When President Donald Trump boarded Air Force One to fly to a Kentucky campaign rally two weeks ago, a plan was in place for him to give final approval to a plan to ban most flavored e-cigarettes.By the time Trump landed back at Joint Base Andrews outside Washington a few hours later, the plan was off. And its future is unclear.For nearly two months, momentum had been building inside the White House to try to halt a youth vaping epidemic that experts feared was hurting as many as 5 million teenagers.Both first lady Melania Trump and Ivanka Trump, the president’s daughter and senior adviser, pushed for the ban, which was also being championed internally by White House counselor Kellyanne Conway, who has taken the lead on some public health issues.But as Trump sat surrounded by political advisers on the flights to and from Lexington, he grew reluctant to sign the ban, convinced it could alienate voters who would be financially or otherwise affected by a vaping ban, according to two White House and campaign officials not authorized to speak publicly about private conversations.A news conference scheduled by Health and Human Services Secretary Alex Azar to announce the ban was canceled, while more meetings with industry leaders and lobbyists were proposed, according to the officials.Trump tweeted last week that he’ll be meeting with vaping industry representatives, medical professionals and others “to come up with an acceptable solution to the Vaping and E-cigarette dilemma.” The White House has yet to announce a date for a meeting.FILE- Flavored vaping solutions are shown in a window display at a vape and smoke shop in New York, Sept. 16, 2019.This month, Trump campaign manager Brad Parscale and others showed the president polling data indicating that e-cigarette users could abandon him if he followed through with the ban, the officials said.Campaign aides also highlighted an aggressive social media campaign — (hash)IVapeIVote —  in which advocates claimed a ban would force the closure of vaping shops, eliminating jobs and sending users of electronic cigarettes back to traditional smokes. Parscale also pointed out the risk that a ban could have on e-cigarette users in key battleground states that Trump narrowly won in 2016.Others in the West Wing, including Conway, have argued that a ban could be a winning issue with suburban voters, including mothers, who have fled the president in large numbers. Few would predict where Trump, who is known to abruptly change his mind, would end up since he recently has been consumed with other matters, notably televised impeachments hearings.The vaping industry’s largest trade group said Monday the administration was heading “in the right direction for adult smokers and their families.”“Bans don’t work, they never have,” Tony Abboud, executive director of the Vapor Technology Association, said in a statement.Gregory Conley, president of the American Vaping Association, an advocacy organization, added that the government should put in place “sensible and targeted regulations” before it resorts to prohibition, which opponents of a ban said could lead to the creation of an underground market for e-cigarettes.But Matt Myers, president of the Campaign for Tobacco-Free Kids, said Trump would be guilty of “terrible public policy” and “bad politics” if he backs down.“This is one of the very few issues on which public views are unified,” Myers said in a telephone interview. “There are a small number of vape shop owners who are loud and don’t care. But there are millions more moms and dads who are deeply concerned.”Robin Koval, president and CEO of the Truth Initiative, a nonprofit, anti-tobacco organization, called on Trump to implement the original plan.“The health of America’s youth must come first and is not for sale or political gain,” Koval said in a statement. The first lady opened the White House to a group of young people from the Truth Initiative in October to tell her about their experiences with vaping.FILE – A high school student uses a vaping device near a school campus in Cambridge, Massachusetts.Trump’s initial pledge Sept. 11 to ban virtually all flavored e-cigarettes stunned vaping proponents and was immediately embraced by anti-tobacco advocates. In an Oval Office appearance with the first lady and Azar, Trump said the government would act within weeks to protect children from fruit, candy, dessert and other sweet vaping flavors, including mint and menthol.The announcement followed a tweet two days earlier by Mrs. Trump expressing concern “about the growing epidemic of e-cigarette use in our children.”