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.

The negative effects of smoking have been well documented in numerous studies. Doctors across the world treat patients who have suffered from the habit every day, but one such doctor has had enough. Dr. Daniel Ouellette, a pulmonologist at Henry Ford Hospital, is suggesting that the legal smoking age be raised to 21.

The suggestion, which is popular amongst anti-smoking advocates, would help limit access to tobacco products for teenagers. This, Ouellette says, would reduce smoking prevalence amongst younger demographics. Health problems related to smoking often start young, so this would be an important step.

“Most of my patients are diagnosed with emphysema or lung cancer at a relatively young age from smoking, despite the media attention given to the health risks of smoking and despite them knowing about those risks,” said Ouellette.

E-cigs not safer

Ouellette is also very against the notion that e-cigarettes are a safer product. “They're unregulated so we can't be sure what's in them. In some studies, it showed that the particulates may be comparable to that of a regular cigarette,” he said. “They also come from China, which makes it hard to know who is manufacturing them.”

Unfortunately, many middle and high school students have latched onto the product. Statistics show that e-cigarette use amongst young people tripled between 2013 and 2014. And while the product is supposed to be safe, there have been hospitalizations related to using it. Conditions attributed to their use include pneumonia, congestive heart failure, and seizure.

Even if the above conditions do not manifest, some researchers say e-cigarettes can often act as a gateway product that leads to actual cigarette smoking – which is still responsible for one in five deaths in the United States.

One study, conducted and released by the Institute of Medicine in March of 2015, concluded that raising the legal age for using tobacco products would likely prevent or delay the start of smoking for adolescents and young adults. While this may seem obvious, it is extremely important since it would lower the prevalence of many age-related health problems associated with smoking.

Many cities and states already support raising the legal age of smoking. In June, Hawaii became the first state to raise the age required to buy tobacco products to 21; since then, 90 cities in 8 different states have followed their lead. Dr. Ouellette will be giving presentations on e-cigarettes and raising the legal age for tobacco products at the American College of Chest Physicians' annual meeting, which takes place in Montreal from October 24-28. 

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 manufacturers of so-called 'little cigars' are deceiving and endangering consumers and our children, and federal rules allow them to get away with it," said California Attorney General Bill Lockyer.

"These products are made like cigarettes, their smoke can be inhaled like cigarettes, and they present the same serious health risks as cigarettes. Yet federal regulations allow the makers to call them cigars and sell them as cigars. That allows them to evade marketing restrictions and higher taxes that apply to cigarettes, and increases youth access by lowering the prices. The federal government should close this dangerous loophole."

The petition urges the federal Alcohol Tobacco Tax and Trade Bureau (TTB) to adopt rules revising the definitions of cigars and cigarettes. The goal is to ensure that "little cigars" -- which actually are cigarettes wrapped in brown paper -- are classified, taxed and priced as cigarettes.

"Little cigars" appeal to youths because they often are sold individually or in "kiddie packs" of less than 20, which makes them cheaper, and because in many cases they are sweetened with flavors such as chocolate, vanilla, strawberry, cinnamon and spearmint. Some of the more popular brand names include Winchester, Smokers Choice, Prime Time and Cheyenne.

Federal law defines cigars as tobacco wrapped in leaf tobacco or substances containing tobacco. Federal and state laws generally define cigarettes as tobacco wrapped in paper or other substances not containing tobacco.

State and federal statutes also define cigarettes as tobacco wrapped in any substance that includes tobacco, if its appearance, the type of tobacco used in the filler, or its packaging and labeling, indicate it will be sold and purchased as a cigarette.

The problem stems from a rule issued by the TTB that sought to clarify the federal definitions. Under the rule, if manufacturers label their products cigars, the presumption is the products will not be sold or bought as cigarettes. Essentially, the rule allows the tobacco companies to self-classify their products as cigars.

Selling their brown cigarettes as cigars provides substantial benefits to manufacturers. It lets them pay significantly lower taxes and avoid the requirement under most state laws that cigarettes be sold in packs of at least 20 sticks. In combination, those two factors permit dramatically lower prices. For example, the taxes on a carton of "little cigars" in California total $3.77, compared to $16.76 for a carton of cigarettes.

