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YTCC Gives Course on Strategies for Reducing Tobacco Use among Young Adults
Members of the Youth Tobacco Cessation Collaborative (YTCC) developed and presented the course, "Strategies for Reducing Tobacco Use among Young Adults" last week at the 2008 Summer Institute in Phoenix, AZ. More than 25 state and local health department tobacco control managers, foundation representatives, and other tobacco control organization representatives attended the three-day course. Recent data on young adults shows that in 2006, prevalence of current smoking among 18-24 year olds was 23.9%. Although this prevalence has decreased almost 50% since 1965 (45.5%), it hasn't changed since 2003. The young adult population has not responded to the cessation treatment and delivery methods that have been shown to work for the older adult population. This population is unique and their smoking behaviors are different from the rest of the adult population. Most smoke less than 10 cigarettes per day and many are casual or social smokers who don't even self identify as smokers. Compared to the rest of the adult population, young adults are more likely to use the internet, use instant messaging and visit social networking sites, and less likely to read the newspaper. The best method of marketing to reach this population is word of mouth. Tobacco companies know this and capitalize on it. The tobacco industry spent $13.1 billion dollars on advertising and marketing in 2005. The industry reaches young adults mostly through buzz marketing, promotions, coupons, and sponsored events at local bars and clubs. Innovative strategies are needed to reduce tobacco use among young adult smokers. Data from recent studies have indicated that there are many promising approaches for reaching this population. Policies have been shown to increase cessation, particularly increases in the price of tobacco. Young adults tend to be more sensitive to price increases because the share of their disposable incomes spent on cigarettes is likely to be larger than that of older adult smokers. Recent estimates indicate that youths are up to three times more sensitive to price than adults. One study estimates that a sustained inflation-adjusted price increase of 10 percent increases the probability of cessation among young adult male and female smokers by 11 and 12 percent, respectively. Media campaigns have also been shown to increase cessation among young adults. In New York City, following implementation of a media campaign in 2006 within a multi-pronged anti-tobacco policy initiative began in 2002, young adult smoking decreased by 17.4%, with an overall significant decrease of 34.9% between 2002-2006. The course, which focused on prevention and cessation strategies for reducing tobacco use among young adults, helped participants gain a better understanding of the young adult population, including their patterns of tobacco use; what makes them unique from other groups of smokers; how the tobacco industry targets young adults; how to reach young adults with specific messages; and unique evaluation considerations for this population. By the end of the course, participants had developed an action plan for addressing tobacco use among the young adult population in their states. The course was developed through a collaborative effort of several YTCC members. This planning committee, through regular meetings, collectively contributed to course content, identified presenters and developed presentations. Course faculty, including Cathy Backinger from NCI's Tobacco Control Research Branch, Todd Phillips from AED, and Ann Malarcher of CDC's Office on Smoking and Health, led the course. To download the presentations from the YTCC course, please visit http://www.youthtobaccocessation.org/. Sponsored by the Centers for Disease Control and Prevention, the Tobacco Technical Assistance Consortium, the American Legacy Foundation, Campaign for Tobacco-Free Kids, Robert Wood Johnson Foundation, American Cancer Society, and the Tobacco Control Network, the Summer Institute offered over 20 courses, ranging from courses addressing coalition building to courses dedicated to the evaluation of tobacco prevention and control programs. For more information on the Summer Institute 2008, please visit http://www.thesummerinstitute.org/index.html. C. Tracy Orleans, Ph.D., Distinguished Fellow and Senior Scientist, The Robert Wood Johnson Foundation As the Robert Wood Johnson Foundation's Senior Scientist, C. Tracy Orleans, Ph.D., leads the Foundation's efforts to develop and disseminate science-based strategies for addressing the major behavioral causes of preventable death and chronic disease. Dr. Orleans also is the Foundation's first Distinguished Fellow (2005-2009), a role in which she is developing innovative approaches for assuring that the Foundation's commitments in key goal areas, especially tobacco control and childhood obesity prevention, will have a broad and lasting impact. She oversees a current portfolio of more than $375 million in RWJF national programs and grants. Recruited to the Foundation in 1996 as a national leader in tobacco control and health behavior change research and practice, Dr. Orleans focused through 1999 on expanding the Foundation's investments in policy-based approaches to tobacco cessation, and on defining the Foundation's strategy in health care system-based approaches to chronic disease management, as convener of both the Tobacco and Chronic Disease Management Working Groups, respectively. She then led the Foundation's Health & Behavior Team, through 2004, in promoting the adoption nationally of healthy behaviors, including the team's pioneering investments in "active living" policy and environmental approaches to physical activity promotion. She has led or co-led over a dozen research-based national programs (e.g., Addressing Tobacco in Managed Care, Helping Young Smokers Quit, The Substance Abuse Policy Research Program, Bridging the Gap, Improving Chronic Illness Care, Active Living Research, and Healthy Eating Research) and has directed numerous external program evaluations. She is a founding member of the Youth Tobacco Cessation Collaborative, National Partnership to Help Pregnant Smokers Quit, National Tobacco Cessation Collaborative and co-chaired the Consumer Demand Roundtable. Dr. Orleans was the first behavioral scientist appointed to the U.S. Preventive Services Task Force. She has contributed to several Surgeon General's Reports and co-edited the first medical text on the management of nicotine addiction. In 2005 she was recognized by the journal Tobacco Control as one of the 100 most widely cited authors in the field of tobacco control. She continues to serve on numerous journal editorial boards, national scientific panels and advisory groups (e.g., Institute of Medicine, National Cancer Institute, National Commission on Prevention Priorities, Legacy Foundation). She has been a principal investigator of many National Institutes of Health grants and has authored or co-authored more than 200 publications. Dr. Orleans earned a Ph.D. in clinical psychology from the University of Maryland with a clinical internship at Duke University Medical Center, and a B.A. summa cum laude and Phi Beta Kappa from Wellesley College. Q1: You Co-Chaired the Consumer Demand Roundtable and Strategic Planning Committee and your work has strongly promoted the need to build consumer demand for proven cessation treatments. Why is building consumer demand so important? Tobacco use remains the nation's leading cause of preventable death and disease accounting for almost 440,000 premature deaths each year. Evidence-based tobacco cessation treatments are among the most effective and cost effective of all medical treatments. There is no better way to improve the health of the nation that to help more smokers quit. Effective counseling is now available free of charge and in multiple languages to smokers throughout the country through the network of state and territorial quitlines (1-800-QUIT-NOW), the majority of which now also offer free cessation medications and/or internet quitting support. Expanded insurance coverage has greatly reduced cost barriers for other effective treatments. Most U.S. smokers want to quit and over 40% make a serious attempt each year -- indicating a strong latent demand for effective help. Yet only 20-30% of