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2/x
Opening Keynote Dr. Brian King - FDA, CTP.
Tobacco use - adult, youth
Health Disparities
FDA 4 pillars - Rules, Applications review, Compliance & Enforcement, Public
Opening Keynote Dr. Brian King - FDA, CTP.
Tobacco use - adult, youth
Health Disparities
FDA 4 pillars - Rules, Applications review, Compliance & Enforcement, Public
3/x King
Menthol and flavored cigar standards
Nicotine Standard
Cessation Care Package
* Some people who smoke could benefit from lower risk products.
Menthol and flavored cigar standards
Nicotine Standard
Cessation Care Package
* Some people who smoke could benefit from lower risk products.
4/x King
TPMP proposed rule
Talking about applications, how many received MDAs - there isn't a defacto flavor ban. Up to the mfgs to prove APPH.
TPMP proposed rule
Talking about applications, how many received MDAs - there isn't a defacto flavor ban. Up to the mfgs to prove APPH.
5/x King
Progress on PMTA, SE, Exemption request, MRTP.
Moving on to compliance and enforcement. 1200 Warning letters issued to date. 4 civil money penalties. 6 injunctions.
Progress on PMTA, SE, Exemption request, MRTP.
Moving on to compliance and enforcement. 1200 Warning letters issued to date. 4 civil money penalties. 6 injunctions.
6/x King
Distributors and Retailers. 123,000 warning letters - including sales to minors.
Moving on to public education...
Distributors and Retailers. 123,000 warning letters - including sales to minors.
Moving on to public education...
7/x King
Real Cost - youth
Next Legends - Native American
Tobacco products exist along a continuum of risk.
Real Cost - youth
Next Legends - Native American
Tobacco products exist along a continuum of risk.
8/x King
His priorities
Sound science
Stakeholder engagement
Communication
Health Equity
His priorities
Sound science
Stakeholder engagement
Communication
Health Equity
9/x King
External Evaluation Planned Actions
Reagan-Udall recommendations
Summary
Q&A coming up
External Evaluation Planned Actions
Reagan-Udall recommendations
Summary
Q&A coming up
10/x King Q&A
Online question about helping older people who smoke. - We have to be mindful of the resources we do have - where do we make the greatest public health impact.
Online question about helping older people who smoke. - We have to be mindful of the resources we do have - where do we make the greatest public health impact.
11/x King Q&A
Saul Shiffman - Pinney
Asking for details about King's statement there isn't a "defecto flavor ban."
Answer focuses on youth...
Saul Shiffman - Pinney
Asking for details about King's statement there isn't a "defecto flavor ban."
Answer focuses on youth...
12/x King Q&A
Matt Holman - PMI
Thanks King for openness to speak to all stakeholders. Holman asks about public education pertaining to reduced risk.
King - yes, more than PSAs are planned. Agrees we need more acute coms opportunities.
Matt Holman - PMI
Thanks King for openness to speak to all stakeholders. Holman asks about public education pertaining to reduced risk.
King - yes, more than PSAs are planned. Agrees we need more acute coms opportunities.
13/x
Jonathan Foulds - Penn State
Asking about misinformation about e-cigs.
King - we are aware that it's accruing and we're working on steps to correct that. It has to be science based. Must hit the right targeted audience.
Jonathan Foulds - Penn State
Asking about misinformation about e-cigs.
King - we are aware that it's accruing and we're working on steps to correct that. It has to be science based. Must hit the right targeted audience.
14/x
Paige M - Altria
Asking about streamlining the application process
King - there will be opportunities later for the public to provide input on this topic.
Paige M - Altria
Asking about streamlining the application process
King - there will be opportunities later for the public to provide input on this topic.
15/x King Q&A
Clive Bates - Counterfactual
Asking about health disparities for kids, who would have smoked but vape instead. Gottlieb said it wasn't a trade he was willing to accept. Is vaping affecting youth use of nicotine?
King - we have to do everything we can to mitigate...
Clive Bates - Counterfactual
Asking about health disparities for kids, who would have smoked but vape instead. Gottlieb said it wasn't a trade he was willing to accept. Is vaping affecting youth use of nicotine?
King - we have to do everything we can to mitigate...
16/x
youth use. I'm not willing to make that tradeoff, either.
This concludes the session with Brian King.
youth use. I'm not willing to make that tradeoff, either.
This concludes the session with Brian King.
17/x Ken Warner - University of Michigan
(I'm really excited to hear him speak and hope I get to meet him today!!!!!)
Reporting on papers done with Sun and Mendez
(I'm really excited to hear him speak and hope I get to meet him today!!!!!)
Reporting on papers done with Sun and Mendez
18/x Warner
Discussing "gateway theory."
Youth smoking rates are down.
Comparing PATH over several years.
(I love the word covariates...back to work! LOL)
Discussing "gateway theory."
Youth smoking rates are down.
Comparing PATH over several years.
(I love the word covariates...back to work! LOL)
19/x Warner
Is vaping connected to established continued smoking? (Sneak preview of a study not published yet)
Vaping wave 3
Smoking at leat 1 cigarette by wave 4
Were they still smoking in wave 5?
Is vaping connected to established continued smoking? (Sneak preview of a study not published yet)
Vaping wave 3
Smoking at leat 1 cigarette by wave 4
Were they still smoking in wave 5?
20/x Warner
Established smoking was having smoked at least 100 cigarettes in a lifetime and smoked past 30 days.
(Me: How low those numbers are is a BEAUTIFUL site to see!!!!!!!)
I'm not seeing a gateway!
Established smoking was having smoked at least 100 cigarettes in a lifetime and smoked past 30 days.
(Me: How low those numbers are is a BEAUTIFUL site to see!!!!!!!)
I'm not seeing a gateway!
21/x Warner
NYTS - results and calculations from their PATH research.
(OMG the numbers are so impressive I got lost in listening and forgot to type!) The good news is, they didn't find a gateway, and it appears that vaping has become an alternative for kids at risk of smoking!
NYTS - results and calculations from their PATH research.
(OMG the numbers are so impressive I got lost in listening and forgot to type!) The good news is, they didn't find a gateway, and it appears that vaping has become an alternative for kids at risk of smoking!
22/x David Levy - Georgetown University
Comparing smoking vs vaping in all age groups.
HA! Like to see someone showing the disparity in reductions in smoking of people in my age group. (OLD FARTS! LOL)
Comparing smoking vs vaping in all age groups.
