In This Issue                                       April 2014




A Note From RobinRobinNote

April has come and gone in the blink of an eye, and through the month, we have worked long and hard to continue our steady stream of life-saving work.While we have made many steps forward, there are still giant leaps to overcome.  
After years of waiting, the FDA finally released their deeming regulations last week, exerting their jurisdiction to regulate
 electronic cigarettes, little cigars, cigarillos and hookah. While we applaud them for finally acting and consider this a good first step, we remain  concerned with the troubling gaps - in particular flavorings and advertising on television. Legacy will be active in the comment period, advocating for rapid implementation of the regulations as well as continuing to push for further rulemaking.

This month, we also joined colleagues at several national partner organizations to applaud U.S. Secretary of the Navy, Ray Mabus on his recent proposal to eliminate tobacco sales on ships and bases. Smoking prevalence among servicemen and women far exceeds the national smoking rate, so this recent consideration of a ban by the United States Navy is a positive step by the United States Congress as it relates to the health of our troops. Wouldn't it be terrific if this were the start of a new ripple effect to protect soldier and sailors' health?

These two bold moves among many others, which could work to help save thousands of lives, are the result of inspired thinking and dynamic discussion. Our provocative Warner Series event last month on the End of Combustibles has proven yet again that Legacy will never shy away from an opportunity to initiate and expand conversation in an effort to make progress. By being bold, our thought leader panels ask the tough questions and challenge convention. If you missed it, the archived webcast is here. 
By collectively continuing bold discussions, innovative thoughts can turn into powerful action, and before we know it, we will have achieved our goal of creating the next Smoke Free Generation. 
Robin Koval,
President and CEO, Legacy 




FDA Takes Step Towards Regulating E-Cigs, But Leaves Behind Candy Flavored CigarsDeemingRegs


Following a long wait, on April 24th, 2014, the U.S. Food and Drug Administration (FDA) finally announced just how the federal agency would regulate additional tobacco products, including e-cigarettes.  Legacy applauds the FDA's action to take this necessary first step to regulate e-cigarettes, little cigars, cigarillos and hookah.  However, we're concerned that these rulemaking proposals fail to address regulation of premium cigars, candy-flavored little cigars and flavored e-cigarettes. Flavored products are often appealing to youth, women, and low socio-economic populations, and in order to accomplish our efforts to create the next Smoke-Free Generation, it is imperative that we rid ourselves of these flavored products - products which can provide a gateway for so many people to nicotine addiction. While there is growing evidence that electronic cigarettes in particular present reduced harm as compared to regular cigarettes, Legacy believes it is imperative that we keep these products out of reach from our nation's youth and young adults. The FDA's decision to curtail marketing practices such as free samples, vending machine sales, and outdoor advertising for all tobacco products is a wise move to protect youth from the dangers of nicotine addiction. In order to adequately respond to the recent call to action by the US Surgeon General to quickly end the use of all combusted tobacco products, Legacy will remain an active participant in the public comment period during the course of the next 75 days. Read more about Legacy's stance on the new regulations proposed by the FDA.




In the Eyes of a Child: Legacy Study Examines Point-Of-Sale Advertising of Electronic CigarettesAdStudyChild


A study conducted by Legacy and published in the March issue of Tobacco Control examined the advertising of electronic cigarettes in the retail environment from February to July 2013, in Central Harlem, New York City, a predominantly African-American neighborhood. The results showed that 26 percent of the 156 retail stores licensed to sell tobacco in the area had e-cigarette advertising placed in the front of the store and 52 percent of those stores sold these products in a variety of flavors.  Flavors in cigarettes, with the exception of menthol, have been banned since September 2009 by the Family Smoking Prevention and Tobacco Control Act.  These products are currently sold in flavors such as cherry, apple and gummy bear, which make them appealing to youth.


This study also showed that many ads were placed less than three feet above the ground, putting them at the eye level of children. Furthermore, these ads featured e-cigarettes in a variety of flavors, which make these products even more appealing to youth. Research conducted by Brian King Ph.D., an epidemiologist with Centers for Disease Control and Prevention's Office on Smoking and Health shows that African-American populations have the greatest increase in awareness, out of all minority groups, of e-cigarettes. This could be attributed to the heightened availability and pervasive advertising of these products in primarily African-American neighborhoods. 


Prior Legacy-conducted research shows that emerging products like little cigars and cigarillos are more prevalent in African American neighborhoods. The research also shows that these products are widely advertised and are cheaper in minority and young adult neighborhoods in Washington, D.C. These products were also not included in the 2009 Family Smoking Prevention and Tobacco Control Act, and are available in a variety of flavors. Combined, these studies contribute to a growing body of evidence that proves the need for FDA regulation of new and emerging products. Read more about research conducted by Legacy on the advertising of emerging products. 





