June 2009


Research Highlights
Other Cessation News


Research Highlights

Other Cessation News




Historic FDA Tobacco Regulation Bill Signed into Law

On June 22, President Obama signed historic bipartisan legislation granting the Food and Drug Administration the authority to regulate the manufacturing, marketing and sale of tobacco products. Forty-five years after the first Surgeon General's report linking cigarette smoking to lung cancer, this law represents the strongest action the U.S. has ever taken to reduce tobacco use. This new legislation provides a critical opportunity for NTCC partners to expand their national tobacco prevention and cessation efforts.

Under the Family Smoking Prevention and Tobacco Control Act, a new FDA tobacco control center will be established that will be funded by industry fees that could amount to as much as $500 million annually by 2013, according to Congressional Budget Office estimates (Source: RWJF Public Health Digest June 15, 2009).

The new law grants the FDA the authority and resources necessary to regulate the manufacturing, marketing and sale of tobacco products. Among other things, it will:

  • Restrict tobacco advertising and promotions, especially to children.
  • Stop illegal sales of tobacco products to children.
  • Ban candy and fruit-flavored cigarettes.
  • Require large, graphic health warnings that cover the top half of the front and back of cigarette packs.
  • Ban misleading health claims such as "light" and "low-tar."
  • Strictly regulate all health claims about tobacco products to ensure they are scientifically proven and do not discourage current tobacco users from quitting or encourage new users to start.
  • Require tobacco companies to disclose the contents of tobacco products, as well as changes in products and research about their health effects.
  • Empower the FDA to require changes in tobacco products, such as the removal or reduction of harmful ingredients or the reduction of nicotine levels (Source: Campaign for Tobacco Free Kids News Release June 22, 2009).

The enactment of this new law by itself does not solve the problem of tobacco use, but it is a step towards significantly reducing use and decreasing the death and disease caused by tobacco. The Congressional Budget Office estimates that youth smoking will drop 11 percent over the next decade and adult smoking will drop by 2 percent (Source: RWJF Public Health Digest June 22, 2009).

FDA regulation will complement the successful work that has been going on at the state and local levels. NTCC and other public health organizations can take a leading role in reducing tobacco use by stepping up tobacco prevention and cessation initiatives and leading research to support these efforts.

One of NTCC’s national priorities is to link tobacco control public policy changes to increased cessation and treatment use and demand. NTCC partners should encourage and support state and local governments in their efforts to adopt and implement scientifically proven measures to reduce tobacco use and exposure to secondhand smoke and increase cessation, including:

  • Higher tobacco taxes: While the average state tobacco tax has increased from 43.4 cents to $1.27 cents per pack since 2002, major tobacco-growing states have an average state tobacco tax of just 38.5 cents per pack.
  • Smoke-free workplace laws: To date, 27 states have passed smoke-free workplace laws that cover restaurants and bars.
  • Well-funded tobacco prevention and cessation programs: Every state should fund programs to prevent kids from smoking and help smokers quit at the levels recommended by the Centers for Disease Control and Prevention. No state currently funds such programs at CDC-recommended levels and only 9 states currently fund such programs at even half the CDC’s recommended levels (Source: RWJF Public Health Digest June 22, 2009).

For more information on the FDA legislation, see http://www.tobaccofreekids.org/reports/fda/.

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Research Highlights

Experts: Big Tobacco Dead in U.S. by 2047, Possibly Sooner

President Obama’s signature on a bill to grant the Food and Drug Administration (FDA) regulatory authority over tobacco was historic, and represents a step in the march to eliminate tobacco use in this country by 2047, two national tobacco experts said.

The pair published “Stealing a March in the 21st Century: Accelerating Progress in the 100-Year War Against Tobacco Addiction in the United States” in the July issue of the American Journal of Public Health. Drs. Michael Fiore and Timothy Baker, director and associate director of the University of Wisconsin Center for Tobacco Research and Intervention, chart milestones in beating tobacco addiction and map a battle plan to eradicate tobacco use in the next few decades. The researchers analyzed data from the 1960s, when the first systemic tracking of smoking rates began, until the present.

“Numerous observers have claimed over time that tobacco use has plateaued and progress against its use has stalled,” the authors write. “However, the remarkable decline in rates of tobacco use since the 1960s belies this claim and underscores the remarkable success of tobacco control efforts to date.”

Data from the Centers for Disease Control and Prevention show adults smoking between 1965 and 2007 dropped by an average of one half of one percentage point per year, from 42 percent to the current rate of about 20 percent rate. While this rate of decline hasn’t occurred each year, the overall decrease has been quite steady.

The two researchers urge a nationwide effort designed to accelerate the rate of decline over the next 50 years through:

  • Substantial increases in federal and state tobacco excise taxes.
  • A national clean-indoor air law.
  • Elimination of nicotine from tobacco products.
  • Funds for an aggressive mass media campaign to counter the tide of tobacco industry ads and sponsorships.
  • A ban on tobacco advertising, promotion and sponsorship.
  • Evidence-based counseling and medication for every smoker who wants to quit.
  • Protecting young people, particularly those 17 and younger, from starting to smoke. Research shows that a major genetic risk for lifelong nicotine dependence can be suppressed if young people avoid daily smoking prior to age 17.

“The progress made in reducing tobacco use over the last 50 years should in no way temper our commitment to further reductions. Nor should that progress be interpreted to mean tobacco use is less toxic or that tobacco companies are now on the ropes. But, if appropriate steps are taken, a tobacco-free nation can be achieved within a few decades,” Fiore said.

Past success has been born of:

  • Tobacco tax increases.
  • Enactment of clean-indoor air laws.
  • Tobacco industry advertising restrictions.
  • Tobacco product labeling requirements.
  • Policies that restrict youth access to tobacco products.
  • Mass media campaigns.
  • Increased availability and effectiveness of treatments to help current smokers quit.

