September 2011

Spotlight

Economic Impact of Smoking High as Children of Smoking Households Miss More School Days

Researchers from Harvard’s Morgan Institute for Health Policy at Massachusetts General Hospital (MGH) found during a recent study that there is an economic impact for parents who smoke in the home due to a higher rate of school absenteeism in their children.

The study, released online in the journal Pediatrics, analyzed data from a 2005 National Health Interview Study of almost 3100 families with children aged 6-11 years old.  They found that 14 percent of households in America have at least one smoker, which amounts to almost 2.6 million children nationwide living with secondhand smoke.

Furthermore, researchers found that children in homes with one smoker missed an average of one day of school more per year than children of non-smokers.  Children living in two-smoker homes missed over 1.5 more days of school.

Dr. Douglas E. Levy, the study leader and an Assistant Professor at Harvard Medical School, said in a news release that “the health impact of living with a smoker is probably more extensive than our study shows.”  Levy added that while the findings do not provide evidence for a direct relationship between parental smoking and their children’s absenteeism, they do offer parents even more incentive to quit the habit.

Also important to consider is the fact that as Levy pointed out, “the absentee levels we report are averages; there probably are kids who miss much more school because they live with smokers than our study found."

The five main questions researchers asked participants to evaluate during this study were:

• How many people smoked inside the home
• How many school days the child missed because of illness or injury during the previous year
• Whether the child had three or more ear infections during the previous year
• Whether the child had a chest cold or gastrointestinal illness during the preceding two weeks
• Whether the child had been diagnosed with asthma, and if so, whether the child had any recent asthma attacks

For this study, researchers only analyzed absences related to ailments such as ear infections and chest colds, which accounted for 24 percent of absences in children living in homes with one smoker and 34 percent of those living in homes with at least two smokers.  They did not include other smoking-related afflictions such as asthma in their data.  A future iteration of this study could include more smoking-related health issues and their effects, if any, on school absenteeism.

A major finding of this study was the economic effects exposure to second-hand smoke has for families—especially those in low-income households.

The authors have estimated that school absences resulting from second-hand smoke-related illnesses may cost families up to $227 million per year from the lost earnings of parents who miss work to stay home with a sick child, and for money lost by childcare providers.

“Since almost half of the smoking households in our study had low incomes, that impact may be strongest on households least able to afford it,” Levy said.

The authors commented that overall the results “illustrate the extent of tobacco's impact on child and family well-being, highlighting academic disadvantage and financial burden in families in which parents smoke."

For more information, see web link:
The Harvard Gazette September 5, 2011

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Research Highlights

Encouraging Exercise May Help Teens Quit Smoking

Encouraging teenage smokers not only to quit, but to get physically active, may boost their odds of truly managing to kick the habit, a study said.

Some research in adults has suggested that exercise may help smokers quit, perhaps by easing withdrawal symptoms or taking the edge off cigarette cravings. The study, reported in the journal Pediatrics, looked at the effects of adding exercise advice to a teen-focused smoking cessation program.

"Not on Tobacco" (NOT) is the American Lung Association's quit program geared specifically for high school students. It's available in public schools across the United States, and studies have found that the average quit rate is about 21 percent.

In the state of West Virginia, where the study was done, smoking rates are high, while exercise rates are low, said lead researcher Kimberly Horn, of the West Virginia University School of Medicine in Morgantown.

"We felt like (exercise) might be important for these kids, and that the effects of NOT could be boosted," Horn told Reuters Health.

To study the question, Horn's team randomly assigned 19 high schools to offer either the standard cessation program, the program plus exercise advice or a "brief intervention" in which teen smokers had one session with a program facilitator.

In all, 233 students took part in one of the three programs.

The standard NOT program offers 10 weekly small-group sessions, in which a facilitator helps teens figure out why they smoke and find ways to kick the habit. Teens in the exercise-added version also got advice on exercise, and a pedometer, to keep track of their daily activity levels.

After six months, the study found, the NOT-plus-exercise group had the highest self-reported quit rate, at 31 percent. That compared with 21 percent in the standard program and just under 16 percent in the brief-intervention group.

When Horn's team looked more closely at the data, the added exercise seemed to help only boys.