Poisoned Via E-Cigarette: More Proof for FDA Regulation ecigpoison 


A study in the April 4, 2014 edition of the Morbidity and Mortality Weekly Report (MMWR) shows that calls to poison centers after being exposed to an electronic cigarette have compounded since September 2010. The study states that e-cigarette exposure calls to poison centers per month increased from one in September 2010 to 215 in February 2014. More disturbingly, calls relating to e-cigarette exposure were mostly for persons aged 0-5 years old. Complaints on the calls included vomiting, nausea, and eye irritation. The study also reported one suicide death that happened as a result from the intravenous injection of nicotine liquid.


E-cigarettes are currently unregulated by the FDA and can be purchased by minors in some parts of the country. States including California and New Hampshire have recently restricted the sales of e-cigarettes to minors. Read the Legacy fact sheet and policy position for more information about e-cigarettes.






Legacy and Partners Support Possible Navy Ban on Tobacco Productsnavy



At an estimated 24 percent, smoking rates among our men and women in uniform are considerably higher than civilian populations. These higher rates have a direct impact on military readiness, and health care expenditures in the armed forces. The recent consideration to ban tobacco on U.S. Navy ships and bases is a move that can significantly boost the health and well-being of our troops. To that end, Legacy, in cooperation with other health care groups, has written a letter to the Secretary of the Navy, the Honorable Ray Mabus, to express strong support for his proposal to ban tobacco on Navy ships and bases. 




Contributing factors to the high smoking rates in the armed forces are high stress levels, sleep deprivation, proximity to danger and even tobacco industry targeting. An added challenge is the perception among soldiers that they need to "leave the army" in order to quit successfully. The Department of the Navy has already taken steps to address high rates of tobacco use in the past by increasing access to cessation services under TRICARE, as well as eliminating price subsidies for tobacco products. Discontinued tobacco use in the military will not take place overnight, but  steps such as Secretary Mabus' proposal is certainly a step in the right direction.


To learn more about smoking in the military, watch a Warner Series panel discussion entitled "Tobacco: A Winnable Battle for America's Armed Forces". 






Join Us: Seminar with Dr. Donna Shelley on Improving Cessation Outcomes Among HIV+ Smokersdonnashelleyseminar


Legacy will host a seminar on Wednesday, May 14, 2014 featuring Dr. Donna Shelley, MD, MPH, entitled "An intervention to increase adherence to cessation medication and improve smoking cessation outcomes among HIV+ smokers." Dr. Shelley will present preliminary data from a NIDA funded R34 study that is testing the feasibility and comparing the effects of three intervention conditions on adherence to varenicline and cessation outcomes.  The three arms are: 1) Usual Care (UC), 2) UC + Text Message (TM) reminders and, 3) UC + TM and telephone counseling. Preliminary data suggest text messaging may be more effective in maintaining adherence to cessation medication compared with the more resource intensive addition of telephone counseling.


Donna Shelley, MD MPH is Associate Professor of Population Health and Medicine and Co-Director of the Section on Tobacco Alcohol and Drug Use in the Department of Population Health in the NYU School of Medicine. Her research focus includes studying organizational changes to improve adherence to guidelines implementation in health care systems, design and testing of smoking cessation interventions for disparate populations and more recently evaluating the feasibly of electronic cigarettes as a harm reduction strategy.


The seminar will take place from 11 a.m. until noon, at Legacy's offices located at 1724 Massachusetts Avenue NW, Washington, D.C. 20036. Please contact Jennifer Cantrell at [email protected] to RSVP by May 12th, 2014.





Prevention for Health Equality: April is National Minority Health MonthNationalMinority


The Department of Health and Human Services (HHS) observed National Minority Health Month this April, focusing on prevention as a way to achieve health equity. Covering a broad spectrum of illnesses, the motto, "a nation free of disparities in health and health care" took center stage. According to HHS, minorities are more likely than non-Hispanic whites to suffer from chronic conditions, many of which are preventable.


Tobacco use is not an equal opportunity killer, and since its inception, Legacy has been dedicated to reducing the disproportionate impact that tobacco has among socially and economically disadvantaged groups. Furthermore, tobacco use is the most widespread cause of preventable death in the United States, yet each day, 2,100 youth and young adults who are occasional smokers progress to become daily smokers. Youth prevention is an important issue to Legacy, as it plays a critical role in reducing the deadly impact of tobacco use among vulnerable populations. We also know that raising taxes and clean indoor-air laws work to reduce tobacco use. It is important to follow up these efforts with increased access to cessation services which these communities need the most.


Read more on Legacy's efforts to address tobacco-related health disparities, as well as on National Minority Health Month to see how you can get involved in creating a nation of health equality. 





The Ripple Effect: An Interview with Kenneth E. Warner on the Impact of the 1964 Surgeon General's ReportKWarner


The 1964 Surgeon General's Report on Smoking and Health was a seminal public health document that showed, for the first time, a positive correlation between smoking and various lethal illnesses. The impact that the report had in terms of lives saved and diseases prevented is astounding. Watch Kenneth E. Warner, PhD, Professor in the School of Public Health at the University of Michigan, and a Founding Member of the Legacy Board of Directors, as he explains just how far we've come, and how far we have to go in our battle with tobacco, in the latest of our Ripple Effect series.   



