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This broad preservation of authority enables states and localities to breast cancer 0 stage treatment buy dostinex 0.5 mg online adopt many comprehensive tobacco control strategies that have been proven to women's health of niagara cheap dostinex 0.5 mg free shipping prevent and reduce tobacco use among youth and young adults menopause quotes buy dostinex 0.5 mg fast delivery. That means that state, local, tribal, and territorial governments could act first in developing regulations, policies, and programs that minimize any individual- and population-level harms of e-cigarettes. The strongest, most innovative tobacco control policies typically have originated at the local level before eventually being adopted at the state level. However, it is important that these strategies are developed with evaluators and epidemiologists that can collect robust data to inform the implementation and sustainment of such strategies. State, local, tribal, and territorial governments should implement population-level strategies to reduce e-cigarette use among youth and young adults, such as including e-cigarettes in smokefree indoor air policies, restricting youth access to e-cigarettes in retail settings, licensing retailers, and establishing specific package requirements. Over 50 years of research offers a strong body of evidence on the effectiveness of certain tobacco prevention and control measures. And from this evidence, state, local, tribal, and territorial entities can take a variety of actions to address e-cigarettes, such as: Including e-cigarettes in smokefree indoor air policies; Restricting youth access to e-cigarettes in retail settings; Licensing retailers; and Establishing specific package requirements. Including E-Cigarettes in Smokefree Indoor Air Policies Most smokefree indoor air policies were put in place before the great rise in e-cigarette use. Because of that, these policies may not cover e-cigarettes or exposure to the Call to Action 243 A Report of the Surgeon General the aerosol they produce. Smokefree indoor air policies should be updated to prohibit the use of both conventional cigarettes and e-cigarettes, thereby preserving standards for clean indoor air. Efforts to include e-cigarettes in smokefree laws should also uphold or strengthen, not weaken, existing protections against exposure to secondhand smoke. Including e-cigarettes in smokefree indoor air policies can: Eliminate health risks from exposure to secondhand aerosol from e-cigarettes; Discourage people from using both combustible and electronic tobacco products (dual use); Simplify compliance with and enforcement of existing smokefree laws; Help to reduce the use of e-cigarettes among youth and young adults; and Maintain tobacco-free norms. Restricting Youth Access to E-Cigarettes When laws prohibiting tobacco sales to youth are strong and actively enforced with the education of retailers, they successfully reduce tobacco use among youth (Task Force on Community Preventive Services 2001; Zaza et al. Extending such laws to include e-cigarettes can further protect youth from exposure to nicotine, which nearly all states have done. Specific strategies can be implemented to deter the access of youth to e-cigarettes and their use in this population: Restricting the sale of e-cigarettes to minors; Placing restrictions on Internet sales of all tobacco products and e-cigarettes, including requirements for verifying age and providing identification at the time of purchase and upon delivery; Requiring age verification at the point of purchase; Displaying clear signage in retail locations about required age for sale; Prohibiting the sale of e-cigarettes from vending machines; Eliminating self-service displays of e-cigarettes; and Enforcing laws on the retail sale of e-cigarettes to minors. Nearly all states prohibit the sale of e-cigarettes to youth under 18 years of age. Some e-cigarette manufacturers have supported state legislation to prevent minors from purchasing e-cigarettes (Healy 2014). Their actions may, to some extent, be responsible for why these age-of-sale laws have been adopted more quickly than laws that prohibit e-cigarette use in public indoor spaces. Ensuring that e-cigarettes are regulated at the state and local levels can facilitate the application of additional tobacco control policies regarding e-cigarettes. Many actions can help to protect young people from the harms of e-cigarettes, such as including e-cigarettes in smokefree indoor air policies, restricting youth access to e-cigarettes in retail settings, licensing retailers, and setting specific package requirements. Establishing Specific Packaging Requirements Federal, state, local, tribal, and territorial governments are actively considering the potential harms of e-liquids. Calls to poison control centers about e-cigarettes and e-liquids have been on the rise, and about half of these calls are for incidents involving young children (American Association of Poison Control Centers 2015). The most common adverse health effects of poisoning are vomiting, nausea, and eye irritation, but some deaths have occurred as well. Enacting laws that require e-liquids to be labeled and sold in childproof packaging is one way to reduce the incidence of poisonings, particularly among children. To date, in addition to the federal Child Nicotine Poisoning Prevention Act of 2015 (2016) enacted in January 2016, more than a dozen states have enacted laws requiring childproof packaging for e-liquids (Tobacco Control Legal Consortium n. Health care providers, the public health community, e-cigarette manufacturers and retailers, and the public should be aware that e-liquids pose a serious public health concern, particularly among young children. Coordinate, evaluate, and share best practices from state and local entities that have implemented programs and policies to address e-cigarette use among youth and young adults. Many governments at the national, state, local, tribal, and territorial levels are involved in the regulation of e-cigarettes. To have the biggest impact on reducing the use and exposure of e-cigarettes among youth and young adults, it is integral for these governments to share best practices and coordinate and evaluate efforts as part of a comprehensive tobacco prevention and control strategy. Licensing Retailers Licensing is another strategy to control access to e-cigarettes among youth and young adults. A tobacco-related license can authorize a business to manufacture, distribute, or sell tobacco products (McLaughlin 2010).
