Category Archives: Tobacco

Jul 30 2014
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Helping the Homeless Quit Smoking: Q&A with Michael Businelle and Darla Kendzor, The University of Texas School of Public Health

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Not surprisingly, a recent study in the American Journal of Public Health found that homeless smokers struggle with quitting more than economically disadvantaged smokers who have their own housing. The study compared homeless smokers receiving treatment at a shelter-based smoking cessation clinic to people enrolled in a smoking cessation program at a Dallas, Texas, safety-net hospital.

“On average, homeless people reported that they found themselves around about 40 smokers every day, while the group getting cessation care at the hospital reported that they were more likely to be around three to four smokers every day,” said Michael S. Businelle, PhD, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health Dallas Regional Campus, and the lead author of the study. “Imagine if you had an alcohol problem and were trying to quit drinking—it would be almost impossible to quit if you were surrounded by 40 people drinking every day. That is the situation homeless folks have to overcome when they try to quit smoking.”

Businelle said research shows that about 75 percent of homeless people smoke and that smoking is a leading cause of death in this population. And although homeless smokers are just as likely to try to quit smoking as are other smokers, they are far less successful at quitting, according to Businelle’s work. He said tailored smoking cessation programs are needed for homeless people, including smoke-free zones in shelters.

NewPublicHealth recently spoke with Businelle and his wife, Darla Kendzor, PhD, who is a co-author of the recent study on smoking and the homeless, as well as an assistant professor at The University of Texas.

NPH: Why did you embark on the study?

Michael Businelle: The smoking prevalence in this population is so high and homeless people are not enrolled in clinical trials so we don’t know what will work best for them. We’ve developed, over the last 50 years, really good treatments for the general population of smokers, but there are very few treatments that have been tested in homeless populations.

Darla Kendzor: And cancer and cardiovascular disease, which are in large part due to tobacco smoking, are the leading causes of death among homeless adults. So quitting smoking would make a big difference for them. 

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Jul 16 2014
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Public Health News Roundup: July 16

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Proposed Tobacco Merger Could Boost Smoking Rates
The proposed merger of the Reynolds American and Lorillard tobacco companies announced earlier this week could result in increased smoking rates, according to the Campaign for Tobacco-Free Kids. “This proposed merger is clearly driven by steep smoking declines in the U.S.,” said Matthew L. Myers, president of Tobacco-Free Kids. Myers said cigarette sales fell by 37.1 percent from 2000 to 2013, with the largest decline in 2009, when a 62 cent per-pack increase in the federal cigarette tax was implemented. “Reynolds and Lorillard no doubt hope the economic and political power of a merged company will help them slow or reverse these trends. Elected officials and regulators must be equally aggressive in working to accelerate progress in reducing smoking and other tobacco use.” Read more on tobacco.

Health Education Program Also Reduces Youth Dating Violence
A health education program designed to delay sexual behavior and promote healthy data relationships also significantly reduces dating violence behaviors among minority youth, according to a new study in the American Journal of Public Health. Researchers at the University of Texas Health Science Center at Houston (UTHealth) analyzed 766 students in 10 middle schools in a large, urban school district in southeast Texas, where 44 percent were African American and 42 percent were Hispanic. They looked at four areas—physical victimization, emotional victimization, physical perpetration and emotional perpetration—finding that the It’s Your Game...Keep it Real program reduced all but physical dating violence, which comprised the smallest portion of the program; a revised program with a heavier emphasis on this area is currently being tested in schools. The U.S. Centers for Disease Control and Prevention estimates that 10 percent of high school youth are victims of physical dating violence (with ethnic-minority students at increased risk), with other studies indicating that as many as 20 percent are victims of emotional dating violence. Read more on violence.

CDC Report Finds High Rates of Youth Fruit, Vegetable Consumption
Approximately 77.1 percent of U.S. youth ages 2-19 years consume fruit on any given day and 92 percent consume vegetables, according to a recent NCHS Data Brief from the U.S. Centers for Disease Control and Prevention. However, the rate drops as youth age, while at the same time the amount of fruits and vegetables they eat should be increasing. The report used data from the National Health and Nutrition Examination Survey, 2009–2010. The focused report looked only at whether the foods were consumed, and now how much was consumed. Read more on nutrition.

