Troisi: Raising age on tobacco purchases would protect Texas children

Author: Catherine Troisi

Tobacco products are a known cancer-causing agent and responsible for one in three cancer deaths. Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders and suicides combined — and thousands more die from smoking-related causes such as fires caused by smoldering cigarettes. E-cigarettes, often touted as a safer alternative, have not been well-studied and may contain unknown poisons.

We are not protecting our children from this danger. Unlike alcohol sales, where you have to be 21 years to purchase legally, adolescents and young adults 18 and over can purchase tobacco products. While the Texas Legislature wisely raised the age to buy e-cigarettes from 14 to 18 years last year, it’s time to look at raising the legal age for all tobacco products to 21.

The problem is not just those age 18 and older smoking. This young legal age to purchase makes it easier for children under age 18 to get access to cigarettes and other products. Each year, 19,000 Texas children under the age of 18 start smoking. In Texas, almost one out of every six high school students smokes — and over their lifetime, half a million Texans who started smoking under age 18 will ultimately die of tobacco-related diseases.

Most of us have someone in our family or know someone who has been affected by a tobacco-related disease. A colleague lost both parents and his only sibling as a result of smoking that began when they were teens. Each relative suffered for over a decade before finally succumbing to the effects of tobacco. His brother was 46 when he was diagnosed with oral cancer. Cancer took his jaw, tongue, teeth and ability to speak clearly and swallow. He suffered for 13 years before it took his life.

There’s also an economic impact. Smoking by children under age 18 costs the state almost $9 billion dollars in direct costs and each Texan household’s federal tax is increased by $756 per year, according to reports from the Campaign for Tobacco-Free Kids. Imagine what we could do with that money both as a state and as individuals rather than use it for tobacco-related medical costs.

The tobacco industry knows that nine out of 10 smokers start before age 18 — and each day 3,200 children smoke their first cigarette. An estimated $636 million is spent on marketing to sell their harmful products just in Texas. Children are twice as sensitive to tobacco advertising as adults and more likely to be influenced to start smoking by these marketing tactics than they are by peer pressure. Tobacco companies have to get children smoking by age 18 — otherwise the odds that they will start are small.

Would raising the legal age to purchase actually stop children from getting these products? The tobacco company Phillip Morris thought so in a 1986 report: “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20)” The Institute of Medicine agreed in a 2015 report predicting that were the minimum age for the sale of tobacco products 21, over time, the adult smoking rate would decline by about 12 percent and smoking-related deaths would decline by ten percent. The report also states, “Although changes in the minimum age … will pertain to individuals who are 18 and older, the largest proportionate reduction …. will likely occur among adolescents of ages 15 to 17 years.” Research shows that kids often turn to older friends as sources of cigarettes. Raising the sale age to 21 would reduce the likelihood that a high school student will be able to legally purchase tobacco products for other students and underage friends.

The legal age for the purchase of tobacco products is set by states and in some cases counties. Hawaii became the first state to raise the tobacco sale age to 21 and just last week California joined them. At least 135 localities in nine states have also raised the tobacco age to 21.

The U.S. Federal Drug Administration recently announced a “deeming rule,” which extends its authority to cover all tobacco products. However, the rule does not restrict online e-cigarette sales and marketing, including flavors such as “cotton candy” and “gummy bears” designed to entice youth.

As Texans, we want to protect our children and make sure they grow up healthy and safe. Raising the legal age to buy tobacco products to 21 years is a proven strategy to do this. Let’s make it a priority to protect our families and communities — while saving money — by starting this discussion.

Note: Catherine Troisi is an epidemiologist at the UT Health School of Public Health in Houston.

Costco Wholesale to stop selling tobacco products at hundreds of locations

Author: Jaleesa Baulkman

Sorry smokers, but you’ll have to go someplace other than Costco to get your cigarettes.

The New York Daily News reported the retailer has spent the past few years quietly phasing tobacco products out of nearly 300 stores; there are 488 in total. Tobacco smoke has been linked to adverse health effects, such as lung and oral cancer, though that’s not why Costco did it. Instead, the company said the decision was more about business than public health.

“Tobacco is a very low margin business, tends to have higher theft and is labor intensive in some cases (due to local municipality regulations) — further, we felt we could better use the space to merchandise other items,” a spokesman from Costco told The Street.

According to The Street, Costco officials first hinted at the ban during a call with analysts, where they said tobacco sales had fallen to a “low double digit.” The company hasn’t made an official announcement because “[press releases] are a waste of money.”

The retail giant’s move is another blow to the tobacco industry, which has seen a significant drop in the percentage of Americans who smoke in the past 50 years. In 2014, the smoking rate hit an all-time low of 17.8 percent, and the rate is still dropping, The Huffington Post reported. Not to mention other retailers have quit selling these kinds of products, too.

In 1996, Target was the first large retail store to stop selling cigarettes, citing costs related to efforts to keep cigarettes out of the hands of minors, The New York Times reported. In 2014, CVS also stopped selling cigarettes in its 7,600 of its pharmacies nationwide. However, unlike Costco and Target, CVS said its decision was an effort to “help people on their path to better health.”

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

Cigarette use is responsible for the deaths of more than 480,000 people each year, according to the Centers for Disease Control and Prevention. Despite the many studies and graphic anti-smoking ads shedding light on the cancers and diseases associated with the habit, more than 20 percent of men and more than 15 percent of women in the United States still light up.