For more information, see PDF:
University of Wisconsin Center for Tobacco Research and Intervention News Release June 25, 2009


Smoking Linked To Brain Damage

New research which suggests a direct link between smoking and brain damage will be published in the July issue of the Journal of Neurochemistry. Researchers, led by Debapriya Ghosh and Dr. Anirban Basu from the Indian National Brain Research Center (NBRC), have found that a compound in tobacco provokes white blood cells in the central nervous system to attack healthy cells, leading to severe neurological damage.

The research centers on a compound known as NNK, which is common in tobacco. NNK is a procarinogen, a chemical substance which becomes carcinogenic when it is altered by the metabolic process of the body.

Unlike alcohol or drug abuse NNK does not appear to harm brain cells directly, however, the research team believe it may cause neuroinflamation, a condition which leads to disorders such as Multiple Sclerosis.

To prove if such a link exists the team conducted two types of tests, one outside of a living host in glass and one in laboratory mice. The team used blot analysis techniques which showed that the introduction of NNK resulted in a clear increase in proinflammatory signaling proteins, proinflammatory effector proteins and other stress related proteins. Increased levels of proinflammatory cytokines, which act as molecular messengers between cells, were also detected.

This shows that NNK provokes an exaggerated response from the brain's immune cells, known as microglia. Microglia cells act as 'destroyers' for the brain by attacking damaged or unhealthy cells. However, when provoked by NNK these cells start to attack healthy brain cells rather than the unhealthy cells they are supposed to attack.

"Our findings prove that tobacco compound NNK can activate microglia significantly which subsequently harms the nerve cells," said Basu.

While other harmful side effects of smoking, such as lung disease, usually derive from tar or smoke this research suggests damage is not confined only to smoking. NNK is present in all forms of tobacco and therefore it can also enter the body through chewing.

The study also suggests that second hand smoking may lead to the same neuroinflamation conditions. Concentrations of NNK in tobacco can vary from 20-310 nanograms in cigarettes. However, NNK is also present in the smoke itself, meaning that smoke-filled air indoors may contain up to 26 nanograms of NNK. This means that both direct and second-hand smoking can lead to substantial measures of NNK intake.

For more information, see web link:
ScienceDaily June 23, 2009


Intensive In-hospital Support Doubles Likelihood Of Smoking Cessation In Heart Patients

Patients admitted to hospital with coronary artery disease are twice as likely to quit smoking after receiving intensive smoking cessation support compared to minimal support, found a new study in Canadian Medical Association Journal.

The study, a randomized clinical trial, compared intensive intervention with minimal intervention and found that patients admitted for open heart surgery had significantly higher long-term abstinence rates at 1 year compared with those admitted for heart attacks.

Other factors that contributed to successful long-term smoking cessation included absence of a previous heart attack, postsecondary education and at least some smoking restrictions at home.

The intervention used in the study resulted in the highest rates of 1-year confirmed smoking cessation in previous tests in the US.

This Canadian study involved 45-60 minutes of bedside education and counselling sessions in hospital followed by 7 telephone counselling sessions with a nurse at specific intervals over 2 months. These calls helped patients to problem-solve by developing cognitive, behavioural and social support strategies for use when they found themselves in high-risk situations; in doing so the patients could maintain their smoke-free status.

"The rates of confirmed long-term abstinence rates observed in this trial are among the highest rates reported in cardiac populations and are among the highest reported absolute differences between minimal and intensive interventions," write Dr. Patricia Smith, Northern Ontario School of Medicine and Dr. Ellen Burgess, University of Calgary.

"Our results suggest that intensive counselling provided during the hospital stay is more effective than a stepped-care approach that provides intensive counselling only after a patient has relapsed," write the authors.

They suggest inpatient programs have the potential to significantly reduce cardiac events and hospital costs and should become standard practice in hospitals.

For more information, see web link:
ScienceDaily June 22, 2009


Preoperative Smoking Cessation Improves Head and Neck Surgery Outcomes

Even a short period of 4 to 8 weeks of smoking cessation prior to surgery to treat upper aerodigestive tract squamous cell carcinoma improves wound healing, according to a review of the literature. If the patient stays tobacco-free, the risk of cancer recurrence is substantially reduced.

However, full cessation is required — simply reducing the quantity of cigarettes smoked per day is of little benefit, Dr. Richard O. Wein from Tufts Medical Center, Boston, reports in the June Archives of Otolaryngology-Head and Neck Surgery.

Studies of the impact of smoking cessation on surgical outcomes within the field of otolaryngology are few and contradictory, Dr. Wein points out. For his review, he drew on studies of smokers operated on for non-otolaryngology conditions as well as for head and neck tumors.

The “bottom line,” he says, is that “although conflicting reports exist within the literature concerning the impact of short-term smoking cessation, it should be noted that the sheer number of articles reporting the negative impact of continued tobacco use on postoperative pulmonary function and wound healing far outweighs those minimizing this impact.”

Furthermore, multiple studies indicate increased risk of recurrence or the development of a second cancer in patients who continue to smoke after their index cancers are diagnosed. One study, for example, found that 40 percent of patients who kept smoking after being treated definitively for a malignant oral cavity tumor had a recurrence or developed a second malignant lesion.

For more information, see web link:
Oral Cancer News June 18, 2009


Social Smokers: Turning The Tables On Big Tobacco

The tobacco industry knows exactly what makes social smokers tick. Now, researchers want to use that once-secret information to help them quit.

Focusing on the effects of secondhand smoke, not on personal health, might be a better tactic with social smokers, who tend to deny that they are at-risk or even smokers, but do care about others.