HA! Like to see someone showing the disparity in reductions in smoking of people in my age group. (OLD FARTS! LOL)
23/x Levy
Similar trends in Canada, NZ, and the UK.
Trends suggest that e-cigs have played a role in reducing combustible product use.
It appears the FDA is headed towards a flavor ban. Marketing orders only granted so far to tobacco companies & NJOY.
Similar trends in Canada, NZ, and the UK.
Trends suggest that e-cigs have played a role in reducing combustible product use.
It appears the FDA is headed towards a flavor ban. Marketing orders only granted so far to tobacco companies & NJOY.
24/x Levy
In areas with flavor restrictions, smoking has gone up.
Retailers and internet sellers are continuing to sell some of the products that have been banned.
In areas with flavor restrictions, smoking has gone up.
Retailers and internet sellers are continuing to sell some of the products that have been banned.
25/x Levy
Tremendous growth in nicotine pouches. Probably lower risk tan e-cigs. Might be less satisfying to sub for for smoking/vaping. Takes longer for nic to hit the system.
Moving on to HTPs. Current US market is nascent. Competition among tobacco companies.
Tremendous growth in nicotine pouches. Probably lower risk tan e-cigs. Might be less satisfying to sub for for smoking/vaping. Takes longer for nic to hit the system.
Moving on to HTPs. Current US market is nascent. Competition among tobacco companies.
26/x Levy
(gosh the internet is slow here...)
"All alternative nicotine delivery products may soon be controlled by the cigarette industry in the US. Is this desirable?"
(gosh the internet is slow here...)
"All alternative nicotine delivery products may soon be controlled by the cigarette industry in the US. Is this desirable?"
27/x Levy
Talking about a suggested roadmap for the FDA regulatory process. Develop - Consider - Refine
(I'm sitting too far off to the side and in the front - and my eyes are old! - I can't read the small print on the slide)
Talking about a suggested roadmap for the FDA regulatory process. Develop - Consider - Refine
(I'm sitting too far off to the side and in the front - and my eyes are old! - I can't read the small print on the slide)
28/x Peter Hajek - Queen Mary University London
Reduced risk products - Gateway In? Gateway Out? No Effect?
GIRO project (Gateway In Or Out?)
Reduced risk products - Gateway In? Gateway Out? No Effect?
GIRO project (Gateway In Or Out?)
29/x Hajek
UK, USA, AU - EC vs smoking
Sweden - Snus
Japan, South Korea - HTP
UK, USA, AU - EC vs smoking
Sweden - Snus
Japan, South Korea - HTP
30/x Hajek
(Note to self: there is a reason @jgitchell told you NOT to chew a nicotine lozenge - OMG I forgot! WOW!)
(Note to self: there is a reason @jgitchell told you NOT to chew a nicotine lozenge - OMG I forgot! WOW!)
31/x Hajek
Comparing cigarettes to alternative products in various countries - it is interesting to look at the trends - short-term vs long-term.
Smoking in youth decreasing at a SLOWER rate in Australia than the UK and US!
Comparing cigarettes to alternative products in various countries - it is interesting to look at the trends - short-term vs long-term.
Smoking in youth decreasing at a SLOWER rate in Australia than the UK and US!
32/x Hajek
In low SES smoking decreasing FASTER in UK and US than in Australia.
Sales of cigarettes decreasing FASTER in UK than Australia.
In low SES smoking decreasing FASTER in UK and US than in Australia.
Sales of cigarettes decreasing FASTER in UK than Australia.
33/x Hajek
Tobacco companies have sales data, but doesn't share it. It would be helpful if scientists had access to it.
Liberal alternative nicotine product regulations seem more conducive to reducing smoking.
Tobacco companies have sales data, but doesn't share it. It would be helpful if scientists had access to it.
Liberal alternative nicotine product regulations seem more conducive to reducing smoking.
34/x Abigail Friedman - Yale University
Going to talk about restrictions on flavored products.
17% of US residents live somewhere that has flavor restrictions on ENDS. These areas have a reduction in ENDS sales.
Going to talk about restrictions on flavored products.
17% of US residents live somewhere that has flavor restrictions on ENDS. These areas have a reduction in ENDS sales.
35/x Friedman
ALL age groups - When ends are more expensive or less accessible leads to increases in cigarette smoking.
Talking about the difference between bans and restrictions on flavors.
Gives her research wish list.
ALL age groups - When ends are more expensive or less accessible leads to increases in cigarette smoking.
Talking about the difference between bans and restrictions on flavors.
Gives her research wish list.
36/x Friedman
Covering a new study with her co-authors.
(I'm hard of hearing and her voice isn't very loud. I'm going to have to watch the video to catch all of her information)
Covering a new study with her co-authors.
(I'm hard of hearing and her voice isn't very loud. I'm going to have to watch the video to catch all of her information)
37/x Friedman
Ends sales go down - cigarette sales go up.
Part of the problem with researching sales figures is that the data doesn't cover specialty stores.
Some of these bans are pushing people who vape back to smoking.
Ends sales go down - cigarette sales go up.
Part of the problem with researching sales figures is that the data doesn't cover specialty stores.
Some of these bans are pushing people who vape back to smoking.
38/x Friedman
Policy Options:
Restrict all (non-medical) nicotine products and flavored ends to 21+ retailers
Ban POS tobacco displays and walls in the view of under 21
Limit new tobacco licenses to 21+
Policy Options:
Restrict all (non-medical) nicotine products and flavored ends to 21+ retailers
Ban POS tobacco displays and walls in the view of under 21
Limit new tobacco licenses to 21+
39/x Friedman
88% of underage cigar use - 6 brands
Can we make corporate bottom line goals meet public health goals?
We have to make sure our policies don't give an economic advantage to the wrong products.
88% of underage cigar use - 6 brands
Can we make corporate bottom line goals meet public health goals?
We have to make sure our policies don't give an economic advantage to the wrong products.
40/x Alex Clark - CASAA
Covering FDA policies, the work that CASAA does driving consumers to contribute in the FDA comment process.
THR opponents, not knowing who CASAA is, make false allegations against them.
Covering FDA policies, the work that CASAA does driving consumers to contribute in the FDA comment process.
THR opponents, not knowing who CASAA is, make false allegations against them.
41/x Clark
We are eager to participate in the process. We want to help improve public health.
Up next: the first panel of the day.
(OMG, the morning is flying by. I am in heaven...)
We are eager to participate in the process. We want to help improve public health.
Up next: the first panel of the day.
