans must also address innovative delivery methods, such as flavour capsules."
Letter
Impact of menthol capsule cigarettes on menthol and non-menthol cigarette consumption in the USA, 2008–2020
Tobacco Control Published Online First: 10 May 2022.
Cristine D Delnevo, Daniel P Giovenco, Andrea C Villanti
https://tobaccocontrol.bmj.com/content/early/2022/05/10/tobaccocontrol-2022-057422
"The 2000 Canadian GWL [graphic warning label] policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status… Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the US."
The differential impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by sex and education: A Difference-In-Difference-In-Difference Model
Nicotine & Tobacco Research, ntac122.
Published: 10 May 2022
Bukola Usidame, Gang Meng, James F Thrasher, Mary E Thompson, Geoffrey T Fong, Nancy L Fleischer
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac122/6583382
Also:
Gender Differences in Reasons for Using Electronic Cigarettes: A Systematic Review
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac108/6584717
Characterization of salivary progesterone in female smokers
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac121/6582861
"A recent Lancet Editorial about the slow pace of tobacco control around the world singled out the UK as a leader in reducing the number of smokers. It has accomplished this feat, the Editorial stated, through measures such as increased tobacco taxes, comprehensive smoke-free laws in public spaces, and health warnings on product packages. Yet, there was no mention of alternative nicotine delivery devices, such as e-cigarettes and heated tobacco products… From September, 2017 to October, 2021, I was President and CEO of the Foundation for a Smoke-Free World, a non-profit entity funded by Philip Morris International, with a mandate to support scientific research and development in the battle against smoking."
Correspondence
Tobacco harm reduction matters
The Lancet
VOLUME 399, ISSUE 10338, P1864-1865, MAY 14, 2022
Published: May 14, 2022
Darek (sic) Yach
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00834-0/fulltext
Also:
Tobacco control: getting to the finish line
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00835-2/fulltext
Referenced Lancet Editorial:
Tobacco control: far from the finish line
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02650-7/fulltext
Note: Open Access.
"Smokers are at higher risk of uro-oncological cancers, infertility, erectile dysfunction, reduced urinary tract function, postoperative complications, and side effects during systemic therapy. Most patients are aware of the link between smoking and lung cancer, yet many urology patients are unaware of the link between smoking and urological illness and postoperative complications. Education initiatives by urologists could address this knowledge gap.. In summary, we hope that the European Association of Urology and other organizations will implement a strong recommendation in urology guidelines to include counseling on smoking cessation as a standard of care. Smoking cessation is one of the most effective interventions urologists can offer patients."
Editorial
Why and How Smoking Cessation Must Be Implemented in Urology Clinics as a Standard of Care
Eur Urol. 2022 May 4;S0302-2838(22)02263-1. Online ahead of print.
Andres Affentranger, Richard S Matulewicz, Christian D Fankhauser
https://www.sciencedirect.com/science/article/abs/pii/S0302283822022631
"The results of this cohort study suggest that a significant proportion of patients with HNSCC [head and neck squamous cell carcinoma] who are daily smokers at the time of diagnosis continue to smoke after treatment. Smokers with HNSCC who successfully quit smoking were most likely to do so in the first 6 months after treatment, which could potentially serve as a preferred window for smoking cessation interventions. These data highlight the need for inclusion of aggressive smoking cessation intervention in head and neck cancer care pathways."
Persistent Tobacco Use After Treatment for Head and Neck Cancer
JAMA Otolaryngol Head Neck Surg.
Published online May 12, 2022.
Tyler Van Heest, Nathan Rubin, Samir S. Khariwala https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2792443
Related coverage:
Three-fifths of smokers diagnosed with head and neck cancer STILL used cigarettes two years after treatment, study finds
A smoke-free generation: New Zealand's tobacco ban
The Lancet
VOLUME 399, ISSUE 10339, P1930-1931, MAY 21, 2022
Chris McCall
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00925-4/fulltext
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2900925-4
Note: Open Access upon registration.
"Despite the current no-tobacco advertising policies, both PMI’s [Philip Morris International's] and Altria’s corporate image campaigns have run extensively in major news outlets (in both physical and digital formats), including the New York Times and Washington Post… They feature high-ranking corporate executives advocating for company-sponsored research coupled with claims that these companies are aligned with public health objectives. Message placement in prominent news outlets suggests a deliberate attempt to position their sponsored content alongside news reporting while helping to ensure message exposure among an influential audience… The extent to which these ‘corporate promotion’ ads have infiltrated major news outlets is concerning, raising questions about how objective media outlets should treat sponsored industry content."
Ad watch
Tobacco industry advertising: efforts to shift public perception of big tobacco with paid media in the USA
Tobacco Control Published Online First: 16 May 2022.
Robin Koval, Nicole Dorrler, Barbara Schillo
https://tobaccocontrol.bmj.com/content/early/2022/05/08/tobaccocontrol-2021-057189
"Our study demonstrates majority support for regulations controlling e-cigarettes in Australia. Parents generally favoured wide-ranging restrictions that could reduce adolescent e-cigarette use. Almost all parents support a ban on marketing and advertising of e-cigarettes to teenagers thus recognising the reach and influence of product appeal, placement and price on this age group. Australian governments have an opportunity to help prevent more widespread e-cigarette use and protect the health of adolescents by limiting their exposure to e-cigarette promotions."
Parents support strong restrictions controlling e-cigarette use in Australia: findings from a national survey
Tobacco Control Published Online First: 17 May 2022.
Mary-Anne Measey, Vikram Palit, Monsurul Hoq, Moya Vandeleur, Anthea Rhodes
https://tobaccocontrol.bmj.com/content/early/2022/05/16/tobaccocontrol-2021-057074
Also:
Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source
https://tobaccocontrol.bmj.com/content/early/2022/05/12/tobaccocontrol-2021-056986
Place-based inequities in cigarette smoking across the USA
https://tobaccocontrol.bmj.com/content/early/2022/05/17/tobaccocontrol-2022-057293
"Due to the low return of saliva samples, validated prolonged abstinence rates in the intention-to-treat analysis were low (39 of 571 (6.8%) versus 25 of 569 (4.4%) in the e-cigarette and NRT [nicotine replacement therapy] arms, respectively) and did not differ significantly between the two study arms… In summary, in the unadjusted primary analysis there was insufficient evidence to confidently demonstrate that e-cigarettes are more effective than NRT in helping pregnant women to stop smoking. The effects of e-cigarettes appear to have been masked by e-cigarette use in the NRT arm. When abstinent participants using non-allocated products were excluded, e-cigarettes were markedly more effective than patches in all abstinence outcomes. "
Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial
Nature Medicine (2022)
Published: 16 May 2022
Peter Hajek, Dunja Przulj, Francesca Pesola, Chris Griffiths, Robert Walton, Hayden McRobbie, Tim Coleman, Sarah Lewis, Rachel Whitemore, Miranda Clark, Michael Ussher, Lesley Sinclair, Emily Seager, Sue Cooper, Linda Bauld, Felix Naughton, Peter Sasieni, Isaac Manyonda & Katie Myers Smith
https://www.nature.com/articles/s41591-022-01808-0
https://www.nature.com/articles/s41591-022-01808-0.pdf
Note: Open Access.
Related coverage:
E-cigarettes ‘as safe as nicotine patches’ for pregnant smokers trying to quit
Vaping may be an effective way to quit smoking during pregnancy
"We did not find a significant difference in the cardiovascular risk of exclusive e-cigarette use compared with nonuse of cigarettes and e-cigarettes, although analyses were limited by a small number of CVD [cardiovascular disease] events in e-cigarette users. Dual use of cigarettes and e-cigarettes was associated with a significantly increased risk of CVD compared with nonuse. The cardiovascular risk of dual use did not differ from the risk among those exclusively smoking cigarettes."
Letter
E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019
Circulation. 2022;0
Originally published 6 May 2022
Jonathan B. Berlowitz, Wubin Xie, Alyssa F. Harlow, Naomi M. Hamburg, Michael J. Blaha, Aruni Bhatnagar, Emelia J. Benjamin and Andrew C. Stokes
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057369
https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.121.057369
Note: Open Access.
"We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014–2018… EC [E-cigarette] use was low in most countries. “Dual use” was common among current smokers and the quit ratio was higher among ECs users… Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals."
Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014–2018 Estimates From Global Adult Tobacco Surveys
Nicotine & Tobacco Research, ntab269.
Published: 21 May 2022
Chandrashekhar T Sreeramareddy, Anusha Manoharan
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntab269/6590320
"Following JUUL’s removal of mint in November 2019, JUUL’s market share dropped from over 66% in Florida and the United States to 37.1% (Florida) and 55.1% (United States). In January 2020, the second leading brands were Puff Bar (15.0%) in Florida and Vuse (18.1%) in the United States. Mint market share decreased and share of all other flavor categories increased, particularly menthol and concept. Total ENDS sales increased in Florida but decreased in the United States. Average prices of ENDS devices decreased. Conclusions: While JUUL’s actions led to a decline in its sales, Puff Bar emerged and menthol and concept flavors experienced growth."
JUUL’s 2019 Removal of Mint-Flavored Pods and Changes to the Retail Environment of Electronic Nicotine Delivery Systems in Florida and the United States
Nicotine & Tobacco Research, ntac128.
Published: 15 May 2022
Jennifer Gaber, Doris G Gammon, Youn Ok Lee, James Nonnemaker, Brittany Young, Annice Kim, Lauren Porter
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac128/6586051
Also:
Adolescents’ understanding of smoking and vaping risk language: Cognitive interviews to inform scale development
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac127/6585952
Secondhand tobacco smoke and functional impairments in older adults living in the community
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac131/6586052
A randomized pilot of a tailored smoking cessation quitline intervention for individuals who smoke and vape
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac129/6586250
"How we define “current use” of tobacco and nicotine delivery products changes our estimates of how individuals transition to, between, and from different patterns of use. We show that the robustness of transition estimates to whether or not non-established users are included as current users and to different frequency-of-use threshold depends in part on whether low-frequency users are categorized as non-current users or as a distinct category. Our results emphasize the importance of intentional definitions of product use that reflect the larger goals of public health and tobacco control."
The impact of current tobacco product use definitions on estimates of transitions between cigarette and ENDS use
Nicotine & Tobacco Research, ntac132.
Published: 19 May 2022
Andrew F Brouwer, David T Levy, Jihyoun Jeon, Evelyn Jimenez-Mendoza, Luz María Sanchez-Romero, Ritesh Mistry, Rafael Meza
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac132/6589520
Also:
The unhealthy association between smoking, vaping, and other drug use
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac130/6588418
Note: Open Access.
"The hardening hypothesis suggests that tobacco control activities influence an individual’s ability to quit, and those who find it challenging to quit are those who remain smokers. Reviews and papers have attempted to demystify this hypothesis, and the debate continues. Adding to the continuing discussions, a recently-published umbrella and systematic review by Harris et al. (2022) strongly opposed the existence of the hardening hypothesis, after conducting a wide-ranging qualitative synthesis of the evidence pertinent to various hardening constructs and indicators. However, several key methodological issues may have ushered a deficient—or worse, unqualified—interpretation of the evidence base."
Correspondence
The Hardening Hypothesis – Further Testing is Still Required
Nicotine & Tobacco Research, ntac125.
Published: 13 May 2022
Isabella Steffensen, Red Thaddeus D Miguel, Julien Carlone
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac125/6585632
Referenced N&TR study:
Smokers increasingly motivated and able to quit as smoking prevalence falls: umbrella and systematic review of evidence relevant to the 'hardening hypothesis', considering transcendence of manufactured doubt
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac055/6542043
Note: Open Access.
"Ever/current [Hungarian] HTP [heated tobacco product] users presented misperceptions about the harms of HTPs, e-cigarettes, and NRT. They underestimated the potential health benefits of NRT and had distorted harm perceptions about HTPs and e-cigarettes. Public education about the relative harms of different nicotine and tobacco products is urgently needed."
Perceived harm of heated tobacco products, e-cigarettes, and nicotine replacement therapy compared with conventional cigarettes among ever and current heated tobacco users
Addict Behav Rep. 2022 May 16;15:100432. eCollection 2022 Jun.
Melinda Pénzes, Tamás Joó, Róbert Urbán
https://www.sciencedirect.com/science/article/pii/S235285322200027X
Note: Open Access.
"We analyzed data from Wave 3 (Sept-Dec 2019) and Wave 5 (Sept-Dec 2020) of a 2-year, 5-wave longitudinal study of young adults across six US metropolitan areas… Of W3 cigarette non-users (n=1693), 5.0% (n=85) initiated cigarettes at W5; predictors of initiation included younger age, lower perceived smoking risk, lifetime cigarette and e-cigarette use, and W3 e-cigarette use. Of W3 e-cigarette non-users (n=1522), 6.3% (n=96) initiated e-cigarettes at W5; predictors included younger age, less news exposure, lifetime cigarette and e-cigarette use, and W3 cigarette use. Conclusions: These findings underscore the need to address cigarette and e-cigarette co-use and related risk perceptions in prevention and cessation interventions."
Changes in cigarette and e-cigarette use among US young adults from before to during the COVID-19 pandemic: News exposure and risk perceptions as potential predictors
Tob Prev Cessat. 2022 May 6;8:18. eCollection 2022.
Breesa Bennett, Katelyn F Romm, Carla J Berg
Note: Open Access.
