August 2010

Spotlight

New Findings by CDC Support Need to Eliminate Smoking in Major Motion Pictures

Despite an overall decline of onscreen smoking, new data released in the Morbidity and Mortality Weekly Report (MMWR) by the U.S. Centers for Disease Control and Prevention (CDC) highlight the large number of references to smoking still found in major motion pictures today, particularly PG-13 movies.

Over the course of 18 years, researchers from the University of California, San Francisco and Breathe California of Sacramento-Emigrant Trails tracked the number of times tobacco was used or implied in the most popular films, including the top 50 films from 1991-2001 and films ranked in the weekly top 10 from 2002-2009. Findings from the report, Smoking in Top Grossing Movies—United States, 1991-2009 found:

• Total tobacco impressions from 1991-2001 peaked at approximately 60 billion per year then declined, reaching a low of about 17 billion in 2009.
• In 2009, still 54 percent of PG-13 films featured tobacco imagery.
• Total tobacco incidents in all films fell by 50 percent in the last four years, yet incidents in 2009 (1,935) films still exceed those in 1998 (1,612).

While some progress has been made over recent years, young Americans still make up a particularly vulnerable group. Nearly 8 out of 10 current adult smokers began before the age of 18, many of whom were influenced by tobacco imagery in movies. Empirical evidence from the National Cancer Institute and a number of other researchers show that the motivating effect of onscreen smoking is a serious public health issue. Youths who are heavily exposed are approximately two to three times more likely to begin smoking than youths who are less exposed.

The report concludes that effective methods are necessary to reduce the potential harmful influence of onscreen tobacco use on young Americans. Policy recommendations by the World Health Organization have won support from a number of public health organizations, including the American Academy of Pediatrics, the American Medical Association, and Legacy, as well as political figures, such as U.S. Congressman Edward J. Markey, (D-MA) and U.S Congressman Joseph R. Pitts (R-PA).

These supporters of political invention are urging film studios to endorse four Smoke-Free Movies goals:

1. Rating "R" any new movie with smoking, with the exception of movies that depict the health consequences of smoking or actual historic figures who smoked;
2. Inserting anti-smoking public service announcements (PSAs) before movies with smoking;
3. Requiring producers to certify that no consideration of any kind was received for tobacco depictions in a film; and
4. Ending the depiction of tobacco brands on screen.

For more information, see “Smoking in Top-Grossing Movies --- United States, 1991-2009” Morbidity and Mortality Weekly Report August 20, 2010 / 59(32);1014-1017.

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Research Highlights

How Secondhand Cigarette Smoke Changes Your Genes

As if the growing number of smoking bans in restaurants, airplanes and other public places isn't sending a strong enough message, researchers now have the first biological data confirming the health hazards of secondhand smoke.

Scientists led by Dr. Ronald Crystal at Weill Cornell Medical College documented changes in genetic activity among nonsmokers triggered by exposure to secondhand cigarette smoke. Public-health bans on smoking have been fueled by strong population-based data that links exposure to secondhand cigarette smoke and a higher incidence of lung diseases such as emphysema and even lung cancer, but do not establish a biological cause for the correlation. Now, for the first time, researchers can point to one possible cause: the passive recipient's genes are actually being affected.

Crystal's team devised a study in which 121 volunteers — some of whom smoked and some of whom had never smoked — agreed to have samples of their airway cells studied for genetic activity. The subjects also provided urine so the researchers could measure the amount of nicotine and its metabolites, like cotinine, for an objective record of their exposure to cigarette smoke.

Airway cells that line the bronchus, from the trachea all the way to the tiny alveoli deep in the lungs, are the first cells that confront cigarette smoke, whether it is inhaled directly from a cigarette or secondhand from the environment. Crystal's group hypothesized that any deterioration in lung function associated with cancer or chronic obstructive pulmonary disease, including emphysema and bronchitis, in which the lungs lose their ability to take in air, would begin with these cells.

And indeed, that's what he and his team found. The researchers removed airway cells from the volunteers using a bronchoscope and tested all 25,000 identified human genes in them to determine which ones were active — either turned on or off — in response to cigarettes. They narrowed the search to 372 genes that were active among the smokers but not in the cells of the nonsmokers. Based on the level of nicotine in the urine, the scientists also divided the volunteers into three groups: smokers, who showed the highest level of the tobacco metabolites; nonsmokers, who showed none of these compounds and a low-exposure group who fell in between. Comparing the 372 genes among these three groups, they found that the low-exposure group shared 34 percent of the same active genes with nonsmokers and 11 percent of the same gene activity with smokers. The low-exposure group included both nonsmokers who have never lit up as well as those who admitted to smoking only occasionally.