CVS’ ban did lead to a 1 percent decrease in cigarette sales, so who’s to say Costco’s elimination won’t have a similar effect?

March, 2016|Oral Cancer News|

e-Cigarette Use Tied to Tobacco Use in Teenagers

Author: Diana Swift

e-Cigarette smoking appears to promote progression to traditional cigarette smoking and may be helping form a new population of smokers, according to a prospective study published online September 8 in JAMA Pediatrics.

Brian A. Primack, MD, PhD, from the Division of General Internal Medicine, University of Pittsburgh School of Medicine in Pennsylvania, and colleagues analyzed data on 694 young nonsmokers who were attitudinally nonsusceptible to smoking at baseline. The very small proportion (2.3%) who already used e-cigarettes at baseline proved more likely to progress to smoking or to being open to it.

The cohort, which was more than 75% non-Hispanic white, consisted of 374 females. The mean age of the 16 baseline e-cigarette users was 19.5 years compared with 20 years for nonusers.

Study data came from waves 2 and 3 of the US-based Dartmouth Media, Advertising, and Health Study, a national survey of adolescents and young adults aged 16 to 26 years who were recruited via random digit dialing using landline (66.7%) and cellular (33.3%) telephone numbers.

The survey, conducted from October 1, 2012, to May 1, 2014, started tracking e-cigarette use at wave 2 (2012 – 2013), which served as the baseline, whereas wave 3 (2013 – 2014) served as follow-up for the current study.

Eligible participants had to be never-smokers and attitudinally nonsusceptible to smoking at baseline. This was assessed with these questions: “If one of your friends offered you a cigarette, would you try it?” and “Do you think you will smoke a cigarette sometime in the next year?” Response options included “definitely yes,” “probably yes,” “probably no,” and “definitely no.” Those who responded “definitely no” to both measures were considered nonsusceptible nonsmokers.

After a year, 11 of 16 baseline e-cigarette users (68.8%) and 128 of 678 participants nonusers (18.9%) progressed to traditional combustible cigarette smoking. After controlling for demographic covariates such as age, sex, and maternal education level, baseline e-cigarette use was independently associated with both progression to smoking (adjusted odds ratio [AOR], 8.3; 95% confidence interval, 1.2 – 58.6) and progression to susceptibility (AOR, 8.5; 95% CI, 1.3 – 57.2) among initially nonsusceptible nonsmokers.

“These findings support regulations that decrease the accessibility and appeal of e-cigarettes to nonsmoking adolescents and young adults,” Dr Primack and associates write.

Conceding that some might see the small percentage of baseline e-smokers as not translating into a substantial public health risk, the researchers caution that e-cigarette use is on the rise. “[D]ata published in 2015 suggest that large numbers of youth are initiating e-cigarette use and that as many as half of these individuals do not smoke traditional combustible cigarettes. Therefore, it will be important to continue surveillance among youth of both e-cigarette use and overlap with use of other tobacco products.”

Noting that many youth may be dual users of cigarettes and e-cigarettes, the authors say nicotine exposure may drive initial e-cigarette users to use cigarettes as a more efficient nicotine delivery device. In addition, nicotine content aside, “e-cigarettes may behaviorally accustom individuals to powerful cigarette smoking cues such as inhalation, exhalation, and holding the cigarette.”

Furthermore, e-cigarettes, which expose users to potentially harmful aerosolized substances other than nicotine, are not subject to regulations limiting cigarette smoking, such as age limits for sale, flavoring and marketing restrictions, clean air laws, taxes, and labeling requirements, which may increase their accessibility to youth. “For example, e-cigarettes are marketed on television, representing the first time in more than 40 years that a smoking-related device is advertised on this medium,” the investigators write.

In an accompanying editorial, Jonathan D. Klein, MD, MPH, an adolescent medicine specialist and an associate executive director of the American Academy of Pediatrics in Elk Grove Village, Illinois, noted that a recent Centers for Disease Control and Prevention report found that e-cigarette use in the National Youth Tobacco Survey increased from 4.5% in 2011 to 13.4% in 2014, affecting more than 2.2 million students. “The article by Primack et al is one more piece of evidence that the effect of e-cigarettes on youth is happening now in real time,” he writes, adding that “these data provide strong longitudinal evidence that e-cigarette use leads to smoking, most likely owing to nicotine addiction.”

Dr Klein also points to mounting concerns among health experts that e-cigarettes will also renormalize smoking, delay or prevent cessation, and cause former smokers to become re-addicted. He says the evidence suggests that e-cigarette users are less likely to quit smoking traditional cigarettes than nonusers In spite of such data and evidence of harm from e-smoking devices. He states that the US Food and Drug Administration has failed to assert authority and oversight over these alternative products.

“We do not need more research on this question; we have the evidence base, and we have strategies that work to protect nonsmokers from e-cigarettes and other forms of tobacco,” Dr Klein writes. “What we still need is the political will to act on the evidence and protect our youth.”

This study was supported by grants from the National Cancer Institute and the National Center for Advancing Translational Sciences. The authors and Dr Klein have disclosed no relevant financial relationships.