The landmark state litigation against the tobacco industry - known as the Master Settlement Agreement - forced tobacco companies to open confidential industry documents to the public; so far, they have released 10 million documents spanning more than 80 years.

Researchers at the University of California at San Francisco mined this mother lode of information, focusing on social smokers. Their study appears in the August issue of the American Journal of Preventive Medicine.

"Tobacco companies probably spent hundreds of millions of dollars for this research," said co-author Stanton Glantz, Ph.D., at the UCSF Center for Tobacco Control Research. "They indentified this group as a large, stable part of the tobacco market way before public health did."

What else did the cigarette manufacturers learn?

Part of the social smoker's self-image is the belief that they are "in control." They restrict themselves, by smoking just on weekends or at parties, or maybe limiting the habit to a few cigarettes a day. They rarely smoke alone and typically do not smoke around non-smokers. Before they light up, they ask people if they "mind."

Most believe they are not addicted to nicotine and that they are immune to the health risks - lung cancer, heart disease - of "real" smokers.

That is wishful thinking, according to study co-author Rebecca Schane, M.D. "It's like, 'you're not just a little bit pregnant.' Either you smoke or you don't. With any smoking, there's risk."

According to the authors, social smoking rates are on the rise and this group now makes up more than a quarter of all smokers.

"It's no surprise that the tobacco industry is interested in social smokers - they want everyone who has lungs to smoke," said Joseph DiFranza, M.D., a professor at the University of Massachusetts Medical School. "They leave no stone unturned."

However, Schane points out that "Public health guidelines do not incorporate treatment for nondaily smokers beyond 'Advise them to quit.'"

Current smoking cessation programs target chronic daily smokers and likely would not work for social smokers, according to the study authors.

"Standard therapies may not be appropriate for these people. Social smokers may not be physically addicted," Schane said. "They can go for periods without craving smoking. Nondaily smokers, who are similar to social smokers, do better with counseling than nicotine replacement."

But, she added, the jury is still out on what treatment advice to give to clinicians working with nondaily and social smokers, as drug studies rarely include those groups.

"[Social] smokers routinely have been excluded from smoking cessation interventions for decades, but there's no reason to suggest that the same interventions wouldn't work for them," DiFranza said.

Clinicians should dig deeper, Schane said, by asking patients about smoking on a daily, weekly or social basis, rather than as a yes-no question.

"We need to do a better job of identifying these smokers," Glantz said. "The tobacco companies are."

Legacy Tobacco Documents Library at UCSF: http://legacy.library.ucsf.edu/.

For more information, see web link:
Medical News Today June 16, 2009


Study Suggests College-Age Smokers Require Multiple Quit Attempts

A study published in a recent issue of the Journal of Consumer Affairs suggests that college-age smokers may require multiple strategies and quit attempts to successfully squash the habit, United Press International reports.

According to a researcher at Milwaukee-based Marquette University, despite plans to stop smoking after graduation, few college students successfully quit smoking, and those who manage to quit often require multiple attempts.

Noting that most college students navigated an extended period of trial and error during their attempts to quit, the study reveals that students who successfully quit smoking did so only after incorporating lessons learned into subsequent quit attempts. The study also found that programs that incorporated the real stories and experiences of those who failed to quit smoking in early attempts, but were eventually successful, proved beneficial to some students' cessation efforts.

For more information, see web link:
RWJF Public Health Digest June 9, 2009


Report: Smoking Declines as Alcohol, Drug Use Hold Steady

A new report on substance abuse and mental health shows a small percentage of people are kicking smoking while alcohol and illicit drug-use levels remain steady.

Many of the trends are similar to past studies, according to Art Hughes, one of the report's lead statisticians, but he cited "the adverse relationship between (perception of) risk of use and use itself" as worthy of examining at the state level.

In states where people reported having a perception of great risk about substance abuse, the problem is more often reported at lower levels than in states where risk is not as great a concern, according to the study, based on the National Surveys on Drug Use and Health. The 2006-2007 interview data is collected from 135,672 persons and is compared to the 2005-2006 data. Smoking declined from 24.96 percent to 24.63 percent with the greatest decrease among 12 to 25 year olds.

"Cigarette use continues to decline," says Hughes. "One statistic we use to try to gauge is the (perceived) risk of smoking cigarettes. If people think it's risky to use cigarettes, we tend to see an opposite effect happening."

For instance, California is among the states with highest percentage of people who regard smoking as a health hazard (77.35 percent) and had the second lowest smoking rate (19.79 percent) behind Utah (17.51 percent). Utah's perception of risk was slightly lower (76.93 percent) than California's. Nationwide, a slight drop was recorded compared to 2005-2006 (74.14 percent vs 73.86 percent). West Virginia, on the other hand, has the highest rate of cigarette users of all states (31.10 percent) for people aged 12 and older and has the lowest perception of risk level associated with smoking (67.88 percent). Oklahoma and Tennessee, which ranked No. 2 and 3 behind West Virginia for percentages of smokers, were also among states with lowest perception of risk.

"We're painfully aware of the problem," said Teresa Mace, media director of West Virginia's Office of Community Health Systems and Health Promotion. "We have a state tobacco quit line and other kinds of cessation programs that are offered to all West Virginians. We've gotten a lot better at getting our message to the people who need to know but it's hard to match the amounts spent by the tobacco industry."

Colorado is the only state showing an increase in tobacco use (from 26.5 percent to 29.8 percent) while seven states had declines: Idaho, Massachusetts, Michigan, Montana, New York, Utah and West Virginia. The Northeast region had a decrease as well (from 28.1 percent to 27.1 percent). Overall, national rates changed only slightly (24.6 percent) from the 2005-2006 report (25 percent).

