February 2009


Research Highlights
Other Cessation News


Research Highlights

Other Cessation News




Tobacco Use Treatments and Electronic Health Records in Two Wisconsin Health Systems

The U.S. Public Health Service's Treating Tobacco Use and Dependence: 2008 Update-Clinical Practice Guideline, not only provides recommendations for new, effective clinical treatments for tobacco dependence and the latest information to help people quit smoking, but also emphasizes the importance of systems-level tobacco intervention efforts. One form of systems-level tobacco intervention efforts is electronic health records (EHR). EHR would allow for integration of these guidelines into the practice workflow, facilitating system-level changes to reduce tobacco use.

The electronic health record is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. Electronic health records, or electronic medical records, are believed to increase physician efficiency and reduce costs, as well as promote standardization of care, improve billing accuracy, reduce duplication of services, reduce medical errors, facilitate clinical trials, and improve access to medical records.

With the support of University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), two health care systems in Wisconsin have been implementing these recommendations from the PHS Guideline by incorporating tobacco use treatment into their patient care through electronic medical records (EMR).

UW-CTRI has an outreach program with six regional outreach specialists, each dedicated to a major region across the state. Outreach staff work with healthcare providers to provide free, evidence-based information and technical assistance to help healthcare providers treat tobacco dependence, including support to implement the Guideline recommendations in the "real world."

UW-CTRI Outreach staff worked with clinicians and quality improvement staff at Aurora Health Care in Milwaukee, WI and Dean Health System in Madison, WI for several years to create systems-level change in tobacco intervention efforts. UW-CTRI's work focused on clinician education and behavior change and systems-level changes to incorporate the 5A's model of treating tobacco dependence into the Aurora and Dean health systems.

From this work, UW-CTRI helped these health systems eventually incorporate the 5A's into their electronic medical records. This has resulted in incorporation of tobacco dependence treatment into their standards of care, better identification and tracking of tobacco-using patients, as well as integration of the Wisconsin Tobacco Quit line as a treatment extender. Ultimately this has led to an increase in the number of tobacco-using patients getting evidence-based treatment to help them quit.

At Dean Health System in Madison, WI, tobacco use treatment is an integral part of their electronic medical record system. At Dean, tobacco use is not just a vital sign, but a prompt to provide appropriate medications and counseling.

With more and more competitors promoting "fast care," Dr. Philip Bain and his colleagues on an internal tobacco task force at Dean took a pragmatic, systematic approach to tobacco treatment. "We only have about 10 to 11 minutes per office visit," said Dr. Bain. "So, in the past, smoking cessation got short shrift."

In order to address tobacco use in a very efficient manner, Dean incorporated tobacco use treatment into its electronic medical records. Since Dean was already converting to EMR, they worked with software producer EPIC to create a standardized protocol for providing brief interventions with smokers. Based on the 5A's, Dean's EMR system prompts rooming staff to quickly discuss tobacco use and willingness to quit. Staff can use computer shortcuts to gather information about the patient's smoking history and readiness to quit. That information helps clinicians efficiently treat the addiction.

The software automatically prompts Dean employees to ask questions and auto-loads information on medications. "You don't have to call up Chantix," Dr. Bain said. "It's right there. We can quickly say, 'Smoking's bad, it's important to quit and there's help.we've tested it and EPIC condenses the physician intervention down to a minute or less. So 60 seconds of that 11-minute visit is taken up by this very important public-health issue." Dean also refers patients to the Wisconsin Tobacco Quit Line for additional support.

"EMR is the tool to quickly do what's right," said Dr. Paul Reber, vice president for clinical excellence at Dean. "The right thing to do is to treat tobacco dependence, but most patients don't come in to quit smoking." They go in to be cured of another problem that quite likely is caused by smoking or exacerbated by it.

The key is to make the EMR as intuitive as possible and to provide prompts so the roomer and physician don't forget to tackle tobacco along with myriad other concerns. "We have people on their first day or who float between departments, so we have to make it as simple as possible," Dr. Bain said.

At Aurora Health Care in Milwaukee, WI the patient-smoking rate has dropped from 24 percent in 2000 to 19 percent in 2008. That's a 20-percent decrease due in part to efforts by Aurora to implement a systematic approach to helping patients and employees quit tobacco use.

"It's the leading cause of preventable disease and death in the state and nation," said Dr. David Smith, medical director for Aurora Care Management. "It's a critical issue. We encourage our nursing staff and anyone who handles rooming duties to leverage relationships with their patients to ask about tobacco use, assess willingness to quit and intervene to help the patients break their addiction to tobacco." They also encourage their providers to assist patients who want to quit with coaching and medications whenever appropriate.