those who try to quit actually use a proven treatment, with lowest treatment use the populations with greatest need, low-income populations with the highest rates of tobacco use. While as a nation we've made great strides in expanding the reach and use of effective treatments through efforts targeted mainly at healthcare providers and public and private insurers, real breakthroughs will increasingly depend on the creative use of marketing and design innovations used by other consumer product developers -- and on our treating smokers as consumers, not just as "patients." Q2: What has been the biggest impact of the Consumer Demand Initiative on the field of tobacco cessation? One effect has been to draw more attention to the need to "design for demand" among many leaders in the field -- researchers, practitioners, tobacco control advocates, service and product providers and developers. The primary goals of the Consumer Demand Roundtable were to change the way people thought about and addressed the problem of treatment underuse, and to catalyze feasible innovations that could take seed and spread. A formal evaluation now underway will examine how well we have met these goals and what the concrete effects have been (on research, practice, surveillance, public policy strategies). It will also outline promising next steps for the multiple funders of the Consumer Demand Initiative (the ACS, CDC, Legacy Foundation, NCI, NIDA, RWJF) and the larger National Tobacco Cessation Collaborative (NTCC) of which it is part. Q3: One of the 6 core strategies for building consumer demand is "Seizing policy changes as opportunities for 'breakthrough' increases in treatment use and quit rates." What public policies have the potential to have the greatest impact on consumer demand for tobacco cessation products and services? Comprehensive smoke-free air laws, which now cover almost half of the U.S. population, tobacco tax increases and cessation media campaigns boost quitting motivation, quit attempts, treatment use and quit rates. As New York City's dramatic successes have demonstrated, aligning these policy strategies has enormous potential to reduce population tobacco use and disparities. Another critical public policy is to protect and expand the use of tobacco excise tax and Master Settlement Agreement funds to support state quitlines and their promotion. Without this critical funding, quitlines will continue to be underused. This is one area where the lack of consumer demand -- in the form of smoker advocacy for treatments they deserve -- needs most to be addressed. Q4: The new 2008 Clinical Practice Guideline - Treating Tobacco Use and Dependence was released at the beginning of May. NTCC plans to translate the recommendations in Guideline for consumers and conduct outreach over the next year. What is the potential impact of the Guideline update on the consumers? The growing awareness of the need to build consumer demand for effective cessation treatments and to address the broad misconceptions smokers have about them has set the stage for unprecedented efforts to communicate Guideline recommendations creatively to consumers themselves. Efforts now planned and underway will use multiple channels from healthcare settings and employers, to local and national print and broadcast media, to new digital technologies critical to viral marketing efforts. I'm especially excited about the Legacy Foundation's "EX" campaign. Efforts like these will greatly magnify the impact of the Guideline update on consumers. Q5: The revised Guideline recognizes the need to address youth smoking and highlights, for the first time, that counseling is an effective treatment for helping youth smokers quit. Can you talk a little about this important milestone and the role Youth Tobacco Cessation Collaborative (YTCC) can play in increasing consumer demand among youth and young adults? In 2000, the YTCC set the ambitious goal of assuring that by 2010, smokers aged 12-24 would have access to effective cessation treatments. At the time, the evidence showed that treatment effective for adults were not necessarily effective for adolescent smokers. YTCC funders and members focused their research efforts on identifying youth treatments that would work and were really gratified not only that this effort led to evidence-based counseling recommendations for youth in the 2008 Guideline update, but also to learn that most state quitlines now offer youth-focused counseling modules. It's not often that one gets to see progress like this within such a short period of time. Both the YTCC and NTCC are now focusing on youth-oriented demand-building efforts, capitalizing on all that we've learned recently about youth treatment preferences and misconceptions. Q6: What do some of the more unconventional NTCC partners, like IDEO and the XPrize Foundation, bring to the field of tobacco cessation? IDEO and the X Prize Foundation have brought new vision, imagination and tools to the challenges of creating and delivering cessation approaches -- with the potential to dramatically increase population quit rates. IDEO's design principles set new standards for all those involved in the development and delivery of effective treatments. And the Tobacco X Prize can put these principles to work transforming our capacity to reach millions of smokers with treatments that could double their chances of successfully quitting. Both have inspired leaders in the cessation and cancer prevention fields to think and work "outside the box" -- to set our aims for real breakthroughs rather than for incremental improvements. Q7: How did you get involved in tobacco control? I got involved in reviewing the literature on health behavior change for the Institute of Medicine's first report, in 1978, on health and behavior. Three of the four of us in Medical Psychology and Psychiatry at Duke Medicine Center who worked on this report were smokers at the time. After learning much more than I ever knew about the harms of smoking, I was dismayed to find that there were very few effective treatments. Immediately after completing that report, two of us quit. While I had tried many times before to quit, this time I learned how hard it was to quit and stay quit. I resolved to find ways to make it easier for people to succeed -- combining a personal challenge with a scientific challenge. I worked to develop an inpatient quit smoking consult service and an outpatient quit smoking clinic at Duke, and then with colleagues at UNC and Group Health Cooperative, to develop the first proactive telephone quitline, Free & Clear. Q8: What has been the most challenging aspect of your work in tobacco control? The most challenging aspect of my work has been to find ways to build public demand and will for putting science-based solutions into practice. This is why I am focusing now, through my work at the Robert Wood Johnson Foundation and as a member of the cessation field, on building consumer demand and also building policy supports for tobacco prevention and cessation. Q9: What has been the most rewarding aspect of your work in tobacco control? That's easy. The people I've had the chance to work with. Not only has their dedication, rigor and imagination inspired me to give my best effort to our common work, but I count the many friendships formed over the years as among the greatest blessings of my life. Q10: What, in your opinion, is the most important challenge facing tobacco control in the year ahead? In this time of economic downturn, we have to find ways to devote sufficient tobacco excise tax and MSA funds to tobacco control efforts. Recent stalls in youth and adult smoking rate declines and the diversion of tobacco control funds to address state budget gaps are cause for great concern. Our continued progress in tobacco control depends on assuring adequate financial support for tobacco control efforts and infrastructure. Cessation progress depends on adequate funding for anti-tobacco media campaigns and for state quitlines which employers, health plans and providers increasingly rely on to help their employees, enrollees and individual patients to quit. Growing employer interest in tobacco prevention and cessation to maximize productivity and reduce rising healthcare costs indicates a clear role for employers, like those who are members of C-Change, as advocates in this effort. And we also need strong public ("consumer") voices!