The results suggest that the genetic changes among the low-exposure volunteers, some of whose exposure is exclusively secondhand, mimicked those of smokers and represent the first molecular steps toward later lung disease. The study did not follow the subjects long enough to document what effect the genetic changes may actually have on the lung tissue, but Crystal says those studies are forthcoming.

"What is interesting to me is how sensitive the lung cells are to any cigarette smoke," he says. "It doesn't matter if you are walking into a cocktail party where other people are smoking or if you smoke one cigarette a week. No matter what level of exposure you have, your lung cells know it and they are responding. It's sort of like canaries in the coal mine — they are crying out and saying, 'I'm changing here, I'm changing the genes that I turn on and off in response to this environmental stress.'"

It's not clear how permanent these genetic changes are, but previous data suggests that, at least in smokers, some of the alterations may be irreversible. Smokers experience a decline in lung function that is accelerated compared with nonsmokers, and even if they kick the habit, they can never achieve the same level of function as those who never lit up. If the genetic results are confirmed, says Crystal, they may help doctors to identify those whose genetic makeup put them at higher risk of developing lung disease when exposed to cigarettes, and potentially steer them toward drugs that can help them suppress the dangerous effects of nicotine on their cells.

In the meantime, the latest findings should reinforce public-health messages about the dangers of cigarette smoke, even if it is secondhand, says Dr. Norman Edelman, chief medical officer of the American Lung Association. "When you look at the biology, there is no safe level of exposure to tobacco smoke," he says. "This [study] adds an important piece of evidence that inhaling secondhand smoke is deleterious and does things to the airway that are not good."

For more information, see web link:
TIME August 20, 2010

New Types of Smokeless Tobacco Present Growing Risks for Youth: Survey: Products Mistaken for Candy

The decline in the U.S. smoking rate is arguably one of the biggest achievements in the nation’s public health history. But as public health makes inroads, the tobacco industry is pushing back, offering new ways to deliver nicotine and hook lifelong customers.

As nonsmoking ordinances sweep across the country, tobacco manufacturers are marketing new smokeless and spitless tobacco products, often selling them as complementary products to cigarettes — pushing the message that such "novel" tobacco products can deliver a nicotine fix whether smoking is allowed or not.

Going by brand names such as Orbs, Snus and Taboka, the products are smokeless and spitless, often dissolving in a user’s mouth. For example, Marlboro Snus comes in a teabag-like pouch that a user puts between the cheek and gum and then discards after about 30 minutes. Camel Orbs look similar to small pieces of candy — almost like a Tic Tac — come in flavors such as "fresh" and "mellow,"and dissolve in a user’s mouth. Camel Sticks and Camel Strips also dissolve in a user’s mouth. A recent Camel Snus ad reads "Boldly Go Everywhere" and "Break Free."

While such products have yet to catch on in a significant way in the United States, public health advocates warn not to underestimate the influence of tobacco marketing, especially in regard to young people. They also warn that tobacco companies seem to be portraying the novel products as a "healthier" alternative to cigarettes or as a quitting aid.

"What we have seen is that whenever concerns about tobacco and health increase, the tobacco industry, for decades, has introduced new products in an effort to expand the marketplace and interest non-users, " said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "The new products we’re seeing today — flavorable dissolvable products, heavily marketed smokeless tobacco products — are a continuation of that trend.

"Fortunately, the novel products come under the jurisdiction of the U.S. Food and Drug Administration’s new tobacco regulatory authority, which officially kicked in this June. Originally signed into law by President Barack Obama last year, the law gives FDA authority over tobacco manufacturing, marketing and sales, which means that like cigarettes, novel tobacco products must also come marked with large warning labels and submit to strict advertising rules. However, in an article published in the May issue of Pediatrics, Lawrence Deyton, MD, MSPH, director of FDA’s new Center for Tobacco Products, and Marisa Cruz, MD, also with the center, noted that while FDA’s "framework is being implemented, the landscape is shifting. "

"As state and local communities across the United States adopt indoor clean-air laws that restrict smoking in public areas and workplaces, the tobacco industry seems increasingly focused on the development and introduction of novel smokeless tobacco products, " Deyton and Cruz wrote. "This shift in focus seems to be reflected in the evolving patterns of tobacco use by youth.

