Spotlight on e-cigs

burkholder1By Rebecca Burkholder, NCL Vice President for Health Policy

The Food and Drug Administration announced in April proposed new regulations that would cover for the first time e-cigarettes as well as other tobacco products, including pipe tobacco, cigars and waterpipe (hookah) tobacco. Electronic (or e-cigarettes) have become a huge billion dollar industry which had escaped federal oversight until now. As tobacco remains the leading cause of death and disease in this country, this expanded FDA oversight is an important moment for consumer protection.

As part of its implementation of the Family Smoking Prevention and Tobacco Control Act signed by President Obama in 2009, the rule sets forth additional tobacco products that would be “deemed” to be subject to FDA regulation. “This proposed rule is the latest step in our efforts to make the next generation tobacco-free,” said HHS Secretary Kathleen Sebelius.

Under the proposed rule, makers of these tobacco products would, among other requirements:

  • Register with the FDA and report product and ingredient listings;
  • Only market new tobacco products after FDA review;
  • Only make direct and implied claims of reduced risk if the FDA confirms that scientific evidence supports the claim and that marketing the product will benefit public health as a whole;
  • Not distribute free samples;
  • Have minimum age and identification restrictions to prevent sales to underage youth;
  • Include health warnings on the products; and
  • Prohibit vending machine sales, unless in a facility that never admits youth.

E- cigarettes resemble traditional cigarettes but they use a heat source, usually powered by a battery, to turn a liquid that usually contains nicotine and flavorings, into an aerosol that is inhaled by the user. Over the last few year e-cigarette usage has exploded, with a doubling of e-cigarette use from 2011 to 2012 among middle and high school students and adults (18-34), according to the Centers for Disease Control (CDC) figures.

Of concern to public health experts is that e-cigarette makers appear to be targeting youth. E-cigarette makers spent $39 million on ads from June through November 2013, much of it on programming targeting youth, the anti-tobacco organization Legacy found. The fear is a whole new generation of people will become addicted to nicotine.

Of note to anti-smoking advocates is that the proposed rule does not contain any proposal to ban flavors in e-cigarettes or cigars. They worry that e-cigarettes sold in flavors such as bubble gum and gummi bear will entice teenagers and children. Public health experts say 90 percent of smokers start by the age of 20.

There are also was no suggestion in the proposed rule to restrict the marketing of e-cigarettes, as is done for regular cigarettes, which are banned from television advertising. According to Legacy, while cigarette advertising is prohibited on television, it is currently fair game to use television to promote electronic cigarettes. Using broadcast and online advertising has allowed the e-cigarette industry to promote its products in a way that has broad reach.

While the proposed regulation takes some very important steps to protect public health by regulating these new tobacco products, especially e-cigarettes, it is essential that FDA continue to look at what further regulation is needed to ensure these products are not marketed to youth.

The proposed rule will be available for public comment for 75 days. The FDA is particularly interested in comments on how cigars should be covered by the rule, and how e-cigarettes should be regulated.

For more information:

Proposed rule: Tobacco Products Deemed to be Subject to the Food, Drug and Cosmetic Act (Deeming)


Last day! Visit to sign up for health insurance before it’s too late.

The last day to sign up for health insurance through the Affordable Care Act (ACA) is here! Monday, March 31 is the last day that eligible adults can enroll in health insurance without being penalized.

For those who miss the deadline, most won’t be able to sign up for Marketplace health insurance again until the next open enrollment period, which starts on November 15, 2014.

Important things to know:

  • The penalty for those who don’t sign up for health insurance this year is $95 for each adult for the year ($47.50 per child) or 1% of your annual household income (whichever number is higher). This penalty is only for those who can afford health insurance. For more information on, who is exempt from this penalty, visit
  • More than 6 million people have signed up for private health insurance coverage since ACA’s care’s open enrollment began in October 2013. More are expected to sign up before the March 31 deadline. It’s expected that federal and state health exchange will be swamped over the next week as procrastinators try to make the deadline. If you need extra help signing up and access the federal or state hotlines, you may experience longer wait times as the deadline approaches.
  • If you have had a “qualifying life event” such as losing your employee health insurance, having a baby, or getting married, you will be able to sign up for health insurance after the March 31 deadline.
  • The March 31 deadline does not apply to those eligible for Medicaid or the Children’s Health Insurance Program. These programs are open year-round to those who are eligible.

One important note, there has been media buzz over the last few days about an ACA extension. Basically, if you are not signed up by March 31 because of website glitches and delays, or if you have started the process on the Marketplace website but have not finished, you will be allowed to enroll after the March 31 deadline. You can do this by asking for an extension on the website, which will give you until mid-April to finish your enrollment.

For more information on the March 31 deadline, the next enrollment period, qualifying life events, and any other questions you may have about the ACA and signing up for health insurance, visit for more information.

Health IT: The next patient frontier

By Sarah Hijaz, Health Policy Intern

Modern technology has dramatically improved the way we communicate, connect, and learn. It is also beginning to improve the way we practice medicine and treat patients. On the 5th anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which created a platform for health information technology to revolutionize our health care system, we are taking a look at what technology has and will do for our health care.