For more information, see web link:
USAToday June 4, 2009


As Movies Portray Fewer Smokers, Fewer Teens Light Up

Blockbuster movies are less likely to portray smokers than they have in the past, according to a new study. What's more, this decline in on-screen smoking may have occurred in tandem with a drop in the number of adolescents who have lit up in real life. Teenage smoking and the number of smoking scenes in movies have declined, according to a study.

While the study can't prove that one is related to the other, the findings would seem to support what critics have long said: Smoking by glamorous (or even not-so-glamorous) people on the silver screen is like free advertising for cigarettes.

"Reducing smoking in movies probably helped to reduce rates of smoking in kids," said study author Dr. James D. Sargent, a professor of pediatrics at Dartmouth Medical School and the codirector of the Cancer Control Research Program at Norris Cotton Cancer Center, both in Lebanon, New Hampshire. "We are on the right track aiming at movies, yet half of movies still contain smoking and more work needs to be done."

About one-third to one-half of adolescents who begin smoking may do so because they see smoking in the movies, some research suggests, and the tobacco industry has spent big bucks in the past to make sure cigarettes appeared in popular movies, according to Smoke Free Movies, a University of California San Francisco project. For years, public health groups have encouraged the movie industry to voluntarily reduce depictions of smoking.

Their efforts may have paid off, at least in younger teens. In the study, researchers looked at smoking scenes in the top 25 highest-grossing movies from 1990 through 2007. Each time a movie character handled or used tobacco, or even when tobacco was seen in the background, it was considered a smoking scene.

In 1990, there were about 3.5 smoking scenes per box-office hit. By contrast, there were only 0.23 instances of smoking in the highest-grossing films of 2007. At the same time, there was a corresponding decrease among eighth graders who smoked. Smoking peaked in 1996 with 21 percent of eighth graders saying they had used cigarettes (defined as having smoked in the previous 30-day period) and dropped to 7.1 percent in 2007, the study showed. Overall, smoking in eighth graders decreased by an average of 1.3 percentage points each year.

"It's great to see smoking on the decline; it's the leading preventable cause of death, and most of those who take up the habit nowadays do so as teens," said Jeff Stier, the associate director of the American Council on Science and Health, a New York City-based group that publicizes the health risks of smoking.

However, the picture in older teens is more complicated. About 27 percent of children in grades 9 through 12 smoked cigarettes in 1991, and that increased to 36 percent in 1997. There was a steep decline after that, hitting about 22 percent in 2003. Since then, teen smoking has plateaued or only declined slightly, and 20 percent of U.S. high school students were cigarette smokers in 2007--approximately 19 percent of females and 21 percent of males.

For more information, see web link:
CNN.com June 3, 2009


Arizona Shows More Than a 20 Percent Drop in Smoking Rates

New information from the Behavioral Risk Factor Surveillance System 2008 shows that the rate of smoking among adults in Arizona has dropped significantly -- more than four percentage points representing a 20.7 percent decrease in prevalence equating to 170,000 Arizonans who quit smoking since 2007. The rate of smoking in one year dropped from 19.8 percent to 15.7 percent.

This decrease, the single largest decline in tobacco use in any state in the U.S. during the past year, moves Arizona from ranking 26th in the nation for smoking prevalence to 7th.

"This is a jump in the ranking of Arizona; and that says great things about the leadership of our state for tobacco control," said Wayne Tormala, Bureau Chief for the Arizona Department of Health Services Bureau of Tobacco and Chronic Disease (ADHS BTCD). "But what this also means is that more Arizonans are making the choice to positively impact their own health, the health of our state, their personal budgets, and our Arizona economy."

"Healthcare costs for smoking related illnesses cost Arizona $3.6 million a day," Tormala added.

Since the end of 2006 many changes have occurred in Arizona that could be part of the reason for the steep decrease. For example:

  • The TRUST Commission worked with American Cancer Society, American Heart Association and American Lung Associations' and other organizations statewide to raise the tax on tobacco by two cents and pass the Smokefree Arizona Law.
  • Smokefree Arizona, the law that eliminates smoking in most indoor businesses went into effect in the beginning of 2007. ADHS' Bureau of Environmental Health has worked with all 15 counties statewide to enforce the smoking ban. around tobacco control statewide.
  • ADHS BTCD did a media campaign including paid advertising featuring Nick, an "everyday" person who was quitting smoking utilizing the state's free quit assistance program - ASHLine. This campaign was effective in getting the message out about free cessation services.
  • ADHS BTCD began working with AHCCCS to provide nicotine replacement as a benefit to clients.
  • ADHS BTCD did a significant 'pilot program' offering free nicotine replacement therapies and medications.

"Whether it's the health impact or the cost, whatever motivates a person to quit, we are excited to see this impact in Arizona," Tormala adds. The Arizona Smokers' Helpline (ASHLine) is the free quit coaching service provided by the state and, he says, "We can help all Arizonans quit too. Call the ASHLine at 1-800-55-66-222 or visit http://www.ashline.org and try the recently launched on-line WebQuit program."

For more information, see web link:
PRNewswire May 27, 2009


To Quit Smoking, Try Logging On

Internet- and computer-based smoking cessation programs are a cost-effective alternative to more expensive telephone hotlines or counseling services for smokers who are trying to quit, according to a new study.

"With the rising cost of health care, there is a need to look for less expensive health programs that are effective," study co-author Joel Moskowitz, director of the Center for Family and Community Health at the University of California, Berkeley, School of Public Health, said in a university news release. "What we found in our meta-analysis was that Web- and computer-based programs, once they're up and running, are a worthy alternative."

The researchers analyzed the findings of 22 trials, involving almost 30,000 participants, that compared smokers who used Web- or computer-based smoking cessation programs with those who tried to quit on their own.

