July 2011

Spotlight

Text Messaging Found to be Effective Smoking Intervention

A recent study conducted in the UK has shown that people receiving encouraging text messages as part of a smoking cessation regime experience a quit rate two times higher than those in a placebo group.

The study, txt2stop, a single-blind, randomized trial, was funded by the UK Medical Research Council. It was constructed using two groups of participants, those who would receive the txt2stop smoking cessation texts, and those who only received generic texts with information and news about the study.

The 5,885 participants in the control group received messages like this one: "Thanks for taking part! Without your input the study could not have gone ahead!" The 5,915 participants in txt2stop group received messages that were often motivational in nature and could be sent in real time in response to the subject's physical or emotional state.

An example of this is in the event of a craving. A participant could text the word "crave" to txt2stop and would receive a message similar to this: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over," according to the txt2stop study authors. This exercise can also be done by texting the word "lapse" as well.

The study's methodology outlined that during the study all participants were to be texted five times a day for the first five weeks, with the following six month period featuring only three texts per week, not including texts in response to "crave" or "lapse" messages.

During the six month trial period all participants were asked to self report their rates of cessation. Once the trial period was over, all study subjects had their saliva tested for actual nicotine levels in order to gauge the real cessation rate.

The results showed that after six months, 10.7% of the txt2stop participants had successfully quit smoking, compared to 4.9% of the control group.

According to Professor Max Parmer, director of the Medical Research Council's clinical trials unit, "This research has shown that texting could be a powerful tool to help people to walk away from cigarettes for good."

While these results are similar to other successful smoking cessation techniques and interventions, they remain important for a few reasons.

First, the study's authors found that the txt2stop intervention is effective in all socioeconomic groups that participated, as well as in both younger and in older smokers.

Second, the txt2stop program is easy to combine with other smoking cessation methods such as medication and one-on-one counseling.

Last, the study's authors point out that the txt2stop intervention is an ideal model for delivery of a tobacco cessation message on a national or international level. They point out that the technicalities involved in making necessary adjustments between cultures and languages are fairly minor. Translation and adaptation can easily be done at a low cost.

This exciting study has contributed a potentially valuable new tool to the smoking cessation arsenal. The prospects for its use in North America are vast, as mobile technology is continually evolving.

Txt2stop already has shown a decent success rate using simple text messages. The possibilities of more involved messages, or even a txt2stop smart phone app that could distract users during a "crave" moment, may lead to an even higher rate of quitting, especially when used in combination with other smoking cessation techniques.

For more information, see web link:
TIME Magazine July 5, 2011

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Research Highlights

ADHD, Learning Issues May Be Linked to Secondhand Smoke

Children exposed to secondhand smoke in their homes face a higher risk of developing attention-deficit/hyperactivity disorder, other behavioral problems and learning disorders, a new study finds.

The research doesn't definitively prove that tobacco smoke can harm children's brains, and it doesn't say how much smoke is too much. However, it does add to the evidence that children may be especially vulnerable to the effects of smoke exposure. "They're in a developmental stage and their body is growing," potentially putting them at greater risk of disruptions to their brains than adults, said study co-author Hillel R. Alpert, a research scientist at Harvard School of Public Health's Center for Global Tobacco Control in Boston.

It's difficult to confirm whether secondhand smoke causes children's health problems because it would be unethical to expose kids to smoke and watch what happens to them. Instead, researchers often must look backward, as they did in this study, and try to eliminate all explanations but one for a link between smoke exposure and illness.

For their study, published online July 11 in the journal Pediatrics, researchers examined the results of a 2007 U.S. telephone survey of families that included 55,358 children under the age of 12. Six percent of them were exposed to secondhand smoke in the home.

After adjusting their numbers to improve their validity from a statistical point of view, the researchers found that about 8 percent of the kids had learning disabilities, 6 percent had attention-deficit/hyperactivity disorder, and almost 4 percent had behavioral and conduct disorders, such as oppositional defiant disorder.