"In 2020, the prevalence of middle and high school students reporting “no” or “little” harm (vs. “some” or “a lot”) was 20.1% for e-cigarettes, 17.4% for hookahs, 14.6% for cigars, 13.5% for smokeless tobacco, and 11.0% for cigarettes. During 2016–2020, perceptions of “no” or “little” harm decreased for e-cigarettes, increased for cigarettes and smokeless tobacco, and exhibited nonlinear changes for hookahs. Discussion: Most youth are aware of tobacco product harms, but opportunities exist to educate youth about the harms of nondaily tobacco product use."
Tobacco Product Harm Perceptions Among US Middle and High School Students, 2016-2020
J Adolesc Health. 2022 May 19;S1054-139X(22)00386-X. Online ahead of print.
Emily Glidden, Nikki A Hawkins, Ahmed Jamal, Teresa W Wang
https://www.jahonline.org/article/S1054-139X(22)00386-X/fulltext
"The implementation of CEASE [Clinical effort against secondhand smoke exposure] in practices was influenced by the adaptability and complexity of the intervention, the needs of patients and their families, the resources available to practices to support the implementation of CEASE, other competing priorities at the practices, the cultures of practices, and clinicians' and office staffs' knowledge and beliefs about family-centered tobacco control."
A Qualitative Study of Factors Influencing Implementation of Tobacco Control in Pediatric Practices
J Smok Cessat. 2022 May 5;2022:4156982. eCollection 2022.
Emara Nabi-Burza, Jonathan P Winickoff, Jeremy E Drehmer, Maurice P Zeegers, Bethany Hipple Walters
https://www.hindawi.com/journals/josc/2022/4156982/
https://downloads.hindawi.com/journals/josc/2022/4156982.pdf
Note: Open Access.
"In the French context, the new plain packaging of tobacco products probably had an impact on smokers’ perception of tobacco by increasing the embarrassment they felt when they took out their pack of cigarettes in plain sight. It also influenced the motivation to quit smoking, and more generally, it could contribute to the denormalization of tobacco."
Plain packaging on tobacco products in France: Effectiveness on smokers’ attitudes one year after implementation
Tob. Induc. Dis. 2022;20(April):35
Anne Pasquereau, Romain Guignard, Raphaël Andler, Karine Gallopel-Morvan, Viêt Nguyen-Thanh
http://www.tobaccoinduceddiseases.org/pdf-146600-74381?filename=Plain%20packaging%20on.pdf
Note: Open Access.
From smoking to vaping: a new environmental threat?
Lancet Respir Med
Published: May 23, 2022
Jérémie Pourchez, Clément Mercier, Valérie Forest
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00187-4/fulltext
https://www.thelancet.com/action/showPdf?pii=S2213-2600%2822%2900187-4
Note: Open Access.
“Globally, in 2019 there were an estimated 2.5 million cancer-related deaths (95% UI: 2.3 to 2.7) and 56.4 million DALYs [disability-adjusted life years] (51.3 to 61.7) attributable to smoking. The global age-standardized death and DALY rates of cancers attributable to smoking per 100,000 decreased by 23.0% (-29.5 to -15.8) and 28.6% (-35.1 to -21.5), respectively, over the period 1990-2019. Central Europe (50.4 [44.4 to 57.6]) and Western Sub-Saharan Africa (6.7 [5.7 to 8.0]) had the highest and lowest age-standardized death rates, respectively, for cancers attributable to smoking. In 2019, the age-standardized DALY rate of cancers attributable to smoking was highest in Greenland (2224.0 [1804.5 to 2678.8]) and lowest in Ethiopia (72.2 [51.2 to 98.0]). Also in 2019, the global number of DALYs was highest in the 65-69 age group and there was a positive association between SDI and the age-standardized DALY rate. Conclusions: The results of this study clearly illustrate that renewed efforts are required to increase utilization of evidence-based smoking cessation support in order to reduce the burden of smoking-related diseases.”
Global, regional, and national burden of cancers attributable to tobacco smoking in 204 countries and territories, 1990-2019
Cancer Med. 2022 May 27. Online ahead of print.
Saeid Safiri, Seyed Aria Nejadghaderi, Morteza Abdollahi, Kristin Carson-Chahhoud, Jay S Kaufman, Nicola Luigi Bragazzi, Maziar Moradi-Lakeh, Mohammad Ali Mansournia, Mark J M Sullman, Amir Almasi-Hashiani, Ali Taghizadieh, Gary S Collins, Ali-Asghar Kolahi
https://onlinelibrary.wiley.com/doi/10.1002/cam4.4647
https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.4647
Note: Open Access.
"This cross-sectional study of 6131 US residents aged 13 to 40 years found that 25.9% had ever used a nonnicotine e-cigarette, 16.7% had used one in the past 30 days, and 12.4% had used one in the past 7 days; 18.8% had ever co-used nonnicotine and nicotine e-cigarettes. The most-used flavors were sweet, dessert, or candy flavors; fruit flavors; and mint or menthol flavors; most common ingredients were tetrahydrocannabinol, cannabidiol, melatonin, caffeine, and essential oils. Meaning: These findings suggest that a significant proportion of US residents are using nonnicotine flavored e-cigarettes marketed with unsupported health claims."
Use Patterns, Flavors, Brands, and Ingredients of Nonnicotine e-Cigarettes Among Adolescents, Young Adults, and Adults in the United States
JAMA Netw Open. 2022;5(5):e2216194.
May 25, 2022
Shivani Mathur Gaiha, Crystal Lin, Lauren Kass Lempert, Bonnie Halpern-Felsher
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792671
Note: Open Access.
“In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States.”
E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017-2020
Am J Public Health. 2022 May 27;e1-e11. Online ahead of print.
David Hammond, Jessica L Reid, Robin Burkhalter, Maansi Bansal Travers, Shannon Gravelly, Andy Hyland, Karin Kasza, Ann McNeill
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2022.306780
Related AJPH Editorials:
E-Cigarette Flavors, Devices, and Brand Preferences Among Youths in Canada, England, and the United States: The Value and Challenges of Comparing International Survey Data
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2022.306903
The Food and Drug Administration's e-Cigarette Flavor Restrictions Have Not Gone Far Enough to Curb the Youth e-Cigarette Use Epidemic
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2022.306822
"Current exclusive and dual/poly e-cigarette use, with 0.2% and 3.5% prevalence in 2015–2018 [National Health Interview Survey data], were associated with higher odds of reporting poor health status than never tobacco users. Poor health status was associated with higher odds of using the four healthcare services and a greater number of ER [Emergency Room] and doctor visits. Annual healthcare expenditures attributable to all current e-cigarette use was $15.1 billion ($2024 per user) in 2018, including $1.3 billion attributable to exclusive e-cigarette use ($1796 per user) and $13.8 billion attributable to dual/poly e-cigarette use ($2050 per user). Conclusion: Adult current e-cigarette use was associated with substantial excess healthcare utilisation and expenditures."
Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults
Tobacco Control Published Online First: 23 May 2022.
Yingning Wang, Hai-Yen Sung, James Lightwood, Tingting Yao, Wendy B Max
https://tobaccocontrol.bmj.com/content/early/2022/05/04/tobaccocontrol-2021-057058
Note: Open Access.
Related PR:
Using e-cigarettes may lead to higher use of and spending on health services
https://medicalxpress.com/news/2022-05-e-cigarettes-higher-health.html
“This review highlights how mitochondrial damage caused by inhaled intoxicants increases ROS [reactive oxygen species] production, apoptosis, reduces respiration, alters mitochondrial membrane potential, and destroys the equilibrium of fission/fusion effects. These detrimental changes contribute to aggravated inflammatory pathways and various disease pathogeneses… The intimate connection between mitochondrial morphological changes and dysfunction impairs multiple pathways and alters downstream signaling. Interestingly, these toxic changes vary based on the chemical composition of different e-liquids.”
Alterations of Mitochondrial Network by Cigarette Smoking and E-Cigarette Vaping
Cells. 2022 May 19;11(10):1688.
Manasa Kanithi, Sunil Junapudi, Syed Islamuddin Shah, Alavala Matta Reddy, Ghanim Ullah, Bojjibabu Chidipi
https://www.mdpi.com/2073-4409/11/10/1688/htm
Note: Open Access.
“About 17.1% of participants reported ever e-cigarette use. Of never users, 17.5% were susceptible to e-cigarette use. E-cigarette advertising exposure was mainly through online sources (31.5%). Most participants (59.4%) perceived e-cigarettes as equally or more harmful than cigarettes… Regulatory actions are needed to address e-cigarette marketing, particularly on the Internet.”
The Mediating Effect of E-Cigarette Harm Perception in the Relationship between E-Cigarette Advertising Exposure and E-Cigarette Use
Int J Environ Res Public Health. 2022 May 20;19(10):6215.
Nan Jiang, Shu Xu, Le Li, Omar El-Shahawy, Nicholas Freudenberg, Jenni A Shearston, Scott E Sherman
https://www.mdpi.com/1660-4601/19/10/6215
Also:
Nicotine Dependence from Different E-Cigarette Devices and Combustible Cigarettes among US Adolescent and Young Adult Users
https://www.mdpi.com/1660-4601/19/10/5846
Do Budget Cigarettes Emit More Particles? An Aerosol Spectrometric Comparison of Particulate Matter Concentrations between Private-Label Cigarettes and More Expensive Brand-Name Cigarettes
https://www.mdpi.com/1660-4601/19/10/5920
Association between Fathers' Use of Heated Tobacco Products and Urinary Cotinine Concentrations in Their Spouses and Children
https://www.mdpi.com/1660-4601/19/10/6275
Note: Open Access.
“We combined data from two cross-sectional samples of youth and young adult (15-24) participants of a monthly surveillance study (data collected April and June 2021)… Over a third of the sample (37.9%) reported increasing e-cigarette use, while 28.9% reported decreasing use, and 33.1% reported no change… Conclusions: This study provides recent data on how the ongoing and evolving COVID-19 pandemic has impacted youth and young adults’ e-cigarette use. Findings identify subpopulations that may benefit from e-cigarette prevention interventions, as well as insights that may inform the content and delivery of such interventions.”
Changes in e-cigarette use among youth and young adults during the COVID-19 pandemic: Insights into risk perceptions and reasons for changing use behavior
Nicotine & Tobacco Research, ntac136.
Published: 26 May 2022
Morgane Bennett, Jessica Speer, Nathaniel Taylor, Tesfa Alexander
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac136/6593856
"Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use."
The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations
Nicotine & Tobacco Research, ntac135.
Published: 23 May 2022
Rhiannon C Wiley, Anthony C Oliver, Miranda B Snow, Janice Y Bunn, Anthony J Barrows, Jennifer W Tidey, Dustin C Lee, Stacey C Sigmon, Diann E Gaalema, Sarah H Heil, Catherine Markesich, Andrea C Villanti, Stephen T Higgins
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac135/6590894
Also:
Associations of California’s Tobacco 21 Minimum Sales Age Law with Tobacco Use among Sexual Minority Adolescents: A Trends Analysis
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac134/6590853
Optimum Urine Cotinine and NNAL Levels to Distinguish Smokers from Non-Smokers by the Changes in Tobacco Control Policy in Korea from 2008 to 2018
https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntac133/6591481
“Across time, NA [negative affect] peaked 1 week post-quit, PA [positive affect] did not change, and craving declined. Less steep rises in NA (indirect effect 95% CI: 0.01 to 0.30) and lower mean craving at 1 week post-quit (CI: 0.06 to 0.50) were mediators of the relationship between varenicline and higher cessation rates at the end of treatment. PA was associated with cessation, but was not a significant mediator. Conclusions: These results partially support the hypothesis that varenicline improves smoking cessation rates by attenuating changes in specific psychological processes and supported negative affect and craving as plausible treatment mechanisms of varenicline.”
Evaluating Treatment Mechanisms of Varenicline: Mediation by Affect and Craving
Nicotine & Tobacco Research, ntac138.
Published: 26 May 2022
Sarah S Tonkin, Craig Colder, Martin C Mahoney, Gary E Swan, Paul Cinciripini, Robert Schnoll, Tony P George, Rachel F Tyndale, Larry W Hawk, Jr
https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac138/6593861
Note: Open Access.
“Findings from our within-subject study suggest that a cigarette displaying the text 'cancer, heart disease, stroke' and a drab dark brown coloured cigarette are most dissuasive for Dutch non-smoking adolescents. Whether dissuasive cigarettes reduce appeal, reduce product trial, or increase perceptions of harm compared to a regular cigarette should be further examined in larger between-subject studies.”
Non-smoking adolescents' perceptions of dissuasive cigarettes
Addict Behav Rep. 2022 May 18;15:100433. eCollection 2022 Jun.
Dirk Jan A van Mourik, Gera E Nagelhout, Nikita L Poole, Marc C Willemsen, Math J J M Candel, Crawford Moodie, Bas van den Putte, James F Thrasher, Hein de Vries
https://www.sciencedirect.com/science/article/pii/S2352853222000281
Note: Open Access.
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Rassegna Stampa Scientifica Luglio 2022
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The End of the Illusion That Smoking Is a Choice
Credit...Illustration by Shoshana Schultz/The New York Times; Photograph by Image Source via Getty
By Sarah Milov
Dr. Milov is an associate professor of history at the University of Virginia and the author of “The Cigarette: A Political History.”