"According to data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance — United States, 2009 report, which was released in June, almost 9 percent of U.S. students nationwide reported using smokeless tobacco on at least one day in the 30 days prior to the survey — an increase from previous years. In addition, a survey released in May by the Virginia Foundation for Healthy Youth found that one out of three teens surveyed incorrectly identified flavored tobacco as candy. Almost 40 percent of people younger than 18 surveyed identified Camel Orbs Fresh as mints or candy based on its packaging, and among respondents who did not currently use tobacco, 27 percent said they would try Orbs based on the packaging.

Myers at the Campaign for Tobacco-Free Kids noted that the novel products’ popularity "depends largely on whether the tobacco industry succeeds in creating an image for those products." He added that when tobacco manufacturers introduced Skoal Bandit, a product similar to Snus, in the early 1980s, few youth were using smokeless tobacco products. But within a few years, it became a fad among young people, especially among young male teens.

"The time to stop the spread of dangerous products is before they become the fad of today, Myers told The Nation’s Health.

FDA’s Tobacco Products Scientific Advisory Committee is set to begin its review of new dissolvable tobacco products that are shaped and flavored like candy. Earlier this year, the agency sent letters to tobacco manufacturers requesting information on the perception and use of such products and about the health consequences of their misuse. Besides being a serious oral health risk, dissolvable products such as Orbs, Sticks and Strips pose a poisoning risk to children. In fact, in April, some members of the U.S. Senate called on FDA to immediately recall the products from the market.

"It was clear from the very beginning that tobacco candy was de-signed and marketed to appeal to children," said Sen. Jeff Merkley, D-Ore. "Now we have clear evidence that children are not only obtaining these candies, they are being poisoned by them."

Such evidence was published in the May issue of Pediatrics. A study examined almost 14,000 tobacco product ingestion cases, 70 percent of which involved infants younger than 1. The study found that smokeless tobacco products were the second-most common tobacco products ingested by children, and such products represent an increasing proportion of tobacco ingestion among children younger than 5. The study noted that compared to cigarettes or moist snuff, novel products such as the candy-like Orbs contain a higher amount of un-ionized nicotine — the form of nicotine most rapidly absorbed in the mouth — which may enhance the product’s toxicity.

Gregory Connolly, DMD, MPH, a co-author of the study and director of the Tobacco Control Research Program at the Harvard School of Public Health, said that even though novel tobacco products typically do not contain as much nicotine as cigarettes, they create the desire for cigarettes — "it’s no accident that these have the same brand names as conventional cigarettes." But while novel products pose their own dangers, smoking remains the biggest threat, he said.

"We should keep our eye on the ball and that’s conventional cigarettes," Connolly told The Nation’s Health. "Those are the killers."

Cheryl Healton, DrPH, president and CEO of the American Legacy Foundation, the organization that created the successful youth anti-smoking campaign known as "truth," said the biggest threat from novel tobacco products are their "gateway" effect, helping to create youth who are “no longer nicotine naive and move on to more dangerous products."

Luckily, she said the same prevention tactics employed by the truth campaign — educating youth that they are "being used by adults (in the tobacco industry) to make a profit" — can also be applied to products such as Orbs and Snus.

"These novelty products represent an entryway into the tobacco market and young people who try them are much more likely to go on to smoke cigarettes," Healton said. "So, they’re not to be ignored."

For more information, see web link:
The Nation’s Health August 16, 2010  

Can Secondhand Smoke Hurt Kids' Grades?

Secondhand smoke is a well-known health threat to children, being linked to increased risks of asthma, as well as bronchitis, pneumonia and other respiratory infections. Studies have also found a connection between smoking during pregnancy and higher risks of childhood behavior problems and attention-deficit/hyperactivity disorder.

Some research has also found that children exposed to cigarette smoke in the womb or at home may trail their peers when it comes to cognitive abilities like reasoning and remembering. But whether secondhand smoke itself is to blame remains unclear.

In the new study, researchers found that among 23,000 11- to 20-year-old non-smoking students, the one-third who lived with at least one smoker were more likely to describe their own school performance as "poor."

