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SpotlightNew Restrictions Take Effect On First Anniversary of Tobacco Regulation Law This month marked the anniversary of the Family Smoking Prevention and Tobacco Control Act which gives the U.S. Food and Drug Administration (FDA) authority to regulate the manufacturing, sale and marketing of tobacco products. During the past year, the FDA has accomplished numerous things under this new law, including establishing the agency's Center for Tobacco Products, appointing a Tobacco Products Scientific Advisory Committee and banning candy and fruit-flavored cigarettes. On June 22, 2010, several new key restrictions on tobacco marketing and sales took effect. These new provisions:
The new marketing and sales rules will ban all tobacco sponsorships of sports and entertainment events; ban free samples and giveaways of non-tobacco items, such as hats and T-shirts; prohibit the sale of cigarettes in packs of less than 20; and require stores to place cigarettes and other tobacco products behind the counter.
More than half of daily smokers, including nearly two thirds of women, say they smoke brands marketed as "light" or "ultra-light” and many believe that using these products helps reduce the risks from smoking.
As smoking rates have declined, tobacco companies have introduced new smokeless tobacco products, including products that look like candy, have candy flavors, and use colorful packaging. Smokeless tobacco use has increased by more than 33 percent among 10th and 12th graders in recent years. The new warnings on smokeless tobacco products must cover 30 percent of package display panels and 20 percent of advertising. In addition to these new restrictions, larger, graphic warning labels on cigarette packs and ads will take effect by 2012. These warnings will feature color photos and graphics depicting the harmful consequences of smoking, such as lung cancer, heart disease and impotence. In addition, promotion, marketing and sales of tobacco products sold over the Internet, by mail-order or other non-face-to-face sales (such as vending machines) will also be restricted. The Centers for Disease Control and Prevention (CDC) and FDA are working together to educate the public and public health partners about new tobacco regulations. NTCC partners can support this effort by:
Smoking-related diseases remain the most preventable cause of death in this country, killing more than 440,000 people each year and costing $96 billion annually in health care expenditures. The FDA law is critical because it will prevent kids from smoking, help smokers quit and save many lives. For more information on the FDA law, go to www.tobaccofreekids.org/reports/fda. Research HighlightsSmoking During Pregnancy Linked to Behavioral Problems in Children, Study SaysMothers who smoke while pregnant increase the risk that their child will develop psychological problems, a new study finds. And a related study found that babies exposed to secondhand smoke from fathers or other people may be at increased risk of developing weight problems, even if mothers are nonsmokers. Both studies appear online in advance of publication in the July issue of the journal Pediatrics. Researchers from the United Kingdom and Brazil, using data on 509 Brazilian and 6,735 British families, say there is reason to believe that mothers who smoke may expose their fetuses to harmful substances that may affect the behavior and conduct of children in later years. “There was some evidence that maternal smoking in pregnancy is associated with greater conduct/externalizing problems [aggressive behavior, rule-breaking behavior] in the offspring at the age of 4,” the authors write. Mary-Jo Brion, PhD, of the University of Bristol, tells WebMD by email that babies exposed to smoke may be prone to rule breaking, such as lying, cheating, bullying, and disobedience. Among other conclusions:
“To some extent it is somewhat surprising that ... maternal smoking may also directly impact child behaviors from exposing the fetus to tobacco in utero,” she tells WebMD. “This study suggests that adverse effects on offspring may extend as far as putting children at increased risk of having behavioral problems.” She says the investigators had “complete information” on mothers, fathers, and their children.