“We need to do all we can to protect the public from tobacco-related disease and death, and prevent e-cigarettes from becoming an on-ramp to nicotine addiction for a generation of youth,” she said.But within days, Trump tweeted that e-cigarettes might be a less-harmful alternative for smokers, a point long made by the industry. Meanwhile, vaping lobbyists, conservative groups and Republican lawmakers from key states warned Trump that a crackdown could cost him with voters.The Vapor Technology Association launched ads and an online campaign promising to punish Trump and other politicians who support vaping restrictions. Conservative groups that have long promoted vaping as an alternative to smoking, including Grover Norquist’s Americans for Tax Reform, joined the criticism.That group and others helped organize protests against banning flavors, including one outside the White House. Trump supporters also showed up at some of his campaign rallies holding signs expressing their opposition to a ban.The industry warned some 15,000 to 19,000 vaping shops across the country — and jobs — could be wiped out if flavors were eliminated.The administration was widely expected earlier this month to announce a scaled-back flavor ban that would exempt menthol, citing research that the flavor was not widely used by children. But no decision came.Trump instead told reporters on Nov. 8 — four days after his political advisers buttonholed him on the Kentucky trip — he was considering new approaches to curbing teen use, including raising the minimum age for purchasing tobacco from 18 to 21.Last week, Wisconsin Republican Sen. Ron Johnson sent Trump a letter warning against “unchecked government action that stifles innovation and restricts adults’ freedom to choose safer alternatives to smoking.”Asked how disappointed the first lady would be if the president did not follow through with a ban, her spokeswoman, Stephanie Grisham, who also speaks for the president, said Mrs. Trump’s priority is the health and safety of children.“She does not believe e-cigarettes or any nicotine products should be marketed or available to children,” Grisham said.Underage vaping has reached what health officials call epidemic levels. In the latest government survey, 1 in 4 high school students reported using e-cigarettes in the previous month.Anticipating a ban on flavors, Juul Labs, the nation’s largest e-cigarette maker, said this month it would stop selling its best-selling, mint-flavored nicotine pods.
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California said on Monday it will halt all purchases of new vehicles for state government fleets from GM, Toyota and Fiat Chrysler and other automakers backing President Donald Trump in a battle to strip the state of authority to regulate tailpipe emissions.Between 2016 and 2018, California purchased $58.6 million in vehicles from General Motors, $55.8 million from Fiat Chrysler, $10.6 million from Toyota and $9 million from Nissan.Last month, GM, Toyota, Fiat Chrysler and members of the Global Automakers trade association backed the Trump administration’s effort to bar California from setting tailpipe standards, which are more rigid than Washington’s proposed national standards.The automakers declined or did not immediately comment on California’s announced ban on purchases of their vehicles.FILE – California Gov. Gavin Newsom addresses a news conference in Sacramento, Calif., July 23, 2019.Starting in January, the state will only buy from automakers that recognize California’s legal authority to set emissions standards. Those automakers include Ford, Honda, BMW and Volkswagen, which struck a deal with California in July to follow revised state vehicle emissions standards.”Car makers that have chosen to be on the wrong side of history will be on the losing end of California’s buying power,” California Governor Gavin Newsom said in a statement.California purchased $69.2 million in vehicles from Ford over the three-year period, $565,000 from Honda and none from the German automakers.The state also disclosed it will immediately no longer allow state agencies to buy sedans powered by an internal combustion engine, with exemptions for certain public safety vehicles.California’s vehicle rules have been adopted by 13 other states.LawsuitsOn Friday, California and 22 other U.S. states challenged the Trump administration’s decision to revoke California’s legal authority to set vehicle tailpipe emissions rules and require a rising number of zero emission vehicles (ZEV).The move follows a separate lawsuit filed in September by the states against the National Highway Traffic Safety Administration seeking to undo a parallel determination.In August 2018, the Trump administration proposed freezing fuel efficiency requirements at 2020 levels through 2026, reversing planned 5% annual increases.The Trump administration’s final requirements are expected in the coming months and are set to modestly boost fuel efficiency versus the initial proposal, with several automakers anticipating annual increases of about 1.5%. That would be much less stringent than the Obama rules.CalMatters, a non-profit California journalism website, reported California’s decision to stop buying some vehicles earlier.
