TIME Research

What to Know About the Science of E-Cigarettes

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

A guide to understanding conflicting and ongoing research

Two Columbia University professors warned in a new study Thursday that the health fears over electronic cigarettes are hindering research. The very same day, another new study showed that smoking e-cigs, or “vaping,” can produce cancer-causing formaldehyde.

Clearly there’s some disagreement among scientists about the risks and benefits of a product that’s growing in popularity. Here’s what you need to know about the latest science.

What’s with the latest disagreement?

Columbia public health professors Amy Fairchild and Ronald Bayer argue in Science magazine that the staunchest opponents of electronic cigarettes are so concerned about the potential downsides that they advocate for an anti-e-cigarette regulatory and research approach that may be bad for public health. This approach of “deep precaution,” they argue, “has served as a kind of trump argument, hostile to the notion of trade-offs, seeing in them perilous compromise. Such a posture does not serve either science or policy well.”

MORE The Future of Smoking

It “may be years before the disagreements over the evidence” about the effects of electronic cigarettes can be resolved, Fairchild and Bayer wrote. On the one hand, electronic cigarettes may serve as gateway drugs for young people to start smoking cigarettes, and “dual” use of electronic cigarettes with tobacco cigarettes may stop some smokers from quitting. Electronic cigarettes may also carry unknown health consequences of their own. On the other hand, they may provide harm reduction for people who have been unable to quit any other way.

Given these two competing possibilities, the authors argued that the best formula for public health is to acknowledge the possibility for costs and benefits and to push for a regulatory scheme that is flexible enough to account for both outcomes. It is better to make public policy and execute scientific research under the assumption that e-cigarettes could bring good as well as bad.

But also on Thursday, the New England Journal of Medicine published a new study reporting that chemicals inside e-cigarettes—like propylene glycol and glycerol—can produce a type of the cancer-causing chemical called formaldehyde when heated during the vaping process. The researchers report that when testing samples of the aerosol from vaped e-cigs, they found that the e-cigs can contain formaldehyde-releasing agents slightly different from regular formaldehyde, and that the levels are especially high when a user vapes at high voltages. Scientists don’t yet know if formaldehyde-releasing agents carry the same risk as pure formaldehyde, but the researchers said in their report that if they assume the substances do carry the same risks, then long-term vaping could be associated with a significantly higher risk for cancer compared to long-term smoking. The researchers said formaldehyde-releasing agents may actually burrow into the respiratory tract more efficiently than regular formaldehyde, though the observation wasn’t confirmed.

Are there other reasons experts are concerned?

There’s also debate over the safety of the liquid nicotine inside e-cigarettes. In April 2014, the Centers for Disease Control and Prevention (CDC) released a report showing what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. Calls went from one a month in September 2010 to 215 calls a month in February 2014, and more than half of the calls involved children age five and under. Forty-two percent involved people age 20 and older. Symptoms of liquid nicotine ingestion are known to be vomiting, nausea and eye irritation.

Researchers are also wary of the long term effects of inhaling propylene glycol, one of the main ingredients in e-cigarettes. The jury is still out, but some physicians are concerned. “As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Thomas Glynn, the director of science and trends at the American Cancer Society, told ABC News. “No one knows the answer to that.”

Are they really attracting young people?

Several recent—but fairly small—studies say yes. A December 2o14 study in the journal Pediatrics surveyed 1,941 Hawaii high school students and found that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, and only 3% smoked conventional cigarettes. The findings suggested that kids who smoked e-cigarettes scored lower on outside risk factors to pick up a conventional smoking habit. “The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors wrote. Numbers released in 2013 from the National Youth Tobacco Survey showed that the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

What’s the argument in favor of e-cigarettes?

Some smokers use e-cigarettes to help them curb their traditional cigarette habit, or even quit. An August 2014 study that surveyed over 20,000 Americans showed that among adults who used a product to help them quit smoking, 57% chose e-cigarettes. That’s compared to the 39% who used prescription drugs like Chantix and the 39% who used other over-the-counter methods like patches or nicotine gum. Another study from July 2014, which reviewed 80 studies on e-cigarettes’ safety and their effects on users, revealed that not only can e-cigarettes help smokers quit, but they are less harmful to smokers and bystanders’ health compared to regular cigarettes.

