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SpotlightCDC Survey Finds Smoking Declines among High School Students Have Slowed A new report from the US Centers for Disease Control and Prevention (CDC) shows that although progress continues to be made in reducing youth smoking, declines have slowed significantly since 2003 and nearly one in five high school students still smoke. Data from the 2009 Youth Risk Behavior Survey (YRBS) shows that current cigarette use among high school students declined to 19.5 percent in 2009. This is the lowest since the survey started in 1991 and a 46 percent decrease since peaking at 36.4 percent in 1997. However, the rate of decline is slowing. Current cigarette use rates declined by just 11 percent between 2003 and 2009 (from 21.9 to 19.5 percent), compared to a 40 percent decline between 1997 and 2003 (from 36.4 to 21.9 percent). Declines in other measures have slowed as well. The survey also examines two other measures of cigarette use in addition to current cigarette use: ever smoked cigarettes, and current frequent cigarette use. The survey found:
As a result of the slow declines in youth smoking, the Healthy People 2010 national health objective to reduce the prevalence of current cigarette use among high school students to 16% or less has not been met. The survey also found an increase in smokeless tobacco use in recent years. Between 2003 and 2009, there was a 33 percent increase in current smokeless tobacco use rates among high school students (from 6.7 to 8.9 percent). Among high school boys, there was a 36 percent increase (from 11 to 15 percent). The CDC cited several factors in the slowing declines, including tobacco marketing; promotional activities including discount prices, depictions of tobacco use in movies, giveaways of nontobacco products (hats and T-shirts), and sponsorship of sports and other entertainment events; and cuts to tobacco prevention and cessation programs. The report recommends several effective, evidence-based efforts to address the slowing declines and further reduce youth smoking rates in the United States:
The Family Smoking Prevention and Tobacco Control Act provides the U.S. Food and Drug Administration (FDA) the power to regulate the manufacturing, marketing and sale of tobacco products. This presents new opportunities for reductions in tobacco use. Last month, several key provisions on tobacco marketing and sales took effect took effect that:
For more information, see "Cigarette Use Among High School Students --- United States, 1991—2009" Morbidity and Mortality Weekly Report July 9, 2010 / 59(26);797-801. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a1.htm?s_cid=mm5926a1_w Research HighlightsElectronic Cigarettes Require More Suction Than Conventional BrandsStronger suction is required to smoke “electronic cigarettes” – marketed as tobacco-free nicotine delivery systems – than conventional brands, with possible adverse effects on human health, researchers at the University of California, Riverside report. The researchers used a smoking machine to compare the smoking properties of eight conventional cigarettes with five e-cigarette brands. They examined the vacuum required to produce smoke (in the case of conventional cigarettes) or aerosol (in the case of e-cigarettes), and compared the density of the smoke/aerosol over time. The researchers found that except for one brand (Liberty Stix), higher vacuums were required to smoke e-cigarettes than conventional brands. The researchers also found that in the case of e-cigarettes, the aerosol density dropped after the first ten puffs, requiring still stronger suction thereafter to produce aerosol. Study results appeared in Nicotine and Tobacco Research. “It is too early to know exactly what effect stronger inhaling and diminishing amounts of aerosol will have on human health, but these factors are likely to lead to compensatory smoking, as has been seen previously with 'light' tobacco cigarettes,” said Prue Talbot, a professor of cell biology and the senior author of the research paper. Talbot’s research team examined the following conventional cigarettes: Merit Ultra Lights, Marlboro Ultra Lights, Marlboro Lights, Marlboro Reds, Camel unfiltered, Camel Lights, Camel filtered, and Pall Mall unfiltered cigarettes. In the case of e-cigarettes, the researchers tested the following kits: Liberty Stix, Crown Seven’s Hydro Kit, NJOY, Smoking Everywhere’s Gold Kit, and a VapCigs starter kit. “Our work shows that aerosol density decreases as e-cigarettes are used, requiring stronger puffs over time to sustain density,” Talbot said. “Manufacturers often claim that e-cigarettes cartridges are equivalent to a certain number of conventional cigarettes. However, this information seems misleading.” Talbot’s lab found that while the first ten puffs of an e-cigarette are similar to a conventional cigarette, later puffs were highly variable in aerosol density and do not duplicate smoking of conventional brands. The researchers found that even though one e-cigarette cartridge may smoke for 200 puffs, cartridges do not smoke uniformly for those 200 puffs and therefore do not duplicate nicotine delivery of individual conventional cigarettes. “Our results show that e-cigarettes smoke very differently than conventional brands,” Talbot said. “In preliminary trials, we observed that some brands of e-cigarettes were difficult to smoke possibly because they have relatively small air intake holes. Moreover, the interior of e-cigarettes is dense compared to the relatively porous tobacco-containing cigarettes.” Talbot, who is also the director of the UCR Stem Cell Center, was joined in the research by Anna Trtchounian, the first author of the paper, and Monique Williams of UC Riverside. The study was supported by the University of California Tobacco-Related Disease Research Program; the University of California Academic Senate; and the Hispanic Serving Institutions-California Cost Reduction and Access Act Science, Technology, Engineering, and Mathematics Pathway Project.
