August 2009


Research Highlights
Other Cessation News


Research Highlights

Other Cessation News




FDA Launches New Center for Tobacco Products, Names Notable Public Health Expert as First Director

The U.S. Food and Drug Administration launched its new Center for Tobacco Products (Center) in an historic effort to curb the hundreds of thousands of deaths caused by these products each year. This announcement comes just two months after Congress approved—and President Obama signed into law—historic legislation giving the FDA authority and resources to regulate the manufacturing, marketing and sale of tobacco products.

The Center will oversee the implementation of the Family Smoking Prevention and Tobacco Control Act*, which, among other things, will:

  • Restrict tobacco advertising and promotions, especially to children.
  • Stop illegal sales of tobacco products to children.
  • Ban candy and fruit-flavored cigarettes.
  • Require large, graphic health warnings that cover the top half of the front and back of cigarette packs.
  • Ban misleading health claims such as "light" and "low-tar."
  • Strictly regulate 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.

Lawrence Deyton, M.D. M.S.P.H., an expert on veterans’ health issues, public health, tobacco use, and a clinical professor of medicine and health policy at George Washington University School of Medicine and Health Sciences, has been named as the Center’s first director.

In a statement from Matthew Myers, President, Campaign for Tobacco-Free Kids, Dr. Deyton is a highly respected and successful public health leader, and an experienced administrator, with a long-standing appreciation of the importance of tobacco. He possesses precisely the type of leadership skills and commitment to public health that will be needed to build the new Center for Tobacco Products.

“I am eager for the challenge of leading the tobacco team at FDA,” said Deyton in a statement. “This is a tremendous opportunity for us at FDA to work hand-in-hand with the CDC, researchers at the National Institutes of Health, and public health leaders in the states to make progress in combating tobacco use – the leading cause of preventable death in the United States.”

Prior to joining the FDA, Deyton was Chief Public Health and Environmental Hazards Officer for the U.S. Department of Veterans Affairs. One of Deyton’s priorities had been revitalization of the VA’s smoking and tobacco use cessation programs. At the VA, he dramatically increased the percentage of veterans offered assistance in quitting. Under Deyton’s leadership, current smoking rates among veterans enrolled in the cessation program fell from 33 percent in 1999 to 22 percent in 2007. He also eliminated the sale of tobacco products at VA facilities, and played a key role in commissioning a study by the Institute of Medicine to identify opportunities for both the VA and the Department of Defense to reduce tobacco use and improve access to effective tobacco cessation programs.

To begin the Center’s work, the FDA will establish the necessary administrative functions for the Center with $5 million from the fiscal year 2009 budget. As set forth in the Family Smoking Prevention and Tobacco Control Act, additional funding for the Center and other activities related to the regulation of tobacco will come from user fees paid by manufacturers and importers of tobacco products.

* The FDA is currently providing an opportunity for all interested parties to provide information and share views on the implementation of the Family Smoking Prevention and Tobacco Control Act. For more information on submitting electronic or written comments, visit Or submit a comment online by visiting

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Research Highlights

Smokers' Cars Loaded With Nicotine

Passengers riding in the cars of smokers are exposed to nicotine levels nearly twice those found in restaurants and bars that permit smoking, a new study suggests.

The dangers of exposure to secondhand smoke are well known, including the risk for heart and respiratory disease, and have led to laws banning smoking in many public places. Many anti-smoking advocates believe the next frontier in the fight against secondhand smoke is in cars.

"These levels of exposure are unacceptable for nonsmoking passengers, particularly children, who are at increased risk for secondhand smoke-related health problems," said study co-author Patrick Breysse, director of the Division of Environmental Health Engineering at the Johns Hopkins University Bloomberg School of Public Health.

Breysse and his co-author Dr. Ana Navas-Acien, an assistant professor of occupational and environmental health at Hopkins, believe that smoking should be banned in cars as it has been in other places.

"The high secondhand tobacco smoke levels measured in this study support the urgent need for smoke-free education campaigns and legislative measures banning smoking in motor vehicles when passengers, especially children, are present," Navas-Acien said.

The report is published in the Aug. 25 online edition of Tobacco Control.

For the study, Breysse and Navas-Acien compared nicotine levels in the cars of 17 smokers and five nonsmokers whose commute to and from work took 30 minutes or longer. The researchers placed airborne nicotine samplers in the cars, one near the front passenger seat headrest and another in the back seat behind the driver.

The researchers then analyzed the samples and found a twofold increase in concentrations of nicotine for every cigarette smoked.

Navas-Acien and Breysse estimate that nicotine concentrations are twice as high in smokers' cars as in other public and private places studied, and 40 percent to 50 percent higher than in restaurants and bars that allow smoking.

"While partially opening windows reduced exposure to secondhand smoke it did not eliminate exposure within motor vehicles," Breysse said. "It is important to remember that there is no known safe level of exposure to secondhand smoke."