The percentage of smokers who remained tobacco-free a year after using the Web- or computer-based programs was 9.9 percent, about 1.7 times higher than the rate for those who tried to quit on their own.

The findings are in the May 25 issue of Archives of Internal Medicine.

"Currently, Web- and computer-based smoking cessation programs are not commonly recommended, because evidence of their effectiveness has been inconsistent," the lead author, Dr. Seung-Kwon Myung, a staff physician in the Smoking Cessation Clinic at the National Cancer Center in South Korea, said in the news release. "But our review of the evidence to date suggests that Web- and computer-based programs have a legitimate place in tobacco dependence treatment options."

Such programs can be particularly helpful for people with no health insurance and those concerned about the stigma of seeking treatment, Myung suggested.

Moskowitz said that many smokers prefer the flexibility and privacy offered by Web- and computer-based programs, which can be translated into various languages to help a wide range of people.

For more information, see web link:
US News & World Report May 26, 2009


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Other Cessation News

Congress Should Take Stronger Steps Toward Eliminating Tobacco Use In Military Populations

Because tobacco use impairs military readiness, harms the health of soldiers and veterans, and imposes a substantial financial burden on the departments of Defense and Veterans Affairs, these agencies should implement a comprehensive strategy to achieve the Defense Department's stated goal of a tobacco-free military, says a new report from the Institute of Medicine. DOD should gradually phase in a ban on tobacco use in the military, starting at military academies and officer training programs and among new recruits, the report says. DOD should also stop selling tobacco products in Army and Air Force commissaries -- Navy and Marine Corps commissaries already do not sell them -- and should stop selling them at a discount in military exchanges and other stores. In addition, Congress should allow VA to establish tobacco-free medical centers.

The report was requested by DOD and VA, who asked the Institute of Medicine to identify policies and practices that could lower rates of smoking and help soldiers and veterans quit.

Tobacco use reduces soldiers' physical fitness and endurance and is linked to higher rates of absenteeism and lost productivity, the report says. In 2005, 32 percent of active-duty personnel and 22 percent of veterans were smokers; rates among active-duty personnel have recently increased, possibly because of growing tobacco use by deployed troops.

"We found that the adverse effects of tobacco use on military readiness, the health of both smokers and nonsmokers, and the financial cost of the medical care of smoking-related illness in military and veteran populations are a sound basis for moving systematically toward a tobacco-free military," said Stuart Bondurant, professor of medicine and dean emeritus of the School of Medicine at the University of North Carolina, Chapel Hill, and chair of the committee that wrote the report. "The state of the art in tobacco control is such that with well-managed programs, DOD and VA could eventually be tobacco free with minimal disruption, and with substantial benefit to military personnel and veterans."

DOD and VA should ensure that all personnel have quick and easy access to comprehensive, evidence-based tobacco-cessation services, the report says. All DOD and VA health care providers should be able to provide brief counseling and nicotine-replacement therapy to patients. In addition, the committee recommended that VA and DOD develop toll-free "quitlines" to provide military personnel and veterans with counseling on quitting tobacco. Quitline counselors should be trained to deal with issues related to these populations, such as post-traumatic stress disorder.

The Defense Department should set a date by which the military will be tobacco-free and require each of the four services to develop and enforce a timeline for achieving this goal, the report says. Recognizing that immediately banning tobacco use in deployed personnel is not realistic, the committee urged an incremental strategy, starting with closing the pipeline of new tobacco users entering the military. Smoking should be banned at military academies, and the current ban on tobacco use during basic training should be extended to include subseqent technical training. That ban could eventually be extended to all new enlistees, who would be informed during recruitment that they would be expected to remain tobacco-free during their entire military careers.

Eventually, all military installations and active-duty personnel should be required to be tobacco-free -- a goal that could realistically be achieved in 20 years or even sooner, if the plan's initial phase for military academies and new recruits starts within a year, the report says.

Only with assistance from DOD and VA will tobacco use be stopped, the report says, and ideally DOD should not sell tobacco products as they inhibit military readiness. As a first step, DOD should prohibit tobacco sales in Army and Air Force commissaries and stop selling tobacco products at a discount in other military stores. Congress should direct DOD to sell any tobacco products in military exchanges at prices equal to those in the civilian sector, and preferably higher.

Congressional action is also necessary to allow VA to implement tobacco-free medical facilities. The VA's efforts to do so have been hampered by the language of the Veterans Health Care Act of 1992, which requires them to maintain smoking areas for veterans and employees. This act should be repealed, the report says.

The study was sponsored by the U.S. Department of Veterans Affairs.

For more information, see web link:
News from the National Academies June 26, 2009


Board of Health Votes to Invite Public Comment on a Health Code Amendment Requiring New York City Tobacco Retailers to Post Health Warning Signs

The Board of Health voted to solicit public comment on a Health Code amendment requiring all tobacco retailers in New York City to prominently display point-of-sale warnings and cessation messages. The required signage would be developed by the Health Department and may include graphic images to depict the adverse heath effects of tobacco products, as well as provide information about how to quit.

“Smoking continues to be the leading cause of preventable death in New York City,” said Dr. Thomas Farley, New York City Health Commissioner. “While the tobacco industry spends billions of dollars every year to glamorize smoking, we will show New Yorkers the harsh realities. These warning signs will help persuade smokers to quit and show children why they shouldn’t start to smoke.”

The proposed measure would require retailers to post the warnings wherever tobacco products are displayed, and also at the cash register or point of purchase. This ensures that any customer contemplating a tobacco purchase visually sees the health effects of tobacco use.

