December 2009


Research Highlights
Other Cessation News


Research Highlights

Other Cessation News




NTCC Develops Tool Kit to Help Build Demand for Cessation

As part of the ongoing Consumer Demand work, NTCC has partnered with IDEO, the nation’s leading innovative product design firm, on a number of projects. Most recently, with funding from the Robert Wood Johnson Foundation, NTCC and IDEO developed an “innovation kit” to address the need to refine and adapt tobacco cessation products and services in order to build consumer demand for them.

To be competitive with the way tobacco companies market and design their products, tobacco cessation products and services need to be designed, communicated, and delivered with the same level of sophistication as other consumer products. This tool kit, Designing for Innovation, provides a step-by-step process to come up with innovative solutions. The aim of this kit is to help the user think about cessation as a consumer experience that can be carefully designed at every step along the quitter’s journey.

Designing for Innovation incorporates IDEO’s design principles and lays out their re-design process, including instructions for conducting the key needs assessment and re-design activities that are part of this process.

The five main steps of the process are: observe, look for patterns, brainstorm, prototype, and get feedback. The process begins with observing how a product or service is currently used, asking the users about their experience, and telling stories to understand how consumers personally resonate with their use of the product or service. The process then moves on to synthesizing the information, brainstorming ideas, creating and refining prototypes, experimenting and then spreading the ideas.

Several groups piloted the tool kit. One pilot test was conducted in Michigan by the Michigan Department of Community Health, Tobacco Section, and the Arab Community Center for Economic and Social Services (ACCESS). Clinic staff implemented the tool kit steps in order to improve the implementation of the 5A’s, provision of NRT and the related interaction between client and health care provider during the visit. Staff conducted observations during clinic visits, brainstormed ideas on how to improve the implementation of the 5A’s and the provision of NRT into the clinic visits, and then developed a standard plan for public health educators to implement the 5A’s in the clinic settings.

ACCESS staff reported that the IDEO tool kit was valuable in evaluating the agency’s current protocol of implementing the 5A’s and providing NRT to clients. They reported that the tool kit helped to identify how the tobacco use treatment sessions could be improved, such as increasing the focus on motivating factors and incentives to quitting tobacco, shortening the time of the sessions, and adding information about the Hookah because of the clients’ ethnicity and culture.

NTCC has worked with IDEO since 2005. NTCC hosted a series of Consumer Demand roundtables and a national conference to address the challenge that most evidence-based cessation products and services are under-used. In addition to convening leading cessation experts, NTCC invited IDEO to provide their expert thinking.

IDEO identified a unique set of design principles specifically related to a consumer’s experience with cessation. These principles can help those working in tobacco cessation take a fresh look at existing evidence-based products and services to identify ways to redesign and improve them. For more information on this, see Consumer Demand Design Principles: 8 IDEO Design Principles for Redesigning Tobacco Cessation Products and Services.

IDEO has worked with various types of organizations, from Fortune 500 companies to healthcare organizations to foundations in order to design and create new and more engaging consumer experiences. An article in the Harvard Business Review highlights IDEO’s process and some of its work.

Some past IDEO projects include:

Keep the Change Service—Bank of America
To attract customers and serve new markets, Bank of America engaged IDEO to identify customer-based innovation opportunities. IDEO designed the “Keep The Change” program, a service that rounds up purchases made with a Bank of America debit card to the nearest dollar, and transfers the difference to a savings account. In less than one year, Bank of America opened 700,000 new checking accounts and 1 million new savings accounts.

Redesigning the Hospital Experience—Kaiser Permanente
IDEO worked with Kaiser Permanente to improve the patient experience in hospital settings. Kaiser staff, including nurses, doctors and facility managers, as well as IDEO's social scientists, designers, architects and engineers, observed patients as they made their way through medical facilities. After this process with IDEO, Kaiser realized it needed to make patients more at ease by offering more comfortable waiting rooms, a lobby with clear instructions on where to go, and larger exam rooms that have space for three or more people and curtains for privacy.

Ripple Effect-Access to Safe Drinking Water—Acumen Fund and The Gates Foundation
Acumen Fund and IDEO, with backing from the Gates Foundation, joined forces to tackle the issues of water transport and storage. The Ripple Effect project aims to improve access to safe drinking water for over 500,000 of the world’s poorest and most underserved people; to stimulate innovation among local water providers; and to build the capacity for future development in the water sector as a whole. The project has been running since 2008 and has taken place in both India and Kenya. To date, the work in India has contributed to new distribution models, automated water vending machines, and better vessels for existing businesses.

NTCC and IDEO, along with their expertise and unique design process, continue to address the need to refine and adapt tobacco cessation products and services to improve their accessibility, appeal, delivery and use of them. To download a PDF copy of the Designing for Innovation tool kit, visit

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Research Highlights

New Survey Shows Slow Decline in Youth Smoking, Troubling Increase In Smokeless Tobacco Use

The 2009 Monitoring the Future Survey released by the National Institute of Drug Abuse shows that the nation continues to make gradual progress in reducing youth smoking, but declines have slowed significantly compared to the dramatic gains early in the decade. In especially troubling news, the survey also finds that smokeless tobacco use has increased among 10th and 12th graders in recent years, a period during which tobacco companies have introduced a slew of new smokeless tobacco products and significantly increased marketing for smokeless tobacco.

