Michael Yudell, PhD, MPH, Associate Professor, Drexel University School of Public Health
Last month's announcement by CVS/Pharmacy that it would “stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide by October 1, 2014” has focused attention on the role that retail outlets play in their sale. If other major retailers were to follow CVS/Pharmacy’s lead, perhaps we could push already declining rates of tobacco use even lower (currently, fewer than 1 in 5 Americans smoke cigarettes).
In the wake of the CVS move, to put pressure on other tobacco-selling retailers, 26 prominent health groups have issued an open letter, calling on drug stores and other retailers to stop selling tobacco products. Recent studies have shown that reasons for the voluntary abandonment of tobacco sales are complex: retailers identified the obvious relationship between tobacco use and disease and death, regulatory pressures, an enhanced image, and already declining tobacco sales among the drivers of change. In their 2011 study published in BMC Public Health, Patricia McDaniel and Ruth Malone, highlight the importance of such changes, writing that “voluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco…”
Let’s hope that ongoing pressure on tobacco-selling retailers can continue to transform social norms around tobacco’s sale and use.
By Jim Buehler, professor of health management and policy, Drexel University
It’s been hard to avoid stories in the news about “electronic cigarettes”—battery-powered devices that in many cases look like regular cigarettes but instead deliver a vaporized mix of nicotine, flavor additives, and traces of the chemicals left over from extracting nicotine from tobacco. Much of the attention to e-cigarettes arises from debates about whether their manufacture, marketing, sales, and use should be subject to the same federal, state, and local regulations and restrictions as those that govern other tobacco products.Depending on your attitudes towards smoking, government health regulations, and your source of news, you might believe that e-cigarettes are:
- A way for smokers to satisfy their appetite for nicotine while avoiding the hazards of tobacco smoke;
- A socially acceptable alternative to smoking (they emit water vapor, not smoke) that should be permitted in public;
- An alternative to nicotine patches or gum that can help smokers quit or reduce their dependence on nicotine (by turning them into “vapers”);
- A way for “big tobacco” to bypass tobacco regulations, offset financial losses resulting from reductions in smoking, and lure a new generation into nicotine addiction;
- A threat to decades of progress in reducing tobacco use;
- Something that health advocates should endorse as a safer alternative to smoking—a “harm reduction” program, like those that provide clean needles and syringes to drug users to reduce exposures to HIV and other infections;
- A product with undocumented benefits and risks;
- Some combination of the above.
While public health advocates are universally committed to reducing smoking, their reaction to the emergence of e-cigarettes has been mixed. Some have called for an outright ban on e-cigarettes until studies have been conducted to document their risks and benefits—a policy that is unlikely to be enacted. Many view e-cigarettes through the same lens as regular cigarettes, remain deeply distrustful of the tobacco industry given its well-documented legacy of concealing information about the risks of smoking, and advocate strong regulations that would limit advertising and make it difficult for teens to purchase e-cigarettes. This position is embodied in statements like one by Erika Seward of the American Lung Association, who was quoted by ABC News as saying, “With e-cigarettes, we see a new product within the same industry—tobacco—using the same old tactics to glamorize their products. They use candy and fruit flavors to hook kids.” Other health advocates view e cigarettes through the “harm reduction” lens and favor regulation of e-cigarettes as “drug delivery devices.” For smokers who are unable or unwilling to abandon their nicotine addiction, this group argues that, despite unknowns about the consequences of inhaling e-cigarette vapors, using e-cigarettes must be less dangerous than inhaling tobacco smoke. Both positions - a ban and regulation as a drug delivery device - are vehemently opposed by e-cigarette-makers.
The e-cigarette industry strongly denies that it markets its products to young people, arguing that there are plenty of adult smokers to convert to their product. Regardless, a growing number of teens are giving them a try. A recent report from the Centers for Disease Control and Prevention (CDC) notes that the percentage of high school students who have tried e-cigarettes doubled from 4.7% in 2010 to 10% in 2012. CDC estimates that there are nearly 1.8 million middle and high-school students who have used e-cigarettes, including 160,000 who have never used regular cigarettes, raising a “serious concern” because of the “negative impact of nicotine on adolescent brain development, as well as the risk for nicotine addiction.” We know that most adult smokers started as teens, but we don’t know yet if the growing number of teens who are trying e-cigarettes will remain e-cigarette users, quit using any form of nicotine, or be drawn into smoking for the first time.
