American association of public health physicians — tobacco

1. AAPHP tobacco policy should be based on the best available scientific evidence.

2. Tobacco use is a major cause of illness and death in the United States.

3. Almost all tobacco attributable mortality in the USA is due to cigarette smoking.

4. While nicotine is the primary addictive substance in cigarette smoke, other factors substantially enhance the addictiveness of cigarettes. These factors include habituation to the cigarette handling ritual, psychological appeal based on advertising themes, the strength and speed of the nicotine hit, and other factors. This set of factors make cigarettes the most addictive of tobacco/nicotine products.

5. Substances in the cigarette smoke, other than the nicotine, inhaled deep into the lung, cause most of the tobacco attributable illness and death in the United States.

6. Smoke free tobacco/nicotine products, as available on the American market, while not risk free, carry substantially less risk of death and may be easier to quit than cigarettes.

7. Since susceptibility to tobacco/nicotine addiction is strongest in adolescence and early adulthood, measures to prohibit sale of tobacco/nicotine products without a physician prescription should be maintained and strengthened.

8. The healthiest option is to never initiate tobacco/nicotine use.

9. For those already using a tobacco/nicotine product, the best option is to quit.

10. Harm Reduction Smokers who have tried, but failed to quit using medical guidance and pharmaceutical products, and smokers unable or uninterested in quitting should consider switching to a less hazardous smoke free tobacco/nicotine product for as long as they feel the need for such a product. Such products include pharmaceutical Nicotine Replacement Therapy (NRT) products used, off label, on a long term basis , electronic e cigarettes, dissolvables (sticks, strips and orbs), snus, other forms of moist snuff, and chewing tobacco.

11. Harm reduction should be considered as an addition to current tobacco control policies and programming and should be done in a way that will minimize initiation of tobacco/nicotine use, maximize quit rates and assure that dual use does not increase potential harm to the user.

12. Mandated health related warnings on tobacco/nicotine products should be periodically reviewed to assure that each warning reflects a real life hazard posed by the product in question and is not misleading in any way.

13. AAPHP tobacco policy should be intended to reduce the burden of illness, death and property damage attributable to tobacco products in American society. In pursuit of this goal, AAPHP must consider the needs and risks of current tobacco users, those potentially exposed to tobacco smoke, and those at risk of initiating future use of tobacco/nicotine products.

14. The tobacco page of the AAPHP web site should be configured to serve as an informational resource to physicians, other health related organizations and the general public.

AAPHP Tobacco Documents

AAPHP 2008 Harm Reduction and Resolutions White Paper AAPHP 2008 Harm Reduction and Resolution White Paper

AAPHP 2010 Harm Reduction Update

AAPHP Statement on the State Regulation of E cigarettes This document is undergoing review at this time.

American Association of Public Health Physicians, Tobacco Control Task Force (AAPHP) Citizen Petition Document ID FDA 2010 P 0095 0001 Docket ID FDA 2010 P 0095 available at /#!documentDetail D FDA 2010 P 0095 0001 Also available here . A second related petition is available here FDA Petition Summary References to materials included as attachments to FDA Petitions Attachment Set A1 A40 For material from all other attachment sets and for additional information please contact Joel L. Nitzkin, MD at jln md

For additional background information relative to Tobacco Harm Reduction, plus brief narratives and bibliographic references to deal with the objections most commonly raised by opponents to Tobacco Harm Reduction, Dr. Nitzkin has posted this «Tobacco Harm Reduction A Public Health Perspective» based on a presentation he gave to a joint committee of the Oklahoma State Legislature, October 3, 2012. 2012NitzkinHarmReduction

Dr. Nitzkin’s lecture given at the AAPHP meeting at the June 2013 AMA House of Delegates meeting is available here Dr Nitzkin’s Lecture AAPHPSavingSmokers0608 The resolution that passed is available here

Other Tobacco Related Documents of Potential Interest to Readers

FDA determination to regulate E Cigarettes and other smokeless tobacco products

2011 Harm Reduction Update

Legislation H.R. 1256 Family Smoking Prevention and Tobacco
Control Act111th Congress 2009 2010 available at

Syracuse hospital bans e-cigarettes after patient on oxygen catches fire while using one

Syracuse, N.Y. A Syracuse hospital is warning patients not to use electronic cigarettes after a patient on oxygen caught fire while puffing on one of the devices.

Joe Galloway, a Syracuse Fire Department investigator, said the cause of the March 22 fire at St. Joseph’s Hospital Health Center has not been determined yet, but he confirmed the patient had an electronic cigarette.