There is no question that we know how to dramatically reduce youth tobacco use. The use of proven strategies has caused smoking rates (the percentage who have smoked in the past 30 days) to decline by 69 percent among 8th graders, 57 percent among 10th graders and 45 percent among 12th graders since peaking in the mid-1990s. This is a remarkable public health success story. Before the recent increase, youth smokeless tobacco use also declined significantly from the mid-1990s to the early 2000s. However, the much slower progress in recent years is a clear warning to elected officials at all levels that they must resist complacency and redouble efforts to implement proven measures – rather than cutting tobacco prevention programs, as 34 states did this year. It is unacceptable to stand still or risk backsliding in the fight against the nation's number one preventable cause of death. It is also unacceptable that one in five high school seniors still smoke (according to the survey, 20.1 percent of 12th graders, 13.1 percent of 10th graders and 6.5 percent of 8th graders reported past-month smoking in 2009).

In addition to the lack of further progress in reducing youth smoking, the increase in smokeless tobacco use among youth is very troubling. According to the survey, there have been significant increases in smokeless tobacco use among both 10th and 12th graders in recent years. The percentage of 12th graders reporting past-month smokeless tobacco use increased from 6.1 percent in 2006 to 8.4 percent in 2009 (a 38 percent increase), while the percentage of 10th graders reporting smokeless tobacco use increased from 4.9 percent in 2004 to 6.5 percent in 2009 (a 33 percent increase).

This increase coincides with the introduction of numerous new smokeless tobacco products and a big increase in smokeless tobacco marketing. In recent years, the top two U.S. cigarette manufacturers, Philip Morris and R.J. Reynolds, have entered the smokeless tobacco market both by purchasing existing smokeless tobacco companies and introducing new smokeless tobacco products. These new products have included Marlboro snus and Camel snus that married the names of these companies' best-selling and most youth-popular cigarette brands to spitless, pouched smokeless tobacco products called snus. In 2008, R.J. Reynolds began test-marketing new dissolvable smokeless tobacco products called Camel Sticks, Strips and Orbs that look like gum and candy and come in "fresh" and "mellow" flavors. These new products no doubt appeal to kids because they are easy to conceal, carry the names of youth-popular cigarette brands and come in candy-like forms and flavors. In addition, more traditional smokeless tobacco products continue to be marketed in a wide variety of kid-friendly candy and fruit flavors.

There has also been a big increase in smokeless tobacco marketing. According to the latest data from the Federal Trade Commission, smokeless tobacco marketing expenditures totaled $354.1 million in 2006, an increase of 53 percent since 2004 and 143 percent since 1998. Smokeless tobacco marketing rose even as cigarette marketing fell slightly from 2003 to 2006. While most cigarette brands have stopped advertising in magazines with large youth readerships such as Sports Illustrated and Rolling Stone, many smokeless tobacco brands continue to advertise in these publications, most notably R.J. Reynolds' Camel snus. Also, more than 60 percent of smokeless marketing is spent on price discounts (including coupons) that make smokeless tobacco products more affordable and appealing to price-sensitive youth customers.

The Monitoring the Future survey also found a decrease in recent years in the percentage of 10th and 12th graders who perceive regular smokeless tobacco use as a great risk to health. This decline in risk perception comes as some smokeless tobacco companies have sought to portray their products as a less hazardous alternative to cigarettes. Rather than reducing the harm caused by tobacco use, the survey indicates that the main consequence of current smokeless tobacco products and marketing is to increase the number of youth who use smokeless tobacco. That is bad news for health because smokeless tobacco is far from harmless. Smokeless tobacco, as traditionally sold in the U.S., has been found to increase risk of oral cancer, gum disease and cardiovascular disease. Constant exposure to tobacco juice has also been linked to cancer of the esophagus, pharynx, larynx, stomach and pancreas.

More information on the Monitoring the Future survey can be found at

For more information, see web link:
Campaign for Tobacco-Free Kids Press Release December 14, 2009


Nicotine Levels Higher in Children Exposed to Secondhand Smoke in the Home

New research published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, supports the World Health Initiative's efforts for a home smoking ban, according to researchers at Johns Hopkins University.

Specifically, hair nicotine concentrations were higher in children exposed to secondhand smoke at home, and the younger the children, the higher the concentration under the same level of secondhand smoke exposure at home.

"This study provides adequate evidence to support home smoking bans, particularly in homes with small children," said Sungroul Kim, Ph.D., a research associate at the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

Kim and colleagues used hair nicotine concentrations as a biomarker of secondhand smoke exposure, because it is less affected by day-to-day exposure variation compared to the presence of nicotine in other body fluid samples.

The study included 1,284 children from 31 countries in Latin America, Asia, Eastern Europe and the Middle East.

Among the houses with high nicotine concentrations in the indoor air (more than 10 mg/m3 compared with less than 0.01 mg/m3), women had three times the level of hair nicotine concentrations; children had a 6.8-fold increase in hair nicotine concentrations.

Furthermore, children who were younger than 6 years old had 12 percent higher levels of nicotine concentration than those who were older. Those who spent more than 19 hours a day at home had 15 percent higher levels of nicotine concentration in their hair than those who spent less than 19 hours a day at home after adjusting other explanatory variables.

"Clearly the younger children are the most at risk; this is a call to action on a global level," said Kim.

For more information, see web link:
ScienceDaily December 5, 2009


Secondhand Smoke Exposure in Childhood Increases Lung Cancer Risk Later in Life

Children exposed to secondhand cigarette smoke have an increased risk of developing lung cancer in adulthood, even if they never smoked.

Results of this study are published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, as part of a special tobacco focus in the December issue.