Those who lived in homes with smokers were more likely to have at least two of the conditions, even after the researchers adjusted their statistics to account for such factors as income and education levels of parents. The researchers estimated that secondhand smoke may be responsible for 274,100 extra cases of the three types of disorders examined. Older children, particularly those between 9 and 11 years old, boys and poor children were most at risk of developing the disorders as a result of smoke exposure, the researchers found.

Children with smoke exposure at home were also more likely to receive behavioral counseling or treatment, which greatly increases health care costs, the survey found.

"Parents should consider banning smoking from their homes," Alpert said.

No only are children vulnerable because of their physiology, "they're also vulnerable because they do not necessarily have the choice about being exposed to smoke or not," he added.

According to the U.S. Environmental Protection Agency, secondhand smoke has been linked to increased severity of asthma in 200,000 to 1 million children and 150,000-300,000 lower respiratory tract infections in babies. Secondhand smoke is also linked to increased risk of sudden infant death syndrome.

Based on the survey results, the researchers concluded that about 4.8 million U.S. children under the age of 12 live in homes with a smoker, which is slightly less than previous estimates.

For more information, see web link:
HealthDay News July 11, 2011

Higher Cigarette Taxes Don't Faze Certain Age, Income Groups

The study focused on the long-term impact of taxing cigarettes and found that higher taxes encourage low-and middle-income earners to quit. However, price increases do not persuade wealthier smokers to quit, according to researchers from Concordia University in Montreal.

In the United States, cigarettes are subjected to state and federal taxes, with New York having the highest cigarette tax of all U.S. states, at an average of $4.35 per pack, while Missouri at $0.17 per pack has the lowest state cigarette tax.

"Overall, it was smokers from lower socioeconomic groups who are more price-responsive than those from higher socioeconomic groups," study researcher Mesbah Sharaf said in a statement. But the numbers of low-and middle-income smokers who kick the habit in response to higher taxes do add up.

"If there is a 10 percent increase in taxes, then smoking participation will fall by about 2.3 percent," Sharaf said. After examining data from the National Population Health Survey conducted from 1998 to 1999 and 2008 to 2009, the researchers analyzed three age groups of daily smokers: ages 12 to 24; 25 to 44; and 45 to 65.

The findings showed that, of the three groups, people ages 25 to 44 kept puffing away even when faced with higher cigarette taxes.

The study also found that people with a postsecondary education, such as a bachelor's or associate's degree, were less likely to smoke than those who did not finish high school.

"The lowest percentage of smokers can be found among women who are married, older, with high income and more education," study researcher Sunday Azagba said.

The findings, which were announced this week, were detailed online May 16 in the International Journal of Environmental Research and Public Health.

For more information, see web link:
LiveScience July 14, 2011

Less Lighting Up in Movies Aimed at Kids

The number of films that children are likely to see that include smoking has dropped for the fifth straight year, a new report finds.

Overall, there has been a nearly 72 percent drop since 2005 in smoking depictions in movies rated G, PG or PG-13 -- from 2,093 incidents of onscreen smoking to 595 in 2010. In addition, the average number of smoking incidents in youth-rated films dropped more than 66 percent -- from about 20 percent in 2005 to 6.8 percent in 2010.

"This study shows that studios know how to eliminate smoking from youth-rated movies and have nothing to fear from a policy requiring them to do so," said Vince Willmore, a spokesman for the Campaign for Tobacco-Free Kids. "The Motion Picture Association of America should move quickly to adopt a policy requiring an R-rating for any movie that depicts smoking that is not in a historical setting," he said.

However, the drop in onscreen smoking varied depending on the motion picture company, according to researchers led by Stanton Glantz, director of the Center for Tobacco ControlResearch and Education at the University of California, San Francisco. His team found that from 2005 to 2010, companies that had policies to reduce onscreen smoking had an average decrease in depictions of almost 96 percent, compared with about 42 percent among companies that have no such policies, according to the report.