Jul 14 2014
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Recommended Reading: Health Affairs and RWJF Primer on E-Cigarettes

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The public comment period for rules regulating the sale and use of e-cigarettes proposed in April by the U.S. Food and Drug Administration (FDA) ends on August 8, after which the agency is expected to release final rules governing the products. Experts say the timing is critical because sales of the products—which weren’t even on the market a decade ago—are heating up, with revenues approaching $1 billion a year, according to Forbes Magazine.

Last week, Health Affairs and the Robert Wood Johnson Foundation (RWJF) released a health policy brief about e-cigarettes that sets out key issues concerning the products and provides important background, particularly for people poised to comment on the FDA’s proposed rules.

Among the issues the policy brief addresses are e-cigarette safety; whether the devices ought to be regulated as a medical (smoking cessation) device or as a cigarette; and whether e-cigarettes pose a risk as a “gateway” drug to tobacco products. It notes that the FDA is currently funding close to 40 studies on e-cigarettes.

The issue is especially critical because sales to kids and teens are increasing, and there is still insufficient information on whether the vapor emitted by the devices pose a cancer risk. A 2013 study of 40,000 middle and high school students around the country by researchers at UC San Francisco found that e-cigarette use in that group doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

Read the policy brief from Health Affairs and RWJF.

>>Bonus Link: Read a NewPublicHealth post on initiatives by major cities to regulate the sale and use of e-cigarettes. 

Jul 1 2014
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Aspen Ideas Festival: Better Health as Better Business

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“Getting cigarettes out of our stores is a first step to making pharmacies a place where health happens,” said Troy Brennan, Executive Vice President and Chief Medical Officer of CVS Caremark Corporation, of the company’s decision earlier this year to stop selling tobacco products in its stores. In a Spotlight: Health session at the Aspen Ideas Festival last week, Brennan and other business CEOs discussed how making health a priority can lead to better business outcomes.

By decreasing the number of places that consumers are exposed to cigarettes and eliminating the convenience of tobacco, he said that CVS is actively trying to reduce smoking rates in the areas it serves. However, the healthy decision is also good for the company’s bottom line—already the decision has had positive business results that it didn’t anticipate, including an increase in the company’s stock price following the announcement.

“Companies that make health a priority—consumers gravitate toward that,” he said. “That’s the business incentive.”

Joining Brennan in the conversation, Vitality Institute Executive Director Derek Yach added that the private sector needs to complement public efforts when it comes to health and prevention. For example, taxes and increased prices must work in concert to discourage consumers from unhealthy products or behaviors.

“There may be an economic hit in the short term,” said Yach of companies that make healthy choices easier. “But in the long term, businesses are going to get an inflow of customers who know that their values are aligned.”

Yach also encouraged using County Health Rankings data to understand the underlying risks in each local area, as businesses are uniquely positioned to tailor their interventions to what the surrounding community needs.

Jun 24 2014
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Public Health News Roundup: June 24

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HUD Releases Progress Report on Rebuilding After Hurricane Sandy
The U.S. Department of Housing and Urban Development’s (HUD) Sandy Program Management Office has issued its first report tracking progress on the Sandy Rebuilding Strategy. “While this report shows we are following through on [our rebuilding commitment] we also recognize that many families and business are still on the road to recovery and delays in connecting them to the services and support they need are often too long,” said HUD Secretary Shaun Donovan. “Although more work needs to be done, HUD and the federal government will continue coordinating with local officials until the region has recovered and we meet all the goals of the Sandy Rebuilding Strategy.”

The report tracks progress on several goals set by HUD, including:

  • Promoting resilient rebuilding
  • Restoring and strengthening homes and providing families with safe, affordable housing options
  • Supporting small businesses and revitalizing local economies
  • Addressing insurance challenges and affordability
  • Building state and local capacity to plan for and implement long-term recovery and rebuilding
  • Improving data sharing between federal, state and local officials

Read more on Hurricane Sandy.

New Report Finds Tobacco Companies Have Made Cigarettes Even More Addictive and Deadly
Design changes and chemical additives introduced by tobacco companies in recent decades have made cigarettes more addictive, more attractive to kids and even more deadly, according to a new report, Designed for Addiction, released by the Campaign for Tobacco-Free Kids.