This year alone, more than 219,000 Americans will be diagnosed with lung cancer; more than 159,000 will die from it and some of those may be people who have never smoked. Studies to date have shown that exposure to secondhand smoke in adulthood has detrimental health effects, but data are limited on one's risk of developing lung cancer when exposed as a child.

What makes this study different from previous research is that it was conducted in two independent cohorts and included a molecular analysis of gene variants of innate immunity -- the mannose binding lection-2 gene, or MBL2 gene. The MBL2 gene is known to affect susceptibility to respiratory diseases.

Using the ongoing National Cancer Institute-Maryland Lung Cancer study (624 cases; 348 controls), Curtis C. Harris, M.D., chief of the Laboratory of Human Carcinogenesis at NCI, and colleagues collected information on secondhand smoke history among men and women. They used DNA for genotyping the MBL2 gene. Then, to compare, Harris, Ping Yang, M.D., Ph.D., professor of epidemiology at the Mayo Clinic in Rochester, Minn., and colleagues used results from a Mayo Clinic study (461 never smokers; 172 cases; 289 controls).

Harris and colleagues found an association between childhood exposure to secondhand tobacco smoke and increased risk of lung cancer in adulthood. Furthermore, MBL2 activity was associated with an even more increased risk among those who were exposed to secondhand smoke in childhood.

Based on the results of this study, Harris said "children should not be exposed to secondhand tobacco smoke due to the long-term health implications they can face in adulthood." He added that these results warrant further investigation in a larger study population.

For more information, see web link:
ScienceDaily December 4, 2009


African American and Hispanic Adults Smoking Menthol Cigarettes Less Likely to Quit Smoking

African American and Hispanic adults who smoke menthol cigarettes may be less likely to quit smoking than those who smoke regular cigarettes, a new study by researchers at the UMDNJ-School of Public Health has found. The report, published in the December issue of Preventive Medicine, is believed to be the first to use national statistics to examine the association between menthol cigarettes and smoking cessation among adults.

The researchers analyzed data from the 2005 National Health Interview Survey and identified 7,815 current and former cigarette smokers who had reported at least one attempt to quit smoking. Just 43.7 percent of African American adults and 48.1 percent of Hispanic adults who smoked menthol cigarettes were able to quit smoking. African Americans and Hispanics who smoked non-menthol cigarettes had similar quit rates to white adults (62.1 percent and 61.2 percent, respectively). Overall, the researchers noted that non-whites tend to smoke fewer cigarettes per day and are about three times more likely than whites to smoke menthol cigarettes.

"Historically, tobacco companies have targeted minority populations when marketing menthol cigarettes," said Cristine Delnevo, PhD, director of the Center for Tobacco Surveillance and Evaluation Research at the UMDNJ-School of Public Health and one of the authors of the study. "Although whites and non-whites have similar smoking prevalence rates, the fact that non-whites are more likely to smoke menthols, and those who smoke menthols are less likely to quit, could explain why minority populations continue to suffer disproportionately from tobacco-caused disease and death."

Daniel Gundersen, lead author and a doctoral student at the UMDNJ-School of Public Health, added, "With the substantial number of smokers smoking menthol cigarettes, particularly among minorities, this is serious cause for concern."

The researchers noted that the Family Smoking Prevention and Tobacco Control Act, which became law earlier this year, banned the use of flavorings in cigarettes, but specifically excluded menthol, citing the need for further research into the impact of menthol cigarettes on youth and minorities.

For more information, see web link:
The Medical News December 4, 2009


Smoking Exposure Now Linked to Colon, Breast Cancers

Add colorectal cancer to the list of malignancies caused by smoking, with a new study strengthening the link between the two.

And other studies are providing more bad news for people who haven't managed to quit: Two papers published in the December issue of Epidemiology, Biomarkers & Prevention, a themed issue on tobacco, strengthen the case for the dangers of secondhand smoke for people exposed to fumes as children and as adults.

Inhaling those secondhand fumes may raise a woman's odds for breast cancer or a child's lifetime risk for lung malignancies, the studies found.

All of the findings, while grim, could be useful in the war against smoking, experts say.

Is this latest round of revelations going to change current screening recommendations? Probably not, at least not yet, said Dr. Peter Shields, deputy director of the Georgetown University Lombardi Comprehensive Cancer Center and senior editor of the journal in which these papers appeared.

One study found that long-term smokers have a higher risk of developing colorectal cancer, a finding that factored into the recent decision by the International Agency for Research on Cancer (IARC) to assert that there is "sufficient" evidence to link the two, up from its previous "limited" evidence.

"It took a long time to figure this out because the relationship [between smoking and colorectal cancer] is not as strong [as for some other cancers]," said Dr. Michael Thun, senior author of the study and vice president emeritus of epidemiology and surveillance research at the American Cancer Society. "The question was, is the association we're seeing really caused by smoking?"

The researchers managed to adjust for other colorectal cancer risk factors, such as not getting screened, obesity, physical activity and eating a lot of red or processed meats. The issue is tricky because people who smoke are already more likely to engage in these types of behavior.

"When they took all of those other things out, smoking was still a small, elevated risk," said Dr. Michael John Hall, director of the gastrointestinal risk assessment program at Fox Chase Cancer Center in Philadelphia.

"We already know that smoking is bad. That doesn't change. A positive thing that comes out of this is that if you can stop smoking earlier, you eliminate your risk later on, but the more you smoke, the risk is higher."

This large prospective study, which followed almost 200,000 people over 13 years, found that current smokers had a 27 percent increased risk of colorectal cancer and former smokers a 23 percent increased risk compared with people who had never smoked.

