Category Archives: Tobacco
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius led off an event at the White House today to mark the 50th anniversary of the inaugural Surgeon General’s Report on Smoking and Health and to release a new progress report on smoking and health by telling the crowd of tobacco advocacy experts that “we’re still a country very much addicted to tobacco.” The new report finds that while the number of U.S. smokers is down from half of the adult population five decades ago to about 18 percent today, if the current smoking trends continue, 5.6 million children alive today will die of tobacco-related diseases in the years ahead.
The report also shows that although many diseases other than lung cancer have been linked to tobacco in the last fifty years, even more illnesses are now known to be linked to tobacco, including:
- Strokes from secondhand smoke
- Rheumatoid arthritis
- Ectopic pregnancies
- Erectile dysfunction
- Colorectal and liver cancer
“Fifty years later, tobacco remains a public health catastrophe and the tobacco fight still rages on every corner of our country,” said HHS Assistant Secretary for Health Howard Koh, MD, MPH at today’s event.
Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention, added that most current smokers want to quit. What is keeping smoking rates high, said Frieden, includes advertising and promotional activities by tobacco companies, especially to children and adolescents, as well as disparities in smoking among certain ethnic groups, low-income populations and many people who are mentally ill.
Effective evidence-based measures cited in the report that can reduce smoking include media campaigns, increased tobacco taxes and new smoking cessation benefits made available to people with health insurance coverage under the Affordable Care Act.
Additionally, actions to reduce smoking that are expected in the coming year include the likely confirmation of a new Surgeon General, a U.S. Food and Drug Administration media campaign aimed at showcasing the dangers of smoking to young people and a new Tips from Former Smokers campaign that will include a video public service announcement (PSA) filmed at the bedside of Terrie Hill, whose previous PSA has been viewed 2 million times and who died of smoking-related illness last year at the age of 53.
>>Bonus Fact: The 1964 Surgeon General Report was released by then-Surgeon General Luther Terry. Among the members of his family attending the White House event today was Dr. Terry’s granddaughter, a graduate of the Harvard School of Public Health.
U.S. Lung Cancer Rates Dropping for Both Men and Women
The rate of new lung cancer cases decreased among men and women in the United States from 2005 to 2009, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), with the fastest drop among adults aged 35-44 years. The rate of decrease has been 6.5 percent per year among men and 5.8 percent per year among women. Lung cancer incidence rates decreased more rapidly among men than among women in all age groups. “These dramatic declines in the number of young adults with lung cancer show that tobacco prevention and control programs work—when they are applied,” said CDC Director Tom Frieden, MD, MPH. Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer among both men and women in the United States, with most lung cancers attributable to cigarette smoking and secondhand smoke. Because smoking behaviors among women are now similar to those among men, women are now experiencing the same risk of lung cancer as men, according to the CDC. Read more on tobacco.
DOT to Fund New Low or No Emission Buses
The U.S. Department of Transportation (DOT) has announced funding of close to $25 million to help fund non-polluting buses in communities across the country. The funds will be awarded competitively to transit agencies and state transportation departments working either independently or jointly with bus manufacturers already making low- and zero-emission buses. According to the DOT, in addition to the environmental benefits, the new buses will also save money for transportation agencies because they can more than double the fuel economy of buses that run on diesel and other fuels. Read more on transportation.
Assistance for Paying Heat Costs
The polar vortex deep freeze much of the country experienced this past week is ending, but there are still many more weeks left of winter. People having trouble paying for heating costs can contact the National Energy Assistance Referral project at: 1-866-674-6327, e-mail email@example.com or access the LIHEAP website to find out where to apply for help to pay for heating costs. Read more on community health.
To mark the 50th anniversary of the 1964 first Surgeon General’s Report on Smoking and Health, JAMA, the Journal of the American Medical Association, released a theme issue this week on fifty years of tobacco control. The study getting the most attention is one by researchers at several medical centers and schools of public health, who estimate that tobacco control efforts in the United States since 1964 have added decades to the lives of eight million American.
Other tobacco topics in the issue include:
- Adults with mental illness have a harder time quitting tobacco than do other smokers
- Smoking rates among most health care providers have dropped sharply in recent years, with the exception being licensed practical nurses
The issue also has several opinion pieces on tobacco-related issues, including one co-written by JAMA Editor Helene Cole, MD, and Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention, who call for key tobacco policy changes such as:
- Increasing tobacco taxes
- Stronger application of U.S. Food and Drug Administration (FDA) regulation of tobacco products, including cigars and e-cigarettes
- Massive public health campaigns
In fact, the FDA has announced it will spend $300 million in 2014 on ads urging teens to be tobacco free, and the U.S. Centers for Disease Control and Prevention plans to continue its “Tips from Former Smokers” campaign.
