May 2011

Spotlight

Physician Advice May Improve Teen Smoking Behavior

A recent study in Pediatrics reveals that physicians represent an important and effective line of defense against youth and teen smoking.

Previous research has shown the significant role physician advice can play in impacting adult smoking behavior. In fact, brief physician advice to quit smoking has been shown to increase adult cessation rates 1 to 3 percent more than unassisted quitting rates. Moreover, annual physician advice has preventive cost savings.

Given the success of physician communication among adult smokers, however, little research has explored the potential benefits of physician advice against smoking among adolescents. The study, conducted by Ashley M. Hum and researchers from the University of Memphis, is the first of its kind to address this gap by examining the relationship between physician communications regarding smoking and a spectrum of tobacco-related variables in adolescent, including expectations about social reinforcement from smoking, knowledge of the effects of smoking, intentions to smoke, tobacco use, intentions to quit, attempts to quit, and success in quitting.

The study included a cohort of 5,145 adolescents from a mid-South school system. Investigators found that physician advice was related to a range of healthier attitudes, believes, and behaviors among adolescents. Moreover, data from the study suggests that physician communication can help smokers and well as non-smokers. For example, regardless of smoking status, teenagers who reported conversations with physicians about tobacco were less likely to believe that smoking would improve their social standing. Furthermore, a combination of physician advice and screening was correlated with improved knowledge of tobacco-related dangers and negative health consequences. Teens who were screened by their physician also reported significantly more quit attempts than those who were not screened or advised.

Even for smokers, teenagers who discussed their smoking behavior with their physician resulted in decreased intention to smoke in five years and a greater likelihood to quit smoking in six months.

"Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors," wrote the authors. "Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease."

Based on findings from this study, physician interaction and communication seemed to positively impact adolescent attitudes, knowledge, intentions to smoke, and quitting behaviors. Results suggest that both screening and advice produce more benefit than no intervention or screening alone.

Brief physician communication and screening have the potential to be a key intervention in the cessation and reduction of smoking among adolescents and teens. Still, additional research is needed to further explore ways in which physicians may combat tobacco use among adolescents and to prevent the onset of smoking.

To find the full report click here.

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Research Highlights

Why Some Smokers Have a Harder Time Quitting

Quitting smoking is never easy, but some smokers have an even harder time kicking the habit, and now new research suggests that they may derive more pleasure form nicotine.

The new study, which appears in the Proceedings of the National Academy of Sciences, may also help foster the development of more effective quitting strategies for certain smokers.

Researchers used PET scans to capture images of the number of “mu-opioid receptors” in the brains of smokers. Smokers with greater numbers of these receptors seem to derive more pleasure from nicotine, and as a result may have a harder time quitting.

“The brain’s opioid system plays a role in smoking rewards, and quitting smoking and some of the variability in our ability to quit among smokers is attributable to genetic factors,” says study researcher Caryn Lerman, PhD, director of Tobacco Use Research Center at the University of Pennsylvania in Philadelphia.

“The ability to quit smoking is influenced by a number of psychological, social, and environmental factors, but also genetic factors,” she says. “For some people, genetic variations may make it more difficult to quit than for someone else who smokes the same amount for same amount of time,” Lerman says.

The study findings are more applicable to quitting smoking than becoming addicted in the first place, she says.

New Quitting Strategies/Tools Needed

There may be a role for personalized medicine when it comes to smoking cessation, Lerman says. Personalized medicine takes the trial and error out of matching treatments by making decisions based on genetic profiles.

“Based on a person's genetic background, we can select the optimal treatment,” she says. “It is a two-pronged approach of developing new medications and being able to make the best choice for a particular person based on existing options."

Importantly, even diehard smokers should not take these findings to mean they can’t quit, she says.

“Don’t become fatalistic,” she says. “You may need particular approaches tailored to you,” she says. Going forward, “we hope to study this pathway in more detail to understand whether examining genetic background and the numbers of brain receptors can help us choose the right treatments for the right individual.”

