December 2010

Spotlight

Upcoming Launch for What Works? A Guide to Quit Smoking Methods

While 70 percent of U.S. smokers report that they want to quit, only a fraction uses evidence-based treatments in their quit attempts. One of the key reasons for this trend is the lack of knowledge and understanding of what cessation methods are most effective. Current cessation recommendations can be hard to understand, and in many cases evidence-based treatments are presented negatively by those marketing unregulated, non-evidence-based treatments (such as hypnotherapy, acupuncture, and laser therapy).

NTCC, through funding from the Robert Wood Johnson Foundation, has developed a “Consumer Reports” style card, What Works? A Guide to Quit Smoking Methods, to help smokers choose appropriate methods for quitting. The content of the card is based on Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline, and was developed in collaboration with Dr. Michael Fiore and others on the Guideline panel. To supplement the printed Guide, a companion website was also developed to provide smokers with more detailed information. Visitors to the website can review explanations of each of the cessation approaches.

In anticipation of the “quitting season” in January 2011 as many smokers resolve to quit, as part of their new year’s resolutions, NTCC will promote the What Works? materials through digital sources. Some of the digital marketing plans for What Works? include:

• Mobile What Works? Site

NTCC will create a mobile version of the What Works? website so that smokers can access the website on their mobile devices.



• Mobile Marketing

Text advertisements will be placed in mobile applications and mobile sites to reach smokers.

• Search Engine Marketing

Ads, with calls to action, will appear alongside relevant online searches as well as related web and mobile content.

• Social Media

Social media outreach will be conducted via Facebook advertisements, blogger outreach, share buttons on the What Works? website, and a description of What Works? on Wikipedia.

Finally, another critical component of this initiative will involve measurement of the scope and effectiveness of the promotion. This will entail monitoring and tracking of audience reach and behavior, for example those who access or download What Works? as an outcome of the marketing efforts. Data will provide lessons learned from this initiative to inform both the development and successful promotion of future cessation resources.

The What Works? Website can be found here. Please consider adding this website link to your cessation-focused websites.

To order hard copies of the What Works? guide, please click here.

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Research Highlights

Even One Cigarette Can Prove Lethal, U.S. Surgeon General Says

As little as one cigarette a day, or even just inhaling smoke from someone else's cigarette, could be enough to cause a heart attack and even death, warns a report released by U.S. Surgeon General Dr. Regina M. Benjamin.

"The chemicals in tobacco smoke reach your lungs quickly every time you inhale, causing damage immediately," Benjamin said in a statement. "Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer."

And the more you're exposed, the harder it is for your body to repair the damage.

Smoking also weakens the immune system and makes it harder for the body to respond to treatment if a smoking-linked cancer does arise.

"It's a really good thing when the Surgeon General comes out and gives a wide scope to the dangers of smoking," said Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City. "They're looking at very small amounts of smoke and this is dramatic. It's showing the effect is immediate and doesn't take very much concentration. In other words, there's no safe level of smoking. It's a zero-tolerance issue."

A Report of the Surgeon General: How Tobacco Smoke Causes Disease - The Biology and Behavioral Basis for Smoking-Attributable Disease, is the first tobacco report from Surgeon General Benjamin and the 30th since the landmark 1964 Surgeon General's report that first linked smoking to lung cancer.

More so than previous reports, this one focused on specific pathways by which smoking does its damage.

Some 70 of the 7,000 chemicals and compounds in cigarettes can cause cancer, while hundreds of the others are toxic, inflaming the lining of the airways and potentially leading to chronic obstructive pulmonary disease (COPD), a major killer in the United States. The chemicals also corrode blood vessels and increase the likelihood of blood clots, upping the risk for heart conditions.

Smoking is responsible for about 85 percent of lung cancers in the United States. But this report puts more emphasis on the link between smoking and the nation's no. 1 killer, heart disease.

"This report went way beyond pulmonary issues, which people are all too familiar with, but got into cardiovascular risks," Horovitz said. "We've known that even a few cigarettes a day could triple your risk of heart disease. If you have a 3 percent risk of cardiac issues, as a light smoker you could have 9 or 10 percent. That's significant. It's a little Russian Roulette."

And the problems don't stop there, the report stated. Smoking cigarettes can interfere with blood-sugar control for diabetes and can help spur a range of pregnancy and birth-related problems such as miscarriage, low birth weight and sudden infant death syndrome (SIDS).