(OMG, the morning is flying by. I am in heaven...)
42/x panel
Question: Floe Foxton (did I spell that right?)
Asking about flawed studies - gateway, etc., how do we combate this?
Clark: We need to get the definitions correct. People who use and understand the products should be consulted by scientists.
Question: Floe Foxton (did I spell that right?)
Asking about flawed studies - gateway, etc., how do we combate this?
Clark: We need to get the definitions correct. People who use and understand the products should be consulted by scientists.
43/x
Friedman: (I couldn't hear all of her response) We need more systematic reviews.
Dave Dobbins - Altria Consultant
Comparing Kings and Warners views on youth use.
Friedman: (I couldn't hear all of her response) We need more systematic reviews.
Dave Dobbins - Altria Consultant
Comparing Kings and Warners views on youth use.
44/x
Warner: Refers to the paper by #TheSRNTfifteen - we need balance.
Levy: There's been so much emphasis on e-cig use and youth. We need to look at other transitions and other ages.
Warner: Refers to the paper by #TheSRNTfifteen - we need balance.
Levy: There's been so much emphasis on e-cig use and youth. We need to look at other transitions and other ages.
45/x
FDA Rep: We need to access the risks vs benefits. As an agency we put a priority on youth prevention. That's where tobacco initiation occurs. Less harmful does not mean without harm. We have to take that seriously when we talk about youth.
FDA Rep: We need to access the risks vs benefits. As an agency we put a priority on youth prevention. That's where tobacco initiation occurs. Less harmful does not mean without harm. We have to take that seriously when we talk about youth.
46/x
Hajek: is fear of youth vaping higher than the adult risk of cancer and heart disease? We need more data on nicotine without smoking tobacco.
Hajek: is fear of youth vaping higher than the adult risk of cancer and heart disease? We need more data on nicotine without smoking tobacco.
47/x
Gentleman from the Canadian Vaping Association
Would FDA consider packaging regulations like Canada to make products less appealing to youth.
FDA: (hard to hear)
Gentleman from the Canadian Vaping Association
Would FDA consider packaging regulations like Canada to make products less appealing to youth.
FDA: (hard to hear)
48/x
Friedman: (back to previous question) This is an ethics question - how many youth experimenters are acceptable for each adult death? (talking about kids being kids) We can't let perfection be the enemy of the good.
Friedman: (back to previous question) This is an ethics question - how many youth experimenters are acceptable for each adult death? (talking about kids being kids) We can't let perfection be the enemy of the good.
49/x
Andy (from a Cancer Center) - are the wrong people vaping? (referring to lack of older adults).
Alex: NY banned flavors at the beginning of the pandemic. All the vape shops in his area have converted to head shops - low income area. It seems older people are more...
Andy (from a Cancer Center) - are the wrong people vaping? (referring to lack of older adults).
Alex: NY banned flavors at the beginning of the pandemic. All the vape shops in his area have converted to head shops - low income area. It seems older people are more...
50/x
... susceptible to the misinformation. Mentions the media needs to be more responsible.
Sharon Cox: Asks about maximizing possibilities - health inequalities.
Friedman: When we look at subgroups we don't have enough data (example Native Americans)
... susceptible to the misinformation. Mentions the media needs to be more responsible.
Sharon Cox: Asks about maximizing possibilities - health inequalities.
Friedman: When we look at subgroups we don't have enough data (example Native Americans)
51/x
Greg Conley - AVM
Asks the FDA representative about regulations increasing smoking.
FDA Rep: zero use is not achievable. There does need to be a balance.
Greg Conley - AVM
Asks the FDA representative about regulations increasing smoking.
FDA Rep: zero use is not achievable. There does need to be a balance.
52/x
Warner: Perplexed at the laser focus on youth e-cig use and not paying attention to other well known risks that kids take.
BREAK TIME!
Warner: Perplexed at the laser focus on youth e-cig use and not paying attention to other well known risks that kids take.
BREAK TIME!
53/x Matthew Carpenter - Medical University of SC
Naturalistic RCT - Adults who smoked but didn't vape. Unguided us of NJOY product, up to study participants.
(I'm struggling to see the slides...)
Comparisons of e-cig group vs. non
Naturalistic RCT - Adults who smoked but didn't vape. Unguided us of NJOY product, up to study participants.
(I'm struggling to see the slides...)
Comparisons of e-cig group vs. non
54/x Carpenter
Participants were a combination of people who wanted to quit and those who didn't.
The effects of providing e-cig were similar between the 2 groups.
Participants were a combination of people who wanted to quit and those who didn't.
The effects of providing e-cig were similar between the 2 groups.
55/x Carpenter
The effect was more pronounced among the lower income group.
More frequent e-cig users had higher rates of quitting smoking or reduced smoking
The effect was more pronounced among the lower income group.
More frequent e-cig users had higher rates of quitting smoking or reduced smoking
56/x Carpenter
Those given exclusively tobacco flavor e-cigs had a lessor rate of reduction/ quit.
Consumer focused study design might give a better real-world scenarios.
Those given exclusively tobacco flavor e-cigs had a lessor rate of reduction/ quit.
Consumer focused study design might give a better real-world scenarios.
57/x Jonathan Foulds - Penn State
Are e-cigs less addictive than cigarettes and why does it matter?
(spoiler, yes, less addictive)
Are e-cigs less addictive than cigarettes and why does it matter?
(spoiler, yes, less addictive)
58/x Foulds
Gives his definition of dependence/addiction.
Covers the measurement tools for dependence/addiction.
Gives his definition of dependence/addiction.
Covers the measurement tools for dependence/addiction.
59/x Foulds
The ones who are highly dependent on vaping - 87% are still vaping a year later.
Compared to those who heavily smoke and then vape, dependence for those who vaped showed less dependence.
The ones who are highly dependent on vaping - 87% are still vaping a year later.
Compared to those who heavily smoke and then vape, dependence for those who vaped showed less dependence.
60/x Foulds
We should be celebrating the low youth smoking rates.
Scrolling through several studies showing ENDS use significantly less dependence than smoking.
We should be celebrating the low youth smoking rates.
Scrolling through several studies showing ENDS use significantly less dependence than smoking.
61/x Foulds
Why less dependence?
Some e-cigs deliver a lower Cmax than smokes. But some vaping products lead to similar nicotine levels and combustible cigarettes.
Why less dependence?
Some e-cigs deliver a lower Cmax than smokes. But some vaping products lead to similar nicotine levels and combustible cigarettes.
