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November 17th, 2015:

Understanding the stakeholders’ intention to use economicdecision-support tools

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E-Cigarettes Gaining in Popularity

The use of e-cigarettes have surpassed the use of conventional cigarettes among young people in the United States.

Mitch Zeller, director of the Center for Tobacco Products at the FDA, called those numbers “astounding and concerning” in an interview earlier this year.

“Nicotine is very harmful to the developing child and adolescent brain,” Zeller said. “Parents should take no comfort in the fact that their kids are using an e-cigarette rather than a burning cigarette because of the presence of nicotine.”

Thousands of Students Studied

More than 45,000 students in Hong Kong participated in the study. Data was collected between 2012 and 2013.

Of the sample population, 1.1 percent of students reported e-cigarette use within the past 30 days. Those students were 30 percent more likely than their peers to report respiratory problems.

The results are suggestive but not definitive. Dr. Norman H. Edelman, senior consultant for scientific affairs for the American Lung Association, found the study intriguing.

“It’s important [but] we need to know if the lungs are injured. It’s not clear if this really affects the lungs. We’re not sure what the symptoms are,” Edelman told Healthline.

He wondered if the young subjects were reporting soreness in their throats, excessive coughing, or difficulty breathing. He would like to see a follow-up study, perhaps in the United States.

We don’t know what the negative effects are. This is just a beginning.
Dr. Norman H. Edelman, American Lung Association
“We need to do lung function tests,” he said.

“Whenever you breathe in something, you don’t know what’s in it. Some of the data suggest irritation,” Edelman said. “We don’t know what the negative effects are. This is just a beginning.”

E-cigarettes and vaporizers use liquids that have varying amounts of nicotine or none at all. These liquids are not regulated by the U.S. Food and Drug Administration (FDA), but generally also contain propylene glycol, a suspected lung irritant, and vegetable glycerin.

“While supporters [of e-cigarette use] are optimistic about the potential for harm reduction in the minority of established cigarette smokers, [for] which convincing evidence is lacking, this does not seem to justify the potential harm of renormalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority of non-smoking young people,” Edelman said.

Teen E-Cigarette Use Linked to Breathing Problems

A study of adolescents in Hong Kong found respiratory issues were 30 percent more likely in vapers than non-vapers.

E-cigarettes and vaporizers, widely touted as a way to quit smoking, remain controversial. For every supporter who sees them as useful, there is a health expert suggesting that these products are dangerous in their own way.

A new study out of Hong Kong is not likely to settle the issue any time soon.

Researchers looked at the respiratory health of Chinese adolescents, both those who use e-cigarettes and those who do not. The results, published in JAMA Pediatrics, have raised concerns about the impact of e-cigarettes on the health of minors.

Indeed, one of the authors of the study, Daniel Ho, Ph.D., of the University of Hong Kong, said in a press release, “E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time.”

Ho is an associate professor in the School of Public Health whose main research interests are in adolescent health in relation to tobacco, alcohol, and obesity.

He and fellow researchers found that adolescents who use e-cigarettes were approximately 30 percent more likely to report respiratory symptoms than adolescents who do not use them.

The Troubling History of Big Tobacco’s Cozy Ties With Black Leaders

And the reason one of the community’s biggest killers is rarely discussed.

Images courtesy of Stanford University's archive of tobacco advertising

Images courtesy of Stanford University’s archive of tobacco advertising

It’s hardly surprising that a tobacco company would donate more money to Republican politicians than to Democrats, who are generally more amenable than GOPers to taxes and regulation. North Carolina’s Lorillard Tobacco, for instance, gave nearly four times as much cash to Republican candidates during the 2014 congressional election cycle. But the company made a striking exception for one particular subset of Democrats: African Americans.

Lorillard Tobacco, which produces Newport cigarettes, gave money to more than half of Congress’ black Democrats but just 1 in 38 nonblack Democrats.

Our analysis of records from the Center for Responsive Politics revealed that half of all black members of Congress received financial support from Lorillard, as opposed to just one in 38 nonblack Democrats. To put it another way, black lawmakers—all but one of whom are Democrats—were 19 times as likely as nonblack Democrats to get a donation.