Secondhand Smoke Raises Stroke Risk for Spouses Nonsmokers who are married to smokers run a significantly higher risk for experiencing a stroke, a new study suggests. Researchers also found that ex-smokers married to men and women who still smoke carry an even greater risk for stroke. However, nonsmoking spouses of former smokers do not appear to bear any higher risk for stroke than those married to someone who had never smoked. "This adds to the growing evidence that secondhand smoke is bad for you, and I hope that it will help people who want to stop smoking to know that it will probably be good for their spouse's health, too," said Maria Glymour, an assistant professor of society, human development and health at the Harvard School of Public Health in Boston. Glymour is also a health and society scholar in the department of epidemiology at Columbia University in New York City. She and her team were expected to publish the findings in the September issue of the American Journal of Preventive Medicine. In the study, all 16,000-plus participants were 50 and older and married. All were categorized according to smoking habits, and observed for stroke incidence over an average of about nine years between 1992 and 2006. Nonsmokers married to a current smoker were found to have a 42 percent increased risk for stroke, compared with those married to spouses who had never smoked. Similarly compared, ex-smokers married to a current smoker had a 72 percent increased risk for stroke. As for those married to ex-smokers, Glymour and her team only observed that the former smokers had kicked their habit at some point one to 50 years before the start of the study. They could not pinpoint exactly how much time would need to elapse after a smoking spouse quits before their husband or wife's stroke risk fully dissipated. "But we think the risk to the spouse probably starts to decline right away," Glymour noted. "And that would be consistent with what we already know about stroke and active smoking, which is that if you stop smoking your own health risks decline quickly." Thomas J. Glynn, director of cancer science and trends at the American Cancer Society, said that he found Glymour's analysis to be "very reasonable." "And, in general, I would say that this study provides further valuable evidence of the general dangers of secondhand smoke, and, in particular, the great and often over-looked danger of heart disease, he said. And, of course, it emphasizes the need for anyone who smokes to stop smoking, and at a minimum to establish smoke-free zones in the home, or not smoke in the home at all. For more information, see web link:
Contests to Quit Smoking Don't Work in the Long Run Despite prizes ranging from lottery tickets to cash payments, quit-smoking contests do not help people kick the habit in the end, according to a new systematic review of studies. None of the 17 studies, which involved roughly 6,300 participants, demonstrated significantly higher long-term quit rates for smokers offered incentives, despite some creative approaches. In one study, participants were encouraged to toss their cigarettes down the toilet and rewarded with one lottery ticket per day. Another offered payments of $10 per month and participation in a monthly worksite lottery. Yet another offered cash prizes ranging from $100 to $250, along with certificates of recognition. The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic. Studies occurred in the United States, Canada, the United Kingdom and Australia. Workplaces and clinics were common settings for the competitions. "In my view, none of them was effective," said review co-author Kate Cahill at the University of Oxford. "One of our main conclusions was that if incentives work at all, they only work while they're in place; if you revisit those quitters 12 or 24 months down the line, they [smokers offered incentives] were generally no more successful" than counterparts not offered incentives. One-year cessation rates for participants in one study were 22 percent - more than double that of those not offered incentives. However, by the one-year evaluation, the quit rate for participants was much closer to that of non-participants. In addition, the difference between participants and the group not offered incentives "had become non-significant at the two-year follow up," the reviewers found. Offering incentives is a tricky business. "An effective incentive should be large enough to attract smokers motivated to try and quit, but not so attractive that the desire to win outweighs the seriousness of the quit attempt," the reviewers say. In a 1994 paper, which was not part of the Cochrane review, an Australian researcher described how one smoking-cessation competition offered a $30,000 car as a grand prize. By polling entrants after the contest, researchers "found that 34 percent were either ex-smokers or never-smokers who had entered the contest solely in order to win the prize, confident that they could confirm their smoke-free status with a breath sample." Cahill recalled. "I think it's a perfectly valid approach to reward people for entering a smoking cessation program . but the risk of deception rises with the scale of the cessation rewards." Public health officials continue a barrage of efforts - including contests. Earlier this summer, a Scottish Health Board announced a three-month incentive plan in Dundee, Cahill said. Smokers who pass a weekly breath test will get the equivalent of about $24 each time in the form of grocery credit. Winners cannot use the money for alcohol or tobacco. For more information, see web link:
Fewer Americans Are Breathing Secondhand Smoke A new study from the Centers for Disease Control and Prevention cleared the air and found fewer Americans are breathing in harmful second hand smoke. The research, published in the Morbidity and Mortality Weekly Report, found nearly half of nonsmoking Americans are still breathing in cigarette fumes, but since the early 1990s the percentage has declined dramatically. "It's still high," said Cinzia Marano, one of the study's authors. "There is no safe level of exposure." Researchers said one driving force behind the decline in secondhand smoke is the growing number of laws and policies that ban smoking in workplaces, bars, restaurants and public places. The CDC reported 46 percent of non-smoking adults had signs of nicotine in their blood according to tests performed in 1999 through 2004. The number was a major drop from the late 1980s when similar tests were done and the number stood at 84 percent. The government report used data that was collected on about 17,000 nonsmokers, ages 4 and up, in the years 1988 through 1994. It looked at the same number of participants in 1999 through 2004. The decline in secondhand smoke exposure was less for black nonsmokers who saw a decline from 94 percent to 71 percent. For whites, the numbers dropped from 83 percent to 43 percent and for Mexican-Americans, 78 percent to 40 percent. The CDC said one troubling statistic, was second hand smoke exposure for children did not decrease as dramatically as it did for adults. According to the data, more than 60 percent of children ages 4 through 11 had recent exposure to cigarette smoke in the 1999-2004 period. "Obviously, the exposure is at home," said Thomas Glynn, the American Cancer Society's director for cancer science and trends. CDC officials say it's unclear if adult smokers are smoking more in their cars or at home due to recent bans. However, researchers said they're probably not smoking much less in those places, a factor that could explain why their kids' exposure to tobacco smoke didn't decline as much as adults. The National Health and Nutrition Examination Survey provided data for the CDC. The survey consisted of sending mobile trailers out to communities where participants were asked about their health, received blood tests, and physical exams. For more information, see web link:
Common Genetic Variations Increase Risk of Life-long Nicotine Addiction for Young Smokers Common genetic variations affecting nicotine receptors in the nervous system can significantly increase the chance that European Americans who begin smoking by age 17 will struggle with life-long nicotine addiction. Published in the July 11 issue of PLoS Genetics, this research, led by scientists at the University of Utah together with colleagues from the University of Wisconsin, highlights the importance of preventing early exposure to tobacco through public health policies. These common genetic variations, or single nucleotide polymorphisms (SNPs), are changes in a single unit of DNA. A haplotype is a set of SNPs that are statistically linked. The researchers found that one haplotype for the nicotine receptor put European American smokers at a greater risk of heavy nicotine dependence as adults, but only if they began daily smoking before the age of 17. A second haplotype actually reduced the risk of adult heavy nicotine dependence for people who began smoking in their youth. The researchers studied 2,827 long-term European American smokers, recruited in Utah and Wisconsin, and to the National Heart, Lung, and Blood Institute's Lung Health Study. They assessed the level of nicotine dependence for all smokers, recording the age they began smoking daily, the number of years they smoked, and the average number of cigarettes smoked per day. DNA samples were taken from all smokers, and the researchers recorded the occurrence of common SNPs, grouped into four haplotypes, which had been identified earlier in a subset of participants. They found that people who began smoking before the age of 17 and possessed two copies of the high-risk haplotype had from a 1.6-fold to almost 5-fold increase in risk of heavy smoking as an adult. For people who began smoking at age 17 or older, presence of the high-risk haplotype did not significantly influence their risk of later addiction. Although the authors caution that different haplotype frequencies would likely be observed in different ethnic populations, Robert Weiss, Ph.D., professor of human genetics at the University of Utah and lead author of the study, explains: "We know that people who begin smoking at a young age are more likely to face severe nicotine dependence later in life. This finding suggests that genetic influences expressed during adolescence contribute to the risk of lifetime addiction severity produced from the early onset of tobacco use." "This study adds to recent advances in understanding how genetic variation can affect susceptibility to nicotine addiction, success or failure of smoking cessation treatments, and the risk of disease associated with tobacco use," says National Institute on Drug Abuse (NIDA) Director Dr. Nora Volkow. "As we learn more about how both genes and environment play a role in smoking, we will be able to better tailor both prevention and cessation programs to individuals." The study was funded in part by NIDA and the National Heart, Lung, and Blood Institute (NHLBI), parts of the National Institutes of Health (NIH). For more information, see web link:
Smoking Ban in England Has Saved 40,000 Lives The nationwide smoking ban has triggered the biggest fall in smoking ever seen in England, a recent report says. More than two billion fewer cigarettes were smoked and 400,000 people quit the habit since the ban was introduced a year ago, which researchers say will prevent 40,000 deaths over the next 10 years. Smoking was outlawed in all enclosed public spaces in England, including pubs and restaurants, on July 1, 2007 after a prolonged political battle that split the Government and inflamed critics of Britain as a nanny state. But longer term opposition to the ban never materialized: more than three out of four people support the law, and compliance has been virtually 100 percent. Similar bans were introduced in Scotland in March 2006 and in Wales in April 2007. Doctors said they were astonished by the numbers quitting. Robert West, director of tobacco studies at the Health Behavior Research Unit, University College London, who carried out the study, said: "These figures show the largest fall in the number of smokers on record. The effect has been as large in all social groups – poor as well as rich. I never expected such a dramatic impact." There was no guarantee that smoking rates would not start to rise again, after falling, and it was crucial to maintain the downward pressure, Professor West said. Currently around 22 percent of the adult population smoke in Britain. "If the Department of Health can keep up the momentum this has created, there is a realistic prospect of achieving a target of less than 15 percent of the population smoking within 10 years," he said. The survey of 32,000 people in England interviewed before and after the ban took effect found the decline in smoking had accelerated. In the nine months before the ban it fell 1.6 percent compared with 5.5 percent in the nine months after the ban. Researchers estimate on the basis of these figures that 400,000 people quit smoking as a result of the ban. Jean King, Cancer Research UK's director of tobacco control, said: "The smoke-free law was introduced to protect the health of workers from the harmful effects of secondhand smoke. The results show it has also encouraged smokers to quit. These laws are saving lives and we mustn't forget that half of all smokers die from tobacco-related illness. We must do everything possible to continue this success – we now need a national tobacco control plan for the next five years." Cigarette sales fell by 6 percent in the past year, according to the market research company, Neilson. In the 10 months from July 2007 to the end of April 2008, 1.93 billion fewer cigarettes were sold in England and 220,000 fewer in Scotland (where the smoking ban was introduced a year earlier), equivalent to a total decline in sales over the full year of 2.6 billion. Jake Shepherd, the marketing director at Neilson, said smoking had been hit by a triple whammy, which accounted for the dramatic effect. "In addition to the smoking ban, sales have been hit by
the outlawing of the sale of tobacco to under-18s and the increase
of duty on tobacco, which is pricing cash-strapped smokers out
of the market," he said. For more information, see web link:
American Lung Association Report Finds Lung Disease Death Rates Increasing While Cancer, Heart Disease and Stroke Death Rates Are Decreasing According to the latest report by the American Lung Association, Lung Disease Data, death rates due to lung disease are currently increasing while death rates due to other leading causes of death such as heart disease, cancer and stroke are declining. Chronic obstructive pulmonary disease (COPD) is expected to become the third leading cause of death by 2020. The American Lung Association publishes Lung Disease Data to serve as a resource to the public, media, healthcare professionals, researchers and lung disease patients and their caregivers on the latest trends and research in lung disease, along with relevant facts and figures about some of the most common lung diseases in the United States today. Lung disease is any disease or disorder where lung function is impaired. Lung diseases can be caused by long-term and immediate exposure to smoking, secondhand smoke, air pollution, occupational hazards such as asbestos and silica dust, carcinogens that trigger tumor growth, infectious agents, and over reactive immune defenses. “Every year, about 400,000 Americans die from lung disease,” said Bernadette Toomey, President and CEO of the American Lung Association. “With our report, Lung Disease Data, we hope to provide valuable information on lung disease to the public, especially to people who become ill and their family members who are caring for them,” she continued. The American Lung Association strongly believes that if cigarette smoking, preventable premature childbirth, disregard for workers’ safety and violation of clean-air laws were to end today, a future largely free of the most lethal forms of lung disease would be possible. The American Lung Association urges Congress to pass the Family Smoking Prevention and Tobacco Control Act and to fund a COPD program at the Centers for Disease Control (CDC). The Lung Association is actively working to pass comprehensive smokefree laws across the country to eliminate people’s exposure to secondhand smoke, as well as to encourage the federal and state governments to pass policies to increase cessation services for the over 45 million U.S. adult smokers. “As our nation wrestles with how to pay for increasing health care costs, we must look at the tremendous financial burden caused by tobacco in this nation,” Toomey added. “Tobacco use costs the United States an estimated $193 billion annually, including $96 billion in direct health care expenditures.” To download the full report, please visit www.lungusa.org