People who had smoked for at least half a century had the highest risk -- 38 percent higher than never smokers -- of developing colorectal cancer.

The good news is that people who tossed their cigarettes before the age of 40 or who had not smoked for 31 or more years had no increased risk.

With the new classification on smoking causing colorectal cancer, 17 cancers are now attributed to smoking.

For more information, see web link:
US News & World Report December 3, 2009


Acculturation Influences Smoking Cessation by Latino Men

Latino men who are more adapted to U.S. culture are more likely to quit smoking than their less-acculturated counterparts, according to research by scientists at The University of Texas M. D. Anderson Cancer Center published in the December issue of Cancer Epidemiology, Biomarkers and Prevention, which has a special emphasis on tobacco.

The researchers found that acculturation has no effect on the likelihood of Latinas quitting smoking. The study of 271 Latino smokers who called a Spanish-language smoking cessation Quitline examined the influence of gender and indicators of acculturation on the ability to quit smoking.

The number of years and the proportion of life spent in the United States, along with English preference for watching news and television programs, were positively related to smoking cessation for men.

"Successful tobacco control efforts must place a special emphasis on reaching Latinos and other underserved groups who have greater difficulty quitting and less access to pharmacological or behavioral treatment," said lead author Yessenia Castro, Ph.D., a postdoctoral fellow in M. D. Anderson's Department of Health Disparities Research. "Our findings indicate that smoking cessation outreach to Latinos also needs to take into account male smokers who have lived in the United States for short periods and who prefer Spanish."

While the researchers uncovered important acculturation-related predictors of smoking cessation, Castro says cultural adaptation probably affects smoking indirectly by influencing other important variables, such as levels of stress, social support, feelings of competency or depression.

"It's critically important for us to understand the mechanisms by which acculturation affects smoking," Castro said. "It's these variables that can and should be targeted in treatment." Castro, senior author David Wetter, Ph.D., professor and chair of Health Disparities, and colleagues are addressing that issue with a long-term cohort study of Mexican-origin smokers.

"Advancing knowledge in these areas can help identify treatment targets, improve current smoking cessation interventions and ultimately aid in eliminating smoking-related health disparities among Latinos," Castro said. "This information can be used to guide tobacco control efforts and media campaigns."

Castro and colleagues initially examined six acculturation factors: years in the United States, proportion of life lived in the United States, immigrant/non-immigrant status, language spoken at home, language spoken at work, and preferred media language. Of those, only language spoken at home and at work were not significant. Data indicated differences by gender in the four remaining areas.

Follow-up analyses indicated no acculturation impact for women, and significant effects for men in years and life proportion spent in the United States and preference for English as the media language.

For example, men who had been in the country for up to five years had about 20 percent abstinence rate at the three-month follow-up point after participating in the Quitline program. But more than 35 percent of men who had been in the U.S. for 23-76 years abstained.

Those who preferred to view news and entertainment mainly or exclusively in English had a 48 percent abstinence rate after three months, while 20 percent of those who preferred Spanish were still not smoking.

For more information, see web link:
ScienceDaily December 3, 2009


No Evidence that Hookah Smoking Is Less Harmful than Cigarette Smoking

Waterpipe smoking is a global phenomenon, especially among adolescents and young adults, driven in part by the belief that this method of tobacco smoking is associated with less exposure to toxic substances and fewer health risks than cigarette smoking. However, a recent study by Drs. Thomas Eissenberg of Virginia Commonwealth University in Richmond and Alan Shihadeh of the American University of Beirut, Lebanon, found that waterpipe tobacco smoking, commonly known as hookah smoking, is associated with greater exposure to carbon monoxide (CO), similar nicotine levels, and “dramatically more smoke exposure” than cigarette use.

The study, published in the December 1 American Journal of Preventive Medicine, involved 31 adults who were each tested after smoking one cigarette and after a 45-minute waterpipe smoking session. CO levels in the blood increased on average by 23.9 parts per million (ppm) after waterpipe smoking, versus 2.7 ppm after smoking a cigarette. The waterpipe smoking session generated more than 40 times the smoke volume compared with a cigarette. Peak nicotine concentrations were similar for cigarette and waterpipe use, but due to the longer duration of waterpipe sessions, “participants were exposed to 1.7 times the nicotine dose” relative to the dose from a cigarette, the researchers reported.

“These data provide no support for the notion that waterpipe tobacco smoke is less lethal than cigarette smoke,” Drs. Eissenberg and Shihadeh concluded. Instead their findings, along with other published studies, “suggest that waterpipe tobacco smoking is likely associated with many of the same tobacco-caused diseases as cigarette smoking, including cancer, cardiovascular and lung disease, and nicotine dependence,” the authors stressed. “Today’s challenge is to reduce current waterpipe tobacco smoking and prevent its further spread.” They expressed hope that their findings will be used by physicians and health authorities to counter public misperceptions about the relative harm of this type of tobacco use.

For more information, see web link:
NCI Cancer Bulletin December 1, 2009


Children Unaffected by Smoking Ban Consequences

The smoking ban in Wales has not displaced secondhand smoke from public places into the home. A study of 3500 children from 75 primary schools in Wales, published in the open access journal BMC Public Health, found that they were exposed to similar amounts of secondhand smoke before and after legislation, which should reassure those worried that exposure to smoking at home could increase following the ban.