JAMA Pediatr. Published online September 8, 2015. Article full text, Editorial full text

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2016|Oral Cancer News|

FDA Clears First Tobacco Product for Marketing

For the first time since it was given the power to regulate tobacco, the US Food and Drug Administration (FDA) has authorized marketing of a new product.

The agency said that eight new smokeless snus products, to be sold in the United States under the “General” brand name by Stockholm-based Swedish Match AB, are now authorized under the premarket tobacco application pathway, which was established by the 2009 Family Smoking Prevention and Tobacco Control Act. Snus cannot be marketed as “FDA-approved,” however.

“Today’s action demonstrates that the premarket tobacco application process is a viable pathway under which products can be marketed, as long as the public health can be protected,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products, in a statement.

This is the first time any tobacco maker has completed the rigorous premarket tobacco application review process at the agency; others have had products approved by proving they are substantially equivalent to what is already on the market.

The agency said that Swedish Match provided evidence that “these products would likely provide less toxic options if current adult smokeless tobacco users used them exclusively.” The agency also agreed with the company that snus’ availability would not result in substantial new use, delay quit attempts, or attract ex-smokers.

Swedish Match had been seeking separately to remove warnings that snus is harmful, but the agency has not yet ruled on that request.

In that separate application, Swedish Match was seeking to have the 10 types of snus it already sells in the United States designated as modified-risk tobacco products. The agency accepted the company’s application in August 2014 and held a meeting of its advisory panel to review the evidence in April 2015.

The company wanted to remove warnings that snus could cause gum disease and tooth loss or mouth cancer. It also sought to label its products with the statement that reads, “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.” The advisory committee could not reach consensus on whether snus was a safer alternative to smoking, and also was not convinced that the product would not attract new users. At that meeting, Dennis Henigan, director of legal and policy analysis for the Campaign for Tobacco-Free Kids, said Swedish Match had failed to show that users would not use both cigarettes and snus, or that young people would not initiate use.

Snus, which is ground tobacco, salt, and water, comes in a pouch that users place under their upper lip. It can be used for up to 30 minutes, according to the company. It is popular in Sweden, but less so in the United States. Swedish Match says its General brand accounts for 11% of American convenience store snus sales. The 60 million cans it sells annually in the United States are dwarfed by the billion cans of smokeless tobacco sold.

The Centers for Disease Control and Prevention estimates that less than 4% of adults use smokeless tobacco, with rates highest among men aged 18 to 25 years (10%). A 2014 Centers for Disease Control and Prevention survey of high school students found that 5.5% of overall used smokeless tobacco, and an additional 1.9% reported current use of snus.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

November, 2015|Oral Cancer News|

Researchers Find Hookah Smoking Can Lead to Serious Oral Conditions – Equivalent To Smoking 100 Cigarettes

Author: PR Newswire

CHICAGO, Oct. 28, 2015 /PRNewswire/ — According to the Centers for Disease Control and Prevention, 2.3 million Americans smoke tobacco from pipes, and many of those who smoke waterpipes, or hookahs, believe it’s less harmful than cigarettes. However, research published in The Journal of the American Dental Association (JADA) suggests hookah smoking is associated with serious oral conditions including gum diseases and cancer.

“We found that waterpipe smoking is associated with serious health problems affecting the head and neck region,” said study author Teja Munshi, B.D.S., M.P.H of Rutgers University. “The public needs to know they are putting themselves at risk. They should be made aware of the dangers of smoking hookahs.”

The authors conducted a literature review that focused on waterpipe smoking and head and neck conditions. They found waterpipe smoking to be associated with gum diseases, dry socket, oral cancer and esophageal cancer among other conditions. According to the World Health Organization, smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session.

“This study sheds light on the common misconception that smoking from a waterpipe is somehow safer than smoking a cigarette,” said JADA Editor Michael Glick, D.M.D. “Whether you are smoking a cigarette, an e-cigarette, a cigar, or tobacco from a waterpipe, smoking is dangerous not only to your oral health but to your overall health.”

The American Cancer Society is hosting The Great American Smokeout on November 19, 2015, an annual event that encourages smokers of all kinds to give up the habit. The event asks smokers to quit even for just one day to take a step toward a healthier life.

Millions of Americans still use traditional methods of smoking, but emerging trends in the smoking industry, such as hookah smoking and e-cigarettes pose dangers as well. E-cigarettes are devices that turn liquid into a vapor containing nicotine. In an editorial in the September 2015 issue of JADA, authors warned readers of the potential dangers of e-cigarettes, indicating that oral health effects of their use has been inadequately investigated.

“Additional research is needed on the impact smoking has on overall health, but it’s clear that smoking of all kinds has the potential to be dangerous,” said Dr. Glick.

Dentists have an important role in advising patients of the dangers of smoking. The American Dental Association has long been a proponent of educating the public about its hazards and has urged for continued research into the adverse health effects of tobacco use. For more information on smoking and its oral health effects, visit


This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2015|Oral Cancer News|

Alternative Tobacco Products as a Second Front in the War on Tobacco

Authors: Samir Soneji, PhD; James D. Sargent, MD; Susanne E. Tanski, MD, MPH; Brian A. Primack, MD, PhD

Associations Between Initial Water Pipe Tobacco Smoking and Snus Use and Subsequent Cigarette Smoking: Results From a Longitudinal Study of US Adolescents and Young Adults

Importance Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes.

Objective To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking.

