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SpotlightStimulus Funding Awarded to States for Tobacco ControlThe U.S. Department of Health and Human Services (HHS) has awarded more than $119 million to U.S. states and territories to support public health efforts to reduce obesity, increase physical activity, improve nutrition and decrease smoking. This money supports the States and Territories Policy and Environmental Change Initiative, one of the four components that make up Communities Putting Prevention to Work, which is funded under the American Recovery and Reinvestment Act of 2009. According to the HHS, the funding for the states and territories initiative will focus on efforts to help communities and schools support healthy choices through a variety of methods including the use of media to support healthy food and beverage choices and increased physical activity. Awards will also support efforts to increase tobacco cessation through quit-lines and media campaigns and additional funding was provided to 13 states to support special initiatives. Awards to states and territories are in three major categories:
1. Tobacco cessation through quitlines and media.
2. Competitive special policy and environmental change.
3. Statewide policy and environmental change. Awards for other Communities Putting Prevention to Work initiatives, including community-based health promotion initiatives, will be announced in the coming weeks. To learn more about Communities Putting Prevention to Work, visit http://www.cdc.gov/chronicdisease/recovery. Research HighlightsCigar and Pipe Smoking Hurts LungsPipe and cigar smoking, both of which are on the rise, are linked to health impacts similar to those seen with cigarette smoking, researchers found. Compared with people who had no smoking history, those who smoked pipes or cigars had increased odds of airflow obstruction, whether they also smoked cigarettes (OR 3.43, 95 percent CI 1.75 to 6.71; P<0.0001) or not (OR 2.31, CI 1.04 to 5.11; P=0.039), according to the report published in the Feb. 15 issue of Annals of Internal Medicine. And the longer a person smoked pipes or cigars the more likely they were to have reduced performance on lung function tests, R. Graham Barr, MD, DrPH, of Columbia University Medical Center, and colleagues wrote. "These findings, together with increased cotinine levels in current pipe and cigar smokers, suggest that long-term pipe and cigar smoking may damage the lungs and contribute to the development of COPD," they concluded. "Physicians should consider pipe and cigar smoking a risk factor for COPD and counsel cessation of pipe and cigar smoking regardless of cigarette smoking history." Although cigarette smoking has decreased substantially since the 1960s, pipe and cigar smoking have increased rapidly in recent years with cigar smoking up by 46.4 percent from 1993 to 1997 and pipe and cigar tobacco smoking up by 28 percent and 8 percent, respectively, from 2002 to 2006, according to the report. And recent questionnaire-based studies found that smoking pipes and cigars raises risk of hospitalization and death, the researchers wrote. To investigate the risk of COPD, Barr and colleagues set out to determine if pipe and cigar smoking resulted in biological absorption of tobacco smoke, as assessed by urine cotinine levels, and whether these forms of smoking were linked to decreased lung function and airway obstruction. They analyzed data from the 3,528 men and women -- ages of 48 to 90 -- who participated in the Multi-Ethnic Study of Atherosclerosis. The participants' exposure to pipe and cigar smoking was determined using self-report questionnaires. Their lung function was assessed using spirometry according to American Thoracic Society guidelines and their urine cotinine levels measured through immunoassay. Among the participants, 9 percent reported pipe smoking (for a median of 15 pipe-years), 11 percent reported cigar smoking (median of six cigar-years) and 52 percent reported smoking cigarettes (median, 18 pack-years). "Some pipe and cigar smokers say they do not inhale, or inhale less than cigarette smokers," the authors wrote. "The elevated cotinine levels in the current study, however, belie this notion and provide a biological measure of nicotine exposure."