Health information technology (HIT) is the new driving force in the health care system. It allows health care providers to quickly search for patient records, have automatic filing systems, and in the future can create an inter-operable electronic database connecting patient records in real-time. Electronic health records (EHRs) present an amazing opportunity to advance care and improve health care provider workflow. For instance, EHRs make it easier to find out what tests have been ordered and medications prescribed by other providers. This cuts down on the chance of unnecessary, duplicate testing and inappropriate prescribing for medicines that should not be taken together.

Health IT also empowers patients.  Prior to the rise of electronic records, many patients, especially those unfamiliar with the healthcare system, thought that their health records were only for the health care provider. When in fact, your health record is yours—and patients should feel free to access it and know what information is in their record.  Now with EHRs, patients can go online and access their health information and make queries of the provider in real time. Some EHRs even allow patients to input information about their health to share with their doctor. By being able to quickly access and easily retain and send out copies of their EHRs, patients have a greater level of control of their personal information. In fact, a recent survey by the National Partnership for Women & Families has shown that 80% of individuals who have online EHR access take advantage of that access.

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Chipotle beefs up sustainable agriculture efforts


By Kelsey Albright, Linda Golodner Food Safety & Nutrition Fellow

As if it wasn’t enough that the restaurant chain Chipotle revolutionized the extremely affordable, locally sourced and 100% delicious fast food meal, now they’re speaking out against the unsustainable and inhumane nature of industrial agriculture.  And they’re doing so in the most entertaining way.  The satirical series, “Farmed and Dangerous,” calling out big agriculture is set to debut February 17, on Hulu.

When I first heard about this series, I was skeptical.  But then it dawned on me that Chipotle does some great things when sourcing their meat and dairy products, holding their producers to higher standards than pretty much every other fast food chain.

The 30 minute, four episode, series seeks to raise consumers’ awareness about industrial farming issues by taking a very serious, grim subject and satirically highlighting its biggest problems.  This “values integration” raises awareness about issues the company combats and in return consumers view Chipotle in a positive light and will eat there in an opportunity to support their efforts.

It’s not Chipotle’s first stab at this blended marketing approach they’re calling ‘strategic entertainment.’  The Scare Crow (2013), Back to the Start (2011) and Meat Without Drugs (2012) are all short films about the disturbing tactics used by large industrial farms.  As a matter of fact, this approach isn’t new at all.  Proctor & Gamble created “soap operas” as a means of cross promotion; as did Ovaltine with shows like Captain Midnight back in the 1950s.  The return to such marketing tactics is most likely driven by consumers ability to skip commercials altogether, with technology like DVR and Netflix.  Even Whole Foods is slated to be releasing a new reality series called “Dark Rye.”

The series mentions Chipotle only once, as a means of debunking the current rumor that McDonald’s owns a controlling stake in the company.  The share was indeed held by McDonald’s for eight years but they divested in 2006.

Full disclosure, the episodes will air on a Chipotle branded Hulu account but maybe they deserve to claim these efforts.  So often we see commercials with entertaining but meaningless messages.  Chipotle could have just as easily spent their money on a thirty second super bowl ad, but instead they chose to spread a message they believe in while getting the most possible bang for their buck.  I know I’ll be watching.

Consumer health advocates continue work on health coverage at the Families USA Conference

burkholder1By Rebecca Burkholder, NCL Vice President for Health Policy

With only 60 days left for consumers to enroll in the Health Care Marketplace, I joined health care advocates from across the country to hear from healthcare experts at the annual Families USA conference.  Keynote speaker, Vice President Joe Biden, opened the conference with rousing words stating, “Now for the first time, health care coverage for all, is the law of the land.” The law is a testament to the power of advocates and others, who worked tirelessly to secure this basic right for Americans.

Vice President Biden kicked off the conference with a challenge to remember what life was like before the passage of the Affordable Care Act (ACA) – when pregnancy was a pre-existing condition, young adults were kicked off their parents’ health plan, lifetime dollar limits were in effect, and patients could be denied coverage because of a pre-existing condition.  Americans no longer go to sleep at night worrying that if a family member gets sick, they might lose their house, their savings, and go bankrupt due to high medical bills and inadequate health insurance. “It is not just about physical health coverage anymore, but about peace of mind,” said Biden.

Many speakers, including Biden, noted that the conversation about health care has changed.  Instead of talking about health care as a privilege, it’s now agreed that health care is a right everyone deserves access to.  People who previously had no access to preventive care are going to the doctor and getting much needed care as a result of the ACA.

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Rates of tobacco use have drastically declined over the last 50 years. Another win for regulations.

By Sally Greenberg, NCL Executive Director

Not long ago I wrote about the miraculous number of lives saved from tough safety regulations on cars and trucks. Some states today are recording the lowest traffic fatalities ever since states began collecting statistics. Why? Because of safety devices (seatbelts, airbags, crash protective car bodies) and designs that were lobbied for by consumer advocates like Ralph Nader, Joan Claybrook, Advocates for Highway and Auto Safety, CARS,  and Consumer Reports/Consumers Union beginning in the 1960s and continuing until today.