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Researchers: Secondhand Smoke Threatens Millions in Public HousingAmericans who live in public housing are exposed to secondhand smoke from their neighbors, according to researchers who demonstrated how smoke from one apartment unit can infiltrate into others. UPI reported June 19 that researchers Jonathan Winickoff of MassGeneral Hospital for Children and Michelle Mello of the Harvard School of Public Health stated, "Even if you are not a smoker and don't smoke inside of your own apartment, if you have a neighbor who is smoking inside of his, the entire building is contaminated." The U.S. Department of Housing and Urban Development has encouraged public-housing authorities (PHAs) to ban smoking in at least some units, but only about 4 percent have done so. "The use of federal regulatory or contractual mechanisms to ensure that PHAs implement no-smoking policies in public housing raises ethical concerns and practical challenges;" the authors concluded, "however, it is justified in light of the harms resulting from exposure to tobacco smoke, the lack of other avenues of legal redress for nonsmoking residents of public housing, and the languid pace at which PHAs have voluntarily implemented no-smoking policies." Smokers' rights groups slammed the report, saying a ban would infringe upon the freedoms of public-housing residents, the New York Times reported June 18. "He wants us to believe we're having an effect on people's health through air ducts?" said Audrey Silk of the group NYC-CLASH, Citizens Lobbying Against Smoker Harassment. "These people have an agenda -- a smoke-free society." The study appears in the June 17, 2010 issue of the New England Journal of Medicine.
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More Evidence that Secondhand Smoke Can KillPeople who breathe in a lot of other people's tobacco smoke are twice as likely to die from heart disease as those exposed to lower levels of "secondhand" smoke, a new study suggests. The findings add to the growing body of evidence linking secondhand smoke to cardiovascular disease, Dr. Steven Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, who was not involved with the study, told Reuters Health. In the study, Dr. Mark Hamer of University College London, UK, and colleagues used a saliva test that is able to measure the amount of secondhand smoke people have been exposed to. They gave this test to over 13,000 people in England and Scotland and then followed them for an average of 8 years, keeping track of who developed heart disease and who died. Over the course of the study, 32 out of about 1,500 people who had never smoked but were exposed to high levels of secondhand smoke died of heart disease, compared to 15 out of about 1,000 "never-smokers" with low exposure. In analyses restricted to never-smokers, high secondhand smoke exposure was associated with more than a two-fold increased risk of dying from heart disease. A "high" level of exposure, Hamer explained, would be equivalent to living with a smoker and getting exposed to secondhand smoke pretty much every day. About 1 in 5 of the people in the study had high exposure levels, according to the saliva test. People exposed to a lot of secondhand smoke, as well as smokers themselves, were younger and more likely to be male, worse off financially, and less physically active than people with low exposure. But even when controlling for these potentially confounding factors, the link between secondhand smoke exposure and heart disease remained. The study is published in the latest issue of the Journal of the American College of Cardiology. Hamer's team also found evidence, as have other research teams, that secondhand smoke triggers inflammation in the body, a known risk factor for heart disease. "Even though the biological mechanisms are not fully understood yet, there's growing evidence that indicates that exposure to fine particles (such as those in cigarette smoke)...results in this low to moderate inflammation," Dr. C. Arden Pope III, an economist and environmental epidemiologist at Brigham Young University in Provo, Utah, told Reuters Health. Pope, who was not involved in the study, said: "There's a fairly substantial literature now that indicates that secondhand smoke is associated with cardiovascular disease. This study...certainly contributes to our knowledge."