What’s the FDA doing about it?

The U.S. Food and Drug Administration (FDA) only regulates e-cigarettes that are marketed for therapeutic purposes, though the agency has proposed a rule that would give it more regulatory power over e-cigarettes but that has not yet been implemented. The FDA has suggested a ban on sale of e-cigarettes to minors, and admits that there is a lot consumers don’t know about the product like whether they attract kids and teens or just how much nicotine is inhaled when a person vapes.

MONEY health

Smoking Can Cost You $1 Million to $2 Million in a Lifetime

smoking cigarette wrapped in money on ashtray
John Knil—Getty Images

Your pack-a-day habit isn't just destroying your lungs, but your bank account as well—more than you ever imagined.

According to the American Lung Association, tobacco kills nearly half a million Americans annually and costs the nation $333 billion per year in health-care expenses and lost productivity to boot. But it’s hard for the average person—specifically, the average smoker—to wrap one’s brain around such an enormous figure.

Coming to the rescue, timed to coincide with the CDC’s Tobacco Awareness Week, is a new state-by-state analysis from WalletHub detailing the lifelong financial costs of smoking for an individual. Because the average price of a pack of cigarettes varies widely around the country—$5.25 in Virginia, $8 in Michigan, $12.85 in New York—the lifetime outlay varies greatly from state to state as well. In all cases, though, the data gathered by WalletHub show that smoking is incredibly costly in addition to being potentially deadly.

The total cost per smoker is estimated at $1,097,690 in South Carolina—and it’s the least expensive state in the nation. A Kansas City Star headline noted that the “cost of smoking is cheap in Missouri … relatively,” as the state ranks as the eighth least expensive on WalletHub’s list, with the total cost for a lifetime of smoking running “only” $1,177,230. At the high end of the spectrum, there’s Rhode Island, Massachusetts, New York, and Connecticut, where the habit costs more than $1.9 million per person in a lifetime. Priciest of all is Alaska, which crosses the $2 million mark.

For a little perspective, federal data estimates that the cost of raising a child to age 18 is about $250,000—a big chunk of change, but only a small fraction of expenses reportedly incurred by smokers.

Right about now, the average smoker (or just the average reader with a healthy degree of skepticism) is probably thinking: hogwash. The process of coming up with such wild figures must involve a fair amount of smoke and mirrors, so to speak, right?

Let’s have a look at what WalletHub did, exactly. By far, the largest expense incorporated into the per-person total is the “tobacco cost per smoker,” measured at $786,346 in South Carolina, up to roughly $1.5 million in Alaska. WalletHub came up with that figure by multiplying the average price of a pack of cigarettes in each state by the number of days in 51 years. Fair enough. There are cheaper ways to go about buying cigarettes, like buying smokes by the case, but many people purchase by the pack.

What’s trickier is the way that WalletHub pumped up its tobacco cost estimates by calculating “the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.” In other words, the assumption is that money not spent on cigarettes would have been dutifully and wisely invested over those same 51 years.

Similar assumptions have also been used in the now (mostly) discredited “latte factor,” which is the theory that holds that people can wind up with millions in the bank by cutting back on everyday expenses like a daily latte. Among other reasons, this line of thinking is questionable because people don’t necessarily invest money that they don’t spend on some product or service—they’re more likely to simply spend that money on something else.

WalletHub also includes other costs that many smokers never think about, factoring in added health care expenses (with state-by-state data from the CDC) and an 8% hit on income due to smoking, as determined in a study by the Federal Reserve Bank of Atlanta.

Add up all of these and a few other estimated expenses, and over the course of a half-century, the cost to the pack-a-day smoker runs $1 million to $2 million, according to WalletHub. Are the figures overblown? Well, perhaps a bit. There’s a good argument to be made that the data were construed to come up with totals that are as big and headline-worthy as possible. (After all, they got our attention.)

Nonetheless, even if the figures are on the inflated side, it’s an undeniable reality that the smoking habit costs big bucks over a lifetime. And oh yeah, it can make your lifetime a lot shorter. Let’s not forget that.