Last year New York City achieved its lowest adult smoking rate on record (15.8%), but about 950,000 New Yorkers still smoke – and tobacco-related illness still claims more than 7,400 lives in the city each year. Smoking kills more New Yorkers than AIDS, drugs, homicide and suicide combined.

Smokers’ health behaviors are strongly influenced by their understanding of the related health risks; studies show that those who perceive greater hazards are more likely to consider quitting. Health warnings, like those proposed by the Health Department, are one of the most effective prompts to get people to quit.

Besides encouraging smokers to quit, the proposed warning rule will help discourage underage smoking – by educating youth about the dangers of tobacco and counteracting the point-of-sale advertising by the tobacco companies. Most smokers start during adolescence, and two-thirds become daily smokers by the age of 19. City and state laws bar tobacco sales to anyone under 18, yet many minors purchase tobacco illegally from licensed retailers.

A public hearing on the new warning rule will be held on July 30th, and the Board of Health is expected to vote on the measure in September. The proposal is available online at: http://www.nyc.gov/html/doh/html/notice/notice.shtml.

For more information on the proposed health warnings, please visit: http://www.nyc.gov/html/doh/html/smoke/smoke.shtml.

For more information, see web link:
New York City Department of Health and Mental Hygiene Press Release June 24, 2009


Unprecedented Effort to Help LA County Residents Quit Smoking Launched

The Los Angeles County Department of Public Health, in conjunction with Ralphs Grocery Company and L.A. Care Health Plan, will participate in the largest in-person giveaway of nicotine patches and gum ever in California. These 30,000 quit smoking aids will be given away to LA County residents at 47 participating Ralphs Pharmacies beginning Monday, June 15, 2009 between the hours of 1pm-8pm, while supplies last.

"We are confident that this giveaway will serve as the first step in a successful quit effort for smokers in Los Angeles County," said Dr. Jonathan E. Fielding, MD, MPH, Director and Health Officer of the Los Angeles County Department of Public Health. "Nicotine patches and gum are helpful tools that will assist smokers in quitting this deadly addiction. And, with no cost, there is no better opportunity and no better time than now to quit."

The 30,000 two-week starter kits of free nicotine patches and gum are part of LA County's ongoing campaign to reduce smoking rates. With funding from the county's allotment of the Tobacco Master Settlement and L.A. Care Health Plan, this campaign attempts to build awareness of existing resources and develop social networks to support smokers in quitting for good.

"Smoking is the number one cause of preventable deaths in the United States. However, quitting cold turkey rarely works. Research has shown that counseling and the use of patches or pills can triple a smoker's chance of quitting," said Elaine Batchlor, M.D., Chief Medical Officer at L.A. Care Health Plan, America's largest public health plan. "We believe that by offering these free nicotine patches and gum, smokers will be encouraged to begin their path to a healthier life."

In an effort to make the public aware of this campaign, LA County has created a Facebook page (keyword: LA Quits), which will include updates on this giveaway and other information about LA County's smoking cessation efforts. A Twitter page (@LAQuits) will also feature cessation tips.

Smokers who are interested in getting the free two-week starter kits of nicotine patches or gum are encouraged to visit their local Ralphs Pharmacy in LA County between the hours of 1pm-8pm beginning Monday, June 15th. "Ralphs and The Kroger Corporation are proud to be partners in this public health campaign. We are excited to be able to offer this resource to our customers at our pharmacies and hope that this will help them quit smoking, and benefit their health," said Kendra Doyel, Group Vice President, Public Relations of Ralphs.

LA County residents 18 years of age or older are eligible for this giveaway and must have a valid form of identification. Participants will be screened for eligibility to ensure that the nicotine replacement therapy will not conflict with any pre-existing conditions. A follow-up survey is required as well.

Smoking is the leading cause of preventable death in the United States, with more than 500,000 people dying of tobacco-related diseases each year. It also is a costly addiction, as purchasing a pack of cigarettes a day costs a smoker nearly $1,600 a year, and costs LA County approximately $4.3 billion due to smoking-related diseases and deaths each year. "During these tough economic times, it is a fiscally smart decision for individuals to quit smoking and save hundreds of dollars a year," continued Dr. Fielding. "Smoking not only puts a strain on your finances, it can also cut years off your life, which is the biggest expense of all."

LA County offers other resources to residents who are currently addicted to tobacco, have already quit, or want to help a friend or relative kick this deadly addiction as well. Residents can visit http://www.LAQuits.com for information and resources about quitting smoking, or call the California Smokers' Helpline, 1-800-NO-BUTTS. The helpline offers free and confidential telephone counseling that has proven to double a smoker's chances of successfully quitting than if the smoker tried to do it alone. The service also assists those trying to quit chewing tobacco and has experts to help teens quit. In addition, Ralphs Pharmacists are specially trained on smoking cessation behavioral techniques and offer individualized appointments to further increase the success rate.

For more information about this giveaway, please visit http://www.LAQuits.com.

For more information, see web link:
Los Angeles County Department of Public Health June 15, 2009


Cigarette Smoking Prevalence and Policies in 50 States: An Era of Change

The chartbook, Cigarette Smoking Prevalence and Policies in 50 States: An Era of Change, released by the Robert Wood Johnson Foundation (RWJF) and Bridging the Gap, presents state and national data on tobacco prevalence, policies implemented to diminish that prevalence, and programs and policies to help smokers quit. The chartbook shows that significant progress has been made in reducing tobacco use in the United States, but it also shows that much work remains to be done to end a tobacco epidemic that continues to cause significant death and disease, especially in places not protected by proven tobacco control measures.

With its extensive analysis of tobacco prevention and control strategies throughout the country and a comprehensive examination of current tobacco usage patterns, the chartbook serves as a primary source of information for tobacco prevention policymaking and further research prioritizing.