People in the study also completed a questionnaire that included questions on their knowledge and attitudes about the health risks of secondhand smoke and relevant regulations and legislation. Both smokers and nonsmokers said smoking in a car posed a health risk to passengers. Among smokers, 53 percent said not being able to smoke in the car would help them to quit, and 93 percent said cars should be smoke-free voluntarily. Only 7 percent of smokers said there should be laws outlawing smoking in cars.

"Results of this research and other studies can be used to develop education campaigns aimed at eliminating secondhand smoke exposure in motor vehicles," Breysse said. "In addition, these results can be used to support legislative efforts aimed at banning smoking in vehicles, particularly when children are present."

For more information, see web link:
US News & World Report August 24, 2009


Smokers Twice As Likely to Get TB

Smokers are twice as likely as nonsmokers to develop active tuberculosis (TB), a new study shows.

Researchers analyzed data from nearly 17,000 people who took part in Taiwan's 2001 National Health Interview Survey. They found that current smokers had a 2.73 times higher risk of active TB than nonsmokers, while the risk for people who had smoked at some point in their lives was 2.69 times greater. After adjusting for other potential factors, the researchers determined that current smokers were two times more likely to develop active TB than nonsmokers.

They also found that younger smokers were more likely than smokers over age 65 to develop active TB, compared to nonsmokers.

The study appears in the Sept. 1 issue of the American Journal of Respiratory and Critical Care Medicine.

"The small number of TB cases in this study prevented us from examining the age-gradient of smoking-TB association at a finer age scale, and more studies are needed to confirm the findings," lead author Hsien-Ho Lin, a postdoctoral research fellow at Brigham and Women's Hospital in Boston, said in a journal news release.

"Because the baseline risk for active TB is higher in the elderly in many countries, a smaller but still elevated relative risk in this population may yet translate to a greater number of cases of active TB, and our findings should not be interpreted to mean that smoking poses a lower risk in the older population," said Lin.

Lin and colleagues said smoking's effects on different biological functions may increase the risk of active TB.

"To our knowledge, this is the first cohort study from a general population that provides evidence on the positive association between tobacco smoking and active TB," Lin said. "Based on results from ours and other studies, policy makers and public health personnel should consider addressing tobacco cessation as part of tuberculosis control. From the perspective of prevention, the target of smoking cessation should aim beyond TB patients to reach high-risk populations who are most likely to benefit from cessation."

For more information, see web link:
US News & World Report August 24, 2009


Majority of US Hospitals Will Have Smoke-Free Campuses by End of Year

While hospital buildings are often smoke-free, a new study finds that by February 2008, 45 percent of US hospitals had adopted "smoke-free campus" policies, meaning that all the property owned or leased by the hospital, both indoors and outdoors, was smoke-free and there were no designated smoking areas on those properties.

The study, "The Adoption of Smoke-Free Hospital Campuses in the United States," is the first of its kind to examine the national prevalence of smoke-free hospital campus policies. It was conducted by The Joint Commission, the world's largest healthcare standards setting and accrediting body, and researchers from the Henry Ford Health System's Center for Health Promotion and Disease Prevention. The study was funded by the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation and appears in the online version of the peer-reviewed journal Tobacco Control.

"Besides the 45 percent that already had smoke-free campuses, another 15 percent indicated that they would be implementing similar policies in the near future. Hence, it is safe to assume on the basis of these results that the majority of US hospitals will have smoke-free campuses by the end of 2009," according to Scott C. Williams, PsyD, of The Joint Commission.

The 2008 data shows that not-for-profit hospitals were more likely to have smoke-free campuses than for-profit hospitals. The 2008 data also shows that hospitals in Arkansas, Iowa, Maine, Minnesota, Oklahoma and Wisconsin had among the highest proportion of smoke-free campuses. Hospitals in several tobacco states also had significant proportion of smoke-free campuses.

"In 1992, The Joint Commission implemented a standard which required hospitals to adopt a non-smoking policy throughout all buildings, limiting smoking to separate, ventilated areas. At that time, fewer than 3 percent of hospitals extended this indoor smoking ban to include the entire hospital campus, both indoors and outdoors. Our study shows that around 2004-2005 this began to change dramatically. Now a majority of the nation's hospitals do not allow smoking anywhere on their property," Williams said.

The study examined the current smoking policies and future plans of 1,916 Joint Commission-accredited hospitals to determine the prevalence of smoke-free hospital campus policies and whether such policies had an impact on smoking cessation counseling offered in those hospitals. The study found that not-for-profit hospitals were slightly more likely to offer smoking cessation counseling than for-profit hospitals.

The study also found that federally owned hospitals were less likely to have smoke-free campuses. This, according to the study, was likely due to the influence of federal legislation requiring all Veterans Administration (VA) hospitals to have a suitable and accessible patient indoor smoking area for patients and residents. "Such legislation makes it virtually impossible for VA hospitals to adopt a completely smoke-free campus," Williams said.

