Just when it seems as if the smoke may be clearing in the anti-tobacco crusade, Wisconsin, Minnesota and Iowa remain enveloped in a fog that earns the states several F’s from the American Lung Association.

Those failing grades, logged in the association’s annual State of Tobacco Control report issued Wednesday, are justified, said Judi Zabel, one of the principals in smoke-free initiatives in the Coulee Region.

“I think it’s a good gauge of where we’ve been and where we are,” said Zabel, an educator with the La Crosse County Health Department.

The report also is a good barometer of where more needs to be done, she said.

The analysis grades all 50 states for performance in four areas: tobacco prevention and control program funding, tobacco taxes, smoke-free air and access to cessation services.

Wisconsin, Minnesota and Iowa are among the roughly half of the states that snag A’s for smoke-free laws, but they break the curve after that.

Minnesota gets an A for access to services to help quit smoking, and Wisconsin and Minnesota get B’s for tax policies, while Wisconsin and Iowa get F’s for access to services and Iowa chalks up another F for taxes.

All three are on the same page for funding prevention and control programs, with a trio of F’s.

On the surface, the F’s for cessation programs might seem to be a tough grade, considering a variety of programs available through Gundersen Health System, Mayo Clinic Health System-Franciscan Healthcare, county health departments and other sources.

But below the surface lingers the challenge of informing the more vulnerable segments of society, especially low-income people, those with less education, people with mental health problems and members of the LGBT community, said Zabel, who also is coordinator for the 7 C’s Health Initiative, which covers La Crosse, Monroe, Vernon, Trempealeau, Jackson, Crawford and Buffalo counties.

“There are resources, but are they available when people need them?” she said. “Will they get that benefit only once a year?”

For example, if someone starts the year with a resolution to quit smoking by enrolling in a program but fails to follow through, Zabel asked whether that person could enroll again in July.

“We know that, on average, it takes six to 11 tries to quit,” she said.

As for taxation, states should tax all tobacco products at the same level, instead of applying the top levy to cigarettes and lower taxes to cigars, chew and other items, she said.

As for programs to quit smoking, Zabel noted that the state of Wisconsin provides $5.3 million for such initiatives, while it takes in $756 million a year in taxes and tobacco settlements.

“We’re grateful for that, but the CDC (Centers for Disease Control and Prevention) recommends $57.5 million” to cover health problems resulting from smoking, she said.

One in four children younger than 11 has tried smoking, she said, adding, “We need to be in our elementary schools, and we’re not. … We also need to be in populations disproportionately high in smoking.”

Every dollar invested in tobacco prevention saves $3 in tobacco-related health care costs, she said.

“We’re a good return on investment,” Zabel said.

Local efforts such as FACT, a youth movement that previously stood for Fighting Against Corporate Tobacco but now representing Spreading the Truth About Tobacco, have made inroads, but much remains to be done, especially in light of flavored tobacco products aimed at the youth market, she said.

Teenage smoking in the Badger State has declined from 33 percent in 2000 to 10 percent today, and it is down to 9 percent in La Crosse, Zabel said.

“Where we’re being challenged is with electronic cigarettes,” she said.

A quarter-million youths nationwide who never have smoked have tried e-cigarettes, she said, with youths’ e-cig use nationally at 4 percent, statewide at 8 percent and in La Crosse, 14 percent.

“Youths know cigarettes cause damage, but they don’t believe e-cigarettes do, even though there is no proof they are safe,” she said.

On the flip side of that coin are sellers of electronic cigarettes, which may or may not include nicotine in the flavored liquids they contain.

“We just want to get people off of cigarettes in the healthiest way possible,” said Michael Sprague, manager of the E-Cig Warehouse, which opened at 70 Copeland Ave. in La Crosse in November.

“All we do is vaping,” he said, using the common term for e-cigarettes because they deliver water vapor instead of smoke. “All we do are electronic — nothing you light a flame to.”

The store, which Sprague said does not sell to people younger than 18 (Wisconsin law bans such sales), features a bar of sorts with 10 barstools where patrons can test 140 flavors available, as well as a lounge area with couches to provide space for kibitzing about the practice.

“There is a lot of chattering, because vapers still are growing,” he said of the clientele, generally between 25 and 35.

Picking your preferred taste is the key to enjoying the practice, said Sprague, who said his favorite flavor these days is Baker’s Dream.

“It is like a sweet banana bread,” he said. “It’s kind of weird, when you get into vaping, you talk about things relative to food.”

Sprague, a former smoker who said vaping helped him quit, acknowledged, “I was originally skeptical about vaping.”

He had been using a vaping pen, one of the low-end devices, but warmed to the practice when he switched to another method.

“I personally needed a different device,” he said.

E-cigarette fluids can have no nicotine, or varied amounts, including high doses and stepping down as one moves toward quitting, he said.

Devices at E-Cig Warehouse range from $40 to $300 for somebody “who really wants that level,” he said. “It’s not that different, but it’s like somebody who likes Prada shoes.”

By the way, fans of smokeless tobacco such as Skoal and other chews might be interested in the fact that Feb. 14-20 is National Through With Chew Week.

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Mike Tighe is the Tribune newsroom's senior citizen. That said, he don't get no respect from the cub reporters as he goes about his duly-appointed rounds on the health, religion and whatever-else-lands-in-his-inbox beats. Call him at 608-791-8446.

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