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About 1 in 5 U.S. adults consume tobacco products, federal agencies say

Independent Tribune - 11/13/2017

Twenty percent of adult Americans, or nearly 49 million, used some form of tobacco product in 2015, federal health care officials said last week.

However, the report from the Centers for Disease Control and Prevention and Food and Drug Administration also stirred again the public-health debate of what is a tobacco product, particularly when it comes to electronic cigarettes and vaporizers.

The federal agencies said the report reflects the first time it has used the annual National Health Interview survey to assess the range of different tobacco products used by adults. The survey has been used to measure adult consumption of cigarettes since 1965.

The agencies found that 87 percent of U.S. adult tobacco consumers, or 42 million, used a combustible product, such as cigarettes, cigars, hookahs and water pipes.

Combustible products are linked with higher health risk to consumers because burning tobacco releases carcinogens.

The other 7 million adults used e-cigs, vaporizers or smokeless tobacco products, such as chewing tobacco, snuff, dip, snus and dissolvable tobacco.

Several anti-smoking advocates and researchers claims that e-cigs and vaporizers should not be considered as tobacco products because they contain liquid nicotine.

Gregory Conley, president of American Vaping Association, said that even under the regulatory averse Trump administration, "the CDC has remained stubbornly unwilling to rethink the way it views nicotine and tobacco issues.

"The CDC is well aware that federal health data shows that great numbers of adults have used vapor products to quit smoking.

"Nonetheless, the agency continues to push out press releases portraying any use of tobacco - even smokefree nicotine when used by an adult smoker as part of a harm reduction strategy - as a public health hazard worthy of a dire warning from the nation's leading public health institute."

The national smoking rate for adults was 17.1 percent in 2016, compared with 17.9 percent in North Carolina, or 1.41 million out of 7.9 million, according to data from N.C. State Center for Health Statistics.

"Too many Americans are harmed by cigarette smoking, which is the nation's leading preventable cause of death and disease," Dr. Brenda Fitzgerald, the CDC's director, said in a statement.

The agencies' report determined that 9.5 million U.S. adults use one or more tobacco products on a daily or "some day" basis, led by cigarettes, e-cigs and cigars.

Males, at 25.2 percent of U.S. adults, are more likely to use a tobacco product than women at 15.4 percent.

The most common age category for tobacco use is ages 25 to 44 at 23.3 percent of the population.

Despite the Southeast, in particular North Carolina, Virginia and Kentucky, being considered as the nation's primary tobacco region, adults in the Midwest were the most likely to use tobacco products.

Other determinations include higher tobacco use among people with a General Equivalency Diploma; people with annual household incomes under $35,000; adults uninsured or insured through Medicaid; people with a disability; and those who are lesbian, gay or bisexual.

The FDA announced July 28 plans for a sweeping regulatory "road map" on tobacco and nicotine product that Commissioner Dr. Scott Gottlieb called "an all or nothing" approach.

Among the proposals are: lowering the nicotine level in traditional cigarettes to non-addictive levels, and limiting or eliminating flavorings, such as menthol in traditional cigarettes and candy and fruits in e-cigs and vaporizers, that the agency says appeal to youths.

"These results make clear that more action is needed to reduce the disease and death caused by cigarette use - and the FDA has announced a comprehensive approach to do just that," Gottlieb said in a statement.

"This will be coupled with efforts to encourage innovation of potentially less harmful products, including electronic nicotine delivery systems."

Some studies, including one by the Royal College of Physicians, have claimed e-cigs and vaporizers are up to 95 percent less harmful than traditional cigarettes.

The Royal College's study on traditional cigarettes played a key role in the landmark 1964 surgeon general's determination.

Meanwhile, then-U.S. surgeon general Dr. Vivek Murthy sounded an alarm Dec. 8 about e-cigs, saying there's no safe use of the products for people younger than 25.

David Sweanor, an adjunct law professor at the University of Ottawa and the author of several e-cig studies, said it was key that Gottlieb focused on "continuum of risk, encouraging innovation, backing off from onerous requirements on alternatives to cigarettes."

"This is a huge switch from the tobacco-free world/abstinence-only/quit or die approach to tobacco and nicotine by U.S. government agencies. It will now be very hard for instance, for the Centers for Disease Control and Prevention, to continue engaging in misinformation campaigns on relative risks."

Dr. John Spangler, professor of family and community medicine at Wake Forest Baptist Medical Center, said it would have been helpful to have more data on adults who consumed two or more forms of tobacco.

"If electronic cigarettes will be used as one national approach to help smokers quit, the proportion of current smokers who dually use electronic cigarettes would be very helpful to know," Spangler said.


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