April 2011

Spotlight

Nationwide Smoke-Free Laws by 2020

Findings from a recent review conducted by the Centers for Disease Control and Prevention (CDC) revealed that half of U.S. states have enacted smoking bans in indoor areas of worksites, restaurants, and bars over the last ten years. Using data collected from December 31, 2000 to December 31, 2010, the numbers confirm the nation’s considerable progress in passing laws to protect nonsmokers from the negative health consequences of secondhand smoke exposure. Unfortunately, regional disparities remain in policy adoption. Southern states have been resistant to ban smoking statewide, with only three southern states enforcing laws that prohibit smoking in any two of the three venues.

Using the CDCs State Tobacco Activity Tracking and Evaluation System database, investigators focused on laws that prohibit smoking specifically in private-sector worksites, restaurants, and bars, as these three venues are major sources of secondhand smoke for nonsmoking employees and the public. The researchers found that:

• 25 states and the District of Columbia have enacted comprehensive smoke-free laws in workplaces, restaurants and bars. The move began with Delaware in 2002, New York in 2003, Massachusetts in 2004, and Rhode Island and Washington in 2005. In 2006 and 2007, Arizona, Colorado, D.C., Hawaii, New Jersey, Minnesota, New Mexico and Ohio enacted laws; Illinois, Iowa, Kansas, Maryland, Maine, Michigan, Montana, Nebraska, Oregon, South Dakota, Utah, Vermont and Wisconsin acted in 2008- 2010.
• Ten states have laws that ban smoking in at least one or two of the three venues.
• Eight states have less-restrictive smoking laws, which allow smoking in designated areas or in areas with separate ventilation.
• Seven states still have no smoking restrictions for any of the three venues, leaving 88 million nonsmokers in the United States exposed to secondhand smoke. These states include: Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia and Wyoming.

"Eliminating smoking from worksites, restaurants and bars is a low-cost, high-impact strategy that will protect nonsmokers and allow them to live healthier, longer, more productive lives while lowering health care costs associated with secondhand smoke," CDC director Dr. Thomas R. Frieden said in an agency news release. "While there has been a lot of progress over the past decade, far too many Americans continue to be exposed to secondhand smoke at their workplaces, increasing their risk of cancer and heart attacks."

A Healthy People 2020 objective (TU-13) calls for the rest of the nation to enact laws to protect nonsmokers in the United States. With secondhand smoke responsible for 46,000 heart disease deaths and 3,400 lung cancer deaths among nonsmokers each year, smoke-free laws would greatly reduce the rate of mortality among nonsmokers. Eliminating smoking in worksites, restaurants, and bars would also substantially improve indoor air quality, help smokers quit, change social norms regarding the acceptability of smoking, and reduce heart attack and asthma hospitalizations.

To find the full report in the April 22 issue of the CDC's Morbidity and Mortality Weekly Report click here.

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Research Highlights

Evidence Ties Smoking to Throat, Stomach Cancer

Smokers face an increased risk of certain types of throat and stomach cancers, even years after they quit, a new study finds.

Combining the results of 33 past studies, Italian researchers found that current smokers were more than twice as likely as nonsmokers to develop cancer, either in their esophagus or in a part of the stomach called the gastric cardia.

In some of the studies, the risk of esophagus cancer remained high even when people had quit smoking three decades earlier.

The two cancers, both known as adenocarcinomas, are relatively uncommon in Western countries. Rates elsewhere are much higher, especially in less developed countries. But in recent decades, rates of the cancers have been rising in the U.S. and Europe, possibly related to growing rates of obesity.

Smoking has long been considered a risk factor for the two cancers.

But these latest findings offer a "better quantification" of the risks, said senior researcher Dr. Eva Negri, of the "Mario Negri" Institute of Pharmacological Research in Milan.

What's more, they suggest that the risks remain higher than average for some time after smokers quit.

"Stopping smoking is highly beneficial at any age, but it appears that for these cancers the risk decreases only slowly," Negri told Reuters Health in an email.