Raymond S. Niaura, PhD, an associate director for science at the Schroeder Institute of the American Legacy Foundation, an antismoking group based in Washington, D.C., says that “there are genetic influences involved in becoming addicted to nicotine and tobacco and on how hard it is to quit smoking.”

The new findings provide “a peek into the genetic and underlying brain processes responsible for nicotine addiction,” he says.

People with this particular genetic variation may benefit from extended treatment, he says. “They may have a certain kind of sensitivity to nicotine, which could explain why they became addicted in the first place and why they may need to use nicotine replacement for a longer time than others.”

Daniel Seidman, PhD, assistant clinical professor of medical psychology and the director of Smoking Cessation Services at Columbia University Medical Center in New York City, agrees.“There are a lot of smokers and everybody gets lumped together, but there are a lot of patterns like with other types of addiction.”

This paper “points to a biological or genetic substrate which predisposes some people to have a hard time,” he says. Quitting smoking can be emotionally charged, he says. Symptoms typically include irritability, anger, and sad mood. “Some people are able to rally more and some may not bounce back as well because they have a harder time finding alternative sources of pleasure,” he says.

Agreeing with Niaura, Seidman says that some smokers seem to need nicotine replacement for longer periods of time. “When they come off nicotine patches or gum, it doesn’t feel right and it may be related to this subtype,” he says. “This is not a problem because nicotine replacement doesn’t cause cancer or go into your lungs.”

For more information, see web link:
WebMD May 16, 2011

Stillbirths Tied to Secondhand Smoke: Study

Pregnant women who live or work with smokers may be at slightly higher risk of having a stillbirth, suggests a study that adds to evidence that even secondhand smoke can harm unborn babies.

Newborns also weighed a little less and had smaller heads if their mothers were passive smokers, Canadian researchers found.

"This information is important for women, their families and healthcare providers," Dr. Joan Crane of Eastern Health in St. John's and colleagues write in the BJOG: An International Journal of Obstetrics and Gynecology.

Secondhand smoke is thought to expose people to about one percent of the smoke that active smokers inhale. According to the researchers, "undiluted side-stream smoke contains many harmful chemicals and in greater concentration than cigarette smoke inhaled through a filter."

Those chemicals may harm the fetus in a variety of ways, for instance by restricting blood flow and possibly damaging the placenta.

Little is known about the risk of stillbirth in passive smokers, so Crane and her colleagues used a database of pregnant women from the Canadian provinces of Newfoundland and Labrador to shed light on the question.

They also looked at other birth outcomes, such as head circumference, which has been linked to kids' intellectual development.

Of nearly 12,000 women in the database, 11 percent said they had been exposed to secondhand smoke.

The rate of stillbirth, in which the baby dies during the third trimester of pregnancy, was 0.83 percent in passive smokers and 0.37 percent in women who didn't breathe tobacco fumes.

That does not prove that smoke itself was the culprit, because other risk factors might be different between the two groups.

Yet when the researchers accounted for several of those, including age and the women's drinking and drug habits, passive smokers had more than three times the odds of stillbirth.

In other words, if smoke is indeed to blame, one extra baby would die in the womb for every 117 women exposed.

"This is huge," said Dr. Hamisu Salihu, an expert on stillbirth at the University of South Florida in Tampa. "We can now inform patients that exposure to secondhand smoke means they can lose their baby."

That link had not been firmly established until now, Salihu, who was not involved in the work, told Reuters Health.

On a global scale, the most common causes of stillbirth are complications during childbirth, infections like syphilis during pregnancy, health problems like high blood pressure or diabetes, fetal growth restriction -- in which babies fail to grow at the proper rate -- and birth defects.

Most miscarriages, on the other hand, happen in the first trimester and most are believed to be due to random genetic abnormalities.

Still, certain lifestyle habits have been tied to a higher risk of miscarriage, including heavy drinking, drug use and, in some studies, smoking.

The Canadian researchers also found that babies born to passive smokers weighed 54 grams, or nearly 2 ounces, less than babies whose mothers lived and worked in smoke-free households.

