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NTCC Develops National Priorities, Strategic Plan for 2009-2010 Earlier this year, NTCC funders met to develop a new vision and concrete direction for NTCC in 2009. They identified several long term, overarching priorities around tobacco cessation that were introduced as the NTCC Tobacco Cessation Priorities for the Nation at last month's 2009 Annual Meeting. NTCC's role in addressing these priorities was discussed at the meeting, and partners identified key NTCC opportunities and activities for the following priorities:
The specific activities related to these priorities that NTCC will undertake this year and early next year are briefly outlined below. 1. Increase consumer demand for evidence-based tobacco cessation treatments and services To increase consumer demand for evidence-based tobacco cessation treatments and services, NTCC plans to do the following:
2. Link tobacco control public policy changes to increase cessation and treatment use and demand Although a fair amount of work has been done related to the priority in past year, including the recent TFK webinar on the tax increase, and the policy playbooks, there are still more ways for NTCC to help link tobacco control public policy changes to increase cessation and treatment use and demand.
3. Promote the inclusion and use of tobacco control and cessation content in electronic health records (EHRs) The first steps for NTCC related to promoting the inclusion and use of tobacco control and cessation content in electronic health records would be to gather more information about the current state of the field.
4. Increase national, state and local longitudinal surveillance of tobacco-use cessation, including quitting motivation and behaviors, treatment beliefs and use, services, and policies To help support an increase in national, state and local longitudinal surveillance of tobacco-use cessation, NTCC will:
NTCC Partners Address Remaining Tobacco Cessation Priorities for the Nation Also at the 2009 Annual Meeting, several NTCC partners were identified as taking the lead to address the remaining NTCC Tobacco Cessation Priorities for the Nation. These priorities, the lead NTCC partner organization and its corresponding activities also are outlined briefly below. 5. Expand access to proven, effective treatments for tobacco addiction NTCC partner Partnership for Prevention is addressing this priority through the National Working Group for ACTTION (Access to Cessation Treatment of Tobacco In Our Nation), which aims to expand access to comprehensive tobacco cessation treatment to 50% of smokers by 2015, and 100% by 2020.
6. Support an expanded research agenda to achieve advances in the reach, effectiveness and adoption of tobacco cessation interventions across both individuals and populations NTCC partner National Institute on Drug Abuse (NIDA) is addressing this priority through focused research in a variety of topic areas (e.g., pharmacogenetics, genes/environment interactions, and behavioral and integrative treatment development) to advance the reach, effectiveness and adoption of tobacco cessation interventions across both individuals and populations.
7. Launch an ongoing, extensive, national paid media campaign on cessation to help Americans quit using tobacco Last year, the American Legacy Foundation launched EX®, a national media campaign that aims to change the way smokers think about the difficult process of quitting and guide them to valuable, free resources to build a successful quit attempt. EX encourages smokers to approach quitting smoking as "re-learning life without cigarettes."
8. Support the increase in the federal and state excise tax on tobacco to expand assistance for tobacco users who want to quit NTCC partner Campaign for Tobacco-Free Kids played an important role in advocating for the recent increase in federal tobacco taxes, including a 62-cent increase in the cigarette tax, and expanding the State Children's Health Insurance Program (SCHIP). The Campaign projects the federal tobacco tax increase to result in:
9. Build capacity for quitlines in order to provide universal access to evidence-based counseling and medications for tobacco cessation NTCC partner North American Quitline Consortium (NAQC) seeks to unite health departments, quitline service providers, researchers and national organizations in the United States and Canada to enable quitline professionals to learn from each other and to improve quitline services.
For a copy of the NTCC National Priorities Strategic Plan for 2009-2010, or for more information, contact Jessica Rowden at jrowden@aed.org. New AHRQ-Funded Study Finds Electronic Health Record-Based Reminders Improve Tobacco Cessation Treatment in Primary Care Primary care clinicians counsel patients to quit smoking more often when they are prompted by an electronic health record, according to a new study supported by HHS' Agency for Healthcare Research and Quality and the National Cancer Institute. The study is published in the April 27, 2009 issue of the Archives of Internal Medicine. Clinicians participating in the study were part of the Partners Primary Care Practice-Based Research Network, a group of 26 primary care practices that currently use a Web-based EHR, affiliated with Boston's Brigham and Women's Hospital and Massachusetts General Hospital. The study covered visits by approximately 130,000 patients from December 2006 to September 2007. The practices were randomly assigned to either an intervention group or a control group. Clinicians in the intervention group received tobacco treatment-related reminders and icons. More than 40 percent of the clinicians in the intervention practices used a new "Tobacco Smart Form," an addition to the electronic health record that prompted them to provide a range of smoking cessation interventions. Other clinicians in the control practices did not have access to the prompts or the Tobacco Smart Form. They could, however, refer smokers to the state quitline or to hospital programs, but could not email the tobacco treatment counselor through the EHR. Intervention practices that received icons, reminders, and the Tobacco Smart Form increased their documentation of smoking status from 37 percent to 54 percent. In contrast, documentation for practices without reminders was somewhat lower, increasing from 35 percent to 46 percent. Among patients who were smokers at the start of the study, more than twice as many (5.3 percent), who went to practices with the prompts or the form quit smoking by the end of the study, largely due to followup with a tobacco counselor (3.9 percent). Fewer patients (1.9 percent) in the other practices quit smoking or followed up with a counselor (0.3 percent). The interventions in this study are based on the Public Health Service Clinical Practice Guideline Update: Treating Tobacco Use and Dependence. To view the guideline, visit www.surgeongeneral.gov/tobacco/. For more information, see web link:
American Legacy Foundation® and Georgetown University Medical Center Create Research Collaboration The Steven A. Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation and the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center ("GUMC") recently announced the establishment of the Schroeder/Lombardi Cancer Control Consortium. The consortium seeks to advance tobacco-related research, policy and education, utilizing the shared knowledge and expertise of these two leading research organizations. "This partnership with Lombardi will dramatically elevate our ability to conduct first-class research on the most important elements of tobacco prevention and control," says Cheryl G. Healton, Dr. P.H., president and CEO of the American Legacy Foundation. "Our Foundation is now celebrating its tenth year, and I can't think of a more exciting way to pave the way for progress in the decade to come than by teaming up with Georgetown and Lombardi," she adds. "By partnering with the American Legacy Foundation, we're able to accelerate the translation of new findings discovered in a laboratory setting into clinical applications and cutting-edge tobacco cessation interventions," explains Peter Shields, M.D., deputy director of Lombardi and interim chair of the Department of Medicine at GUMC. Shields is an international leader in research on the harms caused by tobacco use. "This relationship marries the outstanding strengths of two superb organizations to form a robust consortium with very specific goals for advancing the science of tobacco-related research." The American Legacy Foundation established the Schroeder Institute to provide a nexus for cutting-edge tobacco research to accelerate reduction in smoking prevalence. One of the most pressing challenges to the field of tobacco control is to understand how to move basic and clinical research out of the laboratory and into the real world more effectively and efficiently to inform a coherent, unified national cessation strategy. Led by Dr. David Abrams, research scientists at the Schroeder Institute conduct trans-disciplinary research in tobacco control treatment and policy, with a focus on both the basic and applied science of dissemination. "This is an extraordinary opportunity to combine expertise in biomedical, behavioral, social and population sciences to make a difference in eliminating tobacco-use behavior - the single biggest preventable cause of premature death and disability in our nation," Abrams said. Lombardi is a National Cancer Institute (NCI)-designated Comprehensive Cancer Center dedicated to improving the diagnosis, treatment, and prevention of cancer. Research scientists within Lombardi's Division of Population Sciences conduct cutting-edge research in both basic and applied tobacco research, with specific expertise on the interaction between genes and the environment which increase cancer risk. The establishment of the Consortium will facilitate collaborations between researchers from Schroeder and Lombardi and will leverage the unique strengths, expertise, and resources from each organization. Members of the Consortium will pursue research funding opportunities to improve scientific understanding of the mechanisms of tobacco addiction and to develop and disseminate effective and cost efficient treatment and policy approaches. The ultimate goal of the Consortium is to make a dramatic and timely impact in reducing the population prevalence of smoking. For more information, see web link:
Secondhand Smoke Exposure Pervasive in New York More than half of nonsmoking New Yorkers have elevated cotinine levels from secondhand tobacco smoke, Jennifer A. Ellis, Ph.D., of the New York City Department of Health & Mental Hygiene, and colleagues reported online in Nicotine & Tobacco Research. The New York City rate easily beat the national average (56.7 percent versus 44.9 percent, P0.05), despite lower-than-average smoking prevalence (23.3 percent versus 29.7 percent, P0.05). The findings came from the 2004 New York City Health and Nutrition Examination Survey, which was modeled after the 2003-2004 National Health and Nutrition Examination Survey (NHANES) used for a national comparison. The survey came after the city instituted a comprehensive workplace smoking ban in 2003. "Secondhand smoke exposure in dense, urban settings may pose a particular challenge," the researchers said. NHANES data has suggested there was 70 percent drop in cotinine levels in nonsmoking adults between 1988 and 2002, but similar data over time was not available for New York. No level of secondhand smoke exposure is considered safe, the researchers noted. The objective determinant of recent exposure -- serum cotinine -- was measured in a representative sample of 1,767 adults age 20 and older in the NYC Health and Nutrition Examination Survey as well as 4,476 adults in the same age range in the 2003-2004 NHANES. While a cotinine level over 10 ng/mL indicates active smoking, levels above 0.05 ng/mL were considered elevated in nonsmokers. In both the New York and national surveys, smoking prevalence was generally higher in the youngest, 20-to-39 age group, as well as in men, U.S. versus foreign-born adults, and those with an income of less than $20,000 per year. Among nonsmokers, significant factors associated with elevated cotinine levels that indicated secondhand smoke exposure included the following: 2.37-fold higher prevalence in 20- to 39-year olds compared with those ages 60 and older (95 percent confidence interval 1.57 to 3.56) 1.62 times higher prevalence in 40- to 59-year olds compared with those 60 and over (95 percent CI 1.13 to 2.33) 1.96 times higher prevalence among men than women (95 percent CI 1.50 to 2.55) 2.39-fold higher prevalence among Asians than Hispanics, who had the lowest prevalence among the racial or ethnic groups (95 percent CI 1.38 to 4.14) 1.63 times higher prevalence in those with less than a high school education (95 percent CI 1.09 to 2.46) Notably, Asian New Yorkers had the highest prevalence of elevated cotinine (68.7 percent) of any demographic group in either the city or national surveys, although no national comparison was available for Asian adults. While the high proportion of Asians in the New York demographic mix compared with the rest of the nation may account for part of the secondhand smoke findings, urban density was likely a factor as well, Dr. Ellis' group said. Census data show a whopping 26,000 people and more than 10,000 housing units per square mile, respectively, in the city compared to 80 people and 33 housing units per square mile nationwide. Thus, city residents may get more intense environmental smoke exposure when walking past building and public transportation entrances where smokers congregate. They may also be more likely to live in close quarters with smokers, the researchers said. "More interventions may be needed to reduce home exposure, protect all workers, and reduce public exposure to secondhand smoke," the investigators concluded. For more information, see web link:
Home Life and Popular Culture Pose Smoking Risk to Children Smoking remains a serious health risk for children, who are exposed to secondhand smoke at home or influenced to take it up themselves by its depiction in popular movies, according to two studies published in the April issue of the journal Pediatrics. In one study, Katherine King, of New York University in New York City, and colleagues assessed the exposure of children to secondhand smoke at home. Analyzing data on 46,982 children aged 0 to 18 years from the Medical Expenditure Panel Survey 2000-2004, the researchers found that 34.4 percent of children live with one or more adult smokers. Among poor children, 49.4 percent live with a smoker, and 21.2 percent live with multiple smokers. In the other study, Madeline A. Dalton, Ph.D., of Dartmouth Medical School in Lebanon, N.H., and colleagues assessed the influence of smoking seen in movies on smoking by adolescents. The researchers found a one-third increase in relative risk for established smoking for each successive quartile of movie smoking exposure. Compared to those in the lowest quartile, teens in the highest quartile of baseline movie smoking exposure were found to be twice as likely to be established smokers at follow-up of a mean age of 18.7 years. "To the extent that our results are generalizable, estimates of attributable risk indicate that movie smoking exposure may account for one-third of established smoking by older adolescents and young adults," Dalton and colleagues write. For more information, see web link:
Intensive Management Improves Smoking Cessation Smoking should be treated as a chronic disease and managed intensively. That's the message of two randomized studies on smoking cessation -- one in Kansas and the other in New Jersey -- reported in the April 7 issue of Annals of Internal Medicine. The first study -- by Edward Ellerbeck, M.D., of the University of Kansas Medical Center in Kansas City, KS, and colleagues -- looked at three different combinations of drug therapy and counseling repeatedly offered to smokers living in rural areas of the state. The second -- by Michael Steinberg, M.D., of the University of Medicine and Dentistry of New Jersey in New Brunswick, and colleagues -- examined two programs of drug therapy in medically ill smokers, a group that is often excluded from clinical trials of anti-tobacco medications. In both trials, the most intensive cessation programs produced the best results, the researchers concluded. The findings of the Kansas study "show the importance of taking a disease management approach to smoking cessation," Dr. Ellerbeck said in a statement. "We found that smokers are willing to make repeated medically-assisted attempts at quitting smoking, resulting in progressively greater smoking abstinence," he said. He and his colleagues enrolled 750 smokers with a more-than-10-cigarettes-a-day habit from 50 rural medical practices for four six-month cycles of antismoking therapy. All participants were offered free pharmacotherapy with either a nicotine patch or sustained-release bupropion (Zyban). In addition, 249 participants were offered moderate-intensity counseling consisting of two telephone calls during each six-month cycle, and 251 were randomized to high-intensity counseling with six phone calls. The main outcome measure was self-reported, point-prevalence abstinence at the end of the two-year intervention; a secondary outcome was overall abstinence over the whole program. The researchers found little difference between the three groups at the 24-month point, but observed that abstinence rates increased throughout the study, with overall analyses showing a benefit for more intensive management. Specifically, those in the high-intensity group had higher abstinence than those in the moderate-intensity group, with an odds ratio of 1.43 (and a 95 percent confidence interval from 1.00 to 2.03) that was significant at P=0.05. When the two groups with counseling were compared with the pharmacotherapy-alone group, the odds ratio was 1.47 with a 95 percent confidence interval from 1.08 to 2.00, which was significant at P=0.02. Nonetheless, Dr. Ellerbeck and colleagues argued, the two-year intervention, divided into six-month treatment cycles, suggests that "a disease management approach can reach a high proportion of smokers seen in primary care practice." In the New Jersey study, Dr. Steinbeck and colleagues enrolled 127 smokers with a range of illnesses in a randomized trial comparing standard nicotine-patch therapy with combination treatment with the patch, a nicotine inhaler, and bupropion. The patch-alone therapy followed a standard 10-week tapering protocol, 21 milligrams a day for six weeks, 14 milligrams a day for two weeks, and then seven milligrams a day for two weeks. Those in the triple-therapy group were given a nicotine patch starting at 21 milligrams a day, a nicotine oral inhaler to be used as needed, and sustained-release bupropion at 150 milligrams a day. Treatment length was determined by symptoms, with participants told to continue their initial medication doses until they had gone 14 consecutive days without withdrawal symptoms or tobacco cravings. Then they were to reduce the nicotine patch dosage to 14 milligrams a day for two weeks and if they continued to feel comfortable, to seven milligrams a day for another two weeks. The bupropion would be stopped after another two weeks if symptoms did not recur. Participants would continue to use the inhaler as long as they felt it was needed. The main outcome measure was seven-day, exhaled carbon monoxide-confirmed, point abstinence 26 weeks after each participant's target quit date. Analysis found: Abstinence rates at 26 weeks were 35 percent for the combination group compared with 19 percent for the patch-only group, leading to an adjusted odds ratio of 2.57 (with a 95 percent confidence interval from 1.05 to 6.32) that was significant at P=0.041. The median time to relapse was 65 days in the combination group versus 23 days in the patch-alone group, a difference that was significant at P=0.005. Some side effects were more frequent in the combination group (such as insomnia and anxiety) but the proportion of participants who stopped study medications because of adverse events was 6 percent in both groups. "Medically ill smokers are often highly addicted and at great risk for complications from continued smoking," Dr. Steinberg said in a statement. "Our trial demonstrates that intensive treatment with a triple combination of medications could work well for them." For more information, see web link:
Poor Kids Exposed to More Secondhand Smoke Poor children are exposed to more secondhand smoke than their wealthier counterparts, a new study has found. A big reason for this is that "poor kids are far more likely to live with multiple adult smokers than are non-poor kids," said study author Dr. Michael Weitzman, a professor of pediatrics at New York University. Children exposed to secondhand smoke are more likely to develop respiratory infections, earaches and severe asthma. In addition, studies have linked exposure to secondhand smoke to hyperactivity disorder and behavioral problems. "This paper demonstrates the complex network of who exposes children in their homes," Weitzman said. "Secondhand smoke is the most ubiquitous and pernicious child environmental health exposure in the U.S." For the study, which is in the April issue of Pediatrics, the researchers collected data on families who participated in the Medical Expenditure Panel Survey conducted from 2000 to 2004. They found that slightly more than a third of the children lived in homes with at least one adult smoker. But about 49 percent of children from lower-income households lived with someone who