Cigar makers also do not have to abide by the youth and other marketing restrictions imposed by the Master Settlement Agreement reached in 1998 between tobacco companies and 46 state Attorneys General. And most cigar makers do not have to place federal health warnings on their products.

Consumption of "little cigars" has exploded. From 1998 through 2005, consumption of the products increased by more than 2 billion sticks, from 1.638 billion to 3.772 billion, according to the U.S. Department of Agriculture.

Some data suggest "little cigars" are enjoying rising popularity among younger smokers. A study of college freshmen found that students who said they smoked were more likely to smoke little cigars than cigarettes or regular cigars. Two other studies published in 2004 and 2005 found that high school students in New Jersey and Cleveland, Ohio smoked cigars more often than cigarettes.

"While public health organizations and states have been successful in lowering cigarette smoking rates among teens, little cigar and cigar use is threatening to reverse these gains and plunge another generation into tobacco addiction," said the Attorneys General in their petition to the TTB.

Youths may mistakenly believe they are smoking a product that poses less health risks because it's labeled a cigar. But the products are made to be smoked and inhaled just like cigarettes, which means they present the same addiction and health dangers.

Additionally, while the makers call these products cigars, their advertising actually aims to sell consumers on the concept that the products are just like cigarettes, only cheaper. "So much like cigarettes, its hard to believe they are cigars," proclaims one ad.

The petition to the TTB notes that Harry Preston, national accounts manager for J.C. Newman Cigar Company, has suggested that convenience stores display little cigars near the register and instruct their clerks to tout them as an alternative to cigarettes.

The rule proposed by the AGs would eliminate the current loophole by stripping manufacturers of the ability to self-classify their products as cigars. Instead, tobacco products would be deemed cigarettes if the tobacco filler or packaging possess any one of several specific characteristics, or if "the product is marketed or advertised to consumers as a cigarette or cigarette substitute."

Remember the old Virginia Slims cigarettes slogan, “you've come a long way, baby?” A special article published in this week's New England Journal of Medicine (NEJM), puts what was intended as something positive into a very negative light.

According to the NEJM article, female smokers have a much greater risk of death from lung cancer and chronic obstructive lung disease (COLD) in recent years than did female smokers 20 or 40 years ago, reflecting changes in smoking behavior.

In fact, the increase in risk of death from lung cancer and COLD in female smokers has been large enough to completely offset improvements in longevity from medical advances that have reduced death rates in the rest of the population over the last 50 years.

Smoking like a man

Women smokers today smoke more like men than women in previous generations, beginning earlier in adolescence and until recently smoking more cigarettes per day (consumption peaked among female smokers in the 1980s).

To find out if these changing patterns have caused women's risk to converge with those in men, researchers, researchers led by Michael J. Thun, MD, recently retired as vice president emeritus of the American Cancer Society (ACS), measured fifty-year trends in mortality related to smoking across three time periods (1959-65, 1982-88 and 2000-2010), by comparing five large contemporary studies with two historical ACS cohorts.

In total the study included more than 2.2 million adults 55 years and older.

The rising risk

For women who smoked in the 1960s, the risk of dying from lung cancer was 2.7 times higher than that of never-smokers. In the contemporary cohorts (2000-2010) the risk was 25.7 times higher than that of never-smokers.

The risk of dying from COLD among female smokers was 4.0 times higher than that of never-smokers in the 1960s; in the contemporary cohort, this risk increased to 22.5 times higher than never-smokers. About half of the increase in risk of both conditions occurred during the last 20 years.

In male smokers, lung cancer risk plateaued at the high level observed in the 1980s, while the risk of death from COLD continues to increase for reasons that are unclear. Men and women smokers in the contemporary cohorts had nearly identically higher relative risks (compared to never smokers) for lung cancer, chronic obstructive lung disease, ischemic heart disease, stroke, and other heart disease. This finding strongly confirms the observed prediction that "If women smoke like men, they will die like men."