The Food and Drug Administration recently proposed lowering the nicotine content in cigarettes to less addictive levels. If adopted, this regulation would finally test one of the tobacco industry’s favorite claims: that smoking is a choice. Portraying smoking as a willful, personal decision has long allowed tobacco companies to promote cigarettes even while acknowledging their deadly risks. But the paradigm of individual choice has also guided cigarette regulation, ironically strengthening the industry’s key talking point — until now.
Nicotine is the addictive element in a cigarette. By reducing nicotine levels in cigarettes, federal regulations will, for the first time, address the key driver of cigarette consumption, which claims 480,000 American lives each year. Nicotine’s effects are particularly acute in adolescence, which is when most smokers start.
Tobacco companies have long understood that physiological dependence on nicotine — or what executives preferred to call nicotine satisfaction — was central to their business. Since the 1960s, the tobacco industry has manipulated ammonia levels in cigarettes to enhance nicotine’s effects. As one cigarette company research director commented in 1954, “It’s fortunate for us that cigarettes are a habit they can’t break.”
Publicly, tobacco’s advocates have argued that smoking is a choice of free, responsible adults. As early as 1929, the United States Patent Office granted patents to engineers who had devised processes for denicotinizing tobacco. But as one 1935 American Tobacco Company pamphlet reassured its readers, “The makers of Lucky Strike cigarettes deliberately refrain” from these techniques because “such removal of nicotine produces an emasculated product, shorn of the very qualities which give a cigarette character and appeal.” Selling the cigarette has always involved selling both the illusion of choice and a product designed to preclude it.
Ironically, the argument for individual consent was even bolstered by the earliest federal regulations on cigarettes — some of which the industry quietly lauded. After the surgeon general released the landmark 1964 report on smoking and health, policymakers debated how they would heed its call for “appropriate remedial action” to respond to the deadly health threat posed by cigarettes. The Federal Trade Commission’s proposal for cigarette warning labels that explicitly linked cigarette smoking to cancer and death was pre-empted by the warning label proposed by a tobacco-friendly Congress: “Caution: Cigarette smoking may be hazardous to your health.” These labels, which have intensified in urgency with each revision since 1966, appear to put the responsibility for smoking squarely on the shoulders of the smoker. Having been duly warned, it is the smoker’s decision to smoke and bear the consequences.
While publicly the industry howled that a warning label was unfair, privately lawyers breathed a sigh of relief. The surgeon general’s report and the warning label could bolster the industry’s defense in the courtroom in any future product liability suits. Indeed, when a wave of product liability suits brought by dying smokers or their families hit the industry in the 1980s, industry lawyers could gloat that “no tobacco company has ever paid one penny in damages” to a plaintiff. The warning label shielded companies as much as it informed smokers.
To circumvent the power that the tobacco industry held in Congress and at courthouses, anti-tobacco activists in the 1970s and ’80s pioneered a different strategy. Laws and workplace rules aimed at reducing public smoking — such as the creation of nonsmoking sections and smoking sections, indoor bans and even outdoor bans — were enacted on behalf of nonsmokers. Whatever a smoker may have decided, nonsmokers never agreed to smoke secondhand. One antismoking bumper sticker from the late 1970s playfully satirized the assumption-of-risk paradigm: “Caution: Your smoking may be hazardous to my health.”
The nonsmokers’ rights movement catalyzed a sharp decline in smoking rates. But it left the paradigm of individual consent untouched — or even strengthened. For nonsmokers’ rights activists, the smoker can pursue his choice with full knowledge of the deadly consequences as long as his choices don’t affect others. “I would not mind a smoker killing himself privately,” one nonsmoker explained in support of public smoking restrictions in 1978. “I greatly object to his infecting my air.”
In more recent decades, age restrictions on smoking have reinforced the idea that smoking is the choice of fully consenting adults. After fighting such laws for decades, cigarette manufacturers supported 2019 legislation that raised the minimum purchase age from 18 to 21. Whereas the industry once feared that such laws would “gut our key young adult market,” in the words of a Philip Morris strategy document, it now embraces them as a way to preserve “adult choice.”
“We can’t defend continued smoking as a ‘free choice’ if the person was ‘addicted,’” a tobacco lobbyist observed more than four decades ago. And yet this is precisely what the industry has done — with the unintended blessing of even anti-tobacco lawmakers, whose rules have granted the validity of the cigarette’s engineering while making it ever more difficult, expensive and stigmatized to be a smoker.
The F.D.A.’s nicotine proposal is, at long last, an opportunity to test one of the industry’s core propositions. Only then will we truly see if smoking is a free adult choice rather than the consequence of addiction and skillful product design.
The fact is that most smokers want to quit. For all the industry’s insistence that cigarettes are an emblem of individuality, nearly 70 percent of adult smokers would prefer not to. More than half of the nation’s 31 million adult smokers attempt to quit each year, and only 7.5 percent succeed.
One study found that lowering nicotine levels could save an estimated 8.5 million lives in the next 80 years — lives of current smokers who will find it easier to quit, as well as lives of would-be smokers who never get hooked. It will save many millions more from tobacco-related heart and lung disease and from the unquantifiable grief that attends watching loved ones suffer prolonged and preventable illness. Such a stunning victory for public health is possible only with the kind of regulation that rightfully targets not individual smokers but the cigarette itself.
https://www.nytimes.com/2022/07/06/opinion/nicotine-smoking-cigarettes.html
There's a new status symbol for Britain's teenagers – and it's toxic
Billed as a suitable alternative to tobacco and filling Britain’s high streets, can the nation’s youth resist the allure of e-cigarettes?
By Charlotte Lytton 14 July 2022 • 6:00am
‘If we’re just replacing one bad with another bad, are we really tackling the issue?’
You don’t have to look far in modern Britain to find a group of teenagers exhaling clouds of coloured, scented, flavoured vapour, insouciantly sucking on plastic tubes. Close by, you will probably find clusters of alarmed parents, worrying about their children’s new habit – vaping – but unsure what to do.
For while, in the UK, it is illegal for under-18s to buy e-cigarettes, the market is being flooded with unsafe, dessert-flavoured disposable devices aimed at children, according to Trading Standards in England and Wales, who say they are currently receiving hundreds of complaints per month. Last week, a YouGov survey for Action on Smoking and Health (ASH) found that a quarter of the products purchased did not meet the standards required to be sold on UK shelves.
And the trade seems unstoppable. Vaping has almost doubled among 11 to 17-year-olds to seven per cent, with use of disposable e-cigarettes rising in popularity sevenfold.
While the NHS recommends vaping as a suitable alternative to smoking tobacco cigarettes, what of those who balk at the idea of a ciggie, but have been lured in by the endless shops featuring brightly coloured nicotine pens for a couple of pounds a pop?
The average cigarette contains around 12mg of nicotine. Elf Bars – among the most commonly used in the UK – contain 20mg of nicotine per 2ml of liquid, equating to around 40-50 cigarettes’ worth in fewer than 600 puffs. The amount consumed by vapers is hard to calculate, as cartridges come in different sizes and many users begin inhaling at the outset of the day, and don’t stop.
UK restrictions on what is now a £15 billion industry limit vape cartridge capacity to no more than 2ml, and the volume and strength of nicotine-containing liquid to 10ml and 20mg/ml respectively. These guidelines are among the more relaxed globally: in Australia, vapes can only be purchased by over-18s with a prescription, while they are banned from sale in San Francisco (rules vary state-to-state across the US). In countries from Japan to Brazil, India to Hong Kong, it is illegal to sell e-cigarettes.
Stores full of brightly coloured vials of flavoured vape fluid are common on Britain’s high streets CREDIT: Loop Images Ltd / Alamy Stock Photo
A big part of the UK’s stance is formed by the Government’s encouragement of vaping as a means to wean people off cigarettes, not to encourage them to vape per se – and its pledge to make Britain smoke-free by 2030 (currently 14.5 per cent of over-16s smoke).
“If we’re just replacing one bad with another bad, are we really tackling the issue?” asks dentist Anna Middleton. She has seen a rise in young patients coming into her Chelsea clinic presenting with bleeding gums – brought on by the nicotine in e-cigarettes, which “is a vasoconstrictor, and therefore affects blood supply. It’s a recipe for gum disease, because the bad bacteria is just thriving in that toxic environment.” Those risks aren’t communicated to would-be vapers, she adds.
A 2018 report from the National Academies of Science, Engineering and Medicine also found that e-cigarettes “contain and emit numerous potentially toxic substances,” and exacerbated asthma and wheezing among adolescent users.
The Medicines and Healthcare products Regulatory Agency says it seeks to create “an environment that protects children from starting to use these products”. Yet ASH’s research found that almost half of under-18s surveyed bought their e-cigarettes from shops whose purveyors were clearly unbothered by their customers being underage. Though the cost is comparatively small – from £1.99 for a 600-puff Elf Bar, compared with around £12 for a packet of cigarettes – the industry is predicted to grow 30 per cent year-on-year.
One “very concerned” parent of an 18-year-old says her daughter’s friends “order vape juice online with no problem” – and that while they consider cigarette smokers “disgusting”, they “don’t feel vaping is the same”. Others report that they believe vaping can be a gateway to cigarettes themselves.
Josh, an A-level student from Nottingham, had never smoked before being handed an Elf Bar at school last year, aged 17. E-cigarettes then began popping up in social settings so often, he was soon using them frequently – within a few months becoming so used to the nicotine hit, he switched to tobacco cigarettes. “I had no intention of more than one try for fun,” he says. But “with more and more people using them, I felt I needed to own one”; he didn’t want to seem “uncool or boring”.
Vaping is now something of a status symbol for teenagers, adds Josh. “Middle class teens and students opt for Elf Bars, Geek Bars or other smaller disposable vapes.” At festivals, they are often handed out for free by vape companies.
Vaping has almost doubled among 11 to 17-year-olds to seven per cent, with use of disposable e-cigarettes rising in popularity sevenfold CREDIT: Phoenixns
Image is a huge part of the appeal, says Dr Sandro Demaio, CEO of VicHealth in Australia. “The packaging looks like make-up or products that are very alluring to young people.” While Australia’s e-cigarette laws are far more stringent than the UK’s, he is calling for tighter restrictions on an industry “targeting teenagers, tweens and very young people” who are “breathing highly toxic, highly addictive products deep into their lungs as their bodies, minds and identities are still developing”.
He adds: “We urgently need to do all we can to protect young people to ensure that we don’t end up with another entire generation addicted, for life, to nicotine.”
Dr Demaio says that in the past week, he has met children as young as 10 addicted to vaping – and that a black market for illegal vapes is thriving on the likes of TikTok.
“The glamorous promotion of vaping on social media is completely inappropriate and social media platforms should take responsibility,” agrees Deborah Arnott, chief executive of ASH. The Khan review that produced the 2030 no-smoking benchmark also suggested that £15 million should be invested in enforcement, but “online platforms like TikTok don’t need to wait, they must act now”, Arnott says.
Skirmishes between companies and consumers continue, with little action. In the US, one family sued Juul, another e-cigarette brand, after their 15-year-old became addicted, resulting in seizures. And last month, the company received a ban on sales from the Food and Drug Administration – which was then revoked last week.
Part of the issue for governments considering further restrictions is how useful the devices are as a proxy for tobacco cigarette smokers. “Smoking is still the leading cause of premature death [worldwide],” Arnott points out. “That’s what’s killing people; not vaping.”
The challenge remains the new cohort. “I do believe that vaping products are used as the new cigarette ,” Josh says, adding that it is “now a large part of youth culture and identity in the UK”. There is data to show relative safety, compared with tobacco cigarettes – but nothing that goes beyond around the 15-year mark.
“We have no long-term data on health implications and the concentration of nicotine varies,” the mother of the 18-year-old says. “They think no health problems will pop up in their future.”
Gillian Golden, CEO of the Independent Vape Trade Association, comments: “It is illegal to sell vape products to anyone under 18, so young people should not be able to access them.
“E-cigarettes are meant for adult smokers who are looking to quit, or looking for a far safer alternative to cigarettes. The IBVTA would like to see more funding for enforcement and stiffer penalties for those who break the law.”
F.D.A. Orders Juul to Stop Selling E-Cigarettes
The agency ruled against the company’s application to stay on the market, a decisive blow to a once-popular vaping brand that appealed to teenagers.
In its heyday, Juul occupied 75 percent of the market share and employed 4,000 people. Credit...Jeenah Moon for The New York Times
By Matt Richtel and Andrew Jacobs
June 23, 2022, 10:36 a.m. ET
The Food and Drug Administration on Thursday ordered Juul to stop selling e-cigarettes on the U.S. market, a profoundly damaging blow to a once-popular company whose brand was blamed for the teenage vaping crisis.
The order affects all of Juul’s products on the U.S. market, the overwhelming source of the company’s sales. Juul’s sleek vaping cartridges and sweet-flavored pods helped usher in an era of alternative nicotine products among adults as well, and invited intense scrutiny from antismoking groups and regulators who feared they would do more harm to young people than good to former smokers.
“Today’s action is further progress on the F.D.A.’s commitment to ensuring that all e-cigarette and electronic nicotine delivery system products currently being marketed to consumers meet our public health standards,” Dr. Robert M. Califf, the agency commissioner, said in a statement. “The agency has dedicated significant resources to review products from the companies that account for most of the U.S. market. We recognize these make up a significant part of the available products and many have played a disproportionate role in the rise in youth vaping.”