Design, Setting, and Participants We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non–cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non–cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initiation and current cigarette smoking, accounting for established sociodemographic and behavioral risk factors. We fit similarly specified multivariable ordinal logistic regression models to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with high-intensity cigarette smoking at follow-up.

Exposures Water pipe tobacco smoking and the use of snus at baseline.

Main Outcomes and Measures Among baseline non–cigarette smokers, cigarette smoking initiation, current (past 30 days) cigarette smoking at follow-up, and the intensity of cigarette smoking at follow-up.

Results Among 1596 respondents, 1048 had never smoked cigarettes at baseline, of whom 71 had smoked water pipe tobacco and 20 had used snus at baseline. At follow-up, accounting for behavioral and sociodemographic risk factors, baseline water pipe tobacco smoking and snus use were independently associated with cigarette smoking initiation (adjusted odds ratios: 2.56; 95% CI, 1.46-4.47 and 3.73; 95% CI, 1.43-9.76, respectively), current cigarette smoking (adjusted odds ratios: 2.48; 95% CI, 1.01-6.06 and 6.19; 95% CI, 1.86-20.56, respectively), and higher intensity of cigarette smoking (adjusted proportional odds ratios: 2.55; 95% CI, 1.48-4.38 and 4.45; 95% CI, 1.75-11.27, respectively).

Conclusions and Relevance Water pipe tobacco smoking and the use of snus independently predicted the onset of cigarette smoking and current cigarette smoking at follow-up. Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking.

JAMA Pediatr. 2015;169(2):129-136. doi:10.1001/jamapediatrics.2014.2697

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


October, 2015|Oral Cancer News|

U.S. Chamber of Commerce Works Globally to Fight Antismoking Measures

Author: Danny Hakim
01cigarette-web2-master675A demonstration against World No Tobacco Day in Jakarta, Indonesia, in 2013. The U.S. Chamber of Commerce and its foreign affiliates have joined efforts to fight antismoking laws around the world. Credit Romeo Gacad/Agence France-Presse — Getty Images

KIEV, Ukraine — A parliamentary hearing was convened here in March to consider an odd remnant of Ukraine’s corrupt, pre-revolutionary government.

Three years ago, Ukraine filed an international legal challenge against Australia, over Australia’s right to enact antismoking laws on its own soil. To a number of lawmakers, the case seemed absurd, and they wanted to investigate why it was even being pursued.

When it came time to defend the tobacco industry, a man named Taras Kachka spoke up. He argued that several “fantastic tobacco companies” had bought up Soviet-era factories and modernized them, and now they were exporting tobacco to many other countries. It was in Ukraine’s national interest, he said, to support investors in the country, even though they do not sell tobacco to Australia.

Mr. Kachka was not a tobacco lobbyist or farmer or factory owner. He was the head of a Ukrainian affiliate of the U.S. Chamber of Commerce, America’s largest trade group.

From Ukraine to Uruguay, Moldova to the Philippines, the U.S. Chamber of Commerce and its foreign affiliates have become the hammer for the tobacco industry, engaging in a worldwide effort to fight antismoking laws of all kinds, according to interviews with government ministers, lobbyists, lawmakers and public health groups in Asia, Europe, Latin America and the United States.

The U.S. Chamber’s work in support of the tobacco industry in recent years has emerged as a priority at the same time the industry has faced one of the most serious threats in its history. A global treaty, negotiated through the World Health Organization, mandates anti-smoking measures and also seeks to curb the influence of the tobacco industry in policy making. The treaty, which took effect in 2005, has been ratified by 179 countries; holdouts include Cuba, Haiti and the United States.

Facing a wave of new legislation around the world, the tobacco lobby has turned for help to the U.S. Chamber of Commerce, with the weight of American business behind it. While the chamber’s global tobacco lobbying has been largely hidden from public view, its influence has been widely felt.

Letters, emails and other documents from foreign governments, the chamber’s affiliates and antismoking groups, which were reviewed by The New York Times, show how the chamber has embraced the challenge, undertaking a three-pronged strategy in its global campaign to advance the interests of the tobacco industry.

In the capitals of far-flung nations, the chamber lobbies alongside its foreign affiliates to beat back antismoking laws.

In trade forums, the chamber pits countries against one another. The Ukrainian prime minister, Arseniy Yatsenyuk, recently revealed that his country’s case against Australia was prompted by a complaint from the U.S. Chamber.

And in Washington, Thomas J. Donohue, the chief executive of the chamber, has personally taken part in lobbying to defend the ability of the tobacco industry to sue under future international treaties, notably the Trans-Pacific Partnership, a trade agreement being negotiated between the United States and several Pacific Rim nations.

“They represent the interests of the tobacco industry,” said Dr. Vera Luiza da Costa e Silva, the head of the Secretariat that oversees the W.H.O treaty, called the Framework Convention on Tobacco Control. “They are putting their feet everywhere where there are stronger regulations coming up.”

01cigarette-web1-master315Thomas J. Donohue, the head of the U.S. Chamber of Commerce, has defended the tobacco industry’s right to sue under future international treaties. Credit Brendan Hoffman for The New York Times

The increasing global advocacy highlights the chamber’s enduring ties to the tobacco industry, which in years past centered on American regulation of cigarettes. A top executive at the tobacco giant Altria Group serves on the chamber’s board. Philip Morris International plays a leading role in the global campaign; one executive drafted a position paper used by a chamber affiliate in Brussels, while another accompanied a chamber executive to a meeting with the Philippine ambassador in Washington to lobby against a cigarette-tax increase. The cigarette makers’ payments to the chamber are not disclosed.

