The gateway drug theory and many other ideas about drug use have been put into question in recent years as more resources are dedicated to understanding substance use, which has been highly stigmatized for decades. After initially labeling cannabis as a gateway drug in 2010, President Joe Biden even later walked back his stance, saying in 2019: “I don’t think it is a gateway drug. There’s no evidence I’ve seen to suggest that.”

The roots of substance use disorder are complex and not fully understood, but one of the hallmarks of addiction is understood to be caused by repeated drug use that neurologically changes the brain. Because the use of one substance like alcohol or nicotine is associated with the use of other drugs like cannabis, many have drawn causal links between the use of various drugs in theories like the gateway drug hypothesis. However, this idea has been highly debated, and as the understanding of substance use has improved, scientists began to understand that people may have a “common liability” to substances in general and that drug use is influenced by a host of factors.

A new study published late December analyzed brain scans of adolescents before and after they first tried alcohol, nicotine or cannabis, shedding light on one factor that could be influencing whether people decide to start using drugs. Writing in JAMA Network Open, Dr. Alex Miller, the study’s lead author and an assistant professor of psychiatry at Indiana University School of Medicine, and his team found that adolescents who initiated substance use had differences in certain brain structures compared to kids who didn’t use drugs. Importantly, most differences existed before they started using alcohol, nicotine or cannabis.

“The study sort of helps us highlight which regions may be important to further explore, with respect to their association as pre-existing risk factors for substance use initiation,” Miller told Salon in a phone interview. 

Structural brain differences have been previously found in people who use drugs and were assumed to be effects of drug use, said Dr. Jonathan Foulds, a professor of public health sciences at Penn State College of Medicine who was not involved in the study. This study shows certain differences were there among adolescents who used substances prior to use, meaning they could not have been caused by the substance use, he said.

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“Our behavior is determined basically by our brain and our experience, and our experience can affect our brain as well,” Foulds told Salon in a phone interview. This study "casts doubt on some of the prior gateway theories because it seems like many of the same brain differences that are a risk factor for nicotine use are also a risk factor for alcohol and cannabis use.”

The differences observed in the study were small but statistically significant within a large sample size close to 10,000 participants, Miller said. Specifically, those who initiated these substances before age 15 had larger overall brains and a thinner prefrontal cortex in certain regions compared to kids who didn’t initiate drug use. The prefrontal cortex is responsible for things like decision making and information processing, and some research has found that a thinner prefrontal cortex is associated with more impulsive behavior and risky decision making, which could be linked to kids initiating substance use, Miller said. 

On the other hand, some of the measures observed in this study went in the opposite direction to what is observed in brain scans of people who have substance use disorder. For example, heavy drug use has been linked to smaller overall brain sizes, and heavy cannabis consumption has been linked to smaller hippocampal volumes. In this study, substance use was linked to larger overall brain sizes and larger hippocampal volumes.

Importantly, this doesn’t mean that children with these differences in anatomy will inevitably go on to try drugs, said Dr. Bertha Madras, a psychobiology professor at Harvard Medical School, who was not involved with the study either. There are dozens of risk factors that influence whether kids use drugs, including genetics, accessibility to substances, and the prenatal environment. 

It may be that some other factor is influencing the anatomical differences and drug use, like a predisposition to risky behaviors or teens’ perception of how harmful substance use is, Madras.

“Integrating the whole picture would give us a much better view of what the risk factors for using drugs are and what the risk factors that are consequent to drug use are,” Madras told Salon in a phone interview.

This analysis uses data from the Adolescent Brain Cognitive Development Study, which was designed to follow a large group of children over many years to help determine the neurological origins and consequences of substance use. Miller said he plans to use the data to try and tease out what is behind these brain differences and whether they are due to genetics or potential environmental risk factors. 

In October, another study using the ABCD dataset found that certain brain activity in childhood could predict substance use initiation and that this was associated with children’s exposure to pollution.

“Understanding the complex interplay between the factors that contribute and that protect against drug use is crucial for informing effective prevention interventions and providing support for those who may be most vulnerable,” said Dr. Nora Volkow, the director of the National Institute on Drug Abuse in a press release.

The post Massive study of adolescent brains puts “gateway drug” theory into question appeared first on Salon.com.

The estimated shortened life expectancy is more than what researchers first predicted in 2000, when they found that a cigarette can shorten a smoker's life expectancy by an average of 11 minutes. The data published in Addiction follow up on the 2000 study published in BMJ. It draws from data from the British Doctors Study, which started in 1951 as one of the largest studies looking at the effects of smoking. It also pulls from data from the Million Women Study.

“With smoking, it doesn’t eat into the later period of your life that tends to be lived in poorer health. Rather, it seems to erode some relatively healthier section in the middle of life,” Dr. Sarah Jackson, a principal research fellow in the UCL Alcohol and Tobacco Research Group and lead author of the paper, told CNN. “So when we’re talking about loss of life expectancy, life expectancy would tend to be lived in relatively good health.”

Notably, the study found that when people quit smoking earlier in life they have the same life expectancy as people who have never smoked. However, when people quit later in life, it’s harder for them to regain the time lost to smoking. 

“But as you get older, you progressively lose a little bit more that you then can’t regain by quitting,” Jackson said. “But no matter how old you are when you quit, you will always have a longer life expectancy than if you had continued to smoke. So, in effect, while you may not be reversing the life lost already, you’re preventing further loss of life expectancy.”

While smoking rates have declined over the 2000s, it remains the leading cause of preventable disease and death in the United States. In 2022, the CDC estimated 28.8 million of U.S. adults smoked cigarettes. 

The post New study finds smoking shortens life expectancy by an average of 20 minutes per cigarette appeared first on Salon.com.

The "Twin Peaks" and "Mulholland Drive" filmmaker told Sight and Sound Magazine, “I’ve gotten emphysema from smoking for so long and so I’m homebound whether I like it or not. It would be very bad for me to get sick, even with a cold.”

He continued to share that because of emphysema he "can only walk a short distance before” running out of oxygen. This news took his fans by surprise, with people speculating that the Academy Award-winning director would retire.

Lynch released a statement on Monday, quelling those fears. He said on X, “Yes, I have emphysema from my many years of smoking. I have to say that I enjoyed smoking very much, and I do love tobacco – the smell of it, lighting cigarettes on fire, smoking them – but there is a price to pay for this enjoyment, and the price for me is emphysema.

He explained, "I have now quit smoking for over two years. Recently I had many tests, and the good news is that I am in excellent shape except for emphysema. I am filled with happiness, and I will never retire.”

“I want you all to know that I really appreciate your concern,” Lynch concluded, signing off his message with "Love, David."

Lynch just released a new musical project with "Twin Peaks: The Return" actor and singer Chrystabell on Aug. 2.

Ladies and Gentlemen,

Yes, I have emphysema from my many years of smoking. I have to say that I enjoyed smoking very much, and I do love tobacco – the smell of it, lighting cigarettes on fire, smoking them – but there is a price to pay for this enjoyment, and the price for me is…

— David Lynch (@DAVID_LYNCH) August 5, 2024

The post “I will never retire”: David Lynch reassures fans after revealing emphysema has kept him homebound appeared first on Salon.com.

It isn't a coincidence that when Big Oil tries to wash its hands of climate change, their remonstrations comes across as strikingly similar to the time when Big Tobacco lied about the dangers of nicotine. In both hearings, viewers got to see capitalism's dark underbelly, exposed in all of its ugliness before the world: Businesses depend on profit, and therefore will lie about indisputable facts so they can continue to earn as much money as possible. To trick the public into helping them — even when, in the process, those same members of the public are only hurting themselves — this means they will lie about science.

To do so, they engage in a practice known as "manufacturing doubt." Whether it is chemical companies misleading about pollution, the sugar industry misleading about heart disease, energy companies and their climate change stories or anyone else, all of them draw from a similar cache of tactics intended to sow confusion among good faith actors, provide corrupt politicians with easy talking points and reassure those whose motivated reasoning inclines them against inconvenient scientific truths. As the authors of a 2021 study in the journal Environmental Health put it, Big Tobacco "is widely considered to have 'written the playbook' on manufactured doubt" and "has managed to maintain its clientele for many decades in part due to manufactured scientific controversy about the health effects of active and secondhand smoking."

The Big Tobacco story is at once straightforward and complex. During the heyday of Big Tobacco advertising in the 1950s and 1960s, cigarettes were associated with family friendly-fare; game shows, sitcoms and billboard advertisements associated cute animals with nicotine products.

In the mid-1960s, scientists who understood that cigarette use was linked to lung cancer and heart disease convinced Surgeon General Luther Terry to call out the products as dangerous; one year later, the Federal Cigarette Labeling and Advertising Act of 1965 mandated that warning labels be attached to cigarette boxes. As public health advocates won victory after victory in raising awareness about tobacco products, the industry grew concerned.

By the 1970s, tobacco industry executives formulated a scheme, known as "Operation Berkshire," to undermine or thwart efforts at regulation by sowing doubt in the legitimacy of medical research about tobacco products. In addition to making it more difficult for ordinary people to accurately assess the issue, this strategy also appealed to those who had an economic interest in the tobacco industry and those whose personal preferences made them pro-tobacco, anti-regulation or both as a matter of principle. Most prominent for these efforts was a front group known as the International Committee on Smoking Issues (subsequently the International Tobacco Information Centre).

By appealing to these sentiments and interests — and keeping sympathetic politicians and officials in their pocket — Big Tobacco spent decades creating a false "controversy" around an issue that had, to the scientific community, already been objectively resolved. As Australian researchers for the journal BMJ wrote in 2000, "without question, the creation and promotion of this controversy, and the adoption of strategies implementing the conspiracy resulting from Operation Berkshire, have greatly retarded tobacco control measures throughout the world."

Fortunately, a turning point occurred in the 1990s only because a congressional committee decided to hold Big Tobacco accountable in ways that others had not.

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The moment of truth took place on April 14, 1994. Waxman had shrewdly lured the seven executives to the hearing by "inviting" them and thereby making it clear that the event would occur with or without them. This provided him with an optical win-win: Either they would show up and have to answer unpleasant questions, or they would duck out and look like they had something to hide. After they showed up, Waxman and other members of the House Energy and Commerce Subcommittee on Health and the Environment grilled them mercilessly. No controversy was left untouched — the marketing campaigns to children, the medical details about their products' addictive nature, how cigarettes affected one's health and lifespan, whether the companies were manipulating nicotine. Instead of engaging in protracted legal battles to obtain key corporate documents, the legislators simply asked question in such a way that executives felt compelled to voluntarily agree to share them.

And, of course, there was the iconic decision by those same executives to lie under oath about whether they thought nicotine was addictive. Perjury probes soon followed; the embattled executives all left the industry within a couple years.

Perhaps even more upsetting to the industry was the ensuing litigation, which culminated in a $206 billion judgment against them — a staggering sum equivalent to 2.8% of the U.S. gross domestic product in 1994. And despite the tobacco industry's hysterical claims about the horrors that would result from tobacco regulations, none of their predictions came to pass. One in particular, by former R. J. Reynolds executive James W. Johnston, deserves special examination, as he posited that the inquiries were merely an excuse to ban tobacco products altogether.

"We hear about the addiction and the threat. If cigarettes are too dangerous to be sold, then ban them. Some smokers will obey the law, but many will not. People will be selling cigarettes out of the trunks of cars, cigarettes made by who knows who, made of who knows what."

This sense of persecution, utterly unfettered by any connection to provable reality, spoke to the deeper impulses on which Big Tobacco was preying. It started with a foregone conclusion that cigarette products could not be characterized as posing a serious public health risk; from there, facts needed to be rearranged to support the necessary assertion. This model was used not just for Big Tobacco's approach to political science, but its method for advancing pseudoscience as well.

In the aforementioned article from Environmental Health, researchers examined the strategies used not just by Big Tobacco but their successors and their various controversies: the coal industry and black lung disease, the sugar industry and both cardiovascular and metabolic diseases, the agrochemical business and chemical pollution, and the fossil fuel industry and climate change. They found that all of the industries would use tactics like gaining support from reputable individuals, misrepresenting data, attacking study designs, using hyperbolic and absolutist language and (of course) trying to influence lawmaking. Other popular tactics included manufacturing misleading literature, suppressing incriminating information, hosting bad faith conferences and seminars, pretending to be defenders of health, abusing credentials and taking advantage of scientific illiteracy.

The Big Tobacco tactics have only grown easier to implement in recent years, rather than more difficult. As the researchers pointed out, "the digital age has provided additional opportunities to spread misinformation. Doubt manufacturers have taken advantage of new media platforms, such as blogs and social media, to unite journalists, industry representatives and 'citizen scientists' with the aim of recruiting these individuals to perpetuate manipulated information."

Even the cigarette industry is copying from itself. E-cigarette companies have incurred controversy for using advertising strategies eerily similar to those that were banned when employed by Big Tobacco. North Carolina's attorney general announced last month that he is investigating Puff Bars and others in the distribution chain to make sure they are not targeting children. When defending themselves against that accusation, the pro-vaping community will often tangentially make similar claims that vaping is somehow healthy (or at least healthier than smoking), and sows doubt on existing science in ways that are eerily reminiscent.

The post How Big Tobacco used bad science to avoid accountability — and set the blueprint for Big Oil appeared first on Salon.com.

“You’re too intense now,” said my mother in Michigan.

“I liked you better before,” admitted my cousin, who’d complained whenever I’d lit up but was now annoyed I couldn’t go bar hopping with her. Did she only want me to ax the bad habits we didn’t share?

“You’re no fun anymore,” carped a college buddy I’d once partied with. Did he prefer me stoned and half-conscious? 

Even a mentor said, “You’ve lost your spark.” Did he miss the deep, crazy conversations we had while chain-smoking and guzzling cocktails? I was hurt he found me more fascinating when I was using.

The muscular personal trainer I’d splurged on for a few sessions saw me sweating from nicotine withdrawal and said, “You look horrible. If it’s so painful, why don’t you just smoke?”

“I hired you to help get me over my two-pack-a-day fix,” I replied, startled. “It’s an impulse disorder. I need to learn to ‘suffer well.”

Those were the words of Dr. Woolverton, the substance specialist I saw weekly. Though I’d paid for two more sessions, the doctor suggested I cut my losses. So I quit the trainer too.

“Why all the negative reactions?” I asked in therapy, stunned and confused by the backlash.

“Your sobriety holds up a mirror to everyone’s excesses. It could be seen as threatening,” he explained. “Especially for those who don’t want to — or can’t — stop.”

But maybe there was another reason. What if I sounded like a moralizing, self-righteous prig? Was it time to give up people-pleasing, too? 

Anxious, overweight and friendless at 13, tobacco and pot relieved my social awkwardness and miraculously suppressed my appetite. I was nervous to start college early, so I became popular as the fun girl who threw wild soirees. (Well, wild for Michigan.) We shared smokes, booze (my drink was vodka and Tab), a water bong, magic mushrooms and the occasional Xanax. I relished the role of bohemian poet, sure I needed to be wacked out to write. I clung to those crutches for decades.

It wasn’t so cute at 41 — more like pathetic and depressing. While I was too prissy to try LSD, heroin or Oxy, I loved blow since it kept me from eating for three days. Before I put my entire bank account up my nose, I committed to a year of one-on-one talk therapy with Dr. Woolverton. But each time I cut out a substance, a new fetish surfaced. A psycho-pharmacologist thought I had Attention Deficit Disorder with Hyperactivity and prescribed Adderall. It made me feel like a speed freak, so I threw those pills away. One dose of Wellbutrin almost gave me a seizure.

With no one-size-fits-all balm, we tried an idiosyncratic, all-out behavioral strategy to avoid the “substance shuffle” common with addicts. Eating the icing off a dozen cupcakes caused a sleepless sugar rush, and my jeans refused to zip. A stick of Juicy Fruit gum to quell my nicotine cravings turned into ten packs a day until a nutritionist pushed me toward sugarless — and then the sorbitol made me sick. After losing two fillings, my dentist insisted I quit gum altogether. In a state of chaotic agitation, I ricocheted from the caffeine in endless daily cans of Diet Coke to hundreds of cinnamon sticks to being unable to sleep without Tylenol cough syrup.

“You have such a compulsive personality, you could get hooked on carrot sticks,” Dr. Woolverton said. He delineated the difference between an innocuous ritual versus an obsessive dependency: Stop doing it for two weeks, and if it hurts, you’re getting addicted.

As the nicotine patch stemmed my cigarette cravings, my recovery required retraining my brain to stop reaching for anything to obliterate difficult emotions. To do that, I journaled, recording the complicated feelings I could no longer inhale, imbibe or eat away. I repeated mantras incessantly, like “Lead the least secretive life you can” and “The only way to change is to change. Understanding follows.”

When a colleague called me “a walking Oprah episode,” I thought of toning it down. But then I learned the buff former personal trainer who’d asked, “Why don’t you just smoke?” died of a heart attack in his 40s. Another client of his revealed he’d been on steroids. I was shocked. I’d been so myopically involved in my own recovery, I’d missed signs he was doping. Was my temperance triggering? His death reminded me how dangerous substances could be, with deadly opioid overdoses increasing catastrophically over the last few years.

Without intervention, addictions don’t get smaller; they grow more out of control until they explode, Dr. Woolverton insisted. He advised me to put as many obstacles between myself and my substances as possible. But how?

To stay clean, I had to be boring — and vigilant. As everyone was either part of the problem or part of the solution, it was easier for me to remove people, rituals or entire food groups than be moderate. To avoid gaining weight, ruining my throat and teeth, I nixed gum, diet soda, bars and late meals at restaurants. My friend Karen called to ask me, “Want to go out and get some water?” (We wound up taking a long walk.)

I was now hooked on unhooking.

Catching a glimpse of Marlboros in the purse of a new housekeeper I was trying out made me want to bum one. How could I ask her to leave them home?

“Tell her you need to have a cigarette-free apartment, so you’d appreciate it if she left the pack downstairs with your doorman,” my doctor said. 

“That would make me sound like a control freak,” I lamented.

“You are a control freak,” he said. “Would you rather risk your sobriety than politely ask someone you might hire to help you out with a minor request?”

When I did, she replied, “Sure, no problem. I’m trying to kick it too.”

At least some acquaintances understood my need to be self-protective. Others were miffed by my rudeness. I left pals behind at readings and quickly crossed streets if I smelled a hint of weed to avoid a contact buzz, confusing companions and walking buddies. I offended an acolyte who caught me pawning off the dessert basket she brought me to a neighbor, and insulted a coworker who’d gifted me holiday champagne by saying, “Don’t you know I don’t drink?”

Without my old self-soothing methods, my nerves frayed and my patience was nonexistent. But I allowed my discomfort to surface and to play itself out, telling its own story. Nights and weekends I let myself cry, scrawling purple poetry into my journal, playing Bob Dylan bootlegs lamenting that everybody must not get stoned.

Since addicts depend on substances, not people, I attempted to rely on more humans. Yet I couldn’t handle AA groups where everyone smoked butts outside, guzzled soda and coffee and ate donuts. Instead, I avoided crowds, leaning on a few “core pillars” I trusted, like my therapist, my cousin Molly (also in recovery) and my long-suffering husband. For the first 12 months of my addiction therapy, he’d travel with me, petting my head to calm me, calling himself my “support animal.” Watching a TV show every night, he'd hold me for an hour without speaking, soothing my angst, though one evening he whispered, “The pillars are tired.”

I felt guilty for being so draining, difficult, twitchy, sweaty and claustrophobic in small spaces. At my teaching job, I fought for classrooms with windows and heating and cooling I could regulate, which alienated my bosses. In theaters, airplanes and performance spaces, I needled my companions by demanding specific aisle seats for legroom and faster escape. Everything simple was now a struggle. I’d become the Diva of Deprivation. “Life is easier when you’re anesthetizing yourself,” Dr. Woolverton opined.

My desire to please everyone was becoming toxic, so I quit that too. I skipped superficial New Year fests and literary galas filled with semi-strangers, lest I be tempted by quaffs, canapés or cannabis. I channeled those hours at home into writing and teaching instead. My frenzy and brain fog lifted and I found I could concentrate with a laser-focused intensity. I’d never be non-addictive, but as compulsions go, workaholism seemed comparatively benign, especially with regulation. I’d be at my desk at 9 a.m., then come up for air in time for class or dinner with my husband. Within nine months, something miraculous happened: My marriage, career and a few close friendships flourished.

Turned out the chemicals hadn’t liberated my creativity; they’d held it hostage. After decades of rejections, I sold several books in a row — a few chronicling my recovery — and tripled my income and energy level. Feeling intense empathy toward my students, I increased my class load and felt honored to win teaching awards. I added hours of volunteering and upped charity donations. I was so sure I’d aced clean living. And I let my guard down.

Seventeen years later, the pandemic hit. As I binge-watched TV, I munched nightly on bowls of popcorn, convincing myself it was a good, natural, snack: gluten free, whole grain, high fiber. One day when the grocery ran out of my brand (Bob’s Red Mill Whole Kernel White Popping Corn) I ran to 12 stores, unable to find it anywhere. I sweated out the 24 hours it took to arrive from Amazon. The popcorn had morphed into another obsession I couldn’t live without. A harmless one, I’d thought, before I saw I’d gained 25 pounds. I was unwittingly shuffling substances again. I knew what to do: Give up my favorite snack. It was hard for a few days, then I felt better and dropped the weight.

