Smoking, Tobacco and Cigarette News

New York City enacted a law in 2014 that raised the minimum age to buy cigarettes from 18 to 21. The law was aimed at reducing smoking rates, especially among young people.

A law, of course, is only as effective as its enforcement. And researchers at NYU and UCLA have found that compliance with identification (ID) checks has significantly decreased since the law went into effect last year.

Before the law changed, researchers say 29% of retailers sampled were non-compliant. After the change, 38% of sampled retailers failed to ask for ID when selling cigarettes to young people.

Researchers also examined new minimum price laws for cigarettes and found a similar pattern.

Troubling pattern

"This study reveals a troubling pattern of non-compliance with ID check and minimum price laws among some retailers in New York City," said lead author, Dr. Diana Silver, an associate professor of public health policy at NYU's College of Global Public Health. "Without serious attention to strengthening enforcement of its current laws, New York City will fail to realize the full potential of its efforts to reduce smoking."

There could be several reasons for the lack of enforcement. For one thing, a lot of retailers might still be unaware that the age limit has risen.

Researchers note the new law did not go into effect until nine months after its enactment.

Multiple jurisdictions

Then, there's the fact that enforcement measures for retailer tobacco laws involve five different city and state agencies. Researchers say they all have unique protocols, and in many cases no additional resources were allocated for inspection, prosecution, and follow-up of those violating the new laws.

Under federal law, states are required to make sure non-compliance with ID check laws never fall below 20%. Dr. James Macinko, one of the study's authors, says the current level of non-compliance is troubling.

"In addition, sales below legal minimum prices present additional challenges for controlling access to cigarettes not just among youth, but among the entire city's population," he said.

Children who have at least one parent who smokes have 5.5 times higher levels of cotinine, a byproduct of nicotine, in their urine, according to a study by researchers from Warwick Medical School at the University of Warwick, and the University of Leicester, published online ahead of print in Archives of Disease in Childhood.

Having a mother that smokes was found to have the biggest independent effect on cotinine in the urine -- quadrupling it. Having a smoking father doubled the amount of cotinine, one of chemicals produced when the body breaks down nicotine from inhaled smoke to get rid of it.

Sleeping with parents and lower temperature rooms were also associated with increased amounts of cotinine.

Cotinine was measured in 100 urine samples taken from infants aged 12 weeks. Seventy one of the babies had at least one parent that smoked and the parents of the other 33 were non-smokers.

Smoking babies tend to come from poorer homes, which may have smaller rooms and inadequate heating, the authors say. Higher cotinine levels in colder times of year may be a reflection of the other key factors which influence exposure to passive smoking, such as poorer ventilation or a greater tendency for parents to smoke indoors in winter.

Sleeping with a parent is a know risk factor for cot death and the authors suggest that one reason for this could be inhalation of, or closeness to clothing or other objects contaminated with, smoke particles during sleep.

Nearly 40% of under-fives are believed to be exposed to tobacco smoke at home, and smoke may be responsible for up to 6,000 deaths per year in young children.

Babies and children are routinely exposed to cigarette smoking by their caregivers in their homes, without the legislative protection available to adults in public places, according to the researchers.

But they acknowledge that there are practical difficulties in preventing smoking in private homes because it relies on parents or caregivers being educated about the harmful effects of passive smoking on their children and then acting on that knowledge.

With fewer new smokers and more people kicking the habit – along with restrictions on advertising and marketing – cigarette sales are in decline. The Federal Trade Commission (FTC) reported a 10% decline in U.S. cigarette sales in 2009, following a 62-cent increase in the federal cigarette tax.

In 2012 Lorillard, the nation's third-largest tobacco company, acquired Blu, a brand of e-cigarettes that has experienced rapid growth from former smokers, who say e-cigarettes give them many of the pleasures of smoking, including a nicotine kick. The move was followed last year by Altria Group's release of its own e-cigarette brand, Mark Ten.

