Policy Statement—Tobacco Use: A Pediatric Disease

Tobacco use is the leading preventable cause of death and illness in the United States, causing more than 443 000 deaths each year.
The consequences of tobacco use include harms to the health of the fetus, such as low birth weight and sudden infant death; harms to children from tobacco use and secondhand tobacco-smoke (SHS) exposure, including respiratory illness, infection, and decreased lung function; the uptake and establishment of tobacco use and nicotine addiction by the next generation; fires attributable to smoking; the economic costs of purchasing tobacco and tobacco-use maerials; litter and debris from tobacco products; additional cleaning and maintenance of facilities in which tobacco is used; the health care and emotional costs of diseases associated with tobacco use and SHS exposure; and the costs to families and society because of poor health and lost productivity.
Most tobacco users (80%) started using tobacco products before 18 years of age.
Initiation of tobacco use is often instigated by exposure to tobacco use by parents or peers, depiction in movies and other media, advertising targeting children and adolescents, and other environmental and cultural factors.3–12 The connection between children and tobacco use is so strong that the commissioner of the US Food and Drug Administration declared tobacco use a “pediatric disease” in 1995.
Tobacco use is a pediatric disease because of the extent of harms to children caused by tobacco use and SHS exposure, the relationship of pediatric tobacco use and exposure to adult tobacco use, the existence of effective interventions to reduce tobacco use,14 and the documented underuse of those interventions.15 This statement provides guidance for providers of pediatric services, including the American Academy of Pediatrics (AAP) and its members, and summarizes other AAP policies that have addressed tobacco use and control. Because tobacco use has significant effects on children and families, its management has been reviewed in many AAP policies and official documents.16–18 The information and recommendations described in this statement are consistent with recommendations in the other AAP publications cited as well as with tobacco policies from other clinical professional membership organizations, including the Academic Pediatric Association, the American Academy of Allergy Asthma & Immunology,20 the American Academy of Family Practice, the American Academy of Pediatric Dentistry,22 and the American Medical Association.
The policy is accompanied by 2 technical reports: “Secondhand and Prenatal Tobacco Smoke Exposure”and “Tobacco as a Substance of Abuse.”The AAP recognizes the dangers of tobacco use and SHS exposure to children’s health. Tobacco control was named a strategic priority by the AAP in 2005, and the Julius B. Richmond Center of Excellence (www.aap.org/ richmondcenter), dedicated to the elimination of children’s exposure to tobacco and SHS, was established in 2007 to foster tobacco-control initiatives at the AAP.

3 shops hit for underage tobacco sales

Three local businesses recently were found in violation of state laws against selling products to minors, according to a press release from the authorities.

the inspections were conducted by the Southington Police Department’s Detective Division and Special Investigators of the Department of Mental Health & Addiction Services, Tobacco Prevention and Enforcement Program.

Under the direction and supervision of the Department of Mental Health special investigators youths under 18 employed by the Tobacco Prevention Enforcement Program attempted to purchase tobacco products at 37 establishments.

The three establishments found to be in violation are Sam’s Foods Store, 2201 Meriden Waterbury Turnpike in Marion; Milldale Mobil, 1896 Meriden Waterbury Turnpike in Milldale and Quick Mart located at 802 West St.

The offending clerks at these establishments were each issued an infraction violation with a $200 fine.

The clerk at Sam’s Foods Store was identified as Iftikhar Ahmed, age 49, of Flushing, N.Y.. Ahmed sold two Dutch Master Cigars valued at $1 each.

The clerk at Milldale Mobil was identified as Arthur Riley, age 19, of Meriden. Riley sold one Vanilla cigar valued at $1.35.

The clerk at Quick Mart was identified as Parul Patel, age 43, of Glastonbury. Patel sold one pack of Camel brand cigarettes valued at $6.32.

Tobacco laws to change in October

On June 22, President Barack Obama signed into law the Family Smoking Prevention and Tobacco Control Act, or the FSPTCA. This law grants the FDA permission to control and regulate all tobacco products.

According to the FDA’s Web site, the FDA plans to, by October, prohibit cigarettes from having “candy, fruit or spice flavors as their characterizing flavors.” The FDA is expected to set in more regulations as time passes. Such regulations may include:

By January 2010, tobacco manufacturers and importers are expected to have to submit product information to the FDA.

By April 2010, the FDA plans to reissue a 1996 regulation aimed at reducing tobacco use among minors.

By July of 2010, it is expected that tobacco manufacturers will no longer be able to use the terms “light,” “low” or “mild” without a special order from the FDA. The FDA also plans to revise warning labels on smokeless tobacco products

By October 2012, the FDA plans to strengthen the warning labels on cigarette packs.
In St. Cloud, some businesses rely on the sale of flavored tobacco products.
The Smoke Shop, located on Division Street, is one such shop

The manager of the Smoke Shop, Alex Dodin, said that Djarum cigarettes and Dream cigarettes were going to be banned along with flavored cigarillos as of Sept. 22.