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New Data Measures Americans’ Feelings about Smoking in Public SpacesResults from the annual Social Climate Survey of Tobacco Control indicate that a sizeable group of Americans support smoke-free outdoor public spaces. More than two-thirds (67.3 percent) of Americans feel that smoking should not be allowed within 20 feet of a doorway—a finding that is increasingly relevant as more indoor spaces have gone smoke-free. The survey was funded by Legacy, a non-profit public health organization dedicated to reducing tobacco use in the United States, and by the Flight Attendant Medical Research Institute, through grants to the American Academy of Pediatrics (AAP) Julius B. Richmond Center of Excellence. “As America heads outside this summer, more and more public spaces are smoke-free in light of growing evidence of the dangers of secondhand smoke. Families deserve to have smoke-free spaces to play and relax, both indoors and out,” said Cheryl G. Healton, DrPH, president and CEO of Legacy. “This survey is a consistent reality check on how America perceives tobacco use and exposure to secondhand smoke. This year’s survey focus on outdoor spaces reminds us that passive smoking is a public health threat, whether in a bar, restaurant, office or even at the beach or park.” “Secondhand smoke is among the most harmful environmental dangers to young children. It is encouraging that America is embracing public health recommendations and taking steps to reduce exposure to secondhand smoke for both adults and children,” said pediatrician Judith Palfrey, MD, FAAP, president of AAP. According to the Americans for Nonsmokers’ Rights Foundation, there are currently 100 municipalities, and the state of Maine, that prohibit smoking on public beaches and 464 with smoking bans in city parks. The survey findings reveal that 43 percent of Americans feel that beaches should be smoke-free, and 36.5 percent are in favor of smoking bans in parks. The Social Climate Survey of Tobacco Control is conducted annually by the Social Science Research Center at Mississippi State University and by the AAP Julius B. Richmond Center of Excellence to measure Americans’ attitudes and behaviors as they relate to tobacco and secondhand smoke, and to policies to protect people from smoke exposure.