TIME Addiction

The Best Way to Kick Your Smoking Habit

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The more techy interventions, the better

If you’re really committed to quitting smoking for good, it’s time to get tech-savvy.

A new study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that people who use both phone hotlines and online cessation services to help them quit are much more likely to say they’ve abstained from smoking compared to people who opt for just one or the other.

In general, smoking quitlines are proven to be successful interventions for smokers who want to kick the habit. They offer guidance, support and resources to keep quitters on track. Most quitlines also offer a web version of their services, but until now, it hasn’t been clear that more information really is better.

MORE: Here’s the Best Way to Get Someone to Quit Smoking

The new study suggests that it is. Researchers looked at 7,901 people who reported using either phone-only interventions, internet interventions only, or a combination of both. People who used both methods were significantly more likely to report they hadn’t smoked in 3o days when researchers followed up with them. The researchers speculate that dual usage may improve a quitter’s likelihood of succeeding, possibly because they’re strongly committed to their goal.

“Although telephone and Web-based interventions are effective in tobacco cessation, providing access to multiple types of cessation services might improve the odds of users in achieving long-term cessation,” the researchers write. The hope is that physicians will counsel patients on considering both interventions.

Our ever-connected climate may make this easier, and many public health initiatives are seeing success in sending educational text reminders. The National Institutes of Health (NIH) is paying particular attention to how social media and cell phones can best be used to help break addiction. In October, the NIH pledged $11 million to studying the use of social media to help understand, prevent and treat substance use and addiction.

So if you’re ready to accept the challenge of going cigarette-free in 2015, set yourself up for success and log in.

TIME Addiction

E-cigs Are the New Cool Thing for Teenagers

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High schoolers are more likely to smoke e-cigs than regular cigarettes

Electronic cigarettes are hugely popular with teenagers all across the United States, new government data shows, but fewer teens are smoking regular cigarettes—suggesting that e-cigs may attract young people who wouldn’t otherwise smoke.

Researchers surveyed 1,941 Hawaii high school students about their smoking behaviors as well as their relative risk for picking up smoking. Risk was assessed based on factors like sensation-seeking and prevalence of smoking among peers, parent support and academic involvement.

They found, in their study published in the journal Pediatrics, that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, 3% only smoked conventional cigarettes, and 68% said they did not smoke.

MORE: Debate Over E-Cigs Lights Up

Students who smoked tobacco cigarettes, or who smoked both cigarettes and e-cigs, fell within the highest risk category for picking up the habit. E-cigarette users were lower on the risk threshold than those two groups, suggesting it’s attracting young people who wouldn’t necessarily be interested in conventional smoking. E-cigarette users and dual smokers were also more likely that nonsmokers to believe e-cigarettes are healthier than regular cigarettes.

“The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors write.

Part of this perception and attraction to e-cigs could be the fact that they are heavily marketed in public places the authors suggest.

MORE: In Children’s Hands, E-Cigarettes Can Be Deadly

The trouble with e-cigs is that there’s still not enough research to make any definitive conclusions on their risks or benefits. Some experts argue that since e-cigarettes have fewer unhealthy components than traditional cigarettes, they are a better option. They have even been trumpeted as a possible quitting device. Other experts argue that e-cigarettes are just another gateway to nicotine use, and are therefore unacceptable. Whether young people can access them and get hooked is of great concern.

Currently, the U.S. Food and Drug Administration (FDA) only regulates e-cigarettes marketed for therapeutic purposes, and many products continue to be marketed and sold with little FDA interference. The agency has proposed a rule that would give it more regulatory power over e-cigarettes that would look similar to other tobacco products, but nothing has been finalized. The FDA has also suggested a ban on sale of e-cigs to minors. The agency admits there’s a lot that consumers don’t know about e-cigs, like if they lead young people to smoke other tobacco products or how much nicotine is actually inhaled in each use.

TIME Cancer

U.S. Smoking Rate Hits Historic Low

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And the number of people who say they smoke every day has dropped, too

Cigarette smoking among American adults has hit at an all-time low, health officials said Wednesday.