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Study: More Can Be Done to help Smokers QuitMany healthcare providers are quick to advise patients to quit smoking, but few follow up with programs, plans or prescriptions to help them break the habit, new research from UC Davis has found. In the most comprehensive national study of its kind, Elisa K. Tong of the Division of General Medicine at UC Davis, reported that health professionals in the United States do not fully follow national guidelines for working with patients who use tobacco products. Survey participants cited numerous barriers to compliance with the guidelines, including their own tobacco use, perceptions of patient attitudes about quitting, a lack of training in smoking-cessation interventions and a sense that it was not part of their professional responsibilities. The study appeared online this month in Nicotine & Tobacco Research, and will be published in the July issue of the journal. "This paper presents two important findings," said Steven A. Schroeder of the Division of General Internal Medicine and Smoking Cessation Leadership Center at the UC San Francisco, who contributed to the study. "First, although clinicians could play an important role in helping smokers quit, far too often they do not do so. Second, clinicians themselves have very low smoking rates. Even nurses, who were previously assumed to be heavy smokers, are substantially below the national average. If the entire country smoked at the rate of health professionals, the United States would be one of the healthiest nations in the world." Tong and colleagues surveyed seven groups of health professionals whom smokers are most likely to encounter: primary-care physicians, emergency-medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists and pharmacists. They set out to determine the respondents' smoking status and also to examine whether they perform the "5 A's" with patients: asking, advising, assessing, assisting and arranging follow-up about tobacco use. They found that 13 percent of registered nurses smoke, fewer than the national prevalence of 20 percent, but far more than other categories of health professionals. They also found that up to 99 percent of health professionals report that they ask patients and almost as many advise them about smoking risks. But far fewer help them get the help they need to quit. For example, among registered nurses, 87 percent reported asking if a patient smokes, and 65 percent said they advise smokers to quit. But only 25 percent of respondents reported assisting smokers to set a quit date. The low rate of assistance for patients was similar across the board, except among primary-care physicians, who reported assisting patients to set a quit date nearly 60 percent of the time. Tong said primary-care physicians have been the main focus for smoking-cessation efforts, but are insufficient to help most smokers quit. She cited evidence that non-physician health professionals can be effective and that being asked about smoking by more than one type of health professional can increase the odds of a patient quitting. "We know that provider advice is one of the simplest and most important things to help a smoker to try to quit and stay quit," said Tong. "Providers are not doing enough. It should be a priority for all health professionals, not just primary-care physicians." Tong noted, for example, that smoking prevalence among mental health patients is high and that emergency room physicians are often on the front line of health care, but neither group sufficiently follows the guidelines. Referring to telephone "quitlines" such as the national 1-800-QUIT NOW is one way all health professionals can improve in assisting smokers to quit. "Those are missed opportunities if they don't address tobacco use," she said.
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Secondhand Smoke and Mental HealthSmokers are known to suffer from high rates of depression and other mental health problems, and now a study reports that even people exposed to secondhand smoke are at significantly increased risk — and more likely to be hospitalized for mental illness. The study analyzed data from the Scottish Health Survey of 1998 and 2003, a periodic look at a nationally representative sample of about 5,560 nonsmoking adults and 2,595 smokers. The researchers used a 12-item questionnaire to assess mental health, including sleep problems and symptoms of depression and anxiety. Salivary levels of cotinine, a nicotine byproduct, were used to assess exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke were 1.5 times as likely to suffer from symptoms of psychological distress as unexposed nonsmokers, the study found, and the risk increases the greater their exposure to passive smoking. And though psychiatric hospitalizations were rare over all, the exposed nonsmokers were also almost three times as likely to have to be admitted to a psychiatric hospital, according to the study, published online June 7 in Archives of General Psychiatry. While the association between smoking and mental health problems has long been known, researchers have never been able to establish whether people with mental illness are more likely to pick up the cigarette habit, or whether smoking may actually help cause mental illness, said the paper’s lead author, Mark Hamer, a senior research fellow at University College London. “This research goes some way toward suggesting nicotine is having some sort of impact on mental health,” Dr. Hamer said. “But of course, we need to do further work.”