Cigarettes are also getting more addictive, the report stated, with newer formulations getting the nicotine more quickly and efficiently from the lungs -- where it first enters the body -- to the heart and brain. Compounds other than nicotine that are added to cigarettes also help hook people in, the report said.

"The evidence clearly states that tobacco products are lethal weapons capable of shortening the lifespans of smokers and nonsmokers alike," American Heart Association CEO Nancy Brown said in a statement. "However, tobacco companies will stop at nothing to addict a new generation of smokers."

"We strongly believe the findings will support implementation of new federal tobacco regulations, including the development of graphic warning labels for cigarette packages," she continued. "We also urge state officials to fund smoking prevention and cessation programs at CDC- recommended levels, enact strong smoke-free policies and boost tobacco excise taxes. Policymakers must not allow complacency to rule in the fight against tobacco. Bold, aggressive measures are needed to save lives, reduce the burden of disease and improve quality of life."

View the new report at the Office of the U.S. Surgeon General.

For more information, see web link:
HealthDay News December 9, 2010

Smoking Widespread Among Youth with Diabetes, Raising Heart Disease Risk

Cigarette smoking is widespread among children and young adults with diabetes yet few health care providers are counseling children and young adults with diabetes to not smoke or stop smoking, according to a new report from the SEARCH Study Group, published online in the Journal of Pediatrics.

Children and young adults with diabetes are already at high risk for heart disease before they take up smoking, but few studies have examined the association between cigarette smoking and heart disease risk factors in youth with diabetes.

Funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive Kidney Diseases, the study examined tobacco use and heart disease risk factors in a racially and ethnically diverse group of 3,466 children and young adults with diabetes aged 10 to 22 years old across the United States.

Researchers found that 10 percent of youth with type 1 diabetes and 16 percent of youth with type 2 diabetes were currently using some form of tobacco products: cigarettes, cigars or smokeless tobacco. Less than half of the youth reported that they had been counseled by their health care provider to not smoke or stop smoking.

“We found a substantial proportion of youth with diabetes are current cigarette smokers, which greatly adds to their already elevated risk for heart disease,” said study lead author Kristi Reynolds, PhD, MPH, a research scientist and epidemiologist at the Kaiser Permanente Southern California Department of Research and Evaluation. “Smoking is preventable, so aggressive smoking prevention and cessation programs are needed to prevent or delay heart disease in youth with diabetes.”

These findings were based on analysis of data from the SEARCH for Diabetes in Youth Study, a large multi-center study of youth diagnosed with diabetes before the age of 20 who were enrolled by six clinical centers in California, Colorado, Hawaii, Ohio, South Carolina and Washington.

The study found the prevalence of current cigarette smoking in youth with type 1 diabetes to be 1.3 percent of 10- to 14-year-olds, 14.9 percent of 15- to 19-year-olds, and 27 percent of those 20 years and older. Among youth with type 2 diabetes, 4.4 percent of 10- to 14-year-olds were currently cigarette smokers, 12.9 percent of 15- to 19-year-olds were cigarette smokers, and 37.3 percent in youth 20 years and older were cigarette smokers.

The study also found early signs of heart disease among those using cigarette products. Youth who were past and current smokers had a higher prevalence of high triglyceride levels, high LDL cholesterol levels, low HDL cholesterol levels and more physical inactivity than non-smokers.

“Cigarette smoking is a completely preventable risk factor for cardiovascular and other diseases. While this is true for all children, it is especially true for children with diabetes because of the increased risk of cardiovascular disease in that population,” said study co-author Stephen R. Daniels, MD, PhD, professor and chairman of the Department of Pediatrics at the University of Colorado School of Medicine and Pediatrician-in-Chief at The Children’s Hospital in Denver.

In adults with diabetes, the risk of heart disease is greatly increased compared with adults without diabetes, and smoking may increase that risk. About 90 percent of adult smokers started smoking before age 18. Because of the already increased risk of cardiovascular disease in individuals with diabetes mellitus, the American Diabetes Association emphasizes the importance of smoking cessation for those individuals.

For more information, see web link:
Webwire December 4, 2010

Secondhand Smoke Exposure Increases Risk of Hearing Loss

Previous research indicates that former and current smokers are more likely to lose some of their full range of hearing, but it's not been known whether passive smokers are also prone to this.