The move by the F.D.A. is part of a wide-ranging effort to remake the rules for smoking and vaping products and to reduce illnesses and deaths caused by inhalable products containing highly addictive nicotine.
On Tuesday, the agency announced plans to slash nicotine levels in traditional cigarettes as a way to discourage use of the most deadly of legal consumer products. In April, the F.D.A. said it would move toward a ban on menthol-flavored cigarettes.
The action against Juul in particular is part of a newer regulatory mission for the agency, which must determine which electronic cigarettes currently for sale, or proposed for sale, will be allowed onto U.S. shelves permanently now that the F.D.A. has authority over e-cigarettes.
But it could take years before these proposals take effect — if they can withstand fierce resistance from the powerful tobacco lobby, antiregulatory groups and the vaping industry.
Juul is expected to appeal the F.D.A.’s decision.
Public health groups hailed the ruling.
“The F.D.A.’s decision to remove all Juul products from the marketplace is both most welcomed and long overdue,” said Erika Sward, national assistant vice president of advocacy for the American Lung Association. “Juul’s campaign to target and hook kids on tobacco has gone on for far too long.”
A statement from the American Vapor Manufacturing Association, an industry trade group, hinted at the fight ahead.
“Measured in lives lost and potential destroyed, F.D.A.’s staggering indifference to ordinary Americans and their right to switch to the vastly safer alternative of vaping will surely rank as one of the greatest episodes of regulatory malpractice in American history,” Amanda Wheeler, the association’s president, said in a statement.
Read More on Smoking and Vaping
- Nicotine Levels: Aiming to reduce the toll of smoking, the Food and Drug Administration is planning to require tobacco companies to slash the amount of nicotine in cigarettes.
- Menthol Ban: The F.D.A. has also proposed a plan to ban sales of menthol cigarettes, a measure experts say may save hundreds of thousands of lives, especially among Black smokers.
- ‘Smoking Is Back’: Cigarettes, still the No. 1 cause of preventable death in the United States, are making a comeback with a younger crowd.
- Vaping Loophole: A crackdown on flavored e-cigarettes was meant to curtail teenage vaping, but sales are rising due to synthetic nicotine.
- The Rise of Juul: A Times documentary traced the e-cigarette maker on its path from fledgling start-up to Silicon Valley juggernaut and, eventually, public health villain.
The agency’s ruling capped a nearly two-year review of data that Juul had submitted to try to win authorization to continue selling its tobacco- and menthol-flavored products in the United States. The application required the company to prove the safety of its devices and whether they were appropriate for the protection of public health.
Juul, in particular, had been the target of regulators, schools and policymakers for years, starting in 2018, when the F.D.A. began an investigation into Juul’s marketing efforts. Before that time, Juul had advertised its product using attractive young models and flavors like cool cucumber and creme brulee that critics said attracted underage users.
By April 2018, the F.D.A. announced a crackdown on the sale of such products, including Juul’s, to people under the age of 21.
Use among young people had soared. In 2017, 19 percent of 12th graders, 16 percent of 10th graders and 8 percent of eighth graders reported vaping nicotine in the past year, according to Monitoring the Future, an annual survey done for the National Institute on Drug Abuse.
For its part, Juul routinely denied that it targeted young people, but it was pursued in lawsuits and by state attorneys general, with some cases resulting in millions of dollars in damages against the company. In one settlement in 2021, Juul agreed to pay $40 million to North Carolina, which represented various parties in the state who asserted the company had helped lure underage users to vaping. More than a dozen other states have lawsuits and investigations that are still pending.
Dr. Scott Gottlieb, the former F.D.A. commissioner, explained his approval of the move against Juul on Wednesday, which was first reported in The Wall Street Journal.
The news is somewhat less weighty for the industry now than it would have been in Juul’s heyday, given the company’s plummeting market share. Once the dominant player with 75 percent of the market, Juul now has a considerably smaller share of the market.
But the news delivers a significant blow to Altria, formerly known as Philip Morris and the maker of Marlboro, which in December 2018 bought 35 percent of Juul for $12.8 billion. Because of smaller market share and regulatory headwinds, Altria said, the value of that stake fell to $1.7 billion by the end of 2021.
At its peak, Juul had more than 4,000 employees. It now has slightly over 1,000, mostly in the United States, but with some in Canada, Britain and other countries. Its revenue has fallen to $1.3 billion in 2021, down from $2 billion in 2019, with about 95 percent in U.S. sales.
Nicotine itself is not the cause of lung cancer and other deadly ills from smoking, but the drug is exceedingly addictive, making it difficult for smokers to quit despite the health risks. The adolescent brain is particularly susceptible to nicotine, which can affect memory, concentration, learning and self-control.
Already, the e-cigarette companies have said they will challenge the decision in court.
E-cigarettes have been sold on the U.S. market for more than a decade without formal F.D.A. authorization, because they did not fall under the agency’s regulatory purview for several years.
In 2019, the F.D.A. issued a warning letter to Juul, saying that the company violated federal regulations because it had not received approval to promote and sell its products as a healthier option to smoking.
The agency has been reviewing all types of vaping products, some in development, for more than a year, and companies awaiting a decision have been allowed to keep selling some products.
The F.D.A. recently said it had so far rejected more than a million applications whose products it considered more of a health risk than a benefit. In October, it authorized R.J. Reynolds to continue marketing Vuse. This was the first time the agency granted approval to a vaping product made by a big cigarette company.
In its review of devices that it compared with traditional cigarettes, the agency said that the devices contained a “significant reduction” in harmful chemicals, although some were still present. The review said the toxins and potential cancer-causing chemicals were far lower in the blood and urine of people using the Vuse device compared with those of smokers.
Still, California law required R.J. Reynolds to warn Vuse buyers about exposure to glycidol, which is “known to the state to cause cancer” based on studies of mice and rats.
In March, the agency authorized several tobacco-flavored products from Logic Technology Development, saying the company was able to show that its products were likely to help adults make the transition from traditional cigarettes while posing a low risk of attracting young, new users.
But the agency disappointed some prominent lawmakers and advocacy groups when it announced recently that it would not be able to finish reviewing all of the e-cigarette marketing applications until June 2023, a year after a court-imposed deadline.
Some tobacco-control experts said the decision to ban Juul from the U.S. market was misguided and ultimately counterproductive.
Clifford Douglas, director of the Tobacco Research Network at the University of Michigan School of Public Health, said that the F.D.A. appeared to punish Juul for its past activity marketing to teenagers, and that many experts had come to see Juul and other e-cigarettes as valuable tools for helping adult smokers quit conventional cigarettes.
“They are so-called off ramps that can provide smokers an alternative to combustibles, which are responsible for virtually every death related to tobacco,” he said. “But now that off ramp is being narrowed and sort of paved over, which is putting millions of adult lives at risk.”
Christina Jewett and Sheila Kaplan contributed reporting.
https://www.nytimes.com/2022/06/23/health/fda-juul-ecigarettes-ban.html
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Rassegna Stampa Scientifica Agosto 2022
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State of the Art Review
Impact of vaping on respiratory health
BMJ 2022;378:e065997 (Published 18 July 2022)
Andrea Jonas
https://www.bmj.com/content/378/bmj-2021-065997
Breaking Nicotine’s Powerful Draw
Millions of smokers could be forced to confront the agony of nicotine withdrawal as the F.D.A. weighs calling for a drastic reduction in the addictive lure of cigarettes.
Aug. 2, 2022
At some point in the next few years, the 30 million smokers in the United States could wake up one day to find that cigarettes sold at gas stations, convenience stores and smoke shops contain such minuscule amounts of nicotine that they cannot get their usual fix when lighting up.
Would the smokers be plunged into the agonizing throes of nicotine withdrawal and seek out their favorite, full-nicotine brand on illicit markets, or would they turn to vaping, nicotine gum and other less harmful ways to get that angst-soothing rush?
Such scenarios inched closer to the realm of possibility in June, when the Food and Drug Administration said that it would move toward slashing nicotine levels in cigarettes in an effort to reduce the health effects of an addiction that claims 480,000 lives a year.
The agency set next May as its timetable for introducing a fully developed proposal. But many experts hope regulators will champion an immediate 95 percent reduction in nicotine levels — the amount federally funded studies have determined is most effective for helping smokers kick the habit.
It could be years before any new policy takes effect, if it survives opposition from the tobacco industry. Even so, health experts say any effort to decrease nicotine in cigarettes to nonaddictive levels would be a radical experiment, one that has never been implemented by any other country.
The science of nicotine addiction has come a long way since 1964, when a U.S. Surgeon General report first linked smoking to cancer and heart disease, although it would take another two decades for the mechanics of nicotine dependence to be understood and widely accepted.
Tobacco contains more than 7,000 chemicals, many of them harmful when burned and inhaled, but it is nicotine that keeps smokers coming back for more. Nicotine stimulates a surge of adrenaline in the brain while indirectly producing a flood of dopamine, the chemical that promotes feelings of contentment and relaxation. The effects, however, are short-lived, which is why heavy smokers need a fresh injection a dozen or more times a day.
Eric Donny, a tobacco expert at Wake Forest University School of Medicine who has conducted experiments with low nicotine cigarettes, says many scientists have come to embrace a 95 percent reduction in nicotine levels as ideal for helping study subjects smoke less. Anything higher, he said, can encourage participants to engage in so-called compensatory smoking — inhaling more deeply or smoking more frequently.
The studies he and other scientists have run recently used genetically modified tobacco bred to express less nicotine; bringing nicotine down to zero is not an option under the Tobacco Control Act, a 2009 law that gave the F.D.A. the power to regulate the manufacture and marketing of tobacco.
“When you get the nicotine in tobacco low enough, you just can’t get enough nicotine to maintain the dependence,” Dr. Donny said. “Smoking more creates adverse effects, like nausea, because the lungs can only handle so much of a burned substance.”
But even as tobacco control researchers cheered the F.D.A. announcement, they acknowledged that any move to lower nicotine in cigarettes would be enormously challenging for inveterate smokers — even among the 70 percent who have said they would like to stop. As it is, fewer than one in 10 adults who try to quit smoking succeed, a reflection of nicotine’s addictive prowess and the limitations of nicotine replacement therapy.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, expressed confidence in the studies that backed an immediate cut in nicotine levels versus a gradual tapering. But she said that scientists and regulators still needed to address the welter of unforeseen consequences that could prove disruptive to determined smokers and could fuel the creation of underground markets for full-nicotine cigarettes. “You cannot completely predict outcomes based on a clinical randomized study,” she said. “Biology and life are not so precise.”
Some scientists have urged caution for any plan that would drastically cut nicotine levels in one fell swoop, warning that the existing research on low-nicotine cigarettes is imperfect, given the high number of study participants who cheat. The skeptics, among them tobacco company executives, warn that banning conventional cigarettes would drive determined smokers to seek imports from Mexico and Canada. They also argue that some smokers, including teenagers, could develop a habit that pairs vaping or nicotine gum with low-nicotine cigarettes, which are just as carcinogenic as traditional cigarettes.
Lynn T. Kozlowski, a tobacco researcher at the University at Buffalo who has contributed to four Surgeon General reports on smoking since 1981, said nicotine was a highly addictive drug, with a stranglehold on users that could rival cocaine and heroin, and that the F.D.A. needed to consider how a sweeping decrease of nicotine in cigarettes would affect smoker behavior.
“What scares me is a national experiment with very low nicotine cigarette that is done without some testing in the real world,” he said. The studies many experts cite when promoting a 95 percent drop in nicotine levels relied upon paid participants, he noted, adding that some of them secretly smoked their own brands at the same time that researchers were plying them with low-nicotine cigarettes.
In interviews, smokers who had heard about the F.D.A.’s announcement said they were conflicted by the prospect of being forced to abandon their addiction, despite knowing full well that it damaged their health and would likely shorten their life span. Mike Harrigan, an options trader who was taking a smoking break outside the Chicago Board of Trade, said he feared he might actually end up smoking more if cigarettes contained significantly lower amounts of nicotine. “It may help newer smokers, but it will hurt people who are used to a certain level of nicotine,” said Mr. Harrigan, 55, who has been a pack-a-day smoker for three decades.
Dr. Kozlowski said he was especially concerned by the agency’s mixed messaging and seemingly conflicted stance on e-cigarettes, which deliver nicotine without the tar and many other toxins that are inhaled when tobacco is ignited. Even if the long-term impacts of vaping remain unknown — though health experts agree that teenagers should be discouraged from trying e-cigarettes — there is mounting consensus that such products are useful for helping adult smokers quit.
The F.D.A. has so far approved just six vaping products and has denied more than a million others, including those made by Juul Labs. Earlier this summer, the agency ordered Juul off shelves, citing the potential harm from chemicals that could leach out of its e-liquid cartridges. But the F.D.A. has since granted the company further review.
Dr. Judith Prochaska, an addiction specialist at Stanford University who runs a smoking cessation clinic for patients with cancer and their families, said lighting up during a stressful phone call, while sipping a cocktail or following a meal creates a powerful memory that conditions the mind into associating a cigarette with the stimulation or succor that it delivers via the rush of nicotine.
“All these everyday behaviors cue your brain that nicotine is coming,” she said. “It’s basically the Pavlovian dog effect but conditioned here with a highly addictive drug.”
Over time, the dependency deepens. Regular smoking promotes the formation of additional dopamine receptors — sometimes millions more. When a smoker goes cold turkey, those unrequited receptors prompt the anxiety, irritability and depression that can make nicotine withdrawal so hard to bear.
