February 2011

Spotlight

iPhone Apps for Smoking Cessation: A Content Analysis

A recent study published in the American Journal of Preventive Medicine is the first to look at the content of iPhone applications (apps) for improving health behaviors such as smoking cessation. Given the increased use of new media platforms (e.g. smartphones) to promote behavior change, authors Lorien Abroms from George Washing University School of Public Health and Health Services, Nalini Padmanabhan from the National Cancer Institute, and Todd Phillips from the Academy for Education Development, set out to examine the content of nearly 50 iPhone applications (apps) for smoking cessation. The aims of this analysis were to 1) determine the degree to which apps adhere to established best practices in smoking cessation, 2) the popularity of smoking cessation apps among iPhone users, and 3) the relationship between these variables. In conclusion, greater efforts are needed to bring the attention to evidence-based information as it relates to smoking cessation.

Key findings reveal that iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation:

Adherence Findings

• On average, only 11.3% of apps strongly followed a given guideline.
• None of the apps strongly followed the guidelines to ask users for their tobacco use status, assess their willingness to quit, arrange for a follow-up, recommend the use of approved medications, and recommend the use of counseling and medication to quit smoking.
• Only 4.3% of apps strongly followed the guideline to connect a user to a Quitline.

Popularity Findings

• The top 5 downloaded apps accounted for 67.8 percent of downloads in the sample.
• Of the top five downloaded apps, 60 percent was for calendar apps and 20 percent was for hypnosis apps.

Overall, apps that were more frequently downloaded were less likely to be adherent to established smoking cessation guidelines.

With the proliferation of smartphones comes new possibility for engaging a wider audience and providing cessation services to smokers in real time. As the number of mobile phone subscribers continues to increase every year, smartphones are beginning to reach more young adults and minorities, groups that have traditionally been difficult to engage regarding smoking cessation.

Moving forward, smokers looking to quit must be engaged with evidence-based tools. While nearly 4 dozen apps have been developed for smoking cessation and are currently available for download to smartphones, most are not based on methods that have been proven successful. Similar trends have also been found with YouTube videos and websites for smoking cessation, thus further emphasizing the need for a concerted effort to bring evidence-based materials to media platforms.

To access the full report of the study, click here.
For additional commentary about the analysis, click here.

Background

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 developed to provide smokers with more detailed information. Visitors to the website can review explanations of each of the cessation approaches, common side effects, point of contact regarding questions, and more.

To order copies of the What Works? guide, please visit: http://tobacco-cessation.org/resources/whatworks.html.

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Research Highlights

Smoking Linked to Lou Gehrig's Disease

People who smoke cigarettes or have smoked in the past may be more likely to develop Lou Gehrig's disease, according to a new study.

The disease slowly kills the neurons that send messages between the brain and the rest of the body, causing patients to lose control of their muscles -- including those that are essential for eating and breathing. Most people who are diagnosed with Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, or ALS, don't survive more than five years after the diagnosis.

About 20,000 to 30,000 people in the United States have ALS, according to the Centers for Disease Control and Prevention. While about 10 percent of those cases are caused by a genetic defect, the rest have no known cause. Some previous studies have suggested that smoking may be one factor that increases a person's risk of getting ALS, but others have found no link.

"Results have been rather conflicting regarding the association between smoking and ALS," said Dr. Fang Fang, who has investigated the question at the Karolinska Institute in Stockholm, Sweden, but was not involved with the current study. Many ALS researchers tend to agree on a positive association between cigarette smoking and ALS risk although some quite-recent studies still report no link, he told Reuters Health in an e-mail.

In the current study, researchers led by Dr. Hao Wang of the Harvard School of Public Health collected data from five long-term studies in the United States that altogether included more than a million adults. In all of the studies, participants had been asked if they currently smoked or had smoked in the past, and if so, how frequently and for how many years. The studies tracked participants for between seven and 28 years, and the researchers were able to determine from a national database of deaths which of the participants ultimately died of ALS.

A total of 832 people across the five studies got ALS according to the results, which are published in the Archives of Neurology. Being a past smoker or a current smoker meant a person was 40 to 45 percent more likely to die of ALS than someone who had never smoked. In absolute terms over a ten-year period, an average non-smoker had about a 0.05 percent chance -- about 1 in 2,000 -- of getting ALS, whereas former or current smokers had a 0.075 percent chance of getting ALS -- about 1 in 1,300.