Quitting by 40

The research also confirmed that quitting smoking at any age dramatically lowers mortality from all major diseases caused by smoking, and that quitting smoking is far more effective than reducing the number of cigarettes smoked. The study found smokers who quit by age 40 avoided nearly all of the excess smoking-related mortality from lung cancer and COPD.

"The steep increase in risk among female smokers has continued for decades after the serious health risks from smoking were well established, and despite the fact that women predominantly smoked cigarette brands marketed as lower in 'tar' and nicotine," said Dr. Thun. "So not only did the use of cigarette brands marketed as 'Light' and 'Mild' fail to prevent a large increase in risk in women, it also may have exacerbated the increase in deaths from chronic obstructive lung disease in male smokers, since the diluted smoke from these cigarettes is inhaled more deeply into the lungs of smokers to maintain the accustomed absorption of nicotine."

Never-smokers

Another study appearing in the same issue of the NEJM looks at longevity among current, former, and never smokers in the nationally representative National Health Interview survey. That study, led by Dr. Prabhat Jha at St. Michael's Hospital at the University of Toronto, found that persistent lifetime smokers lose an average of about 10 years of life compared to never smokers. Smokers who die prematurely lose about 20 years of life.

"The findings from these studies have profound implications for many developing countries where cigarette smoking has become entrenched more recently than in the United States, said Dr. Thun. "Together they show that the epidemic of disease and death caused by cigarette smoking increases progressively over many decades, peaking fifty or more years after the widespread uptake of smoking in adolescence. The good news is the benefits of smoking cessation occur much more quickly and are substantial at any age."

Now, Stanford University researchers have conducted the first in-depth study on how smoking affects air quality at sidewalk cafs, park benches and other outdoor locations.

Writing in the May issue of the Journal of the Air and Waste Management Association (JAWMA), the Stanford team concluded that a non-smoker sitting a few feet downwind from a smoldering cigarette is likely to be exposed to substantial levels of contaminated air for brief periods of time.

"Some folks have expressed the opinion that exposure to outdoor tobacco smoke is insignificant, because it dissipates quickly into the air," said Neil Klepeis, assistant professor (consulting) of civil and environmental engineering at Stanford and lead author of the study.

"But our findings show that a person sitting or standing next to a smoker outdoors can breathe in wisps of smoke that are many times more concentrated than normal background air pollution levels."

Klepeis pointed to the 2006 Surgeon General's report, which found that even brief exposures to secondhand smoke may have adverse effects on the heart and respiratory systems and increase the severity of asthma attacks, especially in children.

"We were surprised to discover that being within a few feet of a smoker outdoors may expose you to air pollution levels that are comparable, on average, to indoor levels that we measured in previous studies of homes and taverns," said Wayne Ott, professor (consulting) of civil and environmental engineering at Stanford and co-author of the JAWMA study.

"For example, if you're at a sidewalk caf, and you sit within 18 inches of a person who smokes two cigarettes over the course of an hour, your exposure to secondhand smoke could be the same as if you sat one hour inside a tavern with smokers. Based on our findings, a child in close proximity to adult smokers at a backyard party also could receive substantial exposure to secondhand smoke," he added.

Unlike indoor tobacco smoke, which can persist for hours, the researchers found that outdoor smoke disappears rapidly when a cigarette is extinguished.

"Our data also show that if you move about six feet away from an outdoor smoker, your exposure levels are much lower," Klepeis added.

The public has become increasingly concerned about the effects of outdoor smoking, Ott noted. More than 700 state and local governments have passed laws restricting outdoor smoking at playgrounds, building entrances and other public areas, according to the American Nonsmokers' Rights Foundation.

Some of the strictest ordinances are in California. The city of Santa Monica, for example, recently banned smoking at parks, beaches, ATM machines, theater lines, open-air restaurants and other outdoor locations.

"Throughout the country, cities and counties are looking at various laws against outdoor smoking, and some of the proposals are pretty drastic," Ott said. "The problem is that until now, there have been virtually no scientific data to justify such restrictions. In fact, our paper is the first study on outdoor smoking to be published in a peer-reviewed scientific journal."

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.