October 2010

Spotlight

Secondhand and Thirdhand Smoke a Risk of Apartment Living

For the first time, new evidence published in Nicotine and Tobacco Research reveals how secondhand smoke can transfer from one apartment to another. The study explains that secondhand smoke from smoke-permitted units is capable of traveling to smoke-free units and adjacent hallways within a building. Scientists at the Roswell Park Cancer Institute (RCPI) say the findings suggest that individuals living in multiunit housing are particularly susceptible to the health risks of secondhand smoke exposure, and the most effective way to protect apartment residents and their visitors from exposure is by establishing smoke-free zones.

These findings come at a critical time as the push to restrict smoking in apartment buildings continues to grow. "A lot of demand is just coming from people realizing that smoke doesn’t stay in one unit," said Rita Turner, deputy director of the Center for Tobacco Regulation, Litigation and Advocacy at the University of Maryland Law School. "Buildings are designed to breath." As a result, owners of apartment complexes and condominiums, particularly in California and Washington, are experiencing more pressure to protect tenants from exposure to secondhand smoke that is seeping into their apartments.

According to the Centers for Disease Control and Prevention (CDC), any exposure, even minimal exposure, to secondhand smoke increases the risk for health-related diseases. Research has found that secondhand smoke can cause asthma, respiratory and ear infections, sudden infant death syndrome, heart disease, and lung cancer. The CDC estimates that lung cancer from secondhand smoke kills about 3,400 adult nonsmokers each year, and that 46,000 heart disease deaths each year are the result of nonsmoking adults being exposed to cigarette smoke. Also, nearly 40 percent of children are exposed to secondhand smoke, according to the American Academy of Pediatrics (AAP).

Growing evidence is also showing how thirdhand smoke in indoor environments poses a public health risk, especially for children. University of California researchers have found that the residue from tobacco smoke clings to furniture, clothes, rugs, walls, and floors, and may linger for months forming carcinogens when mixed with common pollutants, such as nitrous acid, an indoor pollutant commonly found in homes. Because the most likely exposure to these carcinogens is through inhalation of dust or contact of skin with contaminated surfaces, thirdhand smoke poses a great risk to children who crawl on floors, touch furniture, and put dirty fingers in their mouth.

As researchers are beginning to learn more about the health effects of toxins found in thirdhand smoke, further investigation is needed to find out whether thirdhand smoke actually causes disease and death like first- and secondhand smoke. Given that there is no risk-free exposure to tobacco smoke at any level, scientists strongly assert that implementation of 100 percent smoke-free environments in public places and residents, particularly multiunit housing, is the most effective tobacco control measure, through elimination of the primary pollution source.

For more information, see web links:
"Secondhand Smoke Transfer in Multiunit Housing" in Nicotine & Tobacco Research and "Formation of Carcinogens Indoors by Surface-Mediated Reactions of Nicotine with Nitrous Acid, Leading to Potential Thirdhand Smoke Hazards" in Proceedings of the National Academy of Sciences.

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Research Highlights

Study: Smoking During Pregnancy May Result in Uncoordinated Kids

As if you needed another reason to quit smoking — especially during pregnancy — consider that women who puff while pregnant may hobble their babies' coordination and physical control. The effect may be most pronounced in boys, according to research published in the Journal of Epidemiology and Community Health, because of the connection between nicotine and testosterone.

"Nicotine can influence development of the brain and interacts with testosterone particularly during the fetal stage, and this could make boys extra susceptible to fetal nicotine exposure," says Matz Larsson, researcher in medicine and consultant physician at Örebro University Hospital in Sweden.

Larsson and Scott Montgomery, a professor at Örebro, analyzed figures collected from more than 13,000 children participating in the National Child Development Study. The children were all born in Great Britain in the same week in March 1958.

When they turned 11, the children's physical control and coordination were assessed. They were told to pick up 20 matches using both their left and right hands. They also had to tick up to 200 squares and copy a simple figure.

The children born to mothers who'd smoked at least nine cigarettes a day while pregnant had a harder time completing the tasks. "Our findings suggest that women who smoke during pregnancy run the risk of harming the child's motor ability," says Matz Larsson. Nicotine influences acetylcholine, a neurotransmitter that acts as a messenger during fetal brain development. But the nicotine could also be contributing to fetal malnutrition, says Larsson.