For more information, see web link:
EurekAlert August 20, 2009


Fewer Smokers in UK Quit in Past Year

The number of people managing to stop smoking with NHS help in England has fallen slightly in the past year - despite a huge increase in funding.

In 2008/09, the NHS spent an extra £13m on helping people to quit - a 21 percent hike in resources.

But the number of people who had successfully quit at the four-week mark fell by 4 percent, official NHS figures show.

It follows record quit-rates two years ago after the introduction of the smoking ban in public places.

The ban - introduced in England and Wales in 2007 and in Scotland in 2006 - was seen as one key reason many more people may have tried to quit that year.

But NHS Information Centre figures from April 2008 to March 2009 showed 1 percent fewer people set a quit date through the NHS Stop Smoking Services than the previous 12 months at 671,259.

Of those who tried to quit, 50 percent were successful at four weeks, but overall 13,746 fewer smokers had managed to kick the habit compared with 2007/08.

The number of pregnant women who successfully stopped smoking also dropped, falling 12 percent to 8,641.

The figures remain high compared with those prior to the smoking ban coming into force.

Compared with 2006/07, the latest data shows 71,000 more people tried to quit over the past year and 17,000 more people were successful.

The NHS now spends £74 million annually on helping people quit, compared with £22m two years ago - not including the cost of any drugs such as nicotine replacement therapy, the NHS Information Centre said.

That is £219 per quitter compared with £160 in 2006/07.

The NHS Information Centre's chief executive Tim Straughan said it was "encouraging" that more people are quitting smoking than before the smoking ban was introduced.

A Department of Health spokeswoman said smokers who quit with NHS support are more than four times more likely to be successful than those who go cold turkey.

She added that increased costs were partly due to inflation.

They have also increased because the NHS was treating more highly dependent "harder to help" smokers, she said.

Professor John Britton, chair of the Royal College of Physicians Tobacco Advisory Group, said that a quarter of a million people quitting would lead to 125,000 fewer deaths from tobacco-related diseases.

"There is no way the government could achieve this result so cost-effectively by any other means; no other country in the world is providing cessation services on the same scale and with the same level of success.

"It is vital that we continue to develop the options available to those who wish to quit and reach out to other smokers."

For more information, see web link:
BBC News August 20, 2009


Mother's Smoking Increases Daughter's Pancreatic Cancer Risk

A woman who smokes during pregnancy and motherhood appears to boost her daughter's odds of developing pancreatic cancer, the deadly disease that will strike an estimated 21,420 women (and 21,050 men) this year.

Researchers from Harvard University and Imperial College London looked at pancreatic cancer rates in the Nurse's Health Study, one of the nation's oldest and largest studies of women and influences on their health. Although it's long been known that tobacco use is associated with higher rates of pancreatic cancer, researchers wanted to explore the effects of secondhand smoke on a person's risk of developing the disease. In the 24 years over which the women were followed, 384 of 86,673 women were diagnosed with cancer of the pancreas.

Pancreatic cancer is often called "the silent killer" because its symptoms are unlikely to be felt until the disease is in an advanced stage.

The study, published in the August issue of the journal Cancer Epidemiology, Biomarkers & Prevention, found that for women whose mothers smoked around them when they were young, rates of pancreatic cancer were significantly higher. A child whose father smoked or who was exposed in adulthood to a smoking family member or co-worker, was not significantly more likely to develop the disease.

Less clear is whether a mother with a smoking habit passes on to her daughter a heightened biological propensity to develop pancreatic cancer or an increased likelihood of smoking. Female nurses who themselves never smoked cigarettes were only slightly more likely than those who did not develop pancreas cancer, even if their moms smoked. The difference was small enough that researchers said it could have been attributable to chance.

But researchers did not rule out the possibility that a fetus or a child's exposure to secondhand smoke might set in motion some biological process that puts that female child at risk. That would put pancreatic cancer in the company of many other negative health consequences for a child exposed to her mother's smoking habit, including low birthweight, greater incidence of asthma and other respiratory diseases, higher risk of Sudden Infant Death Syndrome.

In short, if you smoke and are pregnant or have young children, quit -- for your sake and theirs.

For more information, see web link:
LA Times August 6, 2009


New Analysis: Women of Low Socio-Economic Status Face Unique Challenges Related to Smoking, Smoking Ban Policies

Smoking bans, while a necessary and positive trend for reducing exposure to secondhand smoke, have some unintended consequences—especially for women. The August 2009 issue of the American Journal of Preventive Medicine includes a special supplement, Unintended Consequences of Tobacco Policies, a compilation of nine original, peer-reviewed articles focused on examining these unique challenges related to a smoking stigma, childcare and personal safety.

According to the report, low-income women who live in urban areas may have safety concerns about going outside to smoke when smoking indoors isn't permitted. Moreover, childcare and adequate child supervision may be a concern when they go outside their homes in order to avoid exposing their children to secondhand smoke. The reports go on to find that many women of low socio-economic status feel an increased stigma associated with smoking, more so than their more advantaged counterparts. This stigma often leaves mothers in this category with a label of being “bad mothers” and thus, cause additional unintended consequences including resistance to seeking out help in quitting from healthcare providers.