The authors drew on 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES), a yearly household survey combined with a physical examination of a representative sample of the US population.

In all, a total of 3307 adults aged between 20 and 69 were included in the final analysis. They had all had their hearing tested, and were classified as passive smokers according to levels of a constituent of tobacco smoke (cotinine) in their blood.

They were also able to provide information on their medical history, levels of noise exposure, and whether they had ever smoked or lived/worked with a smoker.

The degree of hearing loss in each ear was assessed by testing the ability to hear pure tones over a range of frequencies from 500 Hz (low) to 8000 Hz (high).

Men, those who were older, and those with diabetes were significantly more likely to have high frequency hearing loss. And this was true of those who were former smokers and those who had never smoked.

But even after taking account of these factors, both former and passive smoking were associated with impaired hearing.

Former smokers were significantly more likely to have impaired hearing. The prevalence of low to mid frequency hearing loss among this group was 14 percent. And almost half (over 46 percent) had high frequency hearing loss (more than 25 decibels).

Although the risk was not as strong among those who had never smoked, almost one in 10 (8.6 percent) had low to mid frequency hearing loss and one in four (26.6 percent) had high frequency hearing loss.

And the stronger findings among former smokers suggest that continued passive smoking in this group, even at low levels, could continue the progression of high frequency hearing loss that began when they were active smokers, say the authors.

"Further research is required to determine whether [passive smoking] potentiates the effect of noise exposure and ageing on hearing," they conclude. "If this finding is independently confirmed, then hearing loss can be added to the growing list of health consequences associated with exposure to secondhand tobacco smoke."

For more information, see web link:
Science Daily November 15, 2010

Heavy Smoking May Double Rheumatoid Arthritis Risk in Blacks

Smoking boosts the risk of rheumatoid arthritis in black Americans, and heavy smokers and those with a genetic risk factor for rheumatoid arthritis are among those most likely to develop the joint disease, a new study has found.

Researchers evaluated 605 black patients with rheumatoid arthritis and 255 healthy black people. They found that those with the disease were slightly more likely to be former or current smokers and less likely to have never smoked.

Heavy smoking was reported by about 54 percent of rheumatoid arthritis patients who were former or current smokers, compared with 35 percent of those in the control group who had ever smoked.

In addition, rheumatoid arthritis patients were more likely than people in the control group (40 percent versus 23 percent) to have at least one "HLA-DRB1 shared epitope-containing allele" -- a genetic risk factor for rheumatoid arthritis.

The study is published in the December issue of the journal Arthritis & Rheumatism.

The investigators found that rheumatoid arthritis risk doubled among blacks who were heavy smokers, and the risk increased to more than fourfold for those who also had the genetic factor, they noted.

"Our results suggest that roughly one in six new cases of rheumatoid arthritis occurring in African Americans could be prevented through smoking cessation or by limiting cumulative smoking exposure to less than 10 pack-years," lead author Dr. Ted Mikuls, of the University of Nebraska Medical Center, said in a journal news release.

For more information, see web link:
HealthDay News November 29, 2010

Giving Up Smoking Linked To Greater Happiness and Elevated Mood

It appears to be a myth that giving up smoking most likely makes you miserable. Brown University researchers found that those who were in the process of quitting smoking were never happier. Their study appears in an article in the journal Nicotine & Tobacco Research.

The authors explained that giving up smoking is known to be good for our physical health; however, nobody really seems to know whether the process makes us happy or depressed. One reads about smokers claiming to derive relief from anxiety and depression from their tobacco products.

Corresponding author, Christopher Kahler says smokers thinking of quitting should be encouraged by the double benefit - both physical and mental. Giving up is far from being a psychological nightmare done just for the sake of living a longer life, he added.

Kahler added:"The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode. What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression."

Kahler and team examined data on 236 male and female smokers who wanted to give up. They were also heavy social drinkers. They were all provided with smoking cessation counseling and nicotine patches and then set a date to give up smoking. A number of the participants were also given counseling on ways to cut down on their alcohol consumption.

They all underwent a standardized test for symptoms of depression seven days before they stopped smoking. Further psychological evaluations for depression took place 2, 8, 16 and 28 weeks after their quit date.