It’s not hard to see why Lorillard might employ this strategy. Federal officials are now considering whether to add menthol, the minty, throat-numbing additive—to the list of flavorings Congress banned from cigarettes in 2009 for public health reasons. Lorillard’s Newport is the nation’s top-selling menthol brand, accounting for billions in annual sales. And who most favors menthols? Black smokers, by a wide margin.

For decades, in fact, the tobacco industry has maintained what amounts to an informal mutual-aid pact with certain black organizations. Over the years, cigarette makers have donated generously to members of the Congressional Black Caucus, and to its affiliate, the Congressional Black Caucus Foundation—not to mention the National Urban League, the NAACP, the United Negro College Fund, and many smaller African American groups.

In return, some of these groups have helped the industry fight anti-smoking measures. Others, public health advocates say, have turned a blind eye to the harms tobacco imposes on the black community.

According to one study, menthols were the choice of 88 percent of black smokers—and 57 percent of smokers under 18.

Menthols account for about 30 percent of cigarette sales in the United States, but according to a study cited by the federal Centers for Disease Control and Prevention (CDC) based on data from 2008 through 2010, menthols were the choice of 88 percent of black smokers—and 57 percent of smokers under 18.

The Family Smoking Prevention and Tobacco Control Act, the landmark 2009 law that authorized the FDA to regulate tobacco products, included a ban on candy, fruit, and spice flavorings because of their appeal to young smokers. But during the political negotiations that preceded the deal, menthol was given a pass. In July 2013, after years of complaints from the public health community, the agency put out a call for comments on whether menthol should be added to the list.

Several other countries have banned menthol in recent years, or imposed deadlines for eliminating it, but not been a peep has been heard from the FDA since it asked the public to weigh in more than two years ago. This past June, in a display of confidence, Reynolds American Inc.—the conglomerate that owns RJ Reynolds Tobacco Co.—completed a merger with Lorillard, paying more than $27 billion for a company that depended on menthols for roughly 85 percent of sales.


The FDA’s menthol limbo is part of a pattern, public health advocates say: The agency has been all but paralyzed by caution and—when it has tried to act—by legal challenges from the industry. In January 2010, the FDA lost a lawsuit from manufacturers opposed to its plan to regulate e-cigarettes as drug-delivery devices, but it has yet to complete the rulemaking process that would extend its oversight of ordinary tobacco products to cigars and e-cigarettes, which are increasingly popular among teenagers. In November 2011, the industry again blocked the FDA in court after the agency tried to require graphic warning labels on cigarette packs—similar to those used in at least 75 countries.

Observers say banning menthol will be impossible without strong support from African American leaders.

The menthol delay is “inexcusable,” says Joelle Lester, a staff attorney with the Public Health Law Center in St. Paul, Minnesota. “Prohibiting menthol in tobacco products should be a very high priority.” (Agency officials declined to be interviewed. A spokesman noted in an email that the FDA “is continuing to consider regulatory options related to menthol.”)

Getting rid of menthol would be politically difficult under any circumstances, but observers say it will be impossible without strong support from African American leaders. And despite support for a ban from some black public-health advocates, the community’s leadership organizations and politicians have been largely silent. Some of the smaller groups that have accepted tobacco money over the years—including the National Black Chamber of Commerce, the Congress of Racial Equality, the National Organization of Black Law Enforcement Executives (NOBLE), and the National Black Police Association (NBPA)—are actively opposed to a ban, claiming that it would trigger an illicit trade in menthol cigarettes. This, they argue, would result in lost tax revenues, higher law enforcement costs, and widespread arrests in the black community.


The NBPA launched a write-in campaign that resulted in more than 36,000 comments opposing a ban, according to an FDA document (PDF). And while that group did not respond to interview requests, John Dixon, a past president of NOBLE and the police chief in Petersburg, Virginia, told me he thought a menthol ban “would probably have an adverse effect on the minority community,” adding that “prohibitions cause a whole other host of problems,” including a “burden on law enforcement.” NOBLE currently lists RAI Services Co.—part of Reynolds American—as one of its financial backers. But this “would not have any influence, one way or another,” on the group’s positions, Dixon insists.

The relationship between Big Tobacco and black groups “is complicated,” notes Delmonte Jefferson, executive director of the National African American Tobacco Prevention Network, a CDC-funded nonprofit. In recent years, minority groups have attracted a wider range of corporate sponsors, making tobacco money less important. But “there was a long time that it was only the tobacco industry that would support” some of them, Jefferson said. “To do an abrupt turn against the same companies—that’s kind of hard for them to do.”