Of students who said they were exposed to smoking at home at least five days a week, 23 percent said their school performance was poor compared with their classmates'. That rate was 20 percent among kids who had less frequent secondhand-smoke exposure at home, and 17 percent among those from smoke-free homes.

The researchers were able to account for certain other factors, like parents' education levels and the type of housing — both markers of socioeconomic status. They found that students' exposure to secondhand smoke, itself, was linked to a 14 percent to 28 percent greater risk of poor school performance, depending on how frequent the exposure was.

Dr. Sai-Yin Ho and colleagues at the University of Hong Kong report the results in the Journal of Pediatrics.

The findings do not prove that secondhand smoke was the reason for the poorer grades.

The study had a number of limitations, including its reliance on students' ratings of their own academic performance and exposure to tobacco smoke. Future studies should include objective measures of secondhand-smoke exposure, using urine samples, as well as official school records, Ho's team writes.

The researchers also could not account for the full range of factors that might be related to both secondhand-smoke exposure and children's school performance. They lacked information, for example, on whether students were exposed to smoking in the womb.

Still, Ho's team notes, it is biologically plausible that the many toxic compounds in tobacco smoke — including lead, arsenic, ammonia and hydrogen cyanide — could affect children's cognitive abilities.

Regardless of whether secondhand smoke does hurt kids' school performance, there are many established reasons for parents to quit smoking and limit their children's exposure to smokers.

These findings, the researchers write, offer another potential reason for parents to "eliminate smoking at home" and warn their children to avoid secondhand exposure.

For more information, see web link:
Fox News July 29, 2010  

Smokers can be Taught to Control Craving, Study Says

When a smoker sees someone else smoking, the sight triggers a craving to light up too. For people who have quit smoking, these impulses make them more likely to start smoking again. But new research from Yale about the neural mechanisms of addiction suggests smokers -- and possibly people hooked on other substances -- may be able to curb their cravings by using their own thoughts.

Hedy Kober of Yale University School of Medicine and her colleagues designed an experiment to test what happened when 21 smokers used a simple strategy from cognitive behavioral therapy. While they lay in a functional magnetic resonance imaging machine that monitored their brain activity, they were shown pictures of cigarettes and high-fat food.

The participants, who hadn’t eaten or smoked for two hours beforehand, had been trained to summon thoughts about cigarettes or food in two time frames. Thinking "now" focused their minds on how good it might feel to smoke or eat. Thinking "later," they concentrated on the long-term consequences of smoking or eating unhealthy food.

When the volunteers were instructed to think "later," the brain region for cognition and regulating emotions lit up on the scans. But the regions for emotions and craving showed decreased activity compared with when the "now" instruction was given. That suggests that craving can be reduced by thinking about long-term consequences.

"A lot of smokers say they feel like they are out of control," Kober said in an interview about the study appearing in Proceedings of the National Academy of Sciences. "This shows that they can control their cravings."

The difference in craving between "now" and "later" states was greater for cigarettes than food. Kober said further research is needed to see what might happen with other addictive substances. Other experiments could also test the hypothesis that people whose cognitive systems are impaired might be less able to control their cravings.

For more information, see web link:
The Boston Globe August 5, 2010

Prenatal Smoke Tied to Poorer Asthma-Drug Response

In a study of more than 1,000 kids between five and 12 years old with mild-to-moderate asthma, researchers found that those who had been exposed to smoke in the womb had less of a response to the inhaled corticosteroid budesonide (Pulmicort) than children with no prenatal exposure to smoking.

Overall, both groups of children improved with the medication. However, children with prenatal smoke exposure had 26 percent less of an improvement in their "airway responsiveness."

Airway responsiveness refers to a "twitchiness" in the airways that, in people with asthma, can be triggered by small amounts of a normally benign irritant, like pollen or pet dander.

Inhaled steroids are the mainstay of therapy for persistent asthma, helping to prevent attacks of coughing, wheezing and breathlessness.

One of the ways doctors measure whether a patient is responding to inhaled steroids is by testing airway responsiveness.

In this study, children with prenatal exposure to maternal smoking had less of an improvement in airway responsiveness after starting budesonide -- and some had no improvement at all, said Dr. Benjamin A. Raby of Brigham and Women's Hospital in Boston, one of the researchers on the study.

The full implications of the difference are not clear. The researchers did not have information on whether children exposed to prenatal smoking actually had higher rates of asthma attacks or hospital visits than other children, despite treatment with inhaled steroids.