Dr. Smith readily admits that policy changes-such as local smoking ordinances and a higher state tobacco tax-have contributed to improved smoking rates. But he added that Aurora has used a diverse set of strategies to create success. In addition to staff education and a smoke-free campus, these strategies also include tobacco use as a vital sign, tracking results in EMR, and referring to the Wisconsin Tobacco Quit Line.

Like Dean Health System, Aurora incorporates the recommendations of the PHS Guideline into their patient care. Aurora's protocol is to ask every patient at every visit if they use tobacco, and whether they'd consider quitting. Staff compliance with addressing tobacco use with every patient at every visit has improved over the years, especially since the dawn of electronic medical records (EMR). Currently, Aurora providers utilize the 5A's with about 52,000 patients each month.

Sue Scholz, quality improvement manager for care management at Aurora said that tracking tobacco use and readiness to quit in EMR has allowed Aurora to collect electronic data for each specific clinic within the health system and even each provider. "There are currently 484 providers and 80 clinics activated for the tobacco-cessation initiative," Scholz said. "This count includes family practice, internal medicine, ob/gyn, nurse practitioners, midwives, physician assistants and geriatric providers."

In addition to tracking tobacco use and readiness to quit, Aurora providers can refer patients to the Wisconsin Tobacco Quit Line. It's available to any Wisconsin resident who wants free coaching and medication to quit tobacco. Aurora even offers to sign patients up for the Fax to Quit program so the Quit Line makes the initial call to the patient at a time specified by the patient. Aurora disseminates so many Quit Line materials that the Aurora adds its own logo and prints large quantities.

Aurora's systematic approach to helping staff and patients quit tobacco use is especially impressive when considering the scope of the task. Aurora employs 27,000 people in 75 communities across eastern Wisconsin. This includes 1,000 physicians at 13 hospitals, 150 clinics and 150 pharmacies.

It took years to build such a successful program through systematic change. Now, Aurora is exploring new horizons like incorporating motivational-interviewing techniques into their tobacco treatment. It's all part of an effort to get more patients who aren't quite ready to quit to consider setting a quit date in the near future. Aurora has also partnered with UW-CTRI to test the latest tobacco treatments in Aurora clinics. "It makes our team feel on the cutting edge," said Dr. Smith. "We know we're contributing to the world's knowledge base to help people quit smoking."

Electronic health and medical records are just one of the tools to support systems-level tobacco intervention efforts. These tools are available for providers to assist their patients in making quit attempts. Electronic health and medical records are also a way for providers to help build consumer demand for evidence-based tobacco treatments and services. For more information about evidence-based tobacco use treatments, see the U.S. Public Health Service's Treating Tobacco Use and Dependence: 2008 Update-Clinical Practice Guideline at http://www.surgeongeneral.gov/tobacco/.

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Research Highlights

Secondhand Smoke Exposure Declines -- Except at Home

Men whose partners smoke are still at increased risk for heart disease, despite overall declines in secondhand smoke exposure over the last 30 years, researchers here said.

Half of the men who had cotinine levels above 0.7 ng/ml -- a risk factor for heart attack -- lived with a partner who smoked, Barbara J. Jefferis, Ph.D., of University College London, and colleagues reported online in Addiction.

"If we are going to reduce people's exposure to tobacco smoke further, then we will need to focus efforts on reducing smoking in the home," Dr. Jefferis said.

To look at long-term changes in environmental tobacco smoke exposure, the researchers analyzed data from the British Regional Heart Study (BRHS) involving men seen at general practices in 24 towns in England, Scotland, and Wales.

They drew blood samples and administered a lifestyle questionnaire at initial data collection from 1978 to 1980 and on follow-up 20 years later.

Serum cotinine measurements were used to assess exposure to environmental tobacco smoke. Levels of serum cotinine below 0.7 ng/ml are associated with low coronary heart disease risk, the researchers said.

Over the 20 years of the study period, mean cotinine levels decreased 86 percent -- from 1.36 ng/ml at baseline to 0.19 ng/ml during follow-up.

The prevalence of cotinine levels =0.7 ng/ml rose from 27.1 percent at baseline to 83.3 percent after 20 years.

Among nonsmokers with cotinine levels greater than 0.7 ng/ml, half lived with a partner who smoked, the researchers said.