“You’re never recovered; you’ll always be in recovery,” Dr. Woolverton warned.

I might have to keep quitting things forever. It won’t win me any popularity contests, but having a smaller circle of VIPs who understand me is a deeper and warmer experience than placating a crowd. Dylan sang that just when you’ve lost everything you find there’s a little more to lose. After 20 years without smoking, toking or drinking, I’d add: And to be gained. By giving up toxic habits, I’ve made room for something more beautiful to take their place.

The post Secrets of a serial addict: How I got hooked on quitting, over and over again appeared first on Salon.com.

The law — which created a steadily rising smoking age so people born after January 2009 could never legally purchase cigarettes — was intended as a so-called "generation ban." The policy included other measures that decimated the number of stores legally allowed to sell cigarettes (from 6,000 to 600), as well as reduced the amount of nicotine legally allowed in tobacco products. While those have taken effect, the generation ban was not scheduled to be implemented until July 2024.

Now it won't be put into effect at all, thanks to recent political negotiations in The Land of the Long White Cloud. Finance Minister Nicola Willis announced on Saturday that the policy is being reversed as the new coalition government seeks alternative methods to fund its tax cuts. The new approach has been met with dismay from public health advocates.

“This is major loss for public health, and a huge win for the tobacco industry – whose profits will be boosted at the expense of Kiwi lives,” Prof Lisa Te Morenga, the chair of non-government industry group Health Coalition Aotearoa, told The Guardian.

The post New Zealand reverses generational ban on smoking, a “major loss for public health,” advocates say appeared first on Salon.com.

The term took off after the Survey Center on American Life reported that over the past 30 years, American friendship groups have shrank in size, and the number of Americans without any close confidants had rapidly increased — especially among men. Multiple studies have shown that a higher number of Americans report having fewer friends and spend less time with the few they have. 

There are many implications to a society that is increasingly seeing fewer people have fewer meaningful friendships. Some have posited that a decline in friendships is leading to a decline in civic engagement. Loneliness can prime a person’s immune system to be more vulnerable to disease and more susceptible to disease progression. Some researchers have found that loneliness can be a risk factor for dementia, and thus friendship can help protect against it.

Considering the detrimental health effects loneliness can have on a person's health, it’s easy to think that having more friendships unequivocally equals good health and there are only upsides to having friends. According to a new study published in Epidemiology and Psychiatric Sciences, there is a “dark side” to friendships, too. (The good news is that it might not matter much in the grand scheme of things.)

In the study, researchers looked at data from around 13,000 adults over age 50 to examine associations between different facets of friendship and 35 health and well-being outcomes four years later. In a phone interview Bill Chopik, an associate professor of psychology at Michigan State University, told me that he and his colleagues wanted to focus on friendships, because most existing literature explores the health effects of marital or parent-child relationships.

But increasingly more Americans are remaining single and finding companionship in familial-like friendships. Curiously, the others wanted to know how much it matters to have friends. Some of the outcomes they found were that friendships were associated with a 24% reduced risk of death, 19% reduced risk of stroke, and a 17% reduced risk of depression. 

“Having good and frequent friendships was associated with you living longer, you’re happy in nearly every way and you have a bit more of a healthy personality,” he said. “Those were by far the good things, and there were some interesting results.”

Specifically, they found that friendships were associated with a 43% increased likelihood of smoking and 48% increased likelihood of heavy drinking.

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“It looks like having more and better friendships has you drinking a little bit more, which we didn't expect, and smoking a little bit more, which we normally try to deter people from doing,” he said. “The interesting thing is you, you imbibe a little bit more in these substances — and yet you still live longer.”

What’s interesting is that being without friends or being lonely in general, is just as bad, if not worse than smoking.  Research has shown that people who seek treatment for substance use problems report feeling lonely, suggesting there is a connection between isolation and substance abuse. Yet it seems if you have more friends, you’re at a higher risk to smoke and drink, too. 

Chopik said this could be part of what’s called the “amplification system” of friendships, which means your friends can amplify either your good or bad behaviors. 

“There’s a saying, ‘you are who your friends are,’” he said. “And that's what we meant by the amplification system, it accentuates our best and worst traits."

However, the trade off is “small,” Chopik said. In other words the increased likelihood of smoking or drinking is worth taking for your health and living longer. The takeaway certainly isn’t to spend the second half of your life without friends for the fear or drinking or smoking. In fact, it’s the opposite. Chopik said he hopes this study reinforces the importance of friendship when it comes to enriching the human experience.

“The trade off isn't as dramatic as I think we're talking about, it’s not like ‘I’m going to force you to smoke three cigarettes in exchange for you being happy,” he said, elaborating that despite the increase in drinking and smoking people with fulfilling friendships are still living longer. "In some ways, the story is really simple that there are no drawbacks to having really amazing friends, the difficulty is finding friends and keeping friends.”

The post Friendship is a health booster, but it has a “dark side,” a surprising study finds appeared first on Salon.com.

The e-cigarette company was founded by Adam Bowen and James Monsees, two ex-cigarette smokers who met while they were graduate students in product-design at Stanford University. Bowen and Monsees were determined to create a sleek e-cigarette that wasn’t anything like its goofy-looking predecessors. They first developed an e-cigarette called Ploom and later, developed Pax vaporizers for cannabis and loose-leaf tobacco. Juul was created in 2015 and quickly became one of the fastest-growing companies in the world.

Today, Juul is long past its glory days and instead, marred by infamy. The product, which was created for a good cause, ultimately became a public health crisis after it got in the hands of countless children and teens nationwide. Once disaster struck, the company struggled to redeem itself in the public eye.

Juul’s epic rise and subsequent downfall is explored in Netflix’s latest docuseries “Big Vape: The Rise and Fall of Juul.” Over the course of four episodes, the documentary explores Juul's early mission, its financial success and its ardent backlash through a series of interviews and old footage. Current and former employees of the company make several appearances throughout the feature. A few even chose to remain unnamed and anonymous for their own safety. As for Bowen and Monsees, they both agreed to not be featured in the documentary.

“At its height, Juul employed over 4,000 people, and was valued at nearly 40 billion dollars,” the documentary said in its opening. “Today, it’s worth less than 5% of that value.”

Here are the 6 biggest Juul revelations from the series:

01

Juul developed a novel form of nicotine that was more potent

Big Vape: The Rise and Fall of Juul (Photo courtesy of Netflix)

In the summer of 2013, Bowen brought on a chemist named Chenyue Xing to figure out how to make the nicotine delivery of Juul equal to that of an actual cigarette. Many Juul users complained that they were still smoking cigarettes because of Juul's low and impotent nicotine levels.  

 

Earlier generations of e-cigarettes used freebase nicotine, a form of the drug which can be incredibly difficult to inhale. Freebase nicotine was also difficult to raise in content because too much of it in an e-cigarette would produce an unpleasant, bitter taste. To combat that issue, Bowen and Xing decided to make salt nicotine — a combination of nicotine and a weak organic acid. Salt nicotine produced a “softer,” less harsh taste while still providing an adequate hit to its users. 

 

When it came to product testing, Jamie Ducharme, the author of the “Big Vape” series, said Bowen and Xing recruited their own co-workers to test the Juul products.

 

“It was called ‘buzz testing,’ because it’s a commonly-used term by smokers to describe the nicotine head hit that they feel,” Xing, who declined to appear in front of the camera, said.

 

An unnamed, anonymous engineer for Ploom described the test as “simple”: testers were asked to take 10 puffs in two minutes and describe how they felt.

 

“Around the fourth or fifth puff, I would have to start tallying because I’d hit the buzz so hard I’d be like, ‘Where am I?’ Then I’d come back and be like, ‘I’m done with number six,’” they said.

 

“The potency, I had never really felt anything like that before since high school, when I tried my first cigarette. Like a punch in the face, ‘Whoa!’ It really opened our minds to what was possible.”

02

Juul pods were a major issue … but Monsees didn’t care

James Monsees in "Big Vape: The Rise and Fall of Juul" (Photo courtesy of Netflix)

A supply chain engineer, who remained unnamed and anonymous in the documentary, said Juul pods were a major problem — out of 100 Juuls produced, only eight contained effective pods.

 

David Pierce, a reporter for Wired, said many users got “a squirt of nicotine” in their mouth when they would inhale a Juul with a faulty pod. 

 

“One employee said he got crème brûlée liquid [a popular Juul pod flavor before it was banned] in his mouth so often that he now can’t eat [actual] crème brûlée because it was so disgusting,” said Ducharme.

 

Juul's sleek and slim design posed a technical challenge. It was difficult to fit in a battery, tubes and a small enough pod that was also functional.

 

“People would say, ‘We need a bigger unit,’” recalled Juul's supply chain engineer. “James [Monsees] refused to budge on the unit size. He really liked the way that unit looked.” Another Juul employee said they were rushed: “About a month before the original launch date, we didn’t have a way to fill pods yet.” 

 

Monsees was adamant that the problems be fixed in that short amount of time. And if they weren’t, Juul would still be launched regardless.

 

“Ever heard the old adage, ‘When in doubt, ship it?” Monsees is heard saying in an old recording. “There’s a variation on that one, which is ‘F**k it, ship it.’”

03

Juul's flashy, “lifestyle-oriented” marketing ultimately led to its downfall

Big Vape: The Rise and Fall of Juul (Photo courtesy of Netflix)

Juul quickly became known as a tobacco-adjacent company thanks to its gaudy marketing. What once began as a business seeking to help adults quit smoking actually encouraged more users — namely adolescents — to pick up the habit.

 

Juul's marketing campaign recruited so-called “cool kids,” who were average yet incredibly good looking millennials, posing and dancing while taking puffs from their e-cigarettes. The resulting advertisements were sophisticated, flashy and alluring, which made the product seem like a sort of toy or lifestyle accessory rather than a beneficial health device. Many were quick to notice that Juul ads greatly resembled those of Big Tobacco companies.

 

“Juul, in its advertising, faithfully followed the playbook of Big Tobacco companies and their cigarette brands,” explained Dr. Robert Jackler, a tobacco marketing expert at Stanford. “[Juul's] Vaporized campaign. It has direct roots from the way the tobacco industry marketed to youth. Take a bunch of 20-somethings, and you have them dance around."

 

Jackler added that Juul took the “very worst” elements of tobacco marketing and thrived on that.

 

“Cigarette makers could no longer advertise on television. Juul could. Cigarette makers could no longer have a billboard on Times Square. Juul could,” said Dr. Robert Proctor, a tobacco historian at Stanford.

 

Shortly after Juul's Vaporized campaign came out, Ad Age magazine published an article that formally called out the company's advertisements for looking very similar to old Big Tobacco ads. Juul's marketing team, led by chief marketing officer Richard Mumby, went into hyperdrive and began redoing aspects of the campaign, even though it had just been released.

 

Many employees said Juul had become a hot mess at that point and pointed fingers at the company's creative leadership, who they claimed had "no knowledge of what was responsible marketing of a tobacco company."

04

Juul was being used by children as young as 12 and 13 years old

Big Vape: The Rise and Fall of Juul (Photo courtesy of Netflix)

Juul's inconspicuous design allowed many young people to discreetly use the product in schools. Many kids tucked their Juul inside their sweatshirt, occasionally taking puffs and exhaling into their sleeves without their teachers knowing. Users as young as 12 and 13 years old were also seen using and passing Juuls around in public, like they were candy.

 

Juul's social media team began doing damage control to sway away from the negative publicity and encourage more adults to use the product responsibly. The company’s social media posts abandoned the Vaporized campaign and instead, displayed images of older folks carrying Juuls. The company's social media team also limited the use of bright colors and ultimately, made its account “stodgy and boring.”

05

Juul representatives went into classrooms and convinced students that vaping wasn’t harmful

Big Vape: The Rise and Fall of Juul (Photo courtesy of Netflix)

Two students recalled the time their school hosted a mental health seminar and invited a mental health speaker to come and talk to them about addiction and drug usage. The so-called “mental health speaker” turned out to be a representative for Juul, who advocated for the product rather than against the consequences of smoking or vaping.

 

“Throughout the presentation, there were slides up in which the speaker was discussing how the Juul was not harmful and how it was 99.9% safer than combustible cigarettes,” said Caleb Mintz. “That’s an actual statistic that was used in the presentation.”

 

“He also pulled a Juul out of his pocket and referred to it as the iPhone of vapes. So he really came off as a salesman.”   

 

Phillip Fuhrman, a teen vaper who began vaping between eighth and ninth grade, said he was convinced that vapes weren’t harmful and didn’t feel compelled to quit after the presentation. Mintz, however, had different thoughts: “After the presentation, I didn’t find that many people shared the sentiment that I had, that this guy was trying to market nicotine products to a bunch of teenagers. It was so absurd, I didn’t feel like a lot of people would believe me, and I felt like the only person who would listen would be my mom.”

06

The FDA ordered Juul to pull its vaping products off the market

Big Vape: The Rise and Fall of Juul (Photo courtesy of Netflix)

Per the documentary, the U.S.Food and Drug Administration (FDA) rejected Juul's premarket tobacco product applications (PMTAs) and ordered the company to pull all of its vaping products off the market. Juul, however, successfully appealed the ban and “remained on the market, pending another PMTA review.”

 

“At the end of 2023, Juul has paid nearly $3 billion in legal settlements across the United States,” the documentary continued. “The future of the company remains uncertain.”

"Big Vape: The Rise and Fall of Juul" is currently available for streaming on Netflix. Watch a trailer for it below, via YouTube:

The post The 6 biggest Juul revelations from Netflix’s docuseries “Big Vape: The Rise and Fall of Juul” appeared first on Salon.com.

This is so self-evident that most Republicans I know agree personally, despite belonging to a political party whose guiding ethos is to be deliberately unpleasant in hopes of getting a rise out of some liberal somewhere. Even people who think Fox News host Greg Gutfeld is funny have enough sense to know that it sucks to smell like an ashtray sucks. Or at least I thought they did.

I wrote an entire book about Republican trolling, so I’m ashamed to admit that I underestimated how pathetic it can get. With the GOP now in control of the House of Representatives, people are smoking indoors again in the Capitol, or at least the half of it governed by the oh-so-powerful Speaker Kevin McCarthy. Gross! I suppose Republicans can congratulate themselves, since they have successfully triggered me with this news. Of course, if they’d like to, they can trigger me even more — maybe by refusing to take regular showers or to wipe their butts after using the bathroom. 

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But in fairness, this isn’t just about trolling. It’s also about a close cousin to trolling, in the constellation of motivations that make right-wingers such baffling and exhausting people: Toxic masculinity. For about as long as supporters basic public health have argued for restrictions on tobacco use, conservatives have acted as if any regulations whatsoever on their foul-smelling phallic symbols literally amounts to prying the penises off their bodies. Before Rush Limbaugh died of lung cancer, the right-wing radio host who coined the term “feminazi” often portrayed smoking as a wholesome, manly activity that liberals wanted to take away from men purely to emasculate them. 

“It’s true that everybody who smokes dies, but so does everyone who eats carrots,” Limbaugh said. 

He wasn’t the only one. Former Vice President Mike Pence, when he wasn’t denouncing the Disney film “Mulan” for teaching girls they could have military careers, also wrote a sneering 2001 op-ed portraying anti-tobacco regulations as “back handed big government disguised in do-gooder health care rhetoric” and making the blatantly false declaration that “smoking doesn’t kill.”

Years later, members of the Proud Boys filmed themselves smoking inside the U.S. Capitol during the Jan. 6 insurrection, a visual fuck-you to those who prefer not to smell like a bar’s trash can. They each got four years in prison, where cigarettes are famously a form of currency, as well as a way to speed up your inevitable demise. But just as House Republicans have made the anti-democratic desires of the Jan. 6 insurrectionists the center of their political vision, this juvenile and offensive gesture of impotent rage at the “nanny state” has gone from the rioters to the offices of members of Congress.

As the Limbaugh and Pence examples show, Republicans have long framed public health measures as a feminizing threat to their snowflake-fragile masculinity. But that rhetoric has gone into overdrive in recent years, as Donald Trump and then the GOP masses made dying of COVID-19 into a marker of partisan identity politics — and almost a noble sacrifice for the cause of so-called freedom. The deep irony of seeing a man behave pathetically while claiming to be “strong” was amply illustrated in Trump’s attempt to deny that he nearly died from COVID by dramatically ripping his face mask off on a White House balcony. He definitely believed he looked confident, but that moment was uncomfortably reminiscent of Trump’s repeated claims that his stubby fingers tell us nothing about what he’s carrying in his pants. 

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So we’ve been forced to endure nearly two years of Republicans defending their masculine bona fides by claiming they’re not afraid of COVID-19, often by acting very, very afraid of the vaccine. So many manly men running around declaring they will prove their toughness by refusing to get stuck with a little tiny needle! Joe Rogan, current king of the trying-too-hard culture of talk-radio masculinity, has been an avatar of this hilarious un-self-aware paradox of dudes who will thump their chests and claim they’re too much man to be felled by a virus, before squealing like babies at the idea of getting the shot. 

I don’t know that the “good health = small dick” mentality has actually gotten dumber over the years, but man, it sure feels that way when you see Republicans like Sen. John Kennedy of Louisiana complaining about liberals who carry around “Ziploc bags of kale” and pronounce that “kale tastes to me like I’d rather be fat.” The gender politics of this stuff are never hard to suss out, as Kennedy also complained about “yoga mats” in that same speech, objects generally associated not just with blue-state exercise routines but also with women. 

The crowd that witnessed Kennedy’s rant — at a December campaign rally for soon-to-be-defeated Georgia Senate candidate Herschel Walker — ate it up, evidently never asking themselves how lion-hearted a man is if he’s terrified of a vegetable. Women have long been subject to stereotypes about being afraid of mice and spiders, which supposedly makes us weak. But somehow the epitome of rugged manhood is to flee at the sight of a leafy green.

Almost nothing is funnier than someone with a massive gulf between the way they perceive themselves and the way they look to other people. I’ve witnessed decades of Republicans declaring themselves to be John Wayne heroes while acting like petulant kindergartners making faces because Mom told them to eat their broccoli. It never stops being hilarious. But there are real costs when conservatives seek relief from their yawning insecurities by sacrificing public health to partisan loyalty. 

As Scientific American reported in July, there’s “a growing gap in mortality rates for residents of Republican and Democratic counties across the U.S.” Even before vaccine refusal led to huge numbers of Republicans pointlessly dying of COVID, the GOP hostility toward routine public health measures already meant that people in more conservative counties are likelier to die of many other causes, including suicide, heart disease, opioid overdoses and obesity-related illness. Some of this is cultural: Republicans are less likely to get enough exercise, for instance. But a lot of it is also due to policy decisions, such as poor access to health care, lax gun laws and inadequate road maintenance.  

As nearly all sensible people understand, perfect health is not a realistic goal for any of us. There are always tradeoffs between the best possible health practices and actually living our lives. People are going to take sexual risks, stay up late, drink alcohol, do drugs, skip workouts and eat fattening food. Most of us have decided that the risks of post-vaccination COVID-19 aren’t severe enough to live like shut-ins for the rest of our lives. Despite hysterical right-wing media claims to the contrary, the government is not coming to take away your gas stove. Contrary to right-wing stereotypes that Democrats will deploy secret-police tactics to make us all live like vegetarian monks, progressive health regulations always try to balance improved public health with ordinary people’s understandable desire to decide how they want to live their lives.

When I was a teenager, more than a third of young people smoked. Now it’s less than 9%, and continuing to fall. High cigarette taxes and prohibitions on smoking in most public and commercial spaces have contributed, but it’s much more that people have realized that the temporary high of nicotine isn’t even remotely worth it. You’re risking agonizing disease and an early death for the payoff of smelling like an old shoe. There are just way too many other good times to be had, with nowhere near the danger. You can have non-procreative sex, take your friends a drag show or read a book, for instance — which as you probably noticed, are all things the modern GOP would like to legislate out of existence. Smoking, by comparison, is just a bummer. Republicans’ petty and self-destructive enthusiasm for it is just another reminder that they’ve become a party devoted to being terrible for its own sake. 

The post Getting lung cancer to own the libs: House Republicans want to make smoking great again appeared first on Salon.com.

The latter practice is what forced Juul to agree to the nine-figure settlement paid out to a number of U.S. states, as studies have repeatedly shown that e-cigarettes have become a preferred method of smoking nicotine among young people. Indeed, a recent peer-reviewed research study estimated that between $130 million and $650 million of Juul’s net 2018 revenue came from youth.

According to a 2021 report by the Food and Drug Administration (FDA), roughly 2.55 million American teenagers — or roughly 1 out of every 11 (9.3%) — currently use a nicotine product; “current” is defined here as meaning they had used the product within 30 days. This includes 2.06 million high school students, or 13.4% of all high schoolers, and 470,000 middle school students (4%).