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New Intervention Helps Latino Parents of Asthmatic Children Quit SmokingAsthma is the most common chronic illness affecting Latino children in the United States, and secondhand smoke is a serious contributing factor. Now a new study from The Miriam Hospital's Centers for Behavioral and Preventive Medicine and Brown University suggests that clinically-based smoking cessation programs may not be enough to help Latino smokers with asthmatic children kick the habit. In the study, Latino parents with an asthmatic child were more likely to quit smoking when they received a culturally-tailored intervention that provides feedback about how much secondhand smoke their children were exposed to, compared to parents who followed existing smoking cessation clinical guidelines. Researchers say these findings reinforce the importance of educating parents about how their own smoking can affect their children with asthma. The study appears in the February issue of the Journal of Consulting and Clinical Psychology in a special edition focused on smoking cessation in underserved populations and innovative treatments. It is the first study to target smoking cessation in Latino caregivers of asthmatic children. "Caregivers who continue to smoke despite their child's asthma need an intervention that not only provides feedback about the harmful effects of cigarette smoke on themselves and their child, but also factors in their cultural values and readiness to quit," said the study's lead author, Belinda Borrelli, PhD, of The Miriam Hospital's Centers for Behavioral and Preventive Medicine. "Our findings suggest that standard smoking cessation clinical guidelines alone may only have limited success with this population." Borrelli, who is also a professor of psychiatry/human behavior at The Warren Alpert Medical School of Brown University, adds that they targeted Latinos specifically for the study, given that 16.5 percent of Latinos smoke yet few smoking cessation programs have been developed specifically for the country's largest minority group. Meanwhile, asthma – which is exacerbated by secondhand smoke – is much higher among Latinos than other racial or ethnic groups. Investigators identified 133 Latino smokers who were caregivers of a child with asthma. These caregivers were randomly assigned to receive one of the two smoking cessation interventions delivered in the home by a bilingual Latina health educator: a behavioral action model (BAM) and a precaution adoption model (PAM). The BAM followed clinical guidelines that focus on problem-solving and building coping skills to help smokers who are ready to quit. Meanwhile, the PAM was intended to help parents better connect their smoking to their child's health by providing physiological feedback about cigarette smoke exposure. It was also designed to be consistent with the values of Latino culture, including the importance of family, communication and intimate relationships. In addition to measuring carbon monoxide levels of parents in the PAM group, the research team also assessed children's secondhand smoke exposure by placing two nicotine monitors in the home for one week. They then mathematically converted these smoke levels into "cigarette equivalents," telling parents, "Your child was exposed to as much smoke as if she/he smoked "x" number of cigarettes him/herself the week that the sampler was placed." Overall, secondhand smoke levels in the homes of both groups were measured at the beginning of the study and after three months, and parents' smoking status was assessed at the end of the study as well as at two-months and three-months post-study. According to investigators, approximately 28 percent of participants in the PAM intervention had quit smoking three months after treatment, compared to about 18 percent of those receiving the BAM intervention. Significant decreases in asthma-related illness were only observed in the children of participants in the PAM intervention.
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Secondhand Smoke Raises TB Risk: StudySmoking has long been known to boost tuberculosis risk, and a new study from Hong Kong suggests that being exposed to someone else's tobacco smoke also increases the likelihood of contracting the disease. Dr. Chi C. Leung of the Wanchai Chest Clinic in Wanchai and colleagues compared TB risk in older women living with at least one smoker to that of women living in smoke-free homes. The study included 15,486 non-smoking women 65 to 74 years old, all of whom lived with their husbands. All of the women had enrolled at one of the territory's 18 Elderly Health Centers between 2000 and 2003, and about one in four lived with a smoker. During follow-up, which lasted through the end of 2008 (or until a person died or was diagnosed with TB), 117 women developed active TB and 69 of these cases were confirmed in a laboratory. Leung's team found that women who had been exposed to secondhand smoke were 1.5 times more likely to develop active TB than women who didn't live with a smoker, while their risk of culture-confirmed TB was 1.7-fold higher. Secondhand smoke exposure accounted for about 14 percent of active TB cases and about 18 percent of culture-confirmed TB cases. The researchers also found that the women who lived with a smoker were significantly more likely to have some type of obstructive lung disease, such as emphysema, as well as diabetes, at the study's outset. The findings appear in the latest issue of the Archives of Internal Medicine.