and visit the research section. For more information, see web link:
CDC Survey Shows a Decade of Progress in Reducing High School Smoking
The latest survey of high school smoking rates, released by the U.S. Centers for Disease Control and Prevention (CDC), shows that while the nation has made remarkable progress in reducing youth smoking since 1997, rates of current smoking have been essentially stalled since 2003. The good news in the 2007 Youth Risk Behavior Survey is that the high school smoking rate declined by 45 percent between 1997 and 2007, from 36.4 percent to 20 percent. The high school smoking rate is now at the lowest level since this survey was first conducted in 1991. Smoking has declined significantly among both boys and girls and among all populations surveyed. Since 1997, smoking has declined by 42 percent among white students, 49 percent among African-American students and 51 percent among Hispanic students. In 2007, high school smoking rates were 23.2 percent for white students, 16.7 percent for Hispanic students and 11.6 percent for African-American students. The dramatic decline in youth smoking since 1997 is powerful proof that scientifically proven measures, implemented primarily at the state and local level, are working. These include higher cigarette prices resulting from state cigarette tax increases and the 1998 state tobacco settlement; a growing number of state and local laws requiring smoke-free workplaces and public places; and effective, well-funded tobacco prevention programs run by the states and nationally by the American Legacy Foundation. Thanks to these efforts, the country has made great progress over the last decade in reducing youth smoking. Unfortunately that decline has stalled in recent years. From 2003 to 2005, high school smoking rates rose by just over one percentage point, from 21.9 percent to 23 percent. While there was a small improvement from 2005 to 2007—rates declined to 20 percent last year—the reduction was not statistically significant. This recent stall in progress coincides with aggressive efforts by tobacco companies to discount cigarette prices and undermine state cigarette tax increases, cuts in tobacco prevention programs, and huge increases in tobacco marketing: From 1997 to 2003, when youth (and adult) smoking rates declined significantly, the average real (inflation adjusted) retail price of a pack of cigarettes increased by 75 percent as a result of the tobacco settlement and cigarette tax increases. Since 2003, however the real price has actually declined slightly despite a number of state tobacco tax increases, and smoking declines have subsequently stalled. Cigarette prices have been stable or even declining because the tobacco companies have cut prices and currently spend more than 80 percent of their $13.4 billion marketing dollars on price discounts that counteract the effects of state cigarette tax increases. The tobacco companies have done this because they know that higher cigarette prices are one of the most effective ways to reduce smoking, especially among kids. Between 2002 and 2005, states cut funding for tobacco prevention and cessation programs by 28 percent (approximately $200 million). While funding has increased somewhat since, only three states (Maine, Delaware and Colorado) fund tobacco prevention programs at CDC-recommended levels for FY 2008 despite the fact all the states combined collect nearly $25 billion a year in revenue from the tobacco settlement and tobacco taxes. At the national level, the American Legacy Foundation had to reduce its highly successful truth® public education media campaign because most of its funding under the 1998 tobacco settlement ended after 2003. While states cut funding for tobacco prevention, tobacco marketing expenditures have skyrocketed since the 1998 state tobacco settlement. From 1998 to 2005, tobacco marketing expenditures nearly doubled from $6.9 billion to $13.4 billion, according to the most recent Federal Trade Commission report on tobacco marketing. This survey demonstrates that we know what works to reduce tobacco use and that elected officials at all levels, including Congress, must step up the fight against the nation's No. 1 killer by aggressively implementing proven solutions. Congress has an immediate opportunity to act by passing legislation to grant the U.S. Food and Drug Administration (FDA) authority over tobacco products, which, among other things, would crack down on tobacco marketing and sales to youth. The CDC survey can be found at www.cdc.gov/mmwr. For more information, see web link:
Billionaires Back Anti-Smoking Effort Bill Gates and Mayor Michael R. Bloomberg recently announced that they would spend $500 million to stop people around the world from smoking. The World Health Organization estimates that tobacco will kill up to a billion people in the 21st century, 10 times as many as it killed in the 20th century. This time, most are expected to be in poor countries like Bangladesh and middle-income countries like Russia. In an effort to cut that number, Mr. Bloomberg's foundation plans to commit $250 million over four years on top of a $125 million gift he announced two years ago. The Bill and Melinda Gates Foundation is allocating $125 million over five years. The $500 million would be spent on a multipronged campaign - nicknamed Mpower - that Mr. Bloomberg and Dr. Margaret Chan, director of the health organization, outlined in February. It coordinates efforts by the Bloomberg Initiative to Reduce Tobacco Use, the World Health Organization, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, the foundation of the Centers for Disease Control and Prevention and the Campaign for Tobacco-Free Kids. It will urge governments to sharply raise tobacco taxes, prohibit smoking in public places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting. Health officials, consumer advocates, journalists, tax officers and others from third world countries will be brought to the United States for workshops on topics like lobbying, public service advertising, catching cigarette smugglers and running telephone help lines for smokers wanting to quit. A list of grants is at www.tobaccocontrolgrants.org. Dr. Richard Peto, an Oxford epidemiologist who leads studies on the effects of smoking in the developing world, called the announcement "excellent news." "I reckon this will avoid tens of millions of deaths in my lifetime and hundreds of millions in my kids' lifetimes," he said. Mr. Bloomberg, founder of the financial news company bearing his name and creator of the Bloomberg Family Foundation, has long been known for his antipathy to tobacco. During his administration, New York has adopted several antismoking measures, including a ban on smoking in bars and restaurants, and significant increases in cigarette taxes. The global campaign promises to be a struggle. Cigarettes not only are highly addictive and supported by huge advertising campaigns, they are also an important source of income for many foreign governments. In China and other countries, tobacco is a state-owned monopoly, and low- and middle-income countries collect $66 billion a year in tobacco taxes. Only about 5 percent of the world's countries have any antismoking measures like those the campaign envisions. But Dr. Peto said antismoking campaigns were already having some effects, even in countries where no-smoking signs are often ignored. He surveyed thousands of tobacco users in China in the 1990s - "before the government was taking it seriously," he said - and found 4 percent who identified themselves as former smokers. Now, he said, 20 percent do. Waves of lung cancer deaths - which typically begin about 40 years after smoking takes hold in a society - help convince the next generation that smoking is dangerous, as in the United States in the 1960s, Dr. Peto said. And, he added, "When doctors and journalists start to take it seriously, things start to change." The Gates Foundation's main focus has been global health, but up until now it has concentrated mostly on infectious diseases. Mr. Gates said he had been "looking at" tobacco deaths but was unsure what to do. "We were thrilled when Michael and his experts took the lead," he said. For more information, see web link:
Next-Gen Stop Smoking Via Text Message Service Launched Mohave County Department of Public Health in Arizona is the first health provider in the USA to roll-out a world-first second-generation smoking cessation text messaging service, STOMP (STop smoking Over Mobile Phone) from Healthphone Solutions. STOMP sends smokers trying to quit a series of personalized text messages over 26 weeks. The next-generation service uses text messages based on a clinically-developed program with proven medical efficacy and offers several interactive features. Clinical trials have shown that using STOMP doubled reported quit rates from 13 percent to 28 percent after six weeks. Mohave County Department of Public Health will use STOMP in a pilot project to reach young smokers, and will enroll high school students caught smoking into the service as a form of youth diversion instead of suspending them from school. Court judges and School Resource Officers in Mohave Country will be asked to refer students to the program. The project is funded by the Arizona Department of Health Services, Bureau of Tobacco Education Prevention Program. "Using mobile phones to stop smoking, we hope will engage the hard-to-reach and at-risk groups like young adults in a way that suits them," says Susan Williams, Mohave County Tobacco Use Prevention Program Coordinator. "Quitting tobacco is a very personal and uphill battle to overcome a powerful addiction. Using a text message program allows participants to receive cessation messages at their fingertips throughout the entire day when the participant needs it the most." STOMP empowers smokers to quit by enabling them to be a stakeholder in their own well being, acting as a reminder that they want to give up smoking and providing distraction and motivation to help them stop smoking. Messages follow a clinically-developed 26 week program with phases building up to the user's nominated quit day, followed by an intensive period and then maintenance. Messages use various intervention techniques including tips on quitting, support while quitting, facts about smoking and the ability for users to respond to multiple choice polls. Users can also send a message to the service when they are craving a cigarette, have accidentally smoked a cigarette or have relapsed and will receive specific support for coping with those problems. Users can designate a period each day when they will not receive texts, and STOMP will not send texts during school hours. The service runs on the Healthphone Messaging Engine which can be tailored to a variety of scenarios and to integrate with other public health services and campaigns. Debbi Gillotti, Chief Executive Officer of Healthphone Solutions says, "STOMP is a great example of how technology can empower and support people to take charge of their own well-being. It offers an excellent means to reach consumers wherever and whenever the urge for smoking occurs because it leverages a device they are very familiar with - their mobile phone." STOMP is hosted by Healthphone and so doesn't place additional demands on health providers' computer resources. For more information, see web link:
New York State Prohibits Smoking in Addiction Recovery Centers Many drug addicts, problem gamblers and alcoholics may find it harder to kick their habits in New York now that the state has become the first in the country to ban smoking at all recovery centers. Some addicts say losing the tobacco crutch could keep them from getting clean and sober, or from trying at all. New York's 13 state-run addiction treatment centers have been tobacco free for more than 10 years. New regulations that took effect on July 24, 2008 apply to private treatment centers. Some are worried that people who need help for drugs and alcohol won't pursue it because they aren't ready to quit smoking. Bryan Lapsker, a 21-year-old PCP addict from Brooklyn who has been getting help for his addiction at a treatment center in Queens for nearly nine months, has been dreading the change every day. "Nicotine helps (addicts) get through the day," he said. "Now you take the nicotine away from us, it's almost impossible to get through the day ... addiction is addiction, I understand that, but nicotine is a legal substance." Legal or not, state officials behind the new rules believe banning tobacco is critical to successful treatment programs. "Often times smoking was given as a reward in the day-to-day treatment programs, and we need to make sure that we're changing the culture to really promote an overall recovery plan that involves health and wellness for the optimal chance for recovery," said Karen Carpenter-Palumbo, the commissioner of the New York Office of Alcoholism and Substance Abuse Services. About one in five New Yorkers smoke, compared to nine in 10 chemically dependent New Yorkers, she said. Addicts are more likely to have long-term success if they quit smoking at the same time they enter treatment, Carpenter-Palumbo said. A 2004 study in the Journal of Consulting and Clinical Psychology found that smoking cessation intervention provided during addiction treatment was associated with a 25 percent better chance of maintaining long term abstinence from alcohol and drugs. Thomas Carr, the manager of national policy at the American Lung Association, said he's not aware of any other states that have taken this kind of action — although individual facilities around the country have eliminated smoking and offered cessation help. An $8 million grant from the New York Department of Health will help train employees to deal with treating nicotine dependence and provide free nicotine replacements. Treatment facilities will have a six-month grace period in which tobacco use won't be a factor in whether their certification is renewed. They will also be able to develop their own plans to become tobacco-free and decide at what point an addict would have to leave for violating the rules. Roy Kearse is the vice president of residential services at Samaritan Village, the Queens-based long-term treatment facility where Lapsker and other addicts get treatment at multiple locations. While Kearse supports eliminating tobacco use among addicts, he is concerned the zero-tolerance policy could discourage some from seeking help. "We don't know how many people will leave, if any at all will leave," Kearse said. "But we did have patients who said 'I didn't come in here to deal with my smoking addiction, I came in here for my heroin addiction, or my addiction to crack.'" Lapsker, getting treatment through a court-ordered mandate, says he is grateful for his time at Samaritan. But he said if he faces a potential relapse after leaving the facility he will "definitely not" go seek help because he doesn't want to quit smoking. "I look forward to my every cigarette that I smoke,"
Lapsker said. "That's what gets me through the day, through
the stress, through the pressure."