“Women of low socio-economic status have elevated challenges across-the-board when it comes to smoking and access to quit-smoking resources,” said Dr. Pebbles Fagan, Health Scientist, Tobacco Research Branch, Division of Cancer Control and Population Sciences at the National Cancer Institute. “Unfortunately, the articles in this issue find that this group also faces a unique set of consequences related to the evolving policy context of smoking worldwide.”

The American Legacy Foundation the National Cancer Institute and the National Cancer Institute’s Office of Science Planning and Assessment co-sponsored the supplement.

"Collectively, the papers in this special issue draw attention to the need for lawmakers to consider how the policies they enact may differentially affect less powerful groups in our society. For example, weak provisions for enforcing smoke-free workplaces may result in low SES female bartenders being obliged to breathe secondhand smoke in order to work," said supplement editor Roland Moore, Ph.D., Senior Research Scientist at the Pacific Institute for Research and Evaluation.

“We are hopeful that the findings in this special issue bring light to the need for increased sensitivity and strengthened resources for this group of women struggling to quit smoking,” said Cheryl G. Healton, Dr. P.H., president and CEO of the American Legacy Foundation. “Tobacco control policies have made a significant contribution toward reducing tobacco use in the U.S. and worldwide. We hope that with greater effort, the groups of women studied will also benefit from the positive effects without the burden of unintended consequences.”

Remedies in the supplement’s forward are proposed for practitioners to help reduce the unintended burden on the population groups outlined:

  • Ensure that secondhand smoke-related messages target PARENTS, not just mothers, and are delivered in culturally appropriate ways
  • Focus smoking-cessation messages to an individual woman’s health, as well as the health of her children and family
  • Build acceptance and trust within the patient-provider relationship to facilitate treatment initiation among women and mothers who smoke
  • Underscore the need for smoke-free policy initiatives to be coupled with increased access to smoking cessation programs
  • Develop strategies for women who work in bars and restaurants where smoking is still allowed and/or where smoke-free laws are not enforced.

"We still know remarkably little about if and how tobacco policies affect men and women differently. We do have growing evidence to suggest that there are differences based on both sex and gender, which then interact with economic and cultural factors. Smoke-free policies are a good example. They affect women, especially disadvantaged and low-SES women at all levels- in relationships, at home, in public and at work-sometimes in deleterious ways. Women's gendered responsibilities for child care, unequal power in relationships and lower earning power are among the factors that affect women's exposure to secondhand smoke and their ability to control exposures. Much more investigation, and special programming, needs to be developed to deal with these issues,” added Lorraine Greaves, British Columbia Centre of Excellence for Women's Health and President, International Network of Women Against Tobacco.

For more information, see web link:
American Legacy Foundation Press Release August 3, 2009


Oklahoma State University study puts ex-smokers’ cigarettes to use

For smokers trying to quit their habit, that "last” cigarette is usually the final one in the pack.

To an addict, cigarettes are so valued that not finishing the pack would be downright wasteful, said Oklahoma State University researcher Jared Dempsey.

Even those who have quit but relapse and buy a pack are likely to smoke the entire thing, further derailing their cessation.

His solution? Donate those unused cigarettes to science.

Dempsey and his research team will use the cigarettes to help others stop smoking and to help understand the impact of visual cues on an addict’s brain.

Dempsey will use some of the cigarettes in photographs of smokers and smoking that scientists across that world can use when testing brain reaction to positive and negative stimuli.

For example, a smoker’s brain registers pleasure when seeing a cigarette being lit, but aversion to an image of a cigarette being finished.

The cessation treatment Dempsey advocates is called brand-fading. Smokers are weaned off cigarettes by lowering nicotine levels, by only smoking brands they don’t like and with nicotine patches.

"Smokers love their brand and their brand only,” said Dempsey, a psychology professor. "They do not like it when they smoke another brand.”

For others, cessation means breaking more than one habit because smoking often is associated with a specific behavior.

"Smokers often use smoking during bonding events like partying with friends and also during the most painful moments in life,” Dempsey said.

"The smoker is not only fighting a pure chemical addiction but is simultaneously losing a pleasurable activity with friends and also a support technique during emotionally difficult times.”

About one in four Oklahoma adults now use tobacco products, compared to about one in five nationally. But 75 percent of Oklahoma adults and 50 percent of youth that use tobacco say they want to quit, according to the state Health Department.

A federal study among the 50 states released earlier this year ranked Oklahoma as having the fifth-highest death rate from smoking.

For more information, see web link:
The Oklohoman August 2, 2009


Study Suggests Cigarette Packaging Impacts Perception of Health Risk

A study published in the online edition of the Journal of Public Health suggests that the manner in which smoking warnings are presented on cigarette packaging influences consumers' perception of health risk, United Press International reports.

