News
The Southwest Journal of Pulmonary, Critical Care & Sleep periodically publishes news articles relevant to pulmonary, critical care or sleep medicine which are not covered by major medical journals.
Younger Smokers Continue to Smoke as Adults: Implications for Raising the Smoking Age to 21
A review article published in Pediatrics assesses the evidence that smoking is particularly harmful the younger a smoker begins (1). Not only do youths tend to accumulate more pack-years but they have more difficulty quitting. The recent shift in smoking trends from tobacco cigarettes to e-cigarettes may not be helpful since both contain the addictive component, nicotine. Although e-cigarettes are marketed as a smoking cessation tool, there is no strong evidence to support these claims, the authors report.
"I think most people realize nicotine is addictive, but I don't know if there's an understanding of just how addictive it is – particularly for youths," said Lorena M. Siqueira, MD, MSPH, lead author of the report (2).
Evidence shows that the earlier in life a person is exposed to nicotine, the more likely they will consume greater quantities and the less likely they will be able to quit (1,2). The vast majority of tobacco-dependent adults (>99%) started smoking before age 26 years. Approximately two thirds of children who smoke in sixth grade, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults. Youths require more attempts to quit smoking before being successful compared to adults. Only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year.
"There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later," said Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California and a coauthor of the review (2). Instead of making quitting easier, e-cigarettes make it harder, Dr. Glantz added.
An Institute of Medicine report notes that the age of initiation of smoking is critical (3). The report estimates that that raising the minimum age for the sale of tobacco products to 21 will, over time, reduce the smoking rate by about 12 percent. This reduction is estimated to result in reducing smoking-related deaths by 10 percent, which translates into 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost (3).
These data may prove valuable in evaluating the potential health impact of this legislation. California became the second state to raise the tobacco sale age to 21 in 2016, joining Hawaii (3). At least 210 localities have raised the tobacco age to 21, including New York City, Chicago, Boston, Cleveland, Kansas City and Cottonwood, Arizona. Statewide legislation to do so is being considered in several other states and will probably be introduced in Arizona during this legislative session.
Richard A. Robbins, MD
Editor, SWJPCC
References
- Siqueira LM; Committee on Substance Use and Prevention. Nicotine and tobacco as substances of abuse in children and adolescents. Pediatrics. 2017 Jan;139(1):e20163436. [CrossRef] [PubMed]
- Melville NA. Nicotine's highly addictive impact on youth underestimated. Medscape. January 3, 2017. Available at: http://www.medscape.com/viewarticle/873955?nlid=111769_2863&src=wnl_dne_170104_mscpedit&uac=9273DT&impID=1266832&faf=1 (accessed 1/5/17).
- Campaign for Tobacco Free Kids. Increasing the minimum legal sale age for tobacco products to 21. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0376.pdf (accessed 1/5/17).
Cite as: Robbins RA. Younger smokers continue to smoke as adults: implications for raising the smoking age to 21. Southwest J Pulm Crit Care. 2017;14(1):24-5. doi: https://doi.org/10.13175/swjpcc002-17 PDF
Election Results of Southwest Ballot Measures Affecting Healthcare
Earlier this week an article was posted listing Southwest ballot measures that affect healthcare. Below are the results obtained from various internet sources.
States
Arizona
1. Recreational marijuana. Proposition 205: Legalizes recreational marijuana use for people 21 and older. Opponents of the measure include the Arizona Health and Hospital Association and Insys Therapeutics, a company that makes a cannabis-based pain medication.
Defeated: Yes 929,518 (48%)
No 1,011,836 (52%)
California
1. Medi-Cal hospital fee program. Proposition 52: Requires the legislature to get voter approval to use fee revenue for purposes other than generating federal matching funds and funding enhanced Medicaid payments and grants for hospitals. The initiative, which was written by the California Hospital Association and is supported by most state lawmakers, would also make the program permanent, requiring a supermajority in the legislature to end it.
Passed: Yes 5,950,642 (70%)
No 2,599,764 (30%)
2. Tobacco tax. Proposition 56: Increases the state's cigarette tax by $2 a pack and impose an "equivalent increase on other tobacco products and electronic cigarettes containing nicotine." The revenue primarily would support healthcare programs.
Passed: Yes 5,551,236 (63%)
No 3,271,626 (37%)
3. Prescription drug price regulations. Proposition 61: Ties the prices California state agencies pay for prescription drugs to the discounts negotiated by the U.S. Veterans Affairs Department. The initiative, backed by the AIDS Healthcare Foundation, has drawn more than $100 million in spending from opponents, most of it from the pharmaceutical industry.
Defeated: Yes 3,933,084 (46%)
No 4,570,245 (54%)
4. Legalization of recreational marijuana. Proposition 64: Legalizes recreational marijuana use for people 21 and older and creates taxes on the cultivation and retail sale of the drug.