Tack that on to the laundry list of other woes related to smoking during pregnancy, including lower birth weights, poor fetal growth and increased risk of premature delivery. The U.S. Public Health Service estimates if pregnant women stopped smoking, there would be an 11 percent reduction in U.S. stillbirths and a 5 percent reduction in newborn deaths.

For the 10 percent of women who smoke while pregnant, this is yet another reason to toss out those cigarettes.

For more information, see web link:
TIME September 28, 2010

Intervention Program Prevents Smoking Relapse, Increases Breastfeeding Duration

New mothers who smoke are less likely to breastfeed. But those who quit smoking during or just prior to becoming pregnant were significantly more likely to remain smoke free and continue breastfeeding if they received support and encouragement during the first eight weeks following child birth, according to a study presented at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco.

Mothers who smoke are more than twice as likely to quit breastfeeding before their child is 10 weeks old, and more than 50 percent of mothers who quit smoking during their pregnancy, begin smoking again, usually two to eight weeks postpartum.

In the study, "Increasing the Duration of Breastfeeding by Preventing Postpartum Smoking Relapse," mothers who had quit smoking during or just prior to pregnancy, and had babies admitted to the Neonatal Intensive Care Unit (NICU), were placed into two groups: a "relapse prevention" group and a "standard of care" group. Both groups of mothers received information about the importance of providing a smoke-free environment for their baby and breastfeeding support. Because stress is a major factor in smoking relapse, the mothers in the intervention group also received information about newborn behaviors, and were encouraged to have frequent skin-to-skin contact with their babies, fostering mother-infant bonding in the NICU.

At the end of eight weeks postpartum, 82 percent of mothers in the intervention group remained smoke free and 86 percent continued to breastfeed. In the standard of care group, 44 percent of mothers were smoke free after eight weeks, and only 7 percent continued to breastfeed.

"By decreasing secondhand smoking exposure and increasing breastfeeding duration, both of which have well documented short- and long-term benefits, this intervention can make a significant contribution to the health of infants and their mothers," said Raylene Phillips, MD, FAAP, lead author of the study, who presented the research results at the AAP conference.

For more information, see web link:
The Medical News October 5, 2010

New Study Finds Economic Benefits of Quit Smoking Programs

A new study released today by the American Lung Association, and conducted by researchers at Penn State University, finds that helping smokers quit not only saves lives but also offers favorable economic benefits to states. The study, titled Smoking Cessation: the Economic Benefits, provides a nationwide cost-benefit analysis that compares the costs to society of smoking with the economic benefits of states providing cessation (quit-smoking) coverage. The study comes at an important time, as important cessation benefit provisions are being implemented at the federal and state levels as a result of healthcare reform legislation.

Each year, tobacco use kills 393,000 people in America, and this new study identifies significant and staggering costs directly attributable to death and disease caused by smoking. For example, the study finds that smoking results in costs to the U.S. economy of more than $301 billion. This includes workplace productivity losses of $67.5 billion, costs of premature death at $117 billion, and direct medical expenditures of $116 billion.

In Utah, the annual direct costs to the economy attributable to smoking are in excess of $1.1 billion, including workplace productivity losses of $337 million, premature death losses of $353 million, and direct medical expenditures of $448 million. While the retail price of a pack of cigarettes in Utah is on average $4.81, the combined medical costs and productivity losses attributable to each pack of cigarettes sold are approximately $16.75 per pack of cigarettes.

"This study spells out in dollars and cents the great potential economic benefits to states of helping smokers quit. We urge the District of Columbia and all states to offer full coverage of clinically proven cessation treatments for smokers, which will not only save lives but also money," Charles D. Connor, President and CEO of the American Lung Association.

Smoking is the number one preventable cause of illness and death in the United States and surveys show that 70 percent of tobacco users want to quit. Quitting can often take several attempts before a smoker is successful. Using evidence-based treatments increases smokers' chances of quitting - but many smokers don't have access to or don't know about what kind of treatments are available to them.