And their heads were slightly smaller, too, measuring 0.24 centimeters (about 0.1 inch) less on average.

Salihu said head circumference has been associated with IQ, although the link is indirect. "Policy makers should really take this matter seriously," he concluded. "We need to enact laws to protect these babies."

For more information, see web link:
Reuters Health April 29, 2011

Positive Health Messages Can Help African-Americans to Quit Smoking

While African-American smokers are less likely to receive quitting advice from their doctors or use quit aids, media campaigns that offer positive encouragement can have an impact on getting them to quit, finds a new study.

Past research has shown that mass media smoking cessation campaigns have been less effective among African-American and Hispanic smokers as well as those in low income groups compared to smokers who are better off — despite the fact that this group is most in need of help.

"It was absolutely critical that we develop a campaign that would resonate with lower education and lower income smokers," said lead author Donna Vallone of the American Legacy Foundation, in Washington. "These individuals not only smoke at higher rates and quit at lower rates, they also have worse long term outcomes from tobacco-related disease."

In the study, appearing in the American Journal of Health Promotion, Vallone and her colleagues surveyed 4,067 current adult smokers before and six months after the launch of the national "EX campaign" in August 2008. The EX ads featured diverse characters and were promoted on television, the Internet and radio. The tone of the message was sympathetic and encouraged smokers to "relearn" life without cigarettes.

"There is some evidence to suggest that health communication messages which use positive frames may be more effective among African-American audiences," Vallone said. "The EX message could certainly be characterized as positive."

Results showed African-Americans who were aware of the EX campaign had a threefold increase in making a quit attempt during the campaign period. Participants with less than a high school education doubled their odds of trying to quit.

Alonza Robertson, chief strategist for Consigliere Emerging Media in New York, agreed positive health messages have more impact on changing minorities' behavior.

"In aiming messages at minority communities, the campaign must all be respectful of language, cultural beliefs, and literacy levels," he said. "And to influence behavioral change and outcome, it's better to focus on influencing the consumer's future about what he can do than criticizing and marginalizing about what he cannot."

For more information, see web link:
News Medical April 30, 2011

Some Social Smokers Find It Difficult To Quit

Self-identified "social smokers" may be considered a high-risk group with particular challenges for cessation, reports a national study from the American Journal of Public Health.

Researchers compared the association between three different definitions of social smoking - a common pattern among young adults - and cessation indicators. The three different definitions of social smoking they used included: (1) self-identified; (2) smoking mainly with others; or (3) smoking only with others. They used a Web-enabled, cross-sectional national survey of 1,528 young adults between the ages of 18 and 25 from a panel maintained by the research group.

The total sample was ethnically diverse, with 61 percent identifying themselves as White American, 13.9 percent as African American, 18.3 percent as Hispanic American, 3.9 percent as other non-Hispanic and 3 percent as biracial Hispanic. The sample was equally distributed between men and women. Researchers found that self-identified social smokers were less likely to have cessation intentions; whereas behavior social smokers (mainly or only smoked with others) were more likely than self-identified social smokers to have cessation intentions or attempts.

The study's authors suggest, "Smoking cessation in young adults - particularly among social smokers - is both a challenge and an opportunity. ...Clinicians and researchers need to address the differences between self-identification and behavior as a social smoker to develop more effective smoking cessation strategies tailored to these two distinct groups."

For more information, see web link:
Medical News Today May 12, 2011

How Secondhand Smoke Affects the Brain

Secondhand smoke has a direct, measurable impact on the brain similar to what’s seen in the person doing the smoking, according to a new study. The finding highlights the importance of limiting exposure to secondhand smoke in cars and other enclosed spaces.

Tobacco is the leading cause of preventable death nationwide. People who smoke are up to 6 times more likely than non-smokers to suffer a heart attack. Tobacco is also one of the strongest cancer-causing agents. Up to 90 percent of lung cancer deaths are attributed to smoking.

