Health oriented organizations and President Barack Obama praised the move.

“As one of the largest retailers and pharmacies in America, CVS Caremark sets a powerful example, and today’s decision will help advance my administration’s efforts to reduce tobacco related deaths, cancer, and heart disease, as well as bring down health care costs ultimately saving lives and protecting untold numbers of families from pain and heartbreak for years to come,” Obama said in a statement Wednesday.

“This is an important, bold public health decision by a major retail pharmacy to act on the long understood reality that blending providing health care and providing cigarettes just doesn’t match,” said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.

“We need an all hands on deck effort to take tobacco products out of the hands of America’s young generation, and to help those who are addicted to quit,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “Today’s CVS Caremark announcement helps bring our country closer to achieving a tobacco free generation. I hope others will follow their lead.”

It remained unclear whether other pharmacies will follow CVS’ lead.

“We have been evaluating this product category for some time to balance the choices our customers expect from us with their ongoing health needs,” Walgreens spokesman Jim Graham said in a statement.

“We will continue to evaluate the choice of products our customers want, while also helping to educate them and providing smoking cessation products and alternatives that help to reduce the demand for tobacco products.”

Meanwhile, David Howard, spokesman for R.J. Reynolds Tobacco Co., said, “We value the long term relationship with CVS and respect their commercial decision. We will work with them as they transition out of the tobacco category in the coming months.”

Stopping cigarette sales comes at a price. CVS Caremark estimates it will take an annual loss of $2 billion from tobacco shoppers $1.5 billion in tobacco sales and the rest from other products tobacco shoppers purchase while in the store.

The company has enjoyed growing revenues in recent years, boosted by its pharmacy services business and prescription drug sales.

CVS Caremark hasn’t reported its year end results yet, but it took in nearly $94 billion in revenues in the first nine months of 2013, up slightly from the same period in 2012, according to its most recent earnings report.

In 2012, CVS Caremark reported $123.1 billion in revenues, a 15% jump from $107.1 billion the previous year.

“We commend CVS for putting public health ahead of their bottom line and recognizing the need for pharmacies to focus on supporting health and wellness instead of contributing to disease and death caused by tobacco use,” the American Medical Association said.

Asked Wednesday about the reaction of tobacco executives to the decision, CVS Caremark’s Merlo said they were “disappointed. At the same time, I think they understand the paradox that we face as an organization, and they understand the rationale for the decision.”

On whether CVS would extend its ban to other products known to be unhealthy candy, potato chips or alcohol, for instance Merlo told reporters those items, in moderation, do not have the same adverse effects as the use of tobacco.

We know it can kill us Why people still smoke

Helping people quit

The company also announced Wednesday it plans to launch a national smoking cessation program in the spring. The program will include information and treatment on smoking cessation at CVS/pharmacy and Minute Clinic locations in addition to online resources.

Members of the pharmacy benefit management plan will be able to access comprehensive programs to help themselves stop smoking.

Smoking cessation products such as nicotine patches or gum will continue to be available at CVS/pharmacy locations, Dr. Troyen Brennan, chief medical officer for CVS Caremark, said Wednesday.

The last cigarette Nine ex smokers who quit the habit for good

Fewer people smoke today than in the mid 20th century, but there are still a lot of Americans lighting up. In 1965, 42% of the population smoked, compared with 19% today, according to the Centers for Disease Control and Prevention. Experts said the decline in smoking has plateaued.

It’s no secret that tobacco causes health problems. Cancer, stroke, heart disease and lung diseases are among the results of smoking, according to the CDC. More than 5 million deaths per year are caused by tobacco use. Smokers also tend to die 10 years before nonsmokers, according to the CDC.

Support from public health advocates

The company’s announcement is “a huge step toward our country being able to have a really long lasting culture of health,” said Dr. Risa Lavizzo Mourey, president and CEO of the Robert Wood Johnson Foundation, the largest U.S. philanthropy devoted to public health.

In addition to eliminating a point of sale of tobacco, CVS Caremark’s removal of tobacco products also takes away an advertising opportunity, said Robin Koval, president and CEO of Legacy, an organization that conducts research on tobacco use. Young people who shop at CVS/pharmacy for other reasons will no longer see the array of tobacco products available.

“It’s obviously a landmark decision and one that I hope wakes up the entire retail industry that it’s the right thing to do,” Koval said.