For their study, published in the journal Epidemiology, Negri and her colleagues pooled the results of 33 previous studies. In most of them, researchers had compared a relatively small group of patients with either esophagus or gastric cardia tumors against a cancer-free group. In three studies, researchers had followed large groups of adults over time, charting any new cases of esophageal or gastric cardia cancers.

Overall, Negri's team found, current smokers had more than double the odds of developing either of the cancers, compared to people who had never smoked.

And while that risk declined after people stopped smoking, it was still 62 percent higher in former smokers than in lifelong non-smokers. In some studies, the extra risk of esophagus cancer persisted up to 30 years after people had quit.

Since both esophageal and gastric cardia adenocarcinomas are fairly uncommon in the West, the absolute risks to any one smoker may be low.

According to the American Cancer Society, the average American has a one in 200 chance of developing any type of esophageal cancer over a lifetime, and a one in 114 risk of developing some form of stomach cancer.

By comparison, the odds of developing lung cancer are about one in 13 for men, and one in 16 for women, counting both smokers and non-smokers. Smokers would be at much greater risk than lifelong non-smokers.

Lung cancer, heart disease, and other ills are "numerically more important" than esophageal and gastric cardia cancers when it comes to the health consequences of smoking, Negri noted.

The types of studies that were available for her team to analyze can't prove that smoking causes adenocarcinoma of the esophagus or gastric cardia. To do that, researchers would have to purposely expose some people to years of tobacco smoke and see what happens to them over time - and ethical reasons make a study like that impossible.

Still, Negri and her colleagues say, the risks seen in the current study offer smokers one more reason to quit, and non-smokers one more reason to never start.

For more information, see web link:
Fox News March 30, 2011

Secondhand Smoke Isn't Just Bad for Kids' Bodies, It's Bad for Their Brains

Children and teens exposed to secondhand smoke are more likely to develop symptoms for a variety of mental health problems, including major depressive disorder, attention-deficit/hyperactivity disorder and others, according to a study published in the journal Archives of Pediatrics and Adolescent Medicine.

At this point, it should come as no surprise to anyone that exposure to tobacco smoke is unhealthy. Plenty of studies have linked secondhand smoke to respiratory problems, asthma, sudden infant death syndrome, middle ear infections, and other physical health problems. But the link between secondhand smoke and mental health has not been examined as closely.

The new study is believed to be the first that looks at how secondhand smoke exposure – as measured by the presence of a nicotine metabolite in the blood – is associated with mental health in a nationally representative sample of American kids and teens.

Researchers from the National Institutes of Health, the University of Miami and Legacy, the nonprofit that fights tobacco use, used data on 2,901 youths who were between the ages of 8 and 15 when they were part of the National Health and Nutrition Examination Survey from 2001 to 2004. As part of the study, the kids were asked to provide blood samples; those who were exposed to secondhand smoke had higher levels of the cotinine, which is produced as the body metabolizes nicotine. The kids were also assessed for a variety of mental health disorders as defined by the National Institute of Mental Health’s Diagnostic Interview Schedule for Children Version IV.

Here’s what the researchers found: On average, the kids had almost five symptoms of major depressive disorder, almost four symptoms of ADHD, almost three symptoms of generalized anxiety disorder, and more than one symptom of conduct disorder.

After taking into consideration the kids’ health history and other factors, the researchers determined that levels of cotinine in the blood were strongly correlated with ADHD symptoms and weakly linked with symptoms of major depressive disorder, conduct disorder and generalized anxiety disorder. Overall, the links between cotinine and psychiatric symptoms were greater for boys than for girls, and for whites compared to blacks and Mexican Americans.

But none of those symptoms added up to a single diagnosis of a mental health disorder that could be linked with exposure to secondhand smoke in the children and teens in the study. At first, it looked like higher cotinine levels might be associated with a higher risk of ADHD. But upon further analysis, it turned out that the increased ADHD risk was actually due to smoking by mothers during pregnancy.

Still, the authors make the undeniable point that there’s no upside to secondhand smoke for kids, teens – or anyone else:

“Efforts to ban smoking in public places where children and adolescents are present, including all child care settings and schools, should continue, as well as increased efforts to develop interventions targeted directly at parents and designed to prevent [secondhand smoke] exposure in the homes of children and adolescents.”

The study is available online here.