But the smoker is not the only one harmed by cigarette smoke. According to the U.S. Centers for Disease Control and Prevention, almost 50,000 deaths per year can be attributed to secondhand smoke. A Surgeon General’s Report in 2006 concluded that secondhand smoke causes heart disease and lung cancer in nonsmoking adults. It also causes serious health conditions in children, including sudden infant death syndrome, respiratory infections and more severe asthma.

Previous research has shown that exposure to secondhand smoke increases the likelihood that children will become teenage smokers and makes it more difficult for adult smokers to quit. Laboratory studies give some insight into the mechanisms at work. Nicotine, a chemical found in all tobacco products, is addictive. Long-term exposure to cigarette smoke leads to nicotine dependence in rats and an increase in nicotinic acetylcholine receptors (nAChRs) in the brain.

A team led by Dr. Arthur Brody of the University of California, Los Angeles, set out to study how secondhand smoke affects the human brain. They used an imaging technique to visualize when nicotine occupies brain nAChRs. The method depends on a special tracer molecule that binds specifically to nAChRs and can be detected by positron emission tomography (PET). Nicotine displaces the tracer molecule at the receptor, so the more nicotine that binds to nAChRs, the lower the tracer signals.

The scientists recruited 24 young adult participants—11 moderately dependent cigarette smokers and 13 nonsmokers. The participants were given the tracer molecule and then asked to sit in the passenger’s seat of a car for 1 hour. They did this twice, a week apart. In one session, they were exposed to moderate secondhand smoke; in the other they weren’t. Afterward, they underwent PET scans. The study, which was partly funded by NIH’s National Institute on Drug Abuse (NIDA), appeared online in Archives of General Psychiatry.

The researchers found that about 1 in 5 nAChRs in the brains of both smokers and non-smokers became occupied by nicotine after 1 hour of exposure to secondhand smoke. The smokers also had a significant increase in craving following exposure to secondhand smoke.

“These results show that even limited secondhand smoke exposure delivers enough nicotine to the brain to alter its function,” says NIDA Director Dr. Nora D. Volkow. “Chronic or severe exposure could result in even higher brain nicotine levels, which may explain why secondhand smoke exposure increases vulnerability to nicotine addiction.”

“This study gives concrete evidence to support policies that ban smoking in public places, particularly enclosed spaces and around children,” Brody says.

For more information, see web link:
NIH May 16, 2011

Smokers Have Slimmer Odds of Surviving Colon Cancer

Smokers aren't just more likely to develop colon cancer than non-smokers, they might also be at higher risk of dying from the disease, a new study suggests.

The results, reported in the journal Cancer, show that smokers were 30 percent more likely to die of colon cancer during the study and 50 percent more likely to die of any cause than their smoke-free peers.

Former smokers also had worse survival odds than non-smokers, but had a better outlook than current smokers.

"If you needed another reason not to smoke, or to quit smoking, this is as good a reason as any," said lead researcher Amanda Phipps, of the Fred Hutchinson Cancer Research Center in Seattle.

The findings are based on 2,264 people diagnosed with colon cancer sometime between 1998 and 2007. They were interviewed about their pre-cancer smoking and drinking habits, and the researchers followed their rates of death into 2010.

Of 920 non-smokers, 22 percent died of colon cancer during the study. That compared with 30 percent of those who were current smokers around the time of their cancer diagnosis, and 25 percent of former smokers.

When Phipps and her colleagues accounted for other factors -- like patients' age, education and whether they'd gotten routine colon cancer screening -- current smokers were still 30 percent more likely than non-smokers to die of the disease.

Former smokers were 14 percent more likely to die of colon cancer.

The findings, according to Phipps, once again underscore the importance of kicking the smoking habit, and preferably never picking it up. Whether quitting after a diagnosis helps extend colon cancer patients' lives is unclear.

Still, Phipps said, since smoking is related to a range of health problems, including heart and lung disease, "there is always a reason to quit."

In the U.S., it's estimated that 1 in 20 adults will develop colon cancer in their lifetime. Studies have suggested that together, current and former smokers have a 20-percent greater risk of developing the cancer than lifelong non-smokers.