The report is published in the July 15 issue of the U.S. Centers for Disease Control and Prevention's journal, Morbidity and Mortality Weekly Report.

The report is published in the July 15 issue of the U.S. Centers for Disease Control and Prevention's journal, Morbidity and Mortality Weekly Report.

According to the U.S. National Cancer Institute, studies show that seeing smoking in movies is directly related to getting adolescents to start smoking.

In fact, teens exposed to the most onscreen smoking are twice as likely to start smoking as teens who see little or no onscreen smoking, the new report said.

That's why it's heartening that "the percentages of 2010 top-grossing movies with no tobacco incidents were the highest observed in two decades," according to the studyauthors. They contend that the drop in onscreen smoking "might have contributed to the decline in cigarette use among middle school and high school students."

Teens' Hearing Loss Linked to Secondhand Smoke

Smoke gets in your ears -- if you're a teen exposed to secondhand smoke -- and is associated with hearing loss, a large study suggested. Exposed adolescents were 1.83 times more likely to experience low-frequency hearing loss (95% CI 1.08 to 3.41) than those who had no exposure, according to Anil K. Lalwani, MD, and colleagues from New York University in New York City.

And the greatest risk for hearing loss -- a 2.72-fold increase (95% CI 1.46 to 5.06) -- was in those with the highest levels of exposure as determined by serum cotinine levels, Lalwani's group reported in the July Archives of Otolaryngology-Head & Neck Surgery.

The list of potentially harmful outcomes associated with exposure to secondhand smoke continues to grow, from low birth weight to behavioral and cognitive problems and respiratory tract infections -- and more than half of U.S. children are exposed.

In the first study to examine secondhand smoke exposure and sensorineural hearing loss in young people, the investigators analyzed cross-sectional data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES).

They identified 1,533 nonsmokers ages 12 to 19 who had undergone audiometric testing and whose serum cotinine levels had been measured.

Low-frequency sensorineural hearing loss was defined as a pure-tone level above 15 dB for 0.5, 1, and 2 kHz, while high-frequency loss was a level above 15 dB for 3, 4, 6, and 8 kHz.

Overall rates of hearing loss were:

• Unilateral low-frequency, 9.55%
• Bilateral low-frequency, 2.19%
• Unilateral high-frequency, 15.38%
• Bilateral high-frequency, 3.68%

Yet only 18.43% of the teens with these forms of hearing loss were aware of the problem.

In a bivariate analysis of factors that could influence hearing loss, unilateral low-frequency loss was more prevalent among teens exposed to secondhand smoke (11.82% versus 7.53%, P=0.04). Rates of unilateral high-frequency loss also were higher among the exposed (17.09% versus 13.86%), although this difference was not significant.

Other factors associated with hearing loss included a history of eczema, black race, and having been cared for in a neonatal intensive care unit.

When participants were divided into quartiles by level of serum cotinine, the prevalence increased from 7.53% in nonexposed adolescents to 17.05% of those with the highest level of this marker of tobacco exposure (0.858 μg/L to 15 μg/L).

The researchers noted that the link of secondhand smoke exposure with elevated thresholds ranging from 0.5 kHz to 8 kHz suggests "that the injury to the inner ear is global."

In addition, the unilateral hearing loss is probably an early phase of ocular damage that is likely to progress in severity, they cautioned.

The elevated thresholds at 2, 3, and 4 kHz were particularly important, according to Lalwani and colleagues. "These mid-to-high frequencies are critical for hearing in humans and are responsible for the clarity of hearing that allows us to discriminate between similar sounding words," they observed.

Possible mechanisms by which secondhand smoke could result in auditory damage include effects on the vasculature of the inner ear and injury from nicotine or other components of the smoke.

Hearing loss in young children has been shown to interfere with not only speech and language development, but also cognitive function, academic progress, and social interaction.

But neonates and young children are routinely screened for hearing difficulties, while adolescents are not.