Tobacco is the black community’s leading preventable cause of death, with its related illnesses killing about 47,000 African Americans each year.

While smoking rates for black and white adults are comparable, blacks have disproportionately higher death rates from tobacco-related ailments, including various cancers and cardiovascular and respiratory diseases. About 47,000 African Americans die annually from smoking-related illnesses, the CDC reports, making tobacco the black community’s greatest preventable cause of death.

Menthols do not appear to be any more toxic per se than regular cigarettes. “A menthol cigarette is just another cigarette and should be regulated no differently,” David Howard, a spokesman for Reynolds American, writes in an email. But health authorities view menthols as a starter product. saying that menthol’s anesthetizing effects help beginners tolerate the harshness of tobacco smoke, making them more likely to become addicted to nicotine.

“Menthol has no redeeming value other than to make the poison go down more easily,” notes a report in the American Journal of Public Health. Some research also suggests that menthol smokers are more nicotine-dependent and have more trouble quitting. It is “likely that menthol cigarettes pose a public health risk above that seen with non-menthol cigarettes,” states a 2013 FDA report. The industry disputes this. “The best available scientific evidence,” the Reynolds spokesman claims, “demonstrates that menthol cigarettes do not cause people to start smoking earlier, smoke more cigarettes…or make smokers more addicted than non-menthol cigarette smokers.”


In any case, Big Tobacco has worked hard to befriend the black community. Early on, cigarette makers touted menthols as good for smokers with a cough or cold, and “African Americans became attached to the notion” that menthols were safer, according to public health activist and researcher Phillip S. Gardiner. The companies reinforced the popularity of Kool and other brands by sponsoring cultural events and pouring marketing dollars into black media and neighborhoods—all part of what Gardiner calls “the African Americanization of menthol cigarette use.”

The industry’s hiring practices were also quite progressive for their time. During the 1950s, the White Sentinel, a white supremacist publication, urged a boycott of Philip Morris for having “the worst race-mixing record of any large company in the nation.” Philip Morris “was first in the tobacco industry to hire Negroes instead of Whites for executive and sales positions,” the publication lamented, and “the first cigarette company to advertise in the Negro press.”

Philip Morris led the way in making tobacco companies charitable pillars of black cultural, educational, and political organizations.

Indeed, Philip Morris—America’s top cigarette maker and part of Altria Group—led the way in making tobacco companies charitable pillars of black cultural, educational, and political organizations. In 1987, for instance, the company donated $2.4 million to more than 180 black, Latino, and women’s organizations and their local chapters.

That same year, the National Black Monitor, a now-defunct magazine, published an article ghost-written by an official from RJ Reynolds—a tobacco company that funded journalism scholarships for African American students and in 1985 was named advertiser of the year by a black newspaper publishers group. The article compared the treatment of tobacco companies to that of oppressed blacks. While racial minorities no longer face “the systematized injustice they once did,” the writer argued, “relentless discrimination still rages unabashedly on a cross-country scope against another group of targets—the tobacco industry and 50 million private citizens who smoke.”


At the NAACP’s annual convention in 2009, two delegates from the group’s Berkeley, California, branch tried to convince the organization to take a stand against Big Tobacco. The two, Valerie Yerger, then an assistant professor of health policy at UC-San Francisco, and Carol McGruder, co-chair of the African American Tobacco Control Leadership Council, tried to introduce a resolution that called on NAACP leadership to make tobacco control “a national priority” and push for a menthol ban.

The measure hadn’t been vetted by the NAACP’s resolutions committee, as was customary, and the women’s request to introduce it on an emergency basis was not well received. The late Julian Bond, then the group’s chairman, “was not going to have any conversation with us about this,” Yerger recalls. “He was in our face yelling at us, okay? I was determined not to cry, but this was, like, a hero that I grew up with,” she adds. “As a young black kid, you grow up knowing who the hell Julian Bond is.” McGruder doesn’t recall Bond yelling, but “he wasn’t happy about it and he wasn’t going to entertain it,” she says.

The flow of tobacco money to minority groups seems to have ebbed in recent years. But the industry “still has a pretty heavy influence financially,” says Jefferson of the National African American Tobacco Prevention Network. Last year, for instance, Altria gave $1 million to Smithsonian’s National Museum of African American History and Culture.