Moreover, men who lived with a current smoker had mean cotinine values that were almost eight times higher than those who lived with nonsmokers (1.19 ng/ml versus 0.15 ng/ml, respectively), the researchers said.

For more information, see web link:
MedPage Today February 13, 2009


Secondhand Smoke Linked to Dementia

People exposed to secondhand smoke may face as much as a 44 percent increased risk of developing dementia, a new study suggests.

While previous research has established a connection between smoking and increased risk for dementia and Alzheimer's disease, this new study is the largest review to date showing a link between secondhand smoke and the threat of dementia, the authors said.

"There is an association between cognitive function, which is often but not necessarily a precursor of dementia, and exposure to passive smoking," said lead researcher Iain Lang, a research fellow in the Public Health and Epidemiology Group at Peninsula Medical School in Exeter, England.

What's more, Lang said, the risk of impaired cognitive function increases with the amount of exposure to secondhand smoke, the findings suggest. "For people at the highest levels of exposure, the risk is probably higher," he said.

The study was published online Feb. 13 in the journal BMJ.com.

For the study, Lang's team collected data on more than 4,800 nonsmokers who were over 50 years old. The researchers tested saliva samples from these people for levels of cotinine. The study participants also took neuropsychological tests to assess brain function and cognitive impairment. These tests evaluated memory, math and verbal skills. People whose scores were in the lowest 10 percent were classified as having some level of cognitive impairment.

The researchers found that people with the highest cotinine levels had a 44 percent increased risk of cognitive impairment, compared with people with the lowest cotinine levels. And, while the risk of impairment was lower in people with lower cotinine levels, the risk was still significant.

"We know that active smoking is bad -- being a smoker is bad for your health and increases your risk of Alzheimer's. This study suggests that this is the same for passive smoking," Lang said. "We know that passive smoking is associated with an increased risk of stroke and heart disease. This is just another reason to avoid exposing other people to your smoke, and if you are not a smoker to stay away from smoking places."

For more information, see web link:
Forbes February 11, 2009


Tobacco Companies Targeting Teens, Study Says

Tobacco company ads are reaching teenagers and influencing their desire to smoke and what brands they choose, U.S. health officials report.

"We are continuing to find that Marlboro, Newport and Camel brands, among the most heavily advertised brands, continue to be overwhelmingly the preferred brands of cigarettes smoked by middle school and high-school students," said Terry F. Pechacek, associate director for science in the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention.

"The industry will deny that they are marketing to underage youth, but our data are showing that the advertising is still reaching the kids," Pechacek said.

A spokesman for one of the tobacco companies defended its marketing program. "Kids should not use tobacco products of any kind," said Philip Morris USA spokesman David Sutton. "We take youth access to tobacco products seriously."

"We have made a significant effort, both at retail and marketing, to connect only to adult smokers," Sutton added.

The brand preferences in the report mirrors what is seen in the marketplace among adult smokers, Sutton said. "If you look at those preferences, they line up with market share among adult tobacco consumers," he said.

Each of the major cigarette companies in the United States has a leading youth brand, Pechacek said. "Industry documents show that all the tobacco companies are continuing to note that if they don't have a leading youth brand, they are in corporate trouble," he said.

The report, in the Feb. 13 issue of the CDC's Morbidity and Mortality Weekly Report, found that 78 percent of middle school students and 87 percent of high-school students prefer to smoke these three brands.

In addition, there was a considerable difference in the brands preferred by boys and girls, and blacks and whites.

Marlboro is preferred by 50 percent of middle school girls and 54 percent of high-school girls, while the brand is preferred by 38 percent of middle-school boys and 50 percent of high-school boys. Camels were smoked by 12 percent of middle-school boys, compared with 4 percent of girls.

Newport, a menthol cigarette that is primarily marketed to black communities, was the preferred brand for 60 percent of black middle-school students and 79 percent of black high-school students, according to the report.

In a recent report, the U.S. National Cancer Institute said there is sufficient evidence to conclude that tobacco advertising is directly related to getting people to smoke, Pechacek said.

"Our data in this study, without implying intention, [shows] we are finding that adolescents are being heavily exposed to advertising," Pechacek said.

Pechacek noted that the U.S. National Cancer Institute report found that partial bans on tobacco advertising are ineffective, and a 2007 report by the Institute of Medicine called for stronger measures to control tobacco advertising.

The World Health Organization's Framework Convention on Tobacco Control has called for a complete ban on tobacco advertising as far as possible within constitutional restraints, Pechacek said.