The report finds that tobacco companies have:

  • Made cigarettes more addictive by controlling and increasing nicotine levels and enhancing the impact of nicotine.
  • Made cigarettes more attractive to kids by adding flavorings such as licorice and chocolate that mask the harshness of the smoke, menthol that makes the smoke feel smoother and other chemicals that expand the lungs’ airways and make it easier to inhale.
  • Added ingredients that make cigarettes even more deadly, according to a Surgeon General's report on tobacco and health, released in January which found that smokers today have a much higher risk of lung cancer than smokers in 1964, when the first Surgeon General's report disclosed the harms caused by smoking.

Read more on tobacco.

CDC to Launch Fourth ‘Tips From Former Smokers’ Series
The U.S. Centers for Disease Control and Prevention (CDC) will be launching its next “Tips from Former Smokers” series on July 7. The ads will run nationwide for nine weeks on television, radio and billboards, as well as online, in theaters, in magazines and in newspapers. According to the CDC, the Tips national tobacco education campaign has helped hundreds of thousands of smokers quit since it began in 2012.

“These new ads are powerful. They highlight illnesses and suffering caused by smoking that people don’t commonly associate with cigarette use,” said CDC Director Tom Frieden, MD, MPH. “Smokers have told us these ads help them quit by showing what it’s like to live every day with disability and disfigurement from smoking.”

Smoking remains the leading cause of preventable death and disease in the United States, according to the CDC, and kills about 480,000 Americans each year. More than 16 million Americans are living with a smoking-related disease. For every person who dies from a smoking-related disease, about 30 more people suffer at least one serious illness from smoking.

The most recent “Tips” campaign resulted in more than 100,000 additional calls made to 800-QUIT-NOW. On average, weekly quitline calls were up 80 percent while the ads were on the air, compared to the week before they began running. Read more on tobacco.

Jun 17 2014
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Public Health News Roundup: June 17

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NIH Releases Tools to Help Older Adults Quit Smoking
While overall U.S. smoking rates are dropping, approximately 10 percent of adults over the age of 65 still smoke. The National Institutes of Health (NIH) has created a new online resource with videos, worksheets, interactive tools, strategies, quizzes and more to help older smokers who are thinking about quitting. “Most older adults know that smoking is harmful, and many have tried unsuccessfully to quit, often a number of times. But stopping smoking is a difficult goal that still eludes many older smokers,” said Erik Augustson, program director of the Tobacco Control Research Branch at the National Cancer Institute (NCI), which developed the topic for NIHSeniorHealth. “This new topic, which offers a mix of tips and tools geared to the needs and experiences of older smokers, is an important, easy-to-use resource that can benefit those trying to quit for the first time as well as those who have tried before.” Read more on tobacco.

AHA: Only One-third of Cancer Patients with Heart Problems Seek Proper Treatment
Approximately 12 percent of older breast cancer patients go on to develop heart failure within three years—often as a result of their cancer treatment—but only one-third of those patients sought the help of a cardiologist within 90 days of experiencing heart problems, according to the American Heart Association. Patients who do not see a cardiologist are less likely to receive the standard therapy for heart failure, putting them at risk of lower quality of care and demonstrating an important area where oncologists and cardiologists can collaborate, according to Jersey Chen, MD, MPH, lead author of the study and a research scientist and cardiologist at Kaiser Permanente. “The bottom line is, if you have breast cancer and you’re treated with anthracyclines or trastuzumab, you should know they have side effects,” said Chen in a release. “And if you have symptoms of heart problems like shortness of breath or swelling in the feet or legs, seek attention quickly, preferably with doctors familiar and comfortable with treating heart failure after cancer therapy.” Read more on heart health.

Long Hours Spent Sitting Linked to Higher Risk for Colon, Endometrial Cancers
Previous studies have linked extended time spent sitting to health problems such as heart disease, blood clots, higher blood sugar and even early death. According to a new study in the Journal of the National Cancer Institute, you can now add increased risk for colon and endometrial cancers to the list. Researchers analyzed the findings of 43 studies covering 70,000 cases of cancer, determining that:

  • People who spent the most time sitting during the day had a 24 percent increased risk of getting colon cancer
  • People who spent the most time sitting in front of a television has a 54 percent increased risk for colon cancer
  • There was a 32 percent increased risk for endometrial—or uterine—cancer for women who spent the most time seated and a 66 percent increased risk for those who watched the most television
  • Every two-hour increase in sitting time was linked to an 8 percent increased risk of colon cancer and a 10 percent increased risk of endometrial cancer

Read more on cancer.