62/x Foulds
Vapers don't vape like a person smoking cigarettes, or like how they are asked to in some studies.
If e-cigs are less addictive, some people will not use them for decades like cigarettes.
Vapers don't vape like a person smoking cigarettes, or like how they are asked to in some studies.
If e-cigs are less addictive, some people will not use them for decades like cigarettes.
63/x Jamie Hartmann-Boyce University of Oxford
(This summit is so fun! I love listening to experts that I have followed and respected for so long!)
(This summit is so fun! I love listening to experts that I have followed and respected for so long!)
64/x Hartmann-Boyce
Explaining what Cochrane is/does.
First version of the e-cig review was published in 2014 looking at if e-cigs help people stop smoking. Update when they find new evidence that changes the conclusions to the review.
Explaining what Cochrane is/does.
First version of the e-cig review was published in 2014 looking at if e-cigs help people stop smoking. Update when they find new evidence that changes the conclusions to the review.
65/x Hartmann-Boyce
Covers what kind of studies are included.
Smoking cessation at 6 months or longer.
Last update published Nov '22
78 Studies over 22,000 participants
22 studies recruited people not motivated to quit smoking.
Covers what kind of studies are included.
Smoking cessation at 6 months or longer.
Last update published Nov '22
78 Studies over 22,000 participants
22 studies recruited people not motivated to quit smoking.
66/x Hartmann-Boyce
Findings were not sensitive to studies viewed at high risk of bias or industry-funded (similar results when the studies were included and not included).
Findings were not sensitive to studies viewed at high risk of bias or industry-funded (similar results when the studies were included and not included).
67/x Hartmann-Boyce
High certainty - more quit smoking with e-cig than NRT.
More quit with nicotine e-cigs than non nicotine e-cigs
High certainty - more quit smoking with e-cig than NRT.
More quit with nicotine e-cigs than non nicotine e-cigs
68/x Hartmann-Boyce
Addressing criticisms about the underpinning research - and their response to these
*RCTs
*Claims that other stop smoking mediations do better
*e-cigs fail more often than they succeed
*We are "less independent"
*inclusion criteria is too broad
Addressing criticisms about the underpinning research - and their response to these
*RCTs
*Claims that other stop smoking mediations do better
*e-cigs fail more often than they succeed
*We are "less independent"
*inclusion criteria is too broad
69/x Hartmann-Boyce
(I'm back - lost internet for a bit)
She's now taking about tribalism.
(I'm back - lost internet for a bit)
She's now taking about tribalism.
70/x Clive Bates - Counterfactual
(Heads up: There's no way in hell I'll keep up with Clive!)
Talking about risk perceptions...
(Heads up: There's no way in hell I'll keep up with Clive!)
Talking about risk perceptions...
71/x Bates
(YES! Here's a voice I can hear!)
Where is the risk? The big problem is adult smoking, but we focus on youth vaping.
(YES! Here's a voice I can hear!)
Where is the risk? The big problem is adult smoking, but we focus on youth vaping.
72/x Bates
(Tech issue - his slides are in the wrong order....)
Covering the misperceptions of how harmful vaping is vs smoking.
(Go Clive as he wings it over the slide issue - what a pro he is at this!)
(Tech issue - his slides are in the wrong order....)
Covering the misperceptions of how harmful vaping is vs smoking.
(Go Clive as he wings it over the slide issue - what a pro he is at this!)
73/x Bates
56% wrongly believe that nicotine causes cancer.
72% wrongly believe that smokeless tobacco is as harmful as smoking.
OMG - he is showing the vaping is as dangerous as skydiving without a parachute poster!
56% wrongly believe that nicotine causes cancer.
72% wrongly believe that smokeless tobacco is as harmful as smoking.
OMG - he is showing the vaping is as dangerous as skydiving without a parachute poster!
74/x Bates
Now discussing the NGOs and how they contribute to the public's misperceptions.
(He is so could at interjecting humor while educating people!)
Now covering misinformation from Health professionals.
Comparing US to UK (Hint: US, you should be embarrassed!!!!)
Now discussing the NGOs and how they contribute to the public's misperceptions.
(He is so could at interjecting humor while educating people!)
Now covering misinformation from Health professionals.
Comparing US to UK (Hint: US, you should be embarrassed!!!!)
75/x Bates
Covering the EVALI kerfuckle still exists... and how mislead people and still continues to do so. How this false narrative effected the views of people in other countries.
Covering the EVALI kerfuckle still exists... and how mislead people and still continues to do so. How this false narrative effected the views of people in other countries.
76/x Bates
Showing the harms caused by misperceptions of risk.
Professionals should take great care in how they describe risks.
Showing the harms caused by misperceptions of risk.
Professionals should take great care in how they describe risks.
78/x Bates
What is Appropriate for the Protection of Public Health?
Gives his famous beer example and the audience laughs. I don't think anyone in the room is bored. Clive is on fire!
What is Appropriate for the Protection of Public Health?
Gives his famous beer example and the audience laughs. I don't think anyone in the room is bored. Clive is on fire!
79/x Bates
Talking about the definition of addiction.
Quotes Matt Myers things about "then you'd have coffee."
Who is threatened by nicotine w/o much harm?
Talking about the definition of addiction.
Quotes Matt Myers things about "then you'd have coffee."
Who is threatened by nicotine w/o much harm?
80/x Maciej L. Goniewicz - Roswell Park Comprehensive Cancer Center
"Key differences and similarities of vaporized cannabis versus nicotine"
(I need to slow down - recovering from a chipped bone in wrist and an hairline fracture in arm - this is getting painful - be back soon)
"Key differences and similarities of vaporized cannabis versus nicotine"
(I need to slow down - recovering from a chipped bone in wrist and an hairline fracture in arm - this is getting painful - be back soon)
81/x Neal L. Benowitz - University of California, San Franciso
"Interactions between cannabis and nicotine use"
(I'm still taking a break)
"Interactions between cannabis and nicotine use"
(I'm still taking a break)
82/x Time for the 2nd panel of the day.
Ken Warner to Jamie: asking about criticism about using RCTs in systematic reviews. Isn't it important to understand the population impact of e-cigs?
Jamie: We need to look at population levels. Confounders are important.
Ken Warner to Jamie: asking about criticism about using RCTs in systematic reviews. Isn't it important to understand the population impact of e-cigs?
Jamie: We need to look at population levels. Confounders are important.
83/x
Ethan Nadelman (spelling?
Asking about combining THC and nicotine.