Nicotine patches, gum and vapes can help to satisfy some of the cravings, but they cannot replace the rituals of having a cigarette: the retreat outside with a co-conspirator, the crinkling of cellophane and foil as you open a new pack, the heady buzz of that first drag.
Bruce Holaday, 69, a retired educator from Mill Valley, Calif., knows full well the power of nicotine. Over the past five decades, Mr. Holaday reckons he has tried to quit 100 times, often relying on nicotine replacement products. But he invariably returned to his lifelong, pack-a-day affair with Marlboro Lights.
His last attempt in August, a cold turkey gambit without nicotine replacement therapy, triggered an excruciating maelstrom of cravings that lasted several months. “It was like a sudden earthquake of desire and need, and then there would be these tremors for the next 10 to 15 minutes,” he said.
But this time, Mr. Holaday joined a support group at Stanford Health Care, which introduced a powerful social component into his quest. He described the effect as “not wanting to let the team down” and said he learned to avoid stressful situations, like watching the news. He discovered that if he could face down the initial waves of craving, they invariably subsided.
In late June, he passed the one-year mark since taking his last drag.
He gained weight but no longer gets easily winded on hikes. And he is confident he will never go back to smoking.
Asked about the prospect of drastic government intervention to compel Americans to quit, Mr. Holaday paused and thought about the first puff he took a half-century ago as a college freshman. “Without that nicotine rush, I would have probably walked away and never smoked again,” he said. “It will be rough for smokers, but anything we can do to prevent a new generation from getting hooked is a good thing.”
Robert Chiarito contributed reporting from Chicago.
Andrew Jacobs is a health and science reporter, based in New York. He previously reported from Beijing and Brazil and had stints as a metro reporter, Styles writer and national correspondent, covering the American South. @AndrewJacobsNYT
A version of this article appears in print on Aug. 2, 2022, Section D, Page 1 of the New York edition with the headline: A Plan to Ease the Cravings of Smokers.
https://www.nytimes.com/2022/08/02/health/fda-nicotine-addiction.html
Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019
International Journal of Cancer
First published: 10 August 2022
Farhad Islami, Emily C. Marlow, Jingxuan Zhao, Daniel Wiese, Samuel Asare, Priti Bandi, Blake Thomson, Zhiyuan Zheng, Nigar Nargis, K. Robin Yabroff, Ahmedin Jemal
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.34217
Related coverage:
Smoking Still Ends 123,000 American Lives Each Year
Note: The information in the article accurately reflects the study findings, but the headline omits the reference to cancer deaths. The overall toll of tobacco-related mortality in the US is generally cited as 480,000 annual deaths.
“In this national cohort study of 17 073 children with neuroimaging outcomes, a significant association was found of early-age initiation of tobacco use with lower crystalized cognition composite score and impaired brain development in total cortical area and volume. Region of interest analysis also revealed smaller cortical area and volume across frontal, parietal, and temporal lobes… These findings suggest that youths vulnerable to e-cigarettes and tobacco products should be treated as a priority population in tobacco prevention.”
Longitudinal Assessments of Neurocognitive Performance and Brain Structure Associated With Initiation of Tobacco Use in Children, 2016 to 2021
JAMA Netw Open. 2022;5(8):e2225991.
August 10, 2022
Hongying Daisy Dai, Gaelle E. Doucet, Yingying Wang, Troy Puga, Kaeli Samson, Peng Xiao, Ali S. Khan
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794988
Related JAMA Netw Open Commentary:
Understanding the Association of Childhood Tobacco Use With Neuropathological Outcomes and Cognitive Performance Deficits in Vulnerable Brains
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794992
Note: Open Access.
“The FCTC [Framework Convention on Tobacco Control] offers a framework to interpret state obligations to progressively realize the human right to health, with Article 14 and its guidelines providing a basis to clarify state obligations to ensure that those addicted to tobacco receive cessation support. However, Article 14 implementation has been limited. The right to health provides an alternative basis under international law to recognize the inherent dignity of those addicted to tobacco, implement FCTC
obligations under Article 14 and facilitate state accountability.”
Could international human rights obligations motivate countries to implement tobacco cessation support?
Addiction
First published: 06 July 2022
Benjamin Mason Meier, Martin Raw, Donna Shelley, Chris Bostic, Anahita Gupta, Kelsey Romeo-Stuppy, Laurent Huber
https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15990
Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019
International Journal of Cancer
First published: 10 August 2022
Farhad Islami, Emily C. Marlow, Jingxuan Zhao, Daniel Wiese, Samuel Asare, Priti Bandi, Blake Thomson, Zhiyuan Zheng, Nigar Nargis, K. Robin Yabroff, Ahmedin Jemal
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.34217
Related coverage:
Smoking Still Ends 123,000 American Lives Each Year
Note: The information in the article accurately reflects the study findings, but the headline omits the reference to cancer deaths. The overall toll of tobacco-related mortality in the US is generally cited as 480,000 annual deaths.
“In this national cohort study of 17 073 children with neuroimaging outcomes, a significant association was found of early-age initiation of tobacco use with lower crystalized cognition composite score and impaired brain development in total cortical area and volume. Region of interest analysis also revealed smaller cortical area and volume across frontal, parietal, and temporal lobes… These findings suggest that youths vulnerable to e-cigarettes and tobacco products should be treated as a priority population in tobacco prevention.”
Longitudinal Assessments of Neurocognitive Performance and Brain Structure Associated With Initiation of Tobacco Use in Children, 2016 to 2021
JAMA Netw Open. 2022;5(8):e2225991.
August 10, 2022
Hongying Daisy Dai, Gaelle E. Doucet, Yingying Wang, Troy Puga, Kaeli Samson, Peng Xiao, Ali S. Khan
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794988
Related JAMA Netw Open Commentary:
Understanding the Association of Childhood Tobacco Use With Neuropathological Outcomes and Cognitive Performance Deficits in Vulnerable Brains
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794992
Note: Open Access.
“The FCTC [Framework Convention on Tobacco Control] offers a framework to interpret state obligations to progressively realize the human right to health, with Article 14 and its guidelines providing a basis to clarify state obligations to ensure that those addicted to tobacco receive cessation support. However, Article 14 implementation has been limited. The right to health provides an alternative basis under international law to recognize the inherent dignity of those addicted to tobacco, implement FCTC
obligations under Article 14 and facilitate state accountability.”
Could international human rights obligations motivate countries to implement tobacco cessation support?
Addiction
First published: 06 July 2022
Benjamin Mason Meier, Martin Raw, Donna Shelley, Chris Bostic, Anahita Gupta, Kelsey Romeo-Stuppy, Laurent Huber
https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15990
“Globally, there has been substantial progress in reducing exposure to tobacco that can be linked to coordinated international and national prevention efforts. Interventions through taxation and regulatory policies for tobacco smoking, including smoke-free policies, increased tobacco taxes, and advertisement bans guided by the WHO Framework Convention on Tobacco Control, have played a major role in these efforts… Smoking continues to be the leading cancer risk factor globally, with other substantial contributors to cancer burden varying around the world.”
The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
The Lancet
VOLUME 400, ISSUE 10352, P563-591, AUGUST 20, 2022
Published: August 20, 2022
GBD 2019 Cancer Risk Factors Collaborators
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01438-6/fulltext
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2901438-6
Related coverage:
Smoking, alcohol, high BMI leading causes of global cancer deaths: Lancet study
Smoking, Alcohol, High BMI Main Causes Of Global Cancer Deaths: Lancet
“Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality… A deeper understanding of the links between tobacco product use and disease risk could help to shape public health recommendations and to improve the clinical care of those with a history of tobacco dependence.”
PERSONAL VIEW
Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research
Lancet Resp Med
Published: August 16, 2022
Neal L Benowitz, Maciej L Goniewicz, Bonnie Halpern-Felsher, Suchitra Krishnan-Sarin, Pamela M Ling, Richard J O'Connor, Mary Ann Pentz, Rose Marie Robertson, Aruni Bhatnagar
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00182-5/fulltext
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Rassegna Stampa Scientifica Settembre 2022
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Juul Settles Multi-State Youth Vaping Inquiry for $438.5 Million
The tentative deal would close a yearslong investigation by nearly three dozen states into the company’s marketing and sales practices.
Juul Labs has tentatively agreed to pay $438.5 million to settle an investigation by nearly three dozen states that focused on the company’s sales and marketing practices that they claim fueled the teenage vaping crisis.
The investigation found that the company appealed to young people by hiring young models, using social media to court teenagers and giving out free samples. William Tong, Connecticut’s attorney general, said in a news conference that the investigation found that the company had a “porous” age verification system for its products and 45 percent of its Twitter followers were ages 13 to 17.
“We think that this will go a long way in stemming the flow of youth vaping,” Mr. Tong said. “We are under no illusions and cannot claim that it will stop youth vaping. It continues to be an epidemic. It continues to be a huge problem. But we have essentially taken a big chunk out of what was once a market leader.”
Juul said on Tuesday that the settlement “is a significant part of our ongoing commitment to resolve issues from the past. The terms of the agreement are aligned with our current business practices which we started to implement after our companywide reset in the fall of 2019.”
But the company said it was not acknowledging any wrongdoing in the settlement.
The tentative settlement prohibits the company from marketing to youth, from funding education in schools and misrepresenting the level of nicotine in its products. Juul had already discontinued several marketing practices and withdrawn many of its flavored pods that appealed to teenagers, under public pressure from lawmakers, parents and health experts a few years ago when the vaping crisis was at a peak.
The company’s ability to continue to sell its products has been in question in recent months. The Food and Drug Administration announced in June that it was denying the company’s request for marketing authorization to sell the vapes, saying its application lacked evidence to prove they would benefit public health. The agency also cited “insufficient and conflicting” data from the company. The company quickly went to court and got a temporary reprieve.
The company responded days later that it helped two million adult smokers quit combustible cigarettes and took exception with the agency’s conclusions about chemicals in its products. The F.D.A. then announced that it would allow the products to stay on the market pending additional review of “scientific issues.”
Christina Jewett covers the Food and Drug Administration. She is an award-winning investigative journalist and has a strong interest in how the work of the F.D.A. affects the people who use regulated products. @By_Cjewett
https://www.nytimes.com/2022/09/06/health/juul-settlement-vaping-crisis.html
"Nicotine gummies are a public health crisis just waiting to happen among our nation's youth, particularly as we head into a new school year," FDA [Food & Drug Administration] Commissioner Dr. Robert Califf warned last month. The FDA last month sent a warning letter to VPR Brands, one of the companies that makes nicotine gummies, advising that the products were being sold illegally. By law, manufacturers need to submit an application and have it approved by the FDA before a tobacco product can be legally marketed in the United States. The agency says VPR had not asked for this "premarket authorization" for the gummies. Each of the gummies had 1 milligram of nicotine, and they came 12 to a package. The FDA says 1 to 4 milligrams of nicotine could be severely toxic to children under 6 as well as to older children, depending on their weight.” [Jen Christensen. Nicotine gummies are a 'public health crisis just waiting to happen,' FDA says, CNN]
“Non-tobacco oral nicotine products were the second most prevalent nicotine product used by adolescents. They were disproportionately used by certain racial or ethnic, sexual, or gender minority groups, and those with a history of nicotine use. Adolescent non-tobacco oral nicotine product use surveillance should be a public health priority.”
Adolescent Use of Flavored Non-Tobacco Oral Nicotine Products
Pediatrics
Volume 150, Issue 3, September 2022
Online First: August 08 2022
Alyssa F. Harlow, Erin A. Vogel, Alayna P. Tackett, Junhan Cho, Dae-Hee Han,Melissa Wong, Myles G. Cockburn, Steve Y. Sussman, Jennifer B. Unger, Adam M. Leventhal, Jessica L. Barrington-Trimis
Note: Open Access.
US: Kennedy Center Promotes Big Tobacco; NZ: Convenience Store Lobby
“With all we know now about the tobacco industry’s tactics, discriminatory marketing, targeting of youths and addictive, deadly products, what would he think about the institution bearing his name promoting cigarette companies? The Met and others brought down the curtain on their Sackler [opioid-pushing Purdue Pharma] sponsorships. If it’s serious about its social impact, it’s time the Kennedy Center ended its dance with Big Tobacco.” [The Kennedy Center should stop promoting Big Tobacco, Washington Post]
“Let us carry on peddling death, or our businesses will die, dairy owners have told MPs, though not in those exact words… The Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill is designed to “significantly” limit the number of retailers allowed to sell smoked tobacco products. Fewer places selling “cancer sticks” will mean fewer opportunities for young people to start smoking, and will mean it’s easier for smokers to quit, supporters argue… But if dairies (sic) primary function is peddling cigarettes, the closure of dairies sounds like a gain for the community. And given the choice between dead people, and dead businesses, the people win.” [Rob Stock. How can dairies survive if their business is built on smokes?, Stuff (NZ)]
“Shocking new footage suggests you might want to make sure you're using the correct charger for your e-cigarette. Video from experts at London charity Electrical Safety First shows a powerful explosion from a small lithium ion battery inside an e-cigarette… [J]ust like smartphones and electric cars, e-cigarettes contain lithium-ion batteries that can burst into flames or explode if pierced, damaged or overheated… Brits may already be reconsidering keeping their vape in their pocket after instances of the devices exploding and causing horrific burns.” [Jonathan Chadwick. Do you vape? Check your charger NOW: Shocking video shows the lithium battery from an e-cigarette EXPLODING during charging test, Daily Mail]
Opinion
The Kennedy Center should stop promoting Big Tobacco
By Rebecca Perl
September 9, 2022
A view from the Roosevelt Bridge of the Reach, a new multiuse complex at the Kennedy Center in D.C. (Bill O'Leary/The Washington Post)
Rebecca Perl, a former health and science reporter for The Post, is vice president of partnerships and initiatives for Vital Strategies, a partner in tobacco industry watchdog, STOP and advises governments and nongovernmental organizations on communication strategies for tobacco control campaigns around the world as part of the Bloomberg Initiative to Reduce Tobacco Use.