Dr. Sandra Sulik, the hospital’s vice president of medical affairs, is convinced an e cigarette sparked the fire. «There’s no doubt about it,» she said.

Electronic cigarettes, or e cigarettes, deliver nicotine or other substances to a user in the form of vapor. The fire investigation at St. Joe’s comes at a time when there is growing concern nationally about the safety of e cigarettes which are not regulated by the government and have been linked to poisonings and fires.

The patient, whose identity was not released by the hospital, was burned across her face from ear to ear, said St. Joe’s spokeswoman Kerri Howell. The patient had an e cigarette in her mouth and was using oxygen when the fire started, Howell said. The patient is now at home doing well, Howell said.

The woman suffered first and second degree burns and was transported to the burn unit at Upstate University Hospital, according to Galloway.

Brandon Leonard, a St. Joe’s patient safety representative, was in the patient’s first floor room helping her roommate when he heard a loud pop and saw flames through a privacy curtain separating the patients’ beds.

Leonard, who is also an emergency medical technician, ran to the other side of the room where he saw flames around the patient’s nose and fire shooting out of the end of a hose connected to an oxygen outlet in the wall. Leonard said he grabbed a blanket and put out the flames on the patient in less than a minute. Gyan Dahl, a nursing student working on the floor, came into the room and turned off the oxygen. As a precaution, the hospital briefly shut off oxygen to the entire floor and patients who needed oxygen were hooked up to oxygen tanks.

Oxygen itself is not flammable. But medical oxygen increases oxygen levels of normal air, making it easier for fires to ignite. That’s why people are advised not to smoke or have other ignition sources near oxygen.

Jennie DeLee, a registered nurse at St. Joe’s, heard yelling and went into the room where the fire occurred. «The patient was standing at the side of the bed,» she said. «I just saw black soot and charred skin. She was in shock.»

DeLee summoned the hospital’s rapid response team who stabilized the patient and moved her to the intensive care unit before she was taken to Upstate.

Hospital officials said the quick response of Leonard, Dahl, Delee and other staff prevented what could have been a catastrophe and more serious injury to the patient.

E cigarettes typically contain a rechargeable, battery operated heating element, a replaceable cartridge filled with liquid nicotine or other chemicals and an atomizer that when heated converts the contents of the cartridge into a vapor. Manufacturers of the smokeless, odorless devices say they can be used almost any place.

Thomas Kiklas, cofounder of the Tobacco Vapor Electronic Cigarette Association, said he’s not heard of any cases of e cigarettes igniting oxygen.

Kiklas said there have been a few reports of e cigarettes exploding. He said those cases involved e cigarettes that were overcharged or users who put the wrong batteries in them.

The federal Centers for Disease Control and Prevention recently reported a dramatic increase in calls about e cigarettes to poison control centers. Many of the calls involve children who got sick after swallowing or touching liquid nicotine.

The U.S. Food and Drug Administration also has received at least four reports of e cigarettes causing fires. Those reports are listed on its website.

Three of the reports indicate e cigarettes exploded while the devices were charging. Those reports say the explosions burned an e cigarette user, set a 3 year old’s clothing on fire and ignited a house fire. A fourth report says an e cigarette exploded while the user was driving a car, causing second degree burns to his mouth and face.

The York Press, a British newspaper, recently reported an e cigarette exploded in a crowded pub, scorching the dress of the bartender.

There is no government regulation of e cigarettes. The FDA is expected to issue proposed rules governing e cigarettes soon.

The FDA says e cigarettes have not been evaluated for safety and effectiveness. Limited laboratory studies by that agency found significant quality issues. The FDA says cartridges labeled as containing no nicotine contained nicotine. It also found three different electronic cartridges with the same label that emitted a different amount of nicotine with each puff.

Since the fire, St. Joe’s has been telling patients e cigarette use is not allowed. The hospital has a policy that prohibits tobacco use inside its buildings or outdoors on its campus. The policy also prohibits e cigarette use.

Sulik said some e cigarette users who have quit smoking regular cigarettes do not consider themselves smokers and assume anti smoking rules do not apply to them. Sulik said the patient who was burned had quit smoking three years ago, but had not told hospital staff about her e cigarette use before the fire.

Now when staffers question patients about tobacco use they ask if patients use e cigarettes and explain why they are not safe to use in the hospital, Sulik said. The hospital also is making new signs to alert patients, visitors and staff that e cigarette use is prohibited.

You can contact health writer James T. Mulder at jmulder or (315) 470 2245. Follow him on Twitter JamesTMulder.