Among boys in that version of the program, 37 percent had quit by the six-month mark, versus only about 18 percent in the standard program. Girls' quit rates, however, were similar in both groups -- at 26 percent and 23 percent, respectively.

The reasons for the gender gap were not clear, Horn said.

"We're a little puzzled by it," she added.

In general, it's known that girls' exercise levels "plummet" in the teen years, whereas boys are more likely to stay active to some degree, Horn said.

The study did not actually measure the students' exercise levels, so it's not clear how changes in physical activity correlate with quitting success. Future studies will look at whether the program really did boost activity levels, and whether the type of exercise matters to quitting smoking.

What's encouraging, Horn said, is that the exercise portion is easy to add to an existing NOT program. The hope is that even after they quit smoking, the teens will keep exercising and gain those extra health benefits as well.

"It's just a modest amount of encouragement (to exercise) from the facilitator. And we found that even that small 'dose' might have very important effects."

For more information, see web link:
Reuters September 21, 2011

CDC: As Smoking Declines So Does Lung Cancer

New diagnoses of lung cancer fell from 2006 to 2008 among Americans of both sexes -- the first time in decades that the incidence in women has declined, and probably because of successful anti-smoking efforts, the CDC reported.

Nationwide, the reductions in incidence amounted to 2.2% among women from 2006 to 2008 and 2.9% among men from 2005 to 2008, according to data from two CDC registries appearing Thursday in Morbidity and Mortality Weekly Report.

Accompanying and probably explaining these trends were declines in smoking prevalence and increases in so-called quit ratios, seen in responses to the CDC's Behavioral Risk Factor Surveillance System survey, the report indicated.

Quit ratios are the number of "former smokers" (those responding that they did not currently smoke but had previously smoked at least 100 cigarettes during their lifetimes) divided by the total of current and former smokers.

States with higher quit ratios -- which the authors suggested were the result of media campaigns, tobacco tax hikes, and other anti-smoking programs -- had greater decreases in new lung cancer diagnoses (r=-0.55 for men, -0.33 for women, both P<0.001).

The findings point to "recent decreases in lung cancer incidence that closely parallel smoking behavior patterns across the U.S.," wrote S. Jane Henley, MSPH, and colleagues in the CDC's National Center for Chronic Disease Prevention and Health Promotion.

"Although great strides in tobacco control and lung cancer incidence reduction have been made, further progress requires intensified efforts to reduce cigarette smoking and secondhand smoke exposure. These efforts depend on adequate funding of tobacco control programs," they added.

New lung cancer diagnosis counts in the study came from the Surveillance, Epidemiology, and End Results (SEER) and National Program of Cancer Registries (NPCR) databases, covering 1999 to 2008, the most recent year with full data.

Incidences among men nationwide declined through the entire period, from approximately 93 per 100,000 population to less than 80 per 100,000.

In women, on the other hand, national rates had increased from 1999 to 2006 -- from about 54 to 57 per 100,000. But this trend reversed afterward, with the incidence returning to 54 per 100,000 in 2008.

The analysis found substantial differences in regional trends. States showing the best lung cancer incidence patterns since 1999 were concentrated in the West and Northeast -- the same areas where quit ratios were relatively high (the top two quintiles, above 58.8% in women and 60.6% among men).

Although the authors offered no systematic data to link these trends with state-level tobacco control efforts, they argued that these were likely responsible, at least in part.

They pointed to California as a state that has "invest[ed] more fully in these programs" and has also seen "decreases in youth and adult smoking prevalence, decreases in lung cancer, and significant healthcare savings."

At the same time, many state-level programs are in jeopardy because of fiscal hard times brought on by the recession.

"In the past three years, states have cut funding for tobacco control programs by 28% ($199.3 million), and this year states will invest less than 2% of tobacco revenues ($518 million) in tobacco control programs," Henley and colleagues wrote.

Caught between declining tax revenues and increased costs because of the economic recession, many states have tapped their tobacco tax receipts and payouts from the national "master settlement" with tobacco companies for general-purpose spending.

For more information, see web link:
MedPage Today September 15, 2011

Counseling May Not Help Pregnant Smokers Kick Habit

Counseling alone does not seem to help pregnant women quit smoking, according to a review of previous studies that concludes more research on the use of nicotine replacement and other therapies during pregnancy may be needed.