But the findings do raise that possibility, Raby told Reuters Health.

He stressed, however, that no one is suggesting children with prenatal tobacco exposure should forgo inhaled steroids. "Inhaled steroids are the first-line therapy for persistent asthma, regardless of whether children had in-utero exposure to smoking or not," Raby said.

Instead, he explained, the findings offer a potential explanation for why a child with prenatal exposure to smoking may not be responding as well as hoped to inhaled steroids. These children may need a second type of medication -- such as oral drugs known as leukotriene modifiers -- added to their treatment in order to control their asthma, Raby said.

The study, which was led by Dr. Robyn T. Cohen of Drexel University in Philadelphia, is published in the Journal of Allergy & Clinical Immunology.

The data come from a clinical trial in which 1,041 children with persistent asthma were randomly assigned to use budesonide, another type of inhaled asthma medication called nedocromil or a placebo over four years.

Of those children, 150 had been exposed to smoking in the womb, and 39 of them were given budesonide.

The study is the first to link prenatal smoke exposure with a reduced response to inhaled steroids, which, along with the small number of children exposed, means that further research is needed to replicate the findings, according to Raby.

It is also impossible to definitively say that prenatal tobacco exposure is the lone culprit, the researcher noted. He and his colleagues did account for children's current exposure to secondhand smoke at home, but teasing out the impact of prenatal exposure by itself is difficult.

The researchers do think it is biologically plausible that prenatal tobacco exposure could affect children's later response to asthma medication.

Lab research suggests that prenatal exposure to smoke can influence the development of the lung structure or the smooth muscles of the airways, which could affect the body's later response to asthma medications.

For more information, see web link:
Reuters Health August 10, 2010

Ozone and Cigarette Smoke Worse for Asthma than Smoke Alone

Ozone generators are often used in hotel rooms, cars and private homes to get rid of the smell of cigarette smoke, but new evidence suggests that this cure may be worse than the disease. Researchers at the Univeristy of California's Lawrence Berkeley National Laboratory have found that ozone combines with nicotine and other components of cigarette smoke to produce chemicals that are a greater asthma hazard than the original smoke. In particular, the chemicals combine to form ultrafine aerosols that can carry dangerous chemicals deep into the lungs, where they trigger the development of asthma.

Environmental chemist Mohamad Sleiman and his colleagues used the Advanced Light Source at the laboratory to monitor the interaction of ozone with nicotine and other components of cigarette smoke. They reported in the journal Atmospheric Environment that, to their surprise, the chemicals reacted to form the ultrafine aerosols -- smaller than those generated by smoking itself, and thus able to penetrate more deeply into the lungs. They also generated toxic compounds with a strong potential to stimulate asthma.

"The results predict that exposure to these ultrafine particles containing many oxidized species with high 'Asthma Hazard Indices' may increase the risks of asthma," Sleiman said in a statement. “Formation of ultrafine particles appears to be a key dynamic step in the transformation of secondhand smoke to thirdhand smoke."

The Berkeley group had reported earlier this year that smoking can deposit nicotine and other products on furniture and other surfaces, where it can be released over long periods of time. This so-called thirdhand smoke constitutes a previously unsuspected source of exposure to carcinogenic and asthma-inducing chemicals. Attempting to remove the residue with ozone -- which was thought to react with the chemicals and destroy them -- can apparently create even more hazardous compounds, the researchers found.

For more information, see web link:
Los Angeles Times August 16, 2010

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Other Cessation News

HHS Announces Medicare Expands Coverage of Tobacco Cessation Counseling

Policy Playbook - New Updates Now Available

The NAQC's (North American Quitline Consortium) Policy Playbook has been updated, including new content on the pages detailed below. The Playbook focuses on promoting quitline services to smokers following the enactment of new smokefree laws or the implementation of tobacco tax increases. The strategies included in the Playbook help states maximize cessation attempts through the use of quitlines and suggests an ideal approach to accomplish this goal.

Approaches for Smokefree Implementation
Learn more about the approaches quitlines have taken to promote services during smokefree policy implementation. A new case study about North Carolina has just been published.

Tax Increases and Call Volumes
Establishing the impact of tax increases on call volumes continues to present challenges because of the many factors that impact quitline calls. Learn more about the impact 2009 tax increases had on call volumes.