For more information, see web link:
Fox News May 20, 2011

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Other Cessation News

New York City Outdoor Smoking Ban Begins

Smokers in New York City looking to light up in most public places will not be able to without paying a price after an outdoor citywide smoking ban takes effect.

The law, which Mayor Michael Bloomberg signed in February after it was passed by the New York City Council, will make smoking illegal in New York City's 1,700 parks and on the city's 14 miles of public beaches. Smoking will also be prohibited in pedestrian plazas like Times Square.

The ban is designed to help curb exposure to secondhand smoke as well as reduce litter.

Secondhand smoke causes close to 50,000 deaths per year, and side effects may include lung cancer, respiratory infections and asthma, according to the American Lung Association's website. Cigarette butts account for 75 percent of the litter found on New York City beaches, according to a news release from Bloomberg's office.

"Smoking in parks and beaches not only harms people trying to enjoy these recreational facilities, it also causes a litter problem that harms the beauty of our parks," Bloomberg said before he signed the bill into law.

New York City follows in the footsteps of 105 municipalities (in states including California, Hawaii, Massachusetts and New Jersey) that have banned smoking on public beaches, according to data from the advocacy group Americans for Nonsmokers' Rights. Major cities include Los Angeles, Minneapolis, and Seattle.

In states including California, Texas, Illinois, Minnesota and New Jersey, 507 municipalities impose laws that prohibit city parks, or specifically named city parks, to allow smoking. Major cities include Los Angeles, San Francisco, and Salt Lake City.

Puerto Rico prohibits smoking in all parks and beaches.

"These smoke-free laws start at a local level," said Cynthia Hallett, executive director of Americans for Nonsmokers' Rights. "They are based on community demand, science looking at exposure to secondhand smoke and the environmental impact."

Thirty-five states have laws in effect that require 100 percent smoke-free non-hospitality workplaces, restaurants or bars, according to the American Nonsmokers' Rights Foundation's "Summary of 100% Smokefree State Laws and Population Protected by 100% U.S. Smokefree Laws" compiled in April 2011.

In all, 79.4 percent of the country's population is covered by local and state laws banning smoking.

Hallett added that the trend to ban smoking is working from the inside out, starting in the indoor workplace, moving to restaurants with patios and then eventually to the great outdoors.

Not all New Yorkers are embracing the ban. New York City C.L.A.S.H. (Citizens Lobbying Against Smoker Harassment), a grassroots organization, is staging a "smoke in the park" at a city beach to demonstrate "that this law will be paid the respect it deserves," according to its website.

The ban will be enforced by the city's parks department, and if violators are caught, they could be fined $50.

New York City passed its first Smoke Free Air Act in 1988, when smoking was banned in public restrooms and taxicabs. Since then, the law has been amended three times, most notably in 2002, when smoking in some indoor areas -- including restaurants and bars -- was banned.

For more information, see web link:
CNN May 24, 2011

Quest for Vaccines to Treat Addiction

Frustrated by the high relapse rate of traditional addiction treatments, scientists are working on a strategy that recruits the body's own defenses to help addicts kick drug habits.

The new approach uses injected vaccines to block some addictive substances from reaching the brain. If a vaccinated addict on the path to recovery slips and indulges in a drug, such as tobacco or cocaine, no pleasure will result.

"You still have to mentally say to yourself, 'I'm not going to do this,' but it's so much easier to say it when you know if you light a cigarette, you're not going to get any pleasure out of it," says Stephen Ballou, a 56-year-old banker who got a nicotine vaccine in a 2007 clinical trial to help kick his pack-a-day habit. He says he hasn't smoked since.

Some medications currently available to treat addictions typically work by mimicking a drug in the brain. For example, methadone stands in for heroin and the nicotine patch for cigarettes. Other medications block activity in the brain's reward system. Alkermes Inc.'s once-monthly Vivitrol injection does this for alcoholics and opioid addicts, while Pfizer Inc.'s Chantix pills block the brain's pleasure receptors activated when people smoke.