Jun 12 2014
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Public Health News Roundup: June 12

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CDC Study Finds No Significant Change in Use of Smokeless Tobacco
From 2005 to 2010 there was no significant change in the percentage of U.S. working adults who used smokeless tobacco, according to the new National Health Interview Survey from the U.S. Centers for Disease Control and Prevention (CDC). In 2005, approximately 2.7 percent of workers reported using smokeless tobacco, with the percentage climbing slightly to 3.0 percent in 2010; males (5.6 percent) and non-Hispanic whites (4.0 percent) reported the highest usage, followed by adults ages 25-44 years, people with no more than a high school education and people living in the South (all 3.9 percent). By industry, smokeless tobacco use was most common in mining (18.8 percent), and by occupation it was most common in construction and extraction (10.8 percent). According to the CDC, these findings indicate opportunities to engage workers with tobacco cessation efforts, such as  providing employee health insurance coverage for proven cessation treatments; offering help for those who want to quit; and establishing and enforcing tobacco-free workplace policies. Read more on tobacco.

6,000 Steps Per Day May Improve Knee Arthritis, Reduce Future Disability Risk
Walking 6,000 steps a day—or about one hour at the average person’s pace—may both help improve knee arthritis and prevent further disability, according to a new study in the journal Arthritis Care & Research. In a study of approximately 1,800 adults who either had knee arthritis or were at risk, researchers found that for every 1,000 steps a person took a day, their functional limitations were reduced by 16-18 percent. The study also pegged 6,000 steps as the target to reach to ensure the healthiest results. Approximately 27 million Americans age 25 and older live with osteoarthritis, which is the most common type of arthritis and often referred to as “wear-and-tear arthritis,” according to the Mayo Clinic. Read more on physical activity.

Study: Great Recession Contributed to Additional 10,000 Suicides in North America, Europe
Stress and other health issues resulting from the Great Recession were associated with more than 10,000 additional economic suicides—suicides in response to financial hardship—between 2008 and 2010 in North America and Europe, according to a new study in The British Journal of Psychiatry. While job loss, debt and foreclosure can increase the risk of suicidal thinking, researchers determined that many such suicides could have been avoided. They recommend upstream return-to-work programs, antidepressant prescriptions and other interventions as ways to mitigate the risk of economic suicides if and when another economic downturn strikes. Read more on the prevention.

Jun 3 2014
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Public Health News Roundup: June 3

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FDA Initiative Gives Developers Easy Access to Public Health Data
A new online initiative from the U.S. Food and Drug Administration (FDA), openFDA, will give mobile application creators, web developers, data visualization artists and researchers access to the agency’s vast public health datasets in order to streamline the creation of their own applications. The structured, computer-readable format allows researchers to determine what types of data they want to search and how they want to present that data to end-users. “The openFDA initiative leverages new technologies and methods to unlock the tremendous public data and resources available from the FDA in a user-friendly way,” said Walter S. Harris, the FDA’s chief operating officer and acting chief information officer. “OpenFDA is a valuable resource that will help those in the private and public sectors use FDA public data to spur innovation, advance academic research, educate the public, and protect public health.” Read more on technology.

Study: 24 Million U.S. Youth Exposed to E-cigarette Advertisements
Unlike with traditional cigarettes, the U.S. Food and Drug Administration (FDA) does not regulate the marketing of e-cigarettes unless they are advertised as a smoking cessation aid. As a result, e-cigarette companies currently market their products to an audience that includes 24 million youth, according to a new study in the journal Pediatrics. Researchers determined that, from 2011 to 2013, youth exposure to e-cigarette advertisements climbed 256 percent and young adult exposure climbed 321 percent. They also determined that approximately 76 percent of the youth exposure came from advertisements on cable networks. Read more on tobacco.

Study: Global Investment in Midwives Needed to Save the Lives of Mothers, Newborns
Investments in midwifery could save the lives of millions of mothers and newborns, according to a new report from the United Nations Population Fund (UNFPA), the International Confederation of Midwives (ICM) and the World Health Organization (WHO). The report determined that 73 African, Asian and Latin American countries experienced 96 percent of the world’s maternal deaths, 91 percent of stillbirths and 93 percent of newborn deaths, with lack of access to midwives a significant contributing factor. Those countries have only 42 percent of the world’s midwives, nurses and doctors.