E-cigarettes were, by overwhelming numbers, the preferred method for consuming nicotine, with 2.06 million middle schoolers and high schoolers (7.6%) saying that they smoke by vaping. By contrast, only 410,000 (1.5%) said they preferred cigarettes.

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The Centers for Disease Control and Prevention (CDC) reports that, since 2014, e-cigarettes have remained the most frequently used tobacco product among young people. There is also circumstantial evidence that e-cigarettes’ multitude of flavors has helped the product gain traction: as of 2021, 85.8% of high school students and 79.2% of middle school students who consumed e-cigarettes within 30 days did so with a flavored version.

“The first thing is that e-cigarettes almost always contain nicotine,” Robert Schwartz, a professor at the University of Toronto and Executive Director of the Ontario Tobacco Research Unit, told Salon. He explained that nicotine products are “very highly addictive,” adding that “the research has demonstrated very clearly that young people who vape nicotine become dependent on that nicotine.”

He explicitly linked this to e-cigarette marketing campaigns, which he said were indeed analogous to those of Big Tobacco years ago.

“A lot of the same kinds of approaches have been taken,” Schwartz pointed out. “It’s about lifestyle. Juul in its early promotions to young people promoted it as cool. It’s the ‘thing to do,’ and using all kinds of colors and appealing images of young people themselves using the vaping products, they clearly have adopted tobacco tactics.”

As the recent tentative settlement makes clear, the popularity of e-cigarettes like Juul among young people is precisely what put the company in its current predicament. When the company was first proposed in 2004 (under the name Ploom), its founders described it as “the rational future of smoking.” By 2007 the company was off the ground, and was valued by PitchBook at roughly $3 million in February 2008. In 2015, the original founders, Adam Bowen and James Monsees, sold the Ploom brand and vaporizer line to a Japanese tobacco company named JTI, and by June 1st of that same year, JTI officially launched the Juul.

2016 was perhaps the climactic year for the Juul, with sales rising by 600% as the product took off, becoming a cultural touchstone among millennials and Generation Z. By November 2017, Juul products had captured one-third of the e-cigarette market — and with that success came heightened scrutiny for the advertising campaigns that made them appear cool and attractive to young people. Scott Gottlieb, who at the time was FDA commissioner, launched an “undercover blitz” against Juul in April 2018, with the stated goal of ending the sale of tobacco products to young people. In the largest coordinated enforcement effort in the history of the agency, the FDA sent more than 1,300 warning letters and fines to retailers accused of targeting minors with their tobacco products.

Yet despite this negative publicity — as well as increased heat from the FDA and bans on Juul products in municipalities from San Francisco to Israel — Juul continued to prosper. In 2019, however, the House of Representatives joined the FDA in investigating Juul’s marketing practices as well as a recent decision by tobacco company Altria to purchase 35% of the company. Before the end of the year, other nations like China and India had also stopped selling Juul products or banned them altogether. By 2021, Altria and Juul argued that the company was worth anywhere from $5 billion to $10 billion — and it had been valued at $38 billion only two years earlier. In June 2022, the FDA finally dropped the hammer and ruled that Juul could neither sell nor distribute its e-cigarettes in the United States.

Although proponents of e-cigarettes claim that they can be a tool for smoking cessation, the scientific evidence strongly suggests this is not the case. A 2022 meta-analysis of existing scholarship concluded that “the use of e-cigarettes as a therapeutic intervention for smoking cessation may lead to permanent nicotine dependence.” Similarly, a 2022 study in the British Medical Journal about e-vaping in 2017 found that “on average, using e-cigarettes for cessation in 2017 did not improve successful quitting or prevent relapse.”

The post Juul’s woes come full circle: E-cigarette maker must pay $438.5 million appeared first on Salon.com.

It’s a clever setup for the author’s social — and often and personal — answer to that question, a history of the evolution of targeted tobacco marketing, and how the industry strategically created a demand and then peddled their product to Black America. Its a story with roots that stretch back a century, through the political movements of the sixties through the death of Eric Garner and right up to the present day — just this year, the Biden administration sparked controversy by announcing a proposed ban on the flavoring in cigarettes.

Salon spoke recently to Wailoo,a Henry Putnam University Professor of History and Public Affairs at Princeton University, about his new book “Pushing Cool: Big Tobacco, Racial Marketing, and the Untold Story of the Menthol Cigarette.”

This conversation has been edited and condensed for clarity.

You write about and explore from a public health perspective and from a race perspective. But what was it that made you want to draw on what you saw and observed growing up and expand it into this really unique investigation?

The things that you encounter when you’re a young person, they’re very informative, and they stay with you. It’s really sometimes only with the passage of time that you can think back, maybe sometimes with nostalgia and longing. For me, it was the difference between going to elementary and middle school in the Bronx and Queens, and then in high school, moving out to a suburban town in New Jersey. It’s reflecting on what that experience was like as an academic who is interested in issues how health is shaped by one’s environment. It’s that reflecting on your childhood and realizing that the messaging was starkly different in terms of the environment that one navigated every day.

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Now as a person who works on the history of race and health, I’ve long studied this through the lens of things like how cancer trends change over the course of the 20th century. Those changes in cancer trends are the byproduct of those issues, like where you live and smoking trends. There’s a hidden history there.

I didn’t know the way that the menthol cigarette was developed first as a kind of healthy and soothing alternative. Can you talk a little bit about that and about the early genesis of the menthol cigarette in America?

If you are familiar with today’s menthol discussion, you think it’s a cigarette brand that has been racially marked and the targeted racial marketing has defined its market. But if you’re really trying to figure out the full history, you realize that it has its origins in this experience that is woven into lots of different products early in the 20th century — lozenges, ointments. The public comes to an awareness of menthol as therapy, as a product that purports — it doesn’t really do this — to break up congestion and open the airways. The industry realizes the growth of the smoking market in the 1920s after World War I has produced a huge growth in smokers, but it’s also produced something called smokers’ throat, the almost omnipresent cough. And a small company and then another larger company discovered that by taking this substance, menthol, and weaving it into a tobacco product, you can actually sell the idea that a menthol smoke is a way of calming smokers’ throat.

It has this therapeutic promise. The idea that the menthol market starts with a kind of deceitful idea, that it’s therapy, really helps to explain how this niche market emerges as a kind of a solution to the problem of smoking itself.

So even before you get to the kind of racialization of menthol smoking, the industry understood the the social psychology of brand choice, And that menthol had this health promise that even then they knew really it didn’t deliver on. Because very early on, the scientists could tell you that menthol is not a decongestant, it doesn’t open your airways. What it has is this deceptive sensation. If you’ve ever eaten a York Peppermint Pattie or sucked on a menthol lozenge, you feel that rush of what seems like cool air sweeping down your nose and your throat. People associate that with the expanding of the airways. It turns out that it’s just a trick of how menthol works on the brain, but it was enough to sell these products as therapeutic.

Menthol cigarettes are really a textbook example in the way that you can create a taste for something. You can create a desirability for something that is, I’m going to say, objectively disgusting, to cultivate an addiction.

It speaks to the way in which psychology and psychologists were very, very involved in the idea of acquired tastes or cultivated tastes or manufactured tastes. The advertising industry, which was coming into its own in the 1920s and 1930s, understands that what you’re selling is something that needs to intersect with people’s identity. You’re selling a sense of security. You are taking something, as you say, that’s objectively odd. Why would you want this experience? What’s interesting about the early Spud cigarette ads is how they decide, rather than sell people on something that you would like them to love at first smoke, teach them how to learn to love it.

RELATED: Here comes trouble: an anti-tobacco hero’s complicated legacy

There’s a Pavlovian psychology at work here. Dogs don’t salivate at the ringing of the bell the first time. You have to teach dogs that the ringing of the bell is associated with food coming. This is very much the kind of Pavlovian psychology that’s at work in thinking about markets in this time period, which is that you have to teach people how to associate positive experiences with something that is objectively off putting. That’s where the health promise comes in. The idea that you’re getting something of value from this experience, and this is what the industry does extraordinarily well.

Then a couple of decades pass. As the generation of smokers starts to age, you have an identity problem for a brand, which is that then it is seen as older and uncool. This is part of where this new targeting comes in, and it becomes something very, very different.

It goes through a couple of really curious shifts. First there is Kool, having been on the market one of the longest times, and has this old, medication association for an earlier generation. Then Salem comes out from RJR in the mid 1950s and goes straight at promising something new to a new generation in an era when people are looking for something “safe.” Because it’s really not safe.

Into the early 1960s, there’s this new tension over the fact that menthols are on the rise, and which of these brands is going to succeed. The really curious thing happens with the makers of Kool in the context of the second Surgeon General’s report in early 1964, which creates another, what’s called the cancer scare.

On the one hand, the cancer scare creates a lot of pressure from government to reduce youth smoking and to press the industry to not court young smokers as aggressively. It’s really at this moment that the makers of Kool make the calculated decision to compensate for those lost markets. You can’t do what had been really central in building youthful menthol markets in the early 1960s. That’s where they make the decision to aggressively advertise, in the summer of 1964, in Black newspapers around the country. They take the same motifs of upward mobility that had been part of their regular advertising, but they really push it aggressively in the context of the civil rights movement. They make and transform Kool into a product that speaks in many ways to broader ideas about coolness, but also African American consumer trends. It’s a calculated risk on their part that works out, and with the endorsement and support of Black periodicals like Ebony magazine, who need the advertising dollars, periodicals.

Kool really recasts itself in this way, very aggressively through Black media. Then as they succeed, and I’m talking about modestly succeeding, what happens in the ’60s that’s particularly dramatic is other companies move aggressively into the urban inner city marketing of menthol brands along lines of race. In some ways , one company that leads the way, and it becomes a pretty intensive rush at a time when menthol brands are themselves proliferating.

In 1960, you had less than ten menthol brands, and by 1970 you had upwards of thirty menthol brands. So a number of companies are getting into the menthol race and pitching menthols to Black Americans, and pitching that in cities, which are demographically changing with urban migration, white flight, et cetera, et cetera. It’s a complicated game that the industry starts playing in the menthol space that leads to the racialization.

Then there’s exploitation of that, where then it becomes, we want the “lower income” smokers. And there then becomes a very calculated association with, menthol cigarettes are going to be about drugs, they’re going to be about all of these other peripherals that the tobacco industry associates with a particular place and a particular community.

One of the most shocking findings in this book, but also one of the most shocking themes in the history of menthol is the explicitness with which what we call exploitation today is understood in really negative terms. They use the word “exploitation” to talk about exactly this use of Black pride to find markets in cities. One of the shocking documents that I have from St. Louis is from 1967, where a company is explaining to the makers of Camel how you create markets in urban St. Louis by appealing to Black pride, yes, but also appealing to generational pride as in, young people don’t want what their parents want.

Then they go deeper and they explain that young Black consumers don’t get information from television, don’t get information from the president of the board of education. They get information from what are called centers of influence, and that could be barbers or bellhops or bartenders. So you have to identify what are called cell groups, or particular influencers, in the language that we use today and give them free product and have them distribute your product. That way you are cultivating prestige and insider information. These documents, they read like, well, this is what pushing looks like, which is why the book is called “Pushing Cool.” They’re looking at not just images on billboards, but the structure of communities and how you influence behavior. Company after company is doing this in the 1960s through the 1970s.

On the one hand, if they were studying Black communities in an effort to influence behavior that was health promoting, then you’d admire the detailed analysis of how you shape behaviors. But this was all in service of really selling products that were already still carrying this deceitful health message. They study things like drug use to understand what is the connection between the increasing use of marijuana or harder drugs and menthol use, and maybe that’s also our market.

There is a moment where things begin to shift and there becomes a self-awareness and really questioning about what these cigarettes mean to Black American consumers. What happened with Uptown?

Uptown is fascinating story. I should say there’s a little bit of a precursor to it because, one of the continuing ironies of the story is whenever there’s regulation against the industry to limit its market more broadly, that is often followed by this intensive effort to cultivate even more directly Black inner city smokers. The reason why the Uptown story needs a little bit of a setup is that the banning of cigarette advertising on the television and radio led the industry to redouble its efforts with things like urban billboards and posters on public transportation to move even more aggressively than it ever had into the urban space.At the same time, the industry is continuing to lose a broad market.

Cigarette consumption is declining nationwide, partly because of the things like the limiting of advertising, the limiting of things like indoor smoking. The public health infrastructure is growing to limit smoking. And what Uptown represents is an effort to say, well, look, rather than doing this under the radar signaling to Black smokers, let’s just come right out and say, we are making a Black themed menthol cigarette. They really do believe that this is going to be a winning argument. The analogy they make is with Nike. They say, well, if Nike can advertise sneakers directly for Black youths, why can’t we advertise a cigarette for Blacks? And it really runs into a buzzsaw of criticism.

Most surprisingly to them is from Louis Sullivan, an African-American physician, who is then the secretary of Health and Human Services under George Herbert Walker Bush. From a Republican administration, but a physician, and a Black man, he’s dedicated his life to kind of improving the health of African Americans, he goes right at the industry in a scathing fashion. In some ways, that plus the reaction of pastors and activists, turns the tables on the industry. Already there was a kind of increasing dismay and anger about the prevalence of billboards in cities, that cities had become a kind of a place that was dominated by ad for liquor and cigarettes.

You might say that the Uptown story became a catalyst for a public health activism that took aim at targeted marketing, that took aim at billboards and their prevalence in Black communities, and really did end up reshaping the landscape both physically, but also reshaping the landscape of public health activism to take on this targeted marketing. Uptown started off as this RJR thinking that they were just going to be frank, and it turns out that that frank honesty ended up being revealing in a way that ultimately helped to energize the forces of public health.

This takes us right to the near present, and how when you have something that is identified culturally so strongly, things get really sticky and complicated. That brings us to when Bill de Blasio and Al Sharpton wind up on two very different sides of the aisle about what to do about menthol cigarettes. I want to ask about that debate, and what that says about how do we move forward with being sensitive, being advocates for public health, but also understanding those cultural implications?

In some ways we’re living today with the consequences of a decision that Congress did not make in 2008-2009, when in this really dramatic moment in the history of tobacco, the US Congress passed a law that finally gave the FDA jurisdiction over tobacco regulation. It’s amazing that we had practically an entire century where a leading substance, a leading drug, was not under the jurisdiction of FDA. What Congress did at that moment was also ban flavored cigarettes, or what were called characterizing flavors. That is, things that were obviously used as deceitful enticements, particularly to young people to start smoking. But because of the shrewdness of the industry in supporting African American legislators, the Congressional Black Caucus, and therefore the Democrats, split on the question of whether menthol should be exempted.

Menthol has been existing in this different terrain than other flavored cigarettes. It was exempted, but the FDA was told that it had the jurisdiction to decide. Congress basically punted the question rather than deciding on a ban. The de Blasio-Sharpton discussion is a carryover from this discussion that happened in 2009 and has been riding along for the last decade or so.

Most Black people don’t smoke, but of the African Americans who smoke, they overwhelmingly prefer menthol products compared to white people who smoke. The industry has been successful at cultivating the idea that that’s not a byproduct of exploitation or targeted marketing or illegitimate shaping of preferences; it’s an authentic preference that expresses a Black consumer desire. They have been really successful at selling that message in order to protect their market. It has been a successful argument for many, many years. But it is losing its power. Whereas the NAACP was really on the side of the industry ten or fifteen years ago, they have since flipped and said, no, menthols are just generally bad and ought to be banned. What you have with Al Sharpton is, he’s maybe one of the last holdouts among prominent leading African American political figures who is willing to argue for the industry.

The irony is that the argument that he found that carried the day in New York when they were contemplating a ban was not the argument that Black people prefer menthols. It was the argument that was tailored to a Black lives matter moment, which is that Eric Garner was strangled by a police officer for selling loose cigarettes on the corner in Staten island. And that if menthols were banned, it would produce a Black market that would put more young African American men at risk for engaging in illicit illegal activity. That’s the kind of the last gasp, to use a smoking metaphor, of the opponents of menthol ban.  

More Salon public health stories: 

• Being black can be bad for your health: Race, medicine and the cruelest unfairness of all
• Racism derails Black men’s health, even as education levels rise
• What doctors aren’t always taught: How to spot racism in health care

The post How Big Tobacco made menthol racial appeared first on Salon.com.

The cigarette companies despised him, and the feeling was mutual.

“I’d like to just destroy the tobacco industry,” Glantz once said. “It is an industry that kills 5 million people a year. It has no business existing. Make them go do something useful.”

In recent years, however, as a contentious debate over electronic cigarettes has fractured the community of tobacco researchers, many of Glantz’s former allies have turned on the 75-year-old scientist. His critics accuse him of exaggerating the dangers of e-cigarettes and downplaying their benefits. They say that his research into vaping has been driven by politics, not science. Some are even revisiting doubts about his earlier work, saying that his contempt for the cigarette manufacturers — and his activism against them — tainted his influential research into the dangers of secondhand smoke.

In the unkindest cut of all, these critics say that Glantz has become an unwitting ally of the tobacco industry. He has become one of “Big Tobacco’s little helpers,” as David Sweanor, a longtime anti-smoking activist, says.

How can that be? It stems from the belief held by many tobacco researchers, but not by Glantz, that e-cigarettes are safer than combustible tobacco. (Scientists do disagree about how much safer.) Many respected researchers — but again, not Glantz — also believe that e-cigarettes help smokers quit by delivering regular doses of nicotine in a way that won’t end up killing them.

Glantz and his powerful allies in the anti-tobacco movement — nonprofit advocacy organizations the Campaign for Tobacco-Free Kids and the Truth Initiative, as well as the American Lung Association, the American Heart Association, and the American Cancer Society — have mounted a campaign against e-cigarettes funded with $160 million from Bloomberg Philanthropies. Instead of inviting smokers to switch to vaping, Glantz and the nonprofits have promoted more traditional quitting strategies, including those involving the use of FDA-approved medications, while simultaneously working to ban e-cigarettes, tax them, prohibit the sale of flavored e-cigarettes, outlaw their use in smoke-free zones, and generally do whatever they can to stop both adults and children from vaping.

Glantz has made a variety of claims about e-cigarettes — that they are a gateway into smoking, that they don’t help smokers to quit, and that they raise the risk of heart attacks. All have been challenged, and one influential study has been retracted. But as Glantz’s work has been amplified by the nonprofits, they’ve helped turn public opinion against e-cigarettes. His critics say this bad science is driving bad public policy.

“They’ve convinced most of the public, including a majority of smokers, that vaping is as dangerous or more dangerous than smoking,” says Kenneth Warner, a founding board member of the Truth Initiative and former dean of the University of Michigan School of Public Health. “That’s crazy.”

“Stan has always been an advocate and ideologue willing to twist the science,” says David Abrams, a New York University professor and veteran tobacco researcher. He says that some scientists ignored flaws in his work when Glantz focused on combustible tobacco because they, too, strongly opposed smoking. “Frankly, none of us cared if he was a little bit sloppy with his research because the ends justified the means,” Abrams says.

Glantz denies that his research has been distorted by his activism. “That’s just bullshit,” he says. “It’s actually the other way around. The activism follows from the science.” He says the scientists favoring harm reduction — the claim, in the case of e-cigarettes, that vaping can reduce the damage of smoking — fail to grasp the dangers of vaping.

While Glantz retired from USCF last year, he remains the go-to scientist for the anti-tobacco movement and an honored figure on campus. “His research contributions in tobacco control are legendary,” said Pam Ling, who succeeded Glantz as head of USCF’s Center for Tobacco Control Research and Education, at a campus event earlier this year. Supporters and critics alike agree that his work has had an enormous impact on public policy.

For four decades, and especially during the early days of the U.S. anti-smoking movement, Glantz was the “preeminent translator of the science of tobacco and disease into the public discourse of tobacco control,” wrote Michael Pertschuk, the former chairman of the Federal Trade Commission, in his 2001 book, “Smoke in Their Eyes.” The feisty academic became a “master of the sound bite” and a “tactical treasure,” according to Pertschuk’s account. Methodological questions aside, Glantz’s papers have been widely cited and publicized, and his relentless advocacy on behalf of smoke-free environments helped to curb smoking, save lives, and reduce the toll of disease. “He truly has been a hero in this global effort to fight the smoking epidemic,” says Clifford Douglas, director of the University of Michigan Tobacco Research Network.

And the impact of his work on e-cigarettes? That is decidedly more complicated.

* * *

On April 14, 1994, the CEOs of America’s seven largest tobacco companies stood before a congressional committee and a bevy of television cameras and swore under oath that they did not believe that cigarettes were addictive.

Less than a month later, a Federal Express package containing 4,000 pages of confidential tobacco industry documents arrived at Glantz’s office at UCSF. The return address: Mr. Butts, the name of a character in the comic strip “Doonesbury” who encouraged kids to smoke.

The four-foot-tall stack of papers showed that the tobacco CEOs had lied. “Nicotine is addictive,” said a 1963 memo from a vice president at Brown & Williamson, admitting the company was in the business of selling an addictive drug. The papers were rich with other insights; a letter from movie star Sylvester Stallone to Brown & Williamson promised to use its cigarettes in five movies, in exchange for $500,000.