Published in the British Journal of Obstetrics and Gynecology, the analysis included eight clinical trials of nearly 3,300 pregnant women. Researchers looked at whether counseling helped pregnant women quit smoking after six months.

Four of eight trials showed no difference between groups of pregnant women who got smoking-cessation counseling and those who didn't, while the remaining four studies showed just a slightly lower quit rate in women who didn't receive the counseling.

In the study with the highest success rate, for instance, just 24 percent of women who got counseling were able to quit, compared to twenty-one percent who didn't get counseling.

In other words, three out of four moms-to-be in that study continued to smoke whether they had counseling or not, lead author Dr. Kristian Filion noted in an email.

"We were a little surprised by the small number of women that remained abstinent and by the small effect of counseling," he told Reuters Health.

Filion doesn't recommend abandoning counseling as an intervention, but he does see a need to study more effective approaches.

"Evidence regarding the safety and effectiveness of nicotine replacement therapies in pregnant women is limited," he said. "More research in this area is needed so that we can better understand the risk-benefit ratio of nicotine replacement therapies in pregnant women."

Dr. Nancy A. Rigotti, who directs the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston and who was not involved in the study, also agrees that medication should be considered to help pregnant smokers quit.

"There's a concern using any medication in pregnant women," Rigotti told Reuters Health. "But if a woman continues to smoke, exposing the fetus to nicotine and carbon dioxide, I would argue that it would be safer for her to take the small risk of taking a medication."

U.S. Public Health Service guidelines recommend nicotine replacement therapies and drugs such as Wellbutrin and Chantix to help people stop smoking, notes Rigotti. But she wouldn't suggest that pregnant women try Chantix, she added.

In 2009, the FDA required the drug's maker Pfizer to add a so-called black box warning on the label listing side effects such as depression, suicidal thoughts and, just recently, the drug's link to an increased risk of heart problems.

"It's a relatively new medication," Rigotti said. "There really is a lack of animal data to address any questions, and until we know more, we should be careful to use it in pregnant women. It probably wouldn't be my first choice."

Despite public awareness of the dangers of smoking, more than 13 percent of pregnant American women smoked in 2005, according to the Centers for Disease Control and Prevention.

Using counseling, nicotine replacement and other therapies that might help in a quit attempt before getting pregnant is a woman's best bet, said Filion.

"When women think about getting pregnant, it's probably the best time to intervene," he explained. "It's when they can use these drugs and increase the likelihood of quitting."

For more information, see web link:
Reuters September 13, 2011

Quitting Smoking Improves Memory

Former smokers have a better-functioning memory than those who still light up, a new study finds.

On a practical test of their recollection ability, people who on average had quit smoking for 2.5 years  performed 25 percent better than current smokers did. People who had never smoked scored 37 percent better than the smokers.

"We already know that giving up smoking has huge health benefits for the body, but this study also shows how stopping smoking can have knock-on benefits for cognitive function, too," said study researcher Tom Heffernan, a psychology professor at Northumbria University in England.

Lighting up, or learning?

The researchers aimed to measure "real world" memory abilities by sending 69 study participants on a tour of a university campus. Twenty-seven were smokers, 18 were former smokers, and 24 never smoked.

The participants were given a list of 15 locations around campus and an action to perform at each location. For example, upon reaching the library, participants were supposed to remember to check for messages on their cell phones; upon reaching the sports center, they were supposed to remember to ask about the cost of membership.

On average, the smokers performed 8.9 tasks correctly. The participants who had quit smoking averaged 11 correctly performed tasks, and those who had never smoked averaged 12.1. There were no differences between the groups in terms of their IQs, the study said.

Previous studies showed that quitting smoking improves "retrospective memory," which is the ability to learn information and retrieve it later. The new study instead measured participants' "prospective memory," which is the ability to remember to carry out a particular action at some future point in time.

For example, remembering to take medication at a certain time of day requires prospective memory.

Previous research on the effect of smoking on prospective memory yielded mixed results, with some results showing smokers were worse off, and others showing no effect from smoking, the study noted.

How does it work?