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Thirdhand Smoke Forms Cancer-Causing Residue Indoors That LastsTobacco smoke contamination lingering on furniture, clothes and other surfaces, dubbed thirdhand smoke, may react with indoor air chemicals to form potential cancer-causing substances, a study found. After exposing a piece of paper to smoke, researchers found the sheet had levels of newly formed carcinogens that were 10 times higher after three hours in the presence of an indoor air chemical called nitrous acid commonly emitted by household appliances or cigarette smoke. That means people may face a risk from indoor tobacco smoke in a way that’s never been recognized before, said one of the study’s authors, Lara Gundel. “We have considered that nicotine on surfaces has been pretty benign up to this point. It turns out we shouldn’t say that now,” said Gundel, a staff scientist at Lawrence Berkeley National Laboratory in Berkeley, California, in a Feb. 5 telephone interview. “People can be exposed to toxins in tobacco smoke in a way that’s never been recognized before.” A previous study, published in the journal Pediatrics in January 2009, found residual tobacco smoke is deposited on furniture, carpeting and clothing and coined the phrase “thirdhand smoke.” The study found that when the residue from tobacco smoke settled on indoor surfaces, it mixed with indoor air pollutants to form tobacco-specific nitrosamines, or TSNAs, which are potent cancer-causing substances found in unburned tobacco and tobacco smoke. The researchers checked for nitrosamine levels by exposing paper to smoke and then to nitrous acid, which is produced by gas ovens and burners that aren’t properly vented and by cars. They also tested the surfaces on the inside of a truck of a heavy smoker. In both cases they found the reaction between the nicotine in thirdhand smoke and the nitrous acid produced two known and potent nitrosamines. They also found a tobacco-specific nitrosamine that is absent in freshly emitted tobacco smoke. People, particularly infants and toddlers, are most likely exposed to these carcinogens by either inhaling dust or by skin contact, the authors said. Using fans and opening a window doesn’t help eliminate the hazards because most of the nicotine and other substances from burning cigarettes aren’t found in the air, but are absorbed by surfaces, Gundel said. “Buildings, rooms, public places should be 100 percent smoke free,” she said. “Replace nicotine-laden furniture, carpets and curtains. Nicotine absorbs into these materials. The stuff that’s imbedded can continue to come to the surface.” The researchers are trying to determine how long these nitrosamines may last as a result of the interaction of thirdhand smoke and the indoor air pollutant, nitrous acid. They are also looking to develop ways to track exposure to nitrosamines.
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Smoker's Own Secondhand Smoke Adds to Health RisksIn addition to the risks associated with directly inhaling cigarette smoke, smokers also face significant risk from their own secondhand smoke, researchers say. The finding, published online Jan. 29 in Environmental Health, challenges the widely held belief that the threat posed to smokers by secondhand smoke is negligible. The study focused on newsstand agents in Genoa, Italy. "News agents were chosen because they work alone in small newsstands, meaning that any tobacco smoke in the air they breathe is strictly correlated to the number of cigarettes smoked by that news agent," Maria Teresa Piccardo, of the National Cancer Research Institute in Italy, said in a news release from the journal's publisher. "We studied the contribution environmental tobacco smoke made to carcinogen exposure in 15 active smokers." Piccardo and her colleagues concluded that secondhand smoke could have a major impact on smokers' health. For example, smoking 14 cigarettes a day results in secondhand smoke exposure that's equivalent to smoking an extra 2.6 cigarettes, they found. "Both active and passive smoking contributions should always be considered in studies about health of active smokers," Piccardo said.
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Hospital Stay Offers Chance To Help New Parents Quit SmokingParents are often motivated to quit smoking when they welcome a new baby into their family. Catching them while they're still in the hospital may be ideal, according to the study, "Using the Postpartum Hospital Stay to Address Mothers' and Fathers' Smoking: The NEWS Study," published in the March issue of Pediatrics (appearing online Feb. 1). This pilot trial, known as Newborns Excel Without Secondhand Smoke (NEWS), assessed the smoking status of all new parents giving birth at a hospital child birth center during a 14-month period. Researchers enrolled 101 new parents who were smokers or who had recently quit smoking. About half received an in-person counseling session and an invitation to enroll in a telephone quit line. Letters were also sent to the newborn's pediatrician, the parents' primary care provider, and the mother's obstetrician indicating their tobacco use status and recommending strategies to help them quit. Of current smokers, 64 percent of those in the intervention group reported a quit attempt, versus 18 percent in the control group. Researchers noted the hospital stay may be a particularly opportune time to coach new fathers; while 90 percent of mothers were counseled by their obstetricians to quit smoking, only 15 percent of fathers received this advice. A high rate (75 percent) of fathers in the intervention group at the hospital enrolled in the quit line. Researchers concluded it is feasible to enroll mothers and fathers into tobacco treatment services during the immediate postpartum stay, and that it seems to stimulate attempts to quit smoking.