Dr. Jo Holliday and colleagues at Cardiff University's School of Social Sciences carried out the study, funded by the Welsh Assembly Government. They measured the levels of cotinine, a marker of exposure to cigarette smoke, in the saliva of approximately 1750 year 6 children before and after the ban, as well as asking the children about their experiences of passive smoking. Holliday said, "Concerns have been expressed regarding the potential displacement of smoking from public places into the home, affecting non-smokers and, in particular, children. We found that the smoke-free legislation in Wales did not increase second-hand smoke exposure in homes of children aged 10-11. Nevertheless, the home did remain the main source of children's exposure".

The researchers point out that the measured levels of passive smoking still represent a public health concern. According to Holliday, "Almost 40 percent of children had a cotinine concentration above 0.17ng/ml, a level associated with lung dysfunction, and almost six percent of children had salivary cotinine concentrations higher than those of non-smoking Scottish bar workers prior to the introduction of similar legislation in Scotland".

For more information, see web link:
EurekAlert Novmber 30, 2009


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Other Cessation News

San Francisco May Expand Smoking Ban

San Francisco, which was at the vanguard of the anti-smoking movement more than a decade ago when it became one of the first American cities to bar people from lighting up in the workplace, now is poised to enact much tougher restrictions on smoking in public places.

Smokers no longer would be allowed to puff away near the doors, vents and operable windows of any building - restaurants, shops, offices and housing complexes.

Diners no longer would be able to smoke at outdoor tables. Smoking would be banned from farmers' markets, lines for movie theaters, concerts and sporting events, near ATMs and cab stands. The smoking ban in and near transit stops would be expanded.

The city already bans smoking in parks and taxicabs.

The goal, said Supervisor Eric Mar, chief sponsor of the legislation that was introduced Tuesday, is "to protect San Francisco's most vulnerable residents from secondhand smoke."

If approved, San Francisco would join a long roster of Bay Area communities - among them Belmont, Palo Alto, Hayward, Novato and Berkeley - that have made it more difficult for people to find a legal place to smoke. Health risks

The push to curb smoking in places where people congregate accelerated after the surgeon general and the California Air Resources Board issued reports in 2006 that highlighted the health risks associated with exposure to secondhand smoke: lung cancer, heart attacks and asthma among them.

Mar's measure has the strong backing of San Francisco public health officials, who view smoking bans as a beneficial tool to prevent deadly and chronic diseases.

"The ordinance really is trying to reflect the current research on secondhand smoke," said Alyonik Hrushow, who runs the Department of Public Health's Tobacco Free Project.

The restrictions would not go as far as those in some cities, most notably Richmond, which include smoke-free housing laws, but they're a step in that direction, said Serena Chen, the American Lung Association's Bay Area director of policy and tobacco programs.

The San Francisco proposal would prohibit smoking in courtyards, yards, hallways, elevators, lobbies, stairwells, laundry rooms and other common areas of any residential property with two or more units. People who smoke outside would have to stand at least 10 feet away from doors and windows. And anyone who smokes inside their own apartment would be required to keep their doors shut. Single-family homes would not be affected.

The San Francisco Apartment Association, which represents the interests of landlords, has not taken a position, but "supports the concept," said executive director Janan New.

The powerful Golden Gate Restaurant Association no longer opposes the plan. Kevin Westlye, the group's executive director, said making smokers stay 15 feet away from the businesses' doors, windows and vents - instead of 20 feet - is more reasonable.

Westlye said restaurant owners still have concerns that banning smoking at outdoor tables would hurt business, but the prospect of protecting their employees from secondhand smoke won out. "We don't want to put our staffs at risk," he said.

The San Francisco Chamber of Commerce, however, isn't ready to endorse the expanded restrictions, said Rob Black, vice president of public policy for the business group. He said nightclub owners have expressed apprehension over the proposal to ban smoking in front of their premises because it would tamp their ability to control crowds.

For more information, see web link:
San Francisco Chronicle December 16, 2009


Approval of Michigan Smoke-Free Legislation Is Historic Win for Health

The Michigan Legislature delivered a historic victory for health and the public's right to breathe clean air by passing legislation to make almost all workplaces, including all restaurants and bars, smoke-free. Gov. Jennifer Granholm has said she will sign the bill, which will make Michigan the 27th state to pass a strong smoke-free law that includes all restaurants and bars. This legislation is a huge step forward for Michigan's health that will protect workers and the public from the serious health hazards of secondhand smoke.

We applaud the leadership and persistence of the many individuals and organizations that have fought the long battle to make Michigan smoke-free. It is a fitting tribute that the bill is named after the late Ron Davis, M.D., a tobacco control leader nationally and in Michigan and past president of the American Medical Association. It is, however, disappointing that the legislation includes an exemption for the gaming floors of existing casinos. Casino workers deserve the same protection from secondhand smoke as other workers. No one should have to put their health at risk in order to earn a paycheck or enjoy a night out.

The Michigan legislation, which takes effect May 1, 2010, adds to the growing momentum across the country and around the world to protect everyone's right to breathe smoke-free air. Once the Michigan law and all other state and local laws have been implemented, 62 percent of Americans will be protected by strong smoke-free laws that include restaurants and bars.

Michigan joins 26 other states, Washington, D.C., and Puerto Rico in enacting smoke-free laws that cover restaurants and bars. The other states are Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina (effective Jan. 2, 2010), Ohio, Oregon, Rhode Island, Utah, Vermont, Washington and Wisconsin (effective July 5, 2010). South Dakota has also enacted such a law, but it is on hold pending a voter referendum in November 2010.