More Smokers Seek Help with Quitting Since Latest Cigarette Tax Took Effect When Richard Alderman first started smoking 50 years ago, a pack of cigarettes cost a quarter. After New York’s latest tax increase on cigarettes, which brought the price as high as $10 a pack in some stores, Mr. Alderman found himself dipping into his food budget to afford his Marlboros. He said he managed to cut back from a pack a day to about eight cigarettes using the nicotine patch, but decided he needed more help quitting completely. So he went to the smoking-cessation program at St. Luke’s-Roosevelt Hospital Center to get a prescription for Chantix, a non-nicotine medication that reduces the urge to smoke. “It’s another vice I have to give up to survive, not only health-wise, but financially,” explained Mr. Alderman, 58, who said he lives in a single-room-occupancy building in Times Square and depends on federal disability payments and food stamps. Clients like Mr. Alderman at smoking-cessation programs around the city have been citing the $1.25 tax increase that took effect June 3 as their motivation for quitting, and several programs have seen their numbers balloon in the weeks since. Tax increases are the most effective measure known to reduce demand for tobacco, according to reports published by the Centers for Disease Control and Prevention, and The British Medical Journal. Young people and poor people are most responsive to price changes, the research shows. Requests to New York City’s 311 line for advice on quitting tripled during the week of June 2, with 2,700 calls this year compared with 850 calls during the same period in 2007. Calls to the New York State Smokers’ Quitline — including those transferred from 311 — quadrupled, to 9,750 from 2,295 a year ago. “It was a huge surge,” said John Randolph, one of the state’s quitline specialists. “We were answering the phones all day long.” Mr. Randolph, 66, a former smoker who has been telephone-counseling would-be quitters for about two years, said that over and over again, people mentioned the tax as what “pushed them over the edge to quit.” Callers to the state’s toll-free number, (866) 697-8487, can choose to speak to a counselor, have materials mailed to them or listen to recorded “tips to quit.” Those waiting on hold get a litany of tobacco facts more frightening than any Muzak. “If you’re thinking about stopping smoking and need a few more reasons to stop, consider this,” a woman says, with a hint of drama. “Tobacco kills more Americans than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fire and AIDS combined.” Mr. Randolph estimated that 90 to 95 percent of the people he talked to requested a free two-week supply of nicotine-replacement therapy: patches, gum or lozenges. After mailing it out, counselors make a follow-up call a week or two later. Uninsured callers or those on Medicaid can receive up to six weeks’ worth of free packets and get at least four call-backs. Ursula Bauer, the director of the division of chronic disease prevention and adult health for the New York State Department of Health, said 20 to 30 percent of the quitline callers quit successfully within a year, a comparable rate to other state hotlines. “The quitline is impressive when you look at the return on investment,” Dr. Bauer said. “It’s an extremely cost-effective service.” The annual budget for the New York State Smokers’ Quitline is $6.5 million; of that, $3.5 million goes to nicotine replacement therapy. While the vast majority of quitline callers stick to telephone counseling and nicotine replacement therapy, counselors do refer some callers to support groups or hospital-based clinics. Some of these clinics have also seen a surge in clients following the tax increase, bolstered by city- and state-sponsored public-education campaigns and the city’s nicotine patch giveaway on June 3, when smokers picked up free samples of the patch at more than 40 sites. Lourdes Robles, coordinating manager of the quit-smoking program at Woodhull Medical and Mental Health Center in Brooklyn, said enrollment doubled during the two years ending June 30, to 5,172 from 2,501. “Everyone mentions” the tax these days, Ms. Robles said, though cost is usually one of many factors in the ultimate decision to quit. “People will smoke until they’re ready to quit. They
don’t care how much it costs,” Ms. Robles said. “When
they get a warning sign from their doctor, with the price increase,
then they start looking for a program.” For more information, see web link:
Entertainment Industry Foundation Unites Major Studios and State of California for Historic Anti-Smoking Campaign The Entertainment Industry Foundation (EIF) recently announced that the six major studios will include anti-smoking public service announcements produced by the California Health and Human Services Agency on millions of youth-rated DVDs of motion pictures that include scenes with tobacco use. Through this campaign, Paramount Pictures, Sony Pictures Entertainment, Twentieth Century Fox, Universal Pictures, Walt Disney Company and Warner Bros. will place California's anti-smoking public service announcements in the opening minutes of DVDs of all new movies with tobacco use that are rated G, PG and PG-13. "This is a strong and responsible step on the part of the entertainment industry that will go a long way toward countering the influence of tobacco use in films," said Kim Belshe, California Health and Human Services Secretary. "With this agreement, we will be able to promote the benefits of living tobacco-free to millions of viewers at no cost to taxpayers, while encouraging important conversations between parents and their children about the dangers of smoking." EIF, which has focused for several years on combating the negative effects of "glamorized" smoking in films, brought the State of California and the Hollywood studios together and handled the production details to make this first-of-its-kind initiative a reality. "The State of California is a great partner, having produced some of the most successful anti-smoking public service announcements. California's Tobacco Control Program PSAs have helped the state achieve some of the lowest adult and teen smoking rates in the country," said EIF President and CEO Lisa Paulsen. "We're proud to have played a role in bringing the state and all the studios together." The public service announcements will appear before the films on each DVD and can currently be seen online at http://www.TobaccoFreeCA.com. At