He said he was not sure what else would be taken off the market and said these news laws against flavored tobacco would strongly affect his business.

“What else are they going to smoke after this?” Didon added.

Ezekial Butler, SCSU junior and CA for Stearns Hall, had some opinions on the proposed ban.

He said that he occasionally enjoyed the Dream cigarettes and will stock up before the ban takes hold.

“They [The FDA] have a decent reason to ban flavored cigarettes, but it’s unfair to those who are of age that enjoy them,” Butler said. “Even though I plan on quitting, this new ban is not going to stop me from smoking.”

The new laws that are planned to be put into affect are aimed at decreasing smoking among adolescents, but it may also have consequences for those who sell and those who enjoy smoking tobacco legally.

Importer tries to get around clove smoke ban

The nation's top distributor of clove cigarettes is offering fans a new way to get their fix after the spice-flavored cigarettes are banned later this year — cigars.

The new filtered cigars — close to the size of a cigarette and flavored with clove, vanilla and cherry — allow Kretek International Inc., which imports Djarum-brand tobacco products from Indonesia, to avoid new federal laws banning flavored cigarettes other than menthol.

The ban on flavored cigarettes, which critics say appeal to teenagers, goes into effect at the end of September. It doesn't include cigars.

The difference? Cigarettes are wrapped in thin paper, cigars in tobacco leaves. While the cigars also are made with a different kind of tobacco, the taste is similar. The cigars come 12 to a pack, rather than 20 for cigarettes, but cost nearly half as much.

The ban is one of the first visible effects of a new law signed by President Barack Obama in June that gives the Food and Drug Administration wide-ranging authority to regulate tobacco, though it can't ban nicotine or tobacco outright.

The new law gives the FDA the power to ban other products like flavored cigars, but that hasn't happened yet.

Whether the cigars are truly different or just an attempt to circumvent the ban by making superficial changes is in the hands of the FDA, said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

"The key is the legislation gives the FDA the authority to respond to these types of frankly totally irresponsible actions," Myers said.

Myers joined executives from the American Cancer Society, American Heart Association, American Lung Association and the Amercian Legacy Foundation late last month urging the FDA to take a closer look at the issue.

Often associated with hippies and other bohemians, clove cigarettes may be the most well-known target of the ban. Some major cigarette makers experimented with mint- or chocolate-flavored blends earlier this decade, but many of those products are no longer made after coming under fire, accused of targeting children.

John Geoghegan, director of brand development for Moorpark, Calif.-based Kretek International, said the private company has been "puzzled about (the ban) since the very beginning" because clove cigarettes constitute less than 1 percent of cigarettes sold in the U.S.

"For people to say, 'Well, clove is a starter cigarette or a trainer cigarette' or something was just preposterous," Geoghegan said, citing company research about when and how consumers begin smoking.

Kretek International holds a 97 percent U.S. market share with its line of Djarum clove cigarettes, a staple of Indonesian smoking culture.

The U.S. market for clove cigarettes is about $140 million annually, with about 1.25 million clove smokers. Cloves have been imported to the U.S. since the 1960s and are mostly smoked by people younger than 30.

While Geoghegan said clove cigarettes make up about 65 percent of Kretek International's business, the ban is "damaging but not fatal" because of the company's other products like lighters and pipe tobacco.

Now, clove smokers are being forced to decide whether to switch to the new cigars, or quit. Many will likely stock up or try to buy product over the Internet.

And how the ban will work remains a point of contention for shop owners who sell clove cigarettes. But the FDA says the message is clear: Flavored cigarettes are banned, and the agency has the authority necessary to enforce the prohibition.

"So, what do we do with the stuff that's on the shelves? Who eats that? Is it legal to sell until it's gone or what?" asked Jim Carlson, owner of two CVille Smoke Shop stores in Charlottesville, Va., about 70 miles northwest of Richmond.

Carlson said he sells about 3,000 packs of the flavored cigarettes a year.

"You don't make a lot of money, but still it's income ... and it brings customers into the store," he said.

Lake Isabella, Calif., resident Terry Day, 42, used to drive 240 miles round trip to buy clove cigarettes when he lived in rural Valentine, Neb. He said he might try the cigars but was dubious about whether he would like them.

"I certainly don't like to be forced into that choice," said the clove smoker of 14 years. "I'm probably going to buy me enough to last until Oct. 1, then I'm just going to have to quit."

Tobacco Maker Names Chairman

British American Tobacco PLC on Wednesday tapped former Bank of Ireland PLC Governor Richard Burrows as its new chairman.

Mr. Burrows will take over from Jan du Plessis, who will become chairman of Rio Tinto PLC, on Nov. 1.