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Point-of-Sale Advertising Major Cause of Teen Smoking, Study ShowsPoint-of-sale tobacco advertising works impressively well on teens — so well that federal regulators should consider barring such marketing efforts from convenience stores, gas stations and small groceries, a Stanford University School of Medicine researcher said. A study published in the August issue of Pediatrics led by Lisa Henriksen, PhD, senior research scientist at the Stanford Prevention Research Center, reports that teens’ exposure to cigarette advertising at retail outlets substantially increases the odds they will start smoking. According to the findings, students who visited these stores on a regular basis were at least twice as likely to try smoking as those who visited infrequently. The study’s publication comes just as the new federal Tobacco Regulation Law goes into effect, empowering the U.S. Food and Drug Administration to regulate the manufacturing, marketing and sale of tobacco products. As of June 22, tobacco companies are banned from using terms such as “light,” “low” and “mild” on advertising and packaging and sponsoring cultural and sporting events, but regulators may impose additional constraints if warranted. Point-of-sale is the major form of marketing used for tobacco — representing 90 percent of the industry’s $12.5 billion marketing budget in 2006 — and the study suggests that further limits on such activity could affect long-term smoking habits. The teen years are when the vast majority of smokers start, and if teens make it through to adulthood without smoking, their likelihood of ever becoming addicted is very small, Henriksen said. In recent years, the decline in teenage smoking has leveled off. According to the Centers for Disease Control and Prevention, high school students who reported current cigarette use declined sharply from a peak of 36.4 percent in 1997, to 21.9 percent in 2003, after which the percentage dropped just a little to 19.5 in 2009. “The huge decreases are really starting to slow,” said Henriksen. “The train won’t continue downhill without further action. Regulating retail marketing would be ideal for smoking prevention.” Henriksen based the study on repeat surveys of 11- to 14-year-olds at three middle schools in Tracy, Calif., and assessments of cigarette advertisements at stores near the schools. The survey included questions about students’ smoking experience as well as how often they visited the types of stores with lots of cigarette ads — convenience stores, gas stations and small groceries — and then checked back later, first at one year and then at 30 months. Of the 2,110 students surveyed in 2003 when the study began, 1,681 reported never smoking. A survey of these non-smoking students a year later revealed 18 percent of these students had smoked over the year, at least one puff, and that smoking initiation was much more prevalent among the students who had reported frequent visits to stores with the most cigarette ads. Among those who had reported visiting these types of stores at least twice a week, 29 percent had taken at least one puff in the previous year. Among those who rarely visited — less than twice a month — only 9 percent had smoked at all. A survey 30 months after the study began found that by then 27 percent had tried smoking: 34 percent of those who visited stores at least twice a week, and only 21 percent of those who rarely visited. To measure exposure to ads, the researchers multiplied the frequency of visits by the number of advertising “impressions” in stores near the schools — cigarette-branded ads, product displays and functional objects, like clocks, trash cans and register mats. On average, students experienced 325 cigarette-brand impressions per week, ranging from an average of 114 among infrequent shoppers to 633 among those who shopped frequently. “I was surprised by the sheer number of cigarette brand impressions in signs and displays in convenience stores near schools,” said Henriksen. “The exposure is unavoidable. It’s impossible to miss.” Factors other than advertising influence smoking. To determine the effect of point-of-sale advertising alone, the researchers measured many other factors so they could hold these constant in the analysis. These other factors included risk-taking behavior, unsupervised time after school, exposure to smoking in movies or on TV, and smoking by household members and friends. The researchers also factored in grades and demographics including gender, race and ethnicity. When the project’s statistician adjusted for all the variables, she found that the relationship between store visits and smoking initiation was strong. A year after the survey, those who had initially reported moderate visits (a frequency between once every two weeks and twice a week) were 64 percent more likely to have taken at least one puff than infrequent shoppers. Those frequent shoppers, who had reported more than two visits a week, were more than twice as likely. Even 30 months after the initial survey, by which time more students had begun smoking, the apparent influence of the store visits remained: Those who had initially reported moderate store visits were 19 percent more likely than infrequent visitors to have tried smoking; those who had reported frequent visits were 42 percent more likely to have had a puff. How can simply spending time in the presence of advertisements make such an impact? “Young people are very susceptible to advertising messages,” said Stanford adolescent medicine specialist Seth Ammerman, MD, who is medical director of the mobile adolescent health services "Teen Van" at Lucile Packard Children’s Hospital and researches smoking cessation. Ammerman was not involved in the study. “One particularly nefarious aspect of advertising at convenience stores is it really normalizes the product. What do you buy there? Cigarettes, but also soup, laundry detergent, soda, cat food — normal, common things. So advertising there really gives the impression that smoking is normal,” said Ammerman, a clinical professor of adolescent medicine at Stanford. “Tobacco companies understand this. They’re not stupid.”