smoked, compared with 21 percent of kids from wealthier families, and poorer children were more apt to live with more than one smoker as well. Among the approximately 5 million children who did not live with their parents, about 53 percent lived with a grandparent who smoked, and 46 percent lived with another relative who smoked, whereas 33 percent of children who lived with their parents co-existed with an adult smoker. Considering just children who lived with someone who smoked, the smoker was the child's mother 59 percent of the time, and 57 percent of the children lived in homes where two people smoked. In contrast, 17 percent of the children whose mother did not smoke lived with other adult smokers, the researchers noted. "The best thing you can do as a smoker in a household of kids is to stop smoking," said Danny McGoldrick, research director at the Campaign for Tobacco-Free Kids. "We know that kids who have parents who smoke are much more likely to become smokers themselves." "Once again, it's the most vulnerable in our society who pay the price for tobacco use," he said. For more information, see web link:
Not Enough Smokers Find Quit Support at the Doctor's Office Health care providers (HCPs) are one of the most important allies a smoker can have, particularly when it comes to understanding health risks of smoking and learning about the quitting process. Why, then, have more than one in five smokers (21 percent) never talked to a HCP about their smoking? A national survey from the American Legacy Foundation® of more than 1,000 current smokers reveals that smokers may be overlooking critical opportunities to talk to their HCPs about smoking - and, more important, about quitting. "A surprising number of smokers aren't taking advantage of their health care providers' ability to help them quit smoking, and are therefore continuing to put themselves at risk for serious health issues," said Cheryl G. Healton, Dr. P.H., president and CEO of the American Legacy Foundation. "Even more alarming is that when conversations do take place about smoking, patients don't seem to be getting the information they need to begin a successful quit attempt." On average, smokers make 6 to 9 quit attempts in a lifetime. National government guidelines state that the most effective way to quit smoking is through a combination of medication and counseling. But of the smokers surveyed who have talked to their HCP about smoking, just 20 percent were provided with either self-help cessation materials, information about classes and counseling programs, shown a video about quitting, or referred to a cessation specialist the last time they spoke with their HCP. Moreover, fewer than half (44 percent) were recommended a smoking cessation medication, such as over-the-counter nicotine replacement products or prescription drugs. Ironically, nearly eight in 10 (79 percent) smokers surveyed said they were satisfied with the help they received from their HCP, even though so few were given resources to quit and all of them remained smokers. The survey also revealed a disconnect between smokers' perceptions of how their HCP can help in the quitting process and their actions in actually starting a conversation with them. While 83 percent of smokers who want to quit in the next 30 days said they would feel comfortable asking for help, just 53 percent of this group actually asked their HCP for quitting assistance.1 These survey findings also identified the following barriers to smokers seeking and getting support for a quit attempt: Only about half of survey respondents (52 percent) said they think an HCP should help them quit smoking. Nearly half of smokers surveyed (45 percent) said they are very concerned or concerned about their personal health. While talking to their HCP about smoking, 54 percent of respondents felt the negative emotions of guilt, uneasiness, annoyance, pressure or embarrassment, while just 28 percent reported the positive feelings of motivation, pleasure, or confidence. "It's clear from this survey that we need to change the way people think about quitting, and help them realize that nicotine addiction is a chronic medical problem that can be overcome with assistance from a health care provider," added Dr. Healton. For more information, see web link:
Genes May Boost Harm to Kids From Secondhand Smoke Variations in several genes can influence children's lung growth and function, as well as how vulnerable they are to secondhand smoke, say University of Southern California researchers. "Many factors can affect lung function and growth, including genetic variation and environmental exposures such as tobacco smoke and air pollutants," study lead author Carrie Breton said in a USC news release. "We wanted to determine whether specific gene variations would have measurable and predictable effects on lung function growth and susceptibility to environmental insults," she said. "We looked at a class of genes known to be involved in antioxidant defense, the glutathione-s transferase (GST) genes. Overall, we found that variation in several of the GST genes was important. This was particularly true for children of mothers who had smoked during pregnancy." Breton and colleagues analyzed eight years' worth of lung function and genotyping data from more than 2,100 children. They identified three specific halotypes (patterns of genetic variation within genes) that had a significant effect on lung function. These halotypes were found in the genes GSTM2, GSTM3 and GSTM4. The gene variants may not alter lung development, the researchers explained, but they may change the ability of the lungs to defend against damage caused by free radicals, such as those found in smoke. "The GST genes are important to the detoxification of reactive oxygen species, including carcinogens and environmental exposures, such as cigarette smoke. We speculate that the patterns of genetic variation we investigated may alter this process, thereby reducing the lung's ability to detoxify harmful agents and causing a cascade of other events that promote inflammation, bronchial constriction, airway hyper-responsiveness and asthma-like symptoms," Breton said. The study is in the first April issue of the American Journal of Respiratory and Critical Care Medicine. "The next step would be to investigate how these genes interact with one another to jointly affect lung development," Breton said. "Future studies should also investigate the timing and quality of tobacco smoke exposure during pregnancy in combination with variation in these genes to further understand how they jointly affect fetal lung development." For more information, see web link:
New Analysis: Light and Intermittent Smokers Overlooked in Traditional Tobacco Research To date, the majority of research conducted about tobacco use has been related to the impact of moderate to heavy smoking. The March 2009 issue of Nicotine and Tobacco Research is focused on examining light and intermittent smoking. Several of the nation's preeminent public health experts and researchers worked together to uncover trends related to light smokers, those who smoke less than 10-15 cigarettes per day and intermittent or occasional smokers, those who may not smoke every day. According to the CDC, one-fifth of U.S. smokers are intermittent or occasional smokers. Yet, existing research and public health efforts have targeted moderate to heavy smokers. There is no safe level of cigarette smoke, though, and for this reason, the American Legacy Foundation, the National Cancer Institute, the National Institute on Drug Abuse and the National Institutes of Health Office of Behavioral and Social Sciences Research co-funded Light and Intermittent Smoking, a special issue of Nicotine and Tobacco Research. The issue includes 13 original, peer-reviewed articles that stemmed from recommendations made at a meeting of 29 collaborative scientists held in 2005. This unprecedented meeting yielded a concerted effort by the public health community to reduce light and intermittent smoking, and this compilation of research is the beginning of curbing that trend and helping to avoid the 1 billion projected tobacco-related deaths in the 21st century. The articles examine: Smoking Patterns - Light and intermittent smoking is more prevalent among African-Americans, Hispanics/Latinos, Asian American and Pacific Islanders compared with Whites. Those aged 20-34 were more likely than adults aged 35-50 to smoke five or fewer cigarettes per day; male smokers were significantly less likely to have light daily consumption; smokers with lower levels of education were more likely to consume a pack or more per day compared to those who had graduated from college. Trends - Light and intermittent adolescents are an unstable group of smokers. Data indicate that among 12th grade light and intermittent smokers who were followed over time, less than half were found to still be light and intermittent smokers two years post-high school. Another study that examined U.S. trends in smoking from 1991-2002 found that among very light smokers, smoking prevalence declined at all levels among Americans who are more than 30 years old, while light and intermittent smoking between those aged 18-29 increased. Another interesting trend examined was the association between light smoking and tobacco control policies. Young adults in states with strong policies were more likely to be light smokers, and there was a higher prevalence of light and intermittent smoking in young people with smoke-free homes Addiction - Two studies in the issue examine the relationship between cigarette consumption and addiction. Adolescent very light smokers (less than five cigarettes per day), demonstrate no significant withdrawal symptoms after 24 hours without nicotine, while those adolescents consuming four to five cigarettes per day had subjective symptoms of withdrawal. A sub-group of Hispanic/Latino smokers who were studied demonstrated that, despite significant differences on dependence and withdrawal, low-level smoking was not associated with abstinence. Health Effects - A study of college students found that smokers who smoked five or more days per month had a higher occurrence of shortness of breath than nonsmokers. "In order to adequately address the issue of tobacco use in this country, we can not overlook light and intermittent smokers," said Dr. Pebbles Fagan, Health Scientist, Tobacco Research Branch, Division of Cancer Control and Population Sciences at the National Cancer Institute. "Research suggests an impending global pandemic of light smokers, and we must take what this paper outlines and move the agenda forward in advancing research of the full spectrum of smokers." For more information, see web link:
New American Lung Association Report Reveals States Failing to Enact Lifesaving Tobacco Control Policies According to a report released by the American Lung Association, 2008 proved to be a slow year for tobacco control policies on the state level, with only a select few taking the steps that are needed to curb tobacco use and save lives. In its annual update of State Legislated Actions on Tobacco Issues or SLATI, now in its 21st year of publication, the American Lung Association tracks the passage of legislation and other state policies related to tobacco control and prevention, including tobacco taxes, smoking restrictions and funding for tobacco prevention and cessation programs. SLATI is the only comprehensive summary of state tobacco control laws, and is also available online at http://slati.lungusa.org. The website is updated regularly to reflect changes in tobacco control laws as they take effect. "Unfortunately, the significant momentum previously achieved with the passage of smokefree workplace laws stalled during 2008," said Stephen J. Nolan, American Lung Association National Board Chair. "Only two states joined the American Lung Association's Smokefree Air Challenge by adopting comprehensive laws prohibiting smoking in workplaces, restaurants and bars." To date, 24 states including South Dakota in March, plus the District of Columbia have passed comprehensive smokefree laws as part of the American Lung Association's Smokefree Air challenge. A map illustrating the nation's progress towards becoming smokefree can be found online at: www.lungusa.org/smokefree. Only three states and the District of Columbia passed increases in their tobacco taxes in 2008, bringing the average state cigarette tax up to $1.19 a pack. This is a dramatic increase from the beginning of 2002 when the average tax was only 44.6 cents per pack. The revenue from tobacco taxes sometimes funds state tobacco control programs. However, no state has met the Center for Disease Control and Prevention's recommended funding level for these vital public health programs in fiscal year 2009. "Higher cigarette prices help prevent children from starting to smoke and motivate adults to quit," explained Nolan. "The revenue increased tobacco taxes generate can and should be used to fund state tobacco control programs in order to save even more lives from the death and disease caused by tobacco use." SLATI 2008 complements an American Lung Association report released in January 2009, the State of Tobacco Control 2008 report, which grades state tobacco control laws. For more information and to view that report, visit: www.stateoftobaccocontrol.org. For more information, see web link:
M.D. Anderson Researcher to Make Anti-Smoking Video Game for Army A University of Texas M.D. Anderson Cancer Center professor will be part of a team designing a video game aimed at helping members of the United States military quit smoking. Alexander Prokhorov, a professor of behavioral science and a smoking prevention and cessation expert, will be part of a study funded by the Department of Defense to promote health and stress management among the men and women in the armed forces. A $3.7 million grant was awarded to M.D. Anderson by the Peer Reviewed Medical Research Program and the Department of Defense Congressionally Directed Medical Research Program. The center will work with the U.S. Army in Fort Hood to develop and implement the program. Studies show that 38 percent of service members smoke cigarettes, while 15 percent use smokeless tobacco, Prokhorov said in a statement. The prototype for the interactive and educational videogame is modeled after "Escape With Your Life," another tobacco-cessation videogame developed through Prokhorov's research at M.D. Anderson. The Army pilot program will feature animations, audio, video and interactive activities that provide facts about smoking and tobacco use, as well as a soldier-designed Avatar that guides troops through the educational track. Some of the modules will include educating participants on resisting peer pressure, coping with withdrawal symptoms and preventing relapses. For more information, see web link:Houston Business Journal April 15, 2009