In addition to identifying the staggering costs of smoking to the U.S. economy, this new study now provides state governments with compelling economic reasons to help smokers quit. For example, the study finds that if Utah were to invest in comprehensive smoking cessation benefits, each would receive, on average, a 22 percent return on investment. In other words, for every dollar spent on helping smokers quit, states will see on average a return of $1.22.

The study derives these economic benefits by considering lower medical costs due to fewer people smoking, increased productivity in the workplace and reduced absenteeism and premature death due to smoking.

Some of the highest rates of smoking are found among people enrolled in Medicaid, the joint federal and state health program for low-income people. The American Lung Association urges every state to provide all Medicaid recipients and state employees with comprehensive, easily accessible tobacco cessation benefits. A comprehensive cessation benefit includes all seven medications and three types of counseling recommended by the U.S. Public Health Service for tobacco cessation. Only six states now provide comprehensive coverage for Medicaid recipients: Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania.

The Lung Association also recommends that private insurance plans and employers offer comprehensive cessation coverage and encourages states to require them to cover these treatments. Only seven states have such requirements now: Colorado, Maryland, New Jersey, New Mexico, North Dakota, Oregon and Rhode Island.

Researchers at Penn State University with expertise in health economics and administration performed this cost-benefit analysis using government and other published data. The analysis compares the costs of providing smoking cessation treatments (including price of medications and counseling and lost tax revenue) to the savings possible if smokers quit (including savings in health care expenditures, premature death costs, and productivity losses).

For more information, see web link:
Standard-Examiner September 20, 2010

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Other Cessation News

Experts Urge Further Research on Nicotine Reduction to Decrease Tobacco Addiction

Tobacco control experts are calling for additional research on reducing the nicotine content of cigarettes and other tobacco products. Nicotine reduction, they wrote in an article published online October 1 in Tobacco Control, has the potential to profoundly affect smoking rates in the United States, but many outstanding questions remain and will require a focused and collaborative research effort.

Momentum for examining nicotine reduction (a decrease in the amount of legally allowed nicotine per cigarette to levels that do not initiate or sustain addiction) grew with the passage of the Family Smoking Prevention and Tobacco Control Act (FSPTCA) in 2009. The Act gave the FDA regulatory authority over the manufacturing, marketing, and sale of tobacco products in the United States. This regulatory authority includes setting standards for the ingredients of tobacco products, including nicotine, the main substance responsible for tobacco’s addictive nature.

"Of all the measures that could be taken under the FSPTCA, reducing the addictiveness of cigarettes has the greatest potential to significantly reduce tobacco-related mortality," said the article’s lead author, Dr. Dorothy Hatsukami, principal investigator of the NCI-funded Transdisciplinary Tobacco Use Research Center (TTURC) at the University of Minnesota.

"If you do that," she continued, "you could prevent people who experiment with cigarette smoking from becoming dependent, and you would also facilitate cessation among those who are already dependent."

Two meetings, held in 2007 and 2009 and sponsored by NCI’s Tobacco Harm Reduction Network and the University of Minnesota TTURC, brought together experts from diverse disciplines to review the scientific evidence on nicotine reduction and identify priorities for future research. Their recommendations appear in the October 1 paper.

"We wanted to bring people in the field together to identify research needs," said Dr. Cathy Backinger, chief of NCI’s Tobacco Control Research Branch and a co-author of the paper. "Because it’s not clear yet what the best approach is to reducing nicotine in cigarettes, nor what effects doing so will have, we need a multidisciplinary group to answer the questions we identified."

To date, research on nicotine reduction has provided some evidence to support the concept that it could reduce the addictiveness of cigarettes. Studies have shown that very-low-nicotine cigarettes can minimize withdrawal symptoms in smokers who switch to these cigarettes and that they also reduce the number of cigarettes smoked in the long term, as smoking ceases to provide the expected rewards.

In one study, 25 percent of participants quit smoking even though they had not enrolled in the study with the intent to quit. (The trial was intended to test the effects of cigarettes with progressively lower nicotine content on the exposure to carcinogens.) And recently published preliminary data from another clinical trial showed that 36 percent of participants given cigarettes containing 0.05 mg of nicotine as a smoking cessation aid remained abstinent 3 months after treatment, compared with 20 percent of participants using a 4 mg nicotine lozenge.