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Cost to Patients Barrier to Counseling for Obesity and SmokingReducing obesity and smoking have become national priorities in the United States. Research has shown that intensive counseling can positively impact each problem. However, because such counseling is typically not covered by medical insurance, cost can be a barrier. In a study published in the March 2010 issue of the American Journal of Preventive Medicine, researchers from Virginia Commonwealth University, Richmond, Virginia, found that when primary care clinicians and community counselors collaborated to offer free counseling services to patients, there was an overwhelming positive response. Yet, when the same services were offered at a cost to the patient, there was a significant drop in participation. An electronic linkage system (eLinkS) was used to prompt healthcare providers to suggest intensive healthcare counseling for adult patients with unhealthy behaviors. eLinkS then helped to facilitate and automate referrals and communication between primary care practices and community programs. During a 5-week period when funding was available, 5679 patients were evaluated, 1860 had at least one unhealthy behavior (triggering an eLinkS prompt), and 407 (21.8 percent) were referred for intensive counseling. In a 3-week period after funding was exhausted, 2510 patients visited the practices, 729 triggered an eLinkS prompt, but only 5 (0.7 percent) were referred for intensive counseling. Compared to the coverage period, the overall referral rate for patients with an unhealthy behavior decreased by 97 percent. Practice nurses asked 22 percent fewer patients about health behaviors (37 percent vs 29 percent). When prompted by eLinkS, clinicians offered referrals to 79 percent fewer patients (29 percent vs 6 percent). If a referral was offered, 81 percent fewer patients accepted (76 percent vs 14 percent). Patients confirmed that costs introduced a barrier to counseling. Some patients were explicit that charges would prevent participation while others who had deferred counseling in the past were motivated to enroll because it was free. Clinicians reported that removing cost as an impediment, combined with an easy means to refer patients, allowed patient discussions to focus on behavior change. The heightened patient interest reversed when charges were reinstituted. Fewer successes also diminished motivation for the counselors.
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Extended Use of Nicotine Patch Linked to BenefitsThe use of transdermal nicotine patches for an extended duration, compared to the standard eight-week therapy, may improve the chances of smoking abstinence, according to research published in the Feb. 2 issue of the Annals of Internal Medicine. Robert A. Schnoll, Ph.D., of the University of Pennsylvania in Philadelphia, and colleagues analyzed data from 568 adult smokers who were randomized to receive either 24 weeks of transdermal nicotine therapy or eight weeks of therapy followed by 16 weeks of placebo. The primary outcome was seven-day point prevalence abstinence at weeks 24 and 52, verified by carbon monoxide assessment. At week 24, the researchers found that those in the extended group had higher rates of point-prevalence abstinence (31.6 versus 20.3 percent) and continuous abstinence (19.2 versus 12.6 percent). Extended therapy was also associated with a lower risk of lapses and better chance of recovery from a lapse. However, point-prevalence abstinence was similar in the groups at 52 weeks (roughly 14 percent). "Our study demonstrates the benefits of extended-duration therapy with transdermal nicotine and encourages a reexamination of the recommended duration of tobacco-dependence treatment using nicotine patches. Maintaining smokers on transdermal nicotine for 24 weeks improved end-of-treatment abstinence rates compared with standard eight-week treatment and did not increase adverse events or side effects. However, this benefit was lost when therapy was discontinued," the authors write.
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New Investigational Nicotine Vaccine May Help Prevent Smoking Addiction, RelapseRelapse rates for smokers using existing anti-smoking treatment therapies can be as high 90 percent Oregon Health & Science University is among 22 centers participating in a Phase III clinical trial to determine whether a new investigational smoking cessation aid called NicVAX is safe, effective and capable of stimulating an immune response. OHSU was one of nine centers to participate in the earlier Phase II trial of NicVAX, a proprietary investigational vaccine developed by Nabi Biopharmaceuticals. Nicotine is a mind-altering compound that easily crosses the blood brain barrier, a network of blood vessels that makes it difficult for toxic substances to enter the brain. Because nicotine molecules are extremely small, they don’t stimulate an immune or antibody response by themselves. Once in the brain, nicotine binds to specific receptors that trigger the release of a number of neurotransmitters, such as dopamine, that change the way the smoker feels. “Smokers continue to smoke even when they know it’s harmful because of these ‘brain effects,’” explained David Gonzales, Ph.D., OHSU principal investigator and clinical investigator in medicine (pulmonary and critical care medicine) at the OHSU Smoking Cessation Center, OHSU School of Medicine. “While a smoking cessation medication such as varenicline prevents nicotine from binding to receptors once it is in the brain, NicVAX is designed to block nicotine before it enters the brain.” The vaccine stimulates the body’s immune system to produce antibodies that bind to or capture the nicotine molecules in the bloodstream, creating a complex that is too large to cross the blood-brain barrier. As a result, many of the expected rewards from smoking are blocked, making it easier for the smoker to become and remain abstinent. Because antibodies circulate in the bloodstream for an extended period of time, researchers hope the vaccine also will help smokers maintain long-term abstinence from cigarettes. “A nicotine vaccine to help smokers quit smoking is a novel and exciting direction for smoking cessation treatment,” Gonzales said. “Unlike medication treatments where the planned quit day is immediate or within one or two weeks of starting medication, the planned quit day for those taking the vaccine is a number of weeks after the first injection. The longer lead-in to the quit day is to allow the antibody levels to increase. For some smokers, this more gradual run in for quitting may be more appealing.” Because a vaccine is not a drug and not metabolized, explained Gonzales, there is no expected risk of vaccine/drug interactions. Should the results of the study demonstrate that the vaccine is safe and effective and the FDA grants approval, some smokers may be able to use a cessation aid for the first time. Approximately 1,000 male and female smokers aged 18 to 65 will take part in the study for a 12-month period; about 50 will be enrolled at OHSU. Half of study participants will receive the vaccine and half will receive a placebo. At the end of the 12-month observational period, Gonzales and colleagues will evaluate participants’ overall abstinence based on self-reported cigarette use and exhaled carbon monoxide. In addition, the researchers will assess the safety and immune system response to NicVAX at various intervals throughout the study and determine whether the vaccine has an effect on withdrawal symptoms, cigarette consumption, smoking satisfaction and nicotine dependence. Smokers interested in learning whether they qualify for study should call 503-494-0503. This study is funded in part with a $10 million grant from U.S. National Institute on Drug Abuse, part of the National Institutes of Health.