For more information, see web link:
Los Angeles Times April 5, 2011

Taming the Smoker's Brain: A Better Way to Quit?

Any American who has bought a pack of cigarettes since the mid-'60s might have seen the health warnings. One of the first, quaint and timid, said, “Cigarette Smoking May Be Hazardous to Your Health.” By comparison, last year I bought a scary pack of Lucky Strikes that I keep in the freezer for Don Draper-esque emergencies. It says, “SURGEON GENERAL'S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.”

Such government warnings work, sort of — research has shown that smokers in countries with strong warnings are more knowledgeable about smoking risks than those in countries where warnings are weaker. But it's unclear whether smokers who see any warning actually smoke less.

Public-health advocates have known for years that individualized messages are far more effective at getting smokers to stop. For instance, if a doctor reminds a patient that her sister has promised to help her quit, that patient will be much more likely to stop smoking than someone who just sees a general message on a cigarette pack.

It's obvious that such a personalized message would be more psychologically effective — you think fondly of your sister's willingness to help, so you decide not to light up. But now there is evidence that individualized advice can also be physiologically effective — that it can actually change your neural pathways.

A recent study published in the journal Nature Neuroscience shows that tailored antismoking messages engage brain regions involved in how people see themselves. Those regions are the medial prefrontal cortex, which is associated with emotion regulation, and the posterior cingulate region, which is associated with basic human awareness and, possibly, awareness of others' perceptions of us.

The authors of the study, a University of Michigan team led by psychologist Hannah Faye Chua, recruited 91 smokers who wanted to quit. The participants, who smoked an average of 17 cigarettes per day, underwent fMRI scanning for one hour while different messages appeared on a screen. Some messages were tailored to their personal histories (for example, “A concern you have is being tempted to smoke when around other smokers”). Some messages were general antismoking appeals (“Smokers are admitted to the hospital more often than nonsmokers”). And then there was a control group of completely unrelated messages (“Wind is simple air in motion”).

The researchers found that the tailored messages activated the two brain regions significantly more than the non-tailored and neutral messages. In other words, reading a short sentence changed their brain activity — and those who showed stronger activity in those regions were more likely to quit smoking in the following four months.

The reason this paper is important is that it contributes to a growing body of research showing that what is often derided as “talk therapy” can produce real changes in brain function. For instance, a 2006 Molecular Psychiatry paper found that cognitive-behavioral therapy (CBT) quieted the right caudate nucleus in patients with obsessive-compulsive disorder. That nucleus is involved in how we learn behavior. If a patient indulges his compulsions — in effect, learning them over and over — the nucleus becomes more active. Changing behavior through psychotherapy can dial down that nucleus.

Of course, psychiatric drugs also change brain activity, but many studies have found that such drugs are no more effective than evidence-based psychotherapies like CBT. In other words, if you really want to quit smoking, you should commit to a rigorous behavioral-therapy program. It will not only help you stop; it could change how your brain works.

For more information, see web link:
TIME April 14, 2011

Study Finds Thirdhand Smoke Poses Danger to Unborn Babies' Lungs

Stepping outside to smoke a cigarette may not be enough to protect the lungs and life of a pregnant woman's unborn child, according to a new study in the American Journal of Physiology.

The study, by researchers at the Los Angeles Biomedical Research Institute (LA BioMed), found prenatal exposure to toxic components of a newly recognized category of tobacco smoke--known as thirdhand smoke--can have as serious or an even more negative impact on an infants' lung development as postnatal or childhood exposure to smoke.

Thirdhand smoke is the newly formed toxins from tobacco smoke that remain on furniture, in cars, on clothing, and on other surfaces--long after smokers have finished their cigarettes. "Thirdhand smoke is a stealth toxin because it lingers on the surfaces in the homes, hotel rooms, casinos and cars used by smokers where children, the elderly and other vulnerable people may be exposed to the toxicants without realizing the dangers," said Virender Rehan, MD, a principal investigator at LA BioMed and corresponding author of the study. "Pregnant women should avoid homes and other places where thirdhand smoke is likely to be found to protect their unborn children against the potential damage these toxins can cause to the developing infants' lungs.