The percentage of smokers over the age of 18 dropped from 20.9% in 2005 to 17.8% in 2013, according to a new Centers for Disease Control and Prevention (CDC) report. That’s the lowest rate of smoking adults since the CDC started tracking the numbers via its National Health Interview Survey in 1965. Over the course of eight years, the number of U.S. smokers dropped from 45.1 million to 42.1 million, the report reveals.

Still, the CDC worries too many Americans still smoke, and a Nov. 13 report from the agency showed that a high number of young people still smoke, putting millions at risk for premature death.

The good news for health officials is that people seem to be cutting back, if not quitting. The number of people who smoke every day has dropped nearly 4% from 2005 to 2013, and the proportion of smokers who smoke only some days has increased. Of course, smoking less habitually still poses tremendous danger for the health.

“Though smokers are smoking fewer cigarettes, cutting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits,” said Brian King, a senior scientific adviser with the CDC’s Office on Smoking and Health, in a statement.

Cigarette smoking continues to be the leading cause of preventable death among Americans, reportedly racks up $289 billion a year in medical costs and productivity loss.

Around 70% of all cigarette smokers want to kick the habit, and if a smoker quits by the time they turn 40, they can gain almost all of the 10 years of life expectancy they lose by smoking.

Americans who want to quit smoking can call 1-800-QUIT-NOW for free counseling and resources, or visit the CDC’s antismoking tips site here.

TIME China

China Proposes Ban on Smoking in Public Places

Beer Enthusiasts Gather For China's Largest Beer Festival
Chinese men take a smoke break during the 24th Annual Qingdao International Beer Festival on August 20, 2014 in Qingdao, China. Kevin Frayer—Getty Images

Ban would affect the country's 300 million smokers

Soon it could be illegal to smoke in public places in China, as the government considers tightening restrictions on the addictive habit.

The new rules, which are being presented to the public for the first time this week, would also ban smoking at certain outdoor areas like sports venues, restrict selling of tobacco to minors and force tobacco companies to include warnings about the dangers of smoking prominently on their package labels, the New York Times reports.

Smoking is incredibly popular in China: 300 million people partake regularly. It’s also cheap because, unlike in the U.S., the Chinese government doesn’t levy heavy taxes on tobacco products. Pro-smoking advertisements are even a common sight at schools. The World Health Organization had been pushing China to do more to curb smoking in the country for several years.

The reaction to the proposed rules has been largely positive so far, according to the Times. A local Beijing publication claims that 90% of the city’s residents support banning smoking at indoor public places.

[New York Times]

TIME health

Smoking News to Make You Cringe

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Stephen St. John—Getty Images/National Geographic Creative

Read TIME's reports from the era when the medical community thought it was O.K. to smoke

Thursday marks the American Cancer Society’s Great American Smokeout (GASO), a nationwide event encouraging smokers to kick the habit.

We know today that cigarette smoking causes serious diseases in every organ of the body, including lung cancer, diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and more. Tobacco use rakes up more than $96 billion a year in medical costs, and it’s estimated that 42.1 million people, or 18.1% of all adults in the U.S. smoke cigarettes.

This year marked the 50th anniversary of the historic 1964 Surgeon General’s report that concluded that smoking caused lung cancer, and should be avoided. Before then, smoking messaging was depressingly inaccurate. Despite concerns — initially from a small minority of medical experts — the tobacco industry boomed in the U.S., and even doctors considered the effects of cigarettes to be benign.

Here are some examples of tobacco-related beliefs that appeared through the years in TIME Magazine:

1923: In an article about a recent compilation of smoking-related data, TIME was mostly concerned with whether smoking made people more or less brainy: “The outstanding fact of this survey is that every man in the literary group smokes, and the majority of the literary women. Moreover, most of them consider its effects beneficial, and claim that their literary and imaginative powers are stimulated by it.” And later: “From the laboratory data, the author concludes that it is impossible to say that tobacco smoking will retard the intellectual processes of any one person, but in a large group it may be predicted that the majority will be slightly retarded.”

1928: Some experts tried early on to warn about the effect of nicotine, but were met with resistance. In an article about a researcher presenting data on nicotine and the brain, TIME writes: “Many U. S. doctors have contended and often hoped to prove that smoking does no harm. In Newark, N. J., five children of the Fillimon family have been smoking full-sized cigars since the age of two. The oldest, Frank, 11, now averages five cigars a day. All of these children appear healthy, go to school regularly, get good grades.”