A new study in the journal Tobacco Control looks at tobacco company advertising on the Internet and finds that their campaigns now focus for the most part on e-cigarettes, snus and cigars. 

$2 billion in sales

According to the public health foundation Legacy, which conducted the study, annual sales of smokeless tobacco products now exceed $2.93 billion globally and sales of e-cigarettes continue to grow, reaching $2 billion globally in 2011. For now, e-cigarettes are unregulated in the U.S., though the Food and Drug Administration (FDA) is said to be preparing regulations.

Public health and anti-tobacco groups have expressed alarm at the growing popularity of e-cigarettes and have pushed for tight controls. But are e-cigarettes as harmful as tobacco cigarettes have been shown to be? One medical researcher, at least, thinks the jury is still out.

In an editorial in the American Journal of Respiratory and Critical Care Medicine entitled “The Promise and Problems of E-cigarettes, Jerome S. Brody, of the Department of Medicine and Pulmonary Center at Boston University, calls for more study. 

Though research is in its infancy, he notes the known problems with e-cigarettes, which deliver the nicotine without many of the other harmful chemicals in tobacco smoke. He notes that nicotine itself is problematic; it's addictive and has been implicated in a number of cancers.

Ingredients list needed

“There is sufficient evidence about the toxicity of nicotine and other components that have been found in e-cigarettes, including tobacco itself, for regulatory agencies to require a list, with concentrations, of all e-cigarette ingredients,” Brody writes.

On the other hand, he doesn't rule out that e-cigarettes might be a preferable alternative to smoking cigarettes. He notes there have been a few studies that have suggested that very thing. It's time, he says, to find out.

“There clearly is a need for a multicenter clinical trial of the value of e-cigarettes in smoking cessation programs,” he writes.

Legacy says its study shows that not only is e-cigarette advertising widespread on the Internet the ads were placed on websites with the highest average percentage of a youth audience, with some websites having a youth audience as high as 35%.

Pushing the product, not smoking cessation

The study also found that e-cigarette ads were most likely to feature themes of harm reduction; use as an aide to quit smoking; being more environmentally-friendly alternative to cigarettes; or as an alternative to cigarettes when someone cannot smoke. However, Legacy says, when you click on the ad, you typically go to a site that tells you about the product but nothing about how to quit smoking.

Legacy's concern, says CEO Robin Kovel, is e-cigarettes are not being used solely by people who want to quit smoking. Rather, she says they're hooking a whole new generation of consumers on nicotine.

"Any encouragement to use their first tobacco products and initiate a nicotine addiction could potentially lead to them becoming lifelong tobacco users and undermine our efforts to achieve a 'Generation Free' of tobacco use," Koval said.

Sometimes cigarette smokers get a bad rap.

I’m not a smoker, but I do feel for them at times, because their chosen decision to smoke has been almost criminalized.

When smokers were forced to leave bars and restaurants, many believed it was a great idea, and although there were obviously some critics of the new smoking laws, there surprisingly wasn’t too much push-back from either smokers or non-smokers.

In the Southern California enclave of Burbank, my collegue Truman Lewis reports that smoking is now strictly forbidden in all areas of the apartment complex he occupies, including balconies.  This is the result of the Secondhand Smoke Control Ordinance adopted way back on April 3, 2007. The ordinance prohibits smoking in specific locations throughout the city, including multi-family residences.

Truman says this hasn't stopped him from enjoying an evening cigar on his balcony.

"The balcony overlooks the 134 (freeway). Does a single cigar really cause more pollution than ten lanes of traffic?" Lewis wonders. 

Farther north, a new law in San Rafael provides that smoking will not be allowed in multi-family homes, duplexes or condominiums -- and some may ask, if smokers can’t smoke in their own homes or in restaurants, where should they go to smoke? (The answer, of course, is that they must buy a single-family home on a big lot and keep the windows closed).

“We are happy to blaze a trail, said the mayor of San Rafael, Gary Phillips. “We’re most happy to be in the forefront of the issue because we think it will greatly benefit our residents and those visiting San Rafael, and we think it will set the tone for other cities as well.”