The researchers also found that starting to smoke at an earlier age meant people were more likely to get the disease, compared to smokers who started when they were older.

Among smokers, however, there was no relationship between how many cigarettes they smoked each day or how much of their lives they smoked and their chances of getting ALS.

That finding is in contrast to the results of some previous studies which have shown that the more people smoke, the higher their risk of getting ALS. That sort of direct link between smoking "dose" and disease risk would be expected if cigarette smoking, specifically the toxic components of cigarette smoke, were able to damage nerves directly, as some researchers believe.

The current study, therefore, cannot show that smoking causes ALS, only that smoking and risk for ALS are somehow linked.

"There is a range of possible mechanisms for smoking to increase the risk of ALS," Dr. Carmel Armon, the head of neurology at the Baystate Medical Center in Springfield, Massachusetts who was not involved in the current research, told Reuters Health. "In this case ... what we're probably seeing is a change that causes the systematic dismantling" of the system of neurons that control muscle movement, he said. Smoking may change the DNA of cells involved in muscle movement -- changes that would then build up over time.

Because this is a report that includes data from multiple studies, it's hard to know if something about the way those studies were done influenced the finding that more cigarettes and a longer duration of smoking didn't increase a smoker's risk of ALS, Armon said.

While Armon said that the link between smoking and ALS has become more and more clear in recent years, what hasn't been studied is whether people exposed to secondhand smoke are also more likely to get ALS than those who aren't exposed. Because of that, researchers might still be underestimating how much of a risk smoking is for ALS, he said.

For more information, see web link:
Reuters February 14, 2011

Smoking on Screen Lights Up Cravings in Smokers

Previous research has reported that watching actors puff cigarettes on screen triggers cravings in smokers, but a new study points to why.

According to the research, watching actors smoke cigarettes activates the part of the brain that plans hand movements in smokers, such as movements required for lighting up and taking a drag.

US researchers selected the 2003 Nicolas Cage film Matchstick Men because smoking plays a prominent role in the film, but sex, violence, and alcohol abuse don't, which researchers feared would skew the results. The study was published in the Journal of Neuroscience.

To find out what happens in the brain when watching onscreen smoking, the researchers asked 17 smokers and 17 non-smokers to watch the first 30 minutes of the movie while in a functional magnetic resonance imaging machine (fMRI), which measures blood flow to different areas of the brain as a way to track brain activity. The scans revealed that smokers' brains went into action, already planning the movements of their smoking hand, which was not the case for the non-smokers. The volunteers did not know the experiment was about smoking.

The Guardian reports that cigarette smoking is a habit that kills five million people worldwide each year. In 2010, the US Centers for Disease Control and Prevention claimed that smoking scenes encouraged children and adolescents to light up. While smoking on television and in movies may have become less common in recent years, the organization states that around half of the popular US movies in 2009 involved smoking scenes.

For more information, see web link:
The Independent January 22, 2011

Odds of Quitting Smoking May Be Clear on Scans

Brain scans can predict a smoker's chances of being able to quit, according to a new study.

It included 28 heavy smokers recruited from a smoking cessation program. Functional MRI was used to monitor the participants' brain activity as they watched television ads meant to help people quit smoking.

The researchers contacted the participants one month later and found that they were smoking an average of five cigarettes a day, compared with an average of 21 a day at the start of the study.

But there was considerable variation in how successful individual participants were in reducing their smoking. The researchers found that a reaction in an area of the brain, called the medial prefrontal cortex, while watching the quit-smoking ads was linked to reductions in smoking during the month after the brain scan.

Previous research by the same team suggested that activity in the prefrontal cortex is predictive of behavior change.

In the new study, published in the current issue of Health Psychology, "we targeted smokers who were already taking action to quit, and we found that neural activity can predict behavior change, above and beyond people's own assessment of how likely they are to succeed," study author Emily Falk, director of the Communication Neuroscience Laboratory at the University of Michigan Institute for Social Research and Department of Communication Studies, said in a university news release.

"These results bring us one step closer to the ability to use functional magnetic resonance imaging to select the messages that are most likely to affect behavior change both at the individual and population levels," Falk said. "It seems that our brain activity may provide information that introspection does not."

For more information, see web link:
HealthDay News January 31, 2011

Smoking Addiction Linked to Brain Defect, Study Shows

Researchers have uncovered one of the secrets of nicotine addiction, which could lead to breakthrough technologies and treatments to help smokers quit, according to a study released by Nature online. Scientists at the Scripps Research Institute in Florida have pinpointed a brain pathway that aids in regulating our desires to smoke. When the receptor functions normally, consuming nicotine triggers a message to the brain which dampens further urges.