Small-molecule drugs like Chantix that function inside the brain can raise safety concerns. Chantix carries a federally mandated warning to users of possible depression and suicidal thoughts. A spokesman for Pfizer notes that no causal link between Chantix and such symptoms has been made.

By contrast, addiction-treatment vaccines work in the bloodstream, not the brain. Clinical trials have so far revealed no significant side effects, though the vaccines would do nothing to combat cravings. They work by tricking the body to reject drugs as if they are foreign pathogens. Normally, tiny drug molecules wend their way through the bloodstream to the brain, unleashing a flood of chemicals involved with pleasure and gratification. The drug molecules are too small to goad the immune system into generating antibodies to fight them off.

Scientists have figured out how to attach molecules similar to addictive drugs to much bigger antigens, such as deactivated versions of cholera or the common cold. When injected, these so-called conjugate vaccines spur the immune system to create antibodies to fight the tiny, addictive-drug molecules. These antibodies have in several studies glommed on to molecules of nicotine, cocaine and heroin ingested by lab animals and in some cases people, blocking them from triggering the pleasure centers in the brain.

"The antibody is like a sponge," says Kim Janda, a professor of chemistry and immunology at the Scripps Research Institute in La Jolla, Calif. "The drug comes in and it's soaked up, and you try to soak up as much as you can before it crosses the blood-brain barrier."

It could be years, if ever, before any vaccines to treat addiction reach the market. Failures have so far outnumbered successes, and big pharmaceutical companies have not lent their research muscle to vaccines for illegal drugs.

"These vaccines have the potential to transform the way we treat drug addiction, but there are challenges," says Nora Volkow, the director of the National Institute on Drug Abuse.

A small Swedish firm, Independent Pharmaceutica AB, put its development of a nicotine vaccine on hold a year ago after it failed to outperform a placebo in trial. Convinced the concept of a nicotine vaccine remains sound, the company is now considering improvements to how the drug is delivered, says Lena Degling Wikingsson, a consultant and the company's former chief executive.

Another quit-smoking vaccine from Switzerland's Cytos Biotechnology—which has a licensing agreement with Novartis AG—failed to meet its endpoint in a 2009 trial. Work on that drug continues, however, with a new trial funded by the National Institutes of Health at Duke University in collaboration with Wake Forest University to test the vaccine in 65 smokers, Novartis says.

Stephen Evans-Freke, managing general partner of Bermuda-based private-equity firm Celtic Pharma Management, said a 2007 trial of a nicotine vaccine it owns "failed totally" because of a manufacturing error. He said the company could turn back to study the nicotine vaccine if a trial currently underway of the firm's TA-CD cocaine vaccine proves successful.

A vaccine isn't viable for treating alcoholism—among the costliest of addictions—because alcohol molecules are far too small to trigger the immune system, says Thomas Kosten, a pioneer of addiction-vaccine research at Baylor College of Medicine in Houston.

Most commercial vaccine-development efforts are focused on tobacco. Slightly more than a fifth of U.S. adults light up regularly.

Nearly half of U.S. smokers try to quit each year, but just 4 percent to 7 percent of quit attempts—most of them unaided—are successful long-term, according to American Lung Association estimates.

Just one out of three people trying to quit—at best—ends up kicking the habit for good, even with cessation aids, says Norman Edelman, the Association's chief medical officer and a professor of medicine at New York's Stony Brook University.

Nabi Biopharmaceuticals, a Rockville, Md., biotechnology company, is farthest down the path toward possible regulatory approval for an addiction vaccine, with two Phase III trials underway in several U.S. sites of its NicVAX product to help people quit smoking.

"The relapse is the biggest thing," says Raafat Fahim, the company's chief executive. "With antibodies staying a long period of time with you, it then protects you against the relapses."

Nabi in 2009 got a $10 million grant from NIDA, and sealed a licensing pact with the U.K.'s GlaxoSmithKline PLC that, including a $40 million up-front payment, could be worth up to $500 million, plus possible royalty payments.