Key findings from the report include:

  • Substantial progress was made in reducing cigarette smoking in the United States from 1992/1993 to 2006/07, with the prevalence of cigarette smoking among adults declining from 24.5 percent to 18.5 percent.
  • A wide variation in smoking prevalence exists by state, For example, among 18- to 29-year-olds, prevalence was 2.5 times higher in Kentucky (36.2 percent) than in California (14.4 percent).
  • States making the most progress in reducing smoking appear to have proportionately fewer “hard-core” smokers. In 2006/07, smokers living in states where cigarette smoking was lowest were less likely to exhibit indicators of nicotine dependence than were smokers living in states where smoking was higher. Smokers living in low-prevalence states were more interested in quitting, more motivated to quit and more confident in their ability to quit than were smokers in high-prevalence states.
  • Between 1992/93 and 2006/07, the percentage of U.S. adults living in smoke-free homes increased by 84 percent, from 43.1 percent in 1992/93 to 79.1 percent in 2006/07.
  • In 1992/93 only 46.1 percent of indoor workers reported having a smoke-free policy at work. In 2006/07, 75 percent of indoor workers had a smoke-free policy in their workplace.
  • Across all states, cigarette excise tax revenues increased from $10.35 billion in fiscal year (FY) 2002 (adjusted to April 2008 dollars) to an estimated $15.25 billion in FY 2007, an increase of 47 percent.
  • By 2006/07, in 34 states and Washington, DC, more than 50 percent of those who had ever smoked cigarettes had quit.

For more information, see web link:
RWJF Public Health Digest June 10, 2009


District of Columbia Department of Health and DC Tobacco Free Families Team Up With Students to Fight Tobacco Use by Teenagers

The District of Columbia Department of Health (DOH) released a new music video "Nasty" about the many reasons not to use tobacco. The video, created as a teaching tool for teenagers, students from Anacostia Senior High School and was put together through a project of the DC Tobacco Free Families (DCTFF) Campaign, a partnership of DOH, the American Lung Association of DC and the American Cancer Society. DOH funds DCTFF with the District’s tobacco settlement funds.

"Thanks to the hard work of our partners and the students at Anacostia Senior High School we have a new tool in our campaign to educate youth about the dangers of tobacco use," said Dr. Pierre Vigilance, Director of DOH. "The video and song are an entertaining but honest portrayal of the toll smoking can take on someone physically and socially."

The video is part of DCTFF’s goals to reduce tobacco use among DC’s youth by developing strategies and programming with DC youth on tobacco-free messaging, including training youth ambassadors and peer leaders to conduct outreach on the dangers of tobacco addiction.

Steve Fitzhugh, who wrote and performed the song in the video, worked with students at Anacostia High School and Cerebral Lounge, the production company, to come up with the concept and film the video in the Anacostia neighborhood. Members from The House, a youth center in Anacostia, coached, auditioned and provided guidance for the Anacostia Students in the video. The House headquarters also served as a film site.

The video will be used in educational settings and comes with a facilitator’s guide to help teachers and peer leaders lead discussions about the themes and messages of "Nasty". Through the video and discussions, DOH hopes to educate youth about tobacco companies’ strategies to target teenagers and about the consequences of tobacco use.

For more information, see web link:
District of Columbia Department of Health News Release June 5, 2009


Controversy Swirls Around E-Cigarettes

Federal regulators and antismoking groups are taking steps that could snuff out electronic cigarettes, the smokeless nicotine products embraced by a growing number of people trying to kick the habit or avoid bans on smoking in public.

Electronic cigarettes typically consist of a metal tube containing an atomizer, a battery and a cartridge filled with liquid nicotine. When a user sucks on an e-cigarette, a light-emitting diode causes the tip to glow and the atomizer turns the liquid nicotine into a vapor -- thus it is called vaping instead of smoking. The vapor can be inhaled and then exhaled, creating a cloud that resembles cigarette smoke but dissipates more quickly and doesn't have the lingering odor.

The American Lung Association, along with the American Cancer Society Cancer Action Network, the American Heart Association and the Campaign for Tobacco-Free Kids, recently called for e-cigarettes to be removed from the market. The groups say e-cigarettes have yet to be proven safe and that kids may be attracted to the products, some of which come in flavors like chocolate and strawberry. "Nobody knows what the consumers are actually inhaling," says Erika Sward, director of national advocacy at the American Lung Association.

But e-cigarette companies say their product is a better alternative to cigarettes because there is no smoke or combustion involved. "Anybody who doesn't think this product without any smoke attached to it is orders of magnitude less harmful than cigarettes just has no concept of basic science," says Jack Leadbeater, president and chief executive of Scottsdale, Ariz.-based Sottera Inc., which sells the Njoy brand of electronic cigarettes.

There are three large U.S. companies and dozens of smaller ones selling electronic cigarettes, most of which are made in China. Sales of the products, which barely registered in the U.S. just two years ago, have more than doubled over the past 12 months to an estimated $100 million, according to the Washington-based Electronic Cigarette Association, an industry association formed this spring.

A startup kit, which typically includes the e-cigarette device, a set of nicotine cartridges and batteries, costs between $60 and $120. Companies say that using e-cigarettes is cheaper than regular cigarettes in the long run on a cost-per-puff basis.

Regulators have acted quickly to quell the rising popularity of e-cigarettes, saying e-cigarettes are drug devices that need regulatory approval before being legally sold and marketed in the U.S. The Food and Drug Administration says that as of March 1 it "has refused 17 shipments of various brands of these 'electronic' cigarettes, cigars, and pipes, and their components." The agency added that it will continue to evaluate the products on a case-by-case basis "to determine the appropriate action to take."