A growing number of countries have also passed strong smoke-free laws, including Bhutan, Chad, Colombia, Djibouti, Guatemala, Guinea, Iceland, Iran, Ireland, Lithuania, Marshall Islands, Mauritius, New Zealand, Norway, Panama, Turkey, Tuvalu, the United Kingdom, Uruguay and Zambia. All Canadian provinces/territories and Australian states/territories have also enacted such laws.

For more information, see web link:
Campaign for Tobacco-Free Kids Press Release December 10, 2009


New Report: States Cut Funding for Tobacco Prevention Programs Despite Receiving Record Amounts of Tobacco Revenue

The states are collecting record amounts of revenue from the 1998 tobacco settlement and tobacco taxes, but have cut funding for programs to reduce tobacco use by more than 15 percent in the past year, according to a report released by a coalition of public health organizations.

With the nation's adult smoking rate stalled after decades of decline, the report warns that continued progress is at risk unless states significantly increase funding for programs to prevent kids from smoking and help smokers quit. The report also calls on Congress to ensure that health care reform legislation includes adequate funding for disease prevention initiatives, including tobacco prevention and cessation, and mandates coverage in Medicaid and other health insurance programs for smoking cessation medication and counseling.

The report, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 11 Years Later," was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association and Robert Wood Johnson Foundation. These organizations have issued annual reports assessing whether the states have kept their promise to use funds from the state tobacco settlements — estimated to total $246 billion over the first 25 years — to fight tobacco use. The states also collect billions more each year from tobacco taxes.

Key findings of this year's report include:

  • The states this year (Fiscal Year 2010) will collect $25.1 billion in revenue from the tobacco settlement and tobacco taxes, but are spending just 2.3 percent of it — $567.5 million — on tobacco prevention and cessation programs (the states also receive $62 million in federal grants for tobacco prevention, for total funding of $629.5 million). With more states expected to increase tobacco taxes in the coming year, that revenue figure is certain to increase.
  • In the past year, states have cut funding for tobacco prevention by $103.4 million, or 15.4 percent. Including recent cuts approved, New York made the largest cut — $25.2 million, or 31 percent — despite having a successful program that has reduced smoking to well below national rates. Other states with large cuts include Colorado, Maryland, Pennsylvania and Washington.
  • Only one state — North Dakota — currently funds a tobacco prevention program at the level recommended by the U.S. Centers for Disease Control and Prevention (CDC). Only nine other states fund tobacco prevention at even half the CDC-recommended level, while 31 states and DC provide less than a quarter of the recommended funding.
  • Tobacco companies spend $20 to market tobacco products for every one dollar the states spend to fight tobacco use. According to the latest data from the Federal Trade Commission, tobacco companies spend $12.8 billion a year on marketing.

The report comes as recent surveys have found that smoking declines in the United States have slowed and even stalled. The CDC in November reported that the adult smoking rate in 2008 was 20.6 percent — essentially unchanged since 2004 when 20.9 percent smoked. While smoking among high school students has declined by 45 percent from a high of 36.4 percent in 1997, 20 percent of high schoolers still smoke and declines have slowed in recent years.

The report cites conclusive evidence that tobacco prevention and cessation programs work to reduce smoking, save lives and save money. Maine, which has long had one of the best-funded programs, has reduced smoking by 71 percent among middle school students and by 64 percent among high school students since 1997. Washington state, before cutting its program by 42 percent this year, reduced adult smoking by 30 percent and youth smoking by 50. An August 2008 study found that California's tobacco control program, the nation's longest-running, saved $86 billion in health care costs in its first 15 years, compared to $1.8 billion spent on the program, for a return on investment of nearly 50:1.

For more information, see web link:
Campaign for Tobacco-Free Kids Press Release December 9, 2009


Reynolds American Buys Niconovum

Reynolds American Inc. has officially reached an agreement to purchase all outstanding shares of the Swedish-based nicotine replacement therapy company Niconovum AB for 310 million Swedish kronor, or approximately $44 million. Niconovum markets innovative nicotine replacement therapy (NRT) products under the Zonnic brand name in Sweden and Denmark. Its nicotine gum, mouth spray and pouches use proprietary technology for nicotine delivery.

CSP Daily News reported on the impending deal in early November.

"Niconovum's products have great potential in meeting consumer demand and public health objectives," said Susan M. Ivey, chairman, president and chief executive officer of Reynolds American. "This acquisition extends the harm-reduction strategies RAI and its operating companies have been developing over the past several years.

She added, "Longer term, we believe the acquisition of Niconovum will enable an RAI operating company to provide adult tobacco consumers with innovative cessation products that have the potential to reduce the risks of diseases and death caused by tobacco use.

Ivey said that RAI intends to provide Niconovum with the investment capital it needs to focus on product development and the testing required to enter additional markets.

"We believe the technology used in our Zonnic products better meets consumer preferences than other NRTs currently on the market," said Nils Siegbahn, president and chief executive officer of Niconovum. "With today's announcement, Niconovum will have access to the capital it needs to expand distribution of Zonnic to additional markets, and accelerate product refinements and new product development."

Niconovum will be a separate operating company of Reynolds American, and the transaction is expected to be completed by year-end. Founded in 2001, Niconovum is based in Helsingborg, Sweden. Reynolds American's intention is to retain Niconovum's current management team, and its headquarters will remain in Helsingborg.

Winston-Salem, N.C.-based Reynolds American is the parent company of R.J. Reynolds Tobacco Co., Conwood Co. LLC and Santa Fe Natural Tobacco Co. Inc. R.J. Reynolds Tobacco is the second-largest U.S. tobacco company. The company's brands include five of the 10 best-selling cigarettes in the United States: Camel, Pall Mall, Winston, Kool and Doral. Conwood is the nation's second-largest manufacturer of smokeless tobacco products.

