TIME hawaii

Hawaii Raises Legal Smoking Age to 21

Hawaii Smoking Age
Cathy Bussewitz—AP Hawaii Gov. David Ige talks about raising the smoking age on June 19, 2015, in Honolulu.

"I think it's going to have a tremendous impact"

(HONOLULU)—Hawaii’s governor has signed a bill to make his state the first to raise the legal smoking age to 21.

The measure aims to prevent adolescents from smoking, buying or possessing both traditional and electronic cigarettes. Gov. David Ige signed it into law Friday.

Dozens of local governments have similar bans, including Hawaii County and New York City.

“Raising the minimum age as part of our comprehensive tobacco control efforts will help reduce tobacco use among our youth and increase the likelihood that our keiki will grow up tobacco-free,” said Ige, using the Hawaiian word for children.

In Hawaii, 86 percent of adult smokers began smoking before age 21, according to the governor’s office.

“I think it’s going to have a tremendous impact,” said Jessica Yamauchi, executive director of the Coalition for a Tobacco-Free Hawaii. “By really limiting the access it will really help to curb the prevalence.”

But opponents say it’s unfair that a veteran returning from military service who risked his or her life serving the country could be prevented from lighting up.

“I can’t stand cigarette smoking. It’s disgusting,” said Democratic Rep. Angus McKelvey, who voted against the bill. “But to tell somebody you can go and fight for your country and get killed but you can’t have a cigarette, that’s the thing. You can enter a contract. You’re an emancipated adult in the eyes of the Constitution but you can’t have a cigarette anymore.”

Those caught breaking the rules would be fined $10 for the first offense, and later violations would lead to a $50 fine or mandatory community service.

The bill goes into effect on the first day of 2016. Until then, the state Department of Health will reach out to retailers and post signs to educate the public about the law.

According to the state Department of Heath, 5,600 kids in Hawaii try smoking every year. Meanwhile, 1,400 people die from tobacco use or exposure in Hawaii every year, according to the Campaign for Tobacco-Free Kids.

Ige signed another anti-smoking measure Friday to make Hawaii’s state parks and beaches smoke-free.

“This allows us to put one more impediment to people smoking too much,” Ige said.

TIME Cuba

The Hazy Future for Cuban Cigars

TIME-Cuba-Cover
TIME

When long-forbidden Cuban cigars become more available to Americans, will they maintain their aroma of glamour?

From the new TIME special edition Inside the New Cuba. Pick up your copy in stores today. Digital edition available at TimeSpecials.com

If the opening to Cuba proceeds to its logical conclusion, it’ll be cigars all around. The island’s iconic product, forbidden as imports to the U.S. since 1962 by the economic embargo, long ago moved from sorely missed to the realm of nearly fetishistic obsession. After half a century, the hand-rolled House of Habano puros now appear to contain all that was just out of reach to Americans, as well as the flavor distinct to the soil of Pinar del Río, the southwestern province where the world’s most famous tobacco leaves are grown. The 100 million Cuban cigars sold worldwide count as one of the nation’s leading exports, up there with nickel and cane sugar, a crucial source of hard currency for a government that never figured out the economy.

It’s not just the distinctive taste. A great deal of both history and mystique gets wrapped up in the leaves assembled on the wooden tables where the tabaqueros famously sit in rows, facing the elevated platform where a lector reads a newspaper aloud, to occupy the mind while the fingers fly. A tour of the Partagás factory remains one of the tourist mainstays of Havana—state property since its building, farms and brands were appropriated, along with every other private concern, by a revolutionary government that over time actually managed to enhance the brand. Fidel Castro’s cigar was as much a part of his image as his fatigues, and far less egalitarian. The cigar was a Cohiba, a brand created specially for the upper echelons of the Communist elite (Che Guevara loved them too) before being marketed as a global label in 1982, three years before Fidel quit smoking.

The contradiction—elite taste vs. leveling ideology—never seemed to bother anyone; such was the power of a tradition that goes to the heart of Cuba’s appeal as a culture. The modern hotel where U.S. diplomats first openly met Cuban officials to discuss renewing relations was pleasant enough, but you only knew you were in Cuba within the dark wooden walls of its tobacco shop. Beside the door sits an elegantly groomed older man in a guayabera, Arnaldo Alfonso Ibáñez, rolling them fresh in Cohiba wrappers. He may have to pick up the pace. Under the new regulations published by the Obama administration, U.S. citizens can bring back up to $100 of tobacco (or alcohol) products. Should Congress vote to lift the embargo outright, Habanos, a 50-50 partnership of the Cuban state and a British firm, estimates that its sales would jump 70%.