A major unanswered question remains: What is the threshold dose of nicotine associated with addiction? Complicating the question is the likelihood that this dose may be different for adults and for adolescents, whose developing brains may be more sensitive to the addictive effects of nicotine. "Men also may have a different threshold dose compared with women, and it might even differ between races," explained Dr. Hatsukami. "Clearly we need additional research in this area."

Researchers also need to determine whether chemicals other than nicotine produce some of the reinforcing addictive effects of tobacco. Chemicals found in tobacco, such as nornicotine, anabasine, and monoamine oxidase inhibitors, may mediate the reinforcing effects of nicotine or have effects of their own.

"Eventually, we may not just think about reducing nicotine levels; we may actually think about measuring and reducing the overall addictiveness of cigarettes," said Dr. Hatsukami. "That would cover a number of constituents or any other chemicals that could be added to a tobacco product to make it addictive."

"One of the main points of this article was to make people aware that we need to be very strategic and comprehensive in this research, in order to either support or refute the concept of nicotine reduction," she continued. "It’s a call for research and also a call to provide resources to look at this area because of the potentially profound effect it could have on public health."

111th Congress Took Unprecedented Action to Reduce Tobacco Use, Save Lives and Cut Health Care Costs

The following is a statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids:

As the 111th Congress draws to a close, its members and leadership, along with President Obama, deserve great praise for standing up to special interests and taking truly historic action to reduce tobacco use, save lives and reduce health care costs for all Americans.

This Congress did more to protect kids from tobacco than any other in history, and these steps are likely to pay major dividends for years to come. Fewer kids will get addicted, more Americans will get the help they need to quit smoking and we will save billions in health care costs. These actions are critical to improving America's health as tobacco use remains the nation's leading preventable cause of death, killings more than 400,000 Americans and costing $96 billion in health expenditures each year.

The Congressional accomplishments include:

FDA regulation of tobacco products: After more than a decade of struggle, Congress finally gave the Food and Drug Administration the power to regulate the manufacture, marketing and sale of tobacco products. President Obama signed the law on June 22, 2009, and launched a new era in which the deadliest consumer product sold is finally regulated to protect public health. Already the FDA has used its authority to ban candy and fruit-flavored cigarettes and crack down on other predatory marketing schemes directed at children. It has banned use of the deceptive terms "light" and "low tar" to describe cigarettes, and required larger warning labels on smokeless tobacco products, with large, graphic warnings soon to come on cigarette packs.

Tobacco tax increase: Congress enacted the largest-ever federal cigarette tax increase, a 62-cent per pack hike, as part of legislation improving children's health by expanding coverage under the State Children's Health Insurance Program (SCHIP). Increasing cigarette taxes is a proven strategy to reduce smoking and other tobacco use, especially among children. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by about 7 percent and overall cigarette consumption by about 4 percent. The federal cigarette tax hike went into effect in April 2009, and several states also raised their cigarette taxes in 2009. As a result, cigarette sales declined by 8.3 percent in 2009, one of the largest declines in recent years.

Health care reform that makes prevention a priority: The new health care reform law expands private health insurance coverage for proven treatments that help smokers quit and requires state Medicaid programs to cover smoking-cessation treatment for pregnant women. Beginning in 2014, Medicaid programs will no longer be permitted to exclude tobacco-cessation drugs from their medication programs. Lawmakers also created a new Prevention and Public Health Fund to finance proven prevention, wellness and public health activities in communities across the nation. Tobacco prevention and cessation programs received $16.7 million from this fund in fiscal year 2010.

Increased funding for tobacco control efforts: At a time when many states were making severe cuts to tobacco prevention and cessation programs, funds from the American Recovery and Reinvestment Act provided critical support for these life-saving programs. This law has provided $197 million for state and local health department programs dedicated to tobacco control.

Stopping illegal sales of tobacco products over the Internet: The Prevent All Cigarette Trafficking (PACT) Act cracks down on the sale of tax-evading, low-cost cigarettes and smokeless products over the Internet and through the mail. Internet sales make it easier for kids to buy tobacco products, facilitate tax evasion and cost federal and state governments billions in lost revenues.

This Congress overcame years of political inertia to take important steps that will create a healthier America. Now it is critical that future Congresses build on these accomplishments by supporting effective implementation of these new laws and taking additional steps, including funding a national tobacco prevention and cessation campaign. Winning the fight against tobacco use will require a sustained effort from many Congresses.