Passed: Yes 4,957,215 (56%)
No 3,923,777 (44%)
Colorado
1. ColoradoCare, a single-payer health system. Amendment 69: Amends the state's constitution to establish a universal healthcare system financed by payroll taxes and governed by an elected 21-member board of trustees. The plan is opposed by Colorado Hospital Association.
Defeated: Yes 478,107 (20%)
No 1,876,618 (80%)
2. Cigarette tax. Amendment 72: Amends the state's constitution to increase the cigarette tax from 84 cents a pack to $2.59 a pack. Most of the revenue would fund health-related programs, research into tobacco-related health issues and education and prevention. E-cigarettes are exempt.
Defeated: Yes 1,115,022 (46%)
No 1,291,961 (54%)
3. Physician-assisted suicide. Proposition 106: The End of Life Options Act allows physicians to prescribe a lethal drug to their terminally ill patients and allows terminally ill patients to be prescribed lethal drugs to end their life.
Passed: Yes 1,542,219 (65%)
No 847,978 (35%)
Nevada
1. Recreational marijuana. Question 2: Legalizes recreational marijuana use for people 21 and older.
Passed: Yes 602,400 (54%)
No 503,615 (46%)
2. Medical equipment tax. Question 4: Exempts medical equipment like oxygen machines and hospital beds from the state sales tax.
Passed: Yes 768,803 (72%)
No 301,944 (28%)
Cities
1. Albany, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
Passed
2. San Francisco, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
Passed
3. Oakland, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
Passed
4. Boulder, CO. Soda tax: Imposes a 2 cent per ounce tax on sugary beverages.
Passed
Richard A. Robbins, MD
Editor, SWJPCC
Cite as: Robbins RA. Election results of Southwest ballot measures affecting healthcare. Southwest J Pulm Crit Care. 2016;13(5):223-4. doi: http://dx.doi.org/10.13175/swjpcc115-16 PDF
Southwest Ballot Measures Affecting Healthcare
Modern Healthcare (1) has published an article summarizing ballot measures affecting healthcare. Those from the Southwest are listed below:
States
Arizona
- Recreational marijuana. Proposition 205: Legalizes recreational marijuana use for people 21 and older. Opponents of the measure include the Arizona Health and Hospital Association and Insys Therapeutics, a company that makes a cannabis-based pain medication.
California
- Medi-Cal hospital fee program. Proposition 52: Requires the legislature to get voter approval to use fee revenue for purposes other than generating federal matching funds and funding enhanced Medicaid payments and grants for hospitals. The initiative, which was written by the California Hospital Association and is supported by most state lawmakers, would also make the program permanent, requiring a supermajority in the legislature to end it.
- Tobacco tax. Proposition 56: Increases the state's cigarette tax by $2 a pack and impose an "equivalent increase on other tobacco products and electronic cigarettes containing nicotine." The revenue primarily would support healthcare programs.
- Prescription drug price regulations. Proposition 61: Ties the prices California state agencies pay for prescription drugs to the discounts negotiated by the U.S. Veterans Affairs Department. The initiative, backed by the AIDS Healthcare Foundation, has drawn more than $100 million in spending from opponents, most of it from the pharmaceutical industry.
- Legalization of recreational marijuana. Proposition 64: Legalizes recreational marijuana use for people 21 and older and creates taxes on the cultivation and retail sale of the drug.
Colorado
- ColoradoCare, a single-payer health system. Amendment 69: Amends the state's constitution to establish a universal healthcare system financed by payroll taxes and governed by an elected 21-member board of trustees. The plan is opposed by Colorado Hospital Association.
- Cigarette tax. Amendment 72: Amends the state's constitution to increase the cigarette tax from 84 cents a pack to $2.59 a pack. Most of the revenue would fund health-related programs, research into tobacco-related health issues and education and prevention. E-cigarettes are exempt.
- Physician-assisted suicide. Proposition 106: The End of Life Options Act allows physicians to prescribe a lethal drug to their terminally ill patients and allows terminally ill patients to be prescribed lethal drugs to end their life.
Nevada
- Recreational marijuana. Question 2: Legalizes recreational marijuana use for people 21 and older.
- Medical equipment tax. Question 4: Exempts medical equipment like oxygen machines and hospital beds from the state sales tax.
Cities
- Albany, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
- San Francisco, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
- Oakland, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
- Boulder, CO. Soda tax: Imposes a 2 cent per ounce tax on sugary beverages.
Richard A. Robbins, MD
Editor, SWJPCC
Reference
- Modern Healthcare. How the Nov. 8 state elections will affect healthcare. November 5, 2016. Available at: http://www.modernhealthcare.com/article/20161105/NEWS/161109991 (accessed 11/7/16).
Cite as: Robbins RA. Southwest ballot measures affecting healthcare. Southwest J Pulm Crit Care. 2016;13(5):218-9. doi: http://dx.doi.org/10.13175/swjpcc114-16 PDF