To evaluate how cigarette packaging influences consumer perception, a researcher from the University of Waterloo in Canada and colleagues recruited approximately 300 smokers and 300 nonsmokers to evaluate nine pairs of fictitious cigarette packet replicas and select which one that they believed would taste smoother, which one they thought would deliver more tar, and which one they would select if they were trying to reduce the risks to their health.

Each of the cigarette packets featured standard health warnings and differed only with respect to one single design aspect, such as word choice, a number in the brand name or packaging color. The researchers found that 80 percent of those surveyed said they believed that the package labeled "smooth" would be less harmful than the one labeled "regular." In addition, 73 percent of the respondents indicated that the brand labeled "silver" would be less harmful than the one labeled "full flavor," and 84 percent indicated that the pack with the number six in the brand name was less harmful than the brand with the number 10 in the brand name. Meanwhile, the researchers note that 79 percent of the study participants believed that lighter blue packaging conveyed less health risk than darker blue packaging, and 76 percent indicated that the packaging depicting a charcoal filter would be less harmful than the one with no such illustration.

According to the researchers, such misconceptions were more pronounced among smokers, and more prevalent among smokers of brands labeled "light" or "mild" than among smokers of other brands. In light of the study's results, the researchers call for an expansion of the list of words banned from cigarette packaging, which currently prohibits the words "light," "mild" and "low-tar," to include other suggestive phrases. In addition, they suggest that other package design elements that may suggest a product is less harmful be prohibited to ensure that consumers are not being misled. The researchers conclude that the findings lend support to the argument for standardized cigarette packaging.

For more information, see web link:
RWJF Public Health Digest July 30, 2009


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Other Cessation News

Ore. AG, NY County Move to Block e-Cigarette Sales

The state of Oregon has gone to court to block the sale of electronic cigarettes on the same day that a New York county banned their sale to minors.

Oregon Attorney General John Kroger and Jon Cooper, majority leader of the Suffolk County Legislature on Long Island, N.Y., said the lawsuit and the ban are both the first of their kind in the nation.

Electronic cigarettes are battery-powered devices typically made out of plastic designed to look like a traditional cigarette, including a light that simulates its glow.

But instead of tobacco that burns and creates smoke, the "e-cigarettes" use a heating element to vaporize water mixed with ingredients in a disposable cartridge, which can include liquid nicotine.

The e-cigarettes are mostly imported from China by companies that claim they are safe because no smoke is generated or inhaled, only water vapor. But a recent U.S. Food and Drug Administration test of 19 e-cigarette brands found more than half contained a cancer-causing substance.

Kroger and Cooper said the FDA has never declared e-cigarettes safe for public consumption.

"It's my duty to protect the public from products that are falsely advertised as safe," Kroger said.

Kroger and Cooper also said an additional concern is the flavors offered with e-cigarettes, such as bubblegum and chocolate, that attract teenagers and even younger children.

"It would set us back decades in efforts to educate young people that smoking is not cool and it's bad for them," Cooper said.

Two major U.S. e-cigarette importers, Smoking Everywhere Inc. and Sottera Inc., have sued the FDA in U.S. District Court in Washington, D.C., claiming the agency does not have authority to regulate their product.

Kroger already has reached an agreement with Sottera, maker of the Njoy brand, to halt sales in Oregon.

Smoking Everywhere, based in Florida, declined requests by the Oregon attorney general's office to restrict its sales, leading to the lawsuit filed in Marion County Circuit Court at the state capital in Salem.

The lawsuit also names Elico Taieb, president and CEO of Smoking Everywhere.

Taieb did not return calls from The Associated Press.

The Oregon complaint states that other nicotine delivery devices - such as smoking cessation devices - have to be approved by the FDA, which "requires product manufacturers to submit competent and reliable scientific evidence that demonstrates that a product is safe and effective for its intended use."

Similar language was contained in the resolution adopted by the Suffolk County Legislature in New York, which bans the sale of e-cigarettes to anybody under 19 and also restricts their use in public places that already bar tobacco products, such as bars and restaurants.

The New York resolution still must be approved by County Executive Steve Levy, whose spokesman said he favors it.

For more information, see web link:
Miami Herald August 18, 2009


Ohio Bar Sued For Smoking Violations

The Ohio Attorney General and the Ohio Department of Health Director have announced the first lawsuits filed against Ohio establishments for violating the Smoke-Free Workplace Act.

One of the two establishments that has been sued is O'Neal's Tavern in Anderson Township. The other is Zeno's in Columbus.

Officials say the lawsuits were brought against the establishments because of their repeated and extensive violations over the last two years.

O'Neal's Tavern on Beechmont Avenue has been cited for 12 violations accumulating fines of more than $21,000. Zeno's has been cited for nine violations and fines of more than $28,000.

"The issue at hand is clear disregard for Ohio law," said Ohio Attorney General Richard Cordray. "These establishments have been warned and fined repeatedly over a two-year period to no avail. They continuously push the limits and have given us no alternative but to seek the court's intervention."