The findings of this study suggest that teens who are exposed to secondhand smoke should have their hearing tested, and parents and caretakers should be made aware of the auditory hazards of their smoking.

Limitations of the study include its use of cross-sectional data which doesn't allow assignment of causation, lack of information on duration and sources of secondhand smoke exposure -- including prenatal exposure -- and absence of data on other factors such as exposure to loud noises.

The researchers also were unable to rule out the possibility that some of the participants had conductive, rather than sensorineural, hearing loss.

They concluded, "Future studies need to investigate the adverse consequences of this early hearing loss on social development, academic performance, behavioral and cognitive function, and public health costs."

The study was supported by the Zausmer Foundation and the National Institutes of Health

For more information, see web link:
MedPage Today July 18, 2011

Return to Smoking After Heart Attack Ups Death Risk

After a heart attack, quitting smoking may offer a patient more benefits than any medication, but Italian researchers say the flipside is that resuming smoking after leaving the hospital can raise the same patient's risk of dying as much as five-fold.

On average, people who started smoking again after being hospitalized for acute coronary syndrome (ACS) -- crushing chest pain that often signals a heart attack -- were more than three times as likely to die within a year as people who successfully quit in a study led by Dr. Furio Colivicchi of San Filippo Neri Hospital in Rome.

"Relapse is a major risk factor for long term survival," said Dr. David Katz, associate professor of internal medicine at University of Iowa Carver College of Medicine in Iowa City.

Quitting smoking has a similar lifesaving effect for ACS patients as taking recommended drugs to lower blood pressure or cholesterol, added Katz, who was not involved in the new study.

To gauge the effects of resuming smoking after a heart "event," and to see how many people are likely to relapse, Colivicchi and his colleagues tracked 1294 patients who reported being regular smokers before they were hospitalized with ACS.

All the participants had ceased smoking while in the hospital and declared themselves motivated to continue abstaining once they were released. Patients received a few brief smoking-cessation counseling sessions while in the hospital, but no further counseling, nicotine replacement or other smoking-cessation help was provided after they left the hospital.

The researchers interviewed patients about their smoking status at one, six, and 12 months after their release from the hospital and found that a total of 813 (63 percent) had relapsed by the end of the first year. About half had begun smoking again within 20 days of leaving the hospital.

Within a year, 97 patients died, with 81 of those deaths attributed to cardiovascular causes, according to findings published in the American Journal of Cardiology.

After adjusting for patient ages and other variables, the researchers found that resuming smoking raised a person's risk of death three-fold compared to patients who didn't relapse.

The earlier a patient fell off the wagon, the more likely he or she was to die within a year -- those who resumed smoking within 10 days of leaving the hospital were five times as likely to die as those who continued to abstain.

Very few patients relapsed after being smoke-free for six months.

"If you manage to stay off cigarettes for six months, you probably have the addiction beat," said Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Unit at Massachusetts General Hospital in Boston, who was not involved in the study.

Colivicchi's group did not measure how often the patients smoked -- an important predictor of relapse and early death, Katz noted.

Nonetheless, the results indicate a need to improve the way doctors help patients quit smoking, said Rigotti.

"People don't take treating tobacco use seriously in the medical setting," and recommended treatments have not made their way into practice, she said.

Colivicchi agreed. A successful program to help patients quit should take "a comprehensive long-term approach, including individual counseling, post-discharge support and pharmacological treatment," he told Reuters Health in an email.

A recent study from Harvard Medical School suggested that a comprehensive anti-smoking counseling program for heart attack patients could save thousands of lives at a relatively low cost.

These findings, along with the results of the Italian study, said Rigotti, suggest that hospitals and insurers should work together to implement comprehensive anti-smoking programs to continue to help patients after they leave the hospital.

