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SpotlightNTCC Plans Activities for 2010 Last month, NTCC held its annual meeting in Washington, D.C. to share accomplishments and provide updates on key NTCC and partner activities related to the NTCC Tobacco Cessation Priorities for the Nation. These long-term, overarching priorities around tobacco cessation were introduced last year. NTCC and partners have been working on various initiatives and activities to address these priorities over the past year. This includes: 1. Expand access to proven, effective treatments for tobacco addiction David Zauche from Partnership for Prevention presented on the ACTTION State Grant Program. The aim of the State Grant Program is to increase access to, coverage for, and utilization of tobacco cessation treatments. The grantees were chosen in mid-March. They will receive one-year grants of $20-40K that focus on system and policy change. Partnership received 25 proposals from 23 states. The grantees include:
More information can be found on http://acttiontoquit.org/. 2. Support an expanded research agenda to achieve advances in the reach, effectiveness and adoption of tobacco cessation interventions across both individuals and populations No NTCC partner was available to provide an update on this priority. However, HHS is in process of revamping their national tobacco control strategy. It is an ambitious plan and very aggressive actions are being proposed. The plan will be announced in May or June. 3. Launch an ongoing, extensive, national paid media campaign on cessation to help Americans quit using tobacco Bill Furmanski from Legacy presented on Become An EX campaign. Legacy launched EX in March 2008. Longitudinal testing was conducted and has shown promising results. The results showed that 6 months after the campaign launch, 46% of those surveyed had made quit attempt during period. Among those aware of the campaign, they were 60% more likely to increase agreement with statements about quitting. In addition, respondents were 24% more likely to make a quit attempt. There is currently a paper in press with more details. The second national media campaign for EX ran from October to February on major networks including CNN, ABC and Lifetime. For this campaign, the developers tried to increase the focus on sports to attract more men. One of the media buys was during the World Series. This dramatically increased male registrants to site. This campaign was smaller than initial run and was balanced with a PSA component launched in February in collaboration with the AD Council. 4. Support the increase in the federal and state excise tax on tobacco to expand assistance for tobacco users who want to quit Ann Boonn from Campaign for Tobacco-Free Kids presented on tax increases. There have been huge increases in the past few years. There are currently 2 states with $3 or more tax, 13 other states with $2 or more tax, and 14 other states with $1 or more tax. This year, Campaign for Tobacco Free Kids along with ACS-CAN, AHA, ALA and RWJF released a report titled “Tobacco Taxes: A Win-Win-Win for Cash-Strapped States” that reminds decision makers that increasing the tobacco tax is a win-win-win for states facing budget shortfalls — a BUDGET WIN that will raise billions in revenue and help preserve essential services such as health care and education; a HEALTH WIN that will prevent kids from smoking and save lives; and a POLITICAL WIN that is popular with voters. To view the report, visit http://www.tobaccofreekids.org/reports/state_tax_report/. 5. Build capacity for quitlines in order to provide universal access to evidence-based counseling and medications for tobacco cessation Ganon Wegner from NAQC presented on NAQC activities. Results from the NAQC 2008 annual survey were reviewed and preliminary findings from 2009 were presented. Data from the 2009 annual survey will be finalized by late June.
Current NAQC activities focused on building reach and capacity for quitlines, including:
All materials can be accessed on the NAQC website at http://www.naquitline.org. 6. Promote the inclusion and use of tobacco control and cessation content in electronic health records (EHRs) The Multistate Collaborative for Health System Change will take the lead on this priority. One of the major focus areas is to ensure that tobacco dependence treatment is happening throughout health care systems. Documentation on smoking status was recommended in the 2008 PHS Clinical Practice Guideline Update. Electronic health records are an important tool to accomplishing this. There are a lot of examples and models across the country of different EHRs. EHR has to be incorporated into workflow of hospital or clinic to improve care and health outcomes. The difficult part is efficiently and effectively building it into workflow. As part of the stimulus funding, $19 billion has been dedicated to EHR as part of the IT health initiative. The website HealthIT.hhs.gov has the most up to date information. A conference for states and national partners will be held at Emory in October. The conference will focus on the changing health care landscape, with presentations on new data and results from states and large health care systems, and how to work at state level and regional levels to incorporate EHR. If you would like more information on the conference, please contact Donna Warner. 7. Increase consumer demand for evidence-based tobacco cessation treatments and services NTCC conducted several consumer demand activities this year: Innovation Toolkit—This project was funded by a small grant from RWJF. NTCC partnered with IDEO to develop it. The toolkit incorporates IDEO’s design principles and lays out their re-design process and provides a step-by-step guide to developing innovative solutions. This was released in December 2009. AJPM Theme Issue—NTCC developed a special supplement to the March issue of the American Journal of Preventive Medicine. This issue contains over 20 empirical studies, commentaries, and conceptual discussions that bring attention to the importance of having a consumer-oriented perspective in tobacco cessation efforts. PDF files of the articles are available on the NTCC website. Translating the PHS Guidelines for Consumers—NTCC developed several versions of a post-card sized “consumer reports” style card that rates various evidence-based and non-evidence based cessation methods. The card will be tested with smokers over the next month. After testing, the card will be finalized and NTCC will work with partners to promote and disseminate. 