Lessons Learned and Challenges
Is your state planning for the implementation of smokefree laws or tobacco tax increases? Read the lessons learned from other NAQC members.

Integrate with Tax Increases
Although there is often limited time to adequately prepare quitline promotions to coincide with tobacco tax increases, several states have successfully done so. Generate ideas by viewing promotion examples from other states. NAQC has also just released a fact sheet discussing the promotion of quitlines during tax increases.

Selecta Biosciences Receives $3 Million from NIH/NIDA to Develop Nicotine Vaccine for Smoking

Innovative BECOME AN EX Quit Smoking Program Goes Mobile

Legacy and Apperian Inc. have developed an app for iPhone to help smokers who want to quit to "re-learn" their lives without cigarettes on the go with EX. Research estimates that nearly six million people worldwide will lose their lives to tobacco this year, and in the ever-evolving mobile society, innovation in public health education is essential. The Become An EX App provides smokers with a portable version of the comprehensive three-step EX plan available online at www.becomeanex.org.

Quitting on the go just got a little easier with the Become An EX App developed with Apperian Inc. and creative conception by GSD&M Idea City. The app allows users to connect directly to the EX plan to help smokers beat their smoking cravings. Users can play games, watch videos or read top news articles to overcome an urge to smoke by re-focusing their minds on something other than cigarettes. Smokers can also use the app to monitor their smoking behavior throughout the day, so that they can have advance knowledge about when a cigarette craving will most likely hit and can be better prepared to handle it. The app also connects users to the online EX community at BecomeAnEX.org where they can provide and receive support from other EX members. The EX community is a convening point for smokers who want to quit and collaborate on their successes and challenges in the difficult quit process. The app will provide continued updates and include more features in future months.

"We are very excited to bring the EX ‘re-learn life without cigarettes’ method to the App Store," said Cheryl G. Healton, DrPH, President and CEO of Legacy. "It takes an average of 8-11 quit attempts before most smokers can quit for good and the decision to quit is by no means easy. However, access to the proper tools and resources are essential to quitting successfully and the Become An EX App will provide users access to these unique features from their phones in order to stay on track to becoming smoke-free."

"Apperian is pleased to work with Legacy and the NATC to create this innovative app," said Chuck Goldman, CEO of Apperian Inc. "We believe that the Become An EX App demonstrates how a mobile solution can play an important part in someone’s life."

The EX website provides smokers with a free three-step quit plan to help them re-learn life without cigarettes by 1) "Re-learning" their thinking on the behavioral aspects of smoking and how different smoking triggers can be overcome with practice and preparation; 2) "Re-learning" their knowledge of addiction and how medications can increase their chances for quitting success; and 3) "Re-learning" their ideas of how support from friends and family members can play a critical role in quitting.

About 70 percent of Americans who smoke want to quit, but, only about five percent of smokers are successful in quitting long-term. Quitting smoking is ultimately one of the single most important lifestyle changes people can make to improve and extend their lives. Tobacco is the leading cause of preventable death in the United States; smokers, therefore, need to be armed with all the available information to make the best, most informed choices about the smoking cessation medications and resources available to them from home or on the go.

For more information, see web link:
Legacy News Release July 22, 2010  

FDA Mulling Ban on Menthol Cigarette

With their enticing cool and minty flavor, menthol cigarettes have emerged as one of the most controversial products made by the tobacco industry.

Kids are particularly drawn to them, with nearly 45 percent of smokers aged 12 to 17 using menthol cigarettes, according to a 2009 National Survey on Drug Use and Health. Most black teenaged smokers -- and 82.7 percent of black adult smokers -- favor menthols, the same survey found.

"The manufacturers would have you believe there is not a scintilla of evidence that menthol is no more dangerous than other cigarettes to the individual smoker, but we do not agree," said Ellen Vargyas, general counsel for the American Legacy Foundation, a smoking prevention and cessation organization in Washington, D.C., founded with funding from the landmark Master Settlement Agreement between the tobacco industry and state governments. "Over 80 percent of African-American smokers smoke menthol, and African-America smokers have the highest rates of lung cancer. We also know African-Americans with lung cancer are more likely to die from lung cancer."

In addition, the popularity of menthols among younger, newer smokers suggests that maybe the minty taste does encourage people to start, perhaps by masking the harsh taste of regular cigarettes, she added.