>>Bonus Link: Read a NewPublicHealth post on the press conference yesterday by the major tobacco control advocacy groups to mark the 50th anniversary of the 1964 Surgeon General Report on Smoking and Health.
Fifty Years after First Surgeon General’s Report on Smoking and Health, Tobacco Advocacy Groups Pledge to 'End the Tobacco Epidemic for Good'
National tobacco control advocacy groups including the Campaign for Tobacco Free Kids, Americans for Non Smokers Rights, the American Cancer Society Cancer Action Network, and the American Lung and Heart Associations observed the 50th anniversary of the Surgeon General’s Report on Smoking and Health by calling for “bold actions” to “end the tobacco epidemic for good.”
The historic 1964 Surgeons General’s report, the first of many since then that have documented specific health dangers from tobacco, was the first major report to link smoking to lung cancer. It was also a critical first step toward reducing smoking rates from close to 50 percent in 1964 to about 18 percent today, according to the advocacy groups. Significantly, a study published yesterday in JAMA, shows that from 1964 to 2012, at least 8 million premature, smoking-related deaths were prevented, and each of those eight million people gained, on average, 20 years of life. Even more significant, the study authors estimate that reductions in smoking contributed 30 percent of the increase in U.S. life expectancy in from 1964 to 2012.
However, the groups quickly turned their attention to the 440,000 Americans who still die of tobacco-related illnesses each year and resolved collectively to achieve new tobacco control landmarks including:
- Reduce smoking rates to fewer than 10 percent within ten years
- Protect all Americans from secondhand smoke within five years
- Ultimately eliminate the death and disease caused by tobacco smoke
At a question and answer period following the press conference additional proposed strategies were discussed by the groups’ top representatives, including:
- Expanded regulation by the Food and Drug Administration (FDA) of all tobacco products—regulations on some products, such as menthol and electronic cigarettes, are still pending.
- Guidance from the U.S. Department of Health and Human Services on a common smoking cessation benefit Americans can access through the health insurance they receive under the Affordable Care Act.
- Greater inroads on reducing smoking rates among people with mental illness. According to research from the U.S. Centers for Disease Control and Prevention, Americans with mental illnesses have a 70 percent greater likelihood of smoking than the general population.
- Greater efforts to reduce marketing and other tactics by tobacco companies in third world countries where smoking rates remain high.
“We can end the tobacco epidemic by fully and effectively implementing proven strategies,” said Tobacco-Free Kids president Matthew Myers, “including higher tobacco taxes, comprehensive smoke-free workplace laws, hard-hitting mass media campaigns, well-funded tobacco prevention and cessation programs, and effective Food and Drug Administration regulation of the manufacturing, marketing and sale of tobacco products. By doing what we know works, we can accelerate declines in tobacco use and ultimately eliminate the death and disease it causes.”
- Read a NewPublicHealth interview with Mitch Zeller, director of the FDA’s Center for Tobacco Products, on the Center’s goals for ending tobacco use in the United States.
- Read a NewPublicHealth interview on “tobacco end game strategies” with Professor Kenneth Warner, of the University of Michigan School of Public Health and a co-author of the new JAMA study on the lives saved through tobacco-control efforts.
Survey: Half of U.S. Adult Smokers Plan to Quit for New Year
More than half of adult smokers in the United States made quitting tobacco a New Year’s resolution for 2014, according to a new survey from Legacy, a national public health nonprofit. These findings are especially significant today, on the eighth day of the new year, as the eighth day of a quit attempt is when a smoker is most vulnerable to a relapse. This month also marks the 50th anniversary of the first Surgeon General’s report on tobacco. Among the survey’s other findings:
- 41 percent planned to quit smoking "cold turkey" for New Years, which is largely ineffective for the majority of smokers
- 12 percent planned to switch to electronic cigarettes, an unregulated product whose safety risks remain unknown
- 37 percent plan to quit to save money
- 31.7 percent want to quit because they don’t want their clothes and hair to smell
Read more on tobacco.