For more information, see web link:
PRNewswire September 30, 2010

Smokeless Products Face FDA Test

Tobacco maker Star Scientific Inc. hopes there’s fire where there’s no smoke.

The small Virginia company has made itself the test case for a big issue: whether the Food and Drug Administration will allow certain tobacco products — particularly the company’s tobacco lozenges — to be marketed as less harmful than cigarettes.

The application to market the product as safer also highlights a philosophical debate over how best to control tobacco. One camp says there’s no safe way to use tobacco and pushes for people to quit above all else. Others embrace the idea that lower-risk alternatives like smokeless tobacco or electronic cigarettes can improve public health, if they mean fewer people smoke.

How the FDA handles the products is being closely watched by both the public health community and bigger tobacco companies, which are looking for new products to sell as they face declining cigarette demand due to tax increases, health concerns, smoking bans, and social stigma.

A law enacted last year gives the FDA authority to evaluate tobacco products for their health risks and lets the agency approve ones that could be marketed as safer than what’s currently sold.

So far only Star Scientific has applied for approval to market what the agency calls “modified-risk’’ products. The company says the small tablets that dissolve in the user’s mouth contain “below detectable levels’’ of certain cancer-causing chemicals found in tobacco and its smoke. It wants to sell them to smokers as “a useful alternative — with greatly reduced toxin levels.’’

"Why shouldn’t tobacco users . . . have an opportunity to know this and make an informed decision? That’s why we took the risk, that’s why we spent the money, " Paul Perito, president of Star Scientific, said.

The company, formerly known as Star Tobacco and Pharmaceuticals, has sold varieties of the dissolvable tobacco under the Ariva and Stonewall brands since 2001. Its sales have grown about 47 percent since 2007.

The tablets contain tobacco’s most addictive component, nicotine. Star Scientific says its method of tobacco cultivation and preparation creates tobacco leaves with low levels of some carcinogens.

While the FDA’s Center for Tobacco Products has not yet ironed out its guidelines for approval of such products, draft guidelines suggest it could take nearly a year to review an application.

Tobacco companies want to market more smokeless tobacco and other cigarette alternatives to make up for falling cigarette sales. Some have introduced snus — small pouches like tea bags that users stick between the cheek and gum — and dissolving tobacco — finely milled tobacco shaped into orbs, sticks, and strips. But they can’t explicitly market them as less risky than cigarettes.

But a report from the Royal College of Physicians, a UK medical group, titled "Harm Reduction in Nicotine Addiction," — along with other scientific studies — suggests that when compared with cigarettes, some smokeless tobacco products are about 90 percent less harmful.

Meanwhile, GlaxoSmithKline, which makes nicotine replacement therapy products like Nicorette gum and NicoDerm patch, has urged the FDA to take dissolvable tobacco off the market until companies can demonstrate that selling it is appropriate for the protection of public health.

The question remains whether smokers, which total about 46 million in the United States, are really willing to switch, even if it means saving their lives.

But tobacco company research shows that many smokers transition to smokeless products in about a year and a half once they begin to notice the benefits of going smoke-free, said David Sweanor, a Canadian law professor and tobacco specialist who consults with companies and others on industry issues.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the FDA can now keep tobacco companies accountable for health claims and marketing, but also use scientific standards to assess health impacts.

"If there are tobacco products out there that can be marketed in such a way that can significantly reduce the risk of disease, I don’t know of anybody who opposes that," Myers said.

For more information, see web link:
The Boston Globe September 29, 2010

Quitting Smoking? Find Support on Facebook

Facebook is more than just a place to reconnect with old friends—it’s also a forum to build virtual communities and seek social support. As social media has become an increasingly important part of people’s daily lives, many organizations are turning to Facebook to connect with the public and engage them in online conversations.

Last year, NCI’s Tobacco Control Research Branch (TCRB) launched the Smokefree Women Web site and a companion Facebook page as part of an outreach strategy designed to appeal to younger women and get them involved in efforts to quit smoking.