Tobacco cessation programs are underfunded when compared with CDC recommendations, Pechacek said. "Are we reaching a majority of vulnerable kids? The evidence is clearly no," he said. "We are reaching some of the vulnerable kids, probably in the range of 20 to 30 percent."

For more information, see web link:
US News & World Report February 12, 2009


Promise of Cash Prompts Smokers to Quit

Offering hard, cold cash to smokers to spur them to stop their unhealthy habit helps more people give up cigarettes, new research finds.

The study, published in the Feb. 12 issue of the New England Journal of Medicine, included a large group of General Electric Co. employees across the country who were offered up to $750 to give up smoking. After about a year, 14.7 percent of the group that was offered money were still smoke-free, compared to just 5 percent of those who weren't paid to kick the habit.

"Incentives do work in changing health behaviors, and they can be successful in people who have not succeeded using other approaches in the past," said study author Dr. Kevin Volpp, director of the Center for Health Incentives at the University of Pennsylvania School of Medicine and the Wharton School in Philadelphia.

Even though just 15 percent of those offered money ended up quitting for the long term, those success rates are still far higher than what's normally seen in smoking-cessation efforts.

Almost 900 GE employees were recruited for the study, and half were assigned to the incentive program, while the other half was a control group. The employees were mostly white, about two-thirds male, and two-thirds of the group had attended at least some college. Most felt they were still in good health, despite their average pack-a-day habit.

All of the employees were given information about available smoking-cessation programs in their areas. Members of the financial incentive group were also told they would be given $100 for the completion of a smoking cessation program. Then, they would receive an additional $250 if they successfully quit smoking within six months from the start of the study, and they were promised another $400 if they stayed smoke-free for another six months. Smoke-free status was assessed using either a hair or urine sample to test for a substance known as cotinine, which is present when someone has smoked.

Nine to 12 months after the study began, 14.7 percent of the incentive group had kicked tobacco, compared to just 5 percent in the information-only group. Between 15 and 18 months after the study's start, 9.4 percent of those in the incentive group had stayed off cigarettes, compared to just 3.6 percent in the control group.

Volpp said he believe the financial incentives prodded more people to quit and stay off cigarettes because they provided positive feedback as well as immediate gratification.

"I think, in general, people have a lot of trouble making changes for the sake of delayed health benefits," he said.

"This study shows the power that a monetary incentive can offer, and the power of the workplace as a health promotion tool," Glynn said.

For employers, Volpp pointed out that it's often cost-effective to offer a financial incentive for employees to stop smoking. Quitting boosts productivity and decreases absenteeism and health-care costs, he said.

For more information, see web link:
US News & World Report February 11, 2009


Do it for Fido: Smokers May Quit to Help a Pet

People unwilling to quit smoking to improve their own health may consider giving up cigarettes to spare their pets the harmful effects of second-hand smoke, U.S. researchers said.

Twenty-eight percent of pet owners who smoke said in a survey they would try to quit based on knowledge that second-hand smoke could harm their dogs, cats and other pets, the researchers wrote in the journal Tobacco Control.

Another 11 percent said they would think about quitting.

"It's not necessarily that people love their pets more than they love themselves or their children, it's just another motivational factor for people to consider quitting smoking," Sharon Milberger of the Henry Ford Health System in Detroit, who led the research, said in a telephone interview.

Milberger said asking smokers to quit for the sake of their pets may be an appealing new way to get them to throw away their cigarettes. Of the 71 million pet owners in the United States, about a fifth are smokers, Milberger estimated.

Just as second-hand smoke can harm people, studies indicate it can raise a pet's risk of lung cancer and other forms of cancer, allergies, eye and skin diseases and respiratory problems, the researchers said.

The findings were based on a Web-based survey of 3,293 U.S. pet owners, mostly from Michigan.

Among the nonsmokers who owned pets and lived with someone who did smoke, 16 percent said they would ask that person to quit and 24 percent said they would tell the smoker to light up outside instead of indoors, the study found.

"It would be hard to believe that there's any smoker out there now who doesn't know that smoking is bad for them and the people around them," Milberger said.

"For tobacco control advocates, on our team we can now have vets and kennels and pet supply stores. So, for example, when someone takes Fluffy in to the vet, the vet can ask them about their smoking behavior and whether they allow smoking in their home," added Milberger, a nonsmoker with a 1-year-old cat.