Working with colleagues at UCSF, Glantz shared the papers with regulators, litigators, and reporters, published research to expose industry tactics, arranged to have the documents digitized, and over time raised millions of dollars to build a vast and valuable archive of materials created by the food, drug, and chemical industries, as well as the tobacco companies. Today, the tobacco archive alone contains more than 14 million items.

“The documents really transformed the whole tobacco issue,” Glantz says.

Big Tobacco and its allies hit back, hard. Brown & Williamson sued UCSF, claiming the documents were stolen. Californians for Scientific Integrity, an industry-funded group, sued the university system, accusing Glantz of scientific misconduct in connection with a study about the impact of smoking bans on the restaurant industry. Congressional allies of the tobacco industry tried unsuccessfully to terminate a National Cancer Institute grant to Glantz, and pro-smoking forces petitioned to cancel his consulting contract with the U.S. Occupational Safety and Health Administration.

In a letter to OSHA asking the agency to sever its ties with Glantz, the National Smokers Alliance called him “an avowed anti-smoking activist.” That was one charge that Glantz couldn’t deny.

Glantz was an anti-smoking activist even before embarking on his career as a tobacco researcher — and often in his career, he has played both roles simultaneously. In 1978, he volunteered to work on a statewide initiative to restrict smoking in public places in California that was defeated by the tobacco industry. “I just got sucked into the campaign leadership,” he says. He was a founder of Californians for Nonsmokers’ Rights, a nonprofit that incorporated in 1981 and grew into Americans for Nonsmokers’ Rights five years later. He helped to lead the 1983 campaign that made San Francisco one of the first major cities in the U.S. to restrict smoking in public, a milestone that made national and international news.

Activism aside, Glantz has an unusual pedigree for a tobacco scientist. Most are physicians, epidemiologists, economists, lawyers, or psychologists. Glantz has a bachelor’s degree in aerospace engineering from the University of Cincinnati — he worked briefly at NASA — and a master’s and doctorate in applied mechanics from Stanford University. His Ph.D. thesis, a study of cardiovascular function, was titled “A mathematical approach to cardiac muscle physiology.”

His understanding of heart mechanics led him into tobacco research in the early 1980s. He found the tobacco work more rewarding, in every sense. Grants from the National Institutes of Health were available to study the effects of smoking, and funding for tobacco research would only grow. In 2009, Congress mandated that tobacco companies start paying annual user fees to finance regulation by the Food and Drug Administration and academic research overseen by the NIH. (The companies paid more than $700 million in 2020.) Private funders including the Robert Wood Johnson Foundation and the Truth Initiative also supported Glantz’s work, which has attracted well over $75 million to UCSF.

More importantly, tobacco research aligned with Glantz’s lifelong commitment to social change. His very first publication, which appeared in Science when he was a graduate student at Stanford, examined the influence of U.S. Department of Defense contracts on research at the university. He embraced his reputation as a rabble rouser, wearing a T-shirt given to him by colleagues that said, “Here Comes Trouble.”

He says his work to achieve a smoke-free society was especially satisfying. It’s easy to forget today that people used to smoke everywhere — at work, in restaurants, on airplanes, even in hospital waiting rooms. In his book, “Tobacco War,” Glantz recalled: “The executive director of the California division of the American Lung Association was a chain-smoker, and the American Heart Association distributed ashtrays and packs of cigarettes at its board meetings.”

With Glantz’s full-throated support, Americans for Nonsmokers’ Rights took the battle to towns and cities across the country. There, unlike in Washington, grassroots activists could defeat the tobacco industry. More than 400 localities passed laws restricting smoking.

The second-hand smoke issue transformed the politics of tobacco. No longer could the industry defend smoking as a matter of individual choice. Smoking was recast as indoor air pollution and a threat to the health of others. In a 1987 editorial in the journal Circulation, Glantz wrote: “The issue should be framed in the rhetoric of the environment, toxic chemicals, and public health, rather than the rhetoric of saving smokers from themselves or the cigarette companies.”

“Unquestionably, Stan was one of the major warriors in the fight against secondhand smoke,” says James Repace, a former official with the Environmental Protection Agency and one of the first scientists to analyze the health impacts of secondhand smoke.

The cigarette companies recognized the threat early on. In a 1978 report to the Tobacco Institute, the industry’s lobbying arm, a public opinion research group sounded the alarm: “This we see as the most dangerous development to the viability of the tobacco industry that has yet occurred.”

* * *

But how dangerous, really, was secondhand smoke? While experts agree that the risks of sustained exposure are high, especially for children, they may not be as high as many advocates claim. Despite lingering uncertainties, opponents of tobacco distilled the science into three words: Secondhand smoke kills. The Surgeon General said in 1986 “there is no risk-free level of exposure to secondhand smoke.” In an anti-smoking bus poster from 1997 depicting an elegantly dressed couple, the man asked: “Mind if I smoke?” The woman replied: “Care if I die?”

In December 2002, after a hard-fought battle, New York City’s then-mayor Michael Bloomberg signed a law that all but eliminated smoking in restaurants and bars. A few months later, Glantz presented the eye-popping findings of his latest study at a meeting of the American College of Cardiology: The rate of heart attacks in Helena, Montana, had fallen by nearly 60 percent after a six-month smoking ban in the small city.

“This striking finding,” he said at the time, “suggests that protecting people from the toxins in secondhand smoke not only makes life more pleasant; it immediately starts saving lives.” Glantz and two local physicians who worked with him on the study also reported that heart attacks returned to their historic levels when the ban was suspended because of a legal challenge.

The Helena miracle, as the study became known, generated global press coverage, including a New York Times op-ed. It was widely touted by anti-smoking groups. But it defied common sense. California had banned smoking in workplaces and bars, with no discernible impact on heart attacks. In other big cities with smoking bans, no one had noticed drops in heart attacks. The small sample size in Helena — four cases per month during the ban, compared to seven beforehand — should have raised red flags; random fluctuations could have explained the drop in hospital admissions.

When the study, which was funded by the National Cancer Institute, was published in the BMJ, the decline in heart attacks was revised downward to 40 percent — still an extraordinary outcome. Detractors pushed back. “I am truly amazed that a study of such poor quality was not only accepted for publication in a journal with the reputation of the BMJ but was accorded widespread coverage in the lay press,” wrote Henry Mizgala, an emeritus professor of medicine at the University of British Columbia, in a response to the journal. “This is, in my opinion, gross misrepresentation designed to provide maximal public impact in furthering the biased and unscientific opinions of these authors.” (Mizgala noted in a disclosure that he had “submitted affidavits on behalf of defendants in the tobacco litigation.”) Glantz’s former student, Michael Siegel of Boston University, was one of a few anti-smoking advocates to challenge the findings. In his own response to the BMJ, he wrote: “I am afraid that the credibility of tobacco control scientists and practitioners may be threatened if scientific claims are made that are not adequately justified.”

Subsequent research with larger sample sizes contradicted Glantz’s findings. England and New Zealand, both of which imposed national bans on smoking in public places, found much smaller impacts — a 2 percent reduction in heart attacks in England, no significant effects in New Zealand. A study by researchers at the Rand Corporation and elsewhere found that the reductions in Helena — which seemed to be confirmed by studies in other small cities, including Pueblo and Greeley, Colorado — were likely a result of their small sample sizes. The authors concluded: “We find no evidence that legislated U.S. smoking bans were associated with short-term reductions in hospital admissions for acute myocardial infarction or other diseases in the elderly, children or working age adults.”

Glantz stands by his findings. (They’re cited in his current biography.) He points out the study found that at the 95 percent confidence interval the effect was real, but ranged from 1 percent to 79 percent, meaning that the reduction in heart attacks could have been much bigger or smaller. However, the caveat was never mentioned by those who cited the study to argue for smoking bans.

The published version of the Helena study acknowledged its limits, noting the city’s small size. “There is always the chance,” the authors wrote, “that the change we observed was due to some unobserved confounding variable or systemic bias.” They concluded by making the modest claim that smoking bans “may be associated with an effect on morbidity from heart disease.”

When describing the study, though, Glantz showed no such restraint. In the original UCSF press release announcing the results, Glantz was quoted as saying: “Smoke-free laws save lives, and they do it quickly.”

This was the beginning of a pattern. Clive Bates, the former director of the London-based anti-tobacco organization Action on Smoking and Health, says Glantz habitually makes claims to the media or on his blog that go well beyond what his research says.

“We didn’t bother too much about it when he was doing things that we thought were good,” Bates said.

That changed with the arrival of the e-cigarette.

* * *

Glantz plays a cameo role in the origin story of vaping. To develop the device that became JUUL, the leading e-cigarette brand in the U.S., two Stanford graduate students dug deep into UCSF’s tobacco industry archives, studying earlier efforts by tobacco companies R.J. Reynolds and Philip Morris to design electronic cigarettes. The students approached Glantz, seeking his support for what they pitched as a tobacco cessation tool. He declined, warning that vaping would appeal to kids.

On that point, he was right. By 2018, after JUUL blitzed young people with marketing on Instagram, in magazines, and on billboards, one in five high school students had used e-cigarettes. The U.S. Surgeon General at the time decried what he called an “epidemic of youth e-cigarette use.” Then again, fewer young people than ever were smoking cigarettes. Some experts described vaping as a disruptive technology that was helping to drive smoking’s long-term decline.

The debate that ensued polarized the tobacco science community. In a commentary in Nicotine and Tobacco Research, nine early-career researchers led by Dana Mowls Carroll of the University of Minnesota expressed concern that “the continued promotion of select, polarized stances on e-cigarettes will threaten the integrity of research.” In a speech at a 2020 conference on e-cigarettes and public health, Steven Schroeder, the former president of the Robert Wood Johnson Foundation and a professor of medicine at UCSF, accused researchers on both sides of engaging in “strident discourse” and “troublesome activities.” He reserved his sharpest criticisms for the opponents of e-cigarettes. “In their anti-vaping advocacy, some have gone beyond the science, stretched the results, cherry picked the analyses, and skated around standard methodological practices,” Schroeder said.

Glantz staked out his position early, and he has stuck to it. In a background paper prepared for the World Health Organization in 2013 — before the so-called epidemic of vaping began — Glantz and two UCSF colleagues called for an array of policies, including flavor bans, to curb e-cigarette use. Glantz has been in the thick of the debate ever since, producing several dozen scholarly papers on e-cigarettes, most in collaboration with others, some widely cited. His work has addressed the most important questions about e-cigarettes. He makes three broad claims, all of them sharply contested.

The first claim is that e-cigarettes encourage young people to smoke cigarettes. Glantz’s 2014 article in JAMA Pediatrics was the first national study to show that e-cigarettes were a “gateway to nicotine addiction for U.S. teens,” according to a UCSF press release. His 2018 study in Pediatrics also claimed that e-cigarette usage encourages more young people to smoke. “I don’t know anybody credible who doesn’t accept the gateway,” Glantz says.

But neither study proved the existence of a gateway effect. The 2014 JAMA Pediatrics paper found associations between vaping and smoking, but there’s no way to know from the data whether young people first vaped and then smoked, first smoked and then vaped, or had a predilection for both. The 2018 Pediatrics paper claimed a gateway effect, but the alleged link between vaping and smoking disappeared when other teen behaviors, such as using marijuana, were taken into account.

The claims made in JAMA Pediatrics were publicly rejected by scientists at the American Cancer Society and the Truth Initiative, anti-smoking groups that for a brief time in the mid-2000s were open to the idea that e-cigarettes could reduce the harm from smoking. (Both now strongly oppose e-cigarettes.) “The data in this study do not allow many of the broad conclusions that it draws,” Thomas Glynn, a researcher who at the time was at the American Cancer Society, told The New York Times. The Journal of the American Medical Association, the parent publication of JAMA Pediatrics, published a critique of the study written by Glynn, Abrams, and Raymond Niaura, a colleague of Abrams at NYU and another longtime tobacco researcher. Bates, the British anti-smoking activist and persistent Glantz critic, called the study’s conclusions “false, misleading, and damaging” in an open letter.

The 2018 Pediatrics paper was also sharply criticized. Population studies provide the most compelling reason to reject claims of a gateway hypothesis, says Niaura. “Cigarette smoking among kids is going down and down and down,” he adds. “If e-cigarette use was driving cigarette use, smoking would be going up.” (Glantz contends that e-cigarettes have slowed the decline.)

The second contested Glantz claim is that e-cigarettes, when sold as consumer products, don’t help smokers quit. Glantz made this case in two meta-analyses — studies that collect and combine data from other studies — one in The Lancet Respiratory Medicine in 2016, another in the American Journal of Public Health in 2020. “The irony is that quitting smoking is one of the main reasons both adults and kids use e-cigarettes, but the overall effect is less, not more, quitting,” Glantz said in a press release announcing the 2016 findings.

Meta-analyses can be problematic, particularly when they mix and match different kinds of research. They depend entirely on the quality of the underlying studies, and the Lancet research fell short in that regard, critics say.

Scientists in the United Kingdom, where health authorities promote vaping as a safer alternative to smoking, blasted the study as “grossly misleading,” “not scientific,” and a “major failure of the peer review system.” Ann McNeil, a professor of tobacco addiction at King’s College London, issued a response to the Lancet paper, saying that it included information about two studies that she co-authored that was “either inaccurate or misleading” and that in one instance Glantz and his co-author, Sara Kalkhoran, then a physician at UCSF, were told before publication “that they were misreporting the findings.” (Glantz says he doesn’t recall the specific details but that he and Kalkhoran would not have ignored such a warning.)

Plenty of countervailing evidence has surfaced since then. In 2015, Kalkhoran left UCSF for Harvard University where she and colleagues studied U.S. adult cigarette smokers for two years. Using data from 8,000 adult smokers, Kalkhoran and her co-authors concluded that “daily e-cigarette use, compared to no e-cigarette use, was associated with a 77 percent increased odds of prolonged cigarette smoking abstinence.” (Kalkhoran did not respond to requests for comment.) Cochrane, an independent network of researchers, examined randomized control trials of e-cigarettes for smoking cessation and wrote: “We are moderately confident that nicotine e‐cigarettes help more people to stop smoking than nicotine replacement therapy or nicotine‐free e‐cigarettes.” In the U.K., an estimated 3.6 million people use e-cigarettes, and nearly two-thirds are ex-smokers, according to Action on Smoking and Health.

None of that will end the debate over whether e-cigarettes can help smokers quit. But even Glantz and his co-authors, in their 2020 meta-analysis for the American Journal of Public Health, ceded some ground. “Daily e-cigarette use was associated with more quitting,” albeit under limited circumstances, they wrote. But Glantz continues to oppose vaping because, he says, the health risks are too great.

The third and final Glantz claim has attracted the most pushback: That e-cigarettes increase the risk of heart attack. In the space of less than a year, Glantz and colleagues produced two studies that led him to push this idea. In August 2018, he described the results from the first study in the American Journal of Preventive Medicine on his UCSF blog under the headline: “Risk of heart attacks is double for daily e-cigarette users.” Ten months later, when describing the second study, published in 2019 in the Journal of the American Heart Association, Glantz said it provided “more evidence that e-cigs cause heart attacks.”

“E‐cigarettes,” he asserted, “should not be promoted or prescribed as a less risky alternative to combustible cigarettes.”

This work was wildly influential with anti-vaping advocates and government health authorities. The American Journal of Preventive Medicine paper was cited by the WHO chief and the U.S. Surgeon General and covered in nearly 200 news stories. A New York Times article read: “Compared with people who never used e-cigarettes, daily users almost doubled their risk for heart attack.”

Critics pounced on what they called glaring flaws in the analyses. Some of the e-cigarette users had previously smoked, for example, muddying the correlation. Brad Rodu, a University of Louisville professor who has numerous and longstanding connections to the tobacco industry, dug into the raw data and found that at least 11 of the 38 heart-attack victims cited in the Journal of the American Heart Association study had suffered their heart attacks before they started vaping — some as many as 10 years before. Glantz was made aware of the temporality problem before publication because it was raised by a peer reviewer, the journal’s editor subsequently realized.

Sixteen tobacco researchers wrote to the journal editor asking for a retraction, and the Journal of the American Heart Association ultimately did just that — something it has done only a handful of times in its history. Its editor, though, was careful to state in a letter to Glantz that “the retraction notice is intentionally absent of any language suggesting scientific misconduct.”

The 2019 American Journal of Preventive Medicine paper came under pressure as well. Twenty-two tobacco scientists asked for a retraction, noting, among other things, that the association between vaping and heart attacks could be due to heavy smokers at risk of heart disease switching to e-cigarettes, or smokers who suffered heart problems then trying to quit with e-cigarettes. To assert or imply causation from the study is irresponsible, they wrote.

“It’s bad science,” says Niaura.

Matthew Boulton, the journal’s editor-in-chief, declined to retract the paper. But, in a letter to the 22 scientists earlier this year, he acknowledged that the paper suffered from “serious methodological issues,” including the fact that the database used by the researchers “makes it impossible to make causal claims.” The journal has asked new researchers to reexamine the issue in a paper that will be presented to readers as a cautionary tale to highlight how data can be misinterpreted.

Glantz remains unrepentant. On his blog, he blamed the Journal of the American Heart Association retraction on “pressure from e-cig interests,” naming Rodu. None of the other scientists who signed the letters seeking retractions appear to have financial ties to the industry. Abrams from NYU once contributed an op-ed to Filter, a publication owned by The Influence Foundation, which has received support from tobacco companies. (Abrams says he was not paid.)

Andrew Gelman, a professor of statistics at Columbia University who followed the controversy on his blog, was unimpressed with Glantz’s response to the retraction, calling it “anti-scientific.” He wrote: “If someone points out an error in your work, you should correct the error and thank the person. Not attack and try to salvage your position with procedural arguments.”

* * *

Last summer, Glantz retired from UCSF, where he had worked for 45 years. “I’m confident,” he wrote to colleagues, “that there will be more ways that I can keep contributing to fighting the tobacco industry and promoting public health.”

His last years at UCSF brought difficulties besides the controversies over his research. Three women filed complaints of sexual harassment against him and sued both Glantz and the Regents of the University of California, who fought the charges in court; the cases were eventually settled without an admission of guilt.

Meanwhile, there were worrisome signs that the campaign against e-cigarettes led by the Campaign for Tobacco-Free Kids and the Truth Initiative — which by this time had switched its stance on e-cigarettes — was having unintended consequences.

Minnesota enacted a steep tax on e-cigarettes that led to “increased adult smoking and reduced smoking cessation,” a study by researchers with the National Bureau of Economic Research found. In a story headlined “Smoking’s Long Decline is Over,” The Wall Street Journal reported that some e-cigarette users may have returned to combustible cigarettes “because of increased e-cigarette taxes, bans on flavored vaping products, and confusion about the health effects of vaping.” Public opinion polls showed that most people believed, wrongly, that vaping is as dangerous or more dangerous than smoking.

About the timing of his retirement, Glantz says he’d been planning for years to step away from UCSF. He’ll continue to produce academic research and engage in activism, he adds, speaking out on his blog and elsewhere. He says he is proud of having mentored dozens of researchers over the years: “It’s important to give opportunities to others.”

Siegel, one of those mentored by Glantz, has mixed feelings about his mentor. “I love him,” Siegel says. “He’s accomplished great things.” But Siegel says he no longer trusts Glantz and the anti-tobacco nonprofits. “The science is not driving the anti-smoking agenda,” he says. “Rather, the anti-smoking agenda appears to be driving the interpretation of the science.”

For his part, though, Glantz argues that the increasingly popular perception of e-cigarettes as dangerous is a positive development — and one backed by the science. “None of the people who are e-cigarette enthusiasts,” Glantz says, “know anything about biology.”

* * *

Marc Gunther is a veteran reporter whose interests include philanthropy, psychedelics, animal rights, and tobacco.

This article was originally published on Undark. Read the original article.

The post Here comes trouble: an anti-tobacco hero’s complicated legacy appeared first on Salon.com.

If that sounds like a stretch, it probably is. Last month, Juul settled a $40 million lawsuit that accused the company of luring in teens to use its flavored vape products, allowing Juul to avoid the potential PR nightmare of a widely covered jury trial. Juul has also spent tens of millions in federal lobbying efforts over the past several years, presumably in an effort to block comprehensive regulations on the sale of e-cigarettes. 

But the most bizarre Juul news came two weeks ago, when the New York Times reported that the company had funded an entire issue of a scientific journal, in which every article presented evidence that vaping is a beneficial harm-reduction practice that can wean smokers off tobacco cigarettes. 

Last month, the American Journal of Health and Behavior (AJHB), a 44-year-old academic journal that has published many nationally recognized scholars, released a special edition specifically devoted to the question of whether e-cigarettes are harmful or helpful. The 219-page issue is unusual not just by virtue of its niche subject matter — e-cigarettes are a relatively new phenomenon in the field of health behavior — but also because its publication was bankrolled entirely by one source: Juul Labs. 

This fraught episode comes at an exceptionally tumultuous time for the vape maker. In early 2019, Juul, a company founded just four years earlier, was riding a wave of explosive success, boasting $1 billion in revenue. Sales had grown by 641% from 2016 to 2017 alone. A national survey in 2019 found that nearly 30% of U.S. high school students reported using e-cigarettes in the last month, with 60% of them naming Juul as their preferred brand. 