Of the 236 candidates:

• 99 failed straight away (never abstained)
• 44 were only found to be smoking free during their first evaluation after the quit date
• 33 abstained successfully right up to their 8-week check-up
• 33 abstained throughout the whole period of the study
• 29 exhibited none of the above-mentioned quitting behaviors

Among those who managed to quit for a while, the researchers found that they were in very high spirits (happy) during the check-ups when their smoking cessation was being successfully carried out. However, after failing their moods darkened significantly, and in many cases to lower depths than before the whole study began.

Kahler said that enhanced mood and periods of abstinence went hand-in-hand - the correlation was clear.

The participants who failed straight away were still followed up throughout the study and were found to be the unhappiest of all the groups. The ones who managed to abstain throughout the study period had the highest levels of happiness, the authors wrote.

Kahler believes it is possible to extrapolate from this study and generalize over the whole population, even though his participants were relatively heavy drinkers. He refers to a 2002 study of smokers who had all experienced episodes of depression in their lives, but did not all drink.

The authors added that the link between happiness and smoking cessation was strong, regardless of whether the participant was drinking less or the same - the constant was successful smoking cessation.

The researchers believe that giving up smoking relieves symptoms of depression and that it is a myth to believe smoking eases anxiety.

For more information, see web link:
Medical News Today December 5, 2010

Depressed Smokers Less Likely to Stay Tobacco Free

Depressed smokers want to quit the nicotine habit just as much as non-depressed smokers, but a new study suggests that depression can put a kink in their success.

The study, which appears online and in the January 2011 edition of the American Journal of Preventive Medicine, showed that about 24 percent of surveyed callers to the California Smokers’ Helpline currently suffered from major depression and 17 percent of callers had mild depression. Over half the surveyed callers, depressed or not, made at least one attempt to quit after calling the helpline.

At the two-month mark, however, the success rate of those with major depression was much lower than that of mildly depressed or non-depressed callers. Nearly one in five callers with major depression reported success, but of others, nearly one in three was able to remain smoke-free.

Most quitlines do not assess smokers for depression, even though mild depression already is known to reduce the success of quitting. This study suggests that major depression reduces the success rate even farther.

This is important because the California quitline receives a high number of calls from heavy smokers and smokers on Medicaid; two circumstances associated with depression. Since more than 400,000 smokers call U.S. quitlines every year, the authors believe that up to 100,000 depressed smokers nationally are not getting the targeted treatment they need.

“Assessing for depression can predict if a smoker will quit successfully, but the assessment would be more valuable if it were linked to services,” said lead study author Kiandra Hebert, Ph.D., of the University of California at San Diego.

Hebert said an integrated health care model is a potential solution. Depressed smokers could have better quitting success if they receive services that address both issues. Quitlines, which are extremely popular, are in a good position to offer such services to a large number of depressed smokers and to pass on the services they develop to quitlines across the country.

Treatment programs, including quitlines, report that a growing number of callers have other disorders, such as depression, said Wendy Bjornson, co-director of the Oregon Health & Science University Smoking Cessation Center. “The results of this study are important. They show the scope of the problem and point to the need for protocols that can lead to better outcomes.”

For more information, see web link:
Health Behavior News Service December 7, 2010

Teens Get More Ear Infections When Someone Smokes at Home

Family members who smoke are more apt to feel it is okay to smoke indoors as their children get older. But in households with secondhand smoke, children between 12 and 17 are 1.67 times more prone to have recurrent ear infections compared to adolescents who live in a smoke-free environment, a large new study reveals.

Harvard researchers analyzed smoking behavior of 90,961 families surveyed between April 2007 and July 2008.

“Overall, we found that the proportion of households that use tobacco products is the same across all age groups, but family members are increasingly more likely to smoke indoors as their children become preteens and teenagers,” said Summer Hawkins Ph.D., lead study author. “The reason why secondhand smoke may cause ear infections is not known completely, but secondhand smoke is an irritant and that may increase children’s and adolescents’ susceptibility to ear infections.”

Their findings appear online in the Journal of Adolescent Health.

“Parents are usually pretty savvy and know it’s not in their children’s best interest to smoke indoors,” said Ellen Wald, M.D., chair of pediatrics for American Family Children’s Hospital in Madison, Wis. “When they say they never smoke indoors, I’m skeptical. They know that’s the answer people want to hear.”