For more information, see web link:
Reuters February 10, 2009


Smoking, Metabolic Problem Raises Heart Risk

High rates of tobacco smoking and a condition called metabolic syndrome are combining to increase the risks of heart disease and stroke among older individuals in China, according to a report in the Journal of the American College of Cardiology.

Metabolic syndrome refers to a cluster of risk factors for diabetes and heart disease -- including abdominal obesity, high blood pressure, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is typically diagnosed when a person has three or more of these conditions.

"To the best of our knowledge, this is the first study to report the joint effects of tobacco smoke exposure and metabolic syndrome on cardiovascular risk in a population-based study in China," Dr. Yao He from Chinese PLA General Hospital, Beijing, told Reuters Health.

He and colleagues examined the individual and combined effects of active smoking, secondhand smoke, and metabolic syndrome on the risks of heart disease and stroke in a survey of elderly Chinese in Beijing.

More men than women reported ever having smoked tobacco, the authors report, but more women than men reported secondhand exposure to tobacco smoke.

The rate of metabolic syndrome was 34.8 percent in men and 54.1 percent in women.

Metabolic syndrome was associated with an increased risk of heart disease and stroke, the researchers note, and the risk was higher among former and current smokers than among people who had never smoked.

Further analysis showed that the combined effect of smoking and metabolic syndrome on heart disease and stroke was stronger in women than in men. Moreover, only in women was exposure to secondhand smoke associated with these conditions.

For more information, see web link:
Reuters February 4, 2009


Study Blames Secondhand Smoke for 1,200 Hoosier Deaths, $390M in Costs

Indiana University researchers say secondhand smoke is costing the state nearly 400-million dollars a year.

A Bowen Research Center study says Indiana spent 282-million dollars in hospitalization costs connected to secondhand smoke. The center estimates another 108-million of lost future earnings from people who died from secondhand smoke.

Former Indiana Commerce Secretary Mickey Maurer says there are more, unknowable costs not included in the study, from businesses turning away from Indiana after estimating health-care costs. He recalls one firm telling him it had conducted a formal study comparing Indiana's likely health-care costs with Ohio's.

The Bowen Center reviewed illnesses and deaths from 13 smoking-related causes, then used guidelines from the surgeon general's report on secondhand smoke and two other studies to determine how many of those cases can be chalked up to secondhand smoke.

IU calculates 1,194 Hoosier deaths due to secondhand smoke in 2007. Nearly 70 percent of those are deaths from heart disease, but the center also counted deaths from stroke; lung, cervical and sinus cancer; sudden infant death syndrome; asthma; and burns.

The center also tallied hospitalization costs for miscarriage, bronchial and ear infections, and low birth weight babies.

The center then multiplied by average hospital costs and estimates of the economic value of life to reach its final figure.

Researchers maintain if anything, their 390-million-dollar figure is low.

For more information, see web link:
WIBC Indianapolis February 2, 2009


Social Factors Affect Black Women's Ability to Avoid Secondhand Smoke During Pregnancy

Social factors, such as having family members who smoke, were the strongest determinant in black women's ability to avoid secondhand smoke during pregnancy, according to a new study.

Previous research has shown that black women experience more adverse pregnancy affects from smoking and secondhand smoke than white women.

This study, published in the March issue of the American Journal of Preventive Medicine, was conducted by investigators from The George Washington University Medical Center School of Public Health & Health Services, Children's National Medical Center, RTI International, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Researchers examined whether black, non-smoking women were able to avoid secondhand smoke exposure early in pregnancy and the social contextual factors that affected their success in avoiding secondhand smoke.

"Our study highlights the importance of comprehensive prenatal screening to identify a woman's psychosocial and behavioral risk factors," said Nabil El-Khorazatzy, Ph.D., a senior research statistician at RTI and the paper's co-author. "Before addressing secondhand smoking exposure, it is important to gain a complete understanding of the social context of a woman's pregnancy. While providing behavioral counseling and skills-based interventions, it is important to consider other factors that could exacerbate risks for intimate partner violence and poor pregnancy outcomes."

The researchers collected data from more than 1,000 women as part of a randomized, multiple-risk behavior intervention trial that addressed four risks for adverse pregnancy outcomes including cigarette smoking, secondhand smoke exposure, depression and intimate partner violence.

The results showed that 27 percent of pregnant nonsmokers avoided secondhand smoke. The women who were most successful at avoiding secondhand smoke reported having household smoking bans, few or no family members or friends who smoked and fathers who wanted the baby.

Women who were least likely to avoid secondhand smoke reported being in a relationship, having had incidents of intimate partner violence during pregnancy and receiving little social support to prevent secondhand smoke exposure.