Kudos to CVS/Pharmacy for joining the fight against smoking.
Earlier this week the retail giant announced that it would “stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide by October 1, 2014.” The decision comes as CVS/Pharmacy moves towards expanding its miniclinics and providing more health care advice from its pharmacists and nurse practitioners. For CVS, selling tobacco and being a health care company cannot go hand in hand.
Though we should applaud the move, we should also not forget, as one appropriately cynical voice on a tobacco control list serve pointed out, that we are cheering such progress 50 years after the 1964 Surgeon General’s report on the ill health effects of smoking.
Janet Golden, professor of history, Rutgers University-Camden
Pennsylvania is one of 11 states that subsidized 93 percent of recent top-grossing movies featuring characters who smoke, according to researchers at the University of California, San Francisco–and one of seven states that gave more money to those movies than it spent on tobacco prevention.
According to an ad placed in State Legislatures magazine by SmokeFreeMovies, a project of UCSF professor Stanton Glantz, Pennsylvania subsidized production of 24 movies between 2008 and 2012, of which 16 included smoking. It says the industry got $18 million a year in subsidies from the commonwealth for movies that included smoking, and spent $14 million in 2012 on smoking prevention.
“Seven states are now spending more subsidizing movies that promote smoking to kids than they are spending fighting smoking,” writes Glantz, director of UCSF’s Center for Tobacco Control Research and Education, in a new post on his blog.
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A new ranking of the top 30 public health blogs places The Public's Health at No. 14. The complete list is below. Lots of interesting stuff.
And if you want to go beyond reading about public health, join us at 6 p.m. Friday for “Blogging and Beer: Public Health in Philadelphia.” Also with us will be our editor at the Inquirer, public health writer Don Sapatkin, and some of our regular contributors. There is no cover charge for what we hope will be a lively discussion at Rembrandt’s Restaurant in Fairmount, one of several health offerings at the Philadelphia Science Festival that we mentioned last week.
Best Public Health Blogs
Jon Kole is in his fourth and final year of a combined MD and Masters of Medical Ethics program at the University of Pennsylvania.
By Jon Kole
What do Cleveland Clinic, the World Health Organization, and Geisinger Health System in central Pennsylvania have in common? They all reject new job applicants who use cigars, cigarettes or other tobacco products. And here in Philadelphia the University of Pennsylvania Health System recently announced that it too, effective July 1, “will cease hiring tobacco users in our efforts to improve the overall health of our workforce while reducing health care benefit costs.”
By Jonathan Purtle
Earlier this month, Pennsylvania State Sen. Daylin Leach (D., Montgomery-Delaware) announced plans to introduce a bill that would legalize marijuana — not just for medical purposes, as New Jersey recently did, but also for recreational use. The substance would be regulated by the state in a way similar to alcohol and tobacco. As Leach describes on his website, the bill is founded on the idea that marijuana is no more harmful, and less addictive (this is debatable), than both these substances and that the financial costs of keeping marijuana illegal are enormous. Citing data from the White House Office of National Drug Control Policy, Leach points out that 24,685 marijuana arrests were made in Pennsylvania in 2006 — translating into $325 million in criminal justice costs.
Leach’s proposal follows referendums in Colorado and Washington that recently gave those states the green light for recreational marijuana use. And while the Pennsylvania bill will likely go up in smoke — Gov. Corbett has vowed to veto the bill if it reaches his desk — it seems high time to explore the potential pros and cons of legalizing marijuana from a public health perspective.
By Nan Feyler
Exposure to secondhand smoke is dangerous, especially to infants and children. Secondhand smoke can impact children’s lung growth and pulmonary functions. It can cause sudden infant death syndrome (SIDS), respiratory illnesses, ear infections and more frequent and severe asthma attacks.