“How can you talk about health equity,” asks a black anti-tobacco activist, “when you are sponsored by a killer of public health?”

During the 2013-14 election cycle, tobacco companies donated $115,650 to black lawmakers and their affiliated PACs, according to the Center for Responsive Politics. Lorillard was the most generous, distributing $56,500 to 23 black members (there are 46 total) and their PACs. The Black Caucus chair, North Carolina Rep. GK Butterfield, got $5,000 from Lorillard. Rep. Sanford Bishop of Georgia got $10,000. South Carolina Rep. James Clyburn received only $2,000, but his BRIDGE PAC took in $5,000 from Lorillard and $10,000 from Altria.

Shuanise Washington is president and CEO of the Congressional Black Caucus Foundation, which sponsors leadership training, awards scholarships, and hosts an annual legislative conference attended by thousands.

Washington, who declined to comment for this story, was also a past vice president for Altria, which gave the CBCF between $100,000 and $249,000 in both 2013 and 2014, according to the foundation’s website. In addition, Reynolds American is listed as having contributed between $5,000 and $15,000, and Altria was a corporate partner at the legislative conference in September. “How can you talk about health equity,” asks anti-tobacco activist Jefferson, “when you are sponsored by a killer of public health?” (An Altria spokesman said the company’s gifts to the foundation mainly support fellowship and internship programs, reflecting Altria’s “long history of focusing on diversity and inclusion.”)

Lorillard also gave a small donation to Rep. Robin Kelly of Illinois, who heads a panel called the Congressional Black Caucus Health Braintrust. At the caucus foundation’s legislative conference, the panel issued a 144-page report on the health problems afflicting minority citizens. It included entire sections on childhood obesity, nutrition, HIV/AIDs, lupus, sleep disorders, oral health, and gun violence. Tobacco was barely mentioned.

The 2009 legislation that gave the FDA power to regulate tobacco products grew out of a deal between anti-smoking groups, members of Congress, and Philip Morris. But the menthol exception did not sit well with some black public health advocates. “How do you justify removing all of the flavorings which were minuscule in use but leave the No. 1 flavor product? It makes no sense at all,” said William S. Robinson, the former head of the National African American Tobacco Prevention Network, which withdrew its support for the bill in protest.

Seven former secretaries of Health and Human Services weighed in with an open letter to Congress. “Menthol should be banned so that it no longer serves as a product the tobacco companies can use to lure African American children,” it read. “We do everything we can to protect our children in America, especially our white children. It’s time to do the same for all children.”

“The history of African Americans in this country has been one of fighting against paternalistic limitations and for freedoms,” notes a Lorillard ad.

Lorillard, which donated $1 million to the International Civil Rights Center and Museum in its Greensboro hometown soon after, fought back via advertisements in black newspapers: “Some self-appointed activists have proposed a legislative ban on menthol cigarettes in a misguided effort to force people to quit smoking by limiting their choices,” one ad warned. “The history of African Americans in this country has been one of fighting against paternalistic limitations and for freedoms.”

Ultimately, Congress kicked the menthol can down the road. An amendment to the Tobacco Control Act called for the formation of a scientific advisory panel to study and report back to the FDA on the public health impact of menthol, “including use among children, African Americans, Hispanics, and other racial/ethnic minorities.”

The panel issued its report in 2011, concluding that “removal of menthol cigarettes from the marketplace would benefit public health in the United States.” The FDA, however, waited two more years before requesting public comments. Then, in July 2014, it suffered a legal setback. A federal judge ruled that the agency could not base any decisions on the advisory panel’s findings. The ruling emerged from a lawsuit by Reynolds and Lorillard claiming that the FDA had violated ethics laws by appointing experts who had conflicts of interest due to their previous anti-tobacco stands. The decision is under appeal. The FDA could have acted anyway, however, because its own staff had prepared a separate report that reached essentially the same conclusions as the panelists had. But for reasons agency officials won’t discuss, nothing has happened since.

Some activists have simply given up on the feds and moved on to local campaigns. In December 2013, for instance, the Chicago City Council passed an ordinance barring the sale of flavored tobacco products, including menthol cigarettes, cigars, and e-cigarettes, within 500 feet of schools. In Berkeley, Calfornia, a ban on the sale of menthol and other flavored tobacco products (including e-cigarettes) within 600 feet of schools will take effect in 2017.