For more information, see web link:
RTI International News Release January 9, 2009


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Other Cessation News

U.S. Government Dedicates Web Site to Teen Smoking-Cessation Program Created at WVU

The most widely used and widely researched teen smoking-cessation program in the nation - developed at West Virginia University by Kimberly Horn, Ed.D., and Geri Dino, Ph.D. - received a big blast of publicity in Washington, D.C., this month.

The Prevention Research Centers Program office at the Centers for Disease Control and Prevention (CDC) and the Directors of Health Promotion and Education have launched a web site for Not On Tobacco (N-O-T) to ensure that more communities, schools and teen-agers learn about the program, which has been credited with helping thousands of young people quit the health-compromising addiction.

The WVU researchers worked with the American Lung Association to develop N-O-T. Research at WVU and elsewhere has shown that N-O-T significantly decreases smoking and increases smoking-cessation among teenagers. It has been proven sustainable and useful in multiple settings.

N-O-T helps teens quit smoking or reduce cigarette use. The program helps teens learn and understand why they smoke and helps them develop the skills, confidence and support they need to quit. Teens learn the skills they need to tackle tough problems like nicotine withdrawal, getting through urges and cravings and responding to peer pressure to continue smoking. The self-esteem boosting 10 weekly sessions are led by a facilitator who can be a teacher, counselor, school nurse or other trained staff.

NOT is packaged and disseminated to schools and community organizations by the American Lung Association. The ALA lacks the resources to reach all settings in which the intervention could be put to use. The project team used web site development "best practices" to create a site that would expand the ALA's capacity to disseminate N-O-T to any group or organization that wants to use it.

The American Lung Association, in adopting N-O-T, has promoted its use in all 50 states and also internationally by the U.S. military.

In July the U.S. Department of Health and Human Services placed N-O-T on a list of recommended programs dealing with tobacco and drug abuse. N-O-T became the 100th program to be added to the National Registry of Evidence-based Programs and Practices.

The new web site is designed to serve functions of marketing, dissemination and technical assistance related to N-O-T.

The project team plans to test the site and develop a dissemination plan. If this web-based outreach is successful, the concept could become a prototype for conveying information about other chronic disease prevention programs developed by Prevention Research Centers.

For more information, see web link:
Huntington NewsFebruary 14, 2009


Ohio Judge's Ruling Represents an Important Step Toward Preserving Tobacco Funds, Protecting the Health of Ohioans

In Columbus, Ohio, Judge David Fais of the Franklin County Court of Common Pleas preliminary enjoined the State from dissolving the endowment of the Ohio Tobacco Prevention Foundation (OTPF). This decision is a major step forward in the American Legacy Foundation's effort to safeguard the state's tobacco prevention money for its intended purpose: to save Ohioans' lives.

During the course of the months-long battle to save the state's tobacco prevention and cessation funding, the American Legacy Foundation, a national public health foundation created as a result of the Master Settlement Agreement, stepped forward to fight for and safeguard the tobacco settlement dollars Ohio had set aside for tobacco control. After OTPF signed a contract with Legacy to preserve tobacco prevention and cessation efforts in the state, the legislature voted to abolish both OTPF and its endowment. The Franklin County Court of Common Pleas took an important step in protecting these funds for tobacco control use by issuing the preliminary injunction requested by Legacy. While it is an interim decision, the judge's order signals that he believes that permitting the dissolution of the funds would cause irreparable injury and it is in the public interest to protect these funds. The case will now move forward to a decision on whether to make the ruling permanent.

"We did not ask for these funds, but we have been proud to fight to secure them for the citizens of Ohio," said Cheryl G. Healton, Dr. P.H., president and chief executive officer of the American Legacy Foundation. "The court ruling today is a victory for Ohioans and a victory for public health. It would have been a terrible blow to the people of Ohio to dismantle the decade of progress that OTPF had made in preventing smoking among young people and helping smokers quit. Today, we look toward the future as tobacco use remains a vital public health issue with a deadly cost, both in Ohio and across our country," she said.

"This is very good news for smokers in Ohio who are desperate for help as they struggle to quit," said Robert G. Miller of Toledo, Ohio, a plaintiff in this case. "I know from my own efforts to quit that relapse is common so services and programs were critical to helping me. Continued funding for smoking cessation programs and to keep young kids from starting is essential and I'm thrilled that the judge's decision today will keep these funds focused on exactly that."