On Sept. 17, the John F. Kennedy Center for the Performing Arts in D.C. will launch a new exhibit dedicated to its namesake. Advance media coverage praises the center’s investment in its social impact, in line with Kennedy’s ethos and values. But as is often the case when organizations talk about being good citizens, there are gaps between the rhetoric and the reality.
For the Kennedy Center, it is taking money from some of the world’s largest tobacco corporations. Instead of rejecting hundreds of thousands of dollars gained through the sale of products linked to addiction, preventable disease and premature death, the center recently added global cigarette giant Philip Morris International (PMI) as a new corporate sponsor, alongside its long-standing relationship with PMI’s former parent company, Marlboro-maker Altria Group. Combined, they are contributing at least half a million dollars annually — a testimony to a never-ending dance of the underfunded arts with deep-pocketed corporations looking to burnish their reputations.
Yet, despite funding challenges, especially post-coronavirus, other world-class venues are making an ethical choice to end sponsorships from problematic donors. For example, when the Sackler family’s role in the opioid crisis was exposed, the Metropolitan Museum of Art in New York ended its 50-year relationship. The Louvre in Paris and the Guggenheim in New York and many others also dropped the Sackler name. The opioid epidemic claims more than 68,000 lives a year in the United States. The tobacco epidemic? More than 480,000.
The Kennedy Center’s commitments to better serving youths and people of color ring especially hollow while it’s helping the tobacco industry reach groups who have been targeted for decades with deceptive and even racially targeted marketing. Menthol cigarettes, promoted heavily in Black media and in predominantly Black neighborhoods, have caused disproportionate harm to Black people. Products such as nicotine pouches and e-cigarettes are believed to be hooking a new generation.
Visiting the Kennedy Center to see “The Nutcracker” last winter, I could see the Altria-sponsored 50th-anniversary theater season was packed with family- and teen-friendly productions. Attaching Altria’s name to productions for young people reminds me of Chinese tobacco companies sponsoring schools in China and other countries.
What will it take to break the Kennedy Center’s addiction to tobacco dollars? The revelation that industry executives stood before Congress a few miles away, claiming that nicotine wasn’t addictive when the companies knew that wasn’t true, wasn’t enough.
The Kennedy Center didn’t drop Altria when it invested heavily in Juul, after the Food and Drug Administration named the company as a leading player in the United States’ youth vaping epidemic. Nor when Altria spoke out against the FDA’s proposed menthol ban, which could help save up to 6,000 Black lives each year.
Instead, Altria’s brands remain etched into the center’s marble walls, including at the newest Kennedy Center venue, the Reach, which aims to embody “President Kennedy’s vision” and reach a diverse audience through education, youth programs and community outreach. Altria and PMI are on the Kennedy Center’s website, and Altria is splashed across its 50th-anniversary materials, in social media posts, newsletters and performance programs, even celebrated as “a donor that makes a difference” in the 50th-anniversary magazine. Altria’s chief executive is a vice chair of the Kennedy Center’s Corporate Fund Board, alongside PMI’s president of the Americas.
It’s easy to see why the Kennedy Center’s youth-friendly 50th season and the Reach’s youth and community audience appeal to Altria and PMI. As more smokers die or quit, the companies need to tap into the next generation. Altria’s Marlboro and Juul brands are already popular with young Americans. Both companies might also hope to influence D.C. stakeholders in their favor — and that’s potentially bad news for health.
There is, however, something especially insidious about aligning the tobacco industry with performances aimed at preschoolers, children and other youths. Perhaps it is because such shows capture the dreams of little girls and boys and the ambitions of so many young people, who continue to be targeted by cigarette companies.
President Kennedy believed the arts should be a positive force in American life. With all we know now about the tobacco industry’s tactics, discriminatory marketing, targeting of youths and addictive, deadly products, what would he think about the institution bearing his name promoting cigarette companies? The Met and others brought down the curtain on their Sackler sponsorships. If it’s serious about its social impact, it’s time the Kennedy Center ended its dance with Big Tobacco.
https://www.washingtonpost.com/opinions/2022/09/09/kennedy-center-should-stop-promoting-big-tobacco/
How McKinsey Got Into the Business of Addiction
The consulting firm’s work with opioid makers is well known, but for decades McKinsey worked with Big Tobacco and has also advised Juul, the e-cigarette company.
McKinsey & Company in New York City. The firm’s work with opioid makers is well known, but its work with cigarette and vaping companies has escaped public scrutiny.Credit...John Taggart for The New York Times
By Walt Bogdanich and Michael Forsythe
Bogdanich and Forsythe, investigative reporters at The Times, are the authors of the forthcoming book “When McKinsey Comes to Town: The Hidden Influence of the World’s Most Powerful Consulting Firm,” from which this article is adapted.
Sept. 29, 2022
When McKinsey & Company, the global consulting giant, sat down with executives of Juul Labs in late 2017, the vaping company was well on its way to becoming a sensation among teenagers eager to latch on to the latest fad — inhaling flavored, supercharged nicotine vapor through a sleek new device easily hidden from parents and teachers.
With grand ambitions, Juul needed marketing advice from McKinsey, the most respected voice in consulting, to help it on its way to a valuation greater than the Ford Motor Company. For less than two years of work, McKinsey billed Juul $15 million to $17 million.
But the client came with a reputational risk, and McKinsey preferred to keep the arrangement secret. Although its product was conceived as a way to help adults stop smoking, Juul stood accused of marketing nicotine to teenage nonsmokers, addicting a new generation in much the same way the cigarette industry hooked their parents. This month, several years after McKinsey took the company as a client, Juul agreed to pay $438.5 million to settle government investigations into its marketing practices, though it did not acknowledge wrongdoing in the settlement. Those marketing practices had included using young models, social media and flavored nicotine.
McKinsey, which was not involved in the settlement, said its work with Juul had focused on youth vaping prevention. That work was just the latest in a decades-long history of consulting for companies that sell addictive products. The full story of McKinsey’s role in advising these companies — while also consulting for their government regulators — has never been told.
Last year, McKinsey agreed to pay more than $600 million to settle state investigations into its role in helping Purdue Pharma and other drugmakers fuel the opioid epidemic. And for decades, McKinsey has helped manufacturers boost sales of the most lethal consumer product in American history — cigarettes.
As recently as 2016, more than 50 years after the surgeon general confirmed the link between smoking and cancer, McKinsey still saw merit — and profits — in continuing to help companies sell more cigarettes.
In a slide deck prepared for Altria, formerly Philip Morris, McKinsey offered ideas for how the tobacco company could keep customers and lure new smokers. It presented a mock-up of what a Marlboro smartphone app would look like, complete with a way for loyal smokers to win points redeemable for small prizes.
McKinsey felt comfortable proposing ways for the manufacturer of Marlboro cigarettes to sell more of them.Credit...Dolly Faibyshev for The New York Times
McKinsey’s most important work for Juul Labs involved responding to an F.D.A. crackdown on youth vaping.Credit...Caroline Tompkins for The New York Times
“We are one team, working side-by-side,” McKinsey wrote in a slide deck prepared for Altria, illustrated with photos of cigarettes. McKinsey also advised Altria on marketing e-cigarettes, with the goal of making one of its products the “Nespresso of e-vapor” and stopped advising tobacco companies only last year.
McKinsey’s services are highly valued; its clients include many of the most respected blue-chip companies as well as governments around the world. For companies selling addictive products it also offered deep ties to the Food and Drug Administration, a regulatory agency vital to their survival. In four years under President Donald J. Trump, McKinsey took in $77 million in consulting contracts with the F.D.A.
McKinsey’s vaunted value system points to why a company so widely admired could end up working so long for tobacco companies. On one hand, McKinsey used those values to recruit the best and brightest students by suggesting that a job there means more than a big paycheck — it also offers the possibility of doing good, of helping those most in need. Yet McKinsey’s overriding value, No. 1 on its list — to put client interests first — created an environment in which client service sometimes trumped its own moral code.
McKinsey denies any wrongdoing in helping to market opioids, vaping and cigarettes — its trifecta of addiction clients — or that its F.D.A. contracts posed a conflict of interest, because it never advised the agency on any specific drug, a McKinsey spokesman said in a written response.
McKinsey agreed last year to pay more than $600 million to settle state investigations into its role in the opioid epidemic.Credit...Carolyn Kaster/Associated Press
Seth Green, a former McKinsey consultant who worked at the firm for two years and is now a dean at the University of Chicago, questioned the wisdom of rigidly adhering to the client-first dictum. “If we don’t bring a moral purpose to these businesses, then the purpose inevitably becomes the client and whatever the client is trying to achieve,” Mr. Green said.
Juul and the Rise of Youth Vaping
- ‘Move Fast and Vape Things’: From a fledgling start-up to Silicon Valley juggernaut, a Times documentary traced the e-cigarette maker’s path to a public health villain.
- Hooking a Generation: Juul said its e-cigarette was meant to give adult smokers a safer alternative to cigarettes — not hook young people on nicotine. The reality inside the company was different.
- The Price of Cool: E-cigarettes may help tobacco smokers quit. But the alluring devices can swiftly induce a nicotine habit in teens who never smoked.
- Vaping Loophole: The Food and Drug Administration’s crackdown in 2020on flavored e-cigarettes like Juul was meant to curtail teen vaping. Some companies moved just beyond the agency’s reach by swapping out one key ingredient.
Even if that means consulting for Big Tobacco.
Teenagers’ Favorite Flavors
Alfonso Pulido, a McKinsey partner, arrived at the San Francisco offices of the Covington & Burling law firm on a mid-October morning last year to do something antithetical to the firm’s strict code of secrecy: talk about McKinsey’s work with clients, specifically Juul and Altria.
Mr. Pulido was there to give a deposition in connection with an unresolved product liability case filed in a federal court in California. In the deposition, marked highly confidential, Mr. Pulido said McKinsey first discussed doing business with Juul in 2015 when it proposed doing a risk assessment of Juul’s tentative plan to enter the marijuana market.
McKinsey chose not to do the study, Mr. Pulido said, because marijuana “was not regulated or legal at the time.”
It wasn’t until 2017 that the consultancy performed a pricing study for Juul’s vaping device. Afterward, McKinsey offered advice on branding, organization, retail, flavor evaluation, youth vaping prevention and regulatory issues. The company also consulted for Altria, which was trying to muscle into the vaping business.
Flavored nicotine had become highly controversial because health care experts blamed Juul for using flavors that appealed to young people.
Mr. Pulido acknowledged that McKinsey had surveyed teenagers as young as 13, asking them to rank flavor names in order of preference, though he emphasized that no sensory testing had taken place.
Esfand Nafisi, a lawyer representing clients who had sued Juul for marketing to children, pressed him on that answer.
“Did anyone at McKinsey stop and say, ‘Hey, maybe we shouldn’t be helping tobacco companies study teenagers’?”
“The stated objectives were to help inform youth prevention activity as well as responsibly introduce a flavor that was appealing to adult smokers,” Mr. Pulido responded.
“In retrospect, does McKinsey think this survey was appropriate?” Mr. Nafisi asked several minutes later.
“I don’t have an opinion on it,” Mr. Pulido responded. But he added that it “feels correct.”
The survey found that the favorite flavor name among ages 13 to 21 was mint, Mr. Pulido said.
“Did you know that mint would go on to become an incredibly popular flavor with teens a year after this Power Point deck was presented?” Mr. Nafisi asked.
“No, I was not aware of that.”
McKinsey records show that Bob Sternfels played an administrative role on the Juul team. McKinsey says he did not work on the account.Credit...Singapore Press, via Associated Press
The work with Juul attracted interest at the highest levels inside the firm. Bob Sternfels, now McKinsey’s managing partner, played an administrative role on the Juul account, an internal document shows. (A McKinsey spokesman said that while Mr. Sternfels knew a senior Juul executive, he had not worked on that account.)
McKinsey’s most important work for Juul involved responding to the F.D.A.’s crackdown on youth vaping. With the F.D.A. circling, demanding answers as to why teenagers were so attracted to Juul, the company asked McKinsey to help prepare a defense and respond to the agency’s inquiry.
The nature of that work remains a secret, because for those services McKinsey was paid through Juul’s law firm, Sidley Austin, allowing Mr. Pulido to claim lawyer-client privilege. “I know in some instances we are retained through legal counsel as part of privilege,” Mr. Pulido said.
At least one McKinsey partner, Michael Chui, grew concerned watching vaping spike in popularity, though it was not at all clear that he knew McKinsey had Juul as a client. (Consulting teams are not allowed to share information.)
“In just a few years, vaping has wiped out two decades of work getting teens to quit (or never start) cigarette smoking,” Mr. Chui wrote in a public comment on a magazine article about Juul.
Mr. Pulido said McKinsey stopped work with Juul in 2019 because of “increasing regulatory uncertainty and increased awareness of youth use.”