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Other Cessation NewsGroups Urge FDA To Relax Restrictions On Nicotine PatchesTwo smoking-cessation groups are urging the U.S. Food and Drug Administration to relax restrictions on nicotine patches, lozenges and gums amid concerns the agency’s regulations go too far and make it harder for people to quit smoking. The groups say nicotine-replacement therapies such as GlaxoSmithKline Plc’s (GSK) Nicoderm CQ and Nicorette gum should be available everywhere cigarettes are sold, so people who want to quit can find the products easily without having to go to a pharmacy. They also want the FDA to tone down warnings on the products that say they shouldn’t be used when people continue to smoke or in those who have heart conditions. "It sends the message that these products are dangerous and sends the message to the smoker to just continue smoking," said Ken Wassum, former president of the Association for the Treatment of Tobacco Use and Dependence, one of two groups petitioning the FDA to relax the standards. The petition comes at a time when the FDA is fighting to tighten its control over tobacco and nicotine products, not loosen it. The agency is also facing tough court battles over its attempts to severely restrict tobacco advertising and stop electronic cigarettes from being sold in the country. Nicotine patches, gums and other nicotine products are approved by the FDA and deliver small amounts of nicotine generally over a period of a few minutes to a few hours. Cigarettes deliver high doses of nicotine within a few seconds. These nicotine-replacement therapies, as they are called, are sold mostly at pharmacies over the counter, while cigarettes are available at pharmacies and thousands of retail stores across the country. The Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco want to change that, according to a petition they plan to file with the FDA. Their petition cites government statistics showing that smoking kills about 440,000 Americans annually and costs the health-care system about $157 billion a year. The petition also requests the FDA allow people to buy the products in one-day supplies just like cigarettes, something people have been debating for years. FDA regulations prohibit that. Wassum said the groups just want FDA regulations to keep up with current science showing the products are far less harmful than cigarettes. The FDA said it will review the petition.
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New Report: Cigarette Tax Increases Would Raise Billions for Cash-Strapped States, While Reducing Smoking and Winning Voter ApprovalBy increasing cigarette taxes by $1 per pack, the states could raise more than $9 billion in new annual revenue to help close severe budget shortfalls, while also reducing smoking and saving lives, according to a new report released by a coalition of public health organizations. A national poll released along with the report finds that 67 percent of voters support a $1 tobacco tax increase. The poll also found that voters far prefer higher tobacco taxes to other options, such as other tax increases or budget cuts, for addressing state budget deficits. The report details the revenue and health benefits to each state of increasing its cigarette tax by $1 per pack. If every state and Washington, D.C., did so, they would:
The report, Tobacco Taxes: A Win-Win-Win for Cash-Strapped States, was released by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and Robert Wood Johnson Foundation. The report was released as states are grappling with unprecedented budget shortfalls and facing tough choices to raise revenue and/or cut essential services. “This report shows that raising tobacco taxes is truly a win-win-win for the states. It is a budget win that will help protect vital programs like health care and education, a health win that will prevent kids from smoking and save lives, and a political win with the voters,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. According to the national poll released with the report:
The scientific evidence is clear that increasing cigarette prices is one of the most effective ways to reduce smoking, especially among youth. The report’s projections are based on research findings that every 10 percent increase in cigarette prices reduces youth smoking rates by about 6.5 percent, adult smoking rates by two percent, and total cigarette consumption by four percent. According to the report, states can achieve even greater financial and health benefits if they also increase tax rates on other tobacco products, such as smokeless tobacco and cigars, and dedicate some of their tobacco tax revenues to fund programs to prevent kids from smoking and help smokers quit. The current average state cigarette tax is $1.34 per pack, with rates ranging from a low of seven cents in South Carolina to a high of $3.46 in Rhode Island.