Dr. Rehan, a National Institutes of Health-funded investigator who has been researching the effects of smoking on lung development for more than a decade, said this is the first study to show the exposure to the constituents of thirdhand smoke is as damaging and, in some cases, more damaging than secondhand smoke or firsthand smoke.

"We looked at the mechanisms that drive normal lung development and found those mechanisms were clearly disrupted by thirdhand smoke," he said. "Based on this, we can conclude that prenatal disruption of lung development can lead to asthma and other respiratory ailments that can last a lifetime."

Thirdhand smoke is aged secondhand smoke, and it attaches to the surfaces in homes and other surroundings. It is composed of smaller, ultrafine particles with a greater molecular weight that pose a greater asthma hazard than firsthand or secondhand smoke. Although concerns about the dangers from thirdhand smoke have been raised recently, this new study is the first to provide biological data to support these concerns.

Dr. Rehan said touching surfaces contaminated with thirdhand smoke, as well as ingesting dust containing the superfine particles of thirdhand smoke, are the most likely major pathways for exposure to these toxins.

"Children and pregnant mothers in busy households are especially susceptible to thirdhand smoke exposure because they could touch or breathe in the toxic substances from contaminated surfaces," he said. "Among infants, it has been found that the rate of ingesting dust is more than twice that of adults, making babies especially vulnerable to the effects of thirdhand smoke."

He also noted that nicotine levels are six times lower among infants living in homes with strict no-smoking policies.

"The dangers of thirdhand smoke span the globe because smoking is more prevalent in many other countries than it is in the United States," he said. "While further study is needed, the alarming data clearly highlight the potential risks and long-term consequences of thirdhand smoke exposure."

While previous studies had documented the danger of nicotine in thirdhand smoke, this new study measured the effect of two other toxins in thirdhand smoke-1-(N-methyl-N-nitrosamino)-1-(3-pyridinyl)-4-butanal (NNA) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). The researchers found prenatal exposure to thirdhand tobacco smoke components plays a much greater role in altered lung function in offspring than postnatal or childhood exposures.

The study was published online and is scheduled for publication in an upcoming special edition of the American Journal of Physiology on the effects of smoking. The study was funded by the National Institutes of Health (Grant Nos. HL75405, HD51857, HD058948 and HL55268) and the Tobacco-Related Disease Research Program (Grant Nos. 14RT-0073, 15IT-0250 and 17RT-0170.)

For more information, see web link:
Medical News Today April 19, 2011

Starting Chantix Earlier May Help Smokers Quit

The smoking-cessation drug Chantix may work better if people take it several weeks before trying to quit, a new study has found.

Chantix, or varenicline, appears to soothe withdrawal symptoms related to quitting while reducing the urge to smoke. People usually take the drug beginning one week before their targeted "quit date." In the new study, however, researchers in England gave the medication to 53 people beginning four weeks before their quit date and throughout the remainder of the three-month cessation period. That group was compared with people who were given three weeks of a placebo pill followed by one week of Chantix before their quit day and for the remainder of the study. The participants, who entered the study because they wanted to quit smoking, didn't know if they were receiving the standard one week of Chantix or four weeks of the medication in the period before the quit date.

Researchers found that those who started Chantix for a month before the quit date were more likely to be abstinent at the three-month mark: 47.2 percent were abstinent compared with 20.8 percent of the people in the placebo group. People taking Chantix who reduced smoking in the period prior to their quit date were more likely to be nonsmokers at 12 weeks. There were no unusual side effects associated with starting Chantix four weeks before quitting.

The study, while preliminary, raises some interesting questions. Although more research is needed, it could be that the current recommendations for how to use Chantix could be changed to increase the odds of success, such as having a longer "pre-loading" Chantix period, the authors said. A weakness of the study is that it followed the participants for only three months so the long-term success of these participants is unknown.

In addition, Chantix may be useful to help reduce the number of cigarettes people smoke even if they don't quit smoking -- a tactic called harm reduction. "Although various harm reduction approaches remain controversial, there is increasing acceptance among health professionals and government bodies that for some "hard-core" smokers, harm reduction is an option that merits serious consideration," the authors wrote.