The study authors suggest that pediatricians should do more to make parents aware of the hazards of secondhand smoke.

“Parents and health care providers need to work together to create a smoke-free environment for their children,” Hawkins said. “Providers should ask parents about tobacco use during clinic visits. Parents can reduce children’s exposure to secondhand by prohibiting smoke inside the home.”

While no simple answer exists, Wald said, “In order to change behavior you have to talk about it. Physicians are in a good position to send the message that everyone’s vulnerable to secondhand smoke, not just children and adolescents but adults as well.”

For more information, see web link:
Health Behavior News Service December 7, 2010

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Other Cessation News

CDC: Air Travelers at Risk from Secondhand Smoke

Overenthusiastic Transportation Security Administration pat-downs aren't your only travel worry this holiday season, according to the Centers for Disease Control and Prevention. A new report by the agency finds that one in four of the largest U.S. airports still allows smoking indoors, potentially exposing travelers and workers to disease-causing secondhand smoke.

The findings, published in the CDC's Morbidity and Mortality Weekly Report, reveal an unnecessary risk, according to CDC director Thomas Friedan. Secondhand smoke has been linked to heart attacks, lung cancer and asthma attacks, among other ailments.

"Every year, millions of people who travel through and work at these airports are unnecessarily exposed to secondhand smoke," Friedan said in a statement. "Even ventilated smoking rooms do not eliminate secondhand smoke exposure. Eliminating smoking at airports is the only way to fully eliminate exposure."

According to the report, more airports prohibit smoking today than in 2002, when 42 percent of the 31 largest U.S. airports were smoke-free. Of the 29 largest airports examined in the current study, 76 percent were smoke-free indoors.

But seven of the nation's largest airports still allow indoor smoking in designated areas, the CDC reports. That includes Hartsfield-Jackson Atlanta International Airport, Dallas Fort Worth International Airport, and Denver International Airport, three of the five busiest airports in the country. The other four large airports that allow indoor smoking are: Las Vegas McCarran International Airport, Charlotte Douglas International Airport, Washington Dulles International Airport, and Salt Lake City International Airport.

These airports don't allow people to light up willy-nilly; specially ventilated enclosed areas are set aside for smokers. But CDC officials argue that these rooms don’t do enough to protect passersby and workers. The 2006 Surgeon General's Report concluded that even cleaning the air and ventilating buildings don't eliminate the risk of secondhand smoke exposure by people who pass by, work nearby or clean those rooms.

The report also draws attention to the cloud of smoke hovering outside many airport exits. Travelers and airport employees are at risk of inhaling cigarette smoke near outdoor smoking areas, particularly if the areas are enclosed.

The CDC cites a California Air Resources Board study, which found that nicotine concentrations near outdoor smoking sites at airports could be as high as those in a smoker's home. None of the 29 airports studied ban smoking on airport property, the CDC found. One-third of the studied airports allow smoking near airport entries and exits. The CDC recommends a hard line when it comes to public smoking.

"Completely eliminating smoking in all public places and workplaces, including airports, is the only way to fully protect nonsmokers from secondhand smoke exposure," Ursula Bauer, the director of the CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a statement. "Secondhand smoke is responsible for 46,000 heart disease deaths and 3,400 lung cancer deaths each year."

For more information, see web link:
MSNBC November 18, 2010

Smokers Need Not Apply: Is Hiring Ban Trend of the Future?

For about two decades, smokers have been pushed steadily out of the workplace, as lawmakers and employers have sought to minimize exposure to second-hand smoke.

Employers have confined smokers to designated areas, moved smoking areas outside buildings, and limited smoking breaks. Now, some companies are opting to push smokers out of the workplace altogether.

That's the case with the Massachusetts Hospital Association (MHA), an employer of 45 that announced it would no longer hire people who smoke. The firm is the first private employer in Massachusetts to take such a step, though several others elsewhere -- such as the Cleveland Clinic, a medical center based in Ohio; Alaska Airlines; and Union Pacific Railroad -- have also stopped hiring smokers.

Supporters of the hire-no-smokers policy say it will provide smoke-free work environments and help employers control their health-care costs. But critics argue it's a form of discrimination that, moreover, intrudes into the private lifestyle choices of prospective employees.

The decision to stop hiring smokers as of Jan. 1 fits with MHA's mission as a health advocacy organization, says chief executive Lynn Nicholas.