 
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New research has found that U.S. agriculture uses child workers without proper training and care for their safety. The report published last week in the American Journal of Industrial Medicine says 33 children are injured every day while working on U.S. farms, and more child workers die in agriculture than in any other industry. VOA’s Zlatica Hoke reports rights groups blame loopholes in U.S. laws for failing to protect child workers in agriculture
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The World Health Organization is calling for stricter regulations on the marketing and sale of e-cigarettes as more information comes to light about the potentially harmful impact of these products.   Health officials are increasingly worried about the risks posed by e-cigarettes as reported cases of deaths and illnesses from these devices spread from the United States to Europe and beyond. They see the recent death of a young man in Belgium and reports of vaping-related illnesses in the Philippines and other countries in the world as a call to action.  The World Health Organization says it is disturbed that vaping devices continue to be marketed as products that are healthy and that can wean smokers off their nicotine addiction.  WHO spokesman Christian Lindmeier tells VOA these industry health claims are unproven.“While these electronic nicotine delivery systems may be less toxic than conventional cigarettes, this does not make them harmless,” he said.  “They produce aerosols from the vapor that contain toxicants that can result in a range of significant pathological changes.  These ends pose health risks for nonsmokers, to minors, to pregnant women — all of those who should not use such systems.”  The U.S. Centers for Disease Control and Prevention has confirmed at least 42 deaths in 24 states and the District of Columbia, and more than 2,100 illnesses related to vaping products.   Vaping is an extremely profitable growth industry.  The number of people using vaping devices has increased from 7 million in 2011 to 41 million in 2018.  Profits have nearly tripled, from $6.9 billion five years ago to more than $19 billion today.  Getting the tobacco industry to refrain from the sale of electronic smoking devices will be extremely difficult.The World Health Organization says long-term studies of health implications of electronic nicotine devices should begin.  In the meantime, the U.N. health agency is issuing recommendations that in some ways mirror those enacted to control tobacco use.WHO says there should be a ban on the promotion of electronic nicotine delivery systems to nonsmokers, pregnant women and youth; measures should be taken to minimize the potential risks to users and others from these devices, and the tobacco industry should be prohibited from using unproven health claims to market vaping products.    
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Samoa declared a state of emergency this weekend, closing all schools and cracking down on public gatherings, after several deaths linked to a measles outbreak that has spread across the Pacific islands.The island state of about 200,000, south of the equator and half way between Hawaii and New Zealand, declared a measles epidemic late in October after the first deaths were reported.Since then, at least six deaths, mostly infants younger than 2, have been linked to the outbreak, the health ministry said in a statement late last week. Of the 716 suspected cases of measles, 40% required hospitalization.Worst yet to comeAs of the weekend, vaccination “for members of the public who have not yet received a vaccination injection, is now a mandatory legal requirement,” the government said in a statement. Only about two-thirds of the population has been immunized, according to the health ministry.“The way it is going now and the poor (immunization) coverage, we are anticipating the worst to come,” Samoa’s Director General of Health Leausa Take Naseri was cited in the health ministry statement as saying.He added that the children who died had not been vaccinated.New Zealand Foreign Minister Winston Peters said Friday his country would send 3,000 doses of vaccine and 12 nurses to Samoa to assist with the outbreak.“Measles is highly contagious, and the outbreak has taken lives in Samoa,” Peters said in a statement. “It is in everybody’s interests that we work together to stop its spread.”Measles on the riseMeasles cases are rising globally, including in wealthy nations such as the United States and Germany, where some parents shun immunization mostly for philosophical or religious reasons, or concerns, debunked by medical science, that such vaccines could cause autism.In Tonga, about 900km (559.23 miles) from Samoa, the ministry of health last week said an outbreak of measles in the country occurred following the return of a squad of Tongan rugby players from New Zealand.Since then, 251 cases of confirmed or suspected measles have been identified, the ministry said in the statement.American Samoa, a U.S. territory neighboring Samoa, declared a public health emergency Thursday following the measles outbreak in Samoa and Tonga, according to New Zealand media.According to Samoa’s Naseri about 90% of population in Tonga and American Samoa has been immunized and neither of these countries have reported any measles-related deaths.