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Operation Cessation: Curbing Military and Veteran Tobacco UseThe U.S. military has a long history with tobacco products. Cigarettes were issued in daily rations throughout World Wars I and II, and even into the Vietnam War. This unhealthy tradition came to a formal end in 1975, and today many military leaders hope that tobacco use will soon be just that—a thing of the past. The Department of Defense (DoD) has launched an online interactive tobacco cessation program that developers hope will help bring military tobacco use rates down. Quit Tobacco, Make Everyone Proud promotes quitting tobacco as a matter of duty and pride and features campaign materials that convey two themes: role modeling and readiness. The campaign’s Web site and materials present service members as role models for their children and other loved ones, and senior leaders send strong messages about military readiness. Rates of smoking in the military are higher than in the civilian population. According to a June 2009 Institute of Medicine (IoM) report commissioned by the Department of Veterans Affairs (VA) and the DoD, 32 percent of active duty military and 22 percent of all veterans smoke, compared with about 20 percent of the civilian adult population. Smoking rates are even higher among military personnel who have been deployed, and an increasing number of service members use smokeless tobacco products. The VA provides care for 6.7 million of the nation’s 24 million veterans and is the largest provider of care for adults with chronic psychiatric disorders, such as post-traumatic stress disorder. This population smokes at a very high rate, and the VA continues to invest in research on the most effective ways to provide tobacco cessation for these veterans. Researchers are also exploring policy interventions to promote tobacco cessation, such as further restricting the sale of tobacco products on military bases and increasing their price. The June 2009 IoM report, titled “Combating Tobacco Use in Military and Veteran Populations,” includes numerous recommendations for the DoD and VA to make progress towards a tobacco-free military, and concludes that, “given the effects of tobacco use on military readiness and on the health of military personnel, retirees, their families, and veterans, the time has come for DoD and VA to assign high priority to tobacco control.” The IoM report has raised awareness of additional opportunities for the VA and DoD to collaborate, emphasized Dr. Kim Hamlett-Berry, director of the VA’s Office of Public Health Policy and Prevention. “Our goal is to increase access to a menu of evidence-based options, so that any veteran who wants tobacco cessation resources can get them,” she said. “Our next steps are to take this even further and look at how the two systems could work together.” This commitment to tobacco cessation is reflected in the resources both departments provide to address tobacco addiction. All VA medical centers have tobacco cessation specialty clinics and use electronic medical records to build in clinical reminders for tobacco-use screening. The clinics provide free counseling and FDA-approved smoking cessation medications, including over-the-counter smoking cessation medications available on the Veterans Health Administration national formulary. Veterans seen in primary care and outpatient mental health clinics are screened for tobacco use at least once a year. Providers offer brief cessation counseling to current tobacco users, as well as prescriptions for FDA-approved medications and referrals to more intensive counseling to assist veterans with quitting. The DoD’s Quit Tobacco, Make Everyone Proud campaign provides an opportunity to submit questions to tobacco cessation counselors in real time; computer games to distract from tobacco cravings; and short videos and audio podcasts—quitcasts and spitcasts—in which service members share testimonials and advice.