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Personalized Approach to Smoking Cessation May Be Reality in 3-5 YearsA personalized approach to smoking cessation therapy is quickly taking shape. New evidence from Duke University Medical Center and the National Institute on Drug Abuse (NIDA) suggests that combining information about a smoker's genetic makeup with his or her smoking habits can accurately predict which nicotine replacement therapy will work best. "Within three to five years, it's conceivable we'll have a practical test that could take the guesswork out of choosing a smoking-cessation therapy," says Jed Rose, Ph.D., director of Duke's Center for Nicotine and Smoking Cessation Research. "It could be used by clinicians to guide the selection of treatment and appropriate dose for each smoker, and hopefully increase cessation success rates." Statistics show 70 percent of the nation's 46 million smokers say they want to quit, yet successfully kicking the habit has not proven easy. In previously published reports, less than five percent of smokers who tried to quit on their own without any aids were not smoking one year later. Long-term quit rates for smokers who relied on pharmacological intervention hover under 25 percent. The research, which is published online in the July-August issue of Molecular Medicine, follows previous work done by Rose and George Uhl, MD PhD, chief of the molecular neurobiology research at NIDA. After conducting a genome-wide scan of 520,000 genetic markers taken from blood samples of smokers in several quit-smoking trials, they identified genetic patterns that appear to influence how well individuals respond to specific smoking cessation treatments. The latest research focuses on combining the information from those individual genetic markers, called SNPs, into one number that represents a "quit success score," Rose says. The score and the smokers' nicotine dependence, assessed via a simple questionnaire, help predict an individual's likelihood of quitting, as well as whether a high-dose or low-dose nicotine patch would work best. In the trial, 479 cigarette smokers who smoked at least 10 cigarettes per day and wanted to quit were categorized as either high- or low-dependence based on their level of nicotine dependence. The smokers in each group were then randomly assigned to wear two nicotine skin patches daily delivering a high dose ( (42mg) or a standard dose (21 mg). Patches were worn for two weeks prior to their quit date, and the nicotine doses were reduced gradually over the 10 weeks following their quit date. Participants were given denicotinized cigarettes during the two weeks before the quit date to minimize any potential adverse effects from the high dose nicotine patches. The treatment phase lasted for 12 weeks in all. DNA was extracted from participants' blood and was used to assess a quit-smoking success genetic score. At six months follow up, the researchers were able to confirm which smokers fared better or worse on the high-dose compared to the low-dose patch. "The genotype score was part of what predicted successful abstinence. In the future such a score could help us make our initial treatment decisions," said Rose. "People who had both high nicotine dependence and a low or unfavorable quit success genetic score seemed to benefit markedly from the high-dose nicotine patch, while people who had less dependence on nicotine did better on the standard patch." Further studies are needed to replicate these results, and to expand the research to include therapies like verenicline (Chantix, Pfizer) and bupropion hydrochloride (Zyban, Glaxo SmithKline). But the potential this work holds for the future is significant, Rose says.
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Movie Ratings Downplay Smoking RiskThree years after the Motion Picture Association of America (MPAA) and the National Association of Theatre Owners (NATO) announced they would include smoking when assigning ratings to films, a new report shows that more than half of widely released films showing tobacco were youth rated (that is, carrying a rating of G, PG or PG-13). According to this analysis, the film industry rated and released 216 box office films with tobacco imagery between May 10, 2007 and May 9, 2010. More than half (53 percent) of these films were youth-rated. Only 15 percent of youth-rated films with smoking were labeled as containing “smoking” under the MPAA/NATO rating system. “To date, the MPAA and NATO policy has failed to accurately and effectively rate movies for smoking content. As a result, the nation’s youth are still exposed to billions of toxic tobacco impressions,” said Cheryl G. Healton, DrPH, President and CEO of Legacy. “We see this as a great opportunity for the new head of MPAA to take on this issue.” For many years, public health advocates and researchers have been calling on the film industry to eliminate smoking in movies accessible to young people. On-screen exposure to tobacco imagery accounts for an estimated 180,000 new youth smokers annually. The report on MPAA/NATO ratings performance released by the University of California, San Francisco (UCSF), and Breathe California of Sacramento-Emigrant Trails and funded in part by Legacy, shows that the film industry’s trade associations consistently understated the amount of smoking in wide-release films marketed to children and adolescents:
In the three-year period surveyed, popular U.S. films of all ratings delivered 44 billion tobacco impressions to theater audiences. Half were delivered by youth-rated films. Only 15 percent of tobacco impressions were delivered by films with smoking descriptors (18 percent for May 2009-May 2010). “The major studios and large theater chains promised parents a rating system that would give parents the information they needed to make appropriate judgments,” Healton said. “Instead, they have refused to modernize their rating system to give smoking films the R-rating they need to truly help parents. Far from that, they have only labeled a small fraction of films with smoking, suggesting that smoking is not a problem.”