ACS: Cancer Death Rates Fell 20 Percent Over Two Decades
The combined cancer death rate for men and women fell 20 percent in the two decades from 1991 to 2010, with better prevention, screening and treatment critical to continuing this positive trend, according to a new report from the American Cancer Society. The drop translates to approximately 1,350,400 fewer deaths. The report estimates that the United States will see a total of 1,665,540 new cancer cases and 585,720 deaths from cancer in 2014. From 2006 to 2010, cancer death rates decreased by 1.8 percent annually in men and by 1.4 percent in women. Lung, colon, prostate and breast cancers are the most common causes of cancer death, with lung cancer accounting for approximately one in four deaths. Read more on cancer.
‘Green’ Labels for Healthy, ‘Red’ for Unhealthy Foods Improve Nutritional Selections
The “stop” and “go” colors of traffic signals may be able to improve healthy eating choices in cafeterias, according to a new study in the American Journal of Preventive Medicine. A redesign of the cafeteria at Massachusetts General Hospital combined better locations for health food items with red, yellow and green labels marking the nutritional quality of different foods, with junk foods being red. Over two years, green-labeled items sold at a 12 percent higher rate and sales of red-labeled items dropped by 20 percent. "Our current results show that the significant changes in the purchase patterns...did not fade away as cafeteria patrons became used to them," said study lead author Anne Thorndike, MD, of the division of general medicine at the Boston hospital. "This is good evidence that these changes in healthy choices persist over time." To learn more about the study and concept, go to "Traffic-Light Labels and Choice Architecture: Promoting Healthy Food Choices" at RWJF.org. Read more on nutrition.
Study: Newly Insured Visit Emergency Departments More Often
While some experts have speculated that expanded insurance under the Affordable Care Act would decrease the rate of emergency department visits, a new study in the journal Science indicates that newly insured people actually visit the departments significantly more than people who were uninsured. The study of 25,000 Medicaid lottery participants in Oregon in 2008 found that people who received expanded coverage increased their visits by 40 percent—or 0.41 visits—over a period of 18 months. The visits encompassed all manner of health issues, included issues that could have been treated by a primary care physician and would have been covered by the insurance. Read more on access to health care.
Electronic Media Use During Family Meals Tied to Poorer Nutrition and Communication
The use of electronic devices—including television, music with headphones and texting—by teens during meals is linked to less nutritious food and poorer family communication, according to a new study in the Journal of the Academy of Nutrition and Dietetics. In a survey of more than 1,800 parents, researchers asked how often adolescent children used a variety of electronics during family meals, whether they had any rules regarding their use and whether they felt family meals were important; the children were asked questions about family communication, such as how often they discussed their problems with their parents. The study found that two thirds of the teens watched television or movies some of the time, with one quarter watching frequently. Other electronic activities were less common, occurring 18 to 28 percent of the time. About 75 percent of the families had limits on mealtime media. "There is no magic number of how many (family meals) to have, not all food at meals has to be 100% healthy and having electronic media at meals is not all bad (e.g., an occasional movie night with dinner) if it facilitates family time," said lead author Jayne A. Fulkerson. "But, parents can take small steps to have quality time with their children by reducing media use at mealtimes." Read more on nutrition.
Smoking Adds $17 Billion to Post-Surgery Costs Each Year
Smoking-related complications following surgery—for both current and former smokers—add an estimated $17 billion in direct U.S. medical costs each year, according to a new study in JAMA Surgery. The study, led by David Warner, MD, of the Mayo Clinic, looked at surgical patients between April 2008 and December 2009. While the costs for initial hospitalizations was relatively consistent for current smokers, former smokers and people who never smoked, post-surgery costs were an estimated $400 higher for current smokers and $273 higher for former smokers. Read more on tobacco.
NIH: 10 Percent of Driving Time Spent Distracted by Secondary Tasks
About 10 percent of an average driver’s time behind the wheel is spent engaged in something besides focusing on the road, which is especially dangerous for younger drivers, according to a new study in the New England Journal of Medicine. Common distractions include eating, reaching for a phone, texting, or simply taking their eyes off the road. Researchers from the National Institutes of Health (NIH) and Virginia Tech used video technology and in-vehicle sensors to determine their findings. “Anything that takes a driver’s eyes off the road can be dangerous,” said study co-author Bruce Simons-Morton, EdD, MPH, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NIH institute where the study was conducted. “But our study shows these distracting practices are especially risky for novice drivers, who haven’t developed sound safety judgment behind the wheel.” The study found that novice drivers were:
- Eight times more likely to crash or have a near miss when dialing
- Seven to eight times more likely to crash or have a near miss when reaching for a phone or other object,
- Almost four times more likely to crash or have a near miss when texting, and
- Three times more likely to crash or have a near miss when eating.