It is not clear how the chamber’s campaign reflects the interests of its broader membership, which includes technology companies like Google, pharmaceutical giants like Pfizer and health insurers like Anthem. And the chamber’s record in its tobacco fight is mixed, often leaving American business as the face of a losing cause, pushing a well-known toxin on poor populations whose leaders are determined to curb smoking.

The U.S. Chamber issued brief statements in response to inquiries. “The Chamber regularly reaches out to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands, or destroy their intellectual property,” the statement said, adding, “we’ve worked with a broad array of business organizations at home and abroad to defend these principles.”

The chamber declined to say if it supported any measures to curb smoking.

The chamber, a private nonprofit that has more than three million members and annual revenue of $165 million, spends more on lobbying than any other interest group in America. For decades, it has taken positions aimed at bolstering its members’ fortunes.

While the chamber has local outposts across the United States, it also has more than 100 affiliates around the world. Foreign branches pay dues and typically hew to the U.S. Chamber’s strategy, often advancing it on the ground. Members include both American and foreign businesses, a symbiotic relationship that magnifies the chamber’s clout.

For foreign companies, membership comes with “access to the U.S. Embassy” according to the Cambodian branch, and entree to “the U.S. government,” according to the Azerbaijan branch. Members in Hanoi get an invitation to an annual trip to “lobby Congress and the administration” in Washington.

Since Mr. Donohue took over in 1997, he has steered the chamber into positions that have alienated some members. In 2009, the chamber threatened to sue if the Environmental Protection Agency regulated greenhouse gas emissions, disputing its authority to act on climate change. That led Nike to step down from the chamber’s board, and to Apple’s departure from the group. In 2013, the American arm of the Swedish construction giant Skanska resigned, protesting the chamber’s support for what Skanska called a “chemical industry-led initiative” to lobby against green building codes.

The chamber’s tobacco lobbying has led to confusion for many countries, Dr. da Costa e Silva said, adding “there is a misconception that the American chamber of commerce represents the government of the U.S.” In some places like Estonia, the lines are blurred. The United States ambassador there, Jeffrey Levine, serves as honorary president of the chamber’s local affiliate; the affiliate quoted Philip Morris in a publication outlining its priorities.

The tobacco industry has increasingly turned to international courts to challenge antismoking laws that countries have enacted after the passage of the W.H.O. treaty. Early this year, Michael R. Bloomberg and Bill Gates set up an international fund to fight such suits. Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that administers the fund, called the chamber “the tobacco industry’s most formidable front group,” adding, “it pops up everywhere.”

In Ukraine, the chamber’s involvement was no surprise to Hanna Hopko, the lawmaker who led the hearing in Parliament. She said the chamber there had fought against antismoking laws for years.

“They were against the tobacco tax increase, they were against placing warning labels on cigarettes,” she said. “This is just business as usual for them.”

01cigarette-web3-articleLargePlain packaged tobacco products with health warnings in Sydney, Australia. Credit Andrew Quilty for The New York Times


Country-by-Country Strategy

More than 3,000 miles away, in Nepal, the health ministry proposed a law last year to increase the size of graphic warning labels from covering three-fourths of a cigarette pack to 90 percent. Countries like Nepal that have ratified the W.H.O. treaty are supposed to take steps to make cigarette packs less appealing.

Not long afterward, one of Nepal’s top officials, Lilamani Poudel, said he received an email from a representative of the chamber’s local affiliate in the country, warning that the proposal “would negate foreign investment” and “invite instability.”

In January, the U.S. Chamber itself weighed in. In a letter to Nepal’s deputy prime minister, a senior vice president at the chamber, Tami Overby, wrote that she was “not aware of any science-based evidence” that larger warning labels “will have any discernible impact on reducing or discouraging tobacco use.”

A 2013 Harvard study found that graphic warning labels “play a lifesaving role in highlighting the dangers of smoking and encouraging smokers to quit.”

While Nepal eventually mandated the change in warning labels, cigarette companies filed for an extension and compliance has stalled.

“Since we have to focus on responding to the devastating earthquake, we have not been able to monitor the state of law enforcement effectively,” said Shanta Bahadur Shrestha, a senior health ministry official.

The episode reflects the chamber’s country-by-country lobbying strategy. A pattern emerged in letters to seven nations: Written by either the chamber’s top international executive, Myron Brilliant, or his deputies, they introduced the chamber as “the world’s largest business federation.”

Then the letters mention a matter “of concern.” In Jamaica and Nepal, it was graphic health warnings on packages. In Uruguay, it was a plan to bar cigarettes from being displayed by retailers. The Moldovan president was warned against “extreme measures” in his country, though they included common steps like restricting smoking in public places and banning advertising where cigarettes are sold.

A proposal to raise cigarette taxes in the Philippines would open the floodgates to smugglers, the government there was told. Tax revenue has increased since the proposal became law.

“We are not cowed by them,” said Jeremias Paul, the country’s under secretary of finance. “We meet with these guys when we’re trying to encourage investment in the Philippines, so clearly they are very influential, but that doesn’t mean they will dictate their ways.”