"The MHA ... is a spokesperson for hospitals across the commonwealth, and tobacco use is the leading preventable cause of death in the U.S. We want to drive the cost of health care down so that is more affordable," she says.

MHA's employees will be expected to report smoking through an honor system, and cessation programs will be offered to existing employees who smoke, says Nicholas, who lost her father and several other relatives to smoking or secondhand smoke.

"Smoking is a personal choice, and as an employer I have a personal choice within the law about who we hire and who we don't," says Nicholas.

Excluding smokers from the hiring pool is something John Banzhaf, for one, would like to see more companies do.

"Smoking is the biggest factor in controllable health-care costs," says Mr. Banzhaf, executive director of Action on Smoking and Health (ASH), an antismoking group in Washington, and a law professor at George Washington University. Banning the hiring of smokers "appears to be spreading rapidly through the entire private sector -- not just health-related industries -- especially as health-care costs continue to soar."

The average smoker costs companies more than $12,000 a year in health- and disability-related costs and takes four 15-minute breaks a day, reports ASH.

Not everyone is ready to fully embrace this policy, though. Some critics ask how much information employers are entitled to know about the lifestyle choices of prospective employees. If they start screening out smokers, who else might they seek to screen out in the future? Overweight people? People who drink?

"Even if this makes sense, how is this materially different from screening for other high-risk and high-cost behaviors?" says Andrew Tarsy, executive director of the Progressive Business Leaders Network in Massachusetts and a former civil rights attorney. He calls the policy "a slippery slope."

"The question is, will this work for most businesses?" he adds. "Most businesses would be inclined to try other methods."

The American Civil Liberties Union characterizes a refusal to hire smokers as "lifestyle discrimination." On its website, the ACLU notes that the Bureau of National Affairs, a private, independent publisher, "reports that 95 percent of companies banning smoking reported no financial savings, and the US Chamber of Commerce has found no connection between smoking and absenteeism."

Employers, moreover, need to tread carefully so as not to run afoul of state laws that protect employee rights, including those of smokers. Less than 20 percent of American adults smoke.

About 30 states have laws that protect smokers, and some won't let employers exclude smokers in the hiring process. Most do not allow firms to fire workers who smoke.

"The laws are enforceable. There are laws that protect smokers," says Stephen Sugarman, a law professor at the University of California, Berkeley. For instance, "I think it's pretty clear that all of these laws prohibit an employer from firing an employee for smoking."

The ban on hiring smokers is a way to gradually eliminate smokers from a workplace. The Cleveland Clinic, which has some 40,000 employees, stopped hiring smokers in 2007. Since then, it has turned over 30 percent of its workforce, and none of those new workers are believed to be smokers.

All new hires are tested for tobacco use, and if they test positive the job offer is rescinded, says Paul Terpeluk, director of corporate and employee health for the Cleveland Clinic. So far, 250 people have lost out on jobs there because of tobacco use. "Over time," he says, "we will achieve a nonsmoking workforce."

At Kalamazoo Valley Community College in Michigan, the decision to stop hiring smokers in 2005 had support from the 1,000 employees, says Sandy Bohnet of the college's human resources department.

"We do think that, as a result of this policy, we will see fewer tobacco-related [health-insurance] claims in the future," she says.

For more information, see web link:
ABC News November 21, 2010

HHS Launches Healthy People 2020

With 2010 nearly over, the Department of Health and Human Services (HHS) has updated its Healthy People program to reduce health risk factors and disparities, providing new topics and objectives for 2020.

The Healthy People initiative began in 1979 with a Surgeon General's report, which set public health targets to be reached by 1990. It has been revised in 10 year increments ever since.

The 2020 version identifies nearly 600 objectives, ranging from homicides to smoking cessation attempts, in 42 topic areas.

In announcing the update, HHS called the new targets and objectives "ambitious yet achievable."

For example, the department set a national goal for new-onset diabetes of 7.2 cases per 1,000 adults in 2020, compared with the current baseline of 8.0.

The goal setters noted that a wide range of interventions and services are available to meet the goal, such as community-based programs to promote physical activity and healthy diets.

But much of the Healthy People track record fails to support HHS' optimism.

In announcing the new update, the department claimed that "the country has either progressed toward or met" 71 percent of the Healthy People 2010 targets.