1935: Questions began to be raised about the effects on infants, though uptake was limited: “Physiologists agree that smoking does no more harm to a woman than to a man, if harm there be. According to many investigators, the only circumstances under which a woman should not smoke are while she has anesthetic gas in her lungs (she might explode), and while she produces milk for her baby. Milk drains from the blood of a smoking mother those smoke ingredients which please her, but may not agree with her nursling.”

1938 Even if there might be adverse health events for some smokers, not all physicians agreed it was a universal risk: “In step with a recent upsurge of articles on smoking, in the current issue of Scribner’s, Mr. Furnas offers several anti-smoking aids for what they are worth. Samples: 1) wash out the mouth with a weak solution of silver nitrate which ‘makes a smoke taste as if it had been cured in sour milk'; 2) chew candied ginger, gentian, or camomile; 3) to occupy the hands smoke a prop cigaret. For many a smoker, however, this facetious advice may be unnecessary, since many a doctor has come to the conclusion that, no matter what else it may do to you, smoking does not injure the heart of a healthy person.”

1949: By the late 1940s, smoking had become a contentious debate in the medical community: “Smoking? Possibly a minor cause of cancer of the mouth, said Dr. MacDonald. But smoking, argued New Orleans’ Dr. Alton Ochsner, can be blamed for the increase of cancer of the lung. Surgeon Ochsner, a nonsmoker, was positive. Dr. Charles S. Cameron, A.C.S. medical and scientific director, who does smoke, was not so sure. For every expert who blames tobacco for the increase of cancer of the lung, he said, there is another who says tobacco is not the cause.”

1962 More evidence was linking tobacco to cancer, and some groups were trying to get pregnant women to quit out of potential risks to the child, but still: “Some doctors, though, see no direct connection between smoking and prematurity; they argue that the problem is a matter of temperament, that high-strung women who smoke would have a high proportion of “preemies” anyway.”

1964 In a historic move, the 1964 Surgeon General’s report officially stated that cigarette smoking causes cancer, giving authority to anti-smoking campaigns. TIME wrote:

The conclusion was just about what everybody had expected. “On the basis of prolonged study and evaluation,” the 150,000-word report declared, “the committee makes the following judgment: Cigarette smoking is a health hazard of sufficient importance in the U.S. to warrant appropriate remedial action.” More significant than the words was their source: it was the unanimous report of an impartial committee of top experts in several health fields, backed by the full authority of the U.S. Government.

Read TIME’s full 1964 coverage of the Surgeon General’s report, here in the TIME Vault: The Government Report

TIME Cancer

Young Smokers Put Millions at Risk, CDC Says

Kid Smoker
Diverse Images/UIG/Getty Images

5.6 million young people under age 17 could die early

Over 1 in 5 high school students use tobacco products, and unless rates drop significantly, 5.6 million young people under age 17 will die early from a smoking-related illness, according to a recent report from the Centers of Disease Control and Prevention (CDC).

Among young people who use tobacco products, over 90% are using nicotine vectors like cigarettes, cigars, hookahs and pipes. The vast majority of smokers try their first cigarette by the time they turn 18. The findings were published Thursday in the CDC’s Morbidity and Mortality Weekly Report.

The CDC analyzed its National Youth Tobacco Survey and report that in 2013, 22.9% of high school students and 6.5% of middle schoolers said they had used tobacco in the last 30 days. Those rates are slightly down from 2012, where 23.3% of high school students and 6.7% of middle schoolers said they’d used some form of tobacco in the last month. Unfortunately, the new numbers still show that close to 50% of all high schoolers and almost 18% of all middle schoolers have used a tobacco product at least once.

What about e-cigarettes? They’re still less popular than the traditional products: 4.5% of high schoolers and 1.1% of middle schoolers said they used them in the last month. How great of a problem e-cigarettes are for public health is still debated, but the products do contain nicotine, so therefore considered unsafe for kids.