New Report Shows New England States Spending Little on Tobacco Control Despite Receiving $1.8 Billion in Tobacco Funds The Presidents/CEO's of four major voluntary health organizations released a report showing that New England States are not keeping their promise to use a significant portion of funds from the 1998 state tobacco settlement to reduce tobacco's toll on the states' children, families and communities. The report, released during a news conference at the Massachusetts State House, finds that more than 10 years after the settlement, none of the New England states is funding tobacco prevention at levels recommended by the Centers for Disease Control and Prevention. The report, titled "Short Changed: Broken Promises on Tobacco Control Place Millions of Kids Across New England at Risk for Addiction and Early Death," is being released two days before the states receive their next round of multi-million dollar payments from the settlement. The report was compiled by the Washington, DC-based Campaign for Tobacco-Free Kids. Key findings of the report include: This year, New England states will collect $1.8 billion in revenue from the tobacco settlement and tobacco taxes, but will spend only 2.3 percent of it on tobacco prevention programs. It would take only 10.5 percent of total tobacco-generated revenue to fund tobacco prevention and cessation programs at levels recommended by the CDC. Currently, none of the New England states fund tobacco prevention programs at CDC-recommended levels. Only two states - Maine and Vermont - are funding tobacco prevention at even half the CDC recommended level. Tobacco use costs New England states $11.5 billion a year in economic losses, including $7 billion in health care costs and $4.5 billion in productivity losses, according to the CDC. The report warns that the region faces two significant and immediate challenges in the fight against tobacco use: complacency and looming state budget shortfalls. The last time the New England states faced budget shortfalls (2002-2005), they cut funding for tobacco prevention programs by 66 percent. Don Gudaitis, CEO, American Cancer Society, NE Division; Gary J. Balady, MD, President, BOD, American Heart/American Stroke Association; Jeffrey Seyler, President and CEO, American Lung Association of New England; and Matthew L. Myers, President, Campaign for Tobacco-Free Kids, called on the states to live up to their promises to use their tobacco settlement money to address the tobacco problem in their states, and signed a "Resolution" that will be sent to elected officials across the New England states. "While several of the New England states have made significant progress in the fight against tobacco use, there is still much room for improvement in the region. The twin dangers of complacency and budget shortfalls put any future progress at risk unless the states show leadership by making tobacco prevention and cessation a priority," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "It would be penny-wise and pound foolish to cut tobacco prevention during these tough economic times. Tobacco prevention is a smart investment that reduces smoking, saves lives and saves money by reducing tobacco-related health care costs." For more information, see web link:
New Initiative Involves Doctors in Anti-Smoking Efforts Most anti-smoking efforts target smokers, but a new media campaign launched recently aims directly at doctors, nurse practitioners and physician's assistants. "Your Patients Are Listening" features images of patients with enormous ears to dramatize smokers' receptiveness to advice and assistance from their doctors to stop smoking. The statewide public awareness campaign includes a series of articles in medical journals, newspapers and magazines, said Dr. Edwin Heidelberger, who talked about what doctors and nurses can do to help their patients quit. "The five A's," he said. "First, ask you're patient if they smoke. Then advise them to quit. Assess if they are willing to make the attempt to quite smoking. Assist with counseling and medicine. And the last piece is arranging for follow up, usually within one week after the quit date." The impact is tremendous, Heidelberger said. When a physician intervenes, a smoker has a 30 percent better chance of quitting. "Seventy percent of smokers want to quit. Of those, many are successful if the physician is there to listen," he said. Five different Tobacco Cessation Centers in the state of New York, including the one at Roswell Park Cancer Institute, launched the media campaign, said Leslie Blair, director of Roswell Park's cessation center. The cancer institute is home to one of the state's 19 local Tobacco Cessation Centers. Staff members provide free assistance, training and consultation with clinicians and health care organizations to improve stop smoking services in Erie, Niagara, Genesee and Orleans counties. Tobacco addiction is the leading preventable cause of death in the state. About 25,500 New Yorkers die every year from smoking. The $1.1 million public-awareness campaign is financed by the cancer institute. For more information, see web link:
The American Legacy Foundation® and ASPCA® Urge Pet Owners to Safeguard Their Pets from a Silent Killer - Secondhand Smoke The American Legacy Foundation® is challenging pet owners to quit smoking for their pets during the month of April, which kicks off Prevention of Cruelty to Animals Month. A growing body of research shows there are no safe levels of exposure to secondhand smoke-for humans or for animals. And one new study shows that nearly 30 percent of pet owners live with at least one smoker - a number far too high given the consequences of exposure to secondhand smoke ("SHS"). "Secondhand smoke doesn't just affect people," said Dr. Cheryl G. Healton, DrPH, President and CEO of the American Legacy Foundation®, the national independent public health foundation dedicated to keeping young people from smoking and providing resources to smokers who want to quit. "While most Americans have been educated about the dangers of smoking to their own bodies, it is equally important that pet owners take action to protect their beloved domestic pets from the dangers of secondhand smoke." An estimated 50,000 Americans lose their lives to secondhand smoke annually and 4 million youth (16 percent) are exposed to secondhand smoke in their homes. A number of studies have indicated that animals, too, face health risks when exposed to the toxins in secondhand smoke, from respiratory problems, allergies and even nasal and lung cancer in dogs and lymphoma in cats. In addition, the ASPCA, one of the largest animal rights groups in the U.S., lists tobacco smoke as a toxin that is dangerous to pets. "Nicotine from secondhand smoke can have effects to the nervous systems of cats and dogs," said Dr. Sharon Gwaltney-Brant, Medical Director of the