Although it is unclear exactly how smoking may interfere with memory, research has shown that chronic smoking is linked to a breakdown, or atrophy, of parts of the brain.

The researchers hypothesized that smoking could damage brain areas such as the prefrontal cortex, hippocampus or thalamus; all of those regions have been linked in brain imaging studies to prospective memory, they said.

Heffernan also has studied the effects of alcohol and marijuana on memory. He and the other researchers acknowledged that their new study was small and relied on self-reports of smoking, which would be subject to inaccuracy and dishonesty on the part of participants. Future work should follow a cohort of smokers and former smokers over time, they said.

The study will be published in an upcoming issue of the journal Drug and Alcohol Dependence.

Quitting Smoking May Improve Personality, Study Suggests

Aside from the well-known health benefits of quitting smoking, new research suggests that people who kick the habit may improve their personalities as well.

Researchers from the University of Missouri found that smoking is a trigger for impulsivity (acting without thinking) and neuroticism (often being emotionally negative and anxious) among adults under the age of 35. Those who stop smoking, however, can lose these unfavorable traits and improve their personality, the study suggested.

In comparing smokers ranging in age from 18 to 35 years with their peers who had quit smoking, the researchers found that the smokers were more impulsive and neurotic. In addition, they noted that young people with higher levels of impulsivity and neuroticism were more likely to engage in detrimental behaviors, such as smoking.

The researchers concluded that anti-smoking campaigns targeting smokers' impulsivity may be effective on young adults.

"The data indicate that for some young adults smoking is impulsive," Andrew Littlefield, a doctoral student in the psychology department at the College of Arts and Science, explained in a University of Missouri news release. "That means that 18-year-olds are acting without a lot of forethought and favor immediate rewards over long-term negative consequences. They might say, 'I know smoking is bad for me, but I'm going to do it anyway.' However, we find individuals who show the most decreases in impulsivity also are more likely to quit smoking. If we can target anti-smoking efforts at that impulsivity, it may help the young people stop smoking."

The study, slated for publication in an upcoming issue of the journal Nicotine and Tobacco Research, revealed that after quitting, the smokers saw declines in these personality traits, particularly those aged 18 to 25. As smokers age, the authors noted, their reasons for smoking go beyond impulsivity and the habit becomes part of a regular pattern of behavior.

"The motives for smoking later in life -- habit, craving, loss of control and tolerance -- are key elements of smoking dependence and appear to be more independent of personality traits," said Littlefield.

However, like other forms of substance abuse, smoking involves a complex relationship of genetic and environmental factors, he noted. Littlefield plans to research this topic further by studying the genetic influences on personality and alcohol consumption.

For more information, see web link:
Health Day September 14, 2011

Smoking Might Raise Sex Hormone Levels After Menopause

Smoking may increase sex hormone levels in postmenopausal women, a new study suggests.

Previous research has shown that high levels of estrogens and androgens may be risk factors for breast and endometrial cancer, as well as type 2 diabetes.

Researchers examined blood samples from 2,030 postmenopausal women, aged 55 to 81, and found that current smokers had higher circulating levels of androgens and estrogens than former and never smokers.

The findings will be published in the October issue of the Journal of Clinical Endocrinology & Metabolism.

"The observed increase in sex hormone levels with cigarette use suggests that tobacco smoke, apart from its direct toxic and carcinogenic effects, may also influence chronic disease risk through hormonal mechanisms," study author Judith Brand, of University Medical Center Utrecht in the Netherlands, said in a journal news release.

"The good news is that the effect of cigarette smoking appears reversible, as an almost immediate reduction in sex hormone levels was seen in women who quit using cigarettes," she added.

It's well known that reducing the risk of cancer, respiratory and heart diseases are major health benefits of quitting smoking.

"Our research suggests that smoking cessation may have additional effects by modifying hormone-related disease risks, but this was not the subject of the present study and requires further investigation," Brand said.

For more information, see web link:
US News and World Report September 1, 2011

Other Cessation News

With Public Smoking Bans in Place, Hookah Use Is on the Rise

Contrary to popular belief, hookah is not safer than cigarettes, and there are some ways that it poses even greater medical risks

A recent study looked at hookah use in California, and the results were concerning. From 2005 to 2008, hookah use among adults in the state increased by 40 percent, with young men, ages 18-24, reporting hookah use twice as often as all adult men. Use was more common among people with some college education, non-Hispanic whites, young adults, and current and former cigarette smokers.