Protecting tobacco companies is portrayed by the chamber as vital for a nation’s economic health. Uruguay’s president is warned that antismoking laws will “have a disruptive effect on the formal economy.” El Salvador’s vice president is told that “arbitrary actions” like requiring graphic health warnings in advertisements undermine “investment and economic growth.”

On the ground, the chamber’s local affiliates use hands-on tactics.

After Moldova’s health ministry proposed measures in 2013, Serghei Toncu, the head of the American Chamber of Commerce in Moldova, laid out his objections in a series of meetings held by a regulatory review panel.

“The consumption of alcohol and cigarettes is at the discretion of each person,” Mr. Toncu said at one meeting, adding that the discussion should not be about “whether smoking is harmful.”

“You do not respect us,” he told the health ministry at another.

At a third, he called the ministry’s research “flawed from the start.”

His objections were not merely plaintive cries. The American chamber has a seat on Moldova’s regulatory review panel giving it direct influence over policy making in the small country.

“The American Chamber of Commerce is a very powerful and active organization,” said Oleg Chelaru, a team leader on the staff that assists the review panel. “They played a very crucial role in analyzing and giving an opinion on this initiative.”

Mr. Toncu, who has since left the chamber, declined to comment. Mila Malairau, the chamber’s executive director, said its main objective was to make sure the industry “was consulted” in “a transparent and predictable manner.”

After recently passing in Parliament, the long-stalled measures were subject to fresh objections from the chamber and others, and have not yet been enacted.

01cigarette-web4-articleLargeProtesters displayed fake body bags at a tobacco trade show at Pasay, the Philippines, in 2013. Credit Bullit Marquez/Associated Press


Fighting a Trade Exception

In Washington, the U.S. Chamber’s tobacco lobbying has been visible in the negotiations over the Trans-Pacific Partnership, a priority of the Obama administration that recently received critical backing in Congress.

One of the more controversial proposals would expand the power of companies to sue countries if they violate trade rules. The U.S. Chamber has openly opposed plans to withhold such powers from tobacco companies, curbing their ability to challenge national antismoking laws. The chamber says on its website that “singling out tobacco” will “open a Pandora’s box as other governments go after their particular bêtes noires.”

The issue is still unresolved. A spokesman for the United States trade representative said negotiators would ensure that governments “can implement regulations to protect public health” while also “ensuring that our farmers are not discriminated against.”

Email traffic shows that Mr. Donohue, the chamber’s head, sought to raise the issue in 2012 directly with Ron Kirk, who was then the United States trade representative. In email exchanges between staff members of the two, Mr. Donohue specifically sought to discuss the role of tobacco in the trade agreement.

“Tom had a couple of things to raise, including urging that the tobacco text not be submitted at this round,” one of Mr. Donohue’s staff members wrote to Mr. Kirk’s staff. The emails were produced in response to a Freedom of Information request filed by the Campaign for Tobacco-Free Kids, which provided them to The Times.

Mr. Kirk is now a senior lawyer at Gibson, Dunn, a firm that counts the tobacco industry as a client. He said in an interview that during his tenure as trade representative, he met periodically with Mr. Donohue but could not recall a specific conversation on tobacco.

He said trade groups were generally concerned about “treating one industry different than you would treat anyone else, more so than doing tobacco’s bidding.”

The chamber declined to make Mr. Donohue available for an interview.

A Face-Saving Measure

In Ukraine, it was Valeriy Pyatnytskiy who signed off on the complaint against Australia in 2012, which was filed with the World Trade Organization. At the time, he was Ukraine’s chief negotiator to the W.T.O. His political career has survived the revolution and he is now an adviser to the Ukrainian prime minister, Mr. Yatsenyuk.

In a recent interview, he said that for Ukraine, the case was a matter of principle. It was about respecting the rules.

He offered a hypothetical: If Ukraine allowed Australia to use plain packaging on cigarettes, what would stop Ukraine from introducing plain packaging for wine? Then Ukrainian winemakers could better compete with French wines, because they would all be in plain bags marked red or white.

“We had this in the Soviet times,” he said. “It was absolutely plain packaging everywhere.”

Some Ukrainian officials have long been troubled by the case.

“It has nothing to do with trade laws,” said Pavlo Sheremeta, who briefly served as Ukraine’s economic minister after the revolution. “We have zero exports of tobacco to Australia, so what do we have to do with this?”

Last year, he urged the American Chamber in Kiev to reconsider.

“I wrote a formal letter, asking them, ‘Do you still keep the same position?’ ” Mr. Sheremeta said. “Basically I was suggesting a face-saving way out of this.” But when he met with chamber officials, the plain packaging case was outlined as a top priority.

They refused to back down. After Mr. Pyatnytskiy, a tobacco ally, was installed as his deputy, Mr. Sheremeta resigned.

“The world was laughing at us,” he said of the case.

Shortly after The Times discussed the case with Ukrainian government officials, there were new protests from activists. Mr. Yatsenyuk called for a review of the matter. Ukraine has since suspended its involvement, but other countries including Cuba and Honduras are continuing to pursue the case against Australia.