The study was published in the Archives of Internal Medicine.

For more information, see web link:
Los Angeles Times April 25, 2011

Helping Young Smokers Quit: Identifying Best Practices for Tobacco Cessation

In 2000, there were at least 4 million smokers under age 18, according to the National Blueprint for Action: Youth and Young Adult Tobacco-Use Cessation, a consensus document produced by the Youth Tobacco Cessation Collaborative. Another 3,000 adolescents became regular tobacco users each day. At this rate, 5 million young people alive in 2000 would die prematurely of diseases related to tobacco use.

Research has found that many young people who smoke want to quit. Data from the RWJF-funded 2000 National Youth Tobacco Survey indicated that 55 percent of middle school and 61 percent of high school smokers wanted to stop smoking. Some 59 percent of high school smokers said they had seriously tried to quit at least once during the prior 12 months.

Despite many young smokers wanting to quit, little has been known about what strategies or programs would work best for them, according to researchers at the University of Illinois at Chicago School of Public Health. Most evaluations of youth cessation programs were tightly controlled studies in which interventions were evaluated under optimal delivery conditions. Less was known about the effectiveness of programs delivered in real-world settings.

Helping Young Smokers Quit: Identifying Best Practices for Tobacco Cessation ran from 2001 through 2009. Researchers at the University of Illinois at Chicago School of Public Health located and created an inventory of 756 tobacco-cessation programs for people ages 12 to 24 and surveyed 591 of those programs regarding their content, format, sponsoring organization and characteristics of people served. They evaluated 41 smoking-cessation programs serving youth ages 14 to 18 to identify factors associated with recruitment, retention, and quit rates and identified and described programs that were sustained over time and those that were discontinued.

"Through Helping Young Smokers Quit, we demonstrated the feasibility of evaluating existing programs outside of a tightly structured randomized controlled trial," said the program directors, Susan J. Curry, Ph.D., and Robin J. Mermelstein, Ph.D. "We developed a uniform, replicable process for finding and evaluating programs. We believe that this methodology could be used to identify and evaluate other real-world programs, such as weight control programs, as well."

Researchers from the evaluation found:

• Surveyed programs displayed considerable homogeneity. Most were multi-session, school-based group programs that served a modest number of youths per year. Program content included the same cognitive-behavioral elements found in evidenced-based adult programs, along with content more specific to adolescence.
• Community-based, "real world," teen smoking-cessation programs that use evidence-based curricula and have written training manuals have outcomes equivalent to outcomes found in more tightly controlled, "laboratory-type," studies.
• By the end of the 41 evaluated programs, 76 percent of participating youth had tried to quit smoking and 14 percent had been abstinent for seven days.

To find the full report by RWJF click here.

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Other Cessation News

Medicaid to Reward Recipients for Healthy Habits

A federal grant program authorized in the health overhaul law is offering states $100 million to reward Medicaid recipients who make an effort to quit smoking or keep their weight, blood pressure, or cholesterol levels in check.

The grant program is meant to encourage states, many of which are under pressure to cut Medicaid costs, to experiment with an uncertain approach to wellness: offering incentives for healthy behavior.

"Medicaid is almost the sweet spot for financial rewards," said George Loewenstein, a behavioral economist at Carnegie Mellon University who has studied the effect of financial incentives on behavior. Medicaid recipients, he explains, are economically disadvantaged and have more to gain from incentives.

Loewenstein, however, is dubious about whether incentives, especially those tied to weight loss, could really work. He's not alone.

Behavioral incentive programs have shown some promise in specific settings, but they are largely untested in the Medicaid population.

The federal dollars for Medicaid incentives reflect a sharpening emphasis on the role of preventive health in targeting the underlying causes of chronic disease, a central pillar of the Obama administration's health care agenda. States have until May 2 to submit their final proposals to the Centers for Medicare & Medicaid Services for funding, and a number have indicated an interest.

And while states have some flexibility about how they design their incentives, federal guidelines provide a basic profile. Medicaid enrollees who demonstrate a commitment to improving their health will be eligible to receive financial rewards such as coupons or gift certificates. For those who are overweight or trying to quit smoking, that commitment might take the form of weight management classes or tobacco cessation counseling. States are encouraged to provide rewards "on a tiered basis" for attempts at participation, "actual behavior change," and "achievement of health goals."