For more information, see web link:
REUTERS July 22, 2011

 

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Other Cessation News

Safety of Dissolvable Tobacco Products Disputed

The industry touts lozenges and other smokeless products as safer alternatives to smoking. But public health officials and others raise health concerns and worry that they will entice a new generation to get hooked on tobacco.

Tobacco company rep David Howard waxes enthusiastic when he talks about a new product his employer, R.J. Reynolds Tobacco Co., has developed: a pellet of finely cured tobacco, binders and flavoring that dissolves in the mouth in 10 minutes.

Under test market in two U.S. cities — Denver and Charlotte, N.C. — Camel Orbs will join two dissolvable tobacco lozenges already on the market if it graduates to broader distribution. And Howard is optimistic it will.

"These products provide smokers with an option to enjoy the pleasure of nicotine without bothering others," Howard said. "No secondhand smoke. No spitting. No cigarette butt."

Dissolvable tobacco consists of small pieces of compressed, finely ground tobacco powder, binders and flavorings that are shaped into pellets, sticks or strips. When placed in the mouth, they dissolve within minutes, providing a nicotine hit.

The tobacco industry says that the products contain far fewer cancer-causing chemicals such as tobacco-specific nitrosamines and are a "harm reduction" strategy that, like electronic cigarettes, might help people turn to less risky tobacco habits or eventually quit smoking.

But public health officials and anti-smoking advocates fear that the products will help initiate a new generation of smokers. The flavoring and packaging appeal to children, they argue, and teenagers will gravitate toward a product they can easily hide.

On Thursday, the Food and Drug Administration will take up the issue with an advisory committee hearing on the effect of dissolvable tobacco products on public health.

"Tobacco companies are always one step ahead of the sheriff," said Sen. Sherrod Brown (D-Ohio), one of several senators who asked the FDA to review the products. "They have found ways to evade the rules and regulations and public health warnings."

The first dissolvable tobacco product, a lozenge called Ariva, debuted in 2001. But in the last year the number of products on sale or in test marketing has jumped and major tobacco companies have entered the arena. Reynolds is market-testing two other products, Camel Strips and Camel Sticks, in addition to Camel Orbs. Philip Morris is test marketing a dissolvable tobacco stick.

At the same time, use of smokeless tobacco — snuff, chew, electronic cigarettes and, increasingly, dissolvable tobacco — is growing at a rate of about 7% per year, according to a 2010 report by Research and Markets, an international market research and data company.

In some states, use of smokeless tobacco products among men is almost as high as the national prevalence of cigarette smoking among adults, which stands at 20.8%, according to the Centers for Disease Control and Prevention. Across the U.S., 7% of U.S. adult males use smokeless tobacco, the CDC said.

Use among children is growing too. According to a 2010 survey by Monitoring the Future, an annual nationwide study funded by the National Institute on Drug Abuse, 8.5% of 12th-graders said they had used a smokeless tobacco product in the last 30 days compared with 6.7% in 2003.

"Because it has a mild taste, we're concerned dissolvable tobacco will be a starter product for kids," said Matthew Myers, president of the Washington-based anti-smoking group Campaign for Tobacco-Free Kids. "Traditionally, girls have not used smokeless tobacco products. But this product does not have a substantial smell or require spitting. There is a real concern that this product will appeal to adolescent girls, particularly those concerned about weight."

Public health officials also have expressed concern about the effect on teeth and gums of holding the product in the mouth for 10 to 20 minutes and the effect on the stomach from swallowing the tobacco chemicals.

Few studies have been done specifically on the potential health risks of dissolvable tobacco.

One study, published in March in the Journal of Agricultural and Food Chemistry, tested four dissolvable tobacco products, three of which were being test-marketed, and found they contained mostly nicotine and a variety of flavorings, sweeteners and binders.

Some products contained coumarin, which has been banned as a flavoring agent in foods because of its link to liver damage, said study author John V. Goodpaster, an assistant professor in the forensic and investigative sciences program at Indiana University-Purdue University Indianapolis.