Read more on transportation.
Study: Tripling Global Tobacco Taxes Could Prevent 200M Premature Deaths
Tripling the taxes on tobacco could prevent 200 million premature deaths worldwide while dramatically cutting into the total number of smokers, according to a new study in the New England Journal of Medicine. Approximately 1.3 billion people smoke; tobacco currently kills about 6 million people per year, with that total expected to climb to more than 8 million by 2030, according to the World Health Organization. To support their findings, scientists from Cancer Research UK (CRUK) pointed to success in France, where raising taxes well above inflation reduced smoking by half from 1990 to 2005. "The two certainties in life are death and taxes. We want higher tobacco taxes and fewer tobacco deaths," said Richard Peto, the CRUK epidemiologist who led the study. "It would help children not to start, and it would help many adults to stop while there's still time." Read more on tobacco.
HUD Grants to Help Families Get Access to Education, Job Training, Employment
This week the U.S. Department of Housing and Urban Development (HUD) awarded approximately $57 million in grants as part of its Housing Choice Voucher Program, which will go toward helping residents gain access to education, job training and employment. The grants will be used to hire or retain more than one thousand service coordinators who will work to connect the families with the supportive services. “This is a modest investment that can make a world of difference for families looking to find their path to self-sufficiency,” said HUD Secretary Shaun Donovan. “As America’s economy continues to recover, it’s critical that we work to make sure every American has the skills and resources they need to successfully compete for jobs in the 21st Century.” Under the program, participants sign a five-year contract requiring the head of the household to obtain employment and no longer receive welfare assistance by the end of the contract. Read more on housing.
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus link: Mobile Health and FDA Guidance
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
Study: U.S. Graphic Warning Labels Could Get 8.6M Smokers to Quit
A new study out of Canada indicates that the U.S. Food and Drug Administration may have underestimated the potential impact of graphic warning labels on tobacco products. From 2000 to 2009, the warning labels cut Canada's smoking rate somewhere between 12 and 20 percent, which would be the equivalent of between 5.3 million and 8.6 million U.S. smokers. That's also 33 to 53 times larger than the FDA's estimates when they pushed for the warning labels--and when the tobacco industry successfully challenged the measure, with the court pointing to the low impact as one of the reasons for the ruling. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found," said Jidong Huang, MD, the study's author. "Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future." Read more on tobacco.
Expanding Nurse Practitioner Abilities Could Save Patients $472M by 2015
Expanding which health services nurse practitioners at retail health clinics can provide could save at least $34 per visit, or as much as $472 million in health costs by 2015, according to a new study in the journal Health Affairs. The estimated 6,000 retail health clinics, often found in chain pharmacies or "big box" stores, provide walk-in care for minor health problems. The rules for nurse practitioners vary from state to state, with some allowing them to prescribe medications and practice independently of a doctor's supervision. Researchers looked at insurance claims from 2004 through 2007, finding that the state's that grant wider latitude also tend to see lower costs for the patients:
- $704 -- Average cost of treatment in the 14 days after a traditional doctor's office visit
- $543 -- Average cost of care during and after a retail visit in states where nurse practitioners had no independence and could not prescribe medication
- $484 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without the supervision of a doctor
- $509 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without supervision and prescribe medication
Read more on access to health care.
New Estimate Puts 2009 Swine Flu Global Death Toll at More than 200K
The death toll from the 2009 swine flu epidemic was likely far higher than previously believed, according to a new study in the journal PLoS Medicine. Previously, the total stood at about 18,500 laboratory-confirmed deaths, though experts considered that to be a low estimate because it only factored in confirmed cases of H1N1. A new study, bringing together 60 researchers in 26 countries, now places the toll at as many as 203,000 global deaths--or 11 times higher than the previous estimate. "This study confirms that the H1N1 virus killed many more people globally than originally believed," study lead author Lone Simonsen, a research professor in the department of global health at the George Washington University School of Public Health and Health Services. "We also found that the mortality burden of this pandemic fell most heavily on younger people and those living in certain parts of the Americas." Read more on global health.