And what would be lost? A certain cachet. Some memories. I learned to smoke on Cubans, two boxes I carried back to Washington from a visit to Havana in the late 1990s. It was good to start small—the Romeo y Julieta “Cedros”—and in the open air, to build up tolerance before moving on to the second box, Cohiba “Lanceros” so obviously counterfeit that the customs agent at the Dallas airport (“we just had a class on cigars”) handed them back to me, shaking his head. By the time I moved abroad, Havanas were about all you could buy in the duty-free humidors of the airports a foreign correspondent knows better than his own bed. I once expensed a box of Bolivar Gigantes after handing them out to help battle the stench on a Ugandan hilltop that produced not one but two mass graves; the accounting department put it through.

They also made great gifts, though it was a mistake not to tell a friend about the handful I’d tucked into his knapsack before driving him to the airport for his flight back to Los Angeles. A customs agent found them first and “cut them up there in front of me,” he reported later, not happy. He was a freelancer who wrote profiles for Cigar Aficionado, usually celebrities, some of whom would stay in touch after publication, calling him up when they got their hands on some Cubans. “The people who want ’em are getting them,” says Bill Sherman, grandson of the New York tobacconist who took in the owner of Partagás after he was driven out of Cuba. The Nat Sherman Townhouse sells its own brand, but a cabinet of 400 pre-embargo Partagás has pride of place in the members’ vault on 42nd Street in Manhattan, perhaps the largest stock in the U.S. of pre-Revolutionary cigars, a level of exclusivity that approaches either the effervescent or the ridiculous, depending. But there’s a reason for its following.

“What makes a Bordeaux from Bordeaux special?” Sherman asks. “You can’t take a Bordeaux seed and plant it in Napa Valley and get the same wine. It’s the soil, the sun, the climate.” Still, over the years, California has managed some superior varietals of its own, as drinkers grew more sophisticated and learned to trust their own tastes. Something like that may happen if Cubans hit the States.

“I gotta tell you, as a retailer, I’m ecstatic. We’ll be selling them,” Sherman says. But without the mystique of the forbidden, Cubans will have to earn their place in the pantheon. “You go to Spain,” he notes, “and Cuban cigars are less expensive than Domincans.”

From the new TIME special edition Inside the New Cuba. Pick up your copy in stores today. Digital edition available at TimeSpecials.com

TIME White House

Why It Matters if Obama Smokes (and Why It Doesn’t)

President Barack Obama speaks during a news conference after meeting with Gulf Cooperation Council leaders and delegations at Camp David in Maryland.
Pablo Martinez Monsivais—AP President Barack Obama speaks during a news conference after meeting with Gulf Cooperation Council leaders and delegations at Camp David in Maryland.

Since taking office in 2009, President Obama has aced three physicals. He regularly exercises, especially playing basketball, and has a personal chef — not to mention wife — who ensure he eats healthy.

But he has one (potential) vice that keeps coming back up: smoking.

A photo posted on Instagram by a spokesman for Italian Prime Minister Matteo Renzi buzzed around the Internet this week because it appeared to show President Obama on an outdoor balcony at the G-7 summit holding what might be a pack of cigarettes. (Or might not.)

Talking #elmau #g7 #cosedilavoro #germania

A photo posted by Nomfup (@nomfup) on

The general public doesn’t care much. A 2009 poll by CNN found that most Americans’ views of the President aren’t affected by his struggle to quit smoking and only a third wanted to see him give up cigarettes completely.

The White House has typically responded by implying the President is free from his addiction.

Former White House spokesman Robert Gibbs said in December 2010 the President hadn’t smoked in “about nine months.” In 2011, First Lady Michelle Obama said the President hadn’t smoked in “almost a year,” saying his daughters had inspired him to kick the habit for good. After his 2014 physical, Obama’s personal physician said he “remains tobacco free.”

In a press briefing Wednesday, White House spokesman Josh Earnest said the object in Obama’s hands was not a pack of cigarettes. “It’s not,” he said, simply.

Obama clearly still struggles with his former habit, acknowledging that he chews Nicorette gum to quell his desire to smoke. But his previous statements that he’s given up cigarettes entirely raise questions when a photo like this surfaces. And when the White House avoids questions posed by TIME and other outlets about the President’s smoking habits, it allows rumors like this to fester.

In the end, it doesn’t matter that much. As a Washington Post writer noted, Obama has “the best health care and the lousiest gig in the world,” so if he chooses to light up from time to time, he’ll probably be just fine.