ASPCA's Animal Poison Control Center. "Environmental tobacco smoke has been shown to contain numerous cancer-causing compounds, making it hazardous for animals as well as humans. Studies have shown increases in certain types of respiratory cancers in dogs that live in homes with smokers. In addition, exposure to secondhand smoke has been shown to cause many of the same harmful inflammatory changes in the airways and lungs of dogs as their human counterparts. For these reasons, owners should not expose their pets to secondhand smoke in order to minimize the risk of their pets developing lung disease or cancer." According to a study published in the February 2009 edition of Tobacco Control, 28 percent of pet owners who smoke reported that information on the dangers of pet exposure to SHS would motivate them to try to quit smoking. These findings, coupled with the research on the effects of SHS exposure to animals, signals a new front in the public health community's battle to save lives from tobacco-related disease. In order to better protect dogs, cats or other pets, the foundation and ASPCA recommend that smokers - who often consider their domestic pets a part of the family - "take it outside" when they are smoking. The foundation also provides resources and information to smokers who want to quit for their own health through a national campaign called EX®, including a Web site for smokers who are quitting just for their pets. To join or view the community of smokers who are quitting for their pets, visit: http://community.becomeanex.org/group/quittingforourpets. For more information, see web link:
Rhode Island Cigarette Tax Increase Delivers Victory for Kids and Taxpayers; $1 Increase Give State Highest Cigarette Tax in the Nation Rhode Island's leaders have taken decisive action to protect the state's kids and taxpayers from the devastating toll of tobacco use by increasing the state cigarette tax by $1 to $3.46 per pack, making it the highest state cigarette tax in the nation. Rhode Island is also increasing the tax on most other tobacco products. Increased tobacco taxes are a win-win-win solution for Rhode Island - a health win that will reduce tobacco use and save lives, a financial win that will raise revenue to help alleviate budget shortfalls, and a political win that polls show is popular with the voters. The evidence is clear that increasing the cigarette tax is one of the most effective ways to reduce smoking, especially among kids. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent. Rhode Island can expect the $1 cigarette tax increase to prevent more than 7,300 Rhode Island kids from smoking; spur 3,400 Rhode Island smokers to quit for good; save more than 3,200 Rhode Island residents from future smoking-caused deaths; produce $160 million in long-term health care savings; and raise about $13.3 million a year in new state revenue. Governor Don Carcieri had proposed the increase in the cigarette tax in a fiscal year 2009 supplemental budget he submitted earlier this year. The state Legislature approved the tobacco tax increases, adding increases in taxes on other tobacco products and protecting Rhode Island's minimum pricing laws, measures which help thwart big tobacco's efforts to addict kids. By supporting a higher cigarette tax, Rhode Island's leaders have taken action that will improve the health of Rhode Islanders for generations to come and continue the state's leadership in the fight against tobacco use, the No. 1 cause of preventable death in the United States. The tobacco tax increases took effect on Friday, April 10. With Rhode Island's tax increase, the average state cigarette tax is now $1.23 per pack. Rhode Island is the first state with a cigarette tax of $3 or more. Twelve states and the District of Columbia have cigarette tax rates of $2 per pack or more, and 26 states and DC have cigarette tax rates of $1 per pack or more. For more information, see web link:
New Ohio Ad Campaign Calls for Taxing All Tobacco Products at Same Rate All tobacco products - including spit and chew tobacco and flavored little cigars - are addictive and harm health, and should be taxed at the same rate as cigarettes in Ohio, according to a radio advertising campaign launched recently by a coalition of public health organizations. According to the ad, if all tobacco products were taxed at the same rate as cigarettes, the higher prices would discourage youth tobacco use. In addition, it will raise revenue to fund critical programs to keep kids from using tobacco and help current tobacco users quit - programs that were cut from the state budget last year. Currently in Ohio, other tobacco products are taxed at less than half the rate of taxes on cigarettes. The funds generated by equalizing the tax on all tobacco products, an estimated $50 million a year, would be dedicated to the Ohio Department of Health for tobacco prevention and cessation programs. "By increasing the tax on other tobacco products to match the state tax rate on cigarettes, Ohio will reduce all tobacco use among kids, save lives, and improve the physical and financial health of the state," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. The products that would be taxed at the same rates as cigarettes include "little cigars," which look like cigarettes and are often blatantly aimed at children. They are cheaper and more affordable to kids than regular cigarettes because they have lower excise tax rates and they are often sold individually rather than in packs because their classification exempts them from state laws setting minimum pack sizes for cigarettes. Most insidiously, they often have candy and fruit flavors, such as chocolate, vanilla, raspberry, cherry and cinnamon. As with cigarettes, raising the price of smokeless and other types of tobacco products through state tax increases will prompt a reduction in use, especially among adolescents and young adults. For example, one study found that a 10 percent increase in smokeless tobacco prices reduces adult consumption by 3.7 percent and reduces male youth consumption by 5.9 percent, with two-thirds of that reduction coming from kids stopping any use of smokeless tobacco at all. The ad campaign is funded by the Robert Wood Johnson Foundation in cooperation with the Tobacco-Free Youth Coalition, American Lung Association, American Heart Association, American Cancer Society, and Campaign for Tobacco-Free Kids. For more information, see web link:
As Tax Hits, Smokers Call 'Quitlines' for Help Quit-smoking hotlines are being swamped - some as much as four times their usual volume - by smokers ready to kick the habit after the largest-ever increase in the federal tobacco tax. "We're seeing magnificent volume because of the tax," says Mary Kate Salley of Free & Clear, a Seattle company that runs "quitlines" for 17 states. She says the lines got 3,250 calls the day the increase took effect, up 369 percent from the same day in 2008. In 10 other states, calls were 163 percent higher than on the three previous Wednesdays before the tax increase, says Dawn Wiatrek of the American Cancer Society, which runs quitlines in 11 states. Many state hotlines started to see an increase last month, when tobacco companies began raising prices in anticipation of the tax increase. Philip Morris USA raised the price of Marlboros 71 cents a pack, and R.J. Reynolds raised Camel 44 cents. The federal cigarette tax went up 62 cents to $1.01 a pack. The tidal wave of calls was "totally, totally unexpected," says Karen Brown of the Michigan Department of Community Health. On March 11, when her hotline offered free nicotine replacement products, it got 21,000 calls in the first 24 hours. Brown says 400 people fielded calls but couldn't keep up. Smokers said they wanted to quit because of higher tobacco prices, says Brown, who helped work the phones. "I heard a lot of commitment," she says, as callers told her, "This is it!" Michigan provided so much counseling and medications, Brown says, "we're almost completely out of money." The state is now restricting its aid to low-income people. All 50 states and Washington, D.C., have quitlines (800-QUIT-NOW) staffed with counselors, and more than half offer free nicotine patches, gum and lozenges, says Linda Bailey of the North American Quitline Consortium. If smokers try to quit cold turkey on their own, Bailey says, their chance of success is 3 percent. If they get counseling, it is at least 16 percent, and if they add medication, it's about 30 percent. "Quitlines are the most efficient way to help people quit," say Matthew McKenna, director of the Centers for Disease Control and Prevention's Office of Smoking and Health. The tax increase helps fund State Children's Health Insurance Programs, which President Obama expanded this year. McKenna says "stronger discussion" is needed about using some of the revenue to help smokers quit. For more information, see web link:
Cigarette Tax Boost Prods Some to Quit For Tonette Lancaster, it just got to be too much one day -- the worry, the guilt and the money. "Cigarettes were $6 a pack, and now it's almost $7. It's like a bill," the 30-year-old, half-a-lifetime smoker said. "I just said, 'Enough is enough.' " So she slapped on a nicotine patch she got free, along with lots of information and encouragement, from the District of Columbia government. She hopes it inaugurates a cigarette-free life. Lancaster, who is studying computer science at a downtown business college, is not alone in her newfound commitment to quit smoking. In recent weeks across the country, telephone "quit lines" have registered a jump in calls in advance of the biggest-ever increase in federal tobacco taxes. If the past is any guide, the sizable tax boost should have an immediate impact in getting many smokers to quit, and anti-smoking advocates were making the most of the moment. Much research has shown that smoking is an extremely "price sensitive" habit, with fewer people taking up cigarettes and more people putting them down every time a pack becomes more expensive. The 62-cent tax increase was adopted this year as a way to fund the expansion of the State Children's Health Insurance Program. On the day the increase took effect, the District's quit line got 131 calls, a record. The same day a week earlier, it had 44 calls; a month earlier, 19. "Several measures are proven to reduce tobacco use. Foremost is taxation," wrote the author of a report two years ago in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention. A national telephone number, 1-800-QUITNOW, connects callers to programs in all 50 states and the District. In March, it registered 203,374 calls, more than twice February's 91,316. In January, it got 76,685. Normally, February and March have about the same number of calls, and fewer than January, which is a big month for quitting, said Linda A. Bailey, president of the North American Quitline Consortium. In Washington, the number of calls tripled in March, to 1,757, compared with February. The increases in Maryland and Virginia were more modest -- not quite doubling in March in both states. Various forces are at play in addition to the tax increase. Virginia recently enacted a law that will ban smoking in most restaurants starting in December. "That may be contributing to some of this," Phil Giaramita, spokesman for the Virginia Department of Health, said. Maryland's health department ran 67 quit-smoking spots on two Baltimore television stations in early March, and "we did see a bump" in calls after that, said Sara Wolfe, the state's quit-line coordinator. Washington also has an advertising campaign underway. A TV spot featuring former Redskin Darrell Green drove Tonette Lancaster to the 800 number. But the price of cigarettes appears to be the main driver of the recent rise in people seeking help. Philip Morris raised the price of some brands more than a month ago, and some experts believe it was an attempt by the company to get some profit out of the unavoidable price bump ahead. Although the 62-cent increase is the steepest step-up in federal taxes, it is not the biggest tax increase ever. New York City increased its local tobacco tax from 8 cents to $1.50 in July 2002, the biggest single jump by any U.S. jurisdiction. Last year, New York state increased its tax on cigarettes to $2.75 a pack. In 2002, 21.5 percent of New Yorkers smoked -- a proportion that had not changed in a decade. In 2006, after the first tax increase and an ad campaign that graphically described the hazards of smoking, the smoking rate fell to 17.5 percent. For more information, see web link:
U.S. House Takes Giant Step Toward Historic Regulation of Tobacco Products Statement from the Campaign for Tobacco-Free
Kids: We applaud House Energy and Commerce Committee Chairman Henry Waxman (D-CA) and Representative Todd Platts (R-PA) for their leadership in introducing this strong legislation and quickly moving it forward. The 298-112 vote underscores the broad, bipartisan support for this legislation and provides strong momentum for enacting it into law this year. It has been endorsed by more than 1,000 public health, faith, medical and other organizations. A poll last year found that 70 percent of American voters support FDA regulation of tobacco products. It has been endorsed by scientific authorities including the Institute of Medicine and the President's Cancer Panel. This legislation would grant the FDA the authority and resources to effectively regulate the manufacturing, marketing and sale of tobacco products. Among other things, it would: Restrict tobacco advertising and promotions, especially to children. Stop illegal sales of tobacco products to children. Require larger, more effective health warnings on tobacco packages and advertising. Ban misleading health claims such as "light" and "low-tar" and strictly regulate all health claims about tobacco products to ensure they are scientifically proven and do not discourage current tobacco users from quitting or encourage new users to start. Require tobacco companies to disclose the contents of tobacco products, as well as changes in products and research about their health effects. Empower the FDA to require changes in tobacco products, such as the removal or reduction of harmful ingredients or the reduction of nicotine levels. Fully fund the FDA's new tobacco-related responsibilities with a user fee on tobacco companies so no resources are taken from the FDA's current work. For more information, see web link:
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