8. Increase national, state and local longitudinal surveillance of tobacco-use cessation, including quitting motivation and behaviors, treatment beliefs and use, services, and policies Marti Engstrom from CDC Office on Smoking and Health discussed the evaluation work that is part of the Communities Putting Prevention to Work Initiative. All of the states and 44 communities received funds as part of this initiative to reduce risk factors, prevent/delay chronic disease, promote wellness in children and adults, and provide positive, sustainable health change in communities. This initiative also includes an evaluation component. This multi-component evaluation strategy includes community and state level risk factor surveillance, case studies in funded communities and states, cost tracking, and modeling. In terms of quitlines, the evaluation will focus on calls and calls receiving services. States will be required to provide both output and outcome measures. They will have to detail what they have done to increase capacity, such as increasing hours, languages, health care systems, increasing the number of calls answered live, increasing calls from specific population, etc. Outcome measures include total number of calls, number of callers that received a services, those who receive a service that quit, etc. The plan is to build a national quitline data warehouse to house aggregate level data online. 9. Link tobacco control public policy changes to increase cessation and treatment use and demand Ann Boonn from Campaign for Tobacco-Free Kids presented on policy changes. There are 5 types of policy changes to link to increase cessation and treatment use and demand:
One example of linking tax increases to increase in cessation was done in Indiana. The state created resources and conducted outreach to health care providers related to the Federal tax increase. States can also work with media, including Op-Eds and Letters to the Editor, so they can highlight tax increases and encourage people to quit. TFK supports linking smoke-free laws to cessation with the Goingsmokefree.org website. This site has materials and resources for states that want to provide cessation support for those who want to quit. Other recent policy changes that can have an impact cessation and treatment use and demand include the stimulus funding, health care reform and the Prevention Trust Fund. NTCC and partners need to take advantage of this opportunity to link these changes to cessation. Next Steps for NTCC After sharing updates related to each of the priorities, members discussed gaps, key opportunities, and potential activities where NTCC and partners can have a role in the next year to move each of the priorities forward. At the meeting, members suggested:
A survey is currently being conduct to gather additional ideas from members who were not able to attend the meeting. To complete the survey, please visit: http://www.zoomerang.com/Survey/WEB22AHVGZQFNY. If you have any comments, ideas, or suggestions for activities or opportunities, please contact Jessica Rowden. Research HighlightsSmoking May Be in Your GenesFor some people, quitting smoking could be especially difficult because their dependence may be explained in part by genetics, three new studies suggest. One of the reports, part of a trio of findings published online April 25 in Nature Genetics, found three genetic regions that were associated with the number of cigarettes smoked per day. "One region was associated with smoking initiation, and one variant was associated with smoking cessation," said study co-author Helena Furberg, a research assistant professor at the University of North Carolina. "The genetic variants on chromosome 15 that were associated with heavy smoking lie within a region that contains nicotine receptor genes, which other scientists have previously associated with nicotine dependence and lung cancer." The findings came from an analysis of phenotypes of 74,053 people. More research needs to be done before these findings can be translated to the clinic, Furberg said. "At this time, getting tested for these variants will not tell you anything meaningful about your risk of smoking or ability to quit smoking," she said. But in the future, researchers might be able to use these genetic variants to predict the effects of different smoking cessation treatments, she added. "Until this goal is realized, all smokers should be encouraged to quit, regardless of genotype," she said. In the second report, a research team led by Clyde Francks from Oxford University tested the human genome for genes associated with cigarette smoking. Based on an analysis of more than 40,000 people, they found that a group of genes on chromosome 15q25 is associated with the number of cigarettes that people smoke per day. The third study, from researchers in Iceland, also looked through the human genome to find genes associated with the number of cigarettes a person smokes daily. Using data from more than 70,000 smokers, it confirmed that genes on chromosome 15 were linked to tobacco use. The researchers also found two genes, CYP2A6 and CYP2B6, that were involved in nicotine metabolism and two others, CHRNB3 and CHRNA6, that play a role in how the body processes nicotine. Some of these gene regions are also associated with a predisposition to lung cancer, the researchers noted. "Key variants in each region associate with nicotine dependence and lung cancer, bringing up the question of whether the risk for lung cancer is through the effect on smoking behavior or whether it involves increased vulnerability to the harmful effects of smoking as well," the authors wrote.