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Exposure to Secondhand Smoke in the Womb has Lifelong ImpactNewborns of non-smoking moms exposed to secondhand smoke during pregnancy have genetic mutations that may affect long-term health, according to a University of Pittsburgh Graduate School of Public Health study published online in the Open Pediatric Medicine Journal. The abnormalities, which were indistinguishable from those found in newborns of mothers who were active smokers, may affect survival, birth weight and lifelong susceptibility to diseases like cancer. The study confirms previous research in which study author Stephen G. Grant, Ph.D., associate professor of environmental and occupational health at Pitt's Graduate School of Public Health, discovered evidence of abnormalities in the HPRT gene located on the X chromosome in cord blood from newborns of non-smokers exposed to environmental tobacco smoke. In the current study, Dr. Grant confirmed smoke-induced mutation in another gene called glycophorin A, or GPA, that is representative of oncogenes – genes that transform normal cells into cancer cells and cause solid tumors. The GPA mutation was the same level and type in newborns of mothers who were active smokers and of non-smoking mothers exposed to tobacco smoke. Likewise, the mutations were discernable in newborns of women who had stopped smoking during their pregnancies, but who did not actively avoid secondhand smoke. "These findings back up our previous conclusion that passive, or secondary, smoke causes permanent genetic damage in newborns that is very similar to the damage caused by active smoking," said Dr. Grant. "By using a different assay, we were able to pick up a completely distinct yet equally important type of genetic mutation that is likely to persist throughout a child's lifetime. Pregnant women should not only stop smoking, but be aware of their exposure to tobacco smoke from other family members, work and social situations." The research was funded by grants from the National Institute of Child Health and Human Development and the University of Pittsburgh Competitive Medical Research Fund.
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Other Cessation NewsNew Report Finds Nearly Half of States Falling Short on Policies to Prevent and Fight CancerNearly half of all states are falling short on legislative solutions to prevent and fight cancer, according to a new report released by the American Cancer Society Cancer Action Network (ACS CAN). However, despite budget crises in several states, some state lawmakers still made positive progress in the fight against a disease that will kill an estimated 569,000 people in the United States this year. The new report, How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality, was released at the National Conference of State Legislatures annual meeting in Louisville, KY. The report finds that 23 states have reached benchmarks on none or only one of the six legislative priority areas measured by ACS CAN, the advocacy affiliate of the American Cancer Society. No state has met all of the benchmarks for effective cancer-fighting policies. The report also provides an overview of how passage of the new health care law, the Affordable Care Act, will dramatically change the landscape of state health policy in the coming years. How Do You Measure Up? measures state policies and provides a blueprint for effective legislation on six priority areas: breast and cervical cancer early detection program funding; access to care for the uninsured; colorectal screening coverage laws; smoke-free laws; tobacco prevention program funding; and tobacco taxes. Failure to address these issues places barriers in front of those who seek proper preventive care, diagnosis and treatment of cancer. No state reached a benchmark in all six issues and only one state – Hawaii – reached benchmarks in five of the six priority legislative areas in the fight against cancer. Seven states – Alabama, Florida, Idaho, Mississippi, Oklahoma, South Carolina and Tennessee – did not meet the benchmark on any of the six issues, and another 16 received high marks on only one issue. In addition to the six focus areas on which states were rated, the report examines how states are measuring up on issues such as the affordability of health coverage in the individual market and through Medicaid. It also details efforts on pain management as well as state investments in nutrition and physical activity promotion. Despite budget pressures this past year, some state lawmakers have made positive progress in the fight against cancer. Since July 2009, when the report was last published, 11 states and the District of Columbia have passed tobacco tax increases, bringing to 47 