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Similar findings were reported by Durante and colleagues (2011) in two case-control studies zoloft menstrual cycle buy dostinex 0.25 mg free shipping. Two additional studies investigated effects of maternal cigarette use during pregnancy on auditory brainstem responses in newborns (2 days old) (Peck et al grants for women's health issues cheap dostinex 0.5 mg fast delivery. Furthermore womens health group manhattan ks purchase generic dostinex on line, both studies demonstrated doseresponse relationships between altered auditory processing and maternal cotinine levels. Finally, in a study of a small sample of newborns that sought to understand the direct biological pathway, maternal smoking during pregnancy produced changes in newborn cochlear and auditory brainstem functions and changes in placental gene expression in genes that appear to modulate the motility of cochlear hair cells (Katbamna et al. Thus, all three studies indicate effects based on consumption of conventional cigarettes, and they highlight the possibility of a mediating role of maternal nicotine use in altered infant auditory processing, although further work must rule out confounding effects and effect modification by other constituents. Teens whose mothers smoked during pregnancy exhibited decreased accuracy in the tasks, with greater activation of both the temporal lobe and the occipital lobe, regions of the brain that are critical for auditory and visual processing. Additive effects of maternal cigarette use during pregnancy and of adolescent smoking on activation of the temporal and occipital lobes also emerged, indicative of reduced coordination among brain regions during auditory attention tasks. Brief nicotine exposure during this critical postnatal period of sensory cortex development disrupts glutamate transmission (Aramakis et al. Clinical studies and animal studies have linked prenatal exposure to nicotine to subsequent appetitive behaviors (an active searching process that is performed consciously) and consummatory behaviors (such as ingestion of food or drugs) in offspring. Associations have been demonstrated in humans between maternal cigarette use during pregnancy and risk to the child of smoking uptake/nicotine dependence, drug abuse, and obesity; parallel relationships have been shown in animal models between prenatal exposure to nicotine and similar appetitive behaviors of offspring. Parental use of tobacco is one of many well-known risk factors for offspring initiation of tobacco, progression to heavy use, and nicotine dependence. Wakschlag and colleagues (2010, 2011) suggest that maternal smoking during pregnancy has a teratologic effect with abnormalities stemming from the in utero environment which disrupt neural (Kandel et al. For example, nicotinic receptors of laboratory animals exposed to nicotine in utero are upregulated, suggesting a latent vulnerability to nicotine dependence among animals exposed to nicotine in utero (Slotkin et al. However, the association was attenuated and nonsignificant among several studies that controlled for a variety of environmental, social, and cognitive confounders between maternal cigarette use during pregnancy and initiation of offspring smoking (but not nicotine dependence) (Cornelius et al. In summary, evidence from animal models offers a biologic mechanism for, and human evidence is suggestive of, an association between maternal tobacco use during pregnancy with offspring smoking and nicotine dependence, but is insufficient to infer causation. Further research and longitudinal studies that examine these outcomes while assessing the full spectrum of environmental, social, and cognitive mediating pathways are needed to disentangle these issues. A smaller set of literature has documented associations between maternal cigarette smoking during pregnancy and use of other substances by the child (Fergusson et al. In utero exposure to nicotine also affects behavioral responses for drug rewards in both adolescent and adult experimental animals. Prenatal exposure to nicotine increases the preference of adolescents for a saccharin solution containing nicotine compared with saccharin alone (Klein et al. Prenatal exposure to nicotine also increases subsequent oral intake of alcohol (Chang et al. In a large longitudinal study that spanned 40 years, Shenassa and colleagues (2015) found evidence to support effects on nicotine dependence among children of mothers who smoked during pregnancy, but no effects on their progression to marijuana dependence were observed. In sum, a number of studies have documented associations between cigarette use by the mother during pregnancy and smoking initiation, heavy use, and nicotine dependence among her children, although control of confounding reduces this association. In addition, the literature is sparse and inconsistent regarding a connection between maternal cigarette use during pregnancy and the use of nontobacco substances by the child. A large body of literature has demonstrated effects of maternal cigarette use during pregnancy on weight levels and obesity in childhood. For example, three metaanalytic reviews found a 4764% increased risk of obesity in children following exposure to maternal cigarette smoking during pregnancy (Oken et al. However, unmeasured residual confounding or confounding by familial factors, which have not been fully explored, could attenuate the observed associations (Gilman et al. Animal studies support the epidemiologic literature suggesting a potentially causal relationship here by defining biologic pathways (Wong et al. Fetal and neonatal exposure to nicotine in rodents has resulted in neurochemical, neurobehavioral, and metabolic changes in the children that are consistent with obesity and type 2 diabetes (Williams and Kanagasabai 1984; Newman et al. Several of these studies revealed a thinning of the orbitofrontal cortex among persons who were prenatally exposed to maternal cigarette smoking, a thinning that was associated with drug use and experimentation during adolescence (Toro et al. Youth and Young Adults 111 A Report of the Surgeon General with increased fat intake (Haghighi et al. Structural alterations in the orbital frontal cortex have also been shown to result from interactions between maternal cigarette smoking during pregnancy and polymorphisms of brain-derived neurotrophic factor, a growth factor that regulates growth and differentiation of new neurons and supports existing neurons (Lotfipour et al. Although these clinical findings are specific to conventional cigarettes, they converge with results of animal studies of the effects of prenatal nicotine on brain reward centers and thus highlight the potential pernicious effects of e-cigarettes in pregnant women.
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