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Simple Changes Can Prevent 40 Percent of CancerFebruary 4th was World Cancer Day, and in recognition of the celebration, the World Health Organization (WHO) supported an initiative by the International Union Against Cancer to promote “Cancer Can Be Prevented Too”, which focuses on simple measures to prevent cancer. According to WHO, more than 12 million people are diagnosed with cancer each year – and two out of five, or about 40 percent, are potentially preventable through smoking cessation, reduction in alcohol consumption, avoidance of excess UV rays, and achievement or maintenance of a healthy weight through diet and exercise. They also suggest vaccines that target nine cancer-causing infections, saying that 21 percent of all cancers are due to infections. “If there was an announcement that somebody had discovered a cure for 40 percent of the world’s cancers,” said UICC president David Hill, “there would quite justifiably be huge jubilation. But the fact is that we have (it) now; the tragedy is we’re not using it.” According to the National Vital Statistics Report, lung cancer is the leading cause of cancer deaths in the United States. WHO officials call smoking “the single largest preventable cause of cancer.” Tobacco use is responsible for 1.8 million cancer deaths per year worldwide, and approximately a third of cancer-related deaths in the United States. Colon cancer is the second leading cause of cancer deaths, responsible for approximately 639,000 deaths. Regular screenings can prevent polyps from becoming malignant, according to the American Cancer Society. Other considerations include increasing fruit, vegetable and fiber intake; reducing red meat consumption; and maintaining a healthy weight. Hormonally influenced breast and prostate cancers are three and four respectively. The risk of both of these cancers can be influenced by obesity, diet and a sedentary lifestyle. Being overweight or inactive are together responsible for approximately 274,000 cancer deaths each year. Other cancers with links to excess body weight include pancreatic cancer (number 5), esophageal cancer, and kidney cancer. Rounding out the top seven are lymphoma and leukemia. The HIV virus can lead to AIDS-related lymphomas, so practicing safe sex can prevent this type of cancer. Those with AIDS can prevent lymphoma by taking anti-HIV medications to maintain a healthy immune system. The Epstein-Barr virus can also cause a type of cancer called Burkitt’s lymphoma that has an especially high incidence in African children. Cervical and liver cancer, not in the top seven but both caused by infections (HPV for cervical cancer and Hepatitis B and C for liver), could be prevented with vaccines particularly in developing countries where it is estimated that 80 percent of the global cases of cervical cancer occur. Excessive alcohol use is another risk factor for liver cancer. Another preventable type of cancer is skin cancer, or melanoma. The incidence of this disease has dramatically increased in recent years. Estimates suggest that there were 60,000 new cases in 2007 alone. Prevention includes wearing sunblock, preventing sunburn, and getting regular skin exams.
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Florida County Taxpayers Getting Secondhand Smoke Warnings in the MailWhether it has been stickers on envelopes or the image of a child inhaling smoke, thousands of local taxpayers have received warnings on the dangers of cigarettes. Thousands more will receive them when they get their vehicle registration forms in the mail. Since late November 2009, the Hernando County (Florida) Tax Collector has stuffed envelopes with flyers with an image of a sleeping boy strapped in a child-safety seat. Above his head is a statement in bold letters, "Your car. Your smoke. Their future." Tax Collector Juanita Sikes said the flyers are being sent along with every vehicle and mobile home renewal notice. Sikes was approached about the program several months ago by Ann-Gayl Ellis of the Hernando County Health Department, she said. Other neighboring counties also are stepping up their efforts to warn against the dangers of secondhand smoke, focusing their message on its effects on children. On the bottom of the flyer is a message that reads, "Children exposed to secondhand smoke have higher rates of asthma and respiratory infections and are more likely to begin smoking themselves. Help them be safe ... please don't smoke around kids." The flyers were paid for through the Community-Based Tobacco Prevention Grant, according to the health department. "Over the last 25 years, Floridians have been taking steps toward a tobacco-free environment," Ellis said. "We have seen airplanes, movie theaters and public buildings become smoke-free. "Many people have chosen to make their homes smoke-free and if they do smoke, they do so outside," she added. "Smoke-free cars are a logical next step and we hope the campaign will help move Hernando County in that direction." Sikes guessed more than 12,500 people have received the flyers since the program started a few months ago. Roughly 77,000 flyers were printed and all of them should be mailed by the end of the year, she said. Additionally, a yellow sticker has been attached to every envelope. It shows a drawing written in crayon of a smiling child in the back seat with the warning, "Don't smoke in the car with kids." Taxpayers are warned twice when they receive their notices. The flyers don't add to the postage expense, and they were paid for with grant money, Sikes said. "In order to reach and educate parents, we need to get it into their hands," Hammond said. "Using the tax collector is really a novel approach. I don't know of any other county doing that."