the total number of states with tobacco tax increases since 2002 and increasing the current national average to $1.45 (up from $1.28 in 2009). Research has consistently shown that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent. New York now has the highest tax in the nation at $4.35 per pack and is also the first state with a tobacco tax over $4. South Carolina's historic 50-cent increase came after a decade-long battle. Until recently, the state had the lowest tobacco tax in the nation and had not passed an increase since 1977. Missouri now has the lowest tax in the nation at 17 cents. Early in the year, North Carolina became the first major tobacco growing state to implement a 100 percent statewide smoke-free restaurant and bar law. Three states (Kansas, Wisconsin and Michigan) implemented 100 percent comprehensive smoke-free laws protecting workers and patrons from the hazards of secondhand smoke, bringing to 35 the number of states, in addition to the District of Columbia and Puerto Rico that now require 100 percent smoke-free workplaces and/or restaurants and/or bars. Additionally, more than 3,000 municipalities have local laws in effect that restrict where smoking is permitted. Combined, this represents nearly 79 percent of the U.S. population. Other findings in the report:
For state-by-state details or a copy of the complete report, please visit www.acscan.org. For more information, see web link:
Second Year Anniversary Of New York's Tobacco-Free Initiative Proves Promising-Saving More LivesOn July 24, 2007, state Office of Alcoholism and Substance Abuse Services Commissioner Karen M. Carpenter-Palumbo announced a first in the nation initiative that all prevention, treatment and recovery programs in New York would be going tobacco-free. At the time, this was the boldest public health initiative in the addiction field in the entire country. The facts were clear, while the smoking rate in New York is 18.2 percent, it is as high as 92 percent among the 1.8 million New Yorkers who are dealing with alcoholism and drug addiction. On the second year anniversary of the regulation, the results speak for themselves. Over 90 percent of programs are in compliance with the current tobacco-free regulation, and nearly 23,000 people have stopped smoking. Governor David A. Paterson said, "New York is a national leader in prevention, and this first-of-its-kind tobacco-free initiative is preventing not only addiction, but the negative consequences caused by tobacco addiction. This regulation was the right thing to do and what we are seeing so far, proves it." Commissioner Carpenter-Palumbo said, "On the second year anniversary of the tobacco-free initiative, we are making a difference here in New York in the lives of the 110,000 patients treated each day and 35,000 staff and volunteers who work in the OASAS system. We knew that tobacco independence would not be easy and that cultural change would take time. Thanks to the support and leadership within the 1,550 certified OASAS programs across the state, we are seeing tremendous progress in the long-term recovery of individuals and in turn, saving lives." "Enacting tobacco-free regulations in OASAS prevention and treatment programs was a bold step to save the lives of many New Yorkers," New York State Health Commissioner Richard F. Daines, M.D., said. "Integrating tobacco dependence interventions into chemical dependence treatment programs improves treatment outcomes for other addictions. By addressing tobacco addiction when people are seeking help recovering from other addictions, they not only reduce the likelihood that they will die from a tobacco-related illness, but their recovery from other addictions will likely be more successful." In recognition of OASAS as a national pioneer in addressing tobacco in the addiction services system, Commissioner Carpenter-Palumbo was recently honored with the IAWARD (Innovation Award) in Behavioral Healthcare Services for the Tobacco-Free System Change at the 2010 National State Associations of Addictions Services (SAAS) Conference and NIATx Summit in Cincinnati, Ohio. OASAS continues to work with stakeholders to coordinate learning opportunities. Two new training videos are being produced to assist clients and staff in understanding and implementing tobacco-free lifestyles. The training DVDs are funded by the state Department of Health. New Yorkers looking for assistance quitting smoking are urged to talk to their Doctor or contact the New York State Smokers Quitline for free help. The Quitline provides free coaching and quit plans, free nicotine patches, free tips and information, and free online help. The Quitline phone number is 1-866-NY-QUITS (1-866-697-8487). The Quitline's web address is www.nysmokefree.com.