Smoking will also be forbidden in the downtown streets and sidewalks of San Rafael.

Smoke slithers

The primary reason for the new law is that second-hand smoke easily travels through vents, air ducts and hallways of apartment buildings and condominiums, thus potentially affecting other families and households in the  complex.

It's not just cities. States are considering putting these kinds of laws into place in an effort to make smoking so inconvenient for smokers that they’ll eventually quit.  

But does that work? Does imposing strict laws on people really get them to give up a particular lifestyle, even if that lifestyle is bad for them health-wise?  Anyone who has seen a person addicted to drugs could probably answer that question pretty easily.

Critics say the smoking ban robs folks of the option of being themselves in the privacy of their own home, and is a form of punishment for people who choose to go against the health warnings attached to smoking.

“This proposed smoking ban actually intends to punish people for what they do in their own homes,” said a critic of the ban, Thomas Ruppenthal, to the San Rafael city council. “I really feel this is tyranny.”

However, proponents of the new law say it will definitely discourage smoking across the California city, and the statistics prove it.

“The San Rafael ban is a very significant event because it will spread," said Stanford University professor Robert Proctor in an interview. “We’re on the downslope of a big curve. Smoking peaked in 1981 with 630 billion cigarettes sold in the United States. Now it’s down to 350 billion. And that number will keep on going down until smoking is a distant memory.”

Enforcement questions

However the question is, how will officials really keep people from smoking in their homes? Will the new law create a bunch of 911 calls or complaints to the police, because a non-smoker smells smoke in their apartment? Some would say those non-smokers would have good reason to make sure the law is enforced.

Up in the wine country, a Healdsburg, Calif., resident told us he resigned from his condominium association board because he was tired of dealing with complaints about second-hand smoke.

"People keep their noses pressed to the vents, hoping to gather evidence on their neighbors. Who has time for that?" he asked. "I could be over at the tasting room instead."

According to the Centers for Disease Control and Prevention (CDC), second-hand smoke contains about 250 known toxins and 50 chemicals that can cause cancer, heart disease and other illnesses.

In addition, more than 126 million non-smokers inhale secondhand smoke from places like their jobs, vehicles and you guessed it, in their homes.

No escape

But the question remains, where will smokers go where they’re not affecting others with their cigarettes, pipes, or cigars?  They won't be able to go outside much longer. Cities are beginning to ban smoking in all public areas, including the outdoors -- and not just in health-obsessed California.

The Metro subway system in the Washington, D.C., area strictly forbids smoking on its outside sidewalks, escalators and so forth. Tickets are issued with some frequency. (And don't you dare try eating a banana or snack bar either). 

New York City imposed an outdoor citywide smoking ban earlier this year. The law, which Mayor Michael Bloomberg signed in February, makes smoking illegal in New York City's 1,700 parks and on the city's 14 miles of public beaches. Smoking is also be prohibited in pedestrian plazas like Times Square and within a certain number of feet of building exits.

Think you can retreat to the wilderness? Not likely. Smoking and open fires are verboten in many areas of national parks, forests and so forth. Smoking might still be OK on glaciers but they, as we know, are melting. 

Some airports now have smoking rooms -- usually resembling holding cells. Guess that might become the last resort. But would you have to buy an airline ticket just to get into the airport to have a smoke?

When CVS announced in February that it would stop selling cigarettes, it became just a matter of time until other chains followed suit or were pressured to do so by health advocates.

And, sure enough, a coalition of state attorneys general is now calling on Wal-Mart, Walgreens, Rite-Aid, Safeway and Kroger to remove all tobacco products from their shelves. 

“Pharmacies and drug stores, which increasingly market themselves as a source for community health care, send a mixed message by continuing to sell deadly tobacco products,” said New York Attorney General Eric Schneiderman. “The fact that these stores profit from the sale of cigarettes and tobacco must take a backseat to the health of New Yorkers and customers across the country. I urge these companies to do the right thing and remove tobacco products from store shelves.”