Mr. Burrows resigned from the Bank of Ireland in May, following a troubled fiscal year in which the bank's net profit dropped to €69 million ($97.5 million) from €1.7 billion a year earlier and had to seek €3.5 billion in financial assistance from the Irish government. Mr. Burrows apologized to investors at the time for the loss of shareholder value and the cancellation of the company's dividend.

BAT, meanwhile, demonstrated the resilience of the tobacco industry last month when it posted a 16% rise in first-half net profit to £1.45 billion ($2.4 billion).

Sales of cigarettes are continuing to hold up pretty well in the recession because smokers are reluctant to give up tobacco. Also, any dropoff in volume can be offset with price increases. The company's shares have risen 3.4% in the past year.

Analysts weren't concerned by Mr. Burrows's Bank of Ireland record, concentrating instead on his highly successful career in the fast-moving consumer-goods industry.

He was chief executive of Irish Distillers from 1978 until its takeover by Pernod Ricard SA in 1988. He continued to work within the French drinks company and eventually served as co-chief executive of Pernod Ricard from 2000 to 2005.

The BAT chair is a nonexecutive position, but a higher-profile role than at other similarly sized companies. During his five years in the job, Mr. du Plessis took responsibility for commenting on any political issues -- such as antismoking legislation -- leaving Chief Executive Paul Adams to concentrate on operational matters.

Mr. Burrows will be paid an annual salary of £525,000 and will work a two-day week for BAT. The salary is below the £686,000 Mr. du Plessis received to reflect the short working week, the company said.

Tobacco Festival should make big comeback next

The South Carolina Tobacco Festival is returning for its 53rd year in Lake City, although the schedule is leaner this year as a result of the economy. The decision to offer a scaled-down series of events for the 2009 festival, which will run from Sept. 18-20, was a conscious and unanimous one by the Greater Lake City Chamber of Commerce’s board.

In spite of the bleak economic scenery surrounding us, Lake City is fortunate to still have a festival, and an abbreviated schedule is a small sacrifice to make as our local businesses fight to stay alive.

One minor rumor was that the Tobacco Festival wasn’t happening at all this year. While it might not be totally identical to the Tobacco Festival we’re familiar with, several events are still planned, starting with the Street Dance the night of Sept. 18, a Friday. The event will feature the Band of Oz and will run from 8 p.m. to midnight.

The biggest changes to the festival’s schedule are the lack of a parade down Main Street as well as entertainment at the town square stage on Saturday, Sept. 19.

But that doesn’t mean you should just stay home that day; get up early and go support a good cause when the Florence Florence County Disabilities Foundation will hold “Lake City’s Largest Yard Sale” at its thrift shop at 219 N. Church St.

Also on Saturday, the festival beauty pageant will take place at the Blanding Street Auditorium, at 125 S. Blanding St.

Finally, on Sunday, the Lake City Country Club will hold a golf tournament.

The chamber of commerce already is making plans for next year’s festival.

“The hope is that we’ll be able to do it even bigger and better than in the past, and we’re even working on that now,” chamber Director Rita Smith said.

When the economy improves, we hope businesses will be able to resume their sponsorships of the festival. A large number of local businesses have been quite generous to the festival, as shown by the lists of contributors in previous years, so we have a good feeling that things will be looking up.

Smith said most people she’s spoken with have been understanding of the decision to scale back the festival this year. Many vendors have called to show interest in selling their goods at this year’s festival have asked Smith to keep them in mind for next year, she said.

With interest already mounting in the 2010 festival, an economic rebound would bring back a Tobacco Festival like those so many of us have regularly attended with our families.

And, as Smith said, it could be even bigger and better than before.

Festivals are good for the morale in towns and cities. They give residents a chance to have fun and take pride in their community.

The people of Lake City and the surrounding areas still have an opportunity to do that as the Tobacco Festival stays alive, and it’s something to be thankful for.

It’s my choice and I choose to smoke

“Quitters never win and I’m no quitter.” “It’s my choice and I choose to continue using nicotine!” The fact is, we lost “choice” the day nicotine took control. But that doesn’t stop the tobacco industry from spending billions on store marketing to build a mighty facade that screams, “smoking is an adult free-choice activity.” Every time we step up to the counter to purchase tobacco the signs and displays hammer our brains with the message that using it is all about flavor, pleasure and aroma. Apparently few tobacco executives “choose” to buy into the lies.

A former Winston Man, David Goerlitz, asked R.J. Reynolds executives, "Don't any of you smoke?" One executive answered, "Are you kidding? We reserve that right for the poor, the young, the black, and the stupid." Once hooked, our only real alternative is the up to 72 hours needed to purge nicotine from our system. Choice? What users have chosen is to avoid withdrawal.