Nabi's Phase II trial—the one Mr. Ballou participated in—found that smokers taking NicVAX were about three times as likely to be off cigarettes 44 weeks after vaccination than subjects given a placebo, Dr. Fahim says. That test was very small, and the results weren't as good as Pfizer got from a much larger Phase III trial of Chantix, he says. Subjects in Nabi's Phase III trial will get an extra dosage of NicVax compared to those in the Phase II trial.

One of the possible advantages of a vaccine, which would likely be used alongside psychological therapy and possibly other medications, is that it could require a once-a-month injection, as opposed to current anti-addiction medications that sometimes need to be taken several times a day.

"It's a lot easier to take a couple of vaccinations than to put on a patch every day, or keep chewing that nicotine gum, or doing whatever measures you're taking," says Phil Skolnick, director of the division of pharmacotherapies and medical consequences of drug abuse at NIDA.

Recent results from a test of an anticocaine vaccine in mice at Weill Cornell Medical College in New York were encouraging, researchers say.

"We give intravenous dosages of cocaine that's in excess of what humans take and it's like water to the mice" that have received the vaccine, says Ronald Crystal, the study's lead investigator and the chairman of genetic medicine at Weill Cornell. "They don't run around and get hyperactive." The researchers are now studying the vaccine in non-human primates.

Meanwhile, Dr. Kosten continues work on the TA-CD cocaine vaccine with a 300-subject, randomized, multi-site trial. Dr. Kosten says he hopes to report on the outcome of this trial sometime next year.

For more information, see web link:
The Wall Street Journal May 3, 2011

New Special Journal Issue Underscores Need to Increase Access and Exposure to Tobacco Interventions Among Minorities and Low Socioeconomic Groups

New research published today as a special issue in the American Journal of Health Promotion shows that population-based approaches to smoking cessation – mass media campaigns and smoking quitlines – can positively impact quitting behaviors among racial/ethnic minority and low socioeconomic status (SES) smokers, with varying effects across these groups.

The special issue, "Tobacco Control Among Diverse Populations," includes 15 papers that provide insight into how to effectively reduce tobacco's impact on diverse populations who are disproportionately affected by tobacco use, a topic about which little is known. In this special issue, researchers looked at the use and efficacy of various evidence-based interventions among diverse populations, including African Americans and Hispanics.

"We still have a lot to learn about how to reduce tobacco's impact on diverse populations in the United States. This research serves to identify ways in which public health can successfully reach out to racial/ethnic minorities and low SES populations who are more burdened with smoking-related diseases and death," said Pebbles Fagan, Ph.D., M.P.H., Health Scientist, Tobacco Control Research Branch, National Cancer Institute.

Socioeconomic differences, historical factors, and cultural practices, as well as aggressive marketing by the tobacco industry, have all contributed to a higher rate of tobacco use and related disease in certain populations. For example, African Americans experience higher rates of lung cancer although they tend to smoke fewer cigarettes per day than other groups. Those with less than a high school education have higher smoking rates and lower quit rates than smokers with a high school degree or higher.

One study from the special journal issue confirms that exposure to Legacy's national cessation campaign, EX®, increased cessation-related attitudes among Hispanics and smokers with less than a high school education. Furthermore, exposure toEX was associated with increased quit attempts among African Americans and smokers with less than a high school education.

The data indicates that mass media campaigns, when designed for racial/ethnic minorities and low SES groups, can help facilitate quitting. "The data are extremely useful for planning national cessation campaigns like EX, as well as other population-based tobacco interventions. We want to be sure we can reach as many smokers as possible with evidence-based methods, especially those who are most at risk for tobacco-related health consequences," said Donna Vallone, Ph.D., M.P.H., Senior Vice President for Research and Evaluation at Legacy.