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Secondhand Smoke Exposure Associated With Chronic Sinus DiseaseIndividuals who are exposed to more secondhand smoke in private and public settings appear more likely to have chronic rhinosinusitis, according to a report in the April issue of Archives of Otolaryngology-Head & Neck Surgery. C. Martin Tammemagi, D.V.M., M.Sc., Ph.D., of Brock University, St. Catharine's, Ontario, Canada, and colleagues studied 306 non-smoking patients diagnosed as having chronic rhinosinusitis (inflammation of the nose or sinuses lasting 12 weeks or longer). Their exposure to secondhand smoke at home, work, in public places and at private social functions during the five years before diagnosis was compared with that of 306 individuals who were the same age, sex and race but did not have rhinosinusitis. Patients with chronic rhinosinusitis were more likely than control patients to have exposure to secondhand smoke at home (13.4 percent vs. 9.1 percent), at work (18.6 percent vs. 6.9 percent), in public places (90.2 percent vs. 84.3 percent) and at private social functions (51.3 percent vs. 27.8 percent). A dose-response relationship was observed, in which individuals who were exposed to secondhand smoke in more of the four venues had an increased risk of chronic rhinosinusitis. Overall, approximately 40 percent of chronic rhinosinusitis cases appeared to be attributable to secondhand smoke. Mechanisms explaining the connection are not certain, but several possibilities exist, the authors note. Secondhand smoke exposure may increase susceptibility to or worsen respiratory infections, inhibit immune responses and increase the permeability of cells lining the respiratory tract. "Even though more evidence is needed to validate the secondhand smoke-chronic rhinosinusitis association, secondhand smoke is already known to cause many other diseases," the authors conclude. "Thus, there is already ample reason for taking action to eliminate exposure to secondhand smoke. The U.S. Surgeon General recommends that physicians routinely ask their patients about secondhand smoke exposure."
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Tobacco in Candy-like Form Can Poison KidsA new generation of smokeless, flavored tobacco products that look like breath mints or breath-freshening strips may be life-threatening for children who mistake them for candy, according to researchers from the Harvard School of Public Health and the Centers for Disease Control and Prevention (CDC). "Nicotine is a poison, and now we're seeing smokeless tobacco products that look like Tic Tacs or M&M's, which parents can leave on the counter and children can be attracted to," says Greg N. Connolly, D.M.D., the director of the Tobacco Control Research Group at the Harvard School of Public Health, in Boston, Massachusetts. Connolly led a research team that found that smokeless tobacco products are the second most common cause of nicotine poisoning in children, after cigarettes. The researchers reviewed data from 61 poison control centers and identified 13,705 cases of tobacco ingestion between 2006 and 2008, the vast majority of which were in infants. Smokeless tobacco was involved in 1,768 of the cases. The new products -- currently being test-marketed in three cities -- include Camel Orbs, which resemble breath mints; Camel Sticks, which are about the size of a toothpick and dissolve in the mouth; and Camel Strips, which are similar to breath-freshening strips. Small, teabag-like "snus" -- pouches filled with tobacco that are placed between the upper lip and gum -- are also a potential hazard, according to the study, which appears in the journal Pediatrics. These products are not smoking cessation aids; rather, they are marketed as a nicotine alternative in places where smoking isn't allowed. Although children in the study were most often poisoned from eating cigarettes and smokeless tobacco products in general, the researchers single out the new, dissolvable products -- especially Camel Orbs -- as a "major concern." Orbs are available in cinnamon and mint flavors and could easily be mistaken for candy, the researchers say. "The candy form can only mean trouble, particularly for children and infants," says Connolly. "And snus are attractive, flavorful, and easily ingested by an infant or child." R.J. Reynolds spokesman David Howard says that the packaging of Camel Orbs and the other dissolvable products is "100 percent child-resistant in accordance with Consumer Product Safety Commission standards" and bears a label that says "Keep Out of Reach of Children." Adults, he adds, should ensure that "children do not have access to any tobacco products -- including dissolvable tobacco products." Still, the researchers say, the pellets could find their way into children's mouths. Nicotine poisoning can cause nausea or vomiting, and severe cases can result in convulsions, respiratory failure, and even death. Just under 0.5 milligrams of nicotine per pound of body weight is the minimum lethal dose for children, according to Connolly. A chemical analysis conducted by Connolly and his colleagues found that Camel Orbs contain an average of 0.83 milligrams of nicotine in each