FDA launches teen anti smoking campaign

A report from the California Department of Public Health found that while total cigarette sales decreased between 2005 and 2009 in the United States, sales in pharmacies increased. If sales of cigarettes at pharmacies continue rising at the current rate, by 2020 almost 15% of all U.S. cigarette sales will occur at pharmacies, the report said.

According to a 2011 study in Los Angeles, cited in the report, more than 32% of pharmacies sold cigarettes, and traditional chain pharmacies were far more likely to sell cigarettes than independently owned pharmacies.

Wender noted the CVS move is in line with what the American Cancer Society, American Heart Association, American Medical Association, American Lung Association and American Pharmacists Association have advocated to stop sales of tobacco in retail outlets with pharmacies.

On the other side of the issue, there is a lot of money in tobacco. The cigarette industry spent $8.37 billion in 2011 on advertising and promotions, according to the CDC.

Most tobacco is sold in convenience stores, which would be “a tougher nut to crack” in terms of stopping tobacco sales, Wender said.

But pharmacies are a good place to start, Wender said. He is convinced the removal of tobacco products from CVS/pharmacy locations will result in some smokers quitting, particularly those who have a habit of buying their cigarettes there.

“It’s going to force every one of them to pause and say, ‘Why isn’t my CVS selling cigarettes anymore?’ ” Wender said.

How you can prevent most kinds of cancer

CNNMoney’s Melanie Hicken and Aaron Smith and CNN’s Jen Christensen and Miriam Falco contributed to this report.

Are e-cigarettes a ‘gateway to nicotine addiction’? – health news – nhs choices

Brazil discount cigarettes los angeles ca 90022

On average tobacco smokers die significantly younger and spend more of their shorter lives ill. Because e cigarettes can be marketed to young people, there is a worry that if they did lead to more conventional smoking, they could have a potentially disastrous impact on public health.

This current study does suggest that e cigarettes may not be the harmless alternative some believe, and may be acting as a “gateway drug” to conventional smoking.

However, it does not prove that is the case. It is quite plausible that existing teenage smokers are also trying e cigarettes for a variety of reasons.

The debate about the safety and regulation of e cigarettes is likely to continue until more robust long term evidence emerges.

Where did the story come from?

The study was carried out by researchers from the Center for Tobacco Research and Education at the University of California, San Francisco, and was funded by the US National Cancer Institute.

It was published in the peer reviewed medical journal, JAMA Pediatrics.

The Mail Online coverage was balanced and discussed the pros and cons of e cigarettes. It also usefully brought in some wider research from 75,000 Korean adolescents “which also found that adolescents who used e cigarettes were less likely to have stopped smoking conventional cigarettes”.

What kind of research was this?

This was a cross sectional study looking at whether e cigarette use was linked to conventional cigarette smoking behaviour among US adolescents.

E cigarettes are devices that deliver a heated aerosol of nicotine in a way that mimics conventional cigarettes while delivering lower levels of toxins, such as tar, than a conventional combusted cigarette. They are often marketed as a safer alternative to regular smoking, or as a way of helping people quit traditional smoking.

The devices are not currently regulated in the US or the UK, meaning there are limited or vague rules concerning appropriate advertising. The researchers say e cigarettes are being aggressively marketed using the same messages and media channels that cigarette companies used to market conventional cigarettes in the 1950s and 1960s. These include targeting young people to get a new generation of smokers hooked on nicotine for life.

The researchers outline how studies have demonstrated that youth exposure to cigarette advertising causes youth smoking. Meanwhile, electronic cigarettes can be sold in flavours such as strawberry, liquorice or chocolate, which are banned in cigarettes in the US because they appeal to youths.

Given the potential for a new generation to be hooked on nicotine and then tobacco smoking in this unregulated environment, the researchers wanted to investigate whether e cigarettes were associated with regular smoking behaviour in adolescents.

What did the research involve?

The researchers used existing smoking data collected from US middle and high school students in 2011 (17,353 students) and 2012 (22,529) during the large US National Youth Tobacco Survey. They analysed whether use of e cigarettes was linked with conventional tobacco smoking and smoking abstinence behaviour.