Studies on other smokeless tobacco products show they are considerably less risky than smoking cigarettes and cigars, which raises the risk of lung and a variety of other cancers, respiratory illness and heart disease. However, smokeless products still increase the risk of oral, pancreatic and esophageal cancer as well as heart disease. They can cause gum disease and can be unsafe for a fetus, health experts say.

The lowered risks of dissolvable products should be seen as a positive development, said Brad Rodu, a professor of medicine and chairman of tobacco harm reduction research at the University of Louisville in Kentucky.

"One cannot call any tobacco product absolutely safe," said Rodu, who said he received funds from tobacco companies to do his research but had no personal ties to any company. "But the health risks of using smokeless tobacco products over the long term are so low that they are barely measurable by modern epidemiological evidence."

Rodu added that smoking-cessation aids such as nicotine gum and the medication Chantix have limited success and that people who can't quit should be urged to try safer products.

"We have 45 million smokers in the United States," he said. "If we had almost any other activity in society that was this dangerous, we would welcome products that were safer."

Sara Troy Machir, vice president of communications and investor relations at Star Scientific Inc., maker of Ariva and another dissolvable tobacco product called Stonewall, said the Glen Allen, Va.-based company is developing two new products, Ariva BDL and Stonewall BDL, with lower levels of tobacco-specific nitrosamines (BDL stands for "below detection limits").

Machir said the company was founded with the mission of reducing harms associated with tobacco use and that "we have absolutely no interest in recruiting another generation of tobacco users."

Star Scientific applied to the FDA last year for approval to market its two new products as "modified risk tobacco products." To the chagrin of anti-smoking advocates, the FDA announced in March that the products were not subject to regulation under the 2009 Family Smoking Prevention and Tobacco Control Act, which gives the agency the authority to regulate tobacco products.

Twelve senators, including Brown, Jeff Merkley (D-Ore.) and Barbara A. Mikulski (D-Md.), have asked the FDA to reverse its decision.

In April, the FDA announced it was developing a strategy to regulate additional categories of tobacco products and that it would review information on dissolvable tobacco from published studies, manufacturers' research and the advisory committee meeting this week. The agency is expected to eventually close any loopholes that might prevent dissolvable tobacco products from escaping its jurisdiction.

"It's very clear dissolvable products are here to stay, and I believe the FDA will have to deal with them," Rodu said.

For more information, see web link:
LA Times July 21, 2011

FDA to Independently Review Menthol Cigarettes

The Food and Drug Administration is conducting an independent review of research on the public health impact of menthol cigarettes _ which are mint flavored and one of the few growth sectors of the shrinking cigarette business.

The federal agency said Monday members of its Center for Tobacco Products will gather menthol studies and then submit its review to an external peer review panel next month. The process is expected to be completed in the fall of 2011. The results of the review will be available for public comment.

FDA spokesman Jeff Ventura said the review is meant to ensure that the "best available science is used to support regulatory and programmatic decision making."

The review comes after the FDA in March received a report from the Tobacco Products Scientific Advisory Committee on the minty smokes. Panels like the tobacco committee advise the FDA on scientific issues. The agency doesn't have to follow its recommendations, but often does.

The report, which was mandated under the 2009 law giving the agency the authority to regulate tobacco, said removing menthol cigarettes from the market would benefit public health because the flavoring has led to an increase in smokers_ particularly among teens, African Americans, and those with low incomes. It also said that they make it harder for them to quit. The report, however, said menthol smokers are not likely to be at a higher risk of disease or exposed to a greater number of toxins.

The report concluded that more research is needed and the federal agency should develop a program to monitor marketing of menthol cigarettes. It also suggested that should the FDA choose to recommend a ban or other restrictions, the agency should study the potential for contraband menthol cigarettes, a concern raised by the tobacco industry and other trade groups.

A menthol ban or other restrictions on the flavored cigarettes would fall heavily on Lorillard Inc., whose Newport brand is the top-selling menthol cigarette in the U.S., with roughly 35% of the market. Lorillard, the country's third-largest tobacco company, is based in Greensboro, N.C.