Andy Hunder, who took over as president of the American Chamber of Commerce in Kiev in April, said the organization was moving on, adding, “We are looking forward now.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Professional Rodeo Competitors Join Fight Against Oral Cancer

Author: Melissa Allison


The number of oral cancer deaths related to tobacco use is on the rise nationwide according to the Oral Cancer Foundation. Brian Hill is the founder of the OCF and a survivor of the disease.

Kiser-OCFCody Kiser encourages the youth to not start using tobacco to help secure good health. Oral Cancer Foundation


“Up until about (the year) 2000 this was primarily a disease of older men who had smoked a lot or chewed tobacco during their lifetime,” Hill said. “About that point in time we started to see a shift in the cause of the disease.”

Hill said tobacco is still a primary cause of oral cancers and adds that the oral human papillomavirus type 16 (HPV16) is new etiology that has forced the number of cases to accelerate.

According to an October 2014 study by Johns Hopkins researchers the HPV16 causes cancers of the mouth and throat and that any form of tobacco use increases the risk of the virus. The research suggests as few as three cigarettes a day can increase the risk of infection by almost one-third.

Hill created the foundation in 1999 to promote change by educating the public about risk factors that contribute to the disease. Among those risks is the use of spit tobacco.

“The world of rodeo has been the realm of sponsorship by the tobacco industry for decades,” Hill said. “With the nicotine content in a can of dip equaling approximately that of 80 cigarettes, this addiction can be one of the hardest to break. We hope to educate parents and youth about the dangers before they even get started.”

The OCF is turning to professional rodeo competitors to serve as positive role models during a national campaign.

Cody Kiser is a professional bareback bronc rider from Reno, Nevada.  He was in Delta, Utah recently where he competed at the Millard County Fairgrounds. Kiser told parents at the rodeo that nearly 15 percent of high school boys in the United States use smokeless tobacco.

“My dad was a cowboy, so I know what it’s like looking up to cowboys as heroes for my whole life. Health and fitness have always been incredibly important to my family. My dad was a positive role model in my life growing up in that regard, and the idea of using spit tobacco never appealed to me,” Kiser said. “Right now, I’m pursuing rodeo as a passion of mine, and if at the same time I can do some good in the world and set the right example for young kids who might look up to me, then I’m honored and eager to do so.”

Kiser said cowboys have a reputation that is second only to baseball players for being users of tobacco in the world of sports.  He wants to change that reputation throughout the country and in Utah, where rodeo is popular.

“From my point of view, Utah seems to be on the front lines of health and fitness,” he said.  “I’ve been very impressed with Utah as far as a healthy lifestyle, people who don’t smoke and chew so it’s good to see in Utah that they don’t do that as much.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Smoking rates are down, but a different type of tobacco use is on the rise

Author: Anna Almendrala

First, the good news: Smoking rates are down significantly in 26 states. The bad news? The use of smokeless tobacco (also known as dip, snuff or chew) is up in four states, while using both cigarettes and smokeless tobacco is up significantly in five states.

“Although overall cigarette smoking prevalence has declined significantly in recent years in many states, the overall use of smokeless tobacco and concurrent cigarette and smokeless tobacco has remained unchanged in most states and increased in some states,” summed up researchers for the Centers for Disease Control, which published the data in their weekly Morbidity and Mortality report.

From 2011 to 2013, four states showed increased smokeless tobacco use: Louisiana, Montana, South Carolina and West Virginia. Only two states — Ohio and Tennessee — exhibited decreases. In terms of total use, Massachusetts and the District of Columbia reported the lowest numbers of smokeless tobacco, at 1.5 percent, in 2013. In contrast, West Virginia reported the highest use, at 9.4 percent, with Wyoming and Montana coming in second and third, at 8.8 percent and 8 percent, respectively.

Breaking down tobacco use by state helps health officials create more targeted state and local tobacco policies, explained CDC researcher Kimberly Nguyen in an email to HuffPost.

“It’s important to note that the states with lower tobacco use prevalence typically have more robust tobacco control programs and greater adoption of evidence-based population level interventions,” she wrote.



The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

In reality, smokeless tobacco is addictive because of the nicotine it contains, and it can cause oral, esophageal and pancreatic cancer, according to the NIH’s National Cancer Institute. It may also cause other diseases like gum disease, oral lesions and precancerous patches in the mouth called leukoplakia. In no way should it be considered an aid to help people quit smoking, notes the NCI.

“Smokeless tobacco use can also increase risks for early delivery and stillbirth when used during pregnancy, cause nicotine poisoning in children, and may increase the risk for death from heart disease and stroke,” Nguyen added. “Smokeless tobacco is not a safe alternative to smoking.”

The CDC researchers aren’t sure why smokeless tobacco use is going up, but the report notes a few possible reasons.

“These increases could be attributable to increases in marketing of smokeless tobacco, the misperception that smokeless tobacco is a safe alternative to cigarettes, and the lower price of smokeless tobacco products relative to cigarettes in most states,” wrote the researchers. “In addition, the tobacco industry has marketed smokeless tobacco as an alternative in areas where smoking is otherwise prohibited.”

Just last month, the Food & Drug Administration rejected tobacco producer Swedish Match AB’s request to remove cancer warnings from their smokeless tobacco product, Snus, and replace the warnings with the claim that it is safer than cigarettes. And last week, the FDA also rejected a petition from R.J. Reynolds Tobacco Company and American Snuff Company to similarly alter the labels on their smokeless products.