The team found that when rats were genetically modified to alter the receptor function, the amount of nicotine they consumed escalated greatly -- their brain wasn’t getting the “stop” message. The researchers noted that similar genetic variations existed in humans giving them a potential predisposition for cigarette addiction.

"Our data probably explain the fact that individuals with this genetic variation have increased vulnerability to developing tobacco addiction," Kenny told the AFP. "They are likely to be far less sensitive to the averse properties of the drug, and are thus more likely to acquire a nicotine habit."

Roughly one-third of the U.S. population is believed to have a form of the gene that leads to greater cravings, putting them at risk for one of the leading causes of death in the country. Cigarette smoking accounts for 1-in-10 adult deaths and is the reason for 9-out-of-10 cases of lung cancer.

"This study has important implications for new approaches to tobacco cessation," said University of Pennsylvania neuroscientist Jon Lindstrom, who has investigated other nicotine receptors in the brain and will participate in the follow-up research, in an interview with the AFP.

Current cessation strategies focus on patches, which boost reward but are also intrinsically addictive. New drugs could help eliminate the craving altogether. "Restoring or increasing the aversion to high doses of nicotine may complement these approaches and increase their efficacy, or replace them," Lindstrom said.

For more information, see web link:
Fox News January 31, 2011

Researchers Find Link Between Secondhand Smoke, Ear Infections

New research may show exactly what can decrease the number of ear infection cases in America. Researchers from Harvard were analyzing the effects of secondhand smoke and found that as secondhand smoke exposure decreased, so did the number of middle ear infection (otitis media) cases.

The study can be found in the online journal Tobacco Control.

Further illustrating the importance of keeping households smoke free, the study is the first to analyze the direct, short-term benefits for children in non-smoking homes. Avoiding smoking at home can effectively limit the number of doctor and hospital visits for what is the most common cause in children — ear infections.

The United States Surgeon General explained there is enough evidence linking secondhand smoke and the negative effects on children, specifically in terms of ear infections.

The yearly health costs of ear infections may be higher than $5 billion, and the number of cases has been as high as 25 million children in a single year.

Experts explain that a smoke-free home is vital for keeping children healthy and for promoting long-term health.

For more information, see web link:
Daily Health Report January 29, 2011

Among Statin Users, Smoking Cessation Deserves Emphasis

Among patients taking statins for coronary heart disease (CHD), smokers are still more likely to suffer a major cardiovascular event (MCVE), when compared with nonsmokers, according to a study published in the January 15 issue of The American Journal of Cardiology.

Paul Frey, M.D., of the University of California in San Francisco, and colleagues compared the risk of MCVEs, including cardiac death, myocardial infarction, stroke, or resuscitated cardiac arrest among participants on statins who were smokers, never-smokers, and ex-smokers. They pooled data from 18,885 patients in the Treating to New Targets and the Incremental Decrease in End Points through Aggressive Lipid Lowering trials, two studies which evaluated the efficacy of high-dose versus moderate-dose statin therapy in patients with CHD.

The researchers found that despite statin therapy, current smokers were 1.68 and 1.57 times more likely to experience a MCVE than never-smokers and ex-smokers, respectively. The rates of MCVE were increased for smokers compared with ex-smokers, and the differences between them were similar, regardless of intensity of statin therapy. The difference in absolute event rate between current and ex-smokers was found to be more than two times as large as the decrease in absolute event rate between high-dose and moderate-dose statin therapy. Smoking cessation was associated with a number needed to treat of 22 to prevent a MCVE over five years.

"Given the apparent magnitude of benefit from smoking cessation in patients with CHD despite modern medical therapy, smoking cessation deserves considerably more emphasis in secondary prevention," the authors write.

For more information, see web link:
HealthDay News February 3, 2011

A Study Asks, Could E-Cigarettes Really Help Smokers Quit?

Electronic cigarettes, the smokeless battery-operated nicotine-delivery devices that look like real cigarettes, are becoming increasingly available online, with manufacturers marketing them largely to people who are trying to quit smoking. Question is: do they work?

At least one previous study said no, finding that e-cigarettes don't deliver much nicotine and don't reduce smokers' cravings.