In 2018, the tobacco giant Altria — previously known as Philip Morris — took a 35% stake in Juul, believing the acquisition might help recover some of the company’s losses from an overall decline in U.S. cigarette sales over the past several decades. Only a few months later, however, disaster struck. A mysterious respiratory ailment, clearly linked to vaping, sickened more than 1,000 people in the U.S., and by the fall of 2019, 34 vape users had died from lung injuries. Facing an array of potentially devastating lawsuits and pressure from the Food and Drug Administration (FDA), Juul voluntarily pulled its products from many store shelves and canceled its youth advertising campaigns, rapidly losing more than 30% of its market share. 

Now Juul remains in something like corporate limbo, awaiting FDA approval to continue selling its vape products in the U.S. The agency will likely decide this year whether the alleged health benefits of Juul products outweigh their potentially addictive qualities. It’s not entirely surprising, then, that Juul wanted to subsidize an entire edition of a medical journal: Its survival as a corporation is on the line. 

But is the Juul-sponsored journal ethical? That’s a murkier question than it might appear. The special issue of AJHB makes no attempt to conceal the fact that essentially all the studies it contains were funded and facilitated by Juul. As The American Prospect notes, a cursory glance at the journal’s “Conflict of Interest” statements reveals that 18 co-authors of articles in the special issue are Juul employees. 

Five other co-authors work at PinneyAssociates, a firm that “provides consulting on harm reduction exclusively to JUUL Labs,” as its senior scientific adviser, Dr. Saul Shiffman, told Salon by e-mail. “We participate in JUUL’s work to publish their scientific research to inform the public dialogue about tobacco harm reduction,” he added. An additional three co-authors are involved in the Centre for Substance Use Research, another consulting firm that has a contract with Juul. Nearly every study in the issue features the brand name in its title, and all of them effectively conclude that Juul’s products are a safe form of harm reduction.

As one paper in the journal, a study based on population modeling, puts it, “after considering both potentially beneficial and potentially harmful transitions and based on the available evidence to date — the (continued) availability of ENDS [i.e., vape products such as Juul’s] in the US is likely to have a positive impact on population mortality.”

The edition’s closing perspective, written by Dr. Karl O. Fagerström, a Swedish psychologist who specializes in smoking cessation and “tobacco harm reduction,” waxes a bit more philosophical. “Because it is unlikely that humankind will give up drugs, nicotine included,” he writes, “the findings from the studies presented in this issue suggest that ENDS, and JUUL in particular, can be an acceptable substitute for more harmful cigarette alternatives.” (It is duly noted that Fagerström has served as a paid consultant to Philip Morris International and British American Tobacco.)

Outside the world of corporate-sponsored research, the existing scientific literature is mixed, at best, on the question of whether products like Juul offer effective means of smoking cessation. One study from the University of California, San Francisco, found last year that Juul’s products deliver “more nicotine to the blood per puff than cigarettes or previous-generation e-cigarettes (e-cigs) and [impair] blood vessel function comparable to cigarette smoke.”

Another study published this year in Pediatrics, the official journal of the American Academy of Pediatrics, found that e-cigarette smokers are three times more likely to switch to tobacco cigarettes later on. Other studies have found that e-cigarettes elevate the risk of heart disease, high cholesterol and depression.

To get a better sense of how this strange edition of a previously respected journal came into being, Salon contacted dozens of people listed as associate editors or senior associate editors at AJHB — none of whom are paid for their work there. Virtually none of them knew about the Juul-sponsored edition prior to its release.

“There was certainly no email sent out to any of the editors that this was going to happen,” Dr. Richard Olmstead, a research psychologist at UCLA’s Semel Institute for Neuroscience and Human Behavior, and an associate editor of AJHB, told Salon. “I think there would have been quite a bit of pushback had there been some forewarning about it.”

Dr. Carl Fertman, a professor emeritus at the University of Pittsburgh’s School of Education and an associate editor at the journal, described the special issue as a “complete surprise.”

“There was no transparency,” he said in an interview with Salon. “I don’t want to be associated with this journal. It’s upsetting.”

“I think it’s fairly unusual that a single company would sponsor a special issue,” another associate editor told Salon, asking not to be identified by name. “I was surprised to see they called out a specific company in every article.” This person added that was “different” from anything they’d seen before in “any scientific behavioral journal.”

A number of editors, however, acknowledged that there’s nothing new about seeing corporations sponsor scientific research they believe will be favorable to their bottom line. 

For decades, the tobacco industry worked diligently to steer the scientific consensus away from the conclusion — now universally accepted — that cigarette smoking causes lung cancer, emphysema and other serious or life-threatening health problems. Central to that strategy was ginning up fake controversy by pushing junk science that appeared to contradict the overwhelming weight of scientific and medical evidence. Tobacco companies poured money into shadowy front groups that supported dubious science, paid consultants to prepare “expert” testimony to Congress and regulatory bodies and suppressed internal research findings that made clear that the companies themselves understood their products were killing people.

In 1998, a torrent of secret internal documents from a number of tobacco giants was released to the public as part of the Tobacco Master Settlement Agreement. By the early 2000s, the veil was just about lifted. Ruling on a landmark Justice Department suit back in 2006, U.S. District Judge Gladys E. Kessler found that several big-name tobacco companies, including Philip Morris, had systematically defrauded the American public with a decades-long effort to launder pro-tobacco “science” through academic and government channels. 

To be clear, Juul is not a tobacco company. It makes and sells e-cigarettes, aka “vapes,” which contain no tobacco and are meant to simulate the experience of smoking cigarettes. They deliver high doses of nicotine to the brain through water vapor, often flavored in various ways. Whether vaping is “safe” remains an unsettled question, but it’s not the same thing as smoking.

Still, the fact Altria holds a significant interest in Juul creates an uncomfortable parallel, even if the two companies’ products would seem to be in competition. Juul’s decision to bankroll an entire edition of a medical journal struck many people as reminiscent of the Big Tobacco playbook. 

Following AJHB’s publication of the special edition, a number of editors resigned from the journal, according to New York Times reporting later confirmed by Salon. Most editors declined to comment on the scientific merit of the papers published in the special edition. But there are reasons to be dubious about how the journal’s peer-review process worked in this case.

Before studies are published in any scientific journal, they are typically subject to peer review, in which experts in the relevant field read the papers and offer comments. As AHJB states in its ethical guidelines: “To decrease bias during the editorial process, we employ the classic double-blind peer review process. … The Editor-in-Chief transmits reviewer evaluations and comments to the corresponding author, usually within 4 weeks.” 

AJHB editor-in-chief Dr. Elbert Glover, however, apparently told reviewers that the issue was about e-cigarettes in general — and then offered them cash rewards to complete their reviews within a week, according the the Philadelphia Inquirer. Many editors told Salon that in itself was unusual. Only after reviewers reportedly began to ask questions about “fishy” aspects of the studies did Glover reveal that the entire issue was funded by Juul. One reviewer told the Inquirer that the design of one particular study seemed so biased that she recommended it be rejected outright. “I thought, ‘No way it wasn’t funded by Juul,'” she said. 

In an email exchange with Salon, Glover acknowledged that he had been privately approached by Juul, who personally paid him $57,500 to publish the edition. (Glover is the sole owner of the publication.) He maintained, however, that the peer review process was conducted in good faith.

“Reviewers were not initially notified regarding the funder of the special issue as it has been journal policy to not identify the funder of special issues during the review process,” Glover wrote to Salon. “However, during the review process, one reviewer requested the identity of the funder. As a result of the reviewer’s response, I decided to share the identity of the funder with all the reviewers of the special issue.”

Asked whether he believed it was appropriate to publish a corporate-sponsored special issue without consulting the other listed editors, Glover responded that it had not occurred to him, saying he “was more concerned about the science and did not consider who funded this issue.”

“I should have been more perceptive to their issue,” he said. “In retrospect, it was probably an error but I still do not understand the ability to ignore science and allow negative bias to enter into the decision.

“My philosophy is to allow the scientific merit to determine publication, not personal bias. Just because the tobacco industry lied, manipulated data and currently promote a product that causes death, does not mean that I have to compromise my values.”

But it’s precisely because of the tobacco industry’s dark history of lies and manipulative spin that Glover should have come clean about Juul’s sponsorship from the beginning, say experts on the other side of the issue.

“The problem is that the tobacco industry has a decades long history of spinning science to meet its regulatory, legal and PR needs,” wrote Dr. Stanton Glantz, former director of the Center for Tobacco Control Research and Education, in a blog post responding to AJHB’s special issue.

As one meta-analysis of research data found in 1998, “the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry.” 

A number of AJHB editors told Salon that any study funded by an interested party, especially a large corporation, should be met with heightened scrutiny. One said it was “a red flag when the authors are part of the organization that sponsored the research,” adding: “It doesn’t mean that one can dismiss all of the findings, but it needs to be carefully scrutinized.”

It remains unclear which way the wind is blowing for Juul. In September 2019, the FDA issued a formal warning to the company, making clear that “before marketing tobacco products for reduced risk, companies must demonstrate with scientific evidence that their specific product does in fact pose less risk or is less harmful.” 

“JUUL has ignored the law,” the department added, “and very concerningly, has made some of these statements in school to our nation’s youth.”

Months later, it was reported that Juul had begun beefing up its scientific staff, hiring a number of former FDA officials and recruiting researchers in hopes of clearing potential regulatory hurdles. Last July, Juul submitted a Premarket Tobacco Product Application (PMTA) to the FDA, providing “detailed scientific data from over 110 studies totaling over 125,000 pages evaluating the product’s impact on both current users of tobacco products and nonusers, including those who are underage.”

The Juul-sponsored special issue of AJHB is one aspect one part of the company’s PMTA, a Juul spokesperson told Salon in a statement. 

“The research in the special issue derives from an extensive research program designed to provide the US Food and Drug Administration’s Center for Tobacco Products with information, scientific data, and analysis to determine whether JUUL products are appropriate for the protection of public health,” the statement read. “This determination, through the submission of Premarket Tobacco Product Applications (PMTAs), is based on a rigorous, science-based process. Indeed, FDA has received not only the findings and reports reflected in the published papers, but also the subject-level data and other supporting information required through the PMTA process.”

In April of this year, six major health organizations — including the American Academy of Pediatrics, the American Cancer Society, the American Heart Association and the American Lung Association — wrote a letter to the FDA urging the agency to reject Juul’s Premarket Tobacco Product Application.

“The devastating combination of appealing flavors that appeal to youth, targeted marketing strategies, and technological innovations that deliver a powerful hit of nicotine, has caused enormous damage to public health, primarily through youth uptake,” they wrote. “Because of this, no JUUL products currently on the market can meet the public health standard, and therefore, none should be authorized by CTP or be allowed to stay on the market.”

The FDA is expected to rule on Juul’s application by Sept. 9.

The post Shades of Big Tobacco: How (and why) Juul bought an entire issue of a scientific journal appeared first on Salon.com.

The tobacco and entertainment industries have long and tangled histories — including product placement in movies, television sponsorships and promotional relationships with glamorous Hollywood stars. In 2012, the U.S. Surgeon General’s report found “a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.”

Now new forms of nicotine consumption are being reflected in popular culture. Is vaping in movies and television merely a case of history repeating or something else entirely?

Smoking exits stage left

From Humphrey Bogart’s hardboiled detective roles in the 1940s through teen rebels like James Dean and Olivia Newton-John in Grease to Sharon Stone’s femme fatale in the 1990s, smoking was a constant sight for cinema-goers until recently. Then attitudes and policies began to change in line with health warnings and government regulations.

While some major tobacco companies state they no longer pay for or allow their tobacco brands to appear on screen, depictions of smoking remain relatively common, including in global streaming service content with high youth viewership.

Equally, entertainment content creators, such as Disney, have stated they will no longer include smoking depictions in content aimed at children. But policy exceptions mean smoking depictions on screens continue.

Now vaping is also being depicted in films and on television.

Researched since the 1930s but first commercialised in 2003, e-cigarettes were designed to look like cigarettes, cigars, pipes, pens or memory sticks. As told in the podcast The Vaping Fix, battery-operated products like Juul were proposed as a safer form of smoking. They are emerging as far from harmless. In Australia it is illegal to sell e-cigarettes containing nicotine.

Vaping hits the big time

The increasing popularity of e-cigarettes, vaping devices, and heated tobacco has seen these products appear in popular movies and television shows.

One of the earliest on-screen examples of e-cigarette use is from the 2010 film, “The Tourist,” which features Johnny Depp’s character using an electronic cigarette on a train.

Kevin Spacey’s character vapes in a luxe room in the second season of “House of Cards.”

In 2014, a Canadian e-cigarette company reportedly paid for its product to be used by the female lead, played by Milla Jovovich, in the film adaption of “Cymbeline.”

At first glance it seems the vaping industry is simply repeating the highly successful tobacco marketing strategies of the past.

Since these early examples of e-cigarette use on screen, the global tobacco industry has become heavily invested in vaping products and their promotion. Exposure to vaping depictions and imagery on social media platforms is rife and includes paying high profile users to promote e-cigarettes and tobacco products.

On 29 June 2021, e-cigarette maker Juul, of which tobacco giant Altria (parent company of Philip Morris USA) has a 35% share, agreed to pay the US state of North Carolina $40 million for allegedly marketing to teenagers.

From glamour to gritty

In contrast to early cinematic cigarette smoking, vaping in the critically acclaimed and popular television series, “Mare of Easttown,” is depicted as less than glamorous.

Kate Winslet stars as the titular character. Mare is a small-town detective who is haunted by family tragedy and is part of a community affected by drug use, violence, limited health and social services, and poverty. She vapes in scenes of high stress and to escape conflict situations.

While Mare is a highly sympathetic character, her vaping is depicted as an addiction, not as an aspirational activity. (Insiders say the vape was a prop only and didn’t contain nicotine or tobacco.)

Mare also smokes a cigarette in the series which is a realistic portrayal, as nearly 40% of U.S. adult e-cigarette users also smoke. Her smoking is not depicted as desirable or fashionable and the series’ themes make it decidedly adult viewing.

This stands in stark comparison to previous Winslet roles. In the 1997 film “Titanic,” her Rose character smokes using a slender cigarette holder while in the elegant dress and surrounds of the luxury cruise liner.

Other high-profile recent portrayals of vaping on screen include Rosamund Pike’s character, Marla, in the film, “I Care a Lot.” Her character has previously run a failed vape business.

There is no evidence or suggestion the vaping in “Mare of Easttown” or “I Care a Lot” is directly sponsored by the vaping or tobacco industry. These particular depictions may accurately reflect the reality of vaping and its growing popularity.

Can we regulate it?

Given Australia’s strict regulation of vaping products, including advertising restrictions and a ban on the retail sale of any devices that contain nicotine, no paid vaping product placement would be permissible in content that is produced in Australia. However, much of the media and entertainment content viewed in Australia is not made here.

Similarly, while paid tobacco placement or sponsorship of media content produced within Australia would be a violation of the Tobacco Advertising Prohibition Act 1992 Act, it does not prevent content made overseas, that may contain paid promotions, from being distributed here.

Tobacco depictions, even those that glamorise or promote smoking, are permissible provided these is no support or payment by the tobacco industry. Tobacco use may be considered though by the Australian Classification Board when assigning a classification rating.

Several policy solutions have been proposed to reduce smoking depictions on screens and these could equally apply to vaping depictions. They include adult ratings on content that depicts use, certifying that no payoffs were received for vaping depictions and not making vaping brands identifiable on screen.

With the smoking and media landscape changing, it is critical Australia keeps pace with a ban on the advertising and promotion of all tobacco and vaping products.

Becky Freeman, Associate professor, University of Sydney and Christina Watts, , University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The post Vaping on film looks less glamorous than the Hollywood smoking of yesteryear appeared first on Salon.com.

A potential solution to tobacco-related deaths is a corporate “death penalty” – otherwise known as judicial dissolution – when a judge revokes a corporation’s charter for causing significant harm to society. The legal procedure forces the corporation to dissolve; it ceases to exist. Both management and employees lose their jobs.

Although legal, corporate death penalties in the U.S. have not been used in years. Yet even the threat of one can be effective. For example, simply announcing the intention to revoke the charters of two tobacco industry misinformation groups (the Council for Tobacco Research and the Tobacco Institute, Inc.) resulted in both quietly closing in 1999.

I became intrigued with corporate death penalties while researching another topic – alternative energy sources. One statistic stuck with me from my own research: Replacing coal power with solar energy would save an estimated 50,000 American lives per year because of the air pollution produced by coal-fired power plants. The dead would fill the seats of the Sun Bowl.

With solar already widely available and less costly than coal, and as coal companies continue to go bankrupt, there seems no reason to drag out the inevitable. I began to wonder: Is there a way to control an industry that causes unnecessary death?

Cigarette smoke wreaks havoc on the body.

Setting the minimum bar

Building a generalized model for applying a corporate death penalty first requires the comparison of human rights to an industry’s right to existence. My model relies on three assumptions, based on the U.N.’s Universal Declaration of Human Rights:

• Everyone has the right to life.
• Everyone has the right to work.
• Human law should give corporations the right to exist if they benefit humanity.

Put simply, corporations may act as a single legal entity – that is, as a person – to efficiently create jobs and generate profit for the benefit of humans. When corporations create profit and jobs, they can largely be viewed as good, unless they interfere with our right to life.

That last bit is the tricky point. Essentially, it means a company or industry, at the very least, must earn its right to exist by employing more people than it kills each year. Perhaps that sounds a bit arbitrary, but let’s call that the minimum bar for an industry’s existence. (This is the absolute minimum. Most people, including myself, would agree that a single job does not equal the value of one life.)

Industries that would be banned

Imagine the corporate death penalty dealing with a new industry represented by a flagship company: “Lazy Assassins Inc.” Lazy Assassins, under aggressive corporate leadership, estimates it could employ 120,000 professional killers that would eliminate one victim per employee per quarter. That’s 480,000 lives per year.

That’s almost exactly the number of Americans the tobacco industry employs, and almost exactly the number of Americans it kills each year: 124,342 jobs and 480,000 deaths, including 41,000 from secondhand smoke. To put it another way, four Americans die every year for each tobacco industry employee.

Granted, with tobacco companies, this is an all-or-nothing proposition. If only a handful of companies had their corporate charters revoked, other tobacco companies would simply ramp up production to fill the demand.

But if all the charters were revoked, no tobacco company would exist to fund distribution or advertising. There would be only limited access to tobacco products. They could still be produced and used, just not on an industrial scale. That way, we would still maintain the “rights” of smokers to harm themselves.

We have made major changes to our economy to prevent even more COVID-19 deaths. With that in mind, isn’t it reasonable to help 124,342 people find new jobs in exchange for saving 480,000 American lives every year?

Joshua M. Pearce, Wite Professor of Materials Science & Engineering, and Electrical & Computer Engineering, Michigan Technological University

This article is republished from The Conversation under a Creative Commons license.

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The public service message: This is what can happen if you smoke.

I had nightmares about that ad, which today would most likely be tagged with a trigger warning or deemed unsuitable for children. But it was supremely effective: I never started smoking and doubt that few if any of my horrified classmates did either.

When the government required television and radio stations to give $75 million in free airtime for antismoking ads between 1967 and 1970 — many of them terrifyingly graphic — smoking rates plummeted. Since then, numerous smoking “scare” campaigns have proved successful. Some even featured celebrities, like Yul Brynner’s posthumous offering with a warning after he died from lung cancer: “Now that I’m gone, don’t smoke, whatever you do, just don’t smoke.”

As the United States faces out-of-control spikes from COVID-19, with people refusing to take recommended, often even mandated, precautions, our public health announcements from governments, medical groups and health care companies feel lame compared with the urgency of the moment. A mix of clever catchphrases, scientific information and calls to civic duty, they are virtuous and profoundly dull.

The Centers for Disease Control and Prevention urges people to wear masks in videos that feature scientists and doctors talking about wanting to send kids safely to school or protecting freedom.

Quest Diagnostics made a video featuring people washing their hands, talking on the phone, playing checkers. The message: “Come together by spending time apart.”

As cases were mounting in September, the Michigan government produced videos with the exhortation, “Spread Hope, Not Covid,” urging Michiganders to put on a mask “for your community and country.”

Forget that. Mister Rogers-type nice isn’t working in many parts of the country. It’s time to make people scared and uncomfortable. It’s time for some sharp, focused, terrifying realism.

“Fear appeals can be very effective,” said Jay Van Bavel, associate professor of psychology at New York University, who co-authored a paper in Nature about how social science could support COVID response efforts. (They may not be needed as much in places like New York, he noted, where people experienced the constant sirens and the makeshift hospitals.)

I’m not talking fear-mongering, but showing in a straightforward and graphic way what can happen with the virus.

From what I could find, the state of California came close to showing the urgency: a soft-focus video of a person on a ventilator, featuring the sound of a breathing machine, but not a face. It exhorted people to wear a mask for their friends, moms and grandpas.

But maybe we need a PSA featuring someone actually on a ventilator in the hospital. You might see that person “bucking the vent” — bodies naturally rebel against the machine forcing pressurized oxygen into the lungs, which is why patients are typically sedated.