McKinsey and the Tobacco Industry
Vaping became popular as smoking rates across the nation began to decline in response to a drumbeat of scientific findings that cigarettes are highly addictive and deadly, facts that the companies knew but kept secret, choosing deception over disclosure.
McKinsey began counseling the tobacco industry in 1956, when researchers had already reported data suggesting that smoking appeared to cause cancer. Back then, Philip Morris hired McKinsey to conduct a wall-to-wall examination of its manufacturing operation. This was no cursory walk-through. Consultants visited plants, interviewed managers and studied sales figures.
In a subsequent study, McKinsey recommended how the company should set up its research department. The report was significant for another reason: It foreshadowed the industry’s transformation from selling a largely agricultural product to a scientifically engineered cigarette with fine-tuned nicotine levels. It cited the development of “reconstituted tobacco,” a manufacturing process that in subsequent years was shown to help achieve nicotine levels that researchers considered sufficient to ensure addiction.
Surgeon General Luther Terry, center, settled questions over the dangers of smoking when he announced to the nation that studies had confirmed the link between cigarettes and cancer.Credit...Getty Images
In 1964, Surgeon General Luther L. Terry settled questions over the dangers of smoking when he announced to the nation that studies had confirmed the link between cigarettes and cancer. Dr. Terry made his announcement on a weekend to minimize its impact on stock prices.
McKinsey now had another reason to back away from Big Tobacco. But the tobacco companies wanted to keep selling cigarettes, so McKinsey stayed to help them do just that. In addition to Philip Morris, the firm’s clients included R.J. Reynolds, Lorillard, Brown & Williamson, British American Tobacco and Japan Tobacco International.
More health warnings followed.
In 1992, the federal judge H. Lee Sarokin became so outraged reading internal industry documents produced in a liability lawsuit that he cast aside judicial restraint when he wrote: “Who are these persons who knowingly and secretly decide to put the buying public at risk solely for the purpose of making profits and who believe that illness and death of consumers is an appropriate cost of their own prosperity!”
In response to mounting criticism, in 1993 Lorillard’s chief executive, Andrew Tisch, asked employees to cooperate with McKinsey, assuring them that the consultants were “renowned for their ability to solve problems and create opportunity.”
By taking on Lorillard, McKinsey agreed to help a company whose best-selling cigarette by far was Newport, with its high nicotine content and menthol flavor. Menthol masked the harsh taste of burning tobacco, making it appealing for novice smokers. Nicotine took care of the rest, turning them into repeat customers.
McKinsey did allow employees to opt out of helping Big Tobacco, or any other industry they found objectionable, but finding replacements eager to impress senior partners critical to their advancement was usually easy.
In 2006, a federal judge, Gladys Kessler, delivered the harshest condemnation yet of cigarette makers, branding them civil racketeers, saying the industry had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success extracted.”
Ten years later, McKinsey still felt comfortable proposing ways for the manufacturer of Marlboro cigarettes to sell more of them.
‘Startled and Surprised’
Senator Christopher Dodd speaking in 2009 after Congress authorized the F.D.A. to regulate tobacco products. For advice, the agency subsequently went to McKinsey.Credit...Susan Walsh/Associated Press
After Congress gave the F.D.A. the authority to regulate tobacco products in 2009, the agency sought McKinsey’s wisdom on a variety of issues, though its leaders apparently were unaware that the firm had been guiding Big Tobacco’s development for decades. In subsequent years, the agency awarded the consultancy $11 million for advice on tobacco regulation and for organizing the F.D.A. office that includes tobacco regulation.
“We have served the F.D.A. on over 30 initiatives,” McKinsey wrote in securing $1.1 million to advise the agency’s Center for Tobacco Products about, among other things, “risk identification and mitigation” as well as “influencing the behaviors, opinions and practices that are contrary to the goals and objectives” of tobacco regulators. Presumably that included cigarettes.
Eric N. Lindblom, former director of the Office of Policy for the Center of Tobacco Products, said he was “startled and surprised” to learn of these apparent conflicts. “We didn’t think, duh, they are also going to serve the industry,” he said.
Dr. Lawrence Deyton, a physician and the tobacco center’s first director, said he had also been unaware of McKinsey’s work for cigarette companies. “That should have been disclosed,” he said. As late as 2019, McKinsey’s roster of tobacco clients included not just Altria but also Imperial Brands, British American Tobacco and Japan Tobacco International.
From 2018 through early 2020, McKinsey made at least $45 million in fees from these four companies, including more than $30 million from Altria alone, according to McKinsey billing records. This summer, the F.D.A., after years of criticism for not doing enough to protect the public from nicotine addiction, issued two major directives: It ordered Juul off the market over questions of safety, and proposed reducing nicotine in cigarettes to levels where consumers might no longer buy them. Although the decision affecting Juul has been stayed, the actions showed how seriously the agency now views the health risks of both products.
McKinsey declined to answer certain questions about its tobacco work. In a written response, McKinsey said: “Like many other companies and industries, our approach to working on tobacco-related issues has changed significantly over the years. We have imposed ever-stricter limitations on our work in this space until last year, when we ceased tobacco-related work entirely. We ceased all work with the vaping industry in 2020.”
Left unanswered were a host of questions. Among them: How could McKinsey, with its booming health care practice, justify advising hospitals and government agencies on how to reduce health care costs and improve medical outcomes when for years its tobacco clients were filling hospital beds with the sick and dying at an enormous cost to society?
McKinsey also did not explain why it continued to advise cigarette companies long after it was well known and widely reported that their products are harmful and addictive.
With the book “When McKinsey Comes to Town” about to be published, Mr. Sternfels sent a note to veterans of the firm.
“We will not let the fear of criticism, or the possibility that we’ll make mistakes in the future, stop us from trying to help our clients take on tough challenges and make a positive difference through our work.”
Walt Bogdanich joined The Times in 2001 as investigative editor for the Business desk. Since 2003, he has worked as an investigative reporter. He has won three Pulitzer Prizes.
Michael Forsythe is a reporter on the investigations team. He was previously a correspondent in Hong Kong, covering the intersection of money and politics in China. He has also worked at Bloomberg News and is a United States Navy veteran. @PekingMike
https://www.nytimes.com/2022/09/29/business/mckinsey-tobacco-juul-opioids.html
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Rassegna Stampa Scientifica Ottobre 2022
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US: MMWR: NYTS: Teenagers Keep Vaping Despite Crackdowns
“High school students resumed taking the annual National Youth Tobacco Survey in school this year and 14 percent of them reported using e-cigarettes, underscoring how an upstart industry is dodging regulators’ efforts to spare a generation from nicotine addiction… One stark finding was that one in four of the high school students who were e-cigarette users reported vaping every day. Groups opposed to e-cigarettes and tobacco products were particularly troubled by one other result that reflected the highest frequency-of-use to date: Nearly half of the high school students who were vaping said they were doing so 20 to 30 days a month.” [Christina Jewett. Teenagers Keep Vaping Despite Crackdowns on E-Cigarettes, NY Times]
Teenagers Keep Vaping Despite Crackdowns on E-Cigarettes
While use among youths has fallen since the peaks of 2018-19, resumption of in-school classes this year shows students still have access to flavored, disposable vapes.
High school students reported strongly favoring fruit- and candy-flavored vapes.Credit...Gabriela Bhaskar for The New York Times
Oct. 6, 2022
High school students resumed taking the annual National Youth Tobacco Survey in school this year and 14 percent of them reported using e-cigarettes, underscoring how an upstart industry is dodging regulators’ efforts to spare a generation from nicotine addiction.
The number shows a slight change from 11 percent last year, but researchers cautioned against drawing comparisons to 2021’s survey, which was conducted differently because it took place when many schools were closed during the pandemic. The latest results were released by the Centers for Disease Control and Prevention on Thursday.
Though the age-old force of peer pressure may still be encouraging use, the percentage of high school students who reported vaping within the last 30 days was still far lower than record-high levels reached in 2019 of nearly 28 percent.
Overall, the survey found that 2.5 million middle and high school students, or about 9 percent, used e-cigarettes in the last 30 days. That puts their overall rate of use several times higher than that of adults, which is estimated at about 3 percent.
The survey, which was conducted from January through May of this year, showed that 85 percent of adolescent e-cigarette users favored vapes in fruit, dessert and candy flavors. Some mentioned PuffBar, Vuse and Juul as their favorite brand among those on the survey’s list.
But many said their favored e-cigarette brand was not one of the 13 listed. That finding highlights how nimble the industry has been in stamping an array of brand names on vapes with flavors like strawberry ice cream and fresh vanilla that are largely made in China and shipped from warehouses to corner stores and into e-commerce.
“What that shows is that playing Whac-A-Mole with a few products is not going to solve the problem,” said Vince Willmore, a spokesman for the Campaign for Tobacco-Free Kids. “As long as any flavored products are still on the market, kids are going to shift to them. To solve the problem, you have to clear the market of all flavored products.”
Read More on Smoking, Vaping and E-Cigarettes
- The Business of Addiction: McKinsey’s ties to opioid makers are well known, but for decades the consulting giant worked with Big Tobacco and has also advised Juul.
- Youth Vaping Settlement: Juul tentatively agreed to pay $438.5 millionto settle an investigation by nearly three dozen states over marketing and sales practices that they contend set off the teen vaping crisis.
- Ban Suspension: The Food and Drug Administration ordered Juul to stop selling e-cigarettes on the U.S. market, though it later suspended the banciting “scientific issues” that warrant a review of the decision.
- Nicotine Levels: The F.D.A. is planning to require tobacco companies to slash the amount of nicotine in their cigarettes. But experts warn that drastic cuts could prove disruptive and fuel underground markets.
One stark finding was that one in four of the high school students who were e-cigarette users reported vaping every day. Groups opposed to e-cigarettes and tobacco products were particularly troubled by one other result that reflected the highest frequency-of-use to date: Nearly half of the high school students who were vaping said they were doing so 20 to 30 days a month.
“That’s a real signal of addiction and setting up young people for a lifetime of addiction which they don’t want, they didn’t choose and they don’t like,” said Robin Koval, president of the Truth Initiative, a nonprofit organization aimed at eliminating youth tobacco use.
Linda Neff, chief of the epidemiology branch in the C.D.C.’s Office on Smoking and Health, said that the sheer number of young people continuing to vape suggested the agency needed to keep working to educate teens about the effects of nicotine addiction, which “harms the parts of the brain that control learning, mood and impulse control.”
“The frequency of use is disturbing,” she said. “It’s alarming.”
The Food and Drug Administration considers e-cigarettes to be generally beneficial to the extent that they provide an alternative to adult users of traditional cigarettes, which coat the lungs in tar. The agency’s hope for health gains, though, has existed in the shadow of a youth vaping crisis that exploded in 2018-19, prompting an outcry from parents, schools, lawmakers and public health experts.
The F.D.A. began to crack down on vape makers in 2019, banning many flavors and ordering manufacturers to apply for marketing authorization to keep their products on the market — an ongoing process. That effort has been challenged by e-cigarette makers who saw a loophole in making e-cigarettes with synthetic nicotine and jumped into the market with blueberry, kiwi and candy-flavored vapes.
This spring Congress gave the F.D.A. the authority to rein in those devices. The agency said it was reviewing about one million applications to sell synthetic nicotine products. In July, the agency gained authority to remove unauthorized non-tobacco products from the market but has said it needs to move methodically as it enforces the law.
On Thursday, the agency announced that it sent new warning letters to two companies that teenagers singled out as go-to brands in the survey. The F.D.A. issued its second warning to the maker of Puff Bar vapes, this time about its flavored synthetic nicotine products that the agency said were being sold illegally.
The F.D.A. also said Thursday that it denied marketing authorization to Hyde, a company that about 5 percent of adolescents wrote in on the survey as a favored brand — suggesting the rate is higher. The company’s website shows flavors including “pink burst” and “lemon drop.”
In a statement, the agency said that Hyde must stop selling its products or “risk enforcement action.”
Juul Labs, which had been widely blamed for fueling the teenage vaping crisis, pointed to the decline in popularity of its products among youths in a statement it released on Thursday. The company is awaiting a decision from the F.D.A. on its marketing application to remain on the market.
To some, the enforcement drive by the F.D.A. appears self-defeating. Amanda Wheeler, president of the American Vapor Manufacturers, said that the flood of denials faced by U.S. vape businesses were opening the door to foreign companies that would be more difficult to regulate.
As the agency’s rejections mount, “we will continue to see black market actors take advantage of F.D.A.’s wholesale destruction of the category,” Ms. Wheeler said.
The health consequences for teenagers who develop a nicotine addiction are just beginning to be understood. Dr. Rose Marie Robertson, science and medicine officer with the American Heart Association, said scientists were seeing toxic effects from the inhaled flavoring ingredients of e-cigarettes. She said researchers were also detecting signs of use on the heart and lungs.
“It took us 40 years to show that women would develop lung cancer more readily if they smoked,” Dr. Robertson said. “The fact that we’re seeing any effects at an early stage is very worrisome.”
The persistent rate of e-cigarette use among teenagers also concerns experts who were thrilled to see youth cigarette smoking rates fall steadily for years and remain in the single digits, with about 3.3 percent of middle and high school students reporting use in 2020.
“To have decades of progress wiped away by e-cigarettes has been astonishing to us who’ve been there all along,” Dr. Robertson said.
The full results of the survey, which will include levels of other tobacco product use, is expected out later this year.