Now I’m writing about another miraculous success story also related directly to a sustained public health education and awareness campaign. Fifty years ago – in 1964 – the US surgeon general issued a groundbreaking report on smoking and health. The paper offered definitive proof – based on thousands of studies -that smoking causes lung cancer and is linked to other serious diseases. Tobacco companies had spent years denying and obfuscating the evidence. Research since then has shown that tobacco can cause or exacerbate a wide range of ailments, including heart disease, stroke, multiple kinds of cancer, chronic obstructive pulmonary disease, emphysema, asthma and diabetes, and can cause disease in those who inhale the secondary smoke – including wait staff in restaurants and bars and children of smokers.

This sustained campaign to discourage Americans from smoking –including high taxes on cigarettes, banning smoking in bars, restaurants, workplaces, airports, airplanes, trains, and other enclosed spaces, requiring smoking in restricted areas, curbs on advertising, banning sales to minors, penalizing smokers with higher health care premiums, and local and state programs for smoking cessation  – all have  helped to dramatically reduce smoking in the US.

I’m one of those who had a two pack a day habit so I know about smoking. It was incredibly difficult to quit – I did it four or five times for months or years at a time but got hooked again immediately upon taking the first puff.

I did finally call it quits and don’t dare come close to a cigarette today. Why did I quit finally? Lots of reasons, including that I felt shockingly short of breath when going up just a few stairs, the ever escalating cost, and the unpopularity of puffing away and polluting the air I was sharing with colleagues and friends. Not to mention it’s about the stupidest thing you can do, given all the terrible health conditions caused by and exacerbated by smoking. Thirty years after quitting, I also am happy to report that all of the six members of my immediate family who smoked back then have all kicked the habit.

So we are part of the success story. The percentage of American adults who smoke dropped from 42 percent in 1965 to 18 percent in 2012. A new study published in the Journal of the American Medical Association estimated that tobacco control measures adopted since 1964 have saved eight million Americans from premature death and extended their lives by an average of almost 20 years.

However, we still have 44 million smokers. To tackle this challenge, the American Heart Association, the American Lung Association, the American Cancer Society, the American Academy of Pediatrics, and the Campaign for Tobacco-Free Kids have called for a new national commitment to drive down smoking among adults to less than 10 percent over the next decade. The groups also want to protect all Americans from secondhand smoke within five years by having every state enact laws against smoking in all workplaces, bars and restaurants; and ultimately eliminate death and disease caused by tobacco.

The power of the tobacco industry is a challenge. It spends $8 billion a year to market cigarettes and other tobacco products in the US, marketing too often aimed at young people.

The industry also enjoys profits from heavy smoking prevalent in so many developing countries. My recent visits to China and Cuba underscored the ubiquitous use of tobacco around the world. Happily we’re spoiled in the US by being relative smoke free in communal places.

Meanwhile, back in the US, many groups are rededicating themselves to driving rates of smoking down to under 10 percent. Federal, state, and local government health officials are working alongside these groups. So there we have it – another victory for sensible regulation and here’s to the millions of lives saved as a result.

Can a soda tax create a healthier America?


By Kelsey Albright, Linda Golodner Food Safety & Nutrition Fellow

As the obesity rate in Mexico rises, lawmakers have taken action in the form of a tax on sweet drinks and some unhealthy packaged foods.  This action in Mexico might ultimately lead to similar laws in the United States and other parts of the world.  Similar measures are being passed in many South American counties such as Chile, Ecuador, and Peru all of which are promoting healthier eating through law making.  Ecuador even banned industrial food makers from using images of celebrities, cartoons, or animal characters on foods that are high in fat, sugar, and salt and Chile banned toys in fast food meals.

The 8% tax on packaged foods and one peso (about 8 cents) per liter tax on sweet drinks was not passed without criticism.  Food companies argued that snack food is a staple for the poor and that their companies played a large role as contributors to economic growth.  Taxing unhealthy foods raises their cost to competitive monetary levels with their healthier counterparts, causing difficult economic effects on the poorest citizens who may not be able to afford either.  Soda and junk food taxes also earn these foods a “forbidden fruit” reputation which could have negative outcomes, especially in children.

California State Senator Bill Monning proposed a one cent per ounce “soda tax” that a University of California, San Francisco study found would save between $320 million and $620 million in medical costs associated with diabetes.  San Francisco may also move ahead with its own city wide soda tax of two cents per ounce.  It isn’t just California that’s pushing for these taxes either.   Telluride, Colorado and New York City are among the many cities that have proposed their own soda tax.

As junk food taxes are becoming an increasingly popular idea we need to keep in mind the best means of implementation.  Raising taxes alone addresses one area of the obesity issue.  A multifaceted approach that targets junk foods and seeks to make healthy foods more desirable would produce lasting effects. If vegetables and potato chips are similarly priced, we need to make the vegetables are marketed in a way that is more attractive.  Focusing on reducing advertising of foods high in fat, sugar, and salt and targeted toward children while simultaneously initiating campaigns promoting healthy eating would a great starting place.