To learn more, read Dr. Warner's opinion on the endgame for tobacco. Also, visit Legacy's Multimedia Library to watch more

Ripple Effect videos and podcasts.





Register Today! Coordinator Camp 2014 Will Take Youth Tobacco Control Movement to the Next LevelCoordinatorCamp


Coordinator Camp 2014, a youth empowering event hosted by Legacy and the Campaign for Tobacco- Free Kids (CTKF) is now open for registration. This year's event will ask three questions, "Where are we now?", "Where are we going?" and "How do we get there", finding answers to the tobacco endgame along the way. Events include keynote presentations, break-out sessions and panel discussions for adult coordinators of youth prevention programs.


Coordinator Camp 2014 will take place from August 13-15, 2014 in New Orleans, LA. The cost of attendance is $100. Scholarships are available. For information on scholarships, email [email protected]. Registration for the event will close on July 10, 2014. For more information about the event and to register, click here






Call for Quitters: CDC's Tips Campaign is Recruitingtipsrecruiting


The Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health is currently recruiting candidates to be considered for its upcoming national education campaign,

Tips from Former Smokers (Tips). The Tips campaign has been extremely successful in raising awareness of and providing resources for smoking cessation. The 2012 Tips ads more than doubled the number of phone calls received by state quitlines from smokers motivated to quit smoking as compared to 2011. Additionally, research published in the Lancet showed that an estimated 1.6 million additional smokers made a quit attempt due to the Tips campaign.


Similar to the previous Tips Campaign efforts, people who have had life-changing, smoking-related health problems will be featured. The CDC is conducting a national search to find people with compelling stories who are willing to participate in the campaign. All applicants must have been tobacco-free for at least six months.


The CDC is looking for ex-smokers who:

  • Have or have had colorectal cancer that was linked to cigarette smoking (ages 30-65).
  • Have or have had macular degeneration that was linked to cigarette smoking (ages 40-65).
  • Used cigars with cigarettes or used cigarillos or little cigars with or without cigarettes, thinking cigars, cigarillos and little cigars were healthier than cigarettes and developed a serious health condition while smoking (ages 20-60).
  • Used e-cigarettes or smokeless tobacco for at least a year while continuing to smoke some cigarettes; and though using e-cigarettes or smokeless tobacco to cut back on some cigarettes would be good for their health; and despite cutting back, they were later diagnosed with a serious health condition.

Do you know someone who might be interested in applying? For more information please contact Mimi Webb Miller Casting at [email protected].




Kicking Butt(s) for the Planet on Earth DayEarthDay


Legacy employees took to the streets on April 22nd, also known as Earth Day, to host a cigarette butt clean-up in Washington, D.C.  Legacy is committed to reducing the impact of tobacco on our planet and population, and has been focused on the issue of litter from cigarette butts for the past few years.  In April 2011 the foundation hosted a Warner Series lecture on the issue and in 2013 released a Public Service Announcement (PSA). Cigarette butts are the most littered items in America's waterways and on highways and are toxic to the environment when not disposed of properly.  This year, Legacy cleaned up more than 4.57 pounds of cigarette butts in Dupont Circle Park alone. 


To learn more about what you can do locally to help combat this issue, download this toolkit. Additionally, share the PSA on social media this month using #rethinkbutts.  




Follow the Facts with Legacy's Fact SheetsFactSheets


Did you know that menthol cigarette smokers report shorter time to first cigarette after waking up compared to non-menthol smokers? Or that in one year alone, secondhand smoke can cause the death of 42,000 people, including 900 infants? Stay informed; print and share Legacy's downloadable fact sheets, which cover a wide variety of topics including youth smoking, menthol, and secondhand smoke. You can also use the Fact Clipboard to search and find the tobacco facts you're looking for.









Last Call: Apply Now for The Alma S. Adams Scholarship for Outreach and Health Communications to Reduce Tobacco Use Among Priority Populations


Selling a Poison by the Barrel: The Liquid Nicotine in E-Cigarettes


Dr. Georges Benjamin, Executive Director, APHA, Discusses the Role Tobacco Control Plays in Creating a Healthier Population this National Public Health Week


Paving the Way to Engage Youth: Apply to Attend Legacy's 2014 Youth Leadership Institute


Provocative Thoughts from a Public Health Expert: Kenneth E. Warner, PhD on the Endgame for Tobacco


Health Groups Urge President Obama to let FDA Regulate Emerging Products


Breaking the Chains: A Story About Quitting


Just What the Doctor Ordered: U.S. Attorneys General call on Pharmacies to End Tobacco Sales

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                Legacy is dedicated to building a world where young people reject tobacco and anyone can quit. 
               � 2012 American Legacy Foundation