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Smoke-free Air Laws Effective at Protecting Children from Secondhand SmokeResearchers at the Harvard School of Public Health (HSPH) have found that children and adolescents living in non-smoking homes in counties with laws promoting smoke-free public places have significantly lower levels of a common biomarker of secondhand smoke exposure than those living in counties with no smoke-free laws. The children living in non-smoking homes in U.S. counties with smoke-free laws had 39 percent lower prevalence of cotinine in their blood, an indicator of tobacco smoke exposure, compared to those living in counties with no smoke-free laws. Children living in homes with smokers exhibited little or no benefit from the smoke-free laws. The study appears in the June 7, 2010 advance online edition of the journal Pediatrics. "The findings suggest that smoke-free laws are an effective strategy to protect both children and adults from exposure to secondhand smoke. In addition, interventions designed to reduce or prevent adults from smoking around children are needed," said Melanie Dove, who received her doctorate in environmental health at HSPH in 2010 and led the study. The HSPH researchers examined data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey designed to monitor the health and nutritional status of the U.S. population. They analyzed the cotinine levels in 11,486 nonsmoking youngsters, aged 3-19 years, from 117 counties, both with and without exposure to secondhand smoke in the home. In addition to a 39 percent lower prevalence of detectable cotinine, the researchers also found that children in non-smoking homes had 43 percent lower mean cotinine levels. Over the past decade the number of state and local smoke-free laws in the nation has grown significantly. For example, the number of smoke-free laws in workplaces, restaurants and bars in the U.S. has increased from 0 in 1988 to 175 in 2006. "These laws have been shown to reduce exposure to secondhand smoke among adults. Our results show a similar association in children and adolescents not living with a smoker in the home," said Gregory Connolly, senior author of the paper and director of the Tobacco Control Research Program at HSPH. Douglas Dockery, professor of environmental epidemiology and chair of the Department of Environmental Health, also was a study author. According to the 2006 Surgeon General's Report, there is no safe level of exposure to secondhand smoke. Children are particularly vulnerable to the toxic compounds in secondhand smoke because they have higher breathing rates and their lungs are still developing, the authors write. Exposure to secondhand smoke in children can irritate the lungs, resulting in coughing or wheezing, and can trigger an asthma attack in children with asthma. Secondhand smoke also has been associated with sudden infant death syndrome, respiratory illnesses and middle ear disease. For children, the home is the primary source of secondhand smoke exposure and most of the smoking is done by the parents. Potential exposure sources for children outside the home include cars, private child care centers, restaurants, shopping malls and parks. Approximately 20 percent of the youth in the HSPH study lived with a smoker in the home. These children had the highest cotinine levels and could benefit the most from an intervention to reduce exposure, regardless of smoke-free laws that might be in place, say the researchers. "One way to reduce or prevent adults from smoking around children is for physicians to counsel parents to stop smoking," said Connolly.
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Youth Risk Behavior Surveillance — United States, 2009The Centers for Disease Control and Prevention Division of Adolescent and School Health (DASH) has released the 2009 national, state, and local Youth Risk Behavior Survey (YRBS) data in an MMWR Surveillance Summary (http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf). The survey indicates that among U.S. high school students that:
YRBS monitors six categories of priority health-risk behaviors among high school students — behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and physical inactivity — plus the prevalence of asthma and obesity. This year’s Surveillance Summary includes results from the 2009 National YRBS and from 42 state and 20 local YRBSs.
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The Wisconsin Tobacco Quit Line's Fax to Quit Program: Participant Satisfaction and EffectivenessA recent study in the Wisconsin Medical Journal assessed the Wisconsin Tobacco Quit Line's (WTQL) clinic-based Fax to Quit (FTQ) provider referral program in terms of participant satisfaction and short-term quit outcomes, and to compare those findings to a non-FTQ provider referral group. A sample of 432 WTQL callers completed a telephone survey approximately 3 months after they received WTQL services. Of these, 265 contacted the WTQL based on a clinic referral and served as the basis for analyses. Of these 265, 158 FTQ respondents were compared to 107 non-FTQ respondents in terms of satisfaction with the WTQL as well as quit attempts and tobacco abstinence. Overall, survey respondents reported high levels of satisfaction with the WTQL (FTQ = 96.8 percent, non-FTQ = 92.7 percent). Other measures of satisfaction (cultural sensitivity, respondent needs and concerns understood) showed similarly high levels of respondent satisfaction for both groups. FTQ respondents reported a statistically significantly higher 30-day abstinence rate (46.8 percent) compared to non-FTQ respondents (32.7 percent). Participants expressed high levels of satisfaction with WTQL services and demonstrated high short-term quit rates. FTQ-referred WTQL users reported higher rates of tobacco cessation than non-FTQ-referred WTQL users. These findings suggest that fax referral has potential to successfully link smokers visiting primary care clinics to the WTQL, an evidence-based cessation option.