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Comprehensive State-by-State Analysis of Medicaid Coverage of Tobacco Cessation ReleasedPartnership for Prevention's ActionToQuit program has released a comprehensive state-by-state analysis of Medicaid coverage of tobacco cessation. Prepared in collaboration with the American Lung Association, Saving Lives and Money - Helping People on Medicaid Quit Tobacco provides clear guidance to states on necessary steps to provide a comprehensive cessation benefit in accordance with recommendations of the United States Public Health Service. With the recent passage of health reform (Affordable Care Act) which requires that all state Medicaid programs provide comprehensive tobacco cessation care to pregnant women, this is a unique opportunity for states to go farther and expand coverage for the entire Medicaid population. The report will be officially released later this month at an important session of the National Conference of State Legislatures' Health Committee meeting in Louisville, Kentucky. At Partnership's urging, this year the NCSL Health Committee is hearing an important presentation on the remarkable success of the Massachusetts Medicaid program (MassHealth) in promoting a comprehensive tobacco cessation benefit and achieving unprecedented success in reducing tobacco prevalence among the Medicaid population and, significantly, reducing tobacco related health care costs. The new Partnership-ActionToQuit report provides a roadmap of key steps states should take to provide their Medicaid population access to a comprehensive tobacco cessation benefit. The guide can be downloaded on the ActionToQuit website, Resources section: http://actiontoquit.org/resources/.
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Bars, Restaurants See No Significant Employment Change Under Smoking Bans in 2 CitiesThe passage of smoking bans in two large Minnesota cities was not associated with job losses at bars and may in fact have contributed to higher employment in restaurants, according to new research. The study is the first to examine the economic effects of clean indoor air policies on bars and restaurants as independent types of businesses, the researchers said. Consistent with previous published studies of the economic impact of smoking bans, this analysis did not find significant economic effects on the hospitality industry as a whole. In both Minneapolis and St. Paul, the policies were associated with an increase of at least 3 percent in employment at restaurants over a 2 ½-year span following adoption of a local clean indoor air policy. Employment in Minneapolis bars increased more than 5 percent after passage of that city’s smoking ban, while in St. Paul, bar employment had a nonsignificant decrease of 1 percent. The researchers noted that the broad look at total bar and restaurant employment at the city level over time means that this study is not able to describe potential changes at the neighborhood or individual business level. Opponents to smoking bans have argued against enactment of these policies with predictions of large revenue losses, worker layoffs and business closures in the hospitality industry, and at bars in particular because of known correlations between drinking and tobacco use. Proponents of such policies say smoking bans promote a healthful workplace atmosphere for workers and patrons. According to the U.S. Department of Health and Human Services, exposure to secondhand smoke increases nonsmokers’ risks of developing lung cancer, heart disease, respiratory conditions and other diseases. “These clean indoor air policies are designed to protect workers from exposure to secondhand smoke,” said Elizabeth Klein, assistant professor of health behavior and health promotion at Ohio State University and lead author of the study. “We are evaluating business employment because employment is an objective measure of the overall economic health of these businesses. What we have found is that there isn’t a significant economic effect for bars, and in fact for restaurants, there is some positive change in employment. These findings underscore that nothing economically catastrophic happened for bars or restaurants in the Twin Cities as a result of banning smoking in these environments.” The research is published in the July/August issue of the Journal of Public Health Management Practice. In Minneapolis, the comprehensive smoking ban was associated with a 3 percent gradual permanent increase in employment at restaurants and an increase of between 5 percent and 6 percent employment in bars. The estimated change in the rest of the hospitality industry, when compared with either bars or restaurants, was a 1 percent or smaller increase in employment. In St. Paul, the clean indoor air policy was associated with a 4 percent increase in restaurant employment. Bars, which were not subject to the smoking ban until a year later than restaurants in that city, saw a 1 percent or smaller decrease in employment after the smoking ban took effect in bars. When subject to statistical analysis, that decrease was no different from no effect at all.