(Because I had witnessed this suffering as a practicing doctor, I was always upfront about the trauma with loved ones of terminally ill patients when they were trying to decide whether to consent to a relative being put on a ventilator. It sounds as easy as hooking someone to an IV. It’s not.)

Another message could feature a patient lying in an ICU bed, immobile, tubes in the groin, with a mask delivering 100% oxygen over the mouth and nose — eyes wide with fear, watching the saturation numbers rise and dip on the monitor over the bed.

Maybe some PSAs should feature a so-called COVID long hauler, the 5% to 10% of people for whom recovery takes months. Perhaps a professional athlete like the National Football League’s Ryquell Armstead, 24, who has been in and out of the hospital with serious lung issues and missed the season.

These PSAs might sound harsh, but they might overcome our natural denial. “One consistent research finding is that even when people see and understand risks, they underestimate the risks to themselves,” Van Bavel said. Graphs, statistics and reasonable explanations don’t do it. They haven’t done it.

Only after Chris Christie, an adviser to President Donald Trump, experienced COVID, did he start preaching about mask-wearing: “When you have seven days in isolation in an ICU, though, you have time to do a lot of thinking,” Christie said, suggesting that people, “follow CDC guidelines in public no matter where you are and wear a mask to protect yourself and others.”

We hear from many who resist taking precautions. They say, “I know someone who had it and it’s not so bad.” Or, “It’s just like the flu.”

Sure, most longtime smokers don’t end up with lung cancer — or tethered to an oxygen tank — either. (That, in fact, was the justification of smokers like my father, whose two-pack-a-day habit contributed to his death at 47 of a heart attack.)

These new ads will seem hard to watch. “We live in a Pixar era,” Van Bavel reflected, with traditional fairy tales now stripped of their gore and violence.

But studies have shown that emotional ads featuring personal stories about the effects of smoking were the most effective at persuading folks to quit. And quitting smoking is much harder than maintaining physical distance and mask-wearing.

Once a vaccine has proved successful and enough people are vaccinated, the pandemic may well be in the rearview mirror. In the meantime, the creators of public health messaging should stop favoring the cute, warm and dull. And — at least sometimes — scare you.

Subscribe to KHN’s free Morning Briefing.

The post It’s time to scare people about COVID appeared first on Salon.com.

“The flavor ban was associated with statistically significant immediate increases as well as reductions over time” in the use of cigarettes by young adults and youth, wrote researchers from George Mason University’s College of Health and Human Services in a study published the Journal of Adolescent Health. They note that by 2017, the probability that a youth would be a smoker fell by 43% while the chance that a young adult would be a smoker fell by 27%. Older adults’ smoking behavior did not change. The study defined “youth” as individuals between the ages of 12 and 17, and “young adults” as individuals between the ages of 18 and 25.

To determine whether young people smoked fewer cigarettes after the ban, the researchers led by Dr. Matthew Rossheim looked at National Survey on Drug Use and Health data regarding smoking among young people and adults taken between the years 2002 and 2017.

The scholars argue that all flavors and tobacco products should be included in future flavor bans to both maximize the effectiveness of the policy in keeping young people away from smoking, and to reduce the health disparities impacting African Americans.

Carol McGruder, co-chair of the African American Tobacco Control Leadership Council, has advocated banning menthol cigarettes and cigarillos in order to reduce smoking among African Americans. The Centers for Disease Control and Prevention reports that nearly 9 out of 10 African Americans prefer mentholed cigarettes, meaning cigarettes that contain a substance found in mint plants to mask the tobacco flavor and create a cooling sensation. Some civil rights activists oppose this, however, on the grounds that the ban could be abused by law enforcement figures.

“I think there is an Eric Garner concern here,”  the Rev. Al Sharpton told The New York Times in July. Sharpton was referring to the 43-year old African American man who was murdered by police in 2014 as they put him in a chokehold. Garner had been arrested on suspicion of selling cigarettes.

It has also been found that adding flavors to tobacco products creates a false sense of security among consumers.

“Cigarillo pack flavor descriptors, such as grape and sweet, and colors such as pink and purple resulted in more favorable product perceptions among young adults,” wrote Leah Ranney, director of tobacco prevention and evaluation at University of North Carolina at Chapel Hill. “These pack attributes had a greater impact on how people who had never used cigarillos perceived product flavor and taste, compared to current cigarillo users, and people who have previously used them.”

The post Banning flavored cigarettes significantly reduced youth smoking, study finds appeared first on Salon.com.

Cold Spring Harbor Laboratories Fellow Jason Sheltzer and Google engineer Joan Smith analyzed previous data findings for their article published earlier this week in the scientific journal “Development Cell.” They wrote that when people smoke cigarettes, the smoke causes their lungs to produce a protein called ACE2 (angiotensin-converting enzyme 2). The coronavirus latches on to this protein and uses it to enter human cells. Sheltzer and Smith speculate that this may explain why people with a history of smoking are uniquely vulnerable to severe infections if they contract the novel coronavirus.

The good news? Because the change is reversible, quitting smoking can improve your odds of survival if you contract the coronavirus.

In the aftermath of the coronavirus pandemic, there were some studies that offered mixed feedback on the relationship between smoking cigarettes and being harmed by the coronavirus. One, which was led by Greek cardiologist and tobacco harm-reduction specialist Dr. Konstantinos Farsalinos, concluded that a “preliminary analysis does not support the argument that current smoking is a risk factor for hospitalization for COVID-19.” It went on to speculate that “nicotine may have beneficial effects on COVID-19,” although it added that “other confounding factors need to be considered and the accuracy of the recorded smoking status needs to be determined.” Another study, led by French neuroscientist Jean-Pierre Changeux, similarly speculated that nicotine could prevent coronavirus.

Dr. Russell Medford, chairman of the Center for Global Health Innovation in Atlanta, told Salon that the potential benefits of nicotine must not be conflated with the proved risks of smoking.

“The nicotinic acid hypothesis that is the basis for all of these studies is not unreasonable from a molecular standpoint,” Medford told Salon. “The data that relates to cigarette smoking to the progression of COVID-19, in the most recent study that I’m referring to, shows a significant risk of progression of disease in patients who have a current or recent or have a history of smoking. The two are not linked.”

He added, “The nicotinic acid hypothesis and cigarette smoking are not to be linked together. I think that there is an incorrect assessment of the available data, that for some reason cigarette smoking is somehow protective, and it is simply not borne out by any of the data that I’ve seen. And indeed, a great deal of the data on meta-analysis suggests just the opposite — that outcomes and disease severity are enhanced by cigarette smoke.”

In an editorial for The Hill, John Maa, M.D., the past-president at San Francisco Marin Medical Society, and Dr. Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University, raised questions about the integrity of the French study by pointing out that Changeux has “ties to the tobacco industry, having previously accepted $220,000 from the tobacco industry-funded Council for Tobacco Research in the 1990s, and collaborated with RJ Reynolds and Philip Morris.”

The post Studies that said smokers were at lower risk for coronavirus were likely wrong. Here’s why appeared first on Salon.com.

Oddly, such rumors seemed to be rooted in a grain of truth. (We’ll get to that later.) Still, Salon spoke with three experts, all of whom said the same thing: it is almost certain that smoking puts you at greater risk of dying from a coronavirus infection.

“They’re not saying that smoking prevents [coronavirus]. They’re saying that nicotine prevents it,” Dr. William Haseltine, the founder and former CEO of Human Genome Sciences, and currently the chair and president of the global health think tank Access Health International, told Salon regarding an April study in “Comptes rendus biologies” led by French neuroscientist Jean-Pierre Changeux.

“Smoking clearly exacerbates it. The nicotine, maybe an acetone,” Haseltine continued. “I can tell they have to show the data, and I don’t think they show the data here. All they do is speculate. But the danger is that many people may conflate nicotine with smoking. That’s definitely bad for you.”

He added, “There are many studies around the world, many different populations have shown that if you are a current smoker, your chance of dying from an infection is much higher than if you were not. This paper opens the possibility that nicotine may be a useful treatment; it doesn’t show it, but speculates based on some detective logic. That logic may be correct. I can’t say because I have to do the experiments to know if it is correct.”

The study that Haseltine referenced was popularized by a Vice article last month with the headline “Why Are Smokers Being Hospitalized Less Often From Coronavirus?” It noted how the Changeux study found that “of 343 hospitalized patients, only 4.4 percent were recorded as smokers; of 139 outpatients, only 5.3 percent were recorded as smokers.” Changeux notes that “more than a quarter” of the French population smokes cigarettes. 

The article also featured a study led by Greek cardiologist and tobacco harm-reduction specialist Dr. Konstantinos Farsalinos, which concluded that their “preliminary analysis does not support the argument that current smoking is a risk factor for hospitalization for COVID-19 . . . . Instead, these consistent observations, which are further emphasized by the low prevalence of current smoking among COVID-19 patients in the US (1.3%), raises the hypothesis that nicotine may have beneficial effects on COVID-19.” It acknowledged that “other confounding factors need to be considered and the accuracy of the recorded smoking status needs to be determined. However, the results were remarkably consistent across all studies and were recently verified in the first case series of COVID-19 cases in the US.” 

“The generalized advice to quit smoking as a measure to improve health risk remains valid, but no recommendation can currently be made concerning the effects of smoking on the risk of hospitalization for COVID-19,” the study concluded.

Dr. Russell Medford, chairman of the Center for Global Health Innovation in Atlanta, shared his own thoughts with Salon about the studies in question.

“The nicotinic acid hypothesis that is the basis for all of these studies is not unreasonable from a molecular standpoint,” Medford explained. “The data that relates to cigarette smoking to the progression of COVID-19, in the most recent study that I’m referring to, shows a significant risk of progression of disease in patients who have a current or recent or have a history of smoking. The two are not linked.”

He added, “The nicotinic acid hypothesis and cigarette smoking are not to be linked together. I think that there is an incorrect assessment of the available data, that for some reason cigarette smoking is somehow protective, and it is simply not borne out by any of the data that I’ve seen. And indeed, a great deal of the data on meta-analysis suggests just the opposite — that outcomes and disease severity are enhanced by cigarette smoke.”

Medford shared two scholarly articles with Salon that support his claims regarding how smoking increases one’s vulnerability during the pandemic. One was written by Roengrudee Patanavanich, MD and Stanton A Glantz, PhD and published in the May 13 issue of “Nicotine & Tobacco Research.” It concluded that “smoking and e-cigarette use increases risk and severity of pulmonary infections because of damage to upper airways and a decrease in pulmonary immune function. In particular, smokers have a higher risk of infection and mortality from Cov-MERS.”

The other study was published in the journal “PLOS One” earlier this month and concluded that “compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. . . .  Effective preventive measures are required to reduce COVID-19 risk in COPD [chronic obstructive pulmonary disease] patients and current smokers.”

Dr. Georges Benjamin, executive director of the American Public Health Association, echoed Haseltine’s and Medford’s observations.

“People should not think that smoking is going to help them with their disease,” Benjamin explained. “We know that that is not the way the pathology of the disease works. When you smoke, you injure the lining of your airway and your lungs, and you may actually make yourself more susceptible to the virus. Now it may very well be that nicotine has some impact on the virus, but it’s not going to be outweighed by the injury that you have by smoking.”

John Maa, M.D., the past-president at San Francisco Marin Medical Society, and Dr. Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University, wrote an editorial in The Hill warning against studies that suggest smoking can reduce one’s susceptibility to the coronavirus. They pointed out that “a careful review of the data [from the French study] instead reveals the findings are more likely due to statistical flaws and sampling error, along with poor rates of screening and documentation of smoking history by physicians.” They also expressed concern that the lead author of the French study, Jean-Pierre Changeux, had “ties to the tobacco industry, having previously accepted $220,000 from the tobacco industry-funded Council for Tobacco Research in the 1990s, and collaborated with RJ Reynolds and Philip Morris.”

“Until we have unbiased data, supported by solid research design, and free of any tobacco industry influence, we would caution against the likely myth that smoking protects from acquiring COVID-19,” Maa and Halpern-Felsher wrote.

The post Here’s how that rumor that smokers can’t get COVID-19 got started appeared first on Salon.com.

As it turns out, much of this pollution originates not in a person’s own neighborhood, but up to hundreds or even thousands of miles away in neighboring states. And, absent strong federal regulations, there’s very little Americans can do about it.

In a study published on Feb. 12, we used state-of-the-art modeling to estimate the number of air pollution-related deaths that combustion emissions — those from any kind of burning, from cook stoves to car engines to coal power plants — from each state have caused in every other state over the past 14 years.

On average, 41% of these air pollution deaths in the U.S. resulted from what we call “secondhand smoke” emissions that crossed state lines.

This share has been declining over time, down from 53% in 2005, thanks in large part to reductions in sulfur dioxide emissions from the electric power sector. However, not every sector, or every state, has been a success story.

Secondhand smoke — but nationwide

The problem is like what people experience when they are exposed to secondhand cigarette smoke. The smoker endangers their own life the most, but the smoke that gets passed on still poses serious health risks to those exposed.

Outdoor air pollution works this way on a national scale. States emit pollution that, with rare exception, causes the most air quality issues for people within the same state. But that pollution also crosses state lines, leading to tens of thousands of additional early deaths.

Without strong regulations, people in neighboring states have no control over their exposure to “imported” air pollution. They will simply have to put up with it, just as restaurant diners or airline passengers used to do when seated near the smoking section.

Improvements and stagnation

We used estimates of combustion-related emissions from the U.S. Environmental Protection Agency’s National Emissions Inventories. These estimates break down emissions by sector — rail, road, commercial and electricity generation — and chemical species — sulfur dioxide, nitrogen oxides and soot.

Using computer models of the movement and chemistry of air pollution, we were able to calculate the contribution that each sector made to pollution across the country, and how this has changed over time.

For example, we calculated that over 70% of all electricity generation-related early deaths occurred outside of the state in which the emitting plant is located.

In 2005, emissions from this source caused about 24,000 early deaths in the U.S. — 6,000 in the states where the plants were based, but 18,000 in other states. By 2018 those figures had dropped to 9,000 total.

Federal regulations — such as the Cross-State Air Pollution Rule and its predecessor, the Clean Air Interstate Rule — enabled this improvement by mandating reductions in power plant emissions of sulfur dioxide and nitrogen oxides. The EPA has made huge progress in this area by any standard.

Similarly, improving emissions standards for road vehicles between 2005 and 2018 reduced the health impacts from road pollution by 50%, from around 37,000 to 18,000 early deaths per year.

Other sectors have been less successful. Although emissions from rail transportation have fallen over the same period, the total number of early deaths due to their emissions has stayed almost the same. This is due in part to the fact that the air is getting cleaner. As it does so, more pollution will form in response to the same emissions — regardless of the specific sector. Reductions in rail emissions have been too modest to compete with this change.

Meanwhile, early deaths due to emissions of fine particulate matter from the commercial and residential sectors, such as soot from heating and cooking, have increased, from around 20,000 early deaths in 2005 to 28,000 in 2018. Of these, about one-third came from activity originating in another state.

Different land, same air

The number of deaths occurring in each state is not uniform across the U.S., even in percentage terms. The different population densities, distributions and industrial compositions of each state also play a role, as does state policy.

For example, we found that only 3% of the total U.S. early deaths caused by California’s combustion emissions are exported to other states. By contrast, Wyoming exports 96% of the early deaths from its emissions. That’s because Wyoming is small, sparsely populated, upwind of the East Coast and has a large industrial base.

For any given state, these exports are mostly balanced by imported pollution from upwind states, but there are some notable exceptions. A case in point is the Northeast, which exports much of its own emissions out to the ocean.

Overall, our findings reflect the need not only for ongoing investigation of U.S. cross-state air pollution, but also for federal regulation that’s strong enough to significantly reduce it and help save Americans’ lives.

The Clean Air Interstate and Cross-State Air Pollution Rules have brought significant improvements, reflected in the overall downward trend we find for combustion air pollution-related deaths in the U.S. over the last 14 years. But more work at the national level is needed to bring these numbers down further.

Until then, states and their residents will continue to have no refuge from their neighbors’ secondhand smoke.

Sebastian Eastham, Research Scientist, Massachusetts Institute of Technology and Steven Barrett, Professor of Aeronautics and Astronautics, Massachusetts Institute of Technology

This article is republished from The Conversation under a Creative Commons license.

The post The secondhand smoke you’re breathing may have come from another state appeared first on Salon.com.

It’s not like I’m going to take it up again. It will not become my midlife counterargument to yoga retreats and kombucha brewing. I am quite happy to live in a world where we no longer pretend that airplanes and restaurants have magical force fields that can confine smells to designated sections. I like that my hair and my clothes — and those of the people I most enjoy hugging and kissing — do not reek like old ashtrays. It’s nice walking down streets that aren’t strewn with butts. I enjoy spending money on things other than stinky, addictive substances. And I really love the whole thing where fewer people die of very preventable causes. But also, don’t you ever just want to have a cigarette again? To just sit back in a public place and take a little trip to Flavor Country?

Smoking is the toxic, ugly boyfriend all your other friends hated. The one you still sometimes think, “Yeah, but we had some good times” about. For me, smoking will always be entwined with family, with travel, with adventure, with nostalgia. The smell of a cigarette is objectively disgusting; it’s also rooted in a profound and happy place in my memory. It’s one of the first aromas I ever knew. So let’s start there.

It seems completely insane now, of course, but I was born into smoking. My mother and I lived with my grandparents, and Pop was both a steady, serious drinker and a committed, day-long smoker. Into the home of my earliest years also steadily passed my three uncles, all of them similarly accessorized with a permanent Marlboro between their fingers. The women of the family, meanwhile, were either quiet, sneaky smokers in the alleyway or vehement protestors of the habit. I learned the emotional power and mystery of smoking young.

My Pop died of aggressive lung cancer before I turned three. Smoking eventually played a role of the deaths of all my uncles as well. But when I was little and my Nan’s sons would drop by, filling the house with noise and beers and the masculine perfume of Old Spice and tobacco, smoking always brought exciting disruption. This was a time, by the way, when you could still go to any corner store and buy candy made to look like cigarettes, starter packs for kids. I practiced constantly.

It nevertheless took a long time and many failed attempts to figure out how to smoke on my own. And I didn’t ever become truly proficient at it. In old photos that show me smoking, I always look vaguely puzzled, like I have no idea how this strange object arrived in my hand and I am awaiting instructions on what to do with it.

But I remember arriving in Dublin as a college student, and finding myself on a wet winter night in a tobacco stained pub made famous by James Joyce. Somebody handed me a hot whiskey with lemon and honey (I was still very much a Long Island iced tea person at the time). Someone else opened up a pack of Rothmans and pointed it toward me like it was the most natural thing in the world. I was instantly surrounded with new friends. At some point later, I remember fumbling to light a match and a girl explaining how to, in her words, “Strike it like a bloke.” The trick is to swiftly pull the match toward from you, with no hesitation. I think of that, still, when I light the stove.

I never was a big smoker — I could go days without a single one and then demolish no more than half a pack in a night. Maybe that’s why I still associate it with something special, like a treat at the end of a long day. I remember visiting a friend in China, where she demonstrated her new skill at rolling her cigarettes as we polished off a feast of dim sum. I remember taking turns dragging on a single Camel in the darkened kitchen of a man I was crazy about, an act that seemed somehow an intimate extension of what we’d been doing just prior. I remember having the excuse to linger with someone interesting, a little longer, communicated with the flick of a lighter.

Before cellphones, a cigarette was what you occupied yourself with when you wanted to look busy. No, I am not just standing here at the party with nothing to do like a loser; clearly I am deeply engaged in the business of polishing off this Silk Cut. Yes, I would love to dance with you, but I’m so sorry, I have this cigarette to take care of, like a needy pet. Sure thing, boss, I’ll schedule all those meetings for you — just as soon as I get back from my break. Gosh, I would like to meet that person over there; I will go over and bum or offer a cigarette, an instant shot of bravery. That bus is sure taking forever to get here; might as well smoke. I am nervous and stressed; at least this will grant the temporary feeling of reprieve.

I stopped for the same reasons everybody else did. It’s bad for you, it’s bad for the people you’ve living with, it’s expensive, there’s nowhere to do it any more anyway. Fifty years ago, roughly 40 percent of the American population smoked; now only about 14 percent does. Even among people who do smoke, the number of cigarettes they consume per day has plummeted. This is great news for our lungs, air, and wallets, and bad news for the tobacco industry, which isn’t going down without a fight.

As smoking has declined, vaping has skyrocketed, especially among youths. In a 2018 NIH survey, 37 percent of high school seniors said they’d vaped in the last 12 months. Granted, that number encompasses all vaping, but it does demonstrate the continued stranglehold that nicotine has, especially over the young and vulnerable. And the decline in smoking has not been felt proportionally across all Americans. The CDC notes that smoking rates have continued to be higher “among males, those aged 25-64 years, people who had less education, American Indians/Alaska Natives, Americans of multiple races, those who had serious psychological distress, those who were uninsured or insured through Medicaid, those living below the poverty level, those who had a disability, those who were lesbian, gay, or bisexual, and those who lived in the Midwest or South.” Smoking is toxic; it’s also a comfort device and a social bonding tool. I certainly understand that.