"We know the younger you are and the newer the smoker you are, the more likely you are to smoke menthol," said Vargyas. "There is a very strong correlation between being a teenaged smoker and menthol cigarettes."

That's no coincidence, say smoking opponents: The tobacco industry has long targeted youth and minorities for menthol cigarette marketing, even manipulating menthol content in different brands in an effort to recruit new smokers among youth, according to the National Cancer Institute and the Harvard School of Public Health.

The debate over how menthols should be regulated lit up again last month, during the second round of hearings held by the U.S. Food and Drug Administration's Tobacco Products Scientific Advisory Committee.

The advisory committee was established by the Family Smoking Prevention and Tobacco Control Act, signed into law by President Barack Obama in June 2009. The legislation gave the FDA unprecedented power to restrict the marketing of tobacco products.

While the law bans cigarette makers from adding candy or fruit-like flavors such as clove, cinnamon, vanilla, cocoa or strawberry to cigarettes, legislators hedged when it came to menthols, the most popular flavoring by far.

Although menthol was not banned from cigarettes, the law stressed that nothing prevented it from regulating menthol as well. In fact, the act required the FDA advisory committee to consider menthol cigarettes impact on public health -- including its use among children and minorities-- as its first order of business.

During the first round of hearings in March, the advisory committee sought answers about the addictiveness of menthol cigarettes, whether they are more harmful than regular cigarettes and whether the flavor encourages kids in particular to take up smoking.

Anti-smoking advocates say there is no evidence that menthols -- which account for an estimated 33.9 percent of the U.S. cigarette market -- are less deadly than any other cigarette. Research from the University of Medicine and Dentistry of New Jersey, in fact, suggests that they are more addictive, making it harder for smokers to quit, particularly blacks and Latinos.

During the hearings, tobacco industry representatives defended their products, saying menthols are no more harmful than other cigarettes and should not be singled out for a ban.

"We don't think there is any evidence or even any suggestion that youth would choose not to smoke if menthol products weren't available," said Bill True, senior vice president of research and development for Lorillard Tobacco Co., the makers of Newport's. "Kids don't smoke because there are menthol cigarettes. Kids smoke for a variety of reasons which are probably quite complex."

"Cigarettes do pose significant dangers to an individual's health," True added. "In dealing with regulating the product, we believe the FDA should be looking at those things that are the most significant." On that point, anti-smoking advocates agree. Cigarettes are by their very nature a deadly product, and legislation to sharply regulate their manufacture, sale and marketing can't come a moment too soon, said Vargyas.

For more information, see web link:
MSN August 18, 2010  

Electronic Cigarettes: A Safer 'Smoke' or Another Bad Habit?

It looks like a cigarette, tastes like a cigarette, and provides the same nicotine buzz, but the electronic cigarette is a far cry from traditional smokes: for one thing, this battery-powered gadget is practically carcinogen-free.

But while users call this product a "miracle" and a "lifesaver," health authorities are wary of e-cigarettes and already several states, including New Jersey, New York, and New Hampshire, have made moves to ban them.

The e-cigarette uses an internal atomizer to vaporize nicotine, offering a smokeless, odorless, experience that manufacturers say eliminates the many health problems associated with lighting up. Affordable and readily available online by adults and minors alike, some argue that this product, which comes in flavors like chocolate or apple, is just another way for teens to get hooked on nicotine.

Public health organizations, including the Food and Drug Administration, National Cancer Society, and American Lung Association, have publically denounced the unregulated device as potentially unsafe, but that hasn't stopped thousands of smokers from going electronic.

Public Health Fears

Citing lack of research, health authorities have been quick to speak out against e-cigarettes. The American Cancer Society, Cancer Action Network, American Lung Association and others said in a statement on the product that "absent scientific evidence, these claims…that they are safer than normal cigarettes ... are in blatant in violation of FDA rules."

And suspicions about these unregulated devices are not unfounded. The FDA survey of e-cigarettes found that one brand, Smoking Everywhere, contained diethylene glycol, a toxic chemical.

"We Don't Know Enough About E-Cigarettes"

The marketing of these e-cigarettes has also been controversial. The main selling point for some advertisements is that you can puff on e-cigarettes in places that would normally ban smoking such as the office, restaurants, even airplanes.

And this is certainly a draw for most users: one California man, who wished to remain anonymous, is able to use his in the bathroom of the hospital where he works without detection.