Chronic conditions such as diabetes, bad cholesterol, and high blood pressure account for more than 75 percent of the $2.5 trillion the U.S. spends annually on health care, according to data from the Department of Health and Human Services. Cigarette smoking, 10 percent more prevalent among Medicaid enrollees than the population at large, cost Medicaid programs an average of $607 million in 2004, according to the National Center for Health Statistics, and is also the leading preventable cause of death in the U.S.

States Have Mixed Results

To date, a few states have tried transplanting the corporate wellness model to Medicaid, with mixed results. State health officials seem to agree that participation from health care providers and other community organizations, often a challenge, was critical in making their programs work.

West Virginia's approach, which provides an enhanced coverage plan with added benefits to Medicaid enrollees who agree to adhere to healthy behaviors, has been widely criticized by health advocates.

Idaho, which launched an incentive program in 2007, offers $200 in vouchers to Medicaid enrollees who consult with a doctor about losing weight or quitting smoking. Recipients can use the vouchers for gym memberships, weight management programs, nutrition counseling and tobacco cessation products. Tobacco counseling courses are offered free of charge through public health districts in the state. Idaho is now enrolling about 1,500 new Medicaid participants each year.

According to Tom Kearns, who manages Idaho's Preventive Health Assistance initiative, participants have written in with positive feedback -- but the state doesn't have data to show whether the incentives are cost-effective or have a large-scale impact on participants' behavior.

"There's a lot of challenges in tracking the outcomes of this long-term," Kearns said. "Ultimately we'd like to have a large enough population to track."

The state has worked hard to find partners who are willing to accept its vouchers and so far has more luck with community groups, such as the YMCA, than private companies.

Florida has also tried using incentives in its Medicaid managed care pilot program.

The program allows Medicaid enrollees living in five counties to earn up to $125 worth of credits each fiscal year in exchange for their compliance with certain "healthy behaviors," like getting a flu shot or adhering to a prescribed drug regimen. Participants can redeem the credits at participating pharmacies for over-the-counter products such as bandages and diapers.

But logistical setbacks have dampened the impact of the incentives. At first, few were aware that the program even existed, and some pharmacies refused to accept the Medicaid credits. Several hundred people have received credits for participating in a diabetes or hypertension disease management program since 2006, but as of February, only two individuals were on the record for having attended a smoking cessation course, and six individuals have been credited for entering a weight management or exercise program.

"There's a question about whether this is really incentivizing anything ... that link is very dubious," said Greg Mellowe, policy director at the consumer advocacy group Florida CHAIN. Most of the credits distributed through Florida's rewards program in the past five years, Mellowe contends, were awarded for routine visits and immunizations that Medicaid recipients would have sought anyway -- and not for significant behavioral changes.

Research on Incentives is Inconclusive

Research is scant on the effects of incentive programs on mitigating chronic diseases. A smattering of studies have shown that complex behavioral programs with built-in incentives can sometimes produce short-term results—if the incentives are large enough. A 2009 study published in the New England Journal of Medicine found that a program offering people $750 to quit smoking: 15 percent of participants eligible for a reward managed to quit, compared with 5 percent of participants who enrolled in a traditional tobacco cessation program.

A similar study about incentive-based weight loss programs, published by some of the same researchers in the Journal of the American Medical Association, was less optimistic. That study found that financial rewards did help participants lose more weight temporarily, but the losses weren't fully sustained in the end. Few behavioral studies have attempted to determine whether people who receive the incentives are able to maintain their short-term success long term -- the ultimate goal of incentive-based prevention program.

Fewer attempts have been made to address how the design of an incentive program should be adjusted according to the demographics of the target population, such as insuring that low-income participants have transportation to get to appointments and classes.

"In and of itself, without health education and other forms of engagement, it seems to fall short," said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. "The incentives are never going to be enormous because it's never going to be affordable."