Now two new studies of e-cigs, published recently in the American Journal of Preventive Medicine, attempt to shed a little more light on the issue. The first study compared Internet searches for, and purchases of, e-cigarettes and other quit-smoking products like nicotine gum from Jan. 2008 to Sept. 2010 in the U.S., Britain, Canada and Australia. The authors didn't look at the effectiveness of e-cigs, but did find that they were the most popular smoking alternatives or cessation products on the online market, according to a statement.

In another study, researchers at Boston University sent online surveys to 5,000 people who had bought Blu e-cigarettes for the first time during a two-week period in 2009. The number of respondents was small — just 222. They were mostly male and long-time smokers who had tried and failed to quit several times before. Among them, 67 percent said they had cut down on the number of cigarettes they smoked six months after buying Blu, and 31 percent had quit at the six-month mark; 49 percent also said they'd stopped smoking for some unspecified amount of time.

Of course, it's entirely possible that smokers who were more successful at cutting down or quitting were more likely to respond to the survey, which would have biased the results.

"Neither of these two studies provides scientific evidence that e-cigarettes are effective in helping people to quit," said John Pierce, a professor of cancer prevention at the Moores Cancer Center at the University of California, San Diego, in a statement. "It's not clear to me that e-cigarettes aren't harmful in some way. It's not clear to the FDA, either."

In September 2010, the FDA announced it would start regulating e-cigarettes as drug-delivery devices and cited five distributors for "violations of good manufacturing practices, making unsubstantiated drug claims, and using the devices as delivery mechanisms for active pharmaceutical ingredients," according to an agency press release.

In January, the FDA tried unsuccessfully to block e-cigarette importation. Several U.S. states are now moving to ban or restrict their use.

For more information, see web link:
TIME February 10, 2011

Smoking During Radiation Treatments Reduces Overall Chance of Survival

Smokers who continue to smoke while undergoing radiation treatments for head and neck cancer fare significantly worse than those who quit smoking before therapy, according to a study in the February issue of the International Journal of Radiation Oncology, Biology, Physics, an official journal of the American Society for Radiation Oncology (ASTRO).

Although the association between tobacco smoking and head and neck cancers has long been established, there had been little data until now showing whether continued smoking during treatment affects prognosis.

“I’ve always told patients, ‘You should really stop smoking,’ but I had no tangible evidence to use to convince them that they would be worse off if they continued to smoke,” Allen Chen, M.D., lead author of the study and residency training program director at the University of California, Davis, School of Medicine in Sacramento, Calif., said. “I wanted concrete data to see if smoking was detrimental in terms of curability, overall survival and tolerability of treatment. We showed continued smoking contributed to negative outcomes with regard to all of those.”

Chen and colleagues reviewed medical records of 101 patients with newly diagnosed squamous cell carcinoma of the head and neck who continued to smoke during radiation therapy and matched those patients to others who had quit prior to starting radiation therapy for their head and neck cancers. Matching was based on primary disease site, gender, smoking duration, stage of disease, radiation dose, other treatment (surgery and chemotherapy) and date of initiation of radiation therapy.

The researchers found that 55 percent of patients who had quit smoking prior to treatment were still alive five years later, compared with 23 percent of those who continued to smoke. The poorer outcomes for persistent smokers were reported for both patients who had surgery prior to radiation therapy and patients who had radiation alone. Similarly, Chen and his colleagues found that 53 of the patients who still smoked experienced disease recurrence, compared to 40 patients in the control group. Active smokers also experienced more complications of treatment, such as scar tissue development, hoarseness and difficulties with food intake.

Chen said additional research will be needed to explain these differences in outcomes for patients with head and neck cancers. One theory suggests that smoking deprives the body of much needed oxygen.

“Radiation therapy requires oxygenation for the production of free radicals, which attack cancer cells,” he said.

He also emphasized that their findings are based on an observational study, which does not establish a cause-effect relationship between smoking during radiation therapy and poorer outcomes. For instance, they were unable to determine with certainty the actual cause of death of each patient, and active smokers may be at higher risk of death from other medical problems such as heart disease, stroke and diabetes.

“Patients unable to quit may also have non-cancer-related medical and psychosocial problems that could possible contribute to inferior survival,” Chen said.

“Those who continue to smoke even after a diagnosis of head and neck cancer are likely to be at higher risk for alcohol abuse, have less social support and have lifestyles associated with high-risk health behaviors. A diagnosis of cancer is emotionally devastating, and a lot of patients are reluctant to entertain the idea of smoking cessation. Many patients can’t or won’t connect the dots, and unfortunately, our data is showing that by continuing to smoke, they are more likely to gamble away the possibility of cure.”