Panel: Not seeing much use of both combined by a mfg so a consumer gets both at the same time.
Ethan Nadelman (spelling?
Asking about combining THC and nicotine.
Panel: Not seeing much use of both combined by a mfg so a consumer gets both at the same time.
84/x
Online question: Does the Cochrane review deal differently with studies funded by industry vs by anti-vaping organizations.
Jamie: We haven't come across this, but we do look at funders.
Online question: Does the Cochrane review deal differently with studies funded by industry vs by anti-vaping organizations.
Jamie: We haven't come across this, but we do look at funders.
85/x
Lots more questions, but I put my wrist brace back on, and typing sucks...
Good questions. Very interesting conversation.
Lots more questions, but I put my wrist brace back on, and typing sucks...
Good questions. Very interesting conversation.
86/x
We are behind schedule. Working on the last question and then a lunch break.
We are behind schedule. Working on the last question and then a lunch break.
87/x Sonia Johnson - Health Canada
"Canada’s approach to vaping products and achieving <5% tobacco use by 2035"
4 Themes of Canada's Tobacco Strategy
In CA smoking and cigarette sales are declining.
Smoking remains high among Canadians 35+
"Canada’s approach to vaping products and achieving <5% tobacco use by 2035"
4 Themes of Canada's Tobacco Strategy
In CA smoking and cigarette sales are declining.
Smoking remains high among Canadians 35+
88/x Johnson
Communities disproportionately impacted by smoking - similar to US.
Vaping - talking about nicotine and no nicotine, but not THC
Communities disproportionately impacted by smoking - similar to US.
Vaping - talking about nicotine and no nicotine, but not THC
89/x Johnson
Of Canadians over 25 the primary reason for vaping was to stop smoking. Youth was to reduce stress.
Misinformation is a challenge in CA, too many adults believe vaping as harmful or more harmful than smoking.
Of Canadians over 25 the primary reason for vaping was to stop smoking. Youth was to reduce stress.
Misinformation is a challenge in CA, too many adults believe vaping as harmful or more harmful than smoking.
90/x Johnson
(sorry, lost internet again. IDK how to get on the conference internet, so using the one called hotel lobby and it keeps dropping)
Youth in CA with self-reported mental health challenges have higher rates of substance use.
(sorry, lost internet again. IDK how to get on the conference internet, so using the one called hotel lobby and it keeps dropping)
Youth in CA with self-reported mental health challenges have higher rates of substance use.
91/x Johnson
WAY TO GO HEALTH CANADA!!!!
She just talked about how they no longer use the term "smoker" and other stigmatizing language and wraps up with a quote by the amazing @grayjaynine
WAY TO GO HEALTH CANADA!!!!
She just talked about how they no longer use the term "smoker" and other stigmatizing language and wraps up with a quote by the amazing @grayjaynine
92/x Deborah Arnott - Action on Smoking and Health (UK) "Youth data on vaping and the UK approach"
(It is HOT in here!)
How ASH develops policy on vaping...
In the UK 18 is the age of adult. The majority of people who vape in the UK used to smoke. Very few nicotine naive.
(It is HOT in here!)
How ASH develops policy on vaping...
In the UK 18 is the age of adult. The majority of people who vape in the UK used to smoke. Very few nicotine naive.
93/x Arnott
Most youth who vaped used to have smoked. The proportion who have never smoked is rising.
Main reason for vaping (youth)
*try
*other people
*flavors
Most youth who vaped used to have smoked. The proportion who have never smoked is rising.
Main reason for vaping (youth)
*try
*other people
*flavors
94/x Arnott
(Dang, this internet! Dropped again!)
She just gave a bunch of information on youth use and mental health. Now covering what can be done to minimize youth uptake. What can we learn from past tobacco control efforts?
Showing where youth and adults get products.
(Dang, this internet! Dropped again!)
She just gave a bunch of information on youth use and mental health. Now covering what can be done to minimize youth uptake. What can we learn from past tobacco control efforts?
Showing where youth and adults get products.
95/x
Sorry.... the internet is dropping every couple of minutes!
Sorry.... the internet is dropping every couple of minutes!
96/x Ben Youdan - Youdan Consulting - New Zealand
"Vaping and the smoking Endgame. Will New Zealand be smokefree in 2 years?"
Going over vaping regulations. Showing add that says, "Vaping Can Help You Quit Smoking."
MUCH easier to put products on the market in NZ than US.
"Vaping and the smoking Endgame. Will New Zealand be smokefree in 2 years?"
Going over vaping regulations. Showing add that says, "Vaping Can Help You Quit Smoking."
MUCH easier to put products on the market in NZ than US.
97/x Youdan
In NZ stop smoking services are required to support vaping if a consumer asks about it.
Youth smoking has declined, youth vaping has increased.
In NZ stop smoking services are required to support vaping if a consumer asks about it.
Youth smoking has declined, youth vaping has increased.
98/x Youdan
As the age to smoke is raised, the day is coming when it won't be legal for anyone to buy cigarettes in NZ.
Harm reduction has always been part of the plan.
As the age to smoke is raised, the day is coming when it won't be legal for anyone to buy cigarettes in NZ.
Harm reduction has always been part of the plan.
99/x Youdan
Comparing the difference between gov. views of vaping in AU vs. NZ.
Showing the penalties for consumers to have unprescribed nicotine vapor products in AU. (If I thought the US should be embarrassed....I don't even know what to say AU should be)
Comparing the difference between gov. views of vaping in AU vs. NZ.
Showing the penalties for consumers to have unprescribed nicotine vapor products in AU. (If I thought the US should be embarrassed....I don't even know what to say AU should be)
100/x Youdan
Covering denicotinisation of cigarettes...
Showing what is happening with smoking Maori women. Huge reduction! IMPRESSIVE
(someone cranked the air... trust me, it's not hot anymore! LOL)
Covering denicotinisation of cigarettes...
Showing what is happening with smoking Maori women. Huge reduction! IMPRESSIVE
(someone cranked the air... trust me, it's not hot anymore! LOL)
101/x Youdan
Covering Cannabis use in NZ
Back to AU vs NZ - Australia is not doing what is best for public health. NZ focused on smoking - NOT NICOTINE.
Covering Cannabis use in NZ
Back to AU vs NZ - Australia is not doing what is best for public health. NZ focused on smoking - NOT NICOTINE.