For more information, see web link:
Los Angeles Times April 8, 2011

Don’t Even Think About Smoking Here

There’s a new accreditation on the block. Campuses eager to flaunt their smoke-free status can apply for certification by the health-education organization Bacchus Network. The nonprofit offers three levels of certification — silver, gold or diamond.

Bacchus doesn’t actually police campuses. The certification process is something of an audit, requiring documentation about policies and connections to tobacco companies, as well as photographs of signs announcing smoke-free status, says Ann Quinn-Zobeck, director of education and training.

Applicants pay $295, and the process takes roughly a year, she says, mostly because Bacchus likes to see a public campaign and campus organizations backing policies.

So far, nine campuses have tried for certification, and three have prevailed.

Campuses that have officially put out their cigarette butts aren’t rare. According to the American Lung Association, 259 are tobacco free (no chew, snuff). The American Nonsmokers Rights Foundation lists 466 campuses that ban just smoking on university grounds.

How much smoke has actually cleared is questionable. “You’ll see a student walking across campus smoking occasionally and no one minds, except maybe R.A.’s,” says Larry B. MacIntyre, spokesman for Indiana University’s eight campuses. Smoking is banned but Indiana has not sought certification. “There’s one time we definitely don’t try to enforce it,” he says. “That’s during football games. People come and tailgate and smoke, and we don’t try to stop it.”

SILVER

No smoking on campus, at campus-sponsored events and in campus-owned vehicles. No tobacco sales and advertising or tobacco company sponsorship. At least three smoking-cessation resources. Policy is posted.

Certified: Winona State (Minn.)

GOLD

All of above. Also, no use of any tobacco products (including cloves, snuff, hookahs) on campus, at campus-sponsored events and in campus-owned vehicles.

Certified: Nebraska Methodist College and Oklahoma State

DIAMOND

All of the above. Also, does not invest in, or accept direct funds from, tobacco companies.

Certified: 0

For more information, see web link:
The New York Times April 15, 2011

E-cigarettes Will Get FDA Oversight as Tobacco Products

The Food and Drug Administration announced that it will act to ensure the government's right to impose marketing, manufacturing and safety restrictions on "electronic cigarettes," a nicotine delivery device widely billed as an alternative to cigarettes for those trying to quit and for smokers who can't light up.

In a letter posted to the FDA's website, Dr. Lawrence R. Deyton, director of the FDA's Center for Tobacco Products, said the agency will act to regulate e-cigarettes as tobacco products. To shore up its authority to do so, the agency will propose new regulatory language that would specifically define e-cigarettes as a tobacco product.

Electronic cigarettes do not burn tobacco directly, but allow a user to inhale heated nicotine derived from tobacco and suspended in a fluid canister. Instead of emitting tobacco smoke with a consumer's use, electronic cigarettes and their users release only water vapor. While those who make and sell electronic cigarettes maintain the devices are far safer than smoking cigarettes, the FDA has begged to differ, noting that half of the 19 brands of e-cigarettes it sampled contained nitrosamines, a carcinogen found in real cigarettes, and many contained diethylene glycol, a poisonous ingredient in antifreeze.

The FDA's move represents a fallback option for the agency, which had hoped to regulate electronic cigarettes as medical devices. The widespread marketing of e-cigarettes as an aid to quitting smoking, the FDA contended, made e-cigarettes a legitimate target for regulation as a medical device. But in a December 2010 court case, the U.S. Court of Appeals for the District of Columbia Circuit rejected the FDA's claim, saying that while the agency arguably had a right to regulate e-cigarettes as tobacco products, they could not legitimately be considered medical devices because they are not primarily marketed as a smoking cessation device.

While the FDA has bowed to the court's decision, the agency appears intent on taking the court at its word. If e-cigarettes cannot be construed as medical devices, then the FDA said it will consider "whether to issue a guidance and/or a regulation on 'therapeutic' claims." If it takes such a step, the FDA could put a stop to any marketing of the enormously popular cigarette alternatives as an aid to help smokers kick the habit.

For more information, see web link:
Los Angeles Times April 25, 2011

Fed Up with Smoking Bans, Cigar Enthusiasts Seeking Right to Smoke in Public

As quests for freedom go, it’s not exactly the fight against apartheid in South Africa. But cigar smokers around the country are fed up with smoking bans that prevent them from enjoying stogies in cigar bars with friends.