Research shows that tobacco takes an enormous toll on Ohio - both in lives lost and dollars spent. Ohio's smoking rate is 23.1 percent, above the national average of 19.7 percent. Smoking costs Ohio more than $4 billion in annual health care costs and another $4.7 billion annually in smoking-related productivity loss. A 2007 report by the American Legacy Foundation found that Ohio's Medicaid system could save nearly $550 million within five years if all Medicaid beneficiaries who smoke, quit. Ohio would reap the third largest savings of all the states, making the case that despite this economic downturn in Ohio, keeping these funds focused on tobacco control is a wiser long-term investment, ultimately saving Ohioans' lives and money.

For more information, see web link:
American Legacy Foundation News Release February 10, 2009


Tobacco Sale Ban At Schools, Pharmacies in Boston To Take Effect

The ban on tobacco sales at Bay State health care and educational institutions went into effect this month.

The Boston Public Health Commission's Board of Health approved the ban last year. Pharmacies and drug stores -- including those in supermarkets -- and stores on college and university campuses must remove tobacco products from their shelves.

"We hope that these extraordinary steps taken by our Board of Health to restrict the sale of tobacco products greatly reduce exposure to tobacco and its harmful effects," said Dr. Barbara Ferrer, the commission's executive director. "The evidence is overwhelming: Strict tobacco control regulations are effective in saving lives and discouraging people who don't smoke from picking up the habit."

Officials are working with Boston health centers, hospitals and pharmacists to increase access to smoking cessation resources, such as free patches and counseling, to help residents who want to quit.

In December, the Board of Health unanimously approved prohibiting tobacco sales at health care and educational institutions, and those establishments were given 60 days to comply.

The board also closed loopholes in Boston's 2002 workplace smoking ban by restricting smoking in outdoor adjacent areas, such as patios and loading docks, and prohibiting smoking in hotels, inns and bed and breakfasts in Boston.

Other changes the board immediately adopted were a ban on new smoking bars, such as hookah and cigar bars, and a prohibition on the sale of blunt wraps, a tobacco leaf often used to roll marijuana. Smoking bars currently licensed by the city can operate for 10 years, but no new permits will be issued.

For more information, see web link:
WCVB Boston February 6, 2009


Congress, President Deliver Historic Victory for Children's Health By Increasing Tobacco Taxes to Fund SCHIP Program

The Congress and President Obama have delivered a historic victory for the health of America's kids by increasing federal tobacco taxes, including a 62-cent increase in the cigarette tax, and expanding the State Children's Health Insurance Program (SCHIP). The new law will create a healthier future for millions of children by reducing tobacco use - the number one cause of preventable death in America - and expanding health care coverage for kids. The House of Representatives gave final approval to the legislation, and President Obama signed it into law.

Increasing tobacco taxes is a proven strategy to reduce smoking and other tobacco use, especially among children. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent.

The cigarette tax increase will lead to nearly two million fewer kids starting to smoke, help more than one million adult smokers quit, prevent nearly 900,000 smoking-caused deaths and produce $44.5 billion in long-term health care savings by reducing tobacco-caused health care costs. It is further good news that the final legislation immediately increases the tax on so-called "little cigars" to $1.01 per pack, the same rate as for cigarettes, addressing a disparity that has made little cigars cheaper and more appealing to kids.

Higher tobacco taxes are a win-win-win solution for the country - a health win that will reduce tobacco use and save lives, a financial win that will raise revenue to help fund the SCHIP program and reduce tobacco-caused health care costs, and a political win that is popular with voters. Polling conducted for the Campaign for Tobacco-Free Kids found that more than two-thirds of all voters support a significant increase in the federal cigarette tax to provide health care coverage to uninsured children.

For more information, see web link:
Campaign for Tobacco-Free Kids Press Release February 4, 2009


Poll: Texans Strongly Support a Smoke-Free State

More than two-thirds (68 percent) of Texans support prohibiting smoking in all indoor work and public places, including restaurants and bars, according to a statewide poll released by Smoke-Free Texas, a coalition of public health organizations, at a press conference and rally on the steps of the Texas Capitol.

The poll, funded by the Robert Wood Johnson Foundation, found that Texans understand that secondhand smoke exposure is a serious health hazard, and that 72 percent believe the rights of customers and employees to breathe clean air in restaurants and bars is more important than the rights of smokers and business owners.