For more information, see web link:
Newswise February 16, 2011

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Other Cessation News

Hospitals Shift Smoking Bans to Smoker Ban

Smokers now face another risk from their habit: it could cost them a shot at a job.

More hospitals and medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living.

The policies reflect a frustration that softer efforts — like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers — have not been powerful-enough incentives to quit.

The new rules essentially treat cigarettes like an illegal narcotic. Applications now explicitly warn of “tobacco-free hiring,” job seekers must submit to urine tests for nicotine and new employees caught smoking face termination.

This shift — from smoke-free to smoker-free workplaces — has prompted sharp debate, even among anti-tobacco groups, over whether the policies establish a troubling precedent of employers intruding into private lives to ban a habit that is legal.

“If enough of these companies adopt theses policies and it really becomes difficult for smokers to find jobs, there are going to be consequences,” said Dr. Michael Siegel, a professor at the Boston University School of Public Health, who has written about the trend. “Unemployment is also bad for health.”

Smokers have been turned away from jobs in the past — prompting more than half the states to pass laws rejecting bans on smokers — but the recent growth in the number of companies adopting no-smoker rules has been driven by a surge of interest among health care providers, according to academics, human resources experts and tobacco opponents.

There is no reliable data on how many businesses have adopted such policies. But people tracking the issue say there are enough examples to suggest the policies are becoming more mainstream, and in some states courts have upheld the legality of refusing to employ smokers.

For example, hospitals in Florida, Georgia, Massachusetts, Missouri, Ohio, Pennsylvania, Tennessee and Texas, among others, stopped hiring smokers in the last year and more are openly considering the option.

“We’ve had a number of inquiries over the last 6 to 12 months about how to do this,” said Paul Terpeluk, a director at the Cleveland Clinic, which stopped hiring smokers in 2007 and has championed the policy. “The trend line is getting pretty steep, and I’d guess that in the next few years you’d see a lot of major hospitals go this way.”

A number of these organizations have justified the new policies as advancing their institutional missions of promoting personal well-being and finding ways to reduce the growth in health care costs.

About 1 in 5 Americans still smoke, and smoking remains the leading cause of preventable deaths. And employees who smoke cost, on average, $3,391 more a year each for health care and lost productivity, according to federal estimates.

“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” Steven C. Bjelich, chief executive of St. Francis Medical Center in Cape Girardeau, Mo., which stopped hiring smokers last month. “Essentially that’s what happens.”

Two decades ago — after large companies like Alaska Airlines, Union Pacific and Turner Broadcasting adopted such policies — 29 states and the District of Columbia passed laws, with the strong backing of the tobacco lobby and the American Civil Liberties Union, that prohibit discrimination against smokers or those who use “lawful products.” Some of those states, like Missouri, make an exception for health care organizations.

A spokesman for Philip Morris said the company was no longer actively working on the issue, though it remained strongly opposed to the policies.

Meghan Finegan, a spokeswoman for the Service Employees International Union, which represents 1.2 million health care workers, said the issue was “not on our radar yet.”

One concern voiced by groups like the National Workrights Institute is that such policies are a slippery slope — that if they prove successful in driving down health care costs, employers might be emboldened to crack down on other behavior by their workers, like drinking alcohol, eating fast food and participating in risky hobbies like motorcycle riding. The head of the Cleveland Clinic was both praised and criticized when he mused in an interview two years ago that, were it not illegal, he would expand the hospital policy to refuse employment to obese people.

“There is nothing unique about smoking,” said Lewis Maltby, president of the Workrights Institute, who has lobbied vigorously against the practice. “The number of things that we all do privately that have negative impact on our health is endless. If it’s not smoking, it’s beer. If it’s not beer, it’s cheeseburgers. And what about your sex life?”

Many companies add their own wrinkle to the smoking ban. Some even prohibit nicotine patches. Some companies test urine for traces of nicotine, while others operate on the honor system.

While most of the companies applied their rules only to new employees, a few eventually mandated that existing employees must quit smoking or lose their jobs. There is also disagreement over whether to fire employees who are caught smoking after they are hired. The Truman Medical Centers, here in Kansas City, for example, will investigate accusations of tobacco use by employees. In one recent case a new employee returned from a lunch break smelling of smoke and, when confronted by his supervisor, admitted that he had been smoking, said Marcos DeLeon, head of human resources for the hospital. The employee was fired.