For more information, see web link: December 7, 2009


Nicorette Puffs $15 Million Into Ad Blitz

Drug maker GlaxoSmithKline wants people to know that it "sucks" to quit smoking, but there's a way to make it "suck less."

The maker of Nicorette, an over-the-counter nicotine-infused gum that helps some cigarette smokers wean themselves off nicotine, is launching a $15 million campaign that will break on prime-time TV networks ABC, CBS, and NBC. The ad blitz, created by Omnicom ad agency TBWAChiatDay, will feature four 30-second spots with the tagline, "Quitting sucks. Nicorette Makes It Suck Less," that will air until April. Print ads that look like an open letter to cigarette lovers (saying, "Dear Smokers, 2010 is going to suck") will run in magazines such as ESPN, Time and People. The company will spend $15 million between now and the middle of 2010, then another $15 million in the second half of the year.

Nicorette's campaign is an effort to boost business in 2010. It's coming out at the turn of a new year, when smokers make giving up cigarettes a New Year's resolution. "It's a point in time when millions of people are looking for help and we'd like to be there for them," says Michael Roe, marketing director of U.S. Smoking Control at GlaxoSmithKline Consumer Healthcare. Of the 46 million adult smokers in the U.S., 70 percent say they'd like to quit, but less than 5 percent actually do, he says.

The ad blitz also comes at a time when another company is moving in on GlaxoSmithKline's turf. Tobacco giant Reynolds American announced last month plans to buy Niconovum, a Swedish maker of smoking-cessation products. Niconovum's nicotine-replacement wares, Zonnic pouch and Zonnic gum, aren't currently available in the U.S., but they will be once the sale is finalized. Their arrival will create more competition for brands Nicorette and Nicoderm, GSK's nicotine patch product. Global sales of nicotine replacements for last year were an estimated $900 million, of which GSK dominated, with a 55 percent market share, according to research company Nielsen.

The theme of the campaign, which intends to offer smokers empathy, is expected to continue in what will be a five-year broadcast blast to increase consumer awareness for Nicorette, which is sold in boxes that retail for about $45 for 110 pieces of the gum. The company is focusing on the chewing gum over its patch product Nicoderm because it believes the gum is more accessible for first-time quitters, says Roe. Both products make quitting suck less, he says.

For more information, see web link: December 7, 2009


Electronic Cigarettes Under Fire for Targeting Arizona Kids

In a hidden camera investigation, the ABC15 Investigators found Arizona electronic cigarette kiosk salesmen selling their nicotine device to kids.

It is not illegal. But, there is controversy over what the devices do to our bodies.

Amir Hakak operates electronic cigarette kiosks in four Valley malls.

He said the e-cigarette helps people kick the real habit.

“It is the same as the patch or the gum. Actually, we add the vapor to it. The smoker gets the sensation, you feel you smoke; you trick the mind,” said Hakak.

It closely resembles a real cigarette. It blows smoke and has nicotine, but has no tobacco. The vapor is actually water.

It comes with a battery and filter in a variety of flavors.

And, it contains nicotine which not only makes it addictive; it also makes it come under the scrutiny of the Food and Drug Administration.

Last July, the FDA found dangerous chemicals in some electronic cigarettes they tested including diethylene glycol, a chemical used in antifreeze that is toxic to humans.

So then why are these e-cigarettes sold in a variety of flavors at kiosks in the mall -- where teens regularly hangout?

That's the question John Wickwire asked when his 17-year-old son came home from the mall.

“He come (home) excited and saying, 'Oh yeah, there's this new thing. It's so cool. They have these flavors,' and I'm like, 'what is it?' Oh, it's this new kind of cigarette,” said Widkwire.

“We think this is cutting edge,” said former Arizona congressman, Matt Salmon, who helped push through one of the first public smoking bans.

He doesn't smoke, but has seen devastating effects of smoking on his family members.

“Our product is marketed to long-term committed smokers who are killing themselves with combustible tobacco,” said Salmon.

Today, Salmon leads the Electronic Cigarette Association with very specific rules: they don't make health claims, don't sell to minors, and say they shouldn't be sold at kiosks in the mall. And just like real cigarettes, they should not sell flavors targeting children.

But, we found just the opposite. Using a hidden camera, we went to a "Smoking Everywhere" kiosk in the Arrowhead Mall in Glendale.

Not only did the salesman make health claims saying the E-cigarette helps with influenza and pneumonia, but he sold it to our underage shopper.

With permission from his parent, Zach asked to buy the nicotine refills. They sold him 10. They never asked him for his I.D. and never even asked him his age. He is 16.

“This was a critical mistake,” said Hakak, “You can come and check at each of our locations again. There is no way that it could happen again. “

Well, 10 days later, we went back to the same kiosk in the same mall with the same child.

And the very same thing happened. Once again, Zach bought 10 nicotine refills. No one asked him his age or for his I.D.

The only difference this time was that they charged him half as much.

Wickwire thinks there's a better place for this product than the mall.

“It's nicotine. It's addictive. It should be in a drugstore,” said Wickwire.

The FDA warns against the product being sold to minors because of limited testing.

Many countries have banned the cigarettes. But in the U.S., only one New York county bans them.

Visit the FDA’s website for more information about electronic cigarettes.