Ohio Attorney General Mike DeWine is joining Schneiderman in the effort, saying in a letter to CEOs of the chains that, "The health of our kids is just too important” to be sacrificed for profits from tobacco sales.

Tobacco-related disease is the leading cause of preventable death in the United States, causing more than 480,000 deaths in the last year alone – more than AIDS, alcohol, illegal drug use, car accidents and firearm-related deaths combined, the AGs noted in their letter.

Furthermore, health care costs and productivity losses attributable to smoking cost the nation at least $289 billion each year. Almost 90% of all adult smokers start smoking by 18 years of age. “Big Tobacco” relies on getting young people addicted to cigarettes and keeping them as life-long smokers, they said.

Five years after all current smokers who receive Medicaid benefits quit smoking, program expenditures would be an estimated $9.7 billion lower, according to a new report by researchers at RTI International.

The report, funded by the American Legacy Foundation, found that Medicaid expenditures attributable to current smokers account for 5.6 percent of total national Medicaid expenditures.

"Reducing the number of smokers in the United States could save taxpayers billions of dollars in Medicaid costs," said Justin Trogdon, Ph.D., an RTI health economist. "Policy makers looking for ways to reduce health care costs in America would be wise to look at areas of health behaviors that both improve health and reduce health care costs."

According to the research, New York smokers top the list, costing Medicaid $1.5 billion each year. Wyoming had the least Medicaid expenditures due to current smokers, but they still cost the program $15 million each year. The report showed that North Carolinians who smoke cost Medicaid $294 million each year.

The researchers also looked at the cost of Medicaid over the lifetime of 24-year-old smokers because nearly all smokers begin smoking before age 24.

"The benefits of preventing smoking initiation accrue over a longer time horizon," Trogdon said. "Life-cycle estimates are important in gauging the long-term impact of youth smoking prevention on state Medicaid programs. These estimates take into account the differences in life expectancy for smokers and nonsmokers as well as payments into the Medicaid system by smokers."

"This study underscores the need for strong and effective smoking prevention and cessation campaigns," said Cheryl G. Healton, Dr. PH, president and CEO of the American Legacy Foundation. "We hope that this report will serve as a tool for states to use when setting both long- and short-term goals for reducing Medicaid expenditures associated with tobacco use."

Women smokers more costly

The results showed that, over the course of their lifetime, today's 24-year-old smokers will cost Medicaid almost $1 billion. However, most of those costs are due to female smokers, not males.

The researchers found that over the course of their lifetime, tax payments by young male smokers make up for most of their extra Medicaid expenditures from smoking, but the expenditures for female smokers cost Medicaid about $1,300 per person.

This impact is highest in Texas, where the lifetime costs of 24-year old smokers to Medicaid is estimated to be $125 million. In North Carolina, those costs are expected to reach almost $37 million.

"The lifetime costs of young smokers are for one cohort of 24-year-olds," Trogdon said. "Every year a new group of young people will turn 24. Based on these findings, preventing and reducing youth smoking, especially among females, could lower Medicaid costs by billions of dollars."

The research is based on data from the 2000 through 2004 Medical Expenditure Panel Surveys.

While smoking is no longer considered sexy, it may prove a permanent turn-on for some genes.

Research published in the online open access journal BMC Genomics could help explain why former smokers are still more susceptible to lung cancer than those who have never smoked.

A Canadian team led by Wan Lam and Stephen Lam from the BC Cancer Agency in British Columbia, Canada, took samples from the lungs of 24 current and former smokers, as well as from non-smokers who have never smoked. They used these lung samples to create libraries using a technique called serial analysis of gene expression (SAGE), which helps to identify patterns of gene activity.

Only about a fifth of the genes in a cell are switched on at any given time, but environmental changes such as smoking lead to changes in gene activity.

The researchers found changes that were irreversible, and some changes that were reversed by stopping smoking.