102/x Benjamin Apelberg, Ph.DDeputy Director for Regulatory Science in the Office of Science- FDA’s Center for Tobacco Products (CTP) and Kathleen CrosbyDirector, Office of Health Communication & Education- FDA Center for Tobacco Products.
103/x "The role of tobacco regulatory approaches in addressing the evolving tobacco landscape"
Apelberg: Covering smoking rates. Dramatic drop 18-20 year olds. Not much happening 45+ people.
Apelberg: Covering smoking rates. Dramatic drop 18-20 year olds. Not much happening 45+ people.
104/x Apelberg:
Adult disparities and smoking.... while progress is being made, certain groups are behind others. (same for youth)
Showing the significant progress being made in reducing youth smoking.
Adult disparities and smoking.... while progress is being made, certain groups are behind others. (same for youth)
Showing the significant progress being made in reducing youth smoking.
105/x Apelberg:
CTP priorities:d (King covered)
Proposed standards (King covered)
- this is a recap of much of what King said, with a few more details.
CTP priorities:d (King covered)
Proposed standards (King covered)
- this is a recap of much of what King said, with a few more details.
106/x Crosby:
(she is really hard to hear)
Youth use - FDA saw rapid nicotine addiction.
Significant increase of ecigs of young adults from 2015 to 2021. Crosby says this is an area of concern - not legal under 21 (didn't mention which year that took effect)
(she is really hard to hear)
Youth use - FDA saw rapid nicotine addiction.
Significant increase of ecigs of young adults from 2015 to 2021. Crosby says this is an area of concern - not legal under 21 (didn't mention which year that took effect)
107/x Crosby
FDA shifted the Real Cost to vaping almost exclusively since 2017. Trying to explain how the Real Cost ads are supposed to target teens.
(tell that to my former customers who saw those misinformation campaigns and went back to smoking).
FDA shifted the Real Cost to vaping almost exclusively since 2017. Trying to explain how the Real Cost ads are supposed to target teens.
(tell that to my former customers who saw those misinformation campaigns and went back to smoking).
108/x Crosby
(I wish she would speak louder!)
She's explaining how youth harm perceptions of ENDs and other products are increasing over time. Higher harm perceptions are associated with lower likelihood of initiation.
(I wish she would speak louder!)
She's explaining how youth harm perceptions of ENDs and other products are increasing over time. Higher harm perceptions are associated with lower likelihood of initiation.
109/x Crosby
She claims that adults who saw Real Cost ads were not negatively effected.
Now covering adult misperceptions. Covers some nicotine misperceptions. Doesn't mention how the FDA is going to help fix this.
She claims that adults who saw Real Cost ads were not negatively effected.
Now covering adult misperceptions. Covers some nicotine misperceptions. Doesn't mention how the FDA is going to help fix this.
110/x Crosby
Didn't Brian King agree a few months ago that the word "smoker" is stigmatizing? These folks from the FDA use it a lot. MANY of the speakers have used it a lot...
Didn't Brian King agree a few months ago that the word "smoker" is stigmatizing? These folks from the FDA use it a lot. MANY of the speakers have used it a lot...
111/x Nancy A. Rigotti - Massachusetts General Hospital, Boston
"What doctors say…and what patients hear: Should e-cigarettes be more widely recommended as a smoking cessation aid?"
Health Care is a key6 channel for delivering tobacco treatment. Better at asking about smoking.
"What doctors say…and what patients hear: Should e-cigarettes be more widely recommended as a smoking cessation aid?"
Health Care is a key6 channel for delivering tobacco treatment. Better at asking about smoking.
112/x Rigotti
Not good at connecting people who smoke with effective treatment. Treatment not a priority.
"Tobacco harm reduction" is rarely explicitly named.
Not good at connecting people who smoke with effective treatment. Treatment not a priority.
"Tobacco harm reduction" is rarely explicitly named.
113/x Rigotti
Misperceptions persist - nicotine
Covering some studies that show the large % of public and healthcare misperceptions.
Waner, Benowitz, McNeill, Rigotti commentary what is the role of e-cigs on clinical practice?
Misperceptions persist - nicotine
Covering some studies that show the large % of public and healthcare misperceptions.
Waner, Benowitz, McNeill, Rigotti commentary what is the role of e-cigs on clinical practice?
114/x Rigotti
Policies
UK and NZ least restrictive
US and Canada middle
AU most restrictive.
Policies
UK and NZ least restrictive
US and Canada middle
AU most restrictive.
115/x Rigotti
Covering messaging by CDC by Health Canada
Says the same thing - but CDC is worded in a much less positive way.
Now covering guidance by health orgs from the US.
Covering messaging by CDC by Health Canada
Says the same thing - but CDC is worded in a much less positive way.
Now covering guidance by health orgs from the US.
116/x Rigotti
Messaging from US and Canada: Use medically licensed first - how many times? Assumes people won't give up.
Messaging from US and Canada: Use medically licensed first - how many times? Assumes people won't give up.
117/x Rigotti
She asks - does the CTPs authorizing certain products being on the market as APPH, does that reassure clinicians?
Should clinicians discuss e-cigs? Risks/Benefits?
Showing NZ approach.
Conslusion of paper- US, CAN, AU should follow NZ and UK approach.
She asks - does the CTPs authorizing certain products being on the market as APPH, does that reassure clinicians?
Should clinicians discuss e-cigs? Risks/Benefits?
Showing NZ approach.
Conslusion of paper- US, CAN, AU should follow NZ and UK approach.
118/x Rigotti
Giving recommendations from the paper for guidance for clinicians.
Giving recommendations from the paper for guidance for clinicians.
119/x Panel discussion
Online: Asking about flavors sold at "dairies" (c-stores) is the main place youth are getting vapes.
Ben: While people claim that's the source, it's very few that do. It is more than a myth.
(gosh, I'm having a hard time hearing most of the speakers!)
Online: Asking about flavors sold at "dairies" (c-stores) is the main place youth are getting vapes.
Ben: While people claim that's the source, it's very few that do. It is more than a myth.
(gosh, I'm having a hard time hearing most of the speakers!)
120/X
Arnott: Thinks that it is a myth that vape flavors are having an impact - look at how many people smoked cigarettes that won't flavor.
Arnott: Thinks that it is a myth that vape flavors are having an impact - look at how many people smoked cigarettes that won't flavor.
121/x
Tom Miller - former IA AG!!!!!!
Talking about Friedman's numbers earlier, asking FDA if there's any concern about not allowing flavored ENDS products.
FDA Guy: (Ben?): Need to see data that flavors help more people quit smoking. It is concerning to see that states with...