For more information, see web link: December 7, 2009


Survey: Fewer Cigarettes To Minors in Kentucky

Kentucky vendors have reached record-level compliance with a state law preventing tobacco sales to minors, according to a recently released survey from the Cabinet for Health and Family Services (CHFS).

The 2009 Annual Synar Buying Survey of retail tobacco outlets showed that 96.5 percent of retailers complied with the law barring tobacco sales to anyone under the age of 18.

The Department of Alcoholic Beverage Control (ABC) conducted the survey during the summer to measure the rate of illegal sales of tobacco to Kentucky youth. The survey was completed in cooperation with the Division of Behavioral Health in the Department for Behavioral Health, Developmental and Intellectual Disabilities (BHDID), part of CHFS.

"Reducing the prevalence of tobacco sales to minors is a crucial piece of our work to prevent youth smoking and tobacco use," said CHFS Department for Public Health Commissioner William Hacker, M.D.

"The results of this survey indicate we’re moving in the right direction. Fewer people are dependent on tobacco products – which is the mission of our substance abuse program, the Alcoholic Beverage Commission (ABC), the Department of Agriculture and the Office of Drug Control Policy (ODCP)."

In addition to vendor compliance checks, Kentucky is engaged in numerous efforts to reduce the prevalence of smoking. Gov. Steve Beshear recently announced a partnership with the Legacy Foundation to promote the "Become an Ex" campaign – a mass marketing campaign to encourage people to stop smoking – across the state. Similarly, Kentucky legislators voted during the 2009 legislative session to increase the state excise tax on cigarettes by 30 cents, bringing the state tax to 60 cents per pack. The state tax increase took effect April 1.

Kentucky’s Synar rate remained around 94 percent from 2003 until last year when it increased to 95.3 percent. This year’s 96.5 percent is a sharp increase from a low of 80.3 percent in 1999.

Tony Dehner, ABC commissioner, emphasized the importance of cooperation in the effort to combat youth access to tobacco products.

"The ABC considers our role in the annual survey extremely important in the effort to reduce youth access to tobacco," said Dehner. "Through the checks we conduct, retailers get the message that Kentucky is serious about preventing sales to minors, and many make sure to educate their staff on verifying the customer’s age. The prevention of underage tobacco sales helps to create safer and healthier communities."

"Kentucky once again has a low rate of non-compliance, which is an important step for us as we continue to reduce youth access to tobacco," said Van Ingram, ODCP executive director.

"Through the efforts of the Regional Prevention Centers, the Division of Behavioral Health, ODCP and ABC, the health of young Kentuckians is being improved by reducing the illegal use of tobacco products."

For more information about this program and other substance abuse prevention or treatment programs, call Johnnie Woods at (502) 564-4456.

For more information, see web link:
The Kentucky Post December 2, 2009


Professional Rodeo Cowboys Association Ends Tobacco Sponsorship; Grassroots Activists Applaud PRCA, Call for a Healthy Sponsor to Replace Big Tobacco

As thousands gathered in Las Vegas for the largest U.S. rodeo event of the year, activists praised the Professional Rodeo Cowboys Association (PRCA) for ending its national sponsorship contract with the U.S. Smokeless Tobacco Company (USSTC) after 2009.

"We applaud the PRCA for ending tobacco sponsorship of its rodeos," said Andrea Craig Dodge, director of the Buck Tobacco Sponsorship Project. "Tobacco marketing including sampling booths, scoreboards, banners, and ads gives young rodeo audience members the message that using tobacco is part of being an adult cowboy or rodeo fan."

For several years, a number of tobacco control advocates and community members have called for an end to tobacco sponsorship of rodeos. "Rodeo has been around since the 1800s - long before tobacco sponsorship of rodeos began in 1986," said "Cowboy Ted" Hallisey, a longtime print and broadcast journalist for the sport of rodeo. "Without big tobacco, rodeos will move into mainstream sports because they will be more comfortable for children and families to attend," he said.

"Rodeo has been growing in popularity," said Mark Hicks, project coordinator at Wyoming Through With Chew. "Now that the PRCA is ending its association with USSTC, the sport will thrive even more."

Nationwide, 14 percent of boys ages 12 to 17 use smokeless tobacco, and the rates are higher in rural states, according to the Centers for Disease Control and Prevention.

Dodge, Hallisey, and Hicks are collaborating with advocates around the country to circulate an open letter praising the PRCA for allowing its sponsorship agreement with USSTC to expire, and encouraging them to take this opportunity to establish the PRCA as a tobacco-free sport. They are also working with the Campaign for Tobacco-Free Kids to obtain grassroots support for their efforts. "The Campaign for Tobacco-Free Kids has set up a website at that allows grassroots advocates to email the PRCA to encourage them to replace USSTC's sponsorship with a healthy sponsor," said Dodge.

The Buck Tobacco Sponsorship Project, a program of Public Health Law & Policy, Public Health Institute, has worked since 2002 to end tobacco marketing at rodeos and other family-oriented outdoor events. For more information, visit

Cowboy Ted's Foundation For Kids is a 501(c)(3) organization that works with youth across the United States to encourage them to make Healthy Choices. Their mission statement is to introduce young people to positive role models who encourage youngsters to choose a healthy lifestyle for themselves, including the choice to refuse to use tobacco products. For more information, visit

Wyoming Through With Chew began in 2002. Many of their programs are featured on, a resource for tobacco prevention advocates, healthcare providers, and other organizations and individuals who care about tobacco prevention, education, and cessation.

For more information, see web link:
AScribe Newswire December 1, 2009


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