To combat rising rates of smokeless tobacco use, the CDC recommend that states increase their spending on anti-tobacco programs, which include increasing the price on products, restricting tobacco advertising, increasing anti-tobacco graphics and commercials, and helping users quit their addictions. Indeed, while states will bring in more than $25 billion in settlement payments and tobacco taxes in 2015, they’re also projected to spend less than two percent of that revenue on such programs — much less than the CDC-recommended levels for each state.

FDA Advisory Committee hesitates to endorse message of safe smokeless tobacco

Author: Shannon Firth

An FDA advisory panel were reluctant to recommend a gentler warning label for one brand of smokeless tobacco products at a committee hearing on Friday.


Swedish Match North America (SMNA), the first company to be considered for a modified risk tobacco designation by the FDA, is asking to replace a current label warning, “This product is not a safe alternative to cigarettes,” with this: “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

It also wants to drop warnings required for other smokeless tobacco products about oral cancers, tooth loss, and gum disease.

In a key vote, the eight-member FDA’s Tobacco Products Scientific Advisory Committee split 4-4 on whether the claim that snus offer a “substantially lower risk” claim relative to cigarettes is justified.

Many members said the health risks were lower for certain tobacco-related illnesses, but not for all health concerns. Those who disputed the claim argued that it could not be taken as a “global statement” — as there are known risks to pregnant women and uncertain risks for adolescents.

As for the proposed label change, the whole committee agreed that the sponsor’s statements would not suffice. Gary Giovino, PhD, chair of the department of Community Health and Health Behavior at the State University of New York at Buffalo, felt the statement was “dismissive of the health risks.” The word “but” in any sentence seems to negate the first half, he said.

Snus is a finely ground smokeless tobacco powder in a filter packet that is placed under the upper lip.

In his opening remarks on Thursday, Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products, said that in the past companies alone decided how to advertise their products — a practice which proved damaging to consumers’ health. “Now it’s the FDA who serves as the regulatory gatekeeper, standing between consumers and the companies seeking to make claims about their products.”

To meet the standards of a modified risk tobacco product, Zeller explained, “Applicants must not only demonstrate that the products, as actually used by consumers, will significantly reduce risks to individual users of those products; they must demonstrate that they will benefit the population as a whole – taking into account both users and non-users of tobacco products.”

In its application, Swedish Match has asked to revise the labels for 10 snus products. It would maintain its warning that smokeless tobacco is addictive.

Oral Safety Unproven
The committee was unmoved by the firm’s evidence related to gum disease and tooth loss and voted 8-0 against supporting a conclusion that snus products “do not pose a risk of gum diseases or tooth loss.”

Or as Thomas Novotny, MD, MPH, the graduate school of public health at the University of California San Diego State said, when explaining his vote, “It’s not causal relationships that we’re after, it’s perception of risk and the studies don’t rule that out.”

The committee’s vote was likely influenced by Scott Tomar, DMD, MPH, DrPH, of the department of Community Dentistry and Behavioral Science, at the University of Florida, who said that “advanced gingival recession can result in tooth loss.” One of the studies presented showed a relationship between gingival recession and snus use.

As to whether snus products also “do not pose risks of oral cancer” to consumers, the committee was split 3-3 with two abstentions.
“I think the data are tending towards no increased risk but I’m not quite ready to go there,” said Giovino, one of the abstainers.

Pebbles Fagan, PhD, MPH, associate professor and member of the Cancer Prevention and Control Program at the University of Hawaii, said that based on the absence of women in the larger cohort studies, she was not comfortable claiming that snus products posed no risk of oral cancer.

Can the ‘Swedish Experience’ Cross the Ocean?
Perhaps the most important questions the committee voted on was whether the proposed labeling change would help or harm consumers. Swedish Match threw the weight of its argument behind the “Swedish Experience,” a series of government, academic ,and industry studies showing a dramatic shift from cigarette smoking to snus in the mid-1990s. The firm argued that Swedish men reduced their risk of tobacco-related diseases.

But asked whether American tobacco users would likely follow suit — swapping cigarettes for snus — panel members were unconvinced.

Only one committee member said such a switch was likely, against six voting against and one abstention.

Richard O’Connor, PhD, associate professor of oncology at the Roswell Park Cancer Institute, in Buffalo New York, the lone panelist to agree that the experience in Sweden might translate to the U.S., said the data informed “a potential pattern in the U.S.”

Another subpopulation of obvious concern is adolescents. Timothy McAfee, PhD, MPH, director of the Office on Smoking and Health at the CDC, cited animals studies on tobacco addiction that showed “deleterious effects on adolescent brain development.”

On the plus side for Swedish Match, the majority of the committee felt it unlikely that nonusers of tobacco would pick up the snus habit, although three committee members abstained from this question because they did not believe there was enough data to support such a scenario.

Lars-Erik Rutqvist, the senior vice president of scientific affairs at Swedish Match said the company was pleased with the discussion at the hearing. “On the whole they seemed to accept the fact that there is a considerable risk reduction in our products and of course that’s very important. It’s part of the definition of a modified risk product.” Rutqvist added that he would expect to continue discussions with the FDA while awaiting their decision this summer.

“I look forward to the path forward for us.”

The FDA is not required to follow the advice of its advisory committee but it usually does.

April, 2015|Oral Cancer News|