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Other Cessation NewsAmerican Lung Association Highlights Health Disparity in New Report on Tobacco Prevalence in Lesbian, Gay, Bisexual and Transgender (LGBT) CommunityThe American Lung Association's latest health disparity report, Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community, examines the trend of higher tobacco use among the lesbian, gay, bisexual and transgender (LGBT) community and the need for additional research specific to this community. Most state and national health surveys do not collect information on sexual orientation and gender identity; however, there are current data indicating the LGBT population smokes at a higher rate than the general public. Key facts regarding this disparity include the following:
"The American Lung Association issued Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community to raise awareness of this health disparity and address the need for additional research specific to the LGBT community and tobacco use," said Charles D. Connor, American Lung Association President and CEO. "Like other groups disproportionately affected by tobacco use, including African Americans and Native Americans, the LGBT population needs targeted efforts to reduce smoking rates, which will ultimately save lives." The Lung Association's report presents a compilation of research that examines possible contributing factors to the LGBT smoking rate including stress and discrimination related to homophobia, the tobacco industry's targeted marketing to LGBT consumers, and lack of access to culturally appropriate tobacco treatment programs. The American Lung Association is calling on the Centers for Disease Control and Prevention (CDC) and all state Departments of Health to include sexual orientation and gender identity questions in public health surveys. State and local tobacco control programs should work to ensure prevention and cessation programs, materials and staff are culturally competent and inclusive of the LGBT community. LGBT advocacy organizations should advocate for policies to promote tobacco prevention and cessation programs, and identify alternative funding sources to tobacco industry sponsorship. The Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community report is the American Lung Association's second report in a series taking an in-depth look at lung health disparities in specific populations. This report builds on the American Lung Association's long-standing commitment to saving lives and improving lung health for all Americans. For a compendium of information about lung disease in various populations, see the recently released State of Lung Disease in Diverse Communities: 2010 and Too Many Cases, Too Many Deaths: Lung Cancer in African Americans, available at www.LungUSA.org. To download Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community, visit http://www.lungusa.org/assets/documents/publications/lung-disease-data/lgbt-report.pdf.
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AAFP Recruiting Practices for Smoking Cessation PilotThe AAFP is recruiting 50 family medicine practices for a pilot project that will train "office champions" to implement system changes that encourage the integration of tobacco cessation activities in daily office routines. The program will educate these office champions through an online training module, live teleconferences and a practice manual. The office champions will be required to submit an implementation plan to the AAFP and track and report results. "I can say from experience that changing the system in which you practice can help improve care on a consistent basis," said Saria Carter Saccocio, M.D., of Rome, Ga., a member of the Academy's Tobacco Cessation Advisory Committee. Carter Saccocio, who is associate director of the Floyd Family Medicine Residency in Rome, said that implementing a similar tobacco cessation program improved her residency's quality of care by putting a bigger emphasis on the issue. "We used to occasionally ask patients if they smoked, or we might have asked if we smelled smoke on the patient," she said. "Now it's just a part of our practice. We ask every patient, and it goes on the chart." Office champions in the pilot project can be physicians, but they more likely will be practice administrators, nurses, physician assistants or other staff members. "Having an opportunity to have your team involved makes a difference," Carter Saccocio said. "It's not just the physician. When your whole team buys in to the system, you're more likely to be successful." The deadline for applications is Aug. 16. Additional information and applications are available online. Members with questions may contact AAFP tobacco control manager and project director Pamela Rodriguez by e-mail or by calling (800) 274-2237, Ext. 3135. Practices chosen to participate will be announced in September, with implementation and evaluation scheduled to take place from October through May 2011. Practices that complete the program will be reimbursed for administrative costs associated with the project. Participating practices also will receive a recognition kit that includes
Additionally, practices that complete the project will receive recognition
The project is supported by a $400,000 grant from Pfizer Inc.