Ohioans passed the Smoke Free Act in November of 2006. That made Ohio the 12th state to protect all workers and the public from exposure to secondhand smoke in public places.

Enforcement of the law began on May 3, 2007 and since that date, more than 44,000 allegations have been called in to Ohio's toll-free enforcement number of (800)559-OHIO (6446).

Over 280,000 public places and businesses are covered by the indoor smoking ban. Ohio Department of Health Director Alvin Jackson says the vast majority of businesses are complying with the law. That being said, he added that health officials will continue to aggressively investigate all complaints in their efforts to protect and improve the health of all Ohioans.

Officials say more than 3,100 warning letters have been issued to violators and more than 1,800 fines have been assessed.

For more information, see web link:
WCPO Ohio August 14, 2009


Canadian Smoking Rate Drops to 18 Percent

A national tobacco use monitoring survey found 18 percent of Canadians age 15 or older were active smokers in 2008, Canadian Cancer Society officials said.

Officials say the Canadian Tobacco Use Monitoring Survey indicates that national smoking rates also declined by 1 percent after remaining stable at 19 percent in the previous three years. The smoking rate of Canadian teens ages 15-19 is 15 percent, or 300,000 teens, for the second year in a row, the report said.

The rate of children exposed to second-hand smoke varies among different provinces.

Quebec has the highest rate of children and teens ages 0-17 who are regularly exposed to second-hand smoke at home at 14.5 percent, compared to 8 percent nationally. However, in Ontario, 5 percent of children and teens are regularly exposed to second-hand smoke, with 4 percent exposed to second-hand smoke in British Columbia.

For more information, see web link: August 13, 2009


Ohio Judge Rules Tobacco Settlement Funds Should be Used as Intended -- To Reduce Tobacco Use and Save Lives

An Ohio judge delivered an important victory for the state's children and health by ruling that Governor Ted Strickland and the Legislature acted illegally when they sought to take back $230 million in tobacco settlement funds they had placed in an endowment to fund programs to reduce tobacco use. Judge David Fais of the Franklin County, Ohio, Court of Common Pleas issued a permanent injunction on the diversion of funds and ordered that they must be used as intended: to fund programs to prevent kids from smoking and help smokers quit.

The Court rightly found that the seizure of the tobacco settlement funds and the reduction or elimination Ohio's highly successful tobacco prevention programs would cause profound harm to the health of the citizens of Ohio. As Judge Fais wrote in his ruling, "Depletion of the Endowment Fund, and discontinuance or reduction of the tobacco prevention and cessation programs funded by the Endowment Fund, would result in a substantial increase in tobacco-related premature death and disease in Ohio, and result in a substantial increase in medical expense for both Ohioans and the state of Ohio for treatment of tobacco-related disease."

At the time of the 1998 state tobacco settlement, Ohio leaders promised to use a portion of the approximately $300 million in settlement funds the state receives each year for programs to prevent kids from smoking and help smokers quit. In 2000, they created the Ohio Tobacco Prevention Foundation to receive this portion of the annual settlement funds and establish a permanent endowment to run tobacco prevention and cessation programs. However, Ohio leaders since regularly diverted funds intended for the Foundation. Then last year, Governor Strickland and the Legislature sough to raid the Foundation's remaining funds to help pay for an economic development plan.

The Ohio Tobacco Prevention Foundation has a strong record of success. The Foundation's programs have helped reduce smoking by 63.5 percent among middle school students and by 42 percent among high school students since 2000. Adult smoking in the state has declined as well, with 20.1 percent of Ohio adults reporting that they smoke, down from 26.3 percent in 2000.

It is critical that Ohio continue to invest in programs to prevent children from starting to smoke and help smokers quit. Tobacco use is the leading preventable cause of death in Ohio. Each year in Ohio, tobacco use claims 18,500 lives and costs the state $4.37 billion in health care bills, including $1.4 billion in Medicaid payments alone. Government expenditures related to tobacco amount to a hidden tax of $625 a year on every Ohio household.

For more information, see web link:
Campaign for Tobacco Free Kids News Release August 11, 2009


AMA Secondhand Smoke Initiative

Secondhand smoke is a major contributor to respiratory and heart disease. Even low levels of exposure have a negative health effect. It is particularly harmful to children, especially those with asthma or an existing respiratory problem. Despite the fact that secondhand smoke exacerbates or results in disease, physicians do not regularly address it in office visits. Inner city medical practices are especially challenged to find the time and resources to counsel parents and families.

The American Medical Association (AMA), with cooperative agreements from the Environmental Protection Agency, is implementing an initiative to increase physician counseling on secondhand smoke to reduce children’s exposure. The initiative focuses on providing physicians and other health care providers with the tools they need to overcome practice-based barriers and offer families advise on how to protect their children and themselves from secondhand smoke exposure.