"We continue to strongly believe that an objective, thorough and rigorous scientific review will lead the agency to conclude that menthol cigarettes do not present any more harm than non-menthol cigarettes," Gregg Perry, a spokesman for Lorillard, said in a statement on Monday.

In a statement, Richmond-based Altria Group Inc., parent company of the nation's largest cigarette maker, Philip Morris USA, said the review of menthol in cigarettes should be "science-and evidence-based."

Lawrence Deyton, director of the FDA's Center for Tobacco Products, signaled in March that a ban is not a sure thing, saying that the report does not set FDA policy or actions. But many analysts believe the FDA won't ban menthol, which about 19 million Americans smoke.

Menthol cigarettes are one of the few growth areas in a shrinking cigarette market. The percentage of cigarette smokers using menthol brands grew from 31% in 2004 to 33.9% in 2008, according to a study by the federal Substance Abuse and Mental Health Services Administration, with more significant growth among younger smokers.

There's evidence consumers perceive that menthol cigarettes offer some health protection or medicinal benefit that non-menthol cigarettes don't, according to the report. It also says menthols are disproportionately marketed to African Americans and younger smokers. Meanwhile, a tobacco industry report to the FDA acknowledges that all cigarettes are hazardous but says there's no scientific basis for regulating menthols differently.

In response to the FDA's latest move, Matt Myers, president of the Campaign for Tobacco-Free Kids, said the advisory panel did a thorough and expert job reviewing the science and the March report "deserves great weight."

"Our hope is that FDA will move forward quickly to determine what action follows from those scientific conclusions," Myers said.

For more information, see web link:
USA Today June 29, 2011

Companies Get Tougher with Employees Who Smoke

Many companies use quiet incentives to encourage desired employee behavior, such as losing weight. Not Macy's (M). Beginning on July 1, workers at the department store chain who admit to using tobacco will be surcharged $35 a month, or $420 a year, for health coverage. The extra cost will be deferred only if smokers enroll in a free quit-smoking class. Their progress will then be reviewed after six months.

Instead of using carrots to encourage smokers to kick the habit, businesses increasingly are wielding sticks. At PepsiCo (PEP), smokers pay an annual $600 insurance surcharge, while publisher Gannett (GCI) charges $60 a month. Some go even further: Union Pacific (UNP) and Scotts Miracle-Gro (SMG) refuse to hire smokers.

Between medical spending and productivity losses, smoking costs the U.S. more than $193 billion a year, says the U.S. Centers for Disease Control and Prevention. Tobacco use is responsible for one in five U.S. deaths. For employers, a smoker is 18 percent more expensive than a nonsmoker, says Cathy Tripp, a consultant at Aon Hewitt (AON).

That cost gap likely will widen beginning in 2018 when, under a provision of health reform legislation passed last year, companies with health plans that spend way more than average will have to pay an additional federal tax. That may push some to reduce employee coverage. "Employers have two choices: cut benefits or cut the trend" of rising medical costs to avoid the levy, Tripp says. "It has made all of them a lot bossier when it comes to employee lifestyle choices."

Businesses also are looking at how they can get workers to keep closer tabs on their health. Scotts Miracle-Gro cuts insurance rates up to $60 monthly for workers and spouses who get their weight, cholesterol, and blood pressure checked regularly. Union Pacific offers free fitness club access.

Michael Wood, a benefits consultant at Towers Watson, says smoking is employers' most effective "wellness" target since smoking cessation programs have a relatively high 25 percent success rate. "Employers see wellness as one of the last levers they can pull to try to control health-care spending," Wood says. "You have to get to the root causes of the spending if you want to cut the trend from the 7 or 8 percent [increases] many employers see annually to something closer to the 2 to 3 percent inflation in consumer spending."