For more information, see web link:
The Wall Street Journal June 2, 2009


Massachusetts Hails Anti-Smoking Program

A state anti-smoking campaign has helped 33,000 smokers who use the state’s medicaid program to quit, according to the Massachusetts Department of Public Health.

Health officials are hailing the development as the first significant drop in smoking rates within that demographic to date.

Since the MassHealth tobacco cessation benefit was established in 2006, the number of MassHealth members who smoke has dropped by 26 percent. In the 12 months prior to the benefit going into effect, the smoking rate among MassHealth members was 38.3 percent, more than twice as high as the rate for the general population.

The percentage fell to 28.3 percent in 2008. Researchers found a smaller decrease in the smoking rate for other low income groups that did not have MassHealth coverage.

The MassHealth tobacco cessation benefit provides prescription and over-the-counter medication to members who want to quit smoking. The program also includes optional face-to-face counseling, with the goal of reducing smoking-related health care costs for MassHealth.

“Three out of four smokers say that they want to quit, but the cost of medications that help with cravings is a significant financial barrier to many low income people,” said Department of Public Health Commissioner John Auerbach. “The success of the MassHealth benefit shows that smokers will utilize such a benefit, and they will quit in large numbers with the appropriate supports.”

Smoking remains the number one preventable cause of illness and death in the state, officials said, adding that tobacco use is associated with $4.3 billion in excess health care costs in Massachusetts each year.

For more information, see web link:
Boston Business Journal June 1, 2009


PA Department of Health Launches Spanish-Language Smoking Cessation Resource Web Site

Pennsylvania Secretary of Health Everette James announced the launch of Estoydecidido.com, a resource tool to help Latino residents of Pennsylvania go tobacco free.

Estoydecidido.com - which translates to "I am determined" - is the Spanish version of the state's popular DeterminedToQuit.com site.

"Latinos have become an emerging target for tobacco companies," said Secretary James. "Our department is dedicated to addressing tobacco-related health concerns in the Latino communities. Realizing that language barriers may discourage some of our Hispanic residents from seeking cessation assistance, Estoydecidido.com was developed to provide critical information associated with tobacco health-related risks and support for Latino residents who want to quit using tobacco products."

The new site was developed to provide Latinos with an online community of support and tools to make it easier for them in their quit attempts. The site includes the Quit Companion, a free online support program that allows users to update and monitor their quit attempts; schedule encouraging messages to be delivered automatically to their mobile phones at times when they typically take smoking breaks as well as receive messages of encouragement from loved ones. All messages would be available in Spanish text. The site also includes references and links to local cessation programs that offer free Nicotine Replacement Therapy, or NRT.

According to the U.S. Department of Health and Human Services, certain tobacco products are advertised and promoted disproportionately to members of racial/minority communities. For example, marketing toward Hispanic consumers has included advertising and promotion of cigarette brands with names such as Rio and Dorado, as well as sponsored cultural events such as parades, festivals and national heritage month observances.

To access more information and support to quit smoking, call the Pennsylvania Free Quitline at 1-800-784-8669 or visit http://www.DeterminedToQuit.com or http://www.estoydecidido.com.

For more information, see web link:
PRNewsWire May 29, 2009


Health Groups Renew Anti-Smoking Campaign with Hollywood

Despite a decline in teenage smoking rates, a coalition of health groups has renewed a campaign to discourage Hollywood from making movies with characters who smoke.

As part of the campaign, a mobile billboard featuring a teenage girl asking, "Which movie studios will cause me to smoke this summer?" will be driven around the Los Angeles area.

Young people also will be encouraged to use social networking sites like Facebook to voice their opinions on films made by Paramount, Disney Pictures, Sony Pictures, 20th Century Fox, Universal and Warner Bros.

The campaign was launched by the American Medical Association Alliance, the Los Angeles County Department of Public Health and the California Youth Advocacy Network.

The coalition plans to keep a tally of tobacco-related images in this summer's movies, including "X-Men Origins: Wolverine," a PG-13 rated film that shows the character portrayed by Hugh Jackman smoking a cigar.

"I'm willing to bet not one child would have enjoyed that movie any less if he hadn't been smoking," said Sandra Frost, President of the 27,000-member AMA Alliance.

The group launched its Screen Out! campaign in 2006, to discourage smoking youth-rated films.

Dr. Jonathan Fielding, director for the Los Angeles Department of Public Health, said the Motion Picture Association of America should expand its ratings system to include smoking as a factor.

"I can't imagine a movie executive wanting their children to become nicotine addicts because of what they saw in their movies," Fielding said. "This is not new news to Hollywood, but I think they should step up.

"Let's be clear, any movie with smoking should be rated R. If the industry worries about (the rating), they should work to remove gratuitous smoking from movies."

MPAA spokeswoman Angela Martinez said smoking is already a consideration in the ratings system, and can result in a rating being changed from a G to PG or even to PG-13.

"The rating system has been around for 40 years, and there are several ways the raters make judgements," Martinez said. "Their main job is to rate a movie with all the information parents will want to see. Three out of four movies already rated R are often movies that have depictions of smoking. If a movie is rated G and there's smoking in that movie, it probably will up it to a PG."

Wolverine's descriptor reads: "Rated PG-13 for intense sequences of action and violence, and some partial nudity."

Both Fielding and Martinez agreed such films a "Good Night and Good Luck," a biopic depicting the 1953 clash between Edward R. Murrow and Sen. Joseph McCarthy, is allowed because of its historical context.

But Fielding also praised films such as "Star Trek" for its smoke-free purity.

Martinez also said the MPAA is a member of Hollywood Unfiltered, which educates the industry of all the health consequences of smoking, and last year, major motion picture studios announced that they would be including anti-smoking public service announcements on youth-rated DVDs.

For more information, see web link:
Los Angeles Daily News May 27, 2009


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