One item of particular concern to the FDA are cigars, because they are taxed at a lower rate and often made to look like cigarettes, even having fruity flavors. Some are not regulated by the FDA in the way cigarettes are, which experts cite as a major concern.

Cigarette smoking kills more than 480,000 Americans every year, and for each death, there are about 32 people living with a smoking-related illness. It costs the U.S. economy billions in medical costs and loss in productivity. One strategy to make smoking less appealing to young people (besides the long list of terrifying health risks, like lung cancer) is by hiking up the price of tobacco, and launching more youth-targeted social campaigns, the CDC says.

Smokers can get free help quitting by calling 1-800-QUIT-NOW.

TIME tobacco

Here’s the Best Way to Get Someone to Quit Smoking

Antismoking messaging works differently depending on who's watching, a new study shows

For years, the U.S. government has gone back and forth about whether or not it’s legal to force tobacco companies to use images of cancerous lungs and other graphic pictures on their cigarette packaging. The assumption, of course, is that the images will terrify any smoker into kicking the habit.

However, a new study published in the journal Nicotine & Tobacco Research shows that the graphic tactic might not work on all smokers. The effectiveness of antismoking messaging depends on the attitude of the smoker.

Researchers from the Georgetown Lombardi Comprehensive Cancer Center studied 740 smokers to figure out what type of antismoking campaigns worked best. They discovered that messages that stress the benefits of quitting, like “quitting smoking reduces the risk of death due to tobacco,” were more effective at getting smokers to quit if those smokers thought that quitting would be very hard. The more graphic and negative ads like “smoking can kill you” tended to work best for smokers who thought they could quit whenever they wanted.

One of the reasons motivating messaging worked best among smokers who viewed quitting as a challenge could be that they’re already well aware of the health risks. On the other hand, the researchers speculate that loss-framed messaging — the kind that focuses on the negative consequences of continuing a behavior — worked better for smokers who felt they had more agency in their cessation because the negative ads built up motivation to stop.

Ultimately, the researchers believe that having a mixture of various messaging strategies is the best way to appeal to a broad range of smokers, and that currently there are far more negative messages than positive ones.

That’s not to say that scary ads don’t work. For a couple years, the Centers for Disease Control and Prevention (CDC) has poured resources into an intensive ad campaign called “Tips From Former Smokers” which features real former smokers who have experienced serious setbacks from their habit, like no longer being able to speak properly or having a baby too early. During past campaigns, the CDC has said that their quit lines experience 80% more activity when the ads are running compared with the weeks before.

Terrifying ads aren’t going away anytime soon, but mixing in more motivating messages might appeal to would-be quitters of all kinds.

TIME Retail

CVS Quits Selling Tobacco 3 Weeks Ahead of Schedule

Changes corporate name from CVS Caremark to CVS Health

CVS announced Wednesday that it has yanked cigarettes and other tobacco products from shelves at 7,600 stores nationwide, beating its original goal for ending cigarette sales by almost a month.

The retailer also changed its corporate name from CVS Caremark to CVS Health, a name the company believes “reflects our broader health care commitment.”

CVS pledged tobacco products would be off its shelves by Oct. 1 when it announced its plan to stop selling cigarettes in February, but they’re gone three weeks early.

“Every day, all across the country, customers and patients place their trust in our 26,000 pharmacists and nurse practitioners to serve their health care needs,” Helena B. Foulkes, President of CVS/pharmacy said in a statement posted on the company’s website. “The removal of cigarette and other tobacco products from our stores is an important step in helping Americans to quit smoking and get healthy.”

“We’re the first national pharmacy chain to step up and take this action,” CEO Larry Merlo said in a video accompanying the original statement announcing the halt in sales. “Tobacco products have no place in a setting where health care is delivered.”

Merlo also said the company plans to launch a “robust smoking cessation program” next year, to help the 7 in 10 smokers who say the way to quit achieve that goal.

The move comes as CVS is increasingly trying to rebrand itself as a health-care company, with in-pharmacy clinics and partnerships with hospitals. Now that cigarettes have disappeared, customers can expect to see new signage and an “enhanced selection” of nicotine replacement products.

First Lady Michelle Obama, who has made public health a key priority during her time in the White House, thanked CVS in a Twitter message.

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