pellet. Some of the nicotine is "un-ionized," which allows for more rapid absorption and may be more toxic than other forms of the drug, they write. "A small pellet with a rapid release of nicotine and a young child with a low body weight can be a very serious problem," Connolly says. "We have to look at high-risk groups who may ingest these thinking that they are candy and be very cautious about dispensing them and not leaving them around." Regulators, he adds, "must ask tough questions about who is at risk from these products, and who we are trying to help with them." "I would feel safer if the FDA...looked at the packaging [of these products] as well as their safety," says Dr. Jonathan P. Winickoff, M.D., an assistant professor of pediatrics at Harvard Medical School. While accidental infant poisonings are certainly cause for concern, purposeful ingestion of smokeless tobacco products by kids and teens may be a larger problem, Winickoff points out. As the study notes, the use of smokeless tobacco products among adolescents increased 6 percent per year from 2002 to 2006. "An adolescent thinks this is harmless because it looks harmless, but they're exposing their brain to nicotine, and there's a chance that they would be primed to develop a nicotine addiction," says Winickoff, who was not involved in the study. "If teens ended up using smokeless product because they are attracted to candy flavors and they end up getting addicted to nicotine, the public health benefit of smokeless tobacco is neutralized." One of the study authors, Terry F. Pechacek, Ph.D., the associate director for science at the CDC's Office on Smoking and Health in Atlanta said that more than half of people who use smokeless tobacco are underage. Products such as Camel Orbs, he says, "look like candy, are more easily concealed, and can be used at school or in front of parents. That raises even greater concerns."
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Smoking Ban in Public Places Reduces Smoke Exposure and Heart AttacksA new study indicates that policies that ban or restrict smoking in public reduce exposure to secondhand smoke and reduces heart attacks. Restriction of smoking area helps non smokers to avoid being exposed to tobacco smoke and the health consequences A review published in the April, 2010 issue of The Cochrane Library states that countries and states that have polices restricting public smoking have less exposure to secondhand smoke. These areas also have a reduction in the number of people who have heart attacks and an improvement in other health indicators. "Taken together, the benefits for workers and the reduction of hospital-related morbidity are impressive," says Professor Cecily Kelleher, School of Public Health, Physiotherapy and Population Science at University College Dublin, Ireland. Countries around the world are introducing polices that restrict where people can some. Policies were implemented largely because of findings that tobacco smoke is the second major cause of death in the world. Smoking is currently responsible for the death of about one in ten adults, according to the World Health Organization (WHO). Smoking is a complex personal and social activity, so researchers stated that there is an ongoing need to monitor the effect of non-smoking legislation to see if it is benefiting people. The recent research indicates that banning smoking does help to prevent health problems, including heart attacks. "The balance of evidence suggests that legislative smoking bans have achieved their primary objective of reducing exposure to secondhand smoke. The impact on active smoking is not yet conclusively demonstrated," says Professor Kelleher in a press release dated April 13, 2010. A team of researchers used data from 50 different studies that followed 50 different situations where smoking bans had been implemented. People often react negatively to any restrictive rules, but researchers found that once the smoking bans were in place people approved of them.
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Smoking Bans May Be Boosting Public HealthSince Toronto banned smoking in public places such as restaurants in 2001, there has a major slide in hospital admissions for cardiovascular and respiratory conditions, Canadian researchers report. The 10-year population study found 39 percent fewer admissions for cardiovascular conditions such as heart attack, angina and stroke, and 33 percent fewer admissions for respiratory problems such as asthma, emphysema, and pneumonia or bronchitis after the ban went into effect. The findings are "consistent with the evidence that exposure to secondhand smoke is detrimental to health and legitimizes legislative efforts to further reduce exposure," wrote Dr. Alisa Naiman, of the Institute for Clinical Evaluative Sciences at the University of Toronto, and colleagues. Further research is needed to determine which types of smoking bans are most effective, they added. The study appears April 12 in the Canadian Medical Association Journal. Tobacco is the leading cause of preventable disease and death worldwide, and secondhand smoke is the third leading cause of preventable health problems and premature death in developed countries.