The Facebook platform acts as a virtual support system, said TCRB’s Dr. Erik Augustson, who leads the project. It provides a place for women to gather, share, and connect with others trying to quit smoking. And starting today, there will be another reason to visit the Smokefree Women Facebook page: video blogs will be posted to the page, showing women talking about topics related to smoking.

"Our Facebook video campaign is brought to real women by real women," said Alison Pilsner. She leads the mobile team that interviews women about issues such as how they've been successful in quitting, smoking while pregnant, and helping family members or friends quit smoking. The hope is that these videos will serve as a launching point for discussions on the Smokefree Women Facebook page.

"Research suggests that social support might have a particular benefit for women who are trying to quit smoking," said Dr. Augustson. "Participating in conversations and building a community is a way that new media tools, like Facebook, can help NCI integrate social support into our interventions and remove barriers associated with typical smoking cessation treatments."

NCI's Tobacco Control Research Branch has a new Facebook video campaign where women on the street talk about quitting smoking.

Obstacles, such as taking time off from work or commuting to attend face-to-face support groups, are removed by internet-based interventions, he explained. "Support is available for you whenever you need it, and that is one of the main driving forces that has led us to be involved in social media and why we’re seeking to increase our involvement with it." To Dr. Augustson’s knowledge, the Smokefree Women Facebook page is one of the first of its kind in the Federal government that seeks to deliver an intervention in this format.

Engaging younger female smokers in smoking cessation efforts is a priority for TCRB because quitting early in life can reduce the health consequences of smoking for both women and their children. Yet previous research has shown that white women in their 40s and 50s were the typical visitors of Smokefree.gov, which is the age that women start getting serious about their quit attempts, Dr. Augustson said.

The new Smokefree Women website and social media outreach strategy are intended to target women in their child-bearing years, with the Facebook videos engaging younger audiences so that they can hopefully quit smoking at a younger age, when the health benefits are most pronounced.

Using Web analytic software, TCRB staff will study how the use of the Facebook page and Smokefree Women Web site changes as a result of the video blogs. Who is participating in the online discussions, and what are they saying? The staff is also interested in how information is spread through other online channels, like Twitter, and whether the videos drive traffic to the Web site. This information will be used to refine the campaign and tools. TCRB staff also plan to share their results at scientific conferences.
For more information, see web link:
NCI September 21, 2010

Smokeless Tobacco: CV Risks Lower than Cigarette Smoking, but Danger for Disease Remains

CV risks were lower in those who used smokeless tobacco products instead of cigarettes, but there was still an increased risk for CVD, including fatal MI and stroke. These findings led the American Heart Association to publish a statement in which the organization would not endorse nor recommend smokeless tobacco as an alternative to cigarette smoking or as a smoking cessation product.

In the Scientific Statement appearing in Circulation, Piano and colleagues, on behalf of AHA, performed a meta-analysis on the CV risk associated with various forms of smokeless tobacco (ST), including snuff and chewing tobacco. They also set out to provide clarification as to whether ST products should be recommended to smokers instead of cigarettes to reduce the morbidity and mortality associated with smoking and to enhance smoking cessation.

Currently, ST products are used by an estimated 8.1 million individuals of all ages in the U.S. In their article, the researchers wrote that, similarly to cigarette smoking (CS), nicotine is the principal alkaloid present in ST products, although the amount varies significantly from product to product. Although regular uses of ST products take in an equal amount of nicotine per day as cigarette smokers, a major difference between the two is that nicotine inhaled via CS is absorbed quickly in the lungs, which then continues in high concentrations into the arterial circulation, and then to the heart, brain and other organs. Conversely, the absorption rate of nicotine from ST is much slower, with absorption continuing for 30 minutes or more.

They said the finding is relevant because the speed of absorption and maximum arterial blood levels achieved are determinants of the acute CV effects of nicotine. "More rapid absorption of nicotine is associated with greater heart rate acceleration," the researchers said. "Thus … it is likely that the same daily dose of nicotine from CS would cause more injury than from ST."

Relationship of ST to Disease
To determine the CV risks associated with ST products, researchers performed a thorough, comprehensive search in PubMed and Cochrane Library databases for systematic reviews and meta-analyses related to this topic. They included English-language studies of adult men and women at least 18 years of age, most of which were conducted in the U.S. and Sweden.