Tom Miller - former IA AG!!!!!!
Talking about Friedman's numbers earlier, asking FDA if there's any concern about not allowing flavored ENDS products.
FDA Guy: (Ben?): Need to see data that flavors help more people quit smoking. It is concerning to see that states with...
122/x
...flavor bans have increases in smoking. We have to look at products on a case by case basis.
Arnott: Asking FDA guy if they could change their framework and look at flavors as a category instead of case by case.
FDA: we have to do as we're required by congress.
...flavor bans have increases in smoking. We have to look at products on a case by case basis.
Arnott: Asking FDA guy if they could change their framework and look at flavors as a category instead of case by case.
FDA: we have to do as we're required by congress.
FDA: we have to find the balance...
Cochrane review is insightful.
Mike Madden MD: Asking about misperceptions and then products are authorized about APPH - wouldn't it be advantageous for the FDA to educate physicians about this?
Cochrane review is insightful.
Mike Madden MD: Asking about misperceptions and then products are authorized about APPH - wouldn't it be advantageous for the FDA to educate physicians about this?
124/x
Crosby: Saying that all health orgs need to create critical mass that the key stakeholders can agree on, FDA can't do it alone.
(My thought, shouldn't the FDA take a leadership role on this?)
Crosby: Saying that all health orgs need to create critical mass that the key stakeholders can agree on, FDA can't do it alone.
(My thought, shouldn't the FDA take a leadership role on this?)
125/x
John Oyston asked about some countries that have banned nicotine pouches.
Arnott: the pharmaceutical industry has been very unhelpful - no interest in pouches.
John Oyston asked about some countries that have banned nicotine pouches.
Arnott: the pharmaceutical industry has been very unhelpful - no interest in pouches.
126/x
Rigotti: back to the previous question. Would like to see the FDA work with physicians.
And then goes to John's question - compares vape and pouches.
Rigotti: back to the previous question. Would like to see the FDA work with physicians.
And then goes to John's question - compares vape and pouches.
127/x
I didn't catch her name, but I think her last name was Thorn - asking FDA about lack of targeting people of color and ethnic groups to reduce the harms of smoking.
Crosby: Next Legends, LGTBQ, etc. have some targeted ads. Talks about menthol smoking.
I didn't catch her name, but I think her last name was Thorn - asking FDA about lack of targeting people of color and ethnic groups to reduce the harms of smoking.
Crosby: Next Legends, LGTBQ, etc. have some targeted ads. Talks about menthol smoking.
128/x
Ricard Butcher (not sure who he's with): Another question about targeting messages.
Crosby: we have communications with stakeholder organizations in specific communities.
Ricard Butcher (not sure who he's with): Another question about targeting messages.
Crosby: we have communications with stakeholder organizations in specific communities.
129/x
Michael Fisher (JUUL) to Arnott: Why is misperceptions on the rise in the UK with the good messaging from the gov.
Arnott: Terrible tabloid press articles. "experts" who like to be involved with media but refuse to talk to people like Arnott.
Michael Fisher (JUUL) to Arnott: Why is misperceptions on the rise in the UK with the good messaging from the gov.
Arnott: Terrible tabloid press articles. "experts" who like to be involved with media but refuse to talk to people like Arnott.
130/x
Greg Conley to Crosby:
Asking will FDA release data about spillover from ads
Crosby: Yes
Greg Conley to Crosby:
Asking will FDA release data about spillover from ads
Crosby: Yes
131/x
Scot Ballin (spelling?)
The FDA should be a facilitator of conferences, etc., of getting people together to find common ground.
Scot Ballin (spelling?)
The FDA should be a facilitator of conferences, etc., of getting people together to find common ground.
132/x
Time for the conference to take a quick break.
Time for the conference to take a quick break.
133/x Andy Hyland - Roswell Park Comprehensive Cancer Center
"What can we learn from historical events and US per-capita cigarette data from 1984 to present?"
"What can we learn from historical events and US per-capita cigarette data from 1984 to present?"
134/x Hyland
Nice history lesson that includes smoking, and the tobacco industry.
(Off topic, I got to meet Tom Miller, former AG of IA today!)
Nice history lesson that includes smoking, and the tobacco industry.
(Off topic, I got to meet Tom Miller, former AG of IA today!)
135/x Hyland
As he works his way through this history lesson, he's showing the reduction in smoking.
Now adding the introduction of e-cigs while continuing his world history lesson. Up to the first e-cig to get FDA marketing orders.
This is interesting, connecting it all
As he works his way through this history lesson, he's showing the reduction in smoking.
Now adding the introduction of e-cigs while continuing his world history lesson. Up to the first e-cig to get FDA marketing orders.
This is interesting, connecting it all
136/x Hyland
79% reduction in cigarette sticks per person 18+ over the last 40 years. (In the US?)
Are we failing or succeeding?
Do new tools replace old tools or complement them?
What constitutes success? For whom?
79% reduction in cigarette sticks per person 18+ over the last 40 years. (In the US?)
Are we failing or succeeding?
Do new tools replace old tools or complement them?
What constitutes success? For whom?
137/x Robin Mermelstein - University of Illinois, Chicago
"E-cigarettes and mental health disorders: Opportunity or Concern?"
So many conversations cigarette smoking is down BUT e-cig use is up. What if that's a good thing?
"E-cigarettes and mental health disorders: Opportunity or Concern?"
So many conversations cigarette smoking is down BUT e-cig use is up. What if that's a good thing?
138/x Mermelstein
Those with mental health (MH) and substance use disorder (SUD) large behind in smoking cessation.
She gives specific stats on various kinds of MH smoking rates.
ADHD higher rates of smoking, too.
Those with mental health (MH) and substance use disorder (SUD) large behind in smoking cessation.
She gives specific stats on various kinds of MH smoking rates.
ADHD higher rates of smoking, too.
139/x Mermelstein
Genetics, nicotine - impact on cognitions, shared social environmental factors. All contributing to use.
Smoking serves lots of functions to people who smoke.
Genetics, nicotine - impact on cognitions, shared social environmental factors. All contributing to use.
Smoking serves lots of functions to people who smoke.
140/x Mermelstein
She's giving quotes made by people who smoke. (Nice to see them given a voice while they express what it's like to smoke)
She's explaining why e-cigs might help replace what's missing for people when they stop smoking.
She's giving quotes made by people who smoke. (Nice to see them given a voice while they express what it's like to smoke)
She's explaining why e-cigs might help replace what's missing for people when they stop smoking.