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New York Cigarette Tax Increase Delivers Victory for Kids and Taxpayers, State Needs to Increase Funding for Tobacco Prevention and Cessation ProgramsGovernor David Paterson and the New York Legislature have taken historic action to protect the state's kids and taxpayers from the devastating toll of tobacco use by increasing the state cigarette tax by $1.60 to $4.35 per pack. This increase will give New York the highest cigarette tax in the nation and continues New York’s national leadership in the fight against tobacco use, the number one cause of preventable death in the United States. The state is also increasing the tax on other tobacco products and taking action to ensure that taxes are properly paid on cigarettes sold by Native American tribes to non-tribal members. Together, these actions will prevent kids from smoking and using other tobacco products, motivate smokers to quit, and save lives and health care dollars. However, the increase in the state tobacco tax makes it more important than ever that New York increase funding for tobacco prevention and cessation programs. The new cigarette tax increase will motivate more smokers to quit and seek help in doing so. The Legislature and Governor should ensure that smokers receive the help they need to quit successfully and kids are prevented from starting. The tobacco tax increase is a win-win-win solution for New York — a health win that will reduce tobacco use and save lives, a financial win that will help to balance the state budget and fund essential programs, and a political win that polls show is popular with the voters. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by about 6.5 percent and overall cigarette consumption by about four percent. New York can expect the $1.60 cigarette tax increase to prevent 170,500 New York kids from becoming smokers; spur 86,100 current adult smokers to quit; save 77,300 New York residents from premature, smoking-caused deaths; save $3.8 billion in future health care costs; and raise $210.3 million a year in new state revenue. In New York, tobacco annually claims 25,400 lives and costs the state $8.2 billion in health care bills. While New York has made significant progress in reducing smoking, 14.8 percent of New York high school students still smoke, and 85,000 kids try cigarettes for the first time each year. With New York's increase, the average state cigarette tax will be $1.45 per pack. New York is the sixth state to increase its cigarette tax this year, joining Utah ($1 increase), New Mexico (75 cents), Washington ($1), Hawai’i (40 cents) and South Carolina (50 cents).
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Navy Bans Tobacco Use on Its Submarine FleetThe smoking lamp is going out all across the Navy’s submarine fleet, where the mission to “run silent, run deep” now will be carried out by sailors ordered to run undersea operations without cigarettes, cigars or pipes. This is the latest front in the long war against tobacco declared by the Pentagon and the Department of Veterans Affairs. Their programs to help military personnel kick the smoking habit are intended to protect the health of the current force — and to save the government hundreds of millions of dollars a year in health care costs for those who have served, and smoked, in uniform. The Navy is cognizant that military service is stressful, especially in long and lonely deployments under the sea. Everybody is aware that smoking is a legal, if harmful, stress reliever. So the Navy banned smoking aboard submarines not with the stated purpose of curing the smokers, but of protecting nonsmoking submarine crew members from the threat of heart and lung disease from secondhand smoke. “Recent testing has proven that, despite our atmosphere purification technology, there are unacceptable levels of secondhand smoke in the atmosphere of a submerged submarine,” said Vice Adm. John J. Donnelly, commander of submarine forces. “The only way to eliminate risk to our nonsmoking sailors is to stop smoking aboard our submarines.” The Navy did not order its submariners to quit cold turkey. For the 5,000 sailors who admitted to being smokers among the submarine fleet’s 13,000 crew members — that is just shy of 40 percent — the ban goes into effect at the end of the year. In the meantime, a senior petty officer aboard each hunter-killer submarine and each nuclear ballistic missile boat will serve as a “smoking cessation coordinator,” helping sailors wean themselves off the habit through discipline — and a ready supply of nicotine gum, nicotine patches and other replacement therapies. There are no plans to impose a “smokeless Navy.” Aboard surface warships, smoking is allowed in specially designated — and open — areas. Across the Navy, those who wish to quit smoking can attend classroom programs. And in many Navy and Marine Corps locations, those wishing to quit can receive help from physicians, dentists and pharmacists during a health care visit. About one-third of all military personnel say they are smokers. While smoking is banned in basic training, more than a third of the current smokers across the armed services say they started after they went on active duty.