The last time I even tried to smoke — a defiant, condemned prisoner gesture after my cancer diagnosis — I got about three puffs in before giving up in nauseated disgust. The last time I really, really wanted to was November 9, 2016 — or as I like to call it, my worst birthday ever. I didn’t. But in my hardest moments, some part of my brain still craves the brief, blissful, all is right feeling that only a deep inhalation of garbage can provide. I don’t suppose that will ever entirely go away.

I know that smoking is a thing that exists firmly in my past, and I hope, never becomes a part of my daughters’ present. I know that everything I miss around smoking can never be recaptured, because it’s all gone. The late nights. The bars with the dirty walls. My uncles, flicking ashes in a heavy amber ashtray in the middle of the table. Most of the time, I’m fine about it. But every once in a while, I’ll pass a stranger on the street and a familiar fragrance will drift into my nostrils. I’ll catch a memory of a friend. A feeling of a time. It’ll feel heady and sweet. And then just as quickly, it’ll disappear. Up in smoke.

The post My God, I miss smoking appeared first on Salon.com.

McGruder, co-chair of the African American Tobacco Control Leadership Council, has tried for years to warn lawmakers that menthol attracts new smokers, especially African Americans. Now that more officials are willing to listen, she wants them to prohibit menthol cigarettes and cigarillos, not just e-cigarette flavors, to reduce smoking among blacks.

McGruder and other tobacco control researchers are using the youth vaping epidemic — and the vaping-related illnesses sweeping the country — as an opportunity to take on menthol cigarettes, even though they are not related to the illnesses.

“We started to see that vaping is something that we could leverage in order to deal with this whole menthol issue,” said Valerie Yerger, an associate professor of health policy at the University of California-San Francisco.

Menthol is a substance found in mint plants that creates a cooling sensation and masks tobacco flavor in both e-cigarettes and cigarettes. Those properties make menthol more appealing to first-time smokers and vapers, even as they pose the same health threats as non-menthol products and may be harder to quit.

Nearly nine out of 10 African American smokers prefer mentholated cigarettes, according to the Centers for Disease Control and Prevention.

But even as tobacco control activists see opportunity, some African Americans, including smokers, fear discrimination. They predict that banning menthol will lead to a surge in illicit sales of cigarettes and result in additional policing in communities that already face tension with law enforcement.

Joseph Paul, director of political and civic affairs at City of Refuge Los Angeles, a church with about 17,000 members in Gardena, Calif., spoke at a board of supervisors meeting in September against a proposed flavor ban in Los Angeles County that was adopted a week later.

If officials truly wanted to end youth vaping, he later told California Healthline, the ordinance should have targeted only vape flavors and exempted adult smokers and their menthol cigarettes.

“Menthol cigarettes are very popular in the black community, my people smoke menthol cigarettes,” he said.

The Los Angeles County ban prohibits sales but not possession of flavored e-cigarette products, menthol cigarettes and chewing tobacco in the unincorporated area of the county, inhabited by about 1 million people. Shops have until April to clear their shelves of flavored tobacco products.

Paul warned that people will start selling menthol cigarettes illegally: “It’s supply and demand.” That will make the community more vulnerable to police harassment, he said.

In New York City, when officials proposed a ban on menthol cigarettes earlier this year, which has yet to be acted upon, the Rev. Al Sharpton made a similar argument against the measure: Banning menthol would lead to greater tensions with police in black communities.

“I think there is an Eric Garner concern here,” the civil right rights activist told The New York Times in July, referring to the well-known case of a 43-year old black man who died in a chokehold in 2014 while being arrested by New York City police on suspicion of selling single cigarettes.

The flavor bans that are currently sweeping the country have more to do with e-cigarettes than menthol cigarettes.

That’s because a mysterious vaping-related illness has sickened more than 2,050 people nationwide and led to at least 39 deaths. In California, at least 150 residents have fallen ill and at least three have died, according to the California Department of Public Health.

Most of those illnesses have been associated with vaping cannabis products, and yet politicians’ urge to adopt flavored tobacco bans continues.

In July 2016, Chicago became the first major U.S. city to ban menthol cigarette sales, but it limited the prohibition to within 500 feet of schools.

Of the more than 200 communities in the country that restrict or ban the sale of flavored tobacco, fewer than 60 include restrictions on menthol cigarettes, according to the Campaign for Tobacco-Free Kids.

Aspen, Colo., will ban all flavored nicotine products, including menthol cigarettes, effective Jan. 1. A few communities in Minnesota already have such bans in place. In California, close to 50 communities restrict or ban flavored tobacco products; of those, more than 30 include restrictions on menthol cigarettes. Notably, San Francisco banned menthol cigarettes along with all flavored tobacco products in 2018, before banning all vapes and e-cigarettes earlier this year.

At the national level, the Food and Drug Administration banned the sale of flavors in combustible cigarettes in 2009, but exempted menthol. Last November, the agency proposed a ban on menthol-flavored combustible cigarettes, calling their use among youths “especially troubling,” but it has not yet taken action.

Then the Trump administration said in September it would soon ban all flavored e-cigarette products, but it may now be backing away from banning mint and menthol.

Menthol, which was first added to cigarettes in the 1920s, is as old-school as it gets when it comes to flavored tobacco, yet it hasn’t prompted action in the way that vape flavors such as cotton candy and strawberry-melon have. That’s because vaping was embraced by a specific population: affluent white teens, Yerger said.

Big Tobacco aggressively pushed menthol cigarettes on black youths in the 1950s and 60s, and now some people consider Kools and Newports part of black culture, McGruder said.

McGruder and others point out that the tobacco industry has supported and funded civil rights groups and causes, forming relationships with prominent black leaders such as Sharpton. Big Tobacco acknowledged that it has contributed to Sharpton’s organization, the National Action Network, and similar groups.

McGruder said it’s difficult for the African American community to contradict respected male civil rights and religious leaders, so when they argue that menthol bans will lead to criminalization, the community listens.

But Bobby Sheffield, a pastor and vice president of the Riverside County Black Chamber of Commerce, said the criminalization argument is a scare tactic.

“We’re not trying to have anyone incarcerated because they have this product in their possession,” Sheffield said. His organization, which represents local businesses, started campaigning this year for menthol bans in California’s Inland Empire, including the cities of Riverside, San Bernardino and Perris.

Some smokers understand the need to keep tobacco out of the hands of children, but they don’t think it’s fair to include menthol cigarettes.

“It’s stupid. Now they’re trying to act like menthol cigarettes are the problem. These have been around for a long time,” said April Macklin of Sacramento, who smokes Benson & Hedges menthols. She smoked when she was younger, quit, and started again three years ago.

The city of Sacramento will ban the sale of flavored tobacco, including menthol cigarettes, effective Jan. 1.

Macklin, 53, said she might just quit because she won’t smoke anything other than menthol. But even with a ban in place, she doubts menthol cigarettes will be gone for good. “I’m sure people will figure something out,” she said.

The post Flavor bans multiply, but menthol continues to divide appeared first on Salon.com.

“My friends are the ones who got me into vaping. And they think I shouldn’t stop, but I want to because I don’t want to hurt my family if I get sick.”

“I feel like I get winded easily and I just know it’s not good for me. I want to quit so bad but it’s really hard when all your friends are vaping around you.”

These are just a few of the messages that teen vapers texted in September to the new “My Life, My Quit” program, which offers phone, text and chat lines to young people trying to quit smoking in 13 states.

Even though “quitlines” were designed to help people kick cigarette habits, calls and texts from people who use e-cigarettes are climbing as more people fall ill with a mysterious and devastating respiratory illness linked to vaping.

Health officials are investigating 1,299 cases in 49 states and the District of Columbia, including at least 26 deaths. In California, more than 120 residents have fallen ill, at least three of whom died, according to the California Department of Public Health.

The department in September called on everyone to refrain from vaping, “no matter the substance or source,” while the investigations continue. The Centers for Disease Control and Prevention also advised people to “consider refraining” from using e-cigarette products, especially those that contain THC, the main psychoactive ingredient in marijuana, which has been linked to most of the illnesses.

The rise in calls to help lines means the message is penetrating, said Stanton Glantz, director of the University of California-San Francisco Center for Tobacco Control Research and Education.

“The more we learn about e-cigarettes, the more dangerous they look,” Glantz said. “Callers are right to be worried, frankly.”

Optum, which operates tobacco quitlines for 23 states and the District of Columbia and for more than 1,000 employers, logged a 50% increase in callers asking for help to quit vaping since the CDC released its first report on the illnesses in early September, said Seth Serxner, the company’s chief health officer.

The majority of state quitlines are run by Optum or National Jewish Health, a respiratory research hospital in Denver, whose My Life, My Quit program is aimed at youths. National Jewish Health runs help lines for 16 states — not all of which offer My Life, My Quit — enrolling about 100,000 people each year into tobacco cessation programs.

The quitlines are publicly funded, and the counseling is free.

Almost 20% of callers to Optum’s help lines said they used vapes, up from 3% during the same period in 2015, Serxner said.

“People are going, ‘Whoa, I didn’t know this was that bad for me,’” he said.

In July, National Jewish Health enrolled 88 people into its cessation program who said they vaped exclusively. In August and September combined, the organization enrolled 457 people who vaped exclusively, more than five times the July figure, said Thomas Ylioja, clinical director for health initiatives at the organization.

Calling 1-800-QUIT-NOW routes callers to counselors in their state, where they can get counseling to help them set quit dates and identify triggers that could lead to a relapse. If clients give permission, counselors follow up with them in the days and weeks after their initial call, when quitting can be most difficult.

Depending on where callers live and what kind of insurance they have, they may qualify for free nicotine replacement therapy, like patches, gum, lozenges or prescription medication. Vapes and e-cigarettes are not a federally approved treatment for smoking cessation, so help lines have not recommended them to clients to help them quit.

Not all state quitlines are seeing an uptick in calls. Calls from vapers were flat for West Virginia’s help line from July through September compared with the same period in 2018, said Lindsy Hatfield, program director for First Choice Services, which operates the state’s quitline.

But starting in August, Hatfield noticed that some callers didn’t realize that their Juul e-cigarettes, the nation’s most popular brand, could addict them to nicotine, even though it is listed as an ingredient on the package.

“Some people we found did not know that Juul was an e-cigarette, vape or nicotine device,” Hatfield said. “They felt that Juul did not have nicotine in it, and so it couldn’t be the same thing” as an e-cigarette.

The University of California-San Diego runs California’s tobacco quitline (which offers help in English and Spanish) and serves about 30,000 callers a year. It also runs a national help line for people who speak Mandarin, Cantonese, Vietnamese and Korean.

Since 2017, the quitline has received a steady increase in calls from people who vape. Most said they were using e-cigarettes to quit or cut down on cigarettes because they thought of vapes as a “better alternative,” said Niki Hoang, a San Diego-based counselor and former smoker who has been with the help line for seven years.

Hoang and her colleagues noticed a change this summer: Callers who used vapes to quit cigarettes are now trying to quit vaping, she said.

And smokers who have never tried vaping are vowing to stay away, saying they don’t want to “be the guinea pig,” according to Hoang.

The summer’s influx of calls prompted the help line to train the California staff — about 60 counselors — on the history of the devices and how to counsel people who want to quit.

The calls for help are a far cry from 2007, about the time vapes hit the U.S. market and were described as safer than cigarettes.

Millions have started using them since then, including teens and young adults. Recent federal data funded by the National Institute on Drug Abuse shows that 25% of this year’s high school seniors and 20% of 10th graders reported vaping nicotine in the past month. That’s more than double the use reported in 2017.

Little research exists on the best strategies to stop vaping, so quitline counselors generally employ techniques they’d use for cigarette addiction.

But there is at least one key difference between smoking and vaping that might make the latter more difficult to quit, said Ylioja of National Jewish Health. Vapers have an easier time evading restrictions on smoking in indoor spaces or public places because the smell dissipates faster, he said.

That makes it difficult for vapers to make a plan to avoid situations or people sparking future cravings.

“They have a harder time identifying what triggers might be,” Ylioja said. “They were using these products in so many different social situations.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

The post As vaping illnesses rise, so do pleas to quit-smoking help lines appeared first on Salon.com.

They’re speaking out after a slew of attacks on their way of life. President Donald Trump announced his support for a vaping flavor ban in September. Some states temporarily banned the sales of vaping tools or flavors. And the Centers for Disease Control and Prevention has warned people to stop vaping until public health experts can find the cause of more than a thousand cases of lung injuries nationwide.

The backlash from vapers and vape shop owners is getting louder as they argue their small businesses and their rights to what some see as a smoking cessation tool are being trampled.

“Rather than just vote a party ticket, they may in fact change their vote for anybody who comes out and wants to have a critical conversation about vaping,” warned Alex Clark, the CEO of the Consumer Advocates for Smoke-Free Alternatives Association, a self-described tobacco harm-reduction nonprofit in Plattsburgh, N.Y.

Political groups are noticing that vaping is an identity, not just a hobby. Conservative powerhouse Grover Norquist, whose Americans for Tax Reform group hosted over 200 vaping advocates last month in Washington, D.C., cautions this is an electorate Trump should not ignore for 2020.

Vaping activists have already claimed success in a handful of races. Now some advocates say this burgeoning anger could shape the votes of the nation’s more than 10 million adult vapers and 20,000 vape shop owners.

“Are there enough vapers to swing states like Michigan?” added YouTube vaping influencer Matt Culley. “Absolutely.”

The vaping electorate

Jason Volpe has owned a vape shop in Caledonia, Mich., for six years. He supports raising the age to buy tobacco to 21 and encourages young customers to use products with lower levels of nicotine.

Volpe, who voted for both President Barack Obama and Trump, is not afraid to talk about politics in his shop. He gives discounts on Election Day to customers with an “I voted” sticker.

Lately, he said, his customers come in angry at what they call government overreach. They are unhappy with Democratic Gov. Gretchen Whitmer, who temporarily banned the sale of nearly all flavors of vaping liquid.

“That’s not supposed to happen in America,” Volpe said. “Are they going to come after our guns next?”

He said his customers — from the liberal to the “very red farmers” — feel under attack. It’s a common grievance in a community that sees itself as continually marginalized by the government even after some vapers used the devices to quit smoking.

There’s a strong libertarian and conservative streak in the movement that the Libertarian Party has capitalized on, selling “I Vape I Vote” T-shirts online alongside a pledge to “vote for candidates who support vaping.” Issues surrounding vaping, like supporting small businesses and promoting personal liberty, are a natural fit for this segment of the right.

Clark, the “smoke-free” advocate, is a registered Democrat who is disappointed that the left isn’t embracing vaping. He considers it hypocritical for them to back marijuana legalization but not vaping.

Volpe just wants his shop to stay open. He feels betrayed that people with heroin addictions can have a safe place to use drugs and that flavored alcohol is still on the market, but not the blueberry maple syrup-flavored vape juice he uses. The stress around the flavor ban sent him to the emergency room last month. What he thought was a heart attack turned out to be anxiety.

A vaper voting block?

Vocal vapers point to Wisconsin Republican Sen. Ron Johnson’s shocking election victory in 2016 as proof of their power.

Johnson became a folk hero on vaping websites after pushing back on proposed Food and Drug Administration vaping regulations. But early in fall 2016, the incumbent was down in the polls and not expected to recover.

Then Mark Block got involved. He’s the former chief of staff for Republican Herman Cain’s 2012 presidential campaign and owned an online vape store at the time. Block said he met with at least a hundred vape shop workers across the state and leveraged their networks to contact what he estimates was upward of 200,000 voters. Some shops registered people to vote. He also started a political action committee, Vape PAC, which raised over $3,000 and distributed some 400,000 postcards.

After Johnson’s victory, the senator specifically thanked vapers: “You made tonight possible; I truly appreciate it. I will be on your side.”

But Tom Russell, campaign manager for Johnson’s opponent, former Sen. Russ Feingold, doesn’t buy the idea that vapers swung the election, saying he didn’t see any money or data to that effect.

“The reality is to the extent there was a Tea Party, previously unmotivated voting bloc, they were motivated by Donald Trump,” he said. “I’m pretty sure it wasn’t ‘Vape Nation.’”

Vaping advocates also point to a 2014 state election in New Mexico as an early victory for their growing cause. That year, state Rep. Liz Thomson, a Democrat, lost her reelection bid to Republican Conrad James, a pro-vaping candidate who got a last-minute boost from Clark’s CASAA and vaping groups. The American Vaping Association put out a celebratory press release, and Americans for Tax Reform called Thomson vaping’s “first victim.”

Thomson, though, considers the loss a fluke, not the work of vapers. “I do not believe they had any effect in my race,” said the legislator, who later won back her seat. “It was a confluence of factors that was bigger than their group.”

In 2018, Block joined the late stages of the California race of embattled U.S. Rep. Duncan Hunter. Known as the vaping congressman, the Republican has helped create pro-vaping legislation.

But he was indicted for campaign finance violations in 2018.

Reusing the 2016 playbook, Block went to vape store after vape store in the last three weeks of Hunter’s race, handing out postcards with an illustration of the congressman vaping that say “Blaze your own trail.”

Hunter narrowly won.

What’s next

Those races were almost like a practice run. Right now, vaping activists are scrambling to create the framework for a broader political campaign.

Clark said CASAA feels pressure to make a voting guide, but it doesn’t have the resources to figure out which candidates are truly pro-vaping. The group’s first attempt at a guide in 2016 involved surveys sent to some 900 candidates, but Clark said only 200 or so of the “most fringe” candidates responded.

The American Vaping Association, a nonprofit advocacy organization in Stratford, Conn., is training vapers on the basics of politics — how to speak at local government meetings, register people to vote and talk to the press and elected officials without getting worked up, said its president, Gregory Conley. He also is focused on targeting primaries, where he said it’s a lot easier and less expensive to have impact.

The seeds of a grassroots movement seem to be in place. The organizing and get-out-the-vote work is happening online and in vape shops, which Norquist calls the “megachurches” of this community.

The Vapor Technology Association, a trade group that represents e-liquid manufacturers, vape shops and other vaping professionals, said state and local associations are ahead of the national organization when it comes to voter mobilization.

“We haven’t really had to move them because they’re doing it already,” said Chris Howard, the association’s board treasurer.

Vapers are terrified they’re about to lose what they say is the only tool that saved them from smoking — and saved their lives. That’s a powerful motivating force, Culley said. Plus, all the jobs lost from a potential flavor ban — which Trump had announced his support for on Sept. 11 — wouldn’t be a good look for the president, he said.

Trump followed that announcement with a tweet two days later that was more ambiguous about his intentions for a ban: “While I like the Vaping alternative to Cigarettes, we need to make sure this alternative is SAFE for ALL! Let’s get counterfeits off the market, and keep young children from Vaping!”

The damage was already done, according to vape shop owner Mike Moran, who offers customers voter registration paperwork in his two stores in New Jersey. He blames Trump’s initial tweet for kicking off the wave of state bans.

“If Donald Trump lets this go down because of his misstatement, I’ll vote against him,” Moran said. “His words caused this.”

The post “We vape, we vote”: How vaping crackdowns are politicizing vapers appeared first on Salon.com.

Many people don’t know what is contained in these vaping devices, what the reported health effects actually mean, and, most importantly, why all of this developed so quickly, considering that e-cigarettes have only been popular for fewer than 10 years.

Vaping describes the process of inhaling aerosols generated by devices such as e-cigarettes.

When e-cigarettes first came to the U.S. in 2006, many smoking cessation experts were optimistic. They viewed the delivery of nicotine through e-cigarettes to be a useful alternative to traditional cigarettes. That is because e-cigarettes did not have all of the other harmful combustion products inhaled through cigarette smoke. Since there is no doubt that smoking traditional cigarettes is harmful to your health — and the number one cause of preventable death in the U.S. — e-cigarettes were marketed as a “safer” alternative.

As an inhalation toxicologist, I study how inhaled chemicals, particles and other agents affect human health. Since e-cigarettes were introduced, I have been concerned about how the scientific community could possibly know the full spectrum of their dangers. After all, it took decades for epidemiologists to discover that regularly inhaling the smoke from burning plant material, tobacco, caused lung cancer. Why would the scientific community be so quick to assume e-cigarettes would not have hidden dangers that might take years to manifest too?

Do e-cigarettes even work as a cessation tool?

Many smokers have reported that switching from cigarettes to e-cigarettes has helped their physical well-being, including reduced coughing.

But a few randomized clinical trials examining the use of e-cigarettes as a cessation tool have shown mixed results. While some trials demonstrate a significant increase in cessation success (from 9.9% to 18%), people using e-cigarettes were much more likely to remain dependent on nicotine as compared to those randomized for more traditional nicotine replacement products, such as nicotine patch, gum and nasal spray. Or, they were more likely to relapse to using cigarettes.

In short, whether, how, and to what extent e-cigarettes have potential as a cessation tool is not yet settled, especially considering that more than 80% of smokers randomized to use e-cigarettes continued to smoke after the cessation trial.