As Joel puts it, it isn’t that we like using nicotine but that we don’t like what happens when we don’t use it. Then there are those of us who claim to smoke knowing full well that it’s killing us. We say we don’t care what happens, that we don't want to get old, that we have to die of something, so why not smoking. Most of us using these “self-destruction” rationalizations do so to hide the fears born of a history of failed attempts, and of a false belief that we’re somehow different than others, and that we’ll never be able to stop using. Try to find anyone who isn't shocked when cancer, emphysema, heart attack or stroke does occur. As Joel writes, "no one ever called me enthusiastically proclaiming, 'It worked, it's killing me!' On the contrary, they were normally upset, scared and depressed."

Choice? Once out from under our dependency’s control then free choice is restored. But just one puff, dip or chew and our freedom and autonomy will again be lost, as our brain is soon begging for more.

Ohio dealt decisive blow in tobacco funds dispute

The Strickland administration will mount an appeal to a Tuesday court ruling that would prevent the state from using $230 million in smoking prevention funding to help pay for home-care services under Ohio’s latest budget.

Franklin County Common Pleas Court Judge David Fais’ decision bars the state from touching $230 million from the dissolved Ohio Tobacco Prevention Foundation. The battle over the money began in April 2008, when Gov. Ted Strickland outlined plans to use tobacco foundation money to partly finance a $1.57 billion jobs stimulus plan in the state.

With the money frozen while the legal fight played out, the state shifted the intended use of the cash to optional Medicaid services, a children’s Medicaid expansion and cancer screenings, said Strickland spokeswoman Amanda Wurst.

In the ruling, Fais wrote that two pieces of legislation backing a liquidation of the foundation and transfer of the money are unenforceable because they “clearly violate” tenets of the state Constitution. Assets in the foundation’s endowment fund are now in the state Treasury’s custody, but they’re to be used solely for tobacco prevention programs mounted by public or private agencies.

Wurst said Strickland was disappointed by the ruling and the time it took to reach a decision. The governor has asked state Attorney General Richard Cordray to speed an appeal of Fais’ ruling “to ensure these vital services continue for Ohioans.”

“Today’s ruling will delay or jeopardize the ability of these health-care services to continue to serve the people of Ohio,” Wurst said.

Fais reiterated a position he held when issuing an injunction on use of the money last February: The state had a reasonable alternative to raiding the tobacco fund for the jobs stimulus plan by issuing bonds instead.

Tough Summer for Tobacco Crop

It's a sight you'll find up and down the Connecticut River Valley, field after field abandoned or already harrowed.

"It's like a ghost town," said Allan Zuchowski. "It's like a spaceship came and took all the farmers away."

It's not the farmers that are gone, but instead their tobacco crops, a result of a very cold and wet summer.

Zuchowski, a farmer in Hadley, has lost seven acres worth.

"It pays the bills. It replaces the equipment. It keeps up the buildings," he said.

Wally Czajkowski, another farmer in town, has lost 30 acres.

"It's just a big hole in the middle of our season," he said.

It's leaving a big hole in Czajkowski's wallet. His tobacco crop makes up a third of his income.

Both farmers say it's a combination of factors that have led to the devastating loss. Four diseases attacked the crops early in the season, and the cold and wet weather made it too difficult for the plants to fight them off.

One virus many tobacco farmers are dealing with leaves spots all over each leaf. When cured, the spots become holes, and the leaf becomes useless.

"Tobacco is a job that requires many hands and many hours and those hands are idle now," said Zuchowski.

"There's going to be a lot of unemployed farm workers this fall," said Czajkowski.

Both Zuchowski and Czajkowski are now paying close attention to their other crops. They must now rely on those to make up for the loss of income.

But both say they're not giving up on tobacco.

"We'll just try again next year," said Czajkowski.

Farm Labor Supply Surprising Tobacco Growers

About the time the economy went in the dumper in 2001 folks started saying that the recession would improve the farm labor supply. But a fellow at an agricultural outlook seminar in Gainesville, Fla., said the supply of field laborers was just fine.

"We have a great system," he said. "It's called Greyhound. It crosses the border, picks up workers and when the job's done, it takes them back home."

No self-respecting American who could get a check in the mailbox would go sweat in a field, the speaker said. At the time, he was accurate.

Either times have changed and some of those folks who could get a check prefer to earn an honest's days wages - as my parents and grandparents taught - or, well, I don't think there is an or. You see, those checks still are available to just about everyone who asks for one and Congress keeps extending unemployment eligibility.

But farmers are reporting Americans coming to see about working in their fields. Laborer jobs. Earlier today Ray Tucker couldn't help grinning when he said an American was among the fellows harvesting the tobacco on his Kentucky farm. And Jay sounded a little proud when he said the American was keeping up with the Mexicans who came here through the H2A program.