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American Lung Association Releases Report on Lung Cancer in African AmericansThe American Lung Association released its report, Too Many Cases, Too Many Deaths: Lung Cancer in African Americans, a compilation of research examining lung cancer among African Americans and the need to eliminate this and other health disparities. The report, which includes a preface by William J. Hicks, M.D., provides important information on the possible biological, environmental, political and cultural factors that make African Americans more likely to get lung cancer and more likely to die from it. Lung cancer is the number one cancer killer in the nation. It has been the leading cause of cancer death among men since the early 1950s, and in 1987 it surpassed breast cancer as the leading cause of cancer deaths among women. African Americans, however, suffer from lung cancer more than any other population group in the United States. Key facts regarding this disparity include the following:
While the reasons for this unequal burden are not entirely clear, the Lung Association's report presents a compilation of research that examines smoking behavior, workplace exposures, genetics, access to healthcare, discrimination and social stress, as well as other possible contributors as to why African Americans are disproportionately affected by lung cancer. "The American Lung Association's report provides overwhelming evidence to support the case for a racial difference in the burden of lung cancer," said Dr. Hicks. "The movement to make lung cancer, a disease which was rarely encountered before the 20th century, another example of man's ability to overcome a public health threat is foretold in this effort." The American Lung Association is calling for increased research funding on lung cancer and other health disparities. Enactment and implementation of proven policies to reduce tobacco including curbing cigarette advertising targeting youth, comprehensive smokefree air laws and coverage of tobacco cessation services, are needed. Radon exposure in federal housing must be addressed. Changes to the healthcare system to improve access to care, improve delivery of healthcare to reduce communication barriers between patients and providers, and recruiting more minorities to the healthcare field. Last month, the Food and Drug Administration's (FDA) Tobacco Products Scientific Advisory Committee met to review the science relating to the issue of menthol in cigarettes and its impact on public health. The Committee's report and recommendations are due in March of 2011. FDA is also required to develop an action plan with stakeholders to enforce restrictions on the promotion and advertising of menthol and other cigarettes to youth. The Lung Association eagerly awaits both sets of recommendations. The Too Many Cases, Too Many Deaths: Lung Cancer in African Americans report is the American Lung Association's first in a series taking an in-depth look at specific lung health disparities in specific populations. This report builds on the American Lung Association's long-standing commitment to saving lives and improving lung health for all Americans. For a compendium of information about lung disease in various populations, see the recently released State of Lung Disease in Diverse Communities: 2010, available at www.LungUSA.org.
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New Report Finds More Smokers Calling Telephone Quitlines But State Budget Cuts Put Progress at RiskRecord numbers of U.S. smokers are turning to telephone quitlines for help in breaking their addiction, but access to this critical service is being put at risk by state budget cuts, according to a report released by the North American Quitline Consortium and other public health organizations. The number of tobacco users calling quitlines—a telephone helpline where smokers can turn for trusted, reliable help when they want to quit—increased 116 percent between 2005 and 2009, according to the report. Despite this increase in demand, total funding for all U.S. quitlines decreased for the first time ever in Fiscal Year (FY) 2010. The full report, U.S. Quitlines at a Crossroads: Utilization, Budget, and Service Trends 2005-2010, is available at: www.naquitline.org/report. This report was produced with funding from the Robert Wood Johnson Foundation. Funding has been cut despite the fact that states will collect $25.1 billion in revenue this year from tobacco taxes and legal settlements with the tobacco industry, and more states have already enacted or are considering tobacco tax increases this year. These increases will motivate more smokers to try to quit and provide additional revenue that states can use to fund quitlines and other tobacco prevention and cessation programs. "At a time when demand for quitlines is at a record level, it is more important than ever to support proven tobacco cessation efforts,” said Linda Bailey, president and chief executive officer of the North American Quitline Consortium (NAQC). "The investment of $2.19 per capita for quitlines, as recommended by the Centers for Disease Control and Prevention, is based on sound science and real-world experience. States that made the necessary investments have been able to provide cessation services to the growing number of smokers who want to quit. We commend the states that have committed the necessary funding to quitline services and encourage them to continue this practice." In late 2009, all publicly-funded quitlines in the U.S. were asked to complete a survey to assess their financial and service capacity. The NAQC-administered survey included questions related to: quitline budgets; changes in budgets over time and their impact; funding sources; promotion and utilization of quitline services; and capacity to provide services to tobacco users. The report shows that while quitlines have made tremendous progress in financial and service capacity, this progress is being put at risk by a seven percent decrease in total funding for all U.S. quitlines in FY 2010. While federal and state economic conditions are difficult, the resources do exist to fully fund quitlines and comprehensive tobacco control programs consistent with the best practices recommended by the Centers for Disease Control and Prevention (CDC). According to a recent report on how states are spending the money collected each year from the Master Settlement Agreement and other tobacco tax revenues, in "Fiscal Year 2010, the states will collect $25.1 billion from the tobacco settlement and tobacco taxes. They will spend just 2.3 percent of it—$567.5 million—on tobacco prevention and cessation programs.” Funding can also be raised through a dedicated tax on tobacco products. The report found that for FY 2009 to FY 2010: 27 states reported quitline funding reductions; 20 experienced reductions in service budgets; 19 states cut back spending on medications; and 25 reduced funding for promotions. While 20 states reported funding increases for quitlines, further analysis found 12 of these states experienced reductions to their overall tobacco control program budgets. State quitline budgets have continued to decline since this data was collected. As states enact tobacco tax increases this fiscal year to address ongoing budget shortfalls, smokers will undoubtedly turn to quitlines for help. But the services they need may not be available. With reduced funding comes longer hold times for smokers when they call, fewer follow up calls from counselors, and less medication assistance, such as the patch, gum, or lozenge.
