Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States.

The continuing high prevalence of cigarette smoking among specific subpopulations, many of them vulnerable, is one of the most pressing challenges facing the tobacco control community. These populations include individuals in lower education and/or socioeconomic groups; from certain racial/ethnic groups; in the lesbian, gay, bisexual, and transgender community; with mental illness; and in the military, particularly among those in the lowest pay grades. Although traditional tobacco control measures are having positive health effects for most groups, the effects are not sufficient for others. More attention to and support for promising novel interventions, in addition to new attempts at reaching these populations through conventional interventions that have proven to be effective, are crucial going forward to find new ways to address these disparities. CA Cancer J Clin 2018;68:106-115. © 2018 American Cancer Society.

Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine.

Answer questions and earn CME/CNE Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core-and highly addictive-constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of "harm," their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use. CA Cancer J Clin 2017;67:449-471. © 2017 American Cancer Society.

Applying the Population Health Standard to the Regulation of Electronic Nicotine Delivery Systems.

Regulatory authorities have devoted increasing attention and resources to a range of issues surrounding the regulation of novel nicotine and tobacco products. This review highlights the inherent complexity of evaluating prospective policies that pertain to products that heat solutions containing nicotine, but not tobacco leaf, sometimes referred to as electronic nicotine delivery systems (ENDS). The US Food and Drug Administration (FDA) is compelled to incorporate a set of public health criteria in their decision making, collectively referred to as the Population Health Standard. Adherence to this standard is necessary to estimate the impact of prospective ENDS policy decisions on net population harm associated with nontherapeutic nicotine products. For policies that are expected to decrease or increase ENDS use, application of the Population Health Standard requires a comprehensive assessment of the status quo impact of ENDS use on population health. Accordingly, this review first assesses the state of the evidence on the direct harms of ENDS and the indirect effects of ENDS use on smoking, particularly rates of initiation and cessation. After that, the example of flavor restrictions is used to demonstrate the further considerations that are involved in applying the Population Health Standard to a prospective ENDS policy. Implications: This narrative review aims to inform regulatory considerations about ENDS through the prism of the Population Health Standard. More specifically, this review (1) describes and explains the importance of this approach; (2) provides guidance on evaluating the state of the evidence linking ENDS to the net population harm associated with nontherapeutic nicotine products; and (3) illustrates how this framework can inform policymaking using the example of flavor restrictions.

Tobacco use among racial and ethnic population subgroups of adolescents in the United States.

INTRODUCTION: Limited data on cigarette smoking among population subgroups hinder the development and implementation of intervention strategies for those subgroups. Because of small sample sizes or inadequate study formats, cigarette smoking among youths has been studied mostly among broad racial or ethnic categories (e.g., Asian, Hispanic) instead of subgroups (e.g., Vietnamese, Cuban). The objective of this study was to evaluate cigarette smoking among U.S. youths by racial and ethnic subgroups. METHODS: The study used a nationally representative sample of youths aged 12 to 17 years who participated in the National Survey on Drug Use and Health in 1999, 2000, or 2001. Outcomes measured include prevalence of cigarette smoking, mean age of smoking initiation, and susceptibility to start smoking. RESULTS: The prevalence of smoking among youths aged 12 to 17 years varied among racial and ethnic subgroups, ranging from 27.9% for American Indians and Alaska Natives to 5.2% for Japanese. Among youths aged 12 to 17 years, the age of smoking initiation ranged from 11.5 years (American Indians and Alaska Natives) to 13.2 years (Japanese); the overall mean age of initiation was 12.3 years. White and African American youths were the only groups that showed a significant sex difference in age of initiation among all 14 subgroups; white and African American boys initiated smoking a few months earlier than white and African American girls. One of every four never-smokers aged 12 to 17 years was classified as susceptible to becoming a smoker. CONCLUSION: The prevalence of cigarette smoking among youths varies widely by racial and ethnic subgroup. There is a need for sustained, culturally appropriate interventions to prevent and control cigarette smoking among youths, particularly within racial and ethnic subgroups with a high prevalence of cigarette smoking.

Prevention and control of coronary heart disease and stroke--nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention.

Successful prevention and control of coronary heart disease and stroke requires extensive collaboration and strategic partnerships with many health and non-health-related organizations and agencies in the voluntary, public, and private sectors. To assure a common language and purpose and to facilitate communication in these multiple settings, a simplified classification of prevention levels for public health practice is essential. This statement proposes three levels of prevention (health promotion, primary prevention, and secondary prevention) as a guide for public health practice. This statement is also intended to inform the design, implementation, and evaluation of programs and research initiatives that address the prevention and control of coronary heart disease and stroke, and to enhance communication and dialogue among health professionals, policymakers, and the public.

Tobacco use and the cardiovascular disease epidemic in developing countries: global crises and opportunity in the making.

Tobacco use is a powerful, independent predictor of deaths related to cardiovascular disease, and is an important contributor to deaths from major chronic diseases. Unfortunately, increasing rates of tobacco use throughout the world are contributing significantly to the burden of death and disability from these diseases, especially in developing countries. If current trends continue, the annual number of people killed by tobacco use will more than triple, to 10 million by 2030. However, we have an opportunity to reverse these trends and avoid this impending epidemic of tobacco-related deaths. In this, article, we examine the current global burden of tobacco-related diseases, and future projections, and conclude by emphasizing that: 1) effective strategies for curbing this epidemic are available; and 2) the time has rome for effective global tobacco-control action.

Clean indoor air: where, why, and how.

Clean indoor air policies are an effective way to eliminate exposure to second hand smoke and reduce smoking among youth and adults; they are strongly recommended by the Surgeon General and the Task Force on Community Preventive Services. How these policies are put into effect and at what level of government can make a difference. Legislation that preempts local action prevents communities from enacting more stringent laws or tailoring laws to address community-specific issues. Preemptive state laws also can be a barrier to local enforcement because communities not involved in decision making may be less aware of laws, may have no enforcement mechanism, and thus may be less complaint. Preemption is clearly a tobacco industry strategy to take away local control, usually in exchange for a weak law offering little protection from second hand smoke. As communities across the country continue to pass stronger local ordinances, eliminating preemptive laws becomes more important. During 2002, Delaware became the first state to repeal clean air preemption. In Iowa, the attorney general's office has been involved in the determination of whether the state clean air law prevents communities from passing more stringent ordinances. And although Minnesota's pioneer Clean Indoor Air Act does not preempt local laws, the debate over preemption there has not ended but instead has taken new forms.