The tough tactics can have an impact: Scotts Miracle-Gro says its health premiums have risen at about half the U.S. average since implementing the smoker hiring ban. The strategy can also ruffle feathers. "Some people like the carrot, and some like the stick," says Ken Bordieri, president of Local 1-S of the Retail, Wholesale and Department Store Union that represents Macy's employees in New York-area stores. "I wish Macy's had stuck with carrots."

Policies that block employment to smokers or charge extra for insurance discriminate against low-income and less-educated workers, says Dr. Cheryl Healton, head of the American Legacy Foundation, the health advocacy group created as part of the civil settlement between cigarette makers and 46 state attorneys general in 1998. The smoking rate is four times higher among teens not bound for college than for those pursuing higher education, and lower-income and less-educated adults also are more likely to smoke, she says.

The Society for Human Resource Management estimated that 59 percent of companies offered wellness programs in 2010; 28 percent paid bonuses for quitting smoking, losing weight, or achieving health goals; and a 10th provided insurance discounts for not smoking, getting a health risk assessment, or joining a weight-loss program.

Health-care companies have been among the most active at tackling smoking. The Cleveland Clinic banned the use of tobacco in 2005 and stopped hiring smokers two years later. Job candidates, including doctors, must have their blood tested for nicotine. Says Toby Cosgrove, chief executive officer of the clinic network: "If we want to be a model of health care, then we as an organization need to show our patients what a healthy lifestyle means."

The bottom line: With new taxes ahead for companies with higher-than-average health spending, employers are targeting U.S. adults who smoke.

For more information, see web link:
Bloomberg Businessweek July 1, 2011

Eco-Friendly Cigarette Ads Make Tobacco Foes Fume

A green cigarette? New magazine ads touting cigarettes with "additive-free" organic tobacco use the term "eco-friendly," prompting anti-smoking activists to fume.

The ads for Natural American Spirit cigarettes make the claim next to a list of environmental efforts by the manufacturer, Santa Fe Natural Tobacco Co. They began appearing in March in magazines such as Esquire, Field & Stream, Wired,Mother Jones,Elle and Marie Claire

"It's an egregious ad. It's trying to greenwash a deadly and addictive product," says Vince Willmore of the Campaign for Tobacco-Free Kids, adding research shows cigarettes also are the No. 1 source of litter. "When you hear a product is eco-friendly, you think it's better for you."

The tobacco company, owned by Reynolds American Inc., says it's not saying its cigarettes are safer but that its manufacturing is greener. It says its facilities are wind-powered, its farmers use fewer chemicals and 70% of its sales staff drive hybrid vehicles.

"We try to be good stewards of the environment," says spokesman Seth Moskowitz. Noting concern about littering of cigarette butts, he says a sister company helps fund Keep America Beautiful.

The magazine ads reflect the surging popularity of green marketing as more than 100 eco-related product labels are now used in the USA.

"This is a perfect example of why green marketing is broken," says Joel Makower, executive editor of GreenBiz.com, which covers business environmental efforts. He says marketers latch on to anything that can be considered green so the term becomes meaningless.

Makower says the company may be accurate in describing its greening initiatives, which he welcomes, but adds, "Products that harm people should not be marketed as green."

The tobacco company has faced similar complaints before. In 2000, after advertising its cigarettes as free of additives, the Federal Trade Commission negotiated a settlement that required it to include this statement: "No additives in our tobacco does NOT mean a safer cigarette." In 2010, after marketing its "organic" tobacco, 33 state attorneys general demanded the company include a statement saying the cigarette was not safer as a result.

The new ads include such disclaimers, but Willmore's group is again appealing to the attorneys general to take action.

"It is misleading to talk about being eco-friendly in a cigarette ad," given the problems of littering and secondhand smoke, says Jeanne Finberg, a deputy attorney general in California who focuses on tobacco litigation.

Says Makower: "The average person is going to look at that ad and ask, 'What are they smoking?'"

For more information, see web link:
USA Today July 26, 2011

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