Some of the highlights of their research included:

• Most studies indicated no increased incidence or prevalence of hypertension in ST product users.

• No significant increase in risk for nonfatal or fatal MI with ST product use, with the exception of one meta-analysis and one long-term follow-up study that indicated a modest increased risk of fatal MI and the INTERHEART study that showed an increased risk for acute MI.
  

• A slight increased risk for stroke mortality in ST product users.
  

• An association between ST product use and dyslipidemia.

One of the key differentiations between CS and ST product use that may explain why CS results in more severe CV events is that the direct oxidants believed to be the class of chemicals contributing most to CS-induced CVD are not an issue in ST products, the researchers reported.

However, the potential risks involved with ST product use should not be underestimated, they added.

"Data from two studies have shown that young nonsmoking men who were ST product users were two to three times more likely to become active cigarette smokers," the researchers wrote. Although two other studies showed little relationship between ST product use and smoking initiation, they said there is concern that the younger population may be lulled into a false sense of security by turning to potential reduced-exposure or ST products.

"There also is concern that marketing one tobacco product as a substitute for others will divert attention from the smoking cessation message," the researchers said.

AHA’s Final Stance

With all of the evidence presented on the role of ST products in CVD, the researchers made the following statement on behalf of AHA:

"As a national nonprofit health organization committed to promoting tobacco control research and policy efforts, the AHA does not recommend the use of ST as an alternative to CS or as a smoking cessation product. Although the evidence is consistent with the suggestion that the CV risks are lower with ST products, ST products are not without harm. … Furthermore, the promotion of ST may lead to fewer people quitting smoking and more dual use of cigarettes and ST products."

As a way to limit the harmful effects of ST products, the researchers recommended prioritizing strategic efforts to evaluate factors associated with the initiation and use of ST products; determine to what extent the use of ST products results in continued tobacco use, including dual smoking and ST product use, in smokers who would otherwise have quit; and assess the effect of "reduced risk" messages related to ST products on public perception, tobacco use and cessation, and policy decision-making.

Based on their findings, they concluded, "Clinicians should continue to discourage use of all tobacco products and emphasize the prevention of smoking initiation and smoking cessation as primary goals for tobacco control."

For more information, see web link:
Cardiology Today October 7, 2010

CDC: Medicaid Could Do More to Fight Smoking

Most Medicaid programs in the U.S. offer at least some form of health care coverage to enrollees who are trying to quit smoking, but in many states more could be done to help people kick the habit, the CDC says.

In its Morbidity and Mortality Weekly Report for October 22, the CDC says it surveyed Medicaid programs in all 50 states and Washington, D.C., and found that 47 offered some coverage for dependence treatment in 2009.

The report says 37 percent of Medicaid enrollees smoke, compared to 21 percent of the overall adult population. Only eight state programs offered coverage of all recommended drug and counseling treatments; 43 programs would need to add additional tobacco-dependence treatments in order comply with U.S. Preventive Services Task Force recommendations.

The CDC says smoking-related medical costs account for 11 percent of Medicaid expenditures.

Of the 51 Medicaid programs surveyed, 47 provided tobacco-dependence treatment coverage for some enrollees and 38 covered at least one treatment for all Medicaid enrollees. Four states -- Connecticut, Georgia, Missouri, and Tennessee -- offered no coverage for enrollees.

Medicaid personnel were asked to fill out online surveys of 45 questions regarding treatment coverage, limitations of coverage, outreach activities, and related subjects.

Coverage for all Medicaid enrollees was reported for the nicotine patch for 34 programs, while 33 covered bupropion (Zyban), 32 covered nicotine gum, and 32 covered varenicline (Chantix).

The Morbidity and Mortality Weekly Report also states that:

• 28 programs covered a nicotine nasal spray


• 27 programs paid for nicotine inhalers


• 25 covered nicotine lozenges

"Insurers that provide adequate access and support for persons seeking to quit smoking can improve cessation rates substantially, with potential for considerable improvement in public health and reduction in medical expenditures," the report's authors write.

Recent federal policy is increasing access to programs to help people quit smoking. The Affordable Care Act, for instance, mandates Medicaid programs to cover tobacco-treatment coverage for pregnant women, and that requirement went into effect October 1.
For more information, see web link:
WebMD October 21, 2010

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