The reversible genes were particularly involved in xenobiotic functions (managing chemicals not produced in the body), nucleotide metabolism and mucus secretion. Some DNA repair genes are irreversibly damaged by smoking, and smoking also switched off genes that help combat lung cancer development.

The researchers identified a number of genes not previously associated with smoking that are switched on in active smokers. One example is CABYR, a gene involved in helping sperm to swim and associated with brain tumors, which may have a ciliary function.

"Those genes and functions which do not revert to normal levels upon smoking cessation may provide insight into why former smokers still maintain a risk of developing lung cancer," according to Raj Chari, first author of the study. The study is the largest human SAGE study reported to date, and also generated a large SAGE library for future research.

Tobacco smoking accounts for 85 percent of lung cancers, and former smokers account for half of those newly diagnosed with the disease.

The State of Oregon has filed two settlements that prevent two national travel store chains from selling "electronic cigarettes" in Oregon. The action is the first of its kind in the country and prevents Oregonians from buying potentially dangerous products that the U.S. Food and Drug Administration has yet to approve.

"When products threaten the health and safety of Oregonians, we will take action," said Mary Williams, Oregon Deputy Attorney General. "If companies want to sell electronic cigarettes to consumers, they have to be able to prove they are safe."

The affected travel store chains, Pilot Travel Centers, which has seven centers in Oregon, and TA Operating, which has four centers in Oregon, both sell "NJOY" brand electronic cigarettes. Electronic cigarettes are actually battery operated nicotine delivery devices constructed to mimic conventional cigarette. Each "cigarette" consists of a heating element and a replaceable plastic cartridge that contains various chemicals, including various concentrations of liquid nicotine. The heating element vaporizes the liquid, which the user inhales as if it were smoke.

Despite FDA issued "Import Alerts" against NJOY and other brands of electronic cigarettes, and despite the fact that the U.S. Customs Service detained several shipments of these devices, sales of electronic cigarettes continue throughout the United States. The products are even advertised on television.

Sales persisted even though just two weeks ago the FDA warned the public about health concerns regarding electronic cigarettes. FDA tests showed a wide variation in the amount of nicotine delivered by three different samples of nicotine cartridges with the same label.

Tests also revealed the presence of nitrosamines a known carcinogen. By the time the FDA issued its warnings, the Oregon Department of Justice had already launched an active investigation of the sale and promotion of electronic cigarettes. NJOY electronic cigarettes were a target of that investigation.

The settlement prohibits the sale of electronic cigarettes in Oregon until they are approved by FDA, or until a court rules the FDA does not have the authority to regulate electronic cigarettes. Even if courts decide that the FDA does not have regulation authority, the settlement stipulates that electronic cigarettes may not be sold in Oregon unless there is competent and reliable scientific evidence to support the product's safety claims.

In addition, the companies must give the Attorney General advance notice that they intend to sell electronic cigarettes in Oregon, provide copies of all electronic cigarette advertising, and provide copies of the scientific studies they maintain substantiates their claims.

Everybody knows smoking is bad for smokers, and any bartender will tell you second-hand smoke is annoying and harmful. But third-hand smoke? Who even knew there was such a thing?

Well, there is and it's as dangerous as second-hand smoke. Third-hand smoke is defined as the second-hand smoke that gets left on the surfaces of objects, ages over time and becomes progressively more toxic, according to a scientist at the University of California, Riverside who, along with colleagues, conducted the first animal study of the effects of third-hand smoke.

"We studied, on mice, the effects of third-hand smoke on several organ systems under conditions that simulated third-hand smoke exposure of humans," said Manuela Martins-Green, a professor of cell biology who led the study. "We found significant damage occurs in the liver and lung. Wounds in these mice took longer to heal. Further, these mice displayed hyperactivity."

The study, which was published in PLOS One, provides a basis for further studies on the toxic effects of third-hand smoke in humans and serves to inform potential regulatory policies aimed at preventing involuntary exposure to third-hand smoke, Martins-Green said.