The special issue also includes a study that examines 18 years of data from the California Smokers' Helpline, which finds that African American adult smokers had higher quitline utilization rates as compared to White adult smokers in California. "Telephone counseling is free and convenient, provides a degree of anonymity for participants, and can encourage program utilization among those who would not normally seek help", said Shu Hong Zhu, Ph.D., Professor, Department of Family and Prevention Medicine, University of California, San Diego. This study also found that compared to Whites, African Americans who called the quitline reported higher rates of awareness of the quitline from mass media campaigns.

"The papers in this special issue further reinforce the importance of appreciating within group as well as between group differences in smoking and cessation patterns. For example, Asian and Hispanic American ethnic groups have unique smoking and quitting patterns based on country of origin and acculturation. Accounting for within group differences can better inform future prevention and cessation efforts in sociodemographic and cultural subgroups," said Kenneth Resnicow, Ph.D., Professor, University of Michigan School of Public Health.

"It is in the best interest of public health to be able to target communities in an effort to effectively reduce disparities in access to tobacco prevention and cessation services. This special supplement underscores the need to provide accessible tobacco prevention and cessation services, including exposure to anti-tobacco mass media, to diverse populations," said Cheryl G. Healton, Dr.P.H., President and CEO at Legacy.

For more information, see web link:
PRNewswire May 2, 2011

Asian Group Joins Effort to Fight Smoking in Chicago

A Chicago-based health and social service agency that works with the city's Asian community plans to announce a new effort to get more Asians to stop smoking.

Asian Human Services has implemented smoking-cessation workshops to counsel those trying to quit and has launched a media campaign to teach young people to identify tobacco marketing in stores, said Abha Pandya, the agency's chief executive officer.

"A lot of young people and women are being targeted in advertisements and overt kinds of outreach toward them, which is very worrying," Pandya said. "This is an effort that we hope can have some impact."

Asian Human Services' initiative is part of a two-year, $11.5 million Chicago Tobacco Prevention Project, a cooperative initiative between the Chicago Department of Public Health and the Respiratory Health Association of Metropolitan Chicago to bring down the smoking rate in Chicago. Funding for the project was provided by a grant from the federal Centers for Disease Control and Prevention.

“Chicago has some of the higher smoking rates," said Joel Africk, president of the Respiratory Health Association. "We believe that by addressing the needs of those particular populations, you can bring down the overall smoking rate in the city."

Part of that approach includes a more focused attempt at conveying the smoking cessation message within more ethnically concentrated neighborhoods, said Harold Wimmer, president of the American Lung Association in Illinois — Greater Chicago.

"One of the challenges that we're trying to meet is to make sure that we're sending the right messages and getting the right information to these cultures," Wimmer said.

Nationally, the overall smoking rate among Asian-Americans remained low when compared with the national average and with other ethnic groups.

According to 2009 figures from the Centers for Disease Control and Prevention, about 12 percent of Asian-American adults smoked, while the U.S. average was about 20 percent. The rate was 21.3 percent among African-Americans, 14.5 percent for Hispanics, 22.1 percent for whites and 23.2 percent for Native Americans.

In Illinois, Wimmer said, the smoking rate among Asian-American adults was around 18 percent, slightly below the state average of 21 percent.

But overall figures do not tell the whole story because smoking rates have remained high among certain Asian subgroups, said Jing Zhang, community health program director for Asian Human Services.

"In some subgroups, tobacco use is a very serious problem, such as (among) the Vietnamese, Chinese, Cambodian, as well as Korean," Zhang said.

Such trends, Wimmer said, were why the American Lung Association expanded its services to offer translations in 92 languages for those seeking counseling on how to quit.

The American Lung Association runs the Illinois Department of Public Health's Illinois Tobacco Quitline.

Despite such resources, Africk said, the challenge remains to convey the stop-smoking message in areas with the most need, a challenge he said agencies such as Asian Human Services can help overcome.

"Respiratory Health Association knows how to help people quit smoking," Africk said. "Some of these groups know much better how to deal with their substance-abuse populations. By giving them a grant, they already have the knowledge of how to deal with that community, and we can kind of tailor our approach to take advantage of their presence and familiarity with that community."

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Los Angeles Times May 11, 2011

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