While public indoor smoking is banned in California, hookah use is allowed in hookah lounges that are classified as retail tobacco shops. The researchers note that the American Lung Association suggests that the public cigarette ban may actually be helping to increase the popularity of the lounges because they provide a legal alternative for smoking socially with peers. It may also give the impression that hookah smoking is safe.

Contrary to popular belief, however, hookah use is not safer than cigarette smoking, and there are some ways that it poses even greater medical risks to users.

A hookah is a water pipe that has a smoke chamber through which the smoke from specially formulated tobacco is passed. It is then drawn into a rubber hose and into a mouthpiece from which it is inhaled. The dangerous contaminants, including tar, carbon monoxide, heavy metals, and carcinogens remain in the smoke, despite passing through the water.

Hookah sessions often last as long as an hour and smokers inhale more deeply from the pipe than from cigarettes, so hookah smokers may in fact inhale 100-200 times the volume of smoke inhaled from a single cigarette in a typical hookah session. They receive the same amount of nicotine as from cigarettes and are at equal risk of addiction.
Hookah smokers are exposed to higher levels of carbon monoxide than cigarette smokers because charcoal is used to heat the tobacco in the pipe. The health risks associated with hookah smoke include lung, bladder, and oral cancers, cardiovascular disease, and low birth weight babies.

Additionally, because pipes are often shared, hookah smoking increases the risk of transmission of infections, including tuberculosis, viruses such as herpes and hepatitis, and others.

The secondhand smoke from a hookah is as dangerous to nonsmokers as from cigarettes and has the additional toxicity of a higher carbon monoxide level.

For more information, see web link:
The Atlantic September 16, 2011

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U.S. Seeks to Ban Electronic Cigarettes on Airplanes

Commercial flights in the U.S. under a new rule proposed by theU.S. Department of Transportation.

Current federal law prohibits passengers from smoking any tobacco product on a commercial plane but does not single out the use of electronic cigarettes.

Most electronic cigarettes do not burn tobacco but use a lithium battery to heat up a liquid nicotine solution, creating a vapor that can be inhaled to deliver the chemical directly into the lungs.

"Airline passengers have rights, and this new rule would enhance passenger comfort and reduce any confusion surrounding the use of electronic cigarettes in flight," U.S. Transportation Secretary Ray LaHood said in a statement.

For years, flight attendants have spoken out against electronic cigarettes, saying passengers have confronted attendants over electronic cigarettes because some air travelers argue that the federal tobacco ban does not apply to electronic cigarettes.

The proposed ban on electronic cigarettes was blasted Wednesday by Ray Story, chief executive of the Tobacco Vapor Electronic Cigarette Assn., a Washington-based trade group that promotes the use of electronic cigarettes as an alternative to traditional tobacco products.

Story said the vapor produced by an electronic cigarette would pose no danger to nearby passengers on a plane. He said the ban would relegate electronic cigarette smokers to airport smoking sections where they would be exposed to the proven harmful effects of traditional tobacco cigarettes.

"How do you ban a product from a plane when it doesn't do anything?" Story said.

Under the federal rule-making process, the public has until Nov. 14 to submit comments on the proposed ban. People can file comments at http://www.regulations.gov. Once there, the public can comment by searching for the keywords "electronic cigarettes."

Federal officials said they could not estimate how long it would take to review the comments and prepare a final rule for adoption.

For more information, see web link:
LA Times , 2011

Taking on Tradition, Baseball Seeks Ban on Chewing Tobacco and Dip

Always a hidebound sport, baseball has accepted interleague play, the wild card and even video replay in the last 20 years.

Now a campaign backed by members of Congress and Commissioner Bud Selig is taking on something that’s been a part of the game’s culture for well over 150 years — chewing tobacco on the field.

Public health groups have gained traction with a classic argument: When ballplayers are seen chewing a wad of tobacco or using dip — products collectively known as smokeless tobacco — they set a bad health example for kids who look up to the athletes as role models.