Similar legislation has been proposed in Baltimore. “I’m not expecting anything” from the FDA, says Carol McGruder, one of the anti-smoking activists rebuffed by the NAACP. “I don’t think that they have the guts.”

This story was reported by, a nonprofit investigative news organization focused on public health, safety, and environmental issues.

San Francisco Considers Raising Age For Buying Tobacco To 21

The city of New York has done it. So has the state of Hawaii.

Now, San Francisco will consider a measure to raise the legal age to buy tobacco from 18 to 21.

According to a report from the Institute of Medicine, raising the legal age to buy tobacco would significantly reduce the number of young people who start smoking. The report says in time, that would reduce smoking-related deaths.

Debra Kelley, the American Lung Association’s advocacy director in San Diego and Imperial counties, said most adult smokers pick up the habit before they’re 21.

“That’s when the tobacco industry can basically turn an experimental smoker into an addicted smoker,” Kelley said. “It really occurs during that 18- to 21-year-old time frame.”

Kelley added enforcing a higher legal age to purchase tobacco would be up to retailers.

Earlier this year, California lawmakers rejected a bill that would have raised the legal age to buy tobacco statewide.

Wiener introduces legislation to raise tobacco purchasing age in SF

SAN FRANCISCO (BCN) – San Francisco Supervisor Scott Wiener Tuesday introduced legislation that would raise the purchasing age for tobacco from 18 to 21.

The legislation, co-sponsored by supervisors Eric Mar and Malia Cohen, follows similar moves by New York City, Santa Clara County, the City of Healdsburg and the state of Hawaii, among others. The City of Berkeley, which recently placed new restrictions on the sale of tobacco products near schools, is also considering raising the purchasing age.

“By raising the tobacco purchase age to 21, we can reduce adolescent tobacco use, which will help combat addiction, stop long-term illness and prevent premature deaths,” Wiener said Tuesday. “For decades we have seen the catastrophic health effects of tobacco use, and every day we spend millions of dollars treating people who suffer from an addiction which often starts in their teens.”

A study released by the Institute of Medicine earlier this year found that increasing the tobacco purchasing age from 18 to 21 would decrease national smoking rates by 12 percent and reduce youth initiation of smoking by 25 percent. The study also found it would result in reductions in preterm births, low birth weight babies and sudden infant death syndrome.

A 2009 study released by the University of California at San Francisco estimated the health care costs of smoking in San Francisco alone at around $380 million.

Philip Morris, Imperial Tobacco products likely to vanish

The tobacco products of retailers Philip Morris and Imperial Tobacco are expected to disappear from shelves soon as the two companyʼs did not agree with Hungary’s centralized tobacco distributor, which begins operations today, Hungarian online daily reported.

After a bill approved by Hungarian Parliament mid-December on the establishment of a centralized distribution company for tobacco products, the concession was reported to have been awarded to British American Tobacco (BAT) and Hungary’s Tabán Trafik. The two companies will act together as middlemen between manufacturers and retailers for the next few years.

Imperial Tobacco Magyarország Kft., JTI Hungary Zrt. and Philip Morris Magyarország Kft. have said the concession was not awarded fairly. They said in a press release in mid-June that they were jointly offering a concession of HUF 6 bln to operate a competition-free tobacco product distribution system that would create 500 jobs, while BAT and Tabán are expected to pay HUF 600 mln to the state for the concession.

According to, the products are expected to disappear from store shelves temporarily, as Philip Morris and Imperial Tobacco are hoping that the European Commission will declare Hungaryʼs centralized tobacco distribution system unlawful, thereby cancelling the new system, and restoring the old one.

However, the Ministry of National Development rejected their unsolicited tender application for the concession of a centralized tobacco distribution system, saying the tender did “not complying with legal requirements”, according to the ministry. “The bid is based on proper calculations, it is deliberate and economically substantial. We still stand by this offer expecting that the Ministry reconsiders it”, the three companies said, adding that they were open to negotiations.

Lajos Csizmadia, the spokesperson of the tobacco workers union (DDTSZ) told the Budapest Business Journal earlier that the new system is likely to cause the dismissal of 1,200 Hungarians who work in the industry.