the end of each 30-second PSA, viewers are directed to http://www.TobaccoFreeCA.com, for information on the dangers of smoking and for help in quitting and helping others quit. Resources are available in all 50 states. The PSAs were developed by the state's Tobacco Control Program, which is operated by the California Department of Public Health, one of 12 departments in the California Health and Human Services Agency. Through its initiative called Hollywood Unfiltered, EIF is committed to working from within the entertainment industry to reduce tobacco's negative consequences by educating members about the impact smoking has on young people and the steps they can take to make a difference. This commitment from the studios is another step in EIF's work to reduce the impact of smoking on young people. Partners in this effort include the Motion Picture Association of America, Alliance of Motion Picture and Television Producers, Directors Guild of America, International Alliance for Theatrical Stage Employees, Screen Actors Guild and Writers Guild of America. Additionally, EIF and the Motion Picture & Television Fund
(MPTF), with support from the Motion Picture Industry Pension
& Health Plan, operate the first ever industry-led smoking
cessation program. Called Picture Quitting, this program combines
free counseling with low-cost medication for people in the entertainment
industry who want to quit smoking. The success rate of this custom-tailored
quit smoking program is twice that of the national average. For more information, see web link:
Governor Doyle Says Adult Smoking Hits All-time Low in Wisconsin Wisconsin Governor Jim Doyle recently announced that adult smoking in Wisconsin has reached a record low. The new adult smoking prevalence rate in Wisconsin of 19.6 percent marks the first time the number has ever been below 20 percent. "We're very encouraged by this news," Governor Doyle said. "This number clearly demonstrates that Wisconsin's tobacco prevention and control efforts are making a difference in the lives of smokers across the state." The new figures come from the 2007 Wisconsin Behavioral Risk Factor Surveillance System Survey, a telephone survey of state residents age 18 and older. The survey measures smoking prevalence by education, age, ethnicity, gender and income. The new adult prevalence rate of 19.6 percent is down from 24 percent in 2000. Currently, the national adult smoking rate is 20 percent. Governor Doyle has taken a number of steps to reduce smoking in Wisconsin, including raising the cigarette tax by $1 and dedicating new funds to cessation programs, providing free quit-smoking medications through the state's Quit Line, and increasing youth tobacco prevention campaigns. Governor Doyle also urged the Legislature to make restaurants and taverns, along with other indoor workplaces, smokefree as part of his strategy to confront the dangers of tobacco. Since January 1, when the cigarette tax went into effect, a record 20,000 people have called the Wisconsin Tobacco Quit Line. The Quit Line (1-800-QUIT NOW) also offers free coaching to smokers. For a fact sheet on the new adult prevalence numbers and information
on Wisconsin's tobacco prevention and control efforts, visit www.dhfs.wisconsin.gov/tobacco. For more information, see web link:
Dell Will Ban Smoking on Its U.S. Campuses Dell Inc. is going tobacco-free throughout the U.S. The company will ban smoking at all its domestic facilities as of Jan. 1, according to a memo sent to employees June 25. The prohibition applies to all employees and visitors, and it covers all the company's owned and leased properties, including parking lots and vehicles in those lots, the memo said. The note did not lay out any specific penalties for violations of the rule. "Like any Dell policy, there's an expectation that employees will follow" this one, said spokesman Jess Blackburn. In the note, Dell said it would provide free programs to help employees quit tobacco products and would pay for up to three months of tobacco-cessation prescriptions. For employees who complete a company-sponsored program to quit, the company will reduce the contributions taken from each paycheck for medical coverage, according to the memo. "This decision actually follows in the footsteps of our Panama campus and many other companies, cities and countries around the world as they show support for healthy people and a healthy planet," the memo said. U.S. companies have instituted a wide range of anti-tobacco policies, in some cases cracking down on employees who smoke anywhere. The push has been sparked in large part by soaring health-care costs, often inflated by higher premiums for individuals who smoke. Though Dell said it crafted the policy to improve workforce health,
Blackburn said that "any programs that result in better employee
health have another natural benefit of reducing health-care costs." For more information, see web link:
Partnership for Prevention® Releases Two New Action Guides Partnership for Prevention® has developed a new tool, Smoke-Free Policies: Establishing a Smoke-Free Ordinance to Reduce Exposure to Secondhand Smoke in Indoor Worksites and Public Places—An Action Guide, to help public health professionals maximize the beneficial impact of smoke-free laws. Rooted in The Guide to Community Preventive Services: What Works to Improve Health? (Community Guide), this tool translates an evidence-based recommendation into practical implementation guidance. Web links to additional resources and tools are provided to assist with planning and implementing a smoke-free ordinance. In addition to this tool, Partnership for Prevention® and the Centers for Disease Control and Prevention have developed Healthcare Provider Reminder Systems, Provider Education, and Patient Education: Working with Healthcare Delivery Systems to Improve the Delivery of Tobacco-Use Treatment to Patients—An Action Guide. This evidence-based tool is for public health practitioners, healthcare providers, and others interested in increasing delivery of tobacco-use treatment in clinical settings. Links to tools and resources, tips for implementation and overcoming potential obstacles, suggested resource needs, and questions and potential data sources for evaluation planning are also included. Visit http://www.prevent.org/actionguides
to order hard copies of the guides or download copies for free. For more information, see web link:
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