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The ACCP and FIRS Elevate Lung Cancer Status During 2010: The Year of the LungDuring the 2010: The Year of the Lung campaign, the American College of Chest Physicians (ACCP) and other members of the Forum of International Respiratory Societies (FIRS) are honoring World Cancer Day, February 4, by elevating the awareness of lung cancer in terms of prevalence and prevention, as well as the amount of funding the disease receives for research in diagnosis and management. Lung cancer is the leading cause of cancer deaths in men and women in the United States and throughout the world, yet it is the least funded. Lung cancer causes more deaths than the next four most common cancers combined, including breast, colon, pancreas, and prostate. Furthermore, lung cancer has one of the lowest 5-year survival rates among the five leading cancer killers, second only to pancreatic cancer. However, in the United States, lung cancer receives just $1,200 of federal funding per death, while breast cancer receives more than $27,000 per death, followed by $14,000 for prostate cancer and $6,500 for colon cancer. "There is a significant disconnect between the tremendous morbidity and mortality caused by lung cancer, compared with other cancers, and the amount of funding provided for lung cancer research," said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. "The lack of significant research dollars and resources for lung cancer research will further hinder the progress in reducing the incidence and management of this devastating disease." Beyond the race for research dollars, lung cancer is in need of significant funding for national awareness campaigns, placing emphasis on the prevention of the disease and how the disease impacts specific populations. Although lung cancer trends show the incidence has slightly decreased among men from 1991 to 2005 (decrease of 1.8 percent per year), the incidence among women continues to grow (increase of 0.5 percent per year). Regarding lung cancer mortality, 30 percent of cancer deaths in men are attributable to lung cancer, while the number is slightly lower at 26 percent in women. However, this gender gap is also decreasing. The death rate per 100,000 was 90.56 for men in 1991 but fell to 69.39 in 2005. In women, the death rate per 100,000 increased from 37.61 to 40.59. In addition to women, African-Americans continue to experience the disproportionate burden of lung cancer incidence and mortality. Compared with other ethnic groups, African-Americans have the highest incidence of lung cancer, highest mortality rate, and lowest 5-year survival rate associated with lung cancer. An increase in federal funding for national, statewide, and community-based initiatives that focus on disease prevention, particularly in the areas of tobacco prevention and cessation, is needed in order to make a significant impact on morbidity and mortality associated with lung cancer. Furthermore, campaigns that place additional emphasis on the risk factors of lung cancer —tobacco use and beyond—are key in helping to educate at-risk populations. "Significant funding and resources have been dedicated to cancer research, which has greatly improved patient awareness and outcomes for breast, prostate, and other cancers," said Dr. Guntupalli. "It is time for lung cancer to receive this same priority in research and awareness." 2010: The Year of the Lung is a global initiative instituted by the Forum of International Respiratory Societies (FIRS), a collaboration of the world's leading professional respiratory organizations, including the ACCP. 2010: The Year of the Lung aims to raise awareness of and advocate for lung health, globally and at the country level, to reduce lung disease morbidity and mortality. A leader in lung cancer education, the ACCP has published a number of provider and patient resources related to lung cancer, including evidence-based lung cancer guidelines and tobacco prevention education materials. To learn more about 2010: The Year of the Lung and corresponding ACCP initiatives, please visit www.chestnet.org. To learn more about World Cancer Day, visit http://www.who.int/mediacentre/events/annual/world_cancer_day/en/index.html.
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FDA Appeals Electronic Cigarette RulingThe Food and Drug Administration is appealing a federal judge's ruling that the agency doesn't have the authority to regulate electronic cigarettes. The FDA asked a federal appeals court in Washington to immediately stay an order that prevented the agency from blocking electronic cigarettes from entering the country. The FDA said it does have the authority to regulate some products containing nicotine as though they are drugs and devices, such as nicotine patches and nicotine lollipops. The agency said the judge was "quite wrong to believe that no injury would result from the use of these harmful and addictive products." The case is testing the reach of FDA's regulatory powers, and the agency and public health advocates have said it could have severe public health implications. In January, U.S. District Judge Richard J. Leon sided with electronic-cigarette makers Smoking Everywhere Inc. and NJoy in finding that the FDA has no authority to regulate the products and can't stop them from entering the country. His opinion came with a preliminary injunction that allowed Smoking Everywhere and NJoy to continue importing their products into the country. The FDA has seized shipments of electronic cigarettes, which contain nicotine and look and taste like cigarettes but don't contain tar, amid concerns the products were being marketed as safer alternatives to traditional tobacco. The FDA asserted its power by saying the electronic cigarettes were essentially drugs or devices that were being imported without FDA approval. Regulating the products as drugs or devices means the companies would have to conduct extensive clinical safety testing and apply for formal FDA approval. Smoking Everywhere and NJoy are trying to avoid that. The companies say their products are used for recreation and, unlike nicotine patches, aren't used as smoking cessation aids. Judge Leon's decision was based on a Supreme Court case decided in 2000 called FDA v. Brown & Williamson Tobacco Corp. In that case, the court decided that allowing cigarettes and smokeless tobacco products to be marketed as drugs or devices would result in their being banned from the market. The FDA said in its appeal that the Supreme Court decision doesn't preclude the agency from regulating tobacco products as though they are drugs or devices. The FDA said Judge Leon also "mistakenly" concluded that electronic cigarettes could be regulated under new tobacco powers signed into law in 2009. The FDA said those laws preclude the FDA from regulating drugs or devices as tobacco products.
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