Christina Jewett covers the Food and Drug Administration. She is an award-winning investigative journalist and has a strong interest in how the work of the F.D.A. affects the people who use regulated products. @By_Cjewett
https://www.nytimes.com/2022/10/06/health/teenage-vaping-e-cigarettes.html
Big Tobacco Heralds a Healthier World While Fighting Its Arrival
The industry continues to fight efforts to restrict certain products, like spending heavily to urge California voters to overturn a law banning tobacco flavors.
The fight shaping up over government restrictions on menthol and nicotine highlights the longstanding resistance of the tobacco industry to regulations, despite corporate claims of support for a smokeless alternative. [Photo Cutline]
By Julie Creswell and Matt Richtel
Nov. 6, 2022
For decades, public health advocates chipped away at the influence of Big Tobacco with measures aimed at discouraging cigarette use. But the bitter legal and political battles were just a prelude to the unfolding climactic clash that could determine the fate of smoking and whether these companies adapt or falter.
U.S. health officials have launched the most aggressive attack by far on cigarettes: Twin government proposals would ban menthol-flavored cigarettes and would limit nicotine levels to make traditional smoking less addictive. At the same time, the government is slowly embracing vaping as an alternative by authorizing the sale of some e-cigarettes, which can provide smokers a nicotine fix without many of the carcinogens.
The measures are the source of a clash expected to play out over the coming months and years in courtrooms, legislative hallways and regulatory hearings. For public health advocates, the steps are aimed at saving millions of lives and reducing the billions of dollars spent on smoking-related illnesses like cancer and heart disease.
Big Tobacco has said it embraces the transition — sort of.
“We have an unprecedented opportunity to move beyond smoking,” Billy Gifford, chief executive of Altria, one of the world’s biggest cigarette conglomerates and the parent company of Philip Morris USA, told Wall Street analysts and investors in late October. The opening slide of his presentation offered a company vision: “To responsibly lead the transition of adult smokers to a smoke-free future.”
Major cigarette companies, like Altria and R.J. Reynolds, acknowledge that cigarettes are dangerous and addictive, and they are heralding their investments in electronic cigarettes and other less-harmful alternatives to cigarettes. But, with much less fanfare, they are taking steps to slow the very smokeless future they claim to want: The companies have submitted letters protesting the proposed menthol ban in traditional cigarettes, and they have signaled they will similarly resist any efforts to lower nicotine levels.
And Big Tobacco isn’t just duking it out at the federal level, but fighting local initiatives. For example, in California, the industry has spent heavily to stop a 2020 law from taking effect that would ban the sale of flavored-tobacco products including menthol. Putting the law in place depends on a majority of state voters supporting a Nov. 8 ballot proposition favoring the law, and the industry has spent $22 million to to try to persuade voters to reject the measure and the flavor ban.
The California Coalition for Fairness, the tobacco industry-funded group behind the campaign that succeeded in getting the referendum on the ballot, argues the flavor ban “benefits the wealthy and special interests while costing jobs and cutting funding for education and health care.”
Mr. Gifford, in his late October call with investors, said of the flavor ban: We don’t believe science supports it.”
In various statements, R.J. Reynolds, owned by British American Tobacco and the second-largest cigarette company in the United States after Altria, has said it also embraces less harm but continues to hew to a business model that critics say puts public health second to profits.
In Reynolds’s filing against the menthol ban, it wrote that, broadly, it “fully supports F.D.A.’s goal of reducing tobacco-related disease.” But, it contended, “menthol smokers would simply switch to nonmenthol cigarettes or turn to riskier options such as illicit market cigarettes.” The company declined further comment beyond its filing.
As the smoking population in the United States has fallen to 13 percent from 21 percent in 2005, far from a peak of about 45 percent of adults in 1954, and public opinion has turned against cigarettes, the legal and political might of Big Tobacco has shrunk, too. A Gallup survey conducted in July found that 74 percent of Americans favored “requiring tobacco companies to lower nicotine levels in cigarettes to make them less addictive.” About 42 percent favored banning menthol-flavored cigarettes. (Under the current proposal, menthol e-cigarettes could be sold.)
But the industry still earns billions of dollars in revenues, and it hopes to use its remaining clout to stall these monumental proposals at the regulatory level and in court — or stop them altogether.
“This spring and summer, I would say, we’ve seen the most significant period of proposed regulations by the F.D.A. ever. Full stop,” said Sarah Milov, an associate professor of history at the University of Virginia and author of “The Cigarette: A Political History.” “With this industry, it’s all about where they are making their money. We will see them fight the menthol and nicotine rules, and that will be another demonstration of their continued commitment to combustible cigarettes.”
A broad group of allies has joined the tobacco industry in the fight against the menthol ban by. There are those with financial stakes in the outcome, like the National Association of Convenience Stores, which say they would lose billions of dollars in annual sales, and the New York City Newsstand Operators Association.
The menthol ban has also drawn opposition from think tanks like the Tax Foundation, which said federal and state governments could lose a combined $6.6 billion in tax revenues the first year. The American Civil Liberties Union has also opposed the ban, saying it would disproportionately affect communities of color.
Major cigarette companies, like Altria and R.J. Reynolds, submitted letters last summer protesting the proposed menthol ban in traditional cigarettes. [Photo Cutline]
In particular, the proposed ban has divided Black leaders across the country, especially since companies heavily marketed menthol cigarettes to Black smokers, who now prefer them at a much higher rate than white smokers do. While some welcomed the proposal as a way to lower cancer and heart disease, others expressed concerns that enforcing such a ban would lead to unwarranted police interactions with Black Americans. Big Tobacco has heavily lobbied against the ban with Black political leaders and retained some to help sew doubt and fear about the ban in communities around the country.
Many opponents have challenged the F.D.A.’s legal authority to regulate tobacco products in far-reaching ways. But no matter how the companies promote their position, industry critics say that their goal is to maintain the lucrative share of the cigarette market at all costs. No wonder: Sales in the U.S. totaled $65 billion in 2021 —- one-third of it from menthol — dwarfing sales of e-cigarettes.
“It’s absolutely false that they want to have their smoking customers quit or shift to less harmful tobacco products,” said Eric Lindblom, a senior scholar at the O’Neill Institute for National and Global Health Law at Georgetown University and a former adviser to the F.D.A. “If they were serious about having smokers quit, they would stop opposing any efforts at the federal, state and local level to regulate and tax smoking tobacco products more sharply.”
Traditional cigarettes have become more expensive, though. A study published this year in JAMA found that from 2015 to 2021, the number of packs of cigarettes sold in the United States fell to 9.1 billion a year from 12.5 billion, a 27 percent drop. To compensate, tobacco companies increased prices — rising 29.5 percent a pack during that period, to $7.22 from $5.57.
Inflation plays a role, too. In the first nine months of this year, Altria reported a steep 9 percent decline in sales volumes, with executives noting that customers were changing behaviors to save money, like buying single packs of cigarettes, rather than cartons.
Company share prices have also fallen.
“Most investors knew new regulation was coming, but the threat seemed far into the future,” said Christopher Growe, an analyst at financial services firm Stifel Financial. “I think menthol has more immediacy, but nicotine regulation is a long, long way away.”
The transformation of tobacco
On some level, the battle over menthol and nicotine limits extends the government’s efforts to chip away at smoking, even as the industry resists at every turn. But this moment is also fundamentally different. For the first time, many public health officials have embraced a strategy of harm reduction, which is not just to curb the cigarette market but to accept and even advocate for an alternative with e-cigarettes.
This strategy is not one that public health officials adopted lightly: For years, many were skeptical about legalizing e-cigarettes, worrying that the devices hooked a new generation on nicotine and lured young people into the vaping crisis.
Twin government proposals involve outlawing menthol-flavored cigarettes and limiting nicotine in cigarettes. At the same time, the government is slowly embracing an alternative by legalizing the sale of some e-cigarettes. [Photo Cutline]
While public health experts debated the merits of e-cigarettes, major companies argued that, absent that alternative or other products, there were no appealing options to help smokers quit.
Mitch Zeller, who retired this year from his post as director of the F.D.A.’s Center for Tobacco Products, said that for all his experience with the companies, he wasn’t sure that they would accept a smokeless future. How they respond to the new proposals will be “a test of their sincerity,” he said.
“It’s a day of reckoning for the industry,” Mr. Zeller said, adding of the tobacco companies. “They’ve got to make a decision.”
He acknowledged that the tobacco companies were in a tough position, having widely deployed “rhetoric” supporting alternatives but, at the same time, having to answer to shareholders whose returns were still reliant on cigarette sales and profits.
“They have a fiduciary duty to their shareholders,” he said. He added, however, that regulation might force the companies to adapt, no matter how hard they resisted.
Still, tobacco giants are pushing back against any efforts to curb sales. The industry has persistently sued to stop the federal government from requiring larger, graphic warnings on packages about the deadly risk of cigarettes. And Big Tobacco companies have continued to ply a tactic they’ve used for years: poaching former F.D.A. employees, mostly recently with Philip Morris International hiring Matt Holman, who was the chief of the science office in the agency’s Center For Tobacco Products.
The tobacco industry has been joined in the struggle against the menthol ban by broad group of allies, like the National Association of Convenience Stores and the NYC Newsstand Operators Association. [Photo Cutline]
If the F.D.A. pushes through a menthol ban, the tobacco industry will “dig in” and go to court, said Marc Scheineson, a former associate commissioner at the agency who is now a partner at the law firm Alston & Bird, which represents some smaller tobacco companies. “If there are rules that are put in place with the F.D.A. sort of ignoring valid scientific objections or criticisms, it will end up in court again.”
He noted a recent win for the Cigar Association of America, which challenged the F.D.A.’s regulation of premium cigars. In that case, U.S. District Judge Amit Mehta in Washington, D.C., said the F.D.A. had acted “arbitrarily and capriciously” and ignored or overlooked evidence provided by the industry. The case is still pending.
In another blow to the F.D.A., the U.S. Court of Appeals for the 11th Circuit in late August set aside marketing denial orders for six e-cigarette companies, saying the agency there, too, had been arbitrary and capricious in its decisions.
Mr. Scheineson said he hoped a compromise could be reached. He asked: Could nicotine be reduced in a slow, laddered way while allowing menthol cigarettes to be sold?
In the interim, all e-cigarette companies have had to apply to the F.D.A. to remain on the market, now that the agency has received expanded authority to regulate vaping devices and e-cigarettes. The F.D.A. is wading through applications for 350 products, according to a letter published in Augustby Brian King, the director for the Center for Tobacco Products. In the last two years, the agency has authorized the sale of about two dozen vaping products.
And the biggest tobacco companies are vying for their piece of the budding market. Last year, the F.D.A. approved several Vuse products by Reynolds. However, the agency has not yet ruled on the sale of Vuse Alto, the company’s biggest seller to date, which accounted for 95 percent of its e-cigarette sales last year and displaced Juul as the top-selling vaping product. Vuse Alto has gained in popularity in recent years for its small, sleek design, longer battery life and the fact that it wasn’t mired in the same teenage-use controversy as Juul.
Altria’s strategy had long appeared to be pinned to its relationship with Juul Labs. In 2018, Altria paid $12.8 billion for a 35 percent stake in Juul. But even before Juul lost its initial bid in June for authorization to keep selling certain products on the U.S. market, the company’s products had been severely restricted by public pressure to pull flavored e-pods off the market out of concerns for their appeal to teenagers. The F.D.A. reversed itself this summer and is granting an additional review to Juul’s application for certain tobacco and menthol products to stay on the market.
By late September, Altria had taken a more than $12 billion cumulative loss on Juul, valuing the investment at $350 million. Altria said it ended its noncompete agreement with Juul, opening up the possibility it could acquire another e-cigarette company to compete in the space, some analysts predict. Meanwhile, reports emerged in October that Juul might seek bankruptcy protection.
Besides Juul, Altria also has stakes in companies that make nicotine pouches, a product that is placed between the cheek and jaw.
Another category of cigarette alternatives are known as “heat-not-burn tobacco sticks.” In October, Altria announced that it sold the U.S. rights to sell IQOS, a heat-not-burn tobacco stick, for $2.7 billion to Philip Morris International.
To fill the void, Altria promptly announced a new joint venture with Japan Tobacco to develop a heat-not-burn stick called Ploom for the U.S. market.
On Altria’s call with investors in late October, Mr. Growe, the Wall Street analyst from Stifel, asked the company’s chief executive when a new Ploom product might be available. “Do you have a reasonable time frame for launching a product in the U.S.” he asked, and then added a few sentences later: “Or am I getting ahead of myself here?”
“I think you’re getting ahead of yourself a little bit,” said Mr. Gifford, Altria’s chief executive.
“Maybe underlying your question is: ‘why are you taking so long,” Mr. Gifford continued. “And I think it goes back to, look, we want to be disciplined.”
Mr. Gifford said that Altria absolutely wants to create an alternative to the cigarette, but not in a hasty fashion. “We need to go about it in a thoughtful manner.”
Julie Creswell is a New York-based reporter. She has covered banks, private equity, retail and health care. She previously worked for Fortune Magazine and also wrote about debt, monetary policy and mutual funds at Dow Jones. @julie_creswell
Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter based in San Francisco. He joined The Times in 2000, and his work has focused on science, technology, business and narrative-driven storytelling around these issues. @mrichtel
https://www.nytimes.com/2022/11/06/health/tobacco-fda-menthol-ban-nicotine.html
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