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World Heart Federation Calls On Cardiologists To Lead Fight Against Tobacco UseAt the World Congress of Cardiology (WCC) in Beijing, China, the World Heart Federation strongly urged cardiologists to ensure that patients and policymakers understand the devastating impact of tobacco on heart health, and called upon cardiologists to take action to reduce tobacco use and exposure. Cardiovascular disease is the leading global cause of death, accounting for 29 per cent of deaths worldwide. And, tobacco use is a major cause of cardiovascular disease. “Tobacco is among the world’s most important risk factors for cardiovascular disease and while many people know that tobacco use causes lung cancer and other respiratory diseases, fewer people know that it causes cardiovascular disease,” said Sidney C. Smith, Jr. M.D, President Elect, World Heart Federation. “Getting people with heart disease to stop smoking and avoid exposure to secondhand smoke improves outcomes as much or more than any single medical treatment that we can offer. We are strongly urging cardiologists to take action to reduce their patients’ and communities’ use of tobacco and to help them avoid the danger of exposure to secondhand smoke.” Specifically, the World Heart Federation calls upon cardiologists and other health care professionals to:
These and other points of action were articulated in the statement, Warning: Secondhand Smoke is Hazardous to Your Heart, which was launched at the WCC along with a film of the same name. The statement and film were developed by the Global Smokefree Partnership in a project involving the Roswell Park Cancer Centre, the United States Centres for Disease Control, the World Heart Federation and the World Lung Foundation, and made possible by funding from the Flight Attendant’s Medical Research Institute. Judith Mackay of the World Lung Foundation, long-time champion of tobacco control, underlined the importance of physicians providing role models for smoke-free lives. Highlighting the power of comprehensive tobacco control policy to improve global health, Haik Nikogosian, Head of the Secretariat of the World Health Organization (WHO) Framework Convention on Tobacco Control, the first international public health treaty, commented “The Framework Convention is a unique, novel legal instrument that offers a new dimension to international health cooperation. Now is the time to use it fully to reduce the toll of heart disease and the many other severe health consequences of tobacco use.”
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Oregon Requires Insurers to Offer Tobacco CessationOregon smokers who want to quit may find it a little easier due to some recent developments. For one, state legislators recently passed a new law that requires health insurance companies that do business in Oregon to provide a tobacco cessation benefit. “This is a great benefit,” said Dr. Charles Bentz, a Portland-based physician who advocated for passage of the new legislation. “It's great news for (smokers) that want to quit.” The Legislature passed the new law in June 2009. It took effect Jan. 1 of this year. But at the time, health insurance companies had already designed their benefit packages for 2010. Bentz recently visited The News-Review to raise awareness of the new law, particularly as health insurers are designing benefit packages for 2011. He was accompanied by Dianne Danowski Smith, who works for a Portland-based public relations firm that's helping Bentz spread the word about the new law. The legislation, known as Senate Bill 734, requires health insurers to include a tobacco cessation benefit of at least $500 in every benefit program they offer in Oregon. The minimum $500 benefit is per member per lifetime. The benefit includes coverage of over-the-counter therapies, oral medicines and counseling. It may be used by users of any tobacco product, from cigarettes to chewing tobacco to cigars. Bentz, who has been working as an internist in Oregon for 20 years, is enthusiastic about the requirement to offer health care coverage of cessation programs. “If you want to get smokers to quit smoking, you've got to cover it,” he said. Bentz said employers pay an extra $3,300 to $5,500 a year for employees who smoke compared to employees who don't. He said that includes the costs of added medical expenses, lost productivity and having to replace the employees due to early death. Although employers will pay more upfront to provide the required tobacco cessation benefit to employees, Bentz estimated they will recoup those costs within two years. The new state law is just one of many recent changes making it easier for smokers to kick the nicotine habit, Bentz and Smith said. As of Jan. 1, Oregon Health Plan beneficiaries no longer have to pay a co-pay to take advantage of OHP's tobacco cessation benefit. Recently, the federal Centers for Disease Control and Prevention awarded the Oregon Quit Line $661,000 to expand its services. Callers who call the Quit Line, at 800-Quit-Now, can receive information about tobacco cessation programs and even talk to a counselor. And an increasing number of places are going smoke-free, partly due to legislation that banned smoking in most restaurants and bars on Jan. 1, 2009.