As part of this initiative, the AMA has produced five informational podcasts to offer a brief overview about secondhand smoke and advice on how to address it with parents in the clinic setting. If you have any questions about the secondhand smoke initiative, contact Janet Williams at (312) 464-5073. Once you have listened to the podcast, we ask that you fill out the brief evaluation form. Your feedback is extremely valuable to us.

Download free podcasts

For more information, see web link:
American Medical Association Smoking & Tobacco Control August 6, 2009


Justice Dept. Won't Seek Rehearing On Tobacco Case

The U.S. Justice Department won't seek a rehearing of a landmark decision this spring that found the tobacco industry violated federal racketeering laws, potentially increasing the odds that the controversy could make its way to the Supreme Court.

Tobacco companies involved in the litigation filed requests due to have the matter heard by the full circuit court, but the Justice Department won't do the same.

The May 22 opinion in the largest civil racketeering case to date was a mixed bag for the U.S. government, with the panel agreeing that cigarette makers conspired to deceive the public about the dangers of smoking, while rejecting the Justice Department's request for additional penalties against cigarette manufacturers.

The unanimous decision by a three judge panel of the U.S. Court of Appeals for the D.C. Circuit also affirmed an earlier ruling that the government could not force cigarette companies to forfeit up to $280 billion of profits.

Odds that an appeals court will agree to rehear a case decided by a smaller three-judge panel are slim, particularly when the panel's decision is unanimous. The fact that the Justice Department isn't asking for the full circuit to review the earlier ruling makes a rehearing even more of a long shot and could prompt litigants to seek review by the Supreme Court.

Defendants in the case include Altria Group Inc.'s (MO) Philip Morris subsidiary, Reynolds American Inc. (RAI), British American Tobacco PLC (BTI) and Lorillard Inc. (LO).

The May ruling affirmed most of the remedies that a trial judge imposed against tobacco companies in 2006, including restrictions on tobacco marketing and a requirement that the industry make corrective public statements about the health effects and addictiveness of smoking. But in a blow to the government and anti-smoking groups, the court rejected additional penalties they sought, including tobacco industry funding of a $10 billion national smoking-cessation campaign.

The court said the tobacco companies "knew about the negative health consequences of smoking, the addictiveness and manipulation of nicotine, the harmfulness of secondhand smoke," and agreed with the government's argument that tobacco firms were likely to commit future racketeering violations.

For more information, see web link: July 31, 2009


District of Columbia Cigarette Tax Increase Delivers Victory for Kids and Taxpayers

The D.C. Council has taken an important step to protect the District's kids and taxpayers from the devastating toll of tobacco use by increasing the cigarette tax by 50 cents to $2.50 per pack — the seventh highest cigarette tax in the nation. We applaud the City Council for its unanimous support of this life-saving proposal, and we look forward to Mayor Adrian M. Fenty signing it into law.

At the same time, the Council missed an opportunity to renew funding for the highly successful DC Tobacco-Free Families tobacco prevention and cessation program. Without action, funding for this program will largely expire at the end of September. To enhance and sustain the benefits from the tax increase, D.C. leaders should act quickly to provide the needed funds.

Higher tobacco taxes are a win-win-win solution for the District of Columbia — a health win that will reduce tobacco use and save lives, a financial win that will raise revenue for critical programs, and a political win that polls show is popular with the voters. With the increase, the District of Columbia will join 11 states that have increased their cigarette taxes this year.

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. The District of Columbia can expect the 50-cent cigarette tax increase to prevent more than 1,300 kids from smoking; spur 1,000 smokers to quit for good; save more than 600 residents from future smoking-caused deaths; produce $32.3 million in long-term health care savings; and raise about $3.6 million a year in new revenue.

With the District of Columbia increase, the average state cigarette tax will be $1.32 per pack. Rhode Island has the highest state cigarette tax at $3.46 per pack. Twelve states and the District of Columbia have cigarette tax rates of at least $2 per pack, and 27 states and D.C. have cigarette tax rates of at least $1 per pack.

For more information, see web link:
Campaign for Tobacco-Free Kids Press Release July 31, 2009


Smoking Is Banned Around New York City’s Hospitals

The New York City Council unanimously approved a bill on to prohibit smoking within 15 feet of the entrance or exit to any hospital. Lawmakers said the measure was a logical and necessary extension of an existing ban on smoking in hospitals, in place since 1988, and the ban on workplace smoking, one of the Bloomberg administration’s key initiatives, which took effect in 2003.

“When visiting a hospital, the last thing patients should have to worry about avoiding second hand smoke,” the Council speaker, Christine C. Quinn, said before the vote. “Patients should not have to walk through plumes of smoke on their way to seeing their doctor.”

The legislation, introduced by Councilwoman Inez E. Dickens, a Manhattan Democrat, applies to general hospitals, diagnostic and treatment centers and residential health care facilities. The measure not only bans smoking within 15 feet of hospital entrances or exits, but also smoking within 15 feet of the entrance to or exit from a hospital’s outdoor grounds.