The National Youth Tobacco Survey was described as an anonymous, self administered, 81 item, pencil and paper questionnaire that included

  • indicators of tobacco use (cigarettes, cigars, smokeless tobacco, kreteks southeast Asian clove cigarettes , pipes, and “emerging” tobacco products)
  • tobacco related beliefs
  • attitudes about tobacco products
  • smoking cessation
  • exposure to secondhand smoke
  • ability to purchase tobacco products
  • exposure to pro tobacco and anti tobacco influences

Smoking behaviour was categorised as

  • conventional cigarette experimenters adolescents who responded “yes” to the question “Have you ever tried cigarette smoking, even one or two puffs?”
  • ever smokers of conventional cigarettes those who replied “100 or more cigarettes (five or more packs)” to the question “About how many cigarettes have you smoked in your entire life?”
  • current smokers of conventional cigarettes those who had smoked at least 100 cigarettes and smoked in the past 30 days
  • ever e cigarette users adolescents who responded “electronic cigarettes or e cigarettes, such as Ruyan or NJOY” to the question “Which of the following tobacco products have you ever tried, even just one time?”
  • current e cigarette users those who responded “e cigarettes” to the question “During the past 30 days, which of the following tobacco products did you use on at least one day?”

Data on intention to quit smoking in the next year, previous quit attempts and abstinence from conventional cigarettes was also collected. The analysis was adjusted for potential confounding factors such as race, gender and age.

What were the basic results?

The main analysis included 92.0% of respondents (17,353 of 18,866) in 2011 and 91.4% of respondents (22,529 of 24,658) in 2012 who had complete data on conventional cigarette use, e cigarette use, race, gender and age. The mean age was 14.7, and 5.6% of respondents reported ever or current conventional cigarette smoking (of these, 5% currently smoked).

In 2011, 3.1% of the study sample had tried e cigarettes (1.7% dual ever use, 1.5% only e cigarettes) and 1.1% were current e cigarette users (0.5% dual use, 0.6% only e cigarettes).

In 2012, the 6.5% of the sample had tried e cigarettes (2.6% dual use, 4.1% only e cigarettes) and 2.0% were current e cigarette users (1.0% dual use, 1.1% only e cigarettes).

Ever e cigarette users were significantly more likely to be male, white and older. The rates of ever tried e cigarettes and current e cigarette smoking approximately doubled between 2011 and 2012.

The main analysis found use of e cigarettes was significantly associated with

  • higher odds of ever or current cigarette smoking
  • higher odds of established smoking
  • higher odds of planning to quit smoking among current smokers
  • among e cigarette experimenters, lower odds of abstinence from conventional cigarettes

How did the researchers interpret the results?

The researchers’ interpretation was clear “Use of e cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.”

They added that, “In combination with the observations that e cigarette users are heavier smokers and less likely to have stopped smoking cigarettes, these results suggest that e cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths. These results call into question claims that e cigarettes are effective as smoking cessation aids.”

Conclusion

This study found US adolescents who use e cigarettes are more likely to smoke conventional cigarettes. They also have lower odds of abstaining from conventional cigarettes than those who don’t try e cigarettes. On the flip side, e cigarette users were more likely to report planning to quit conventional smoking.

The research sample was large, so is likely to provide a relatively accurate picture of the smoking behaviour of US adolescents.

These results suggest that e cigarettes may not discourage conventional cigarette smoking in US adolescents, and may encourage it. However, because of the cross sectional nature of the information, it cannot prove that trying e cigarettes causes adolescents to take up conventional smoking. There may be other factors at play.

And indeed, smoking tobacco cigarettes may cause teenagers to take up e cigarettes. For example, the type of person who may want to try smoking in the past could only try conventional smoking. Nowadays, they have e cigarettes as an option too.

Retrospectively trying to work out if they would have taken up conventional smoking had they not tried e cigarettes first is not possible. This question would require a cohort
study that tracks behaviour over time. You would then be able to see which smoking method they took up first and if one led to the other. This was not possible using the data the researchers had to hand in the current study.

Conventional smoking has been a public health priority for many decades because, on average, smokers die significantly younger (more than a decade in some groups) and they spend more of their shorter lives ill. Consequently, any product that may increase the rates of conventional smoking among the young such as e cigarettes has serious and widespread health consequences.

Currently, regulation around e cigarettes is minimal, but there are plans to introduce stricter rules in the UK. In the meantime, this study provides some evidence that e cigarettes may not be the harmless, safe alternative some believe, and may be acting as a gateway drug to conventional smoking.

The research stops short of proving this, so the debate on whether e cigarettes should be treated similarly to conventional cigarettes, through advertising and sales restrictions, is likely to continue.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.