A rising number of states have moved to exempt cigars from indoor smoking bans, often by establishing cigar bars or smoking lounges inside cigar stores. Pro-cigar groups have sprung up nationally and in most states, spreading a message that their product is fundamentally different from cigarettes.

Cigar smokers are not interested in exposing the general public to their pungent fumes, said Joe Arundel, president of the Cigar Association of Washington. But they don’t see why they can’t smoke in the company of fellow enthusiasts — a gathering known as a “herf” in cigar circles — in businesses dedicated solely to the product.

“It’s not like people walk into a cigar store by accident,” Arundel, who operates Rain City Cigar in Seattle, said.

Washington used to have cigar bars and lounges. But a ban on all indoor smoking in 2005 put them out of business. A bill introduced in the state Legislature this year that would allow a limited number of cigar lounges and bars has languished in committee, after getting vehement opposition from the state Department of Health.

The Health Department opposes any change to the state’s indoor smoking ban, one of the nation’s first, said Tim Church, a spokesman for the agency.

“The indoor smoking law was passed by a great majority in every county in Washington state,” Church said.

The ban is intended to protect the health of non-smokers and especially of employees who work in bars and restaurants, Church said.

“We don’t like the idea of an employee having to sign away their rights to health to have a job,” Church said.

Washington has been inhospitable to smokers for years. The state was an early adopter of smoking bans in bars and restaurants, and its cigarette tax of more than $3 a pack is among the highest in the nation.

Annie Tegen of Seattle, program manager for Americans for Nonsmokers’ Rights, said they oppose any effort to weaken smoking bans.

“The public loves this law,” Tegen said. “There is no reason to weaken this law and put our workers at risk.”

The anti-smoking group Action on Smoking and Health (ASH) of Washington, D.C., said there is no legal right to smoke in the U.S., and many other countries are adopting bans on public smoking.

“The tendency is more towards protecting the health of the population, rather than exemptions,” said Laurent Huber, head of the group.

After years of victories, there are signs that anti-smoking forces are encountering some resistance. A nationwide advocate for cigar smokers said the tide seems to be turning against bans that lump cigars with cigarettes.

Kansas, Minnesota and Illinois also have pending legislation that would loosen smoking bans to allow for cigar bars, said Glynn Loope, executive director of Cigar Rights of America.

“’Five years ago, I wouldn’t give you a $10 bet on any of these bills being drafted,” Loope said. Now some might even be passed, he said. New York, Nebraska, and Oregon are among 13 states that ban indoor smoking but allow exemptions for cigar bars, he said.

Cigars and cigarettes have fundamental differences, cigar advocates say. Premium cigars are more expensive, take longer to smoke and tend to be favored by older people. Cigar smokers don’t chain-smoke and often regard their activity as an occasional luxury to be savored with friends and a drink, Loope said.

“The cigar industry is based on art and culture, and not being abusive to the product,” Loope said. “The average cigar smoker smokes two a month.”

Cigar stores tend to attract only cigar smokers, not people who would be offended by the smoke, he said.

“These shops lose a lot of their character and soul when they can’t allow use of a perfectly legal cigar in the shop,” Loope said.

No one is forced to work in cigar shops, and several states require such employees to sign waivers indicating they understand the dangers of second-hand smoke, Loope said.

Cigar advocates see themselves as oppressed by a hypocritical majority that is obsessed with stamping out tobacco use while tolerating alcohol.

Arundel noted the bill in Washington would allow a maximum of 100 cigar bars to open across the state. By contrast, there are 5,800 liquor licenses, he said.

“Should we be any more discriminated against than anybody else?” Arundel said.

Smoking opponents would no doubt argue with that logic — after all, bartenders can’t get sick from alcohol by serving it, but an employee of a cigar bar is exposed to secondhand smoke. Nevertheless, Arundel said cigar smokers will continue to fight for cigar bars and lounges, a cause they see as standing up for the rights of private property owners.

“All we are asking for in our state is a little bit of reason and fairness,” he said.

For more information, see web link:
The Washington Post April 20, 2011

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