"The first job of government is to protect the people and today, the people of Texas are sending a clear message to their elected representatives: they want protection from secondhand smoke," said Lance Armstrong, founder and chairman of the Lance Armstrong Foundation, which is a member of Smoke-Free Texas. "All of us at Smoke-Free Texas and the Lance Armstrong Foundation applaud the leadership of the legislators championing comprehensive smoke-free legislation. Texans expect and deserve safe, smoke-free places to earn their living and support their families."

Smoke-Free Texas is calling for a law that would provide statewide, comprehensive protections from secondhand smoke exposure in all indoor and public work places, including restaurants and bars.

Texans across the state increasingly recognize the benefits of a smoke-free environment. On January 22, College Station became the 28th Texas city to pass a comprehensive smoke-free ordinance. Three-fourths of Texans polled believe that air quality has improved because of these local ordinances. Local ordinances, however, don't protect all Texans and can't protect the 25 percent of the population who live in unincorporated areas.

"Every Texan has the right to breathe smoke-free air," said Suzanne Lozano, a San Antonio nurse who is a member of the American Heart Association's Texas State Advocacy Committee. "Each of us deserves strong, comprehensive protections from secondhand smoke in all indoor work places."

Across the nation, 24 states have strong smoke-free laws that include restaurants and bars-a significant increase from the 16 smoke-free states when the Texas Legislature convened in 2007, the first session lawmakers debated a smoke-free bill.

"The benefits of a statewide smoke-free law are undeniable," said State Rep. Myra Crownover, R-Denton, author of House Bill 5. "It's good for health, good for business and saves money now spent on health care. It's time for Texas to join the 24 other states that already have comprehensive smoking bans in place. No one should be forced to choose between their health and a paycheck."

For more information, see web link:
RWJF News Release January 30, 2009


Today Show and American Legacy Foundation® Team Up to Help Smokers Call it Quits

The American Legacy Foundation is collaborating with NBC's Today Show to help three parents quit smoking and motivate families nationwide to follow their lead. The three-part series will continue through March.

Throughout the series, viewers will witness the challenges and successes of three parents who are attempting to end their tobacco addictions using three different techniques. Each smoker will create a comprehensive quit plan, seek quit coaching and social support and use medication or other forms of therapy.

The American Legacy Foundation's quit smoking program, EX®, www.becomeanex.org, supported by the National Alliance for Tobacco Cessation, is built on the premise of helping smokers "re-learn their life without cigarettes" by first identifying their triggers -- the things in their daily life that make them want, or feel the need, to smoke. The interactive Web site features action-oriented tools and information to help smokers prepare for quitting by developing a personalized plan. The site offers a virtual community, where smokers share personal stories and best practices about their quit attempt to help encourage others wanting to make the decision to quit. Each of the quitters profiled in Today's series will also talk about their own personal struggles and viewers will have an opportunity to witness their quit attempts.

"Today Calls It Quits aims to provide parents who smoke with every tool in the arsenal they need to quit," said Dr. Nancy Snyderman, NBC's Chief Medical Editor. "Nicotine addiction impacts not only their own health but that of their children so we hope our viewers who smoke will be motivated by this series, follow the lead of the smokers we profile and finally quit for good."

"Quitting smoking is the single most important lifestyle change you can make," said Dr. Cheryl Healton, president and CEO of the American Legacy Foundation. "Parents are role models for their children, so if they smoke, their children are twice as likely to smoke as well. Secondhand smoke and its residue negatively affect young children especially, so we are thrilled to be working with Today on this important series to help families lead healthier, tobacco-free lives."

The Today Calls It Quits series aired on January 29 and 30 with on-air follow-ups scheduled for March. Online components will play a prominent role in the series with invaluable information on smoking cessation from the EX® campaign (BecomeAnEX.org) for smokers on the TodayShow.com and iVillage.com Web sites.

For more information, see web link:
PRNewsWire January 29, 2009


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Funding Opportunities

Call for Papers/Abstracts

  • National Conference on Health Communication, Marketing, and Media 2009
    Call for Abstracts: Deadline for submission is March 16, 2009. The conference planning committee invites abstracts for both oral and poster presentations in the following submission types - Research and Evaluation, Theoretical and Practice/Program-Based in one of four program tracks: Health Marketing: Nuts, Bolts and Beyond; Social Determinants of Health; New Frontiers - Trends and Technology; Partnerships/Collaborations - Synergistic Relationships.

Conferences and Trainings

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American Cancer Society Legacy Centers for Disease Control and Prevention National Cancer Institute National Institute on Drug Abuse Robert Wood Johnson Foundation
Consumer Demand YTCC The National Partnership for Smoke Free Families