TIME risk

Now You Can Find Out When You Are Likely to Die With a Simple Online Test

The test is based on data from the U.K. and aimed at people between the ages of 40 and 70

Are you going to die within the next five years? A new online questionnaire may be able to tell you.

Ubble, the U.K. longevity explorer, uses data from the U.K. Biobank to determine a set of 655 measures and risk factors that can affect the odds of premature death, the Guardian reports. The website contains a series of 11 to 13 questions that will produce the odds of death within the next five years for men and women between the ages of 40 to 70.

Andrea Ganna, one of the scientists behind the project, explained the findings to the Guardian: “We hope that our score might eventually enable doctors to quickly and easily identify their highest risk patients, although more research will be needed to determine whether it can be used in this way in a clinical setting,” he said. “Of course, the score has a degree of uncertainty and shouldn’t be seen as a deterministic prediction. For most people, a high risk of dying in the next five years can be reduced by increased physical activity, smoking cessation, and a healthy diet.”

Read next: 15 Eating Habits That Make You Live Longer

Listen to the most important stories of the day.

TIME China

China Launches Bid to Stub Out Smoking in Beijing

Offenders can be fined or even shamed

China launched an ambitious campaign to curb smoking in its capital city on Monday, with signs urging the masses against the habit and penalties ranging from fines to public shaming.

The rules prohibit smoking in public places like restaurants, hospitals, schools and hotels, Reuters reports, as well as in specific outdoor areas. Individuals who are caught violating the new restrictions will have to pay the equivalent of a $32.25 fine, and multiple offenders could have their names shamed on a government website. Businesses that don’t comply could face a fine of up to $1,600.

Stubbing out public smoking in China, the world’s largest tobacco consumer and home to more than 300 million smokers, has been on the agenda of health advocates for years.

[Reuters]

TIME Research

U.S. Teen Trends In Sex, Bullying, Booze and More

Teenager Smoking Cigarette Boys
Getty Images

Good news: Today's teens experience notably low rates of bullying, drinking, pregnancy and unprotected sex

The latest statistics on teenagers paint a rosy portrait of American teens. They’re drinking, smoking and bullying less than they used to, and fewer are getting pregnant.

“Adolescence is an inherently risky time,” says Dr. Stephanie Zaza, the director of the U.S. Centers for Disease Control and Prevention’s (CDC) division of adolescent and school health. “They are stretching their wings. We can’t eliminate all risk, but we are seeing overall good trends in all areas.”

Here’s a snapshot on teen behavior, based on recent reports:

Bullying

Recent data from the U.S. Department of Education’s National Center for Education Statistics showed bullying at school was on the decline. Bullying among kids ages 12 to 18 dropped to 22% in 2013. The rate is lower than the 28-32% that was reported in all other survey years since 2005. Even cyberbullying—the use of electronic services to harass someone—has dropped. Only 6.9% of students reported being cyberbullied in 2013 compared to 9% in 2011.

Zaza adds that bullying has often targeted LGBTQ youth, and with increasing acceptance and major policy changes regarding same-sex marriage in the news, social norms regarding sexuality may be changing too, and that may contribute to less fighting.

Smoking

Teens are smoking less, too. In the last CDC National Youth Risk Behavior Survey (YRBS), which analyzes health risk behaviors among high school students, revealed that the high school smoking rate had dropped to 15.7%, the lowest recorded level since the survey started in 1991. It meant that the CDC had met its goal of lowering the adolescent smoking rate to under 16% by 2020, several years early.

Zaza says what’s responsible is a combination of widespread public health initiatives and changing social norms. “When you look at excise taxes, smoking bans, quit lines, campaigns and innovations in therapies, you see this amazing trend in adult and youth tobacco use,” says Zaza. “With all of those changes came a really big change in the social norms around smoking.”

Still, data from the CDC suggests that while high schools are smoking fewer cigarettes, e-cigarette use tripled among middle and high schoolers in just one year.

Drinking

The number of students who drink alcohol also dropped. Though it was still high at 35%, teens reported less physical fighting in school, and most students who were sexually active used condoms.

Sex and Babies

National teen pregnancy rates are also at a record low, with recent data from the U.S. Department of Health and Human Services (HHS) showing a continuous drop over the last 20 years, with a 10% decline just between 2012 and 2013. It’s unclear what is driving the decrease, but it appears teenagers are less sexually active than they have been in the past, and teens that are sexually active report using some form of birth control.

“There’s no doubt birth control and sex education are the most important factors in reducing unintended teen pregnancy,” Cecile Richards, president of Planned Parenthood said in an email. “Teens are increasingly using IUDs and implants, which are the most reliable methods of birth control.”