Even antismoking advocates have found the issue tricky to navigate. The American Lung Association, the American Cancer Society and the World Health Organization do not hire smokers, citing their own efforts to reduce smoking.

But the American Legacy Foundation, an antismoking nonprofit group, has warned that refusing to hire smokers who are otherwise qualified essentially punishes an addiction that is far more likely to afflict a janitor than a surgeon. (Indeed, of the first 14 applicants rejected since the policy went into effect in October at the University Medical Center in El Paso, Tex., one was applying to be a nurse and the rest for support positions.)

“We want to be very supportive of smokers, and the best thing we can do is help them quit, not condition employment on whether they quit,” said Ellen Vargyas, chief counsel for the American Legacy Foundation. “Smokers are not the enemy.”

Taking a drag of her cigarette outside the University of Kansas School of Nursing, just beyond the sign warning that smoking is prohibited on campus, Mandy Carroll explained that she was well aware of the potential consequences of her pack-a-day habit: both her parents died of smoking-related illnesses. But Ms. Carroll, a 26-year-old nursing student, said she opposed any effort by hospitals to “discriminate” against her and other smokers.

“Obviously we know the effects of smoking, we see it every day in the hospital,” Ms. Carroll said. “It’s a stupid choice, but it’s a personal choice.”

Others do not mind the strict policy. John J. Stinson, 68, said he had been smoking for more than three decades when he decided to apply for a job at the Cleveland Clinic, helping incoming patients, nearly three years ago.

It turned out to be the motivation he needed: he passed the urine test and has not had a cigarette since. “It’s a good idea,” Mr. Stinson said.

For more information, see web link:
The New York Times February 10, 2011

More Hotels Go Completely Smoke-Free

Hotels, motels and other lodgings are following the trend of airlines and passenger-train operators by banning smoking throughout their premises. Some are doing it voluntarily, as public awareness about the health dangers of secondhand smoke grows. Others are being forced by a growing number of state and local laws.

More than 12,900 lodgings serving the public in the USA are now smoke-free throughout, a USA TODAY analysis of data from AAA, the American Automobile Association, finds. That's nearly 4,600 more than in November 2008, when USA TODAY first analyzed AAA data.

"The smoke-free hotel trend has finally caught up with the rest of the movement," says Bronson Frick, associate director of the Americans for Nonsmokers' Rights. "Airlines went smoke-free in 1990, and California was the first state to enact a strong smoke-free law that included restaurants and bars in 1994. It took the hotel industry until 2006 to catch on that there was public demand and support for smoke-free hotels."

Though the number of smoke-free hotels is growing, the percentage of adults who smoke cigarettes has not declined since 2005, the Centers for Disease Control and Prevention says. About one of every five adults — 46.6 million — smokes cigarettes.

Four of every 10 non-smokers — 88 million people — were exposed to cigarette smoke during 2007-2008, the CDC says. Among other health problems, smoking causes cancer, heart attacks and stroke, and exposure to secondhand smoke causes cancer and heart disease in non-smoking adults and respiratory infections and more severe asthma in children, the agency says.

Many travelers concerned about secondhand smoke welcome the smoke-free trend at hotels.

"I am highly allergic to cigarette smoke and cannot even be on the same floor with smokers," says Suzanne Franka of Austin, who works in the health care industry and spent about 150 nights in hotels last year. "I have to hold my breath as I walk by the smoking areas outside the hotels and wish that they would move them far away from the hotel entrances."

But smokers such as Bruce Arnold of Fort Wayne, Ind., hate to see one of their last refuges for smoking disappear. Arnold says he annually averaged about 160 nights at Marriott hotels but stopped staying at the chain's domestic hotels after they adopted smoke-free policies.

"A dinner in a non-smoking restaurant is an hour and a short walk to the sidewalk," says Arnold, who works in the vending industry and travels up to four nights per week. "A hotel is 12-plus hours and frequently a long walk to go stand outside."

True Measure of the Trend

The number of smoke-free lodgings in the USA is undoubtedly higher than 12,900. A growing number of state and local governments have recently passed laws restricting smoking in hotels and other public places. And AAA, which annually inspects lodgings and has the most extensive list of smoke-free ones, approves and rates only about 31,000 lodgings. The American Hotel & Lodging Association says, however, that there are 50,800 lodgings of 15 or more rooms throughout the country. Many lodgings not rated by AAA are likely to be smoke-free, says AAA's Michael Petrone.