A coalition of antitobacco groups — including the American Cancer Society, the American Lung Association, the American Heart Association and the Campaign for Tobacco Free Kids — supported the legislation.

The city’s 1988 Smoke-Free Air Act already bans smoking in hospitals, clinics, psychiatric facilities, residential health care facilities, physical therapy facilities, convalescent homes and homes for the aged.

In a hearing on the measure, staff members for the City Council reported that several states — Arkansas, Colorado and Hawaii — and municipalities — Buffalo; Duluth, Minn.; and Sioux City, Iowa — had passed similar measures restricting smoking around hospital entrances.

For more information, see web link:
New York Times July 29, 2009


Medical Organizations Collaborate to Press for Private Payer Coverage of Tobacco Cessation Counseling, Pharmacotherapy

America's health insurance companies should include tobacco cessation counseling and associated pharmacotherapy in their standard benefit plan packages, and they should pay physicians fairly to provide those services.

That's the central message of a July 21 letter sent to dozens of health plans and signed by the presidents of the AAFP; the AMA; the American Academy of Pediatrics, or AAP; the American College of Obstetricians and Gynecologists; and the American College of Physicians.

The AAFP took the lead on the letter after 18 months of brainstorming discussions with the AMA and the AAP. The organizations hope to bring commercial insurance coverage in line with Medicare, which has paid for smoking cessation counseling since 2005. They're also looking for ways to eliminate children's exposure to tobacco and secondhand smoke.

According to the letter, primary care physicians are in a unique position to help patients with their tobacco addictions because nearly six of every 10 office visits in this country are made to primary care physicians.

The physician groups made their case for tobacco counseling by listing some facts about tobacco use in America:

  • smoking and exposure to secondhand smoke causes nearly 440,000 deaths in the United States annually;
  • tobacco use is the country's leading preventable cause of death;
  • tobacco use and nicotine addiction costs the country $193 billion each year in health-related costs and lost productivity; and
  • quit rates increase when patients have insurance coverage for smoking cessation treatment.

The organizations pointed out in the letter that the U.S. Public Health Service's Clinical Practice Guideline on Treating Tobacco Use and Dependence: 2008 Update strongly recommends that clinicians screen all adults for tobacco use, provide tobacco cessation interventions for those who use tobacco products and counsel parents to avoid exposing children to secondhand smoke. The guideline recommends that both medication and counseling be considered components of a treatment plan for nicotine addiction in most patients.

The physician groups noted that the National Business Group on Health recommends that preventive health services benefits include both brief and intensive counseling for tobacco use as covered benefits. The letter also said that cost analyses show that the inclusion of tobacco cessation insurance benefits saves employers money because counseling and pharmocotherapy have been proven to double cessation rates.

The letter also noted that although some commercial payers consider smoking cessation an optional benefit, the 2008 Healthcare Effectiveness Data and Information Set, or HEDIS, measures (11-page PDF; About PDFs) include a measure on medical assistance with smoking cessation. That means commercial payers, as well as Medicare and Medicaid, need physicians to provide tobacco cessation counseling if the payers are to receive a favorable HEDIS score.

HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

For more information, see web link:
AAFP News Now July 29, 2009


FDA Analysis Finds Toxins, Carcinogens in Electronic Cigarettes

The idea that electronic cigarettes offer tobacco users a safer alternative than, say, a pack of Marlboros recently seems to have gone up in smoke.

The FDA issued a warning about the so-called e-cigarettes on July 23, advising consumers about health risks associated with the products, which are battery-operated devices designed to look like and be used in the same manner as regular cigarettes. The devices turn nicotine and other chemicals into a vapor that is inhaled by the user. Manufacturers have touted the smokeless products as safer than conventional cigarettes.

However, after analyzing samples of e-cigarettes and components from two leading brands, the Division of Pharmaceutical Analysis in the FDA's Center for Drug Evaluation and Research said the samples showed detectable levels of known carcinogens and toxic chemicals.

The FDA raised a number of specific issues with the products.

  • Tobacco-specific nitrosamines, which are carcinogens, were detected in half of the samples tested.
  • The tobacco-specific impurities anabasine, myosmine and beta-nicotyrine were detected in a majority of the samples.
  • The vast majority of cartridges labeled as containing no nicotine did, in fact, contain low levels of nicotine.
  • On testing three different cartridges with the same label, each cartridge emitted a different amount of nicotine.

Furthermore, FDA officials said the test results "suggested that quality-control processes used to manufacture these products are inconsistent or nonexistent." For example, diethylene glycol, a toxic ingredient used in antifreeze, was detected in one cartridge.

"Electronic cigarettes are made overseas, mainly in China, and have not previously been tested for safety," said FP Tom Houston, M.D., of Dublin, Ohio. Houston is director of OhioHealth's Nicotine Dependence Program and clinical professor in the family medicine department at Ohio State University, Columbus.

For more information, see web link:
AAFP News Now July 28, 2009


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