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Cigarette Makers and Retailers Sue to Block Rule Requiring Antismoking PostersThe nation’s three big tobacco companies, and trade associations representing hundreds of New York City bodegas and convenience stores, are challenging the city’s latest salvo in the antismoking wars: graphic images of diseased brains, lungs and teeth that are posted where cigarettes are sold. The tobacco companies — Philip Morris, Lorillard and R. J. Reynolds — joined with the New York State Association of Convenience Stores and retailers in filing a federal lawsuit against the city in an effort to remove the gruesome placards from about 11,500 establishments. Since late last year, the city has required the retailers to post them within three inches of cash registers or in each place where tobacco products are displayed. The suit contends that the placard rule infringes on the federal government’s authority to regulate cigarette advertising and warnings and violates the First Amendment rights of store owners who disagree with their message, and that the placards are so disgusting that they hurt business by discouraging people from buying not only cigarettes but also more-wholesome merchandise like milk and sandwiches. “This is not the city taking out a billboard, which it would have every right to do,” Floyd Abrams, a First Amendment lawyer who is representing the convenience stores, said. “What it doesn’t have the right to do is to force other people to adopt its expression.” The suit also complains that because of heavy restrictions on cigarette advertising, advertising space near the cash register is one of the last places where companies can promote their brands. By putting ugly posters there instead, the suit says, the city is blocking tobacco companies from communicating with consumers, depriving retailers of coveted advertising revenue and pushing restrictions on tobacco-related speech “past the constitutional tipping point.” In a statement, the city’s health department said that putting warnings where cigarettes were sold was one of the most effective ways to deter people from smoking and to discourage a new generation of smokers. “By trying to suppress this educational campaign,” the statement said, “the tobacco industry is signaling its desire to keep kids in the dark.” The city has spent $80,000 to print and distribute the signs in the eight months since the law was adopted. They are based on research that shows pictures are much more effective at conveying the hazards of smoking than written text, according to the health department.
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A Decade of Experience Promoting the Clinical Treatment of Tobacco Dependence in WisconsinThe University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) is the designated lead agency at the University of Wisconsin-Madison charged with the responsibility of reducing the harms from tobacco use in Wisconsin and beyond. In 2000, the UW-CTRI, with funding from the state of Wisconsin, launched a population-wide effort--the Wisconsin Cessation Outreach Program--to increase the availability and use of evidence-based clinical treatments for tobacco dependence. A recent paper in the Wisconsin Medical Journal describes the program's strategies, outcomes, and impact on the clinical treatment of tobacco dependence in Wisconsin. The program was designed to change the standard of health care in Wisconsin, so that primary care professionals, and the health systems in which they work, universally identified and intervened with tobacco users. Five primary strategies were used to accomplish its goal:
In the 10 years since the program was initiated, progress has been achieved in a number of tobacco use parameters in Wisconsin, including higher rates of Wisconsin smokers making a quit attempt; increased insurance coverage for cessation counseling and medications; higher rates of discussion of cessation treatment options by clinicians; and integration of the Wisconsin Tobacco Quit Line (WTQL) into routine primary care, with almost 100,000 Wisconsin smokers using the WTQL. Nearly half of all WTQL callers were uninsured or Medicaid enrollees. Additionally, smoking rates in Wisconsin have fallen by almost 20 percent during this period, from about 24 percent of all adults in 2000 to less than 20 percent today.
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