Other actions, such as court cases, also may make smoking a vestige in hotels. In January, for instance, a Nebraska District Court judge ruled that exemptions to the state's smoking ban for cigar bars, tobacco stores and hotels are unconstitutional. The ruling is being appealed. But if it stands, Nebraska may join Michigan and Wisconsin, where new laws last year require all hotels to be smoke-free.

Push Began in 2006

The no-smoking trend in hotels caught fire in 2006, and it came voluntarily in many instances.

Westin Hotels & Resorts said it was responding to guests' demands for a healthy environment and became the first chain to go smoke-free at its U.S. hotels. Marriott, the nation's largest hotel company, made nearly all its more than 2,500 U.S. hotels smoke-free several months later. Marriott subsidiary The Ritz-Carlton, Walt Disney, Sheraton,Comfort Suites and a few other chains followed with all smoke-free U.S. hotels.

"We will continue to see either properties go entirely smoke-free or increase non-smoking rooms not only in the United States but around the world," says Joe McInerney, president of the American Hotel & Lodging Association.

Hyatt Hotels & Resorts — which has two smoke-free brands, Hyatt Place and Hyatt Summerfield Suites — agrees.

"We think the trend will continue," says company spokeswoman Lori Alexander. "As we see more and more travelers request non-smoking rooms, the demand for smoking rooms is dwindling."

Hyatt and many other chains continue to reserve some rooms for smokers at many U.S. hotels, and chains that declare they're 100% smoke-free in the USA continue to have rooms available for smokers at their hotels abroad.

Seventeen of Hyatt's 129 full-service hotels and resorts in North America are smoke-free, and 99% of the rooms in most others are non-smoking, Alexander says.

California Leads the Charge

According to USA TODAY's analysis of American Nonsmokers' Rights Foundation data, 27 states — four more than in November 2008 — have laws specifying the minimum percentage of non-smoking rooms that must be in hotels.

Most of the 27 states specify that 75% or 80% of rooms must be non-smoking.

Laws requiring a certain percentage of smoke-free hotel rooms — sometimes as much as 100% — are also in effect in 729 cities and counties, the data show. In November 2008, 534 cities and counties had such laws.

California has more cities and counties — 122 — with laws restricting smoking in hotel rooms than any other state. Massachusetts has 75 cities and counties with such laws, and Illinois has the third-highest number, 71.

California also has the most smoke-free lodgings — 1,575, a 51% increase over the number in November 2008, according to AAA data. Florida and Texas follow, respectively, with 798 and 743.

Frick, of the non-smokers' rights group, says the number of smoke-free lodgings in foreign countries is also growing, particularly at smaller properties. He says it's "disappointing" that chains with smoke-free policies in the USA do not have the same policies abroad.

"They are aware of the health hazards of toxic air to their staff and guests," Frick says. "The lack of consistent policy also makes it impossible for business travelers to book smoke-free travel and meetings based on brand."

Wyndham Hotels and Resorts implemented a smoke-free policy three years ago at its nearly 100 North American hotels, but the policy does not apply to its hotels elsewhere.

"We continue to offer non-smoking guestrooms in all hotels located outside of North America but will allow international properties to accommodate local laws, cultures and preferences when deciding to implement the smoke-free hotel policy," says Evy Apostolatos, spokeswoman for Wyndham Hotel Group, which has 12 hotel brands.

Frequent business traveler Al Bischoff approves the smoke-free trend in hotels everywhere, because people "should not be subjected to smoke" or its smell. He says hotel rooms that have been used by smokers are "disgusting" and he purposely books smoke-free hotels.

"Smoking is a health and cleanliness issue," says Bischoff, a consultant from Hilton Head, S.C.

For more information, see web link:
USA TODAY February 17, 2011

Smoking Ban in Parks Proposed

Two Boston city councilors are proposing to ban smoking in public parks and beaches, carrying the decades-long campaign to reduce tobacco use to some of the last remaining public spaces where lighting up is still allowed.

Hundreds of communities nationwide, including Braintree, have already adopted similar prohibitions.

Councilors Felix G. Arroyo and Salvatore LaMattina, both asthma sufferers who are especially sensitive to secondhand smoke, took the first step toward a ban yesterday by filing an order for a public hearing on their measure, which would still allow smokers to puff on sidewalks.

The issue is scheduled to be presented to the City Council, although action is weeks or months away.