  • Among the report’s recommendations:
  • Increased access to preventive and supportive care from a collaborative midwifery team
  • Immediate access to emergency services when needed
  • Completing post-secondary education
  • And, from a broader perspective, women should delay marriage, have access to healthy nutrition and receive four pre-birth care visits

"Midwives make enormous contributions to the health of mothers and newborns and the well-being of entire communities. Access to quality health care is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere," said Babatunde Osotimehin, UNFPA Executive Director, in a release. Read more on maternal and infant health.

May 29 2014
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‘It Makes You Want to Smoke’

Citylab—formerly Atlantic Citiesreported recently on an architectural award bestowed by Residential Architect on the Corinthian Gardens Smokers Shelter, a 275-square-foot structure in Des Moines, Iowa. It was created by local architectural firm ASK Studio for smokers who live in a nearby apartment building. “This project serves as a reminder that smokers aren’t extinct by quietly celebrating an activity that has gone from banal to banned,” reads the description on the publication’s online portal.

“It’s the sort of structure that has the feel of a private clubhouse for the tobacco-initiated,” according to award juror Cary Bernstein, whose comments were published by Residential Architect. “It makes you want to smoke so you can be in it.”

Wisely, the materials used to construct the shelter are nonflammable. Smokers get benches to sit on while they smoke and lighting for security after dark.

Corinthian Gardens is hardly the only such smoking shelter in the United States. An online search finds several companies that make the shelters, although none seem as glitzy as the one in Des Moines. And late last year a judge in Great Falls, Montana, ruled that smoking shelters that also house gambling machines don’t violate the city’s Clean Indoor Air Act.

So far, it seems, the shelters are legal so long as they adhere to rules governing smoking in the state or city they’re in, such as being built the requisite distance away from a building to avoid blowing second hand smoke at non-smokers. But tobacco- control advocates worry that the shelters, especially the recent award winner, can hurt the goals of completely eradicating smoking as a social norm—especially when 19 percent of U.S. adults still smoke.

“The fact that people are being protected from the elements is fine, we support the design perspective, but we worry about anything that normalizes or glamorizes smoking,” said Robin Koval, president and CEO of tobacco control advocacy group Legacy.

“We don’t’ hate smokers, we love smokers, what we hate is tobacco,” said Koval, “and so you have to call the structure what it is: a waiting room for the cancer ward because one out of two people who use it will die of tobacco-related diseases. To us that’s really the issue.”

May 29 2014
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Public Health News Roundup: May 29

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CDC: Man Previously Reported Having MERS Does Not Harbor the Virus
After completing additional and more definitive laboratory tests, the U.S. Centers for Disease Control and Prevention (CDC) has retracted a report made last week that an Illinois man contracted the potentially deadly MERS virus from a patient who was diagnosed with MERS in the United States after spending time as a health care worker in Saudi Arabia. The confusion over the diagnosis came from earlier tests that indicated antibodies to a coronavirus, the class of virus MERS belongs to. However, more definitive tests found that he did not harbor the MERS virus. There are six known versions of the coronavirus; four cause mild illness and two cause the much more serious MERS and SARS viruses. Read more on infectious disease.

Study: 30 Percent of the World’s Population is Obese
A new analysis of global obesity trends finds that approximately 2.1 billion people—or nearly 30 percent of the world population—are obese, according to a new study in The Lancet. Researchers found that rates of being obese or overweight climbed 20 percent in adults and 47 percent in children during the 33 years analyzed. The study, which was funded by the Bill & Melinda Gates Foundation, determined that while obesity was once more common in wealthier nations, approximately two-thirds of the world’s obese population lives in developing countries. In addition, the statistics for the United States were especially troubling; while only 5 percent of the world’s population lives in the United States, the country is home to approximately 13 percent of the world’s obese population. Read more on obesity.

Study: Lung Cancer Screening Can Scare People into Quitting Smoking
In addition to early detection and treatment of lung cancer, early screening can also scare people into quitting smoking before they even develop the disease, according to a new study in the JNCI: Journal of the National Cancer Institute. Researchers based their findings on an analysis of 14,621 current smokers, 55-70 years old, with a 30 or more pack-year smoking history and who had smoked during the last 15 years. The data was taken from the Lung Screening Study component of the U.S. National Lung Screening Trial. The study found that "...abnormal screening results may present a 'teachable moment'" and that "[f]uture lung cancer screening programs should take advantage of this opportunity to apply effective smoking cessation programs." Read more on tobacco.