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Other Cessation NewsOnline Resource Designed to Make a Smooth Transition after New Smoke Free Law Goes into EffectHealth advocates have launched a new website to help businesses prepare for Wisconsin’s smoke-free workplace law. The online resource, www.wibettersmokefree.com, went up on April 16. It offers signs, employee handouts and quit-smoking resources to help employers plan for the law’s implementation on July 5. “We want to get the word out on this valuable tool,” said Dot Kalmon, Central Wisconsin Tobacco Free Coalition coordinator. “The resources available at the site can help businesses ensure a smooth transition once the law goes into effect.” More resources will be added to the site as July 5 draws nearer. The site also features videos, a map of recently smoke-free establishments, secondhand smoke information and other materials.
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Washington State Cigarette Tax Increase Delivers Victory for Kids and TaxpayersGovernor Christine Gregoire and the Washington Legislature 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 $3.025 per pack. The tobacco tax increase is a win-win-win solution for Washington — a health win that will reduce tobacco use and save lives, a financial win that will help to balance the state budget and fund essential programs, and a political win that polls show is popular with the voters. We applaud Governor Gregoire for proposing the tobacco tax increase and the Legislature for enacting it into law. It is good news for Washington's health that the state is also increasing taxes on other tobacco products. This action will discourage use of all tobacco products, while raising additional revenue for the state. It is disappointing, however, that Washington's leaders failed to allocate any of the new tobacco tax revenue to restore funding for the state's highly successful tobacco prevention and cessation program, which had its funding cut by $11.4 million (42 percent) in the past year. Instead, the budget for the coming year would further cut funding for the program by $2.6 million. This will further erode Washington's efforts to prevent kids from smoking and help smokers quit, at the same time that smokers are more likely to seek help quitting as a result of the cigarette tax increase. Since tobacco taxes are being used to fill Washington's budget gap, it is only fair to Washington's current and potential tobacco users that the state at least maintain its tobacco prevention and cessation efforts. To continue making progress in reducing tobacco use, it is imperative that Washington's leaders seize the earliest possible opportunity to restore funding for these programs. 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 about 6.5 percent and overall cigarette consumption by about 4 percent. Washington can expect the $1 cigarette tax increase to prevent 38,400 Washington kids from becoming smokers; spur 19,200 smokers to quit; save more than 17,300 Washington residents from smoking-caused deaths; lock in $854 million in future health care savings; and raise about $80.7 million a year in new state revenue. Tobacco use is the leading preventable cause of death and disease in Washington, claiming 7,600 lives each year and costing the state $1.95 billion annually in health care bills. While Washington has made significant progress in reducing youth smoking, 14.4 percent of Washington high school students smoke, and 27,000 kids try cigarettes for the first time each year. With Washington's increase, the average state cigarette tax will be $1.40 per pack. Washington is the third state to increase its cigarette tax this year, joining Utah ($1 increase) and New Mexico (75-cent increase). We call on states across the nation to significantly increase the tobacco tax to reduce tobacco use and its devastating health and financial toll, as well as raise much-needed revenue to help close budget shortfalls.
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Smoking to be Banned on Navy SubmarinesThe Navy announced that a smoking ban will go into effect on submarines no later than Dec. 31. Vice Adm. John J. Donnelly, commander of Submarine Forces in Norfolk, Va., said in a press release that the decision was reached to protect non-smoking sailors from secondhand smoke. "Recent testing has proven that, despite our atmosphere purification technology, there are unacceptable levels of secondhand smoke in the atmosphere of a submerged submarine," Donnelly said. "The only way to eliminate risk to our non-smoking Sailors is to stop smoking aboard our submarines." The Naval Submarine Medical Research Laboratory undertook a year-long study in 2009 of the effect of secondhand smoke on U.S. submarines. It observed nine different submarines - at least one from each class - and found that non-smoking sailors were exposed to "measurable levels" of secondhand smoke, according to the press release. Lt. Cmdr. Mark Jones, spokesman for submarine forces, said its up to individual submarine commanders whether they turn out the smoking lamp before Dec. 31. Chewing tobacco will continue to be permitted, but it is highly discouraged. "It poses no secondhand threat to non-chewers," Jones said. Electric cigarettes, which haven’t been approved by the Federal Drug Administration, aren’t authorized. The Navy will offer help sailors quit by providing education, nicotine patches and nicotine gum.