To which Milwaukee Brewers outfielder Mark Kotsay replies: “I’ve seen the president drink a beer, right? I don’t know. I don’t get all the rules and regulations.”
The problem, anti-tobacco advocates say, is the increasing use of smokeless products by young people and the health risks that go with the habit.

The Centers for Disease Control says that smokeless tobacco can cause cancer, oral health problems and nicotine addiction, and stresses it is not a safe alternative to smoking. Despite the risks, the CDC’s most recent survey found that in 2009, 15 percent of high school boys used smokeless tobacco — a more than one-third increase over 2003, when 11 percent did.

The sport’s current collective bargaining agreement expires in December, and Selig, who endorsed the ban in March, has said he will propose it in the new contract. Union head Michael Weiner said in June that a “sincere effort” will be made to address the issue. Neither side would comment on the status of a tobacco ban in negotiations.

“I believe that’ll be a really tough sell,” said Kotsay, a tobacco user.

Nonetheless, Major League Baseball is so keen on scrubbing tobacco from the sport that it asked Sony Pictures to remove scenes depicting its use in the movie “Moneyball,” though the studio declined to do so. In the new film, Brad Pitt plays Oakland A’s general manager Billy Beane, and incorporates several of his habits, including dipping.

“That came pretty easily,” Pitt told reporters this week. “I grew up with a little dip.”
Baseball spokesman Pat Courtney said the studio agreed to many of MLB’s suggestions in the film, but decided to keep Beane’s tobacco use as a matter of authenticity, because he used the product at the time the movie is set (Beane has since quit dipping).

Health groups are urging a ban on players using the product any time they’re on camera, including the field and dugout. Several members of Congress have also urged a prohibition, such as Democratic Sens. Frank R. Lautenberg of New Jersey and Dick

Durbin of Illinois, and Democratic Reps. Henry Waxman of California and Frank Pallone of New Jersey. Smokeless tobacco already is prohibited in the non-unionized minor leagues.

But some players see the commissioner’s proposal as an infringement on their freedom.

“We’re all adults here,” said White Sox pitcher Jake Peavy. “We should get to make our own decisions. I’m a grown man. I’ve got a mortgage. I can make my own decisions.”

For more information, see web link:
The Washington Post September 24, 2011

A Global Push for a Smoke-Free Workplace

The Mayo Clinic, Johnson & Johnson and others are joining forces to try to snuff out smoking in the workplace throughout the world.

Their global smoke-free worksite challenge, announced today at the Clinton Global Initiative in New York, calls on employers to ban smoking at offices and facilities worldwide.

“We are facing a tobacco epidemic, if not a tobacco pandemic,” said Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services, one of the partners in a coalition calling for CGI’s 1,200 members to institute smoke-free policies.

Other entities joining the effort include the American Cancer Society, the Campaign for Tobacco-Free Kids, and GBCHealth  — a group of over 200 companies and nonprofit organizations involved in global-health issues.

“This is about trying to change the workplace back to the norm. Cigarettes are a 20th century phenomenon,” said Richard Hurt, director of the Mayo Clinic’s nicotine-dependence center. The Mayo Clinic has had a smoke-free workplace policy since 1987, he said.

Smoky offices seem like a thing of the past in much of the U.S. They're banned in 25 U.S. states and the District of Columbia.  But globally, only about 11% of people are protected by comprehensive national smoke-free laws, the WHO says.

Smokers miss eight to 10 more days of work a year than nonsmokers, costing companies millions of dollars a year in lost productivity and healthcare costs. Smoke-free environments also protect employees from exposure to secondhand smoke, which, like smoking itself, has been linked to lung cancer, heart disease, and other conditions.

Tobacco use is linked to more than five million deaths a year — more than any other risk factor — and secondhand smoke exposure is linked to another 600,000 deaths a year, according to the World Health Organization.

Some companies already ban smoking globally. Johnson & Johnson has had a smoke-free policy since 1997. But much more can be done, coalition members said. The goal is to protect 100% of employees rather than just 11%, said Koh, whose agency this year banned not only smoking, but the use of all tobacco products — including snus and e-cigarettes - in its buildings.

For more information, see web link:
The Wall Street Journal September 21, 2011

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