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People with severe but stable heart disease from clogged arteries may have less chest pain if they get a procedure to improve blood flow rather than just giving medicines a chance to help, but it won’t cut their risk of having a heart attack or dying over the following few years, a big federally funded study found.The results challenge medical dogma and call into question some of the most common practices in heart care. They are the strongest evidence yet that tens of thousands of costly stent procedures and bypass operations each year are unnecessary or premature for people with stable disease.That’s a different situation than a heart attack, when a procedure is needed right away to restore blood flow.For nonemergency cases, the study shows “there’s no need to rush” into invasive tests and procedures, said New York University’s Dr. Judith Hochman.There might even be harm: To doctors’ surprise, study participants who had a procedure were more likely to suffer a heart problem or die over the next year than those treated with medicines alone.Hochman co-led the study and gave results Saturday at an American Heart Association conference in Philadelphia.Less testing, invasive treatment“This study clearly goes against what has been the common wisdom for the last 30, 40 years” and may lead to less testing and invasive treatment for such patients in the future, said Dr. Glenn Levine, a Baylor College of Medicine cardiologist with no role in the research. Some doctors still may quibble with the study, but it was very well done “and I think the results are extremely believable,” he said.About 17 million Americans have clogged arteries that crimp the heart’s blood supply, which can cause periodic chest pain. Cheap and generic aspirin, cholesterol-lowering drugs and blood pressure medicines are known to cut the risk of a heart attack for these folks, but many doctors also recommend a procedure to improve blood flow.That’s either a bypass — open-heart surgery to detour around blockages — or angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon and place a stent, or mesh scaffold, to prop the artery open.Earlier studyTwelve years ago, a big study found that angioplasty was no better than medicines for preventing heart attacks and deaths in nonemergency heart patients, but many doctors balked at the results and quarreled with the methods.So the federal government spent $100 million for the new study, which is twice as large, spanned 37 countries and included people with more severe disease — a group most likely to benefit from stents or a bypass.All 5,179 participants had stress tests, usually done on a treadmill, that suggested blood flow was crimped. All were given lifestyle advice and medicines that improve heart health. Half also were given CT scans to rule out dangerous blockages, then continued on their medicines.The others were treated as many people with abnormal stress tests are now: They were taken to cardiac catheterization labs for angiograms. The procedure involves placing a tube into a major artery and using special dyes to image the heart’s blood vessels. Blockages were treated right away, with angioplasty in three-fourths of cases and a bypass in the rest.Doctors then tracked how many in each group suffered a heart attack, heart-related death, cardiac arrest or hospitalization for worsening chest pain or heart failure.Results are inAfter one year, 7% in the invasively treated group had one of those events versus 5% of those on medicines alone. At four years, the trend reversed — 13% of the procedures group and 15% of the medicines group had suffered a problem. Averaged across the entire study period, the rates were similar regardless of treatment.If stents and bypasses did not carry risks of their own, “I think the results would have shown an overall benefit” from them, said another study leader, Dr. David Maron of Stanford University. “But that’s not what we found. We found an early harm and later benefit, and they canceled each other out.”Why might medicines have proved just as effective at reducing risks?Bypasses and stents fix only a small area. Medicines affect all the arteries, including other spots that might be starting to clog, experts said.Drugs also have improved a lot in recent years.Having a procedure did prove better at reducing chest pain, though. Of those who had pain daily or weekly when they entered the study, half in the stent-or-bypass group were free of it within a year versus 20% of those on medicines alone. A placebo effect may have swayed these results — people who know they had a procedure tend to credit it with any improvement they perceive in symptoms.Dr. Alice Jacobs, a Boston University cardiologist who led a treatment-guidelines panel a few years ago, said any placebo effect fades with time, and people with a lot of chest pain that’s unrelieved by medicines still may want a procedure.“It’s intuitive that if you take the blockage away you’re going to do better, you’re going to feel better,” but the decision is up to the patient and doctor, she said.The bottom line: There’s no harm in trying medicines first, especially for people with no or little chest pain, doctors said.
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