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Smoke Tax Could Pay for Prevention ProgramsIf states continue to increase taxes on cigarettes and use the new revenue for smoking cessation programs, smoking rates could be drastically reduced, a new CDC report found. Public health officials already have learned that increasing excise taxes on cigarettes -- at the federal, state, or local level -- has the potential to substantially reduce smoking and discourage young people from starting, the agency's researchers noted. A 10 percent increase in the price of cigarettes can reduce consumption by nearly 4 percent among adults, according to a new analysis in the April 9 issue of CDC's Morbidity and Mortality Weekly Report. The report noted that states have been raising cigarette taxes over the last decade, largely to avoid budget shortfalls. On April 1, 2009, the federal cigarette excise tax increased to $1.01 per pack, from $.39 per pack. To examine 2009 state trends, MMWR researchers reviewed legislative data from the CDC to identify 2009 cigarette taxes in each of the 50 states and the District of Columbia. During that period, 15 states, including the District of Columbia, enacted extra taxes on cigarettes, boosting the national mean cigarette tax from $1.18 in 2008, to $1.34 per pack in 2009. Two states -- Connecticut and Rhode Island -- have excise taxes of at least $3.00 per pack, and Hawaii enacted legislation that would incrementally increase the cigarette tax so it hits $3.00 in 2011. Meanwhile, South Carolina -- a major tobacco-growing state -- had the lowest tax, at just $.07 per pack, which has stayed steady since 1977. South Carolina joins California, Missouri, and North Dakota as the only states that haven't raised their state cigarette excise taxes in the past decade. None of the states dedicated any of the new revenue to tobacco control efforts. The study authors recommend that states continue to raise cigarette taxes. If every state were to tack on an extra dollar of tax, the authors estimated, an additional $9 billion would be generated each year in the U.S., even after accounting for the smokers who would quit or cut back in response to the higher price. Money aside, about 1 million premature smoking-related deaths would be prevented and more than 2 million youngsters wouldn't start smoking, the MMWR researchers said. "Additional increases in cigarette excise taxes and dedication of all resulting revenues to tobacco control and prevention programs at levels recommended by CDC, could result in further reductions in smoking and associated morbidity and mortality," the study authors wrote. While excise taxes are effective, cigarette manufacturers are using discounts and coupons to counter the price increases, researchers noted. In a second analysis in the same issue of the MMWR, researchers found that tobacco companies channeled 74 percent of their $12.5 billion marketing and promotion budgets to reducing the retail price of cigarettes in 2009. Many states already have laws setting minimum retail prices for tobacco products. Ironically, those laws were enacted during the 1940s and 1950s to protect tobacco retailers from predatory business practices. But now they also prevent cigarette manufacturers from discounting products to the point where excise taxes no longer deter smokers. CDC researchers determined that 25 states had minimum price laws for cigarettes in 2009, and they required a median retail markup of 8 percent. Seven of the 25 states prohibit tobacco company discounts from being taken into account when determining the minimum price at which a pack of cigarettes can be sold. While these laws have the potential to increase the consumer price for a pack of cigarettes in states with low cigarette excise taxes, only one of the 10 states with the lowest excise taxes -- Louisiana -- has a minimum price law. Meanwhile, of the 10 states with the highest excise taxes, eight have minimum price laws as well (Hawaii and Vermont do not). The authors conclude that state tobacco control programs can partner with tax agencies to explore how cigarette minimum price laws are enforced and how tobacco manufacturers might be exploiting the system to drive down cigarette prices. Additional laws might be necessary to ban all retail promotions such as coupons or two-for-one offers that can decrease the price of cigarettes and make smoking more appealing, the authors said.