141/x Mermelstein
Talking about people with MH disorders and SUD sometimes have stronger withdrawel symptoms than other people do.
Very scant data on if e-cigs can help people with MH disorders or SUDs.
Talking about people with MH disorders and SUD sometimes have stronger withdrawel symptoms than other people do.
Very scant data on if e-cigs can help people with MH disorders or SUDs.
142/x Mermelstein
People with MH and SUD may lack pleasure in life. Smoking may be one of their few pleasures. E-cigs may help with that.
We need a more person centered approach to smoking in the USA. We stigmatize people who smoke in the US.
YES!!!! < that's me, not her! LOL
People with MH and SUD may lack pleasure in life. Smoking may be one of their few pleasures. E-cigs may help with that.
We need a more person centered approach to smoking in the USA. We stigmatize people who smoke in the US.
YES!!!! < that's me, not her! LOL
143/x Mermelstein
We need a less paternalistic approach.
Flavors - it gives people a choice. It may keep them engaged and encourage them to keep trying.
We need to give people who smoke a voice.
We need a less paternalistic approach.
Flavors - it gives people a choice. It may keep them engaged and encourage them to keep trying.
We need to give people who smoke a voice.
144/x Mermelstein
Need to stop the puritanical approach, not wanting people to take pleasure in using nicotine (paraphrasing, hope it got it right - she's moving quickly)
Need to stop the puritanical approach, not wanting people to take pleasure in using nicotine (paraphrasing, hope it got it right - she's moving quickly)
145/x Ray Niaura - New York University
"Tobacco Harm Reduction: What will (does) success look like?"
LOL he's talking about rabbit holes. Instantly my kind of guy. I relate to this.... And he's funny!
"Tobacco Harm Reduction: What will (does) success look like?"
LOL he's talking about rabbit holes. Instantly my kind of guy. I relate to this.... And he's funny!
146/x Niaura
We need to set goals.
People talk about the end game.
Do e-cigs threaten the tobacco endgame?
Many endgame strategies don't specify "end of what"
We need to set goals.
People talk about the end game.
Do e-cigs threaten the tobacco endgame?
Many endgame strategies don't specify "end of what"
147/x Niaura
We have beat the target for youth smoking.
What do we do when we meet or exceed a goal?
"Move the goal post!" (audience laughs)
Showing a circle chart of overlap of various types of youth tobacco/THC use.
We have beat the target for youth smoking.
What do we do when we meet or exceed a goal?
"Move the goal post!" (audience laughs)
Showing a circle chart of overlap of various types of youth tobacco/THC use.
148/x Niaura
ABES - adolescent behaviors and experiences survey. Shows many things!
*Mental health and substance use (if we're targeting youth, should we be focusing on just one thing? He asked)
He shows covariates of which kids are e-cig users.
ABES - adolescent behaviors and experiences survey. Shows many things!
*Mental health and substance use (if we're targeting youth, should we be focusing on just one thing? He asked)
He shows covariates of which kids are e-cig users.
149/x Niaura
(OOPPSS lost the internet again!)
He suggests we switch stuff up and instead of focusing on e-cigs we focus on things like kids considering suicide - showing how causal conclusions can be drawn when no cause is shown.
(OOPPSS lost the internet again!)
He suggests we switch stuff up and instead of focusing on e-cigs we focus on things like kids considering suicide - showing how causal conclusions can be drawn when no cause is shown.
150/x Ann McNeill - Kings College London
"An international standard for vaping health risks research"
Important to understand health risks of vaping as quickly and cost-effectively as possible.
Having a research standard will help.
"An international standard for vaping health risks research"
Important to understand health risks of vaping as quickly and cost-effectively as possible.
Having a research standard will help.
151/x McNeill
UK's endgame
New Swap to Stop scheme
Call for evidence on stopping kids vaping.
Nicotine addiction is a very small contribution of health effects (when not coupled with smoking)
UK's endgame
New Swap to Stop scheme
Call for evidence on stopping kids vaping.
Nicotine addiction is a very small contribution of health effects (when not coupled with smoking)
152/x McNeill
Does terminology matter? Yes it does!
"Tobacco Products" terminology should be limited to products that contain tobacco!
It is mot appropriate to refer to smoking or smoker when describing e-cigarette use!
Does terminology matter? Yes it does!
"Tobacco Products" terminology should be limited to products that contain tobacco!
It is mot appropriate to refer to smoking or smoker when describing e-cigarette use!
153/x McNeill
Person-first language!!!! (Did you hear that loud "YES!"? It me!)
Sorry.... I got lost in her talk and forgot to keep typing! (that has happened a few times today!) But she is still talking about accuracy in terminology and kinds of terms when used in studies.
Person-first language!!!! (Did you hear that loud "YES!"? It me!)
Sorry.... I got lost in her talk and forgot to keep typing! (that has happened a few times today!) But she is still talking about accuracy in terminology and kinds of terms when used in studies.
154/x McNeill
Plea for open science.
She'd appreciate more input on establishing standards for vaping research.
Plea for open science.
She'd appreciate more input on establishing standards for vaping research.
155/x Mitch Zeller and Cliff Douglas
"What Constitutes Success? A Dialogue on the “End State”"
(To hear this is WHY I wanted to be here today! I have enjoyed the day. Glad I heard all the presentations.)
"What Constitutes Success? A Dialogue on the “End State”"
(To hear this is WHY I wanted to be here today! I have enjoyed the day. Glad I heard all the presentations.)
156/x
Q: Endgame vs End state
Zeller: Can we reframe the debate and find common ground? Maybe do we need to start at each person's end state and work backwards. We have no condenses in the United States. Zeller's end state is combustible tobacco free.
Q: Endgame vs End state
Zeller: Can we reframe the debate and find common ground? Maybe do we need to start at each person's end state and work backwards. We have no condenses in the United States. Zeller's end state is combustible tobacco free.
157/x
Zeller: this has been an ugly debate.
Zeller: this has been an ugly debate.
158/x
Zeller just mentioned that we have to be damn sure when we talk about smoking prevalence, when we pick a % at the population level we better be damn sure not to be leaving certain communities behind. ('ya know, people like me.) I am in #tears. I can't tweet, must listen
Zeller just mentioned that we have to be damn sure when we talk about smoking prevalence, when we pick a % at the population level we better be damn sure not to be leaving certain communities behind. ('ya know, people like me.) I am in #tears. I can't tweet, must listen
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