However, a MedPage Today review of data posted on the Healthy People 2010 website indicated that most of this progress was minimal and few of the objectives were met completely.

Among the successes: significant increases in pediatric pneumococcal vaccination rates and reductions in the number of emergency department visits for asthma among children and adults.

Perhaps the most important achievement was in reducing coronary heart disease deaths. The Healthy People 2010 target was 162 per 100,000 population, starting from 203 when that goal was set in 2000.

By 2004, the CHD death rate had already fallen below the target to 160 per 100,000, and it has continued to decrease.

Reductions in stroke deaths have also exceeded the target.

But for most of the targets, progress was minimal or nonexistent.

Adult smoking rates, for example, declined from 23 percent in 2000 to 21 percent in 2008 (the most recent year with data reported by HHS), falling well short of the goal of 12 percent.

The record for diabetes was even worse. Healthy People 2010 set a target of 3.8 new-onset diabetes cases per 1,000 adults for this year, a reduction from the 2000 rate of 5.7 cases per 1,000.

Instead, the rate increased by 40 percent to the current level of 8.0 per 1,000.

The new version sets more modest targets in many cases.

For instance, whereas Healthy People 2010 had sought a 33 percent cut in new-onset diabetes rates, the 2020 update is targeting only a 10 percent reduction.

On the other hand, Healthy People 2020 still sets a goal of 12 percent for adult smoking rates.

Agency officials said the nation needs goals as a framework both for policy and for individual behavior change.

"Healthy People is the nation's road map and compass for better health, providing our society a vision for improving both the quantity and quality of life for all Americans," said Howard Koh, MD, MPH, the department's assistant secretary for health, in a press release.

The American Heart Association issued a statement endorsing the plan's goals for cardiovascular health.

"The obesity epidemic has taken a toll on the health and vitality of communities across the country due to sedentary behaviors and lack of access to healthy foods, areas that promote physical activity, and weight management services," said the group's CEO, Nancy Brown, in the statement.

"We support initiatives that will educate more Americans about recommended levels for sodium consumption, added sugars, saturated fat, and other ingredients that are found in many processed foods and restaurant meals."

She also praised the goals for smoking cessation, although she noted that "work lies ahead to boost funding" for programs that will cut smoking significantly.

For more information, see web link:
MedPage Today December 2, 2010

Smokeless Tobacco Picking Up Steam

Ron Carroll prefers to smoke cigars and pipes. But when he can't do that he says he manages to unobtrusively get his nicotine fix by slipping a packet of tobacco, about the size of a teabag, under his upper lip.

"I use it all the time — movies, planes," said the Chicagoan, who adds that he likes the fact he can remove the packet as easily as a piece of gum. There's no chewing, spitting or mess, he says.

"It's discreet, and you don't look like an addict, he said."Smoking's definitely more about the flavor; the whole experience,'' Carroll said. "With this, it's just taking the edge off."

Cigarette sales by volume have plummeted 17 percent from 2005, partly the result of health warnings and bans on smoking in public places as well as taxation by local and federal governments. And the heat on cigarette smokers is expected to intensify as the federal Food and Drug Administration requires images of corpses and diseased lungs to be featured on cigarette packs in two years.

Smokeless tobacco products — which come in shapes ranging from toothpicks to orbs and in flavors from cherry to peach — so far have not met with the same intense scrutiny, although there have been some changes. In June, the FDA increased the size of warning labels on smokeless products. "This product is addictive" and "This product is not a safe alternative to cigarettes,'' say the warnings.

Scientists say that overall, smokeless tobacco products are less harmful than cigarettes, in large part because of a reduced risk of lung cancer. But medical experts agree that quitting tobacco altogether is the best alternative.

The FDA won't report to the Secretary of Health and Human Services until 2012 on whether such products pose a threat to adolescents and children.

In a letter to tobacco-maker R.J. Reynolds in February, Lawrence Dayton, director for the FDA's Center for Tobacco Products, expressed concern that the Camel dissolvables line — which includes tobacco strips that dissolve in the mouth, sticks that resemble toothpicks and orbs that look like hard candy — could be appealing to children and adolescents.

"Absolutely none of us, no one, wants kids to smoke or to use tobacco products," said Todd Holbrook, senior director of marketing for Camel Snus, at Reynolds.

For more information, see web link:
Chicago Tribune December 6, 2010

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