Safer than a spitting cobra

Cessation claims aside, the messaging of e-cigarettes as a “safer” alternative may have led many of the 3.6 million teenagers in the U.S. who use e-cigarettes today to believe these devices are “safe.” “Safer” does not equal “safe,” and the messaging of “safer” was based on comparisons to cigarettes.

Public Health England, the equivalent of the FDA in the U.K., stated in 2015 that “while vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger.”

This statement did not consider the fact that health effects of inhaling flavoring chemicals contained in popular e-cigarettes are completely unknown, or that heating liquids in these devices causes thermal decomposition of those e-cigarette chemicals that “pose limited danger” into known toxicants. It also did not consider that e-cigarettes are a fast evolving consumer product with ever-changing devices and chemicals, creating mixtures and exposures of unknown health consequences.

This mistake was further advanced by assessing the adverse health effects caused by using e-cigarettes as a comparison to what occurs when someone smokes cigarettes for several years. It is well established that smoking cigarettes causes diseases such as chronic obstructive pulmonary disease, chronic bronchitis, emphysema and cancer. Many of these diseases do not manifest clinically until many years after the first cigarette has been smoked.

No controlled studies were ever conducted assessing whether using e-cigarettes causes any adverse health effects in people who never smoke. To this day, scientists do not know the potential long-term health consequences of using e-cigarettes for decades.

E-cigarettes cause very different health effects than cigarettes

I think that scientists and policymakers should completely stop comparing vaping outcomes to smoking outcomes. The now 450-plus confirmed cases of vaping-associated lung injuries prove this point. The clinical manifestations in these patients are not something a doctor would ever see in somebody who has been smoking cigarettes for a few months.

Similarly, these clinical outcomes have not been reported in marijuana users, even though THC, the psychoactive ingredient in marijuana, has now been associated with a large percentage of these cases.

Furthermore, the onset of these significant health problems is much faster than one would anticipate from smoking-related diseases. Since doctors are seeing severe diseases after relatively short exposures, does that make vaping more harmful than cigarettes?

Considering that the compounds inhaled through cigarette smoke are very different from those inhaled through the vast number of different flavored e-cigarettes and vaping devices, wouldn’t that be like comparing apples and oranges? Nobody would consider it reasonable to compare health effects caused by smoking cigarettes to those induced by smoking crack.

A lot of attention is now being placed on identifying the potential “culprit” for the observed health effects in the more than 450 cases of vaping-induced lung injury. Additives contained in THC liquids have emerged as a potential cause.

However, not all cases identified by the CDC have a documented history of vaping THC, and some have only reported a history of using nicotine products. Furthermore, case reports of vaping-associated lung injury with symptoms similar to those reported by the Centers for Disease Control and Prevention but no history of THC use have been documented before, suggesting that vaping-associated lung injury has been detected before this recent rise in reported cases.

In addition, other vaping-associated clinical outcomes have been reported as well, indicating that vaping-induced adverse health effects can vary. Hence, it is premature to draw any conclusions regarding which compounds — and there are likely several — inhaled by vaping nicotine or THC containing products are causing specific types of lung injury.

While it is too early to say whether or to what extent e-cigarettes can be used to support smoking cessation, one conclusion can already be drawn: Vaping is not without health effects.

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Ilona Jaspers, Professor of pediatrics, microbiology and immunology, and environmental sciences and engineering, University of North Carolina at Chapel Hill

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The post Vaping likely has dangers that could take years for scientists to even know about appeared first on Salon.com.

For nearly 50 years, cigarette advertising has been banned from TV and radio. But electronic cigarettes — those battery-operated devices that often resemble oversized USB flash drives with flavored nicotine “pods” that clip in on the end — aren’t addressed in the law.

Since launching its product in 2015, Juul Labs, based in San Francisco, has taken the e-cigarette market by storm, and now accounts for roughly 75% of e-cigarette sales at convenience stores and mass retail outlets. Until recently, TV ads haven’t played a role in Juul’s marketing, which relied primarily on social media.

But this year, the company launched a $10 million TV advertising campaign, “Make the Switch,” that it said was aimed at helping adults find a healthier alternative to smoking cigarettes. The campaign also features print and radio ads.

Many public health advocates are skeptical of the company’s repeated assertions that adult smokers are its target audience. When the company launched its sleek e-cigarette four years ago, it relied on social media outletssuch as Facebook, Instagram and Twitter to promote its product in ads that, especially at the beginning, featured playful, partying 20-somethings.

As the product caught on, young people helped spread the word to other young people using hashtags like #juul. Social media influencers who posted content praising Juul amplified the message.

“There’s overwhelming evidence that the behavior of Juul contributed to the product being sold to youth,” said Dr. Robert Jackler, a professor and the principal investigator at Stanford Research Into the Impact of Tobacco Advertising (SRITA) at the university’s medical school.

Juul said it is not targeting children and teens and supports efforts to limit tobacco products to people under age 21. “We recognize that youth use of vapor products is a problem that requires an effective and appropriate response from industry and regulatory bodies,” said Ted Kwong, a Juul Labs spokesman. “We strongly support restrictions on social media marketing of vapor products.”

In recent years, the number of high schoolers and even younger kids who say they’ve used e-cigarettes has grown rapidly, alarming parents and public health advocates.

Last year, almost 21% of high school students reported using e-cigarettes in the previous 30 days, according to an analysis of National Youth Tobacco Survey data published by the federal Centers for Disease Control and Prevention. In 2011, the proportion was just 1.5%. Between 2017 and 2018 alone, the number of high school students who said they were current e-cigarette users grew by 78%, to more than 3 million students overall. The CDC said 1 in 20 middle school students, those in grades 6 through 8, reported vaping in the previous 30 days.

In contrast, 3% of adults said they used e-cigarettes in 2017, according to the CDC.

E-cigarettes, also called vapes, were introduced in the United States in the mid-2000s. Some early versions resembled actual cigarettes. Juul’s product can be plugged into a USB port to recharge and fits inconspicuously into the palm, often frustrating parents and teachers seeking to stop teens from using it.

There’s evidence that smoking e-cigarettes may act as a “gateway” that leads young people to try cigarette smoking. And cigarette smoking remains the leading cause of preventable death, killing more than 480,000 people in the United States every year.

E-cigarettes don’t produce tar, in which most of the cancer-causing and other harmful chemicals from tobacco smoke are found. But both products contain nicotine, which is highly addictive and can harm the developing brains of adolescents.

In addition, the vapor that people inhale when the liquid nicotine in e-cigarettes is heated may contain cancer-causing chemicals, heavy metals and other dangerous substances.

Nevertheless, e-cigarettes are often touted as a healthier alternative to cigarette smoking, and that’s the premise of Juul’s “Make the Switch” campaign. The testimonial ads feature adults describing the positive changes in their lives after they gave up smoking cigarettes to use Juul.

“We want adult smokers to hear directly from former adult smokers that Juul Labs provides a true alternative to combustible cigarettes and is showing unprecedented success, with studies showing 40 to 56 percent of adult smokers fully switching within 90 days of use,” said Kwong.

Although adolescents may be more likely to see ads in social media than traditional broadcast and print ads, the Juul TV ads probably have an impact on them, said Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University School of Medicine who developed a tobacco prevention toolkit for teachers.

“When you say that a product is for an adult, the message is not ‘Don’t use,’ it’s ‘Use these products and you’ll appear to be adult or mature,’” Halpern-Felsher said.

Anti-smoking advocates would like to see the same marketing limits applied to e-cigarettes that apply to so-called combustible cigarettes, including banning them from advertising on TV and radio.

They would also like to see the changes that were put in place under the Master Settlement Agreement in 1998 between the largest cigarette manufacturers and the attorneys general of 46 states applied to e-cigarettes. The states had sued the cigarette makers to recover their costs for treating sick and dying smokers. Among other things, the agreement banned most transit and billboard advertising of cigarettes, branded merchandise, free product samples and sponsorships of events, such as concerts and sporting events.

E-cigarette makers, such as Juul, have used some of those advertising methods over the years.

Last year, after the federal Food and Drug Administration said it was cracking down on an “epidemic” of teen vaping, Juul announced changes to its marketing activities.

The company shut down its Facebook and Instagram accounts and limited Twitter communications to non-promotional posts, Kwong said.

That’s like closing the door to the barn after the horse has left, said public health advocates. Young people, they added, are continuing to post about Juul on those sites.

“It’s too late,” said Dave Dobbins, chief operating officer at the Truth Initiative, an anti-tobacco advocacy group. “The kids are doing their work for them.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

The post Joe Camel was forced out of ads. So why is Juul allowed on TV? appeared first on Salon.com.

The study, which was published in JAMA, notes that while emphysema is typically linked to cigarette smoking, it’s also not entirely uncommon in people who have never smoked. To determine why that is, the researchers observed air pollution readings from six highly-populated areas and compared those levels with the increases in emphysema over a ten-year period ending in 2018.

Read more BGR: Baby Jupiter was smacked by a planet 4.5 billion years ago

Over 7,000 adults between the ages of 45 and 84 were included in the study, and the participants hailed from New York City, Los Angeles, Chicago, Baltimore, St. Paul, Minnesota, and Winston-Salem, North Carolina.

The team took a broad approach to calculate the impact of these air pollutants rather than examining each type of pollutant separately. This allowed the researchers to get a better idea of the real-world, combined effects of all the junk that’s floating around in our air. With over 15,000 CT scans to work with over a decade of observation, the results are incredibly unsettling.

Read more BGR: We might soon find out if the Earth-like worlds orbiting TRAPPIST-1 can support life

“The combined health effect of multiple air pollutants — ozone, fine particles known as PM2.5, nitrogen oxides, and black carbon — was greater than when the pollutants were assessed individually,” Bonnie Joubert, Ph.D., of the National Institute of Environmental Health Sciences, said in a statement. “With the study’s long-running duration, repeated CT scans allowed analysis of changes in emphysema over time.”

To put it in perspective, the increase in emphysema among the participants was equivalent to “29 pack-years of smoking,” which means 29 years of a pack-a-day cigarette smoking habit.

Read more BGR: NASA’s methane discovery on Mars just got a whole lot more interesting

The research emphasizes the need for more work to be done in air pollution control, and it highlights how dramatically air quality can affect public health on a large scale.

The post New study finds that breathing in polluted cities is just as bad as smoking appeared first on Salon.com.

This nicotine electronic delivery device was originally introduced to the market as a promising tool to aid smoking cessation among already current smokers. Yet, the lack of federal regulations, the appealing flavors available, and perceptions that these devices were less harmful than regular cigarettes have led to a worrying spike in use among U.S. adolescents. One in five U.S. high school students and one in 20 middle school students currently use e-cigarettes.

U.S. Surgeon General Jerome Adams has declared e-cigarettes an epidemic among youth, stressing that e-cigarette aerosols containing nicotine increase the risk of addiction to nicotine and other drugs, and impact brain development which can induce mood disorders and lower impulse control. Now, new research led by Dr. Bader Chaarani of the University of Vermont and published in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging has found adolescents that smoked only a few cigarettes had smaller and less connected brain areas than their peers who never smoked. This could mean that adolescent smokers’ brains will develop and function differently, which may affect decision-making and self-control in adulthood.

Just like regular cigarettes, e-cigarettes contain nicotine, a neuroactive chemical and an addictive component whose main target is the brain. Nicotine acts upon receptors in our brains — through nicotinic acetylcholine receptors (nAChRs) — to promote the release of a neurotransmitter called dopamine. Dopamine is a feel-good chemical, triggering a pleasurable response in our brains. When linked with the action of smoking, it plays a fundamental role in nicotine addiction.

Nicotine exposure among adults presents lower risks compared to adolescents. This is because our brains develop throughout our first three decades of life. During this maturation period, the brain circuits are being remodeled, especially those involved in reward function (dopamine) and cognitive function (acetylcholine). Therefore, adolescence is a vulnerable developmental period during which exposure to nicotine can fundamentally alter how the brain is wired, making young people even more vulnerable to future addiction.

Previous studies have shown that adolescent smokers have reduced neural activity and show symptoms of nicotine dependency at lower nicotine levels than adults, and that individuals that begin smoking during adolescence are more likely to develop nicotine dependence than individuals that start in their late 20′s.

One big gap in research observing the effects of cigarette smoking on brain volume, connectivity, and function to date is that such studies have been mostly performed on adult smokers rather than adolescent smokers. The majority have also focused on daily and heavy smokers, yet have overlooked occasional smokers, which is relevant due to common experimentation behaviors during adolescence.

The new research by Dr. Chaarani and their team finally addresses these gaps by looking at the brains of adolescent light smokers. They found that just a couple of cigarette puffs can potentially alter the development of adolescent brain.

The research team recruited over 600 14-year-old adolescents and calculated a cigarette-smoking score for each participant based on how many times, during their lifetime, they had smoked cigarettes. Participants ranged from young people who had never smoked to those who have smoked more than 40 times.

The researchers also looked at the brain of each of the participants using functional magnetic resonance imaging (fMRI). These images were used to estimate the brain gray matter volume corresponding to the neuron bodies where synapses occur, and white matter connectivity, meaning the “telephone wires” that connect neurons and brain areas by carrying electrical signals.

Interestingly, Dr. Chaarani and their team found that smoking even a few times was significantly linked to a decreased volume of the gray matter and neuronal connectivity. And the more teens smoked, the more the gray matter volume at the ventromedial prefrontal cortex (vmPFC), and the connectivity at the corpus callosum of their brains was reduced. Scientists have previously linked alterations in the vmPFC volume with a reduction in reward and with an increased risk of anxiety disorders. 

Moreover, reduction in the connectivity could indicate that nicotine induces axonal damage, meaning it may be altering the communication between brain areas. These alterations in brain connection have also been reported in individuals with substance addiction and alcohol dependence. While the research only showed a link between low doses of cigarette smoking and brain alterations, rather than a causal effect, these type of consequences have been consistently reported in many studies on brains of adult smokers.

Although this study focused on adolescents who smoked traditional cigarettes, scientists have demonstrated that such risks are applicable to teenagers who vape using the popular JUUL brand of e-cigarettes since the two methods deliver similar amounts of nicotine.

Researchers are still working to understand the impact of nicotine in the brain of young smokers, particularly now that e-cigarette use among youth has increased rapidly. This new study could play a critical role in educational campaigns, and spur regulatory agencies, parents, and teachers to take an active role in preventing this newest addiction.

The post Even briefly smoking as a teen might alter your brain appeared first on Salon.com.

For state Medicaid plans, though, which pay a heavy price for tobacco-related illnesses, it can be a shot in the arm of sorts. April 15 is also the day when the five largest tobacco companies pay US$9 billion dollars to state governments, each and every year, forever, because of a 1998 legal settlement meant to compensate states for the costs of tobacco-related illness such as cancer, emphysema and heart disease. Actual payments made by the tobacco companies vary year to year because of adjustment factors written into the settlement; each of the states’ payments varies as well.

Payments from tobacco companies, as well as tobacco taxes, help to support health care and other services for low-income people served by state Medicaid programs. Even though the federal government supports each state’s Medicaid program by paying at least half the costs, many states have difficulty finding revenues to pay the remaining share.

Determining how much tobacco use costs states’ Medicaid programs puts the payments from tobacco companies into perspective. One estimate found 15% of nationwide Medicaid costs were caused by tobacco use. But such estimates based on national surveys may not account for which tobacco-related diseases are most prevalent in a particular state. How many of the state’s Medicaid participants smoke, and how hospitals and doctors are paid, also affect a state’s Medicaid costs.

The Center for Mississippi Health Policy was interested in estimating the actual costs to Mississippi Medicaid for treating tobacco-related disease. The center wanted a price tag that more accurately reflected the health-related behaviors of people in Mississippi and health care services available in the state. Our team of researchers from The Hilltop Institute at the University of Maryland, Baltimore County (UMBC) conducted the study. We think our study is the first to focus on Medicaid costs using actual state Medicaid data.

Getting a truer picture

Instead of applying estimates of total costs of smoking from national surveys to individual states as previous studies have done, our research assessed how specific, individual smoking-related illnesses create costs for Mississippi. This lets the state better understand how much it differs from nationwide averages for both its total Medicaid costs and the sources of those costs.

First, we reviewed medical literature for studies that identified how tobacco use or exposure changes the risk of acquiring a particular illness. Many studies of how much smoking increases the risk of getting particular diseases have been conducted since the U.S. surgeon general first reported on the health hazards of smoking in 1964. In 2014, the surgeon general summarized many of these studies in a 50th anniversary report.

Some of the diseases we studied, such as prostate cancer, may have many causes in addition to tobacco use. Others, such as lung cancer, are almost always caused by tobacco. Once we found a number specifying how much smoking increased the risk for contracting each disease, we multiplied those risk scores by the percentage of people in Mississippi Medicaid who smoked. That enabled us to estimate what percentage of Mississippi Medicaid spending for each of these diseases was smoking-related. The Mississippi Medicaid program gave us data to determine the cost of each service paid to treat each person with the specific diagnosis.

We then adjusted this initial estimate for other factors that were not captured in the Medicaid payment data. We added adjusted costs for prescription drugs that could be used to treat smoking-related conditions. In addition, many Medicaid participants are in nursing homes because of diseases acquired from smoking. So we added the costs of nursing home stays based on residents’ diagnoses and the same risk scores.

Tobacco use can also affect the health of nonsmokers exposed to second-hand smoke. Mississippi had estimated the costs of second-hand smoke using national estimates. We updated those numbers based on relative risk of tobacco-related diseases we found in the more recent data.

An expensive set of illnesses

In total, we estimated that the cost of tobacco-related illness to Mississippi Medicaid was $388 million in 2016 and $396 million in 2017. This made up about 9% of Mississippi’s annual spending on Medicaid. Our estimates were somewhat lower than the national cost estimates of 15%. We believe this is because Mississippi Medicaid covers large numbers of children and younger adults — a tobacco-related disease may appear only after many years of smoking.

Many Mississippi Medicaid participants may still be too young to be diagnosed with tobacco-related illnesses. Furthermore, our estimates only included diseases with measures of increased risks because of smoking that are presented in the medical literature or the 2014 surgeon general’s report. So, our estimates are relatively conservative.

We believe our study results will help policymakers in Mississippi assess the benefits of policies affecting tobacco. These could include increasing tobacco cessation services, raising the minimum age for buying tobacco products, raising taxes on tobacco products and requiring smoke-free public places. Our approach to estimating costs could also be used by other states to conduct their own analyses of tobacco-related costs to Medicaid to inform their policy choices.

Charles Betley, Senior Policy Analyst, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The post April 15 is the day tobacco companies paid $9 billion for tobacco illnesses, but is it enough? appeared first on Salon.com.

However you feel about grown-ups using marijuana, you probably don’t want companies piggybacking on pot to make kids think they’re cool. It’s worth repeating: Marijuana remains illegal for kids and has proven risks to developing brains. But try getting your kids to listen when their feeds are filling up with references to 4/20. Consider these from years past: “It’s high time for some Pizza Rolls” (Totino’s); “Sometimes you need a huge bowl to get you through the day” (Chipotle); and “Spicy chicken nuggets are here. just in time for 4/20. how are you firing up?” (Burger King).

It’s no surprise that experts believe that marijuana use among teens is more widespread than alcohol use. In Colorado, marijuana-related emergency room visits by teens is on the rise. Promoting 4/20 Day may not be the reason for this trend — but it isn’t helping.

Raising drug-free kids in an era of legalization, widespread acceptance, and overt marketing of marijuana is one of the biggest challenges of parenting today. Attitudes are changing, as evidenced by big-name brands capitalizing on the shift. But you can’t laugh it off. Normalizing pot use among kids — which is what happens when brands hitch their wagons to 4/20 — poses real health risks to kids. You can lecture about how bad pot is for growing brains and try to get kids to wait as long as possible to try it — and that may work. But also consider helping kids think critically about the content they see online. Asking questions and seeing where they lead may make 4/20 and the brands that support it not look so groovy after all.

Follow the money. Kids may not realize a tweet or a meme (an image that goes viral) is actually an advertisement. But if it’s from a company, it’s promotional. Ask kids about the tricks marketers use to disguise what are really ads — for example, tweets, memes, and filters on Snapchat that actually promote brands. Does it make a brand cool if it can fool you? Or does it make them seem desperate to seem like a cool kid?

Talk about age gates — and how easy it is to get around them. You’re supposed to enter your birth date to see online content that’s intended for adults, such as sites that sell vaping equipment. But age gates are easy to get around. Ask kids if they or their friends are more tempted to buy drug paraphernalia online because no one is checking their ages.

What’s missing? From movies such as “Harold & Kumar Go to White Castle” to memes that treat marijuana as a joke, it’s all fun and games until you overdose, have a bad experience, become demotivated, or hurt yourself. Talk about the real aftermath of getting high and how the negatives are never represented online.

Remember, companies don’t care about you. They may be funny, clever, cool, or witty. But if they’re using pot as a vehicle for promoting their product, they don’t care about your health and well-being. They’re just using a convenient hook to appeal to their demographic.

Impart your values. Teens are still listening to you, despite much evidence to the contrary. Discuss what’s important to you: good character, solid judgment, and belief in a bright future — all of which are compromised by pot use.

The post What parents need to know about 4/20 appeared first on Salon.com.