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President Obama Delivers Victory for Kids and Taxpayers by Signing Legislation Curbing Internet Tobacco SalesPresident Obama continued his strong leadership in the fight against tobacco use when he signed the Prevent All Cigarette Trafficking Act (PACT), which will curb tax evasion and curtail the growing sales of low-cost cigarettes and other tobacco products over the Internet and through the mail. Enactment of this legislation is a milestone in the fight to keep kids from smoking and prevent tax evasion that costs taxpayers billions each year. Internet sales of tobacco products are a serious and growing problem that illegally keeps prices down and smoking levels up. Such sales also make it easier and cheaper for kids to buy cigarettes and facilitate tax evasion. Many vendors that sell cigarettes and smokeless tobacco products over the Internet or through other mail-order sales do not pay applicable tobacco taxes and do not have sufficient safeguards to prevent sales to children, such as effective policies to verify a purchaser's age. Both houses of Congress approved the legislation with wide, bipartisan support earlier this month. We applaud Rep. Anthony Weiner (D-NY), the chief House sponsor, and Sen. Herb Kohl (D-WI), the Senate sponsor, for their leadership and persistence in pursuing this legislation and winning its approval. We thank President Obama for continuing to display strong and consistent leadership in the fight against tobacco use, the leading preventable cause of death in the United States. The President has also signed legislation increasing the federal cigarette tax to fund expansion of children's health insurance and the landmark law giving the U.S. Food and Drug Administration authority to regulate tobacco products and marketing. The Family Smoking Prevention and Tobacco Control Act of 2009 already has led to restrictions on tobacco marketing and sales to kids. The newly enacted PACT Act will:
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Reaching Smokers as Consumers: NTCC Highlighted in RWJF PodcastWhat if proven, effective smoking cessations methods were widely available, but the majority of smokers never tried them out? That’s the reality that key tobacco cessation experts have confronted in the last few years. According to the Centers for Disease Control and Prevention, there are 43.4 million smokers in the U.S., of which 70 percent say they want to quit and 40 percent say they make at least one serious quit attempt each year. But data from the U.S. Department of Health and Human Services finds that most smokers who try to quit don’t use proven treatments that could double or triple their chance at successfully quitting tobacco. “Reaching more smokers, and especially the most underserved, with effective treatments represents an enormous untapped opportunity for reducing the nation’s adult tobacco use—the single greatest cause of preventable death and disease, and a major source of health care burden and disparities,” said C. Tracy Orleans, Ph.D., senior scientist for the Robert Wood Johnson Foundation. Reaching these smokers was the goal behind the National Tobacco Cessation Collaborative (NTCC). The NTCC, formed in 2005, is supported by the leading funders of tobacco control advocacy and research in the U.S., including the American Cancer Society, the Legacy Foundation, the CDC, National Cancer Institute, the National Institute on Drug Abuse and the Robert Wood Johnson Foundation. The U.S. Department of Health and Human Services has found that most smokers who try to quit don’t use proven treatments that could double or triple their chance at success. To address this problem, the National Tobacco Cessation Collaborative (NTCC)’s Consumer Demand Roundtable has identified innovative strategies to substantially increase the demand for, and use of, evidence-based products and services to help people quit smoking. The NTCC is supported by the leading funders of tobacco control advocacy and research in the U.S., including the American Cancer Society, the Legacy Foundation, the Centers for Disease Control and Prevention, National Cancer Institute, the National Institute on Drug Abuse and the Robert Wood Johnson Foundation (RWJF). The NTCC and its consumer-demand initiative are managed by the Academy for Educational Development (AED) in Washington, D.C. “Our focus was on all smokers, but particularly on underserved low-income and racial/ethnic populations where tobacco use is highest and treatment use is lowest,” says Todd Phillips, M.P.A., of the AED. Tobacco control experts say opportunities to help smokers quit have been enhanced by the 2009 law authorizing the Food and Drug Administration to regulate tobacco products and their marketing. “The law gives us an unprecedented opportunity to integrate public health and clinical approaches, and unleash the previously untapped potential to apply a consumer perspective and a comprehensive systems integrative strategy to increase treatment use and decrease tobacco use,” says David Abrams, Ph.D., executive director of the Steven A. Schroeder Institute for Tobacco Research and Policy Studies at the Legacy Foundation, and professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. Abrams is also a Roundtable member. Six key strategies to boost consumer demand are described in the Roundtable’s report : “Innovations in Building Consumer Demand for Tobacco Cessation Products and Services." At the request of the Roundtable, IDEO, the nation’s leading innovative product design firm, developed principles for the Roundtable for designing new quit smoking products and services for wide appeal and reach. Those principles are summarized in “Consumer Demand Design Principles” and highlighted in a video with IDEO’s Peter Coughlan. (To view, click his image on right.) A podcast with Tracy Orleans explores how a consumer approach could vastly increase interest in tobacco cessation products and services. Additional products and results of the NTCC Consumer Demand Initiative include: My QuitLine, the first evidence-based iPhone quit-smoking application linking quitters directly to the National Cancer Institute quitline; “policy playbooks” from the Campaign for Tobacco-Free Kids and North American Quitline Consortium to help state and local health departments better capitalize on the demand for state quitline services; and “Increasing Tobacco Cessation in America: A Consumer Demand Perspective,” a March 2010 supplement to the American Journal of Preventive Medicine, co-edited by Roundtable members, Tracy Orleans, David Abrams, and Patricia L. Mabry, Ph.D., senior advisor in the Office of Behavioral and Social Sciences Research at the National Institutes of Health.
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