Threat to children

Third-hand smoke is a potential health threat to children, spouses of smokers and workers in environments where smoking is, or has been, allowed. Contamination of the homes of smokers by third-hand smoke is high, both on surfaces and in dust, including children's bedrooms.

Re-emission of nicotine from contaminated indoor surfaces in these households can lead to nicotine exposure levels similar to that of smoking. Third-hand smoke, which contains strong carcinogens, has been found to persist in houses, apartments and hotel rooms after smokers move out, the researchers said.

The team led by Martins-Green found that the mice exposed to third-hand smoke in the lab showed alterations in multiple organ systems and excreted levels of a tobacco-specific carcinogen similar to those found in children exposed to second-hand smoke.

In behavioral tests the mice exposed to third-hand smoke showed hyperactivity.

"The latter data, combined with emerging associated behavioral problems in children exposed to second- and third-hand smoke suggests that with prolonged exposure, they may be at significant risk for developing more severe neurological disorders," Martins-Green said.

Previously unknown

Although the potential risks attributed to third-hand smoke exposure are increasing, virtually nothing was known about the specific health implications of acute or cumulative exposure — until now.

"There is a critical need for animal experiments to evaluate biological effects of exposure to third-hand smoke that will inform subsequent human epidemiological and clinical trials," Martins-Green said. "Such studies can determine potential human health risks, design of clinical trials and potentially can contribute to policies that lead to reduction in both exposure and disease."

Her research team was surprised to find that the damage caused by third-hand smoke extends to several organs in the body.

"More recently we have found that exposure to third-hand smoke results in changes that can lead to type II diabetes even when the person is not obese," Martins-Green said. "There is still much to learn about the specific mechanisms by which cigarette smoke residues harm nonsmokers, but that there is such an effect is now clear. Children in environments where smoking is, or has been allowed, are at significant risk for suffering from multiple short-term and longer health problems, many of which may not manifest fully until later in life."

Research has shown that children living with one or two adults who smoke in the home, where second- and third-hand smoke are abundant, are absent 40 percent more days from school due to illness than children who did not live with smokers.

As part of a national effort to prevent youth tobacco use and reduce the number of kids ages 12 to 17 who become regular smokers, the Food and Drug Administration (FDA) has kicked off a national public education campaign.

Tobacco use remains the leading preventable cause of disease, disability and death in the U.S., causing more than 480,000 deaths each year. Each day, more than 3,200 youth under age 18 in the United States try their first cigarette and more than 700 kids under age 18 become daily smokers.

Specific audience

“The Real Cost” campaign targets the 10 million young people ages 12-17 who have never smoked a cigarette but are open to it, and those who are already trying cigarettes and are at risk of becoming regular smokers.

“We know that early intervention is critical, with almost nine out of every ten regular adult smokers picking up their first cigarette by age 18,” said FDA Commissioner Margaret A. Hamburg, M.D.

“The Real Cost” campaign uses a comprehensive multimedia approach, compelling facts and vivid imagery designed to change beliefs and behaviors over time. The ads were developed to educate youth about the dangers of tobacco use and to encourage them to be tobacco-free. The campaign uses several social media platforms to create space for teens to engage in peer-to-peer conversations about the issue in ways that are authentic to who they are.

Multifaceted campaign

Supported by the best available science, the campaign will be evaluated to measure its effectiveness over time. It is the first of several campaigns that the FDA will launch over the next few years. Subsequent campaigns will target additional distinct audiences, including multicultural youth, rural youth, and lesbian, gay, bisexual, and transgender (LGBT) youth.

“The FDA has collaborated with some of the brightest and most creative minds to develop a multimedia initiative designed to make the target audience acutely aware of the risk from every cigarette by highlighting consequences that young people are really concerned about,” said Mitchell Zeller, director of the FDA’s Center for Tobacco Products.