“We want these public places to be smoke-free so that everyone can enjoy our parks, can enjoy our beaches, can enjoy our public spaces without injury to their health,’’ said Arroyo, serving his first term as councilor at large. “We don’t want to expose our young children at the tot lot. We don’t want to expose families at the beach to smoke.’’

Mayor Thomas M. Menino, a strong supporter of smoking bans in bars and restaurants and of the elimination of cigarette sales in pharmacies, has not taken a public position on the councilors’ proposal.

In an interview, the mayor’s top health aide, Barbara Ferrer, was noncommittal about the possible restriction but said she and the mayor are “excited to hear more.’’

The mayor’s position will prove crucial: If he were to oppose the ban, it would take nine of the 13 councilors to override his veto. Menino’s position, whatever it turns out to be, is likely to influence broader debate about the wisdom of further limits on public smoking.

The measure appears to have at least two other supporters on the council, with Councilors Matt O’Malley and Michael P. Ross saying in interviews that they were likely to back the proposal.

New York became the latest big city to eliminate smoking in parks, beaches, and even Times Square. About 500 cities — Los Angeles and San Francisco among them — bar smoking in parks, declaring it a public nuisance and health threat akin to the consumption of alcohol.

Roughly a dozen Massachusetts cities and towns prohibit smoking in parks, according to the American Nonsmokers’ Rights Foundation, an educational group.

Battles in other cities over smoking bans in parks exposed a central tension in public health: When does the quest to protect the public’s well-being start to infringe the rights of individuals?

Dr. Michael Siegel, a tobacco control specialist at Boston University School of Public Health, ardently supported initiatives in Boston and statewide to prohibit smoking in all workplaces, including bars and restaurants. Workers and patrons at a cafe or tavern, he said, cannot escape the swirls of smoke and the well-documented health perils. “

But I would argue in a wide-open space like a park or a beach, there is no necessity for the government to step in and regulate smoking, because nonsmokers can easily avoid exposure,’’ Siegel said. “My fear is if we are going too far and pushing for laws that are no longer justified on public health grounds, the public may begin to view us as zealots who are simply trying to get rid of smoking everywhere.’’

But Dr. Jonathan Winickoff, an associate professor of pediatrics at Massachusetts General Hospital for Children, pointed out that two recent reports from the US surgeon general concluded that any amount of secondhand tobacco exposure poses a health risk. Research has shown that even outdoors, a plume of smoke can contain significant concentrations of toxins, he said.

“Nonsmokers shouldn’t have to depend on favorable winds to breathe clean air in our parks and our beaches,’’ said Winickoff, who added that a ban on smoking in parks would help curtail the proliferation of cigarette butts that litter the ground, posing a danger to pets and children who might ingest them.

Arroyo and LaMattina said they first broached the possibility of a ban last year, but did not aggressively pursue it.

Then, New York acted, with the City Council there giving lopsided approval to smoking prohibition in parks and beaches.

Their move was a bit of a surprise in a city where smoking regulation generally comes from the Boston Public Health Commission.

Ferrer, executive director of the commission, said that the councilors have had informal discussions with her staff but that she was not aware there was going to be a hearing, which has not been scheduled yet, until a reporter called yesterday.

The councilors’ proposal is more of a rough outline than a detailed depiction of precisely where smoking would be banned and where it would not be.

“There needs to be conversations and discourse about what makes sense for Boston,’’ Ferrer said. “The mayor’s interested in learning about this and learning what their proposal would be.’’

O’Malley, who represents Jamaica Plain and West Roxbury, said yesterday that he had not had time to fully digest the proposal but said that he would probably support it. At first glance, he said, it seems like a logical extension on the city’s ban on smoking in bars and restaurants.

Ross — whose district includes the Back Bay, Beacon Hill, and the Fenway — said he, too, was likely to support the measure.

Council President Stephen J. Murphy said he remained “open-minded’’ about the possibility of banning smoking from parks and beaches. “I’d like to hear both sides of it,’’ Murphy said. “But I do get a little bit nervous about how far does government go.’’

LaMattina — who represents Charlestown, the North End, East Boston, and a corner of Beacon Hill — said he was moved to propose a ban when he was in a small downtown park and watched a woman decamp from a bench when a smoker appeared.

“If people want to smoke, it’s their business,’’ he said. “But when you’re in the park or the public space, I think people should smoke away from the public.’’

For more information, see web link:
The Boston Globe February 9, 2011

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