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Five States Increase Cigarette Taxes on July 1To reduce smoking and combat budget deficits, five states implemented cigarette tax increases on July 1. The five states are: New York, $1.60 increase to $4.35 per pack; Hawai'i, 40 cents to $3 per pack; New Mexico, 75 cents to $1.66 per pack; South Carolina, 50 cents to 57 cents per pack; and Utah, $1 to $1.70 per pack. On May 1, Washington increased its cigarette tax by $1 to $3.025 per pack. New York's increase will give it the highest state cigarette tax at $4.35 per pack, while South Carolina's increase — its first since 1977 — means it will no longer have the lowest cigarette tax in the nation. Missouri will now have the lowest cigarette tax at just 17 cents a pack. After the July 1 increases, the average state cigarette tax will be $1.45 per pack, while the federal government levies an additional $1.01 per pack. A new federal law to curb tobacco tax evasion and curtail sales of low-cost cigarettes and other tobacco products over the Internet and through the mail also took effect the first week of July. As required by the law, the Prevent All Cigarette Trafficking (PACT) Act, the U.S. Postal Service will institute a ban on mailing tobacco products (with very minor exceptions). The law also requires Internet tobacco sellers to pay all applicable taxes and affix tax stamps before delivery to any customer; requires that age and identification of purchasers be checked at both purchase and delivery; and provides government officials with new tools to crack down on tobacco tax evasion. "These actions to increase tobacco taxes and prevent tax evasion are a huge victory for the nation's health that will save many lives and billions of dollars in tobacco-related health care costs," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "Higher tobacco taxes continue to be a win-win-win for the states — a health win that reduces smoking and saves lives, a revenue win that helps balance budgets and fund critical programs, and a political win that is popular with voters. We applaud the state and federal officials who have supported these important measures." The evidence is clear that increasing the cigarette tax is one of the most effective ways to reduce smoking, especially among kids. Scientific studies show that every 10 percent increase in the price of cigarettes reduces youth smoking rates by about 6.5 percent and overall cigarette consumption by about four percent. The combined effect of the state cigarette tax increases approved so far this year will be to:
States with the lowest cigarette tax rates are Missouri (17 cents per pack), Virginia (30 cents), Louisiana (36 cents), Georgia (37 cents) and Alabama (42.5 cents).
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AMA Meeting: E-cigarettes Need FDA Regulation, Limits on SalesTesting and safety information on electronic cigarettes is limited, the American Medical Association said, and the devices should be restricted. The AMA House of Delegates adopted policy at the organization's Annual Meeting in June recommending that e-cigarettes be classified as drug delivery devices that are subject to regulation by the Food and Drug Administration. In addition, state legislatures should prohibit the sale of e-cigarettes and all other nicotine devices that are not FDA-approved, and the products should be covered by smoke-free laws, the policy says. "I want them subject to [FDA] regulations so people know exactly what they're inhaling," said Atlanta internist Sandra Fryhofer, MD, a member of the AMA Council on Science and Public Health. The FDA said it detected diethylene glycol, a chemical used in antifreeze that is toxic to humans, during examination of a small sample of cartridges from two leading e-cigarette brands. In several other samples, the agency identified carcinogens in the cartridges, including nitrosamines, which can be found in tobacco smoke. FDA spokeswoman Siobhan DeLancey said the agency welcomes the AMA's support. The FDA also wants the products regulated as drug delivery devices. She said the agency is in litigation with two e-cigarette firms over the regulatory status of the products. The companies did not return requests for comment as of this article's deadline. Also during the Annual Meeting, delegates debated whether individuals should be banned from smoking tobacco products in multiunit buildings because of the possible adverse health impact on other people who live there. "There is an emerging social justice framework requiring us to protect others from secondhand smoke," says Jonathan Klein, MD, MPH, from the American Academy of Pediatrics. Jonathan Klein, MD, MPH, associate executive director of the American Academy of Pediatrics and an alternate delegate for the academy, from Elk Grove Village, Ill., noted that multiunit housing often has shared ventilation systems, meaning that smoke can filter into residences where children and nonsmoking adults live. Tobacco smoke also can move through cracks in walls and floors, through elevator shafts, and along plumbing and electrical lines, according to an article in the June 17 New England Journal of Medicine that advocates a ban on smoking in public housing.
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