America’s teen pregnancy rate is at a record low, but it’s still higher than many developing countries.

Texting While Driving etc.

Zaza says she’s worried about the number of teens who text and drive—41%—as well as the nearly 18% of teens who report using prescription drugs without a prescription.

“I worry about these numbers,” says Zaza, adding that there’s still room for improvement.

TIME tobacco

Big Tobacco Sues British Government Over Effort to Strip Logos From Cigarette Packaging

New laws would strip logos from cigarette packages

Tobacco companies are fighting a recently passed law that would strip logos and branding from cigarette packages to in order to make them less enticing to consumers in the United Kingdom.

Philip Morris International, which owns the Marlboro band, filed suit Friday in a British court seeking to stop regulators from imposing standardized packaging on cigarettes. Philip Morris argues that such regulations would unlawfully deprive the company of use its own trademarks.

“Countries around the world have shown that effective tobacco control can co-exist with respect for consumer freedoms and private property,” Philip Morris said in a statement.

Under the new law, traditional cigarette logos would be replaced with large, graphic health warnings. Australia enacted a similar law in 2012.

According to Philip Morris, Marlboro was the ninth most valuable brand in the world in 2014 with an estimated value of $67 billion.

TIME Smoking

Bribery Is The Best Way To Quit Smoking, Study Shows

People really don't want to lose money

A new study found that the best way to get people to quit smoking was to bribe them.

Published in the New England Journal of Medicine, the study found that even more important than rewarding people with cash if they quit was the threat of losing money if they weren’t successful.

By comparing five different smoking cessation techniques among over 2,000 CVS Caremark employees, the study found that techniques requiring an up-front cash deposit that would be taken away if the participant didn’t successfully quit were much more effective than those that simply offered a cash reward.

“It leveraged people’s natural aversion to losing money,” lead author Dr. Scott Halpern of the Perelman School of Medicine at the University of Pennsylvania told Reuters.

Many more people were willing to enroll in a simple reward-based program than to put down money up front, but according to Halpern, the deposit programs were twice as effective as the more popular reward programs, and five times more effective than providing free non-smoking aids like nicotine replacement therapy.

The study found that group programs were no more effective than individual-based ones.

“The trick now is to refine the deposit programs so they’ll be more popular without losing much, if any, of their effectiveness,” Halpern told Reuters Health.

TIME Research

The New Science of How to Quit Smoking

cigarettes and money
Getty Images

Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

Listen to the most important stories of the day.

TIME medicine

The Best Way to Quit Smoking Isn’t E-Cigs

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Peter Dazeley—Getty Images

In the latest in-depth review of studies investigating which smoking cessation methods work best, experts say there isn’t enough evidence to support using e-cigarettes to kick the habit

The U.S. Preventive Services Task Force, a government-convened group of experts, says that if you want to quit smoking, you’re better off with drug-based methods, behavior modification programs or a combination of both—not puffing on e-cigarettes. There isn’t enough evidence to support claims that e-cigs, which have been touted as the latest way to wean people off tobacco, can actually help people quit.

The task force focused on studies that investigated how effective various smoking cessation methods are, for both adults and pregnant women. Drugs that address nicotine’s effects on the body, as well as nicotine replacement options, are better ways to quit, and the data suggest that they are even more effective if used together. In addition, behavioral interventions, including support groups and counseling sessions, can boost quit rates from 7-13% compared to rates of 5-11% among those who don’t use them.

MORE: E-Cigs Are Smokers’ Favorite Quitting Tool

“We have an embarrassment of riches in terms of a menu of things to offer patients who want to quit smoking,” says Dr. Francisco Garcia, director and chief medical officer of the Pima County Health Department in Arizona and member of the task force. “But every individual is different; some might respond better to behavioral therapy, some might respond better to varenicline, some might feel nicotine replacement is important to bridge them away from tobacco use.” For most people, it’s a matter of discussing with the smoker which method has the most appeal, and which one they are more likely to stick with long enough to go smoke-free.

But for certain populations, there isn’t enough data to support one strategy over another. Among pregnant women, for example, there haven’t been many studies to show how drug-based methods might affect the developing fetus, so it’s hard to determine if the benefits of quitting outweigh he risks represented by the medications. So for now, the task force advises that pregnant women rely on behavioral, non-drug strategies to help them stop smoking.

MORE: This Is The New Best Way to Quit Smoking, Study Finds

And for e-cigarettes, the data is sparse. The panel concluded that there was “insufficient” evidence to determine whether e-cigarettes improve or hinder quit rates.

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