Graphic depictions

One approach in “The Real Cost” campaign dramatizes the health consequences of smoking by graphically depicting health consequences such as tooth loss and skin damage to demonstrate that every cigarette comes with a “cost” that is more than just financial. Another approach reframes addiction to cigarettes as a loss of control to disrupt the beliefs of youth who think they will not get addicted or feel they can quit at any time.

In addition, some ads highlight the fact that menthol cigarettes cause the same health consequences as regular cigarettes, as youth are more likely to report smoking menthol cigarettes.

Ads will run in more than 200 markets throughout the U. S. for at least 12 months. The $115 million campaign is funded by industry user fees and launches nationwide on Feb. 11. The Tobacco Control Act authorized the FDA to collect tobacco user fees from manufacturers and importers of tobacco products to implement the law.

If you have gotten used to buying a pack of cigarettes or a pouch of pipe tobacco when you pick up your prescription at your local CVS drug store, be prepared to change your routine.

The parent company -- CVS Caremark -- says it will stop selling cigarettes and other tobacco products at its more than 7,600 CVS/pharmacy stores across the U.S. by October 1, 2014. That would make it the first national pharmacy chain to do so.

"Ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health," said Larry J. Merlo, President and CEO, CVS Caremark. "Put simply, the sale of tobacco products is inconsistent with our purpose."

President Obama said CVS' decision sends "a powerful message."

“As one of the largest retailers and pharmacies in America, CVS Caremark sets a powerful example,” Obama said. “Today’s decision will help advance my Administration’s efforts to reduce tobacco-related deaths, cancer, and heart disease, as well as bring down health care costs.”

CVS' action also won praise from Health & Human Services Secretary Kathleen Sebelius, who called it "an unprecedented step in the retail industry."

"We also commend CVS Caremark on their new national smoking cessation program. With more than 7,600 CVS/pharmacy locations, this private sector health leader’s new policy will have considerable impact," Sibelius said.

The move is expected to cost CVS $2 billion in annual revenue but the company says removing tobacco will help grow its business of "working with doctors, hospitals and other care providers to improve customers' health."

Reducing the risk

Smoking is the leading cause of premature disease and death in the U.S. with more than 480,000 deaths annually. While the prevalence of cigarette smoking has decreased from approximately 42 percent of adults in 1965 to 18 percent today, the rate of reduction in smoking prevalence has stalled in the past decade.

"CVS Caremark is continually looking for ways to promote health and reduce the burden of disease," said CVS Caremark Chief Medical Officer Troyen A. Brennan, M.D., M.P.H. "Stopping the sale of cigarettes and tobacco will make a significant difference in reducing the chronic illnesses associated with tobacco use."

The American Cancer Society calls the decision "an important new development" in the fight to save lives from the devastating effects of tobacco use. "We applaud CVS Caremark for its leadership," said John R. Seffrin, Ph.D., CEO of the American Cancer Society, "and strongly encourage other industry leaders to follow suit."

Harold Wimmer, national president and CEO of the American Lung Association, applauds CVS Caremark "for boldly acting" to remove tobacco products at all its locations across the U.S. "We urge more retailers to take note of CVS Caremark's actions," he said, "and join in efforts to help reduce access to tobacco and tobacco use, and eliminate tobacco-caused deaths and disease."

Springtime launch

Meanwhile, CVS is launching a quit-smoking program this spring. It's expected to include information and treatment on smoking cessation both in stores and online. 

The program will be available broadly across all CVS/pharmacy and MinuteClinic locations and will offer additional comprehensive programs for CVS Caremark pharmacy benefit management plan members to help them to quit smoking.  

There have been countless methods tried to encourage people to stop smoking. Businesses have offered smoking cessation courses and drugs for their employees who smoke. They've also made it harder to light up at work, restricting when and where employees can smoke.

Now researchers at the University of California (UC) Davis Health System have stumbled across a novel approach. Give employees a pay raise.

They're not talking about paying people not to smoke – that's one of the incentives that's been tried, with mixed results.