The potential for subjecting non-smokers to the vapor of e-cigarettes led Americans for Nonsmokers' Rights to rally for bans on using them in public places:

"We don't know if the vapor is truly safe. We just don't know that much about e-cigarettes. For every environment that's already smoke-free, we believe it should be e-cigarette free," says Cynthia Hallet, executive director.

The ease of concealing an e-cigarette habit (no smoke, no smell) may also make the product more appealing to teens, some argue, and certain brands of e-cigarettes have also been accused of marketing to kids by offering candy-like flavors such as chocolate, cherry, mocha, or almond.

Though he doesn't know any teens who have latched onto the habit, Dr. Petros Levounis, director of the Addiction Institute of New York, says that "there is definitely reason for concern here."

Because teens can get them online by pretending to satisfy the age restrictions many brands place on their websites, "I wouldn't be surprised if this becomes a problem," he says.

Even if e-cigarettes lack the toxicity of tobacco cigarettes, the nicotine in them is still a stimulant substance that you would want to keep out of the hands of minors, just as you would caffeine or alcohol, says Dr. Edwin Salsitz of the Division of Chemical Dependency at Beth Israel Medical Center. Even with the controversy, e-cigarettes have increased in popularity since appearing in the U.S. about three years ago.

Complete with an LCD light that mimics a butt's glowing ember, e-cigarettes are designed to replicate the experience of smoking. An onlooker wouldn't even notice that it is vapor blowing from the "smoker's" lips, not smoke.

Puff Your Way to Nicotine-Free

"In an ideal world, I would prefer that all smokers stop smoking and stop using all nicotine products," says Dr. John Spangler of Wake Forest University Baptist Medical Center, but nicotine without tobacco is at least the lesser of two evils, especially for those smokers who are unable to quit, he adds. And according to users, the switch is often seamless. Whereas the nicotine patch, gum, or other products intended to help smokers stop smoking have high failure rates, users of e-cigarettes are more often than not immediate converts.

FDA-approved tools for smoking cessation like the patch require smokers to give up the act of the cigarette break, but with the e-cigarette, the same routine, with the same amount of puffs can remain stable while the nicotine levels are slowly decreased all the way to the allegedly nicotine-free cartridges. "Over the 18 months I've used them, I've decreased the nicotine level gradually," Wright says, "I'm well on my way to zero."

For more information, see web link:
ABCNews August 13, 2010  

Medicaid and Quitlines: A Toolbox for Expanding Medicaid Benefits and Gaining Reimbursement for Quitlines

Medicaid is the nation’s health insurance program for low-income people, functioning as a safety-net for about 60 million Americans. Those covered include pregnant women, children and parents, people with disabilities, and some seniors. They are among the sickest and most vulnerable people in the nation.

The prevalence of smoking remains higher in the Medicaid population compared to the rest of the U.S. population (MMWR, 2009). Medicaid expenditures attributable to smoking total about $22 billion annually, representing 11% of all Medicaid expenditures (MMWR, 2009). Tobacco control professionals have long been concerned with assuring that effective smoking cessation services are covered by Medicaid and available to its members.

Although progress has been made in gaining comprehensive state coverage for cessation benefits and for Medicaid payment for services provided by traditional medical professionals, significant barriers still need to be addressed to assure: adequate coverage for cessation services in all states; and Medicaid payment for services delivered by traditional medical providers, quitlines, and other qualified counselors. State quitline data shows that Medicaid members comprise about 20% of all callers to the quitlines (NAQC, 2009). An even higher number of Medicaid members could be served if the Center for Medicare and Medicaid Services (CMS) would allow payment to quitlines for their services to Medicaid members.

Call for Action

Recently enacted health care reform provides opportunities to expand tobacco control services for Medicaid members. NAQC calls on its members and partners to take action by:

1. Working with state Medicaid programs to expand coverage for tobacco cessation services to include counseling and medications as recommended by the Public Health Services Clinical Guidelines on Tobacco Use and Dependence. IN, MA, MN, NV, OR, and PA are leading the way on this.
2. In partnership with the Medicaid program, promoting Medicaid benefits and the availability of quitline services to Medicaid members. Many states are working on this with great results!
3. Working with CMS at state and national levels to allow Medicaid reimbursement for quitline services; UT and OR are leading the way at a state level. NAQC is working with other tobacco control organizations on this at a national level.

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