No, they're simply suggesting that giving someone more money in their pay envelope will make them more likely to kick the habit.

10% pay boost

In a workplace study, the researchers found that a 10% increase in wages leads to about a 5% drop in smoking rates among workers who are male or who have high school educations or less. Statistically, the extra pay improves an employee's overall chances of quitting smoking from 17% to 20%.

"Our findings are especially important as inflation-adjusted wages for low-income jobs have been dropping for decades and the percentage of workers in low-paying jobs has been growing nationwide," said study senior author Paul Leigh, professor of public health sciences and researcher with the Center for Healthcare Policy and Research at UC Davis. "Increasing the minimum wage could have a big impact on a significant health threat."

Socioeconomic divide

Earlier this year the Washington Post reported on the odd socioeconomic divide between smokers and nonsmokers. The report cited a 2008 Gallup Poll that showed the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more.

The Post report speculated on three possible reasons, including the fact that lower-income smokers tend to take longer, deeper drags on their cigarettes and are more addicted to nicotine, making it less likely that they will quit.

Leigh and lead author Juan Du wanted to find out if simply raising wages, moving a smoker a little farther up the economic ladder, could make it easier to stop.

The team looked at data on wages, smoking status and state of residence for full-time employees aged 21 to 65 years from the 1999 to 2009 Panel Study of Income Dynamics. They excluded anyone who never smoked, since the goal was to evaluate influences on quitting rather than starting smoking.

"We assume that people begin smoking for reasons other than wages," said Leigh. "About 90% of smokers in the United States started smoking before age 20, so the data captured a sample of most full-time workers who have ever smoked."

Money as treatment

After reviewing the results, Leigh and Du concluded that money is a form of “treatment.” They aren't sure why, but there was a correlation between wage increases and reduced smoking among men and the less educated. They also found there were fewer smokers in states with higher minimum wages or higher rates of unionization.

But there is apparently a limit to what money can do. While better pay seemed to be linked to men kicking the habit, the researchers found no such correlation among women.

One theory? Leigh and Du speculate that men may be more likely to tie self-worth to their pay, increasing the likelihood of risky health behaviors among men in lower-paying jobs.

The Food and Drug Administration has used its newly-acquired tobacco regulating power again – this time to order R.J Reynolds to stop selling four cigarette products.

The order covers Camel Crush Bold, Pall Mall Deep Set Recessed Filter, Pall Mall Deep Set Recessed Filter Menthol and Vantage Tech 13, with the agency ruling the products don't meet guidelines set out in the Federal Food, Drug, and Cosmetic Act (FD&C Act).

The issue, according to the FDA, is these products are different from their versions that were on the market in early 2007. More specifically, the agency concluded the current products have different characteristics than those that came before and the manufacturer failed to show that the new products do not raise different questions of public health. As a result, the four products may no longer be distributed or sold in the U.S.

Science-based review

“These decisions were based on a rigorous, science-based review designed to protect the public from the harms caused by tobacco use,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products. “The agency will continue to review product submissions and exercise its legal authority and consumer protection duty to remove products from the market when they fail to meet the public health bar set forth under law.”

The Family Smoking Prevention and Tobacco Control Act, signed into law in 2009, gave the FDA new powers to regulate tobacco, which it lacked in the past. However, the agency starting exercising those powers only recently.

In late August, the FDA fired off warning letters to three cigarette manufacturers – ITG Brands LLC, Santa Fe Natural Tobacco Company Inc., and Sherman’s 1400 Broadway N.Y.C. Ltd. — for making unsubstantiated claims about their products. That was the first time the FDA acted under the 2009 law.

Changed with no notice

In this latest action the agency expressed concern the cigarette products were changed with no notice, making them different from their previous approved versions.

The FDA said the scientific basis for these four decisions include a “failure to demonstrate that increased yields of harmful or potentially harmful constituents, higher levels of menthol, and/or the addition of new ingredients in the currently marketed products– when compared to the predicate products – do not raise different questions of public health.”