Category Archives: Tobacco
U.S. Cervical Cancer Rates Higher than Previously Reported
Cervical cancer rates in the United States are higher than previously reported, especially among women ages 65-69 and African-American women, according to a study published in the journal Cancer. Previous research showed about 12 cases of cervical cancer per 100,000 women in the United States, with the incidence reaching a peak at age 40-44 and then leveling off. However, those estimates included women who had hysterectomies in which the cervix had been removed and the authors of the new study say excluding these women—who are no longer at risk of developing this cancer—from their analysis, changes the rate to 18.6 cases of cervical cancer per 100,000 women. The new study also found that incidence increased steadily with age and peaked at a higher rate and at an older age—in women 65-69. Read more on cancer.
ADHD Treatment Linked to Lower Smoking Rates
Treating attention deficit hyperactivity disorder (ADHD) with stimulant medication may reduce smoking risk, especially when the medication is taken consistently, according to an analysis of 14 studies published in Pediatrics. The studies evaluated by the researchers were longitudinal studies of cigarette smoking and ADHD treatment which included 2,360 individuals with ADHD; this is the largest meta-analysis on the issue to date, according to the study authors. The researchers looked at data on nicotine dependence, smoking frequency and whether study participants smoked at the time of the study, and found a significant association between stimulant treatment and lower smoking rates. The effect was larger in those with more severe ADHD and when participants took stimulant medications continuously. The researchers say more studies are needed to determine the recommended timing and duration of stimulant treatment to help lower smoking risk. Read more on tobacco.
Number of Nurse Practitioners Working in Primary Care Increases
Almost half of recently licensed U.S. nurse practitioners (NPs) have become part of the U.S. primary care workforce, according to a report released today by the Health Resources and Services Administration. The National Sample Survey of Nurse Practitioners shows that in 1992 approximately 59 percent of graduating NPs worked in primary care, decreasing to 42 percent between 2003 and 2007. However, the new survey shows that 47 percent of NPs graduating since 2008 have entered primary care. According to the report, 76 percent of the NP workforce has certification in a primary care specialty, including family, adult, pediatric, or gerontology care, and nearly half have a family NP certification. More than half of the NP workforce works in ambulatory care settings, while nearly a third work in hospitals. Read more on prevention.
Big Cities Health Coalition, Other Groups Push FDA to Expand Its Proposed Regulations on E-Cigarettes
A growing number of public health groups are urging the U.S. Food and Drug Administration (FDA) to go well beyond the new rules the agency proposed last month to expand its authority over tobacco, including e-cigarettes. Late last week the Big Cities Health Coalition, made up of twenty of the largest cities in the United States—including Boston, New York City, Chicago and Los Angeles—held a briefing in Washington, D.C. to address what they see as significant gaps in the recently released FDA tobacco regulations. The Coalition is a project of the National Association of County and City Health Officials (NACCHO). “What began as a sliver of the tobacco market is now predicted to eclipse traditional tobacco sales by mid-century,” said the Coalition in a letter to the agency last week.
The letter and Washington, D.C., briefing highlighted concerns about regulating e-cigarettes that the current FDA rules do not address:
- E-cigarettes are being marketed in ways that appeal to youth and could undermine existing tobacco regulations
- E-cigarette manufacturers are making unsubstantiated claims regarding health and safety
- E-cigarettes do not carry health warning labels
Marketing to children was a key concern during the Coalition’s briefing. “The FDA should aggressively limit access to minors and not allow marketing to them or flavorings,” said Barbara Ferrer, MPH, PhD, executive director of the Boston Public Health Commission. All of the commissioners at the briefing voiced a need to regulate flavorings, which can include flavors such as—bubble gum and watermelon—and which the commissioners say are a direct enticement for young people.
“Bubble gum is not a flavor that’s aimed at you or me,” said Mary Bassett, MD, MPH, Commissioner of the New York City Department of Health and Mental Hygiene.
Many of the Coalition member cities have already proposed or enacted laws regarding e-cigarettes that are stricter than the ones proposed by last month by the FDA. A sampling of city regulations regarding e-cigarettes includes:
- Boston — E-cigarettes are not permitted in the workplace; sales are not permitted to anyone under 18; and neither cigarette smoking nor e-cigarette “vaping” are permitted in the city’s public parks.
- New York City — Bans the sale of e-cigarettes to anyone under 21, and as of August 2014 “vaping” will not be permitted anywhere cigarette smoking is not allowed.
- Chicago — Requires retailers to obtain tobacco licenses in order to sell e-cigarettes, prohibits sales of e-cigarettes within 500 feet of schools, requires e-cigarettes to be sold behind store counters and prohibits use of e-cigarettes wherever smoking is prohibited.
- Los Angeles — E-cigarettes cannot be used in public buildings, in parks, at beaches and at other locations where cigarette and tobacco smoking is prohibited. Sales are not allowed to people under 18.
“City health commissioners and mayors are playing and will continue to play critical roles in regulating tobacco products, including e-cigarettes,” said Vince Willmore, vice president for communications at the Campaign for Tobacco-Free Kids in Washington, D.C. “Overall, the main things public health advocates can do is to comment on the FDA rule and urge that it be finalized as quickly as possible; push for action in their own states and communities to regulate e-cigarettes as tobacco products; and continue to focus attention on the problems posed by e-cigarettes.”
The FDA has proposed a 75-day comment period rather than the usual 90-day period, pointed out Robin Koval, president and CEO of Legacy. Last week the organization released a new report on e-cigarettes that looked at the rise of e-cigarette use among youth, as well as the entry of the major tobacco companies into the e-cigarette market.
Koval said she would like to see the FDA commit to a specific time frame for sending its proposed rules to Congress once the comment period is over because “there isn’t’ any time to lose in getting the regulations out...these markets are building growth aggressively.”
>>Bonus Link: Read about a new study in The New York Times, which found that e-cigarettes can become hot enough to release some carcinogens found in conventional cigarettes.
FDA Proposes Rule for Regulation of E-cigarettes
The U.S. Food and Drug Administration (FDA) today released its long-expected proposed new rule that would expand its authority to include the regulation of e-cigarettes. Under the proposed rule, FDA would also be able to regulate products that meet the statutory definition of a tobacco product, including cigars, pipe tobacco, nicotine gels, waterpipe (or hookah) tobacco and dissolvables not already under the agency’s authority. “This proposed rule is the latest step in our efforts to make the next generation tobacco-free,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius. Read more on tobacco.
Study: 1 in 13 U.S. Kids Take Prescription Drugs for Emotional or Behavioral Issues
One in 13 U.S. schoolchildren take medication for emotional or behavioral issues, with more than half of the parents of these children reporting that the drugs have helped “a lot,” according to a new report from the U.S. National Center for Health Statistics. Only about one in five parents said the medication had not helped at all. The report also found that among youth ages 6-17 years, a higher percentage of children insured by Medicaid or the Children's Health Insurance Program used such prescribed medication than did children with private health insurance or no health insurance, and that a higher percentage of children in families having income below 100 percent of the poverty level used prescribed medication for emotional or behavioral difficulties than did children in families at 100 percent to less than 200 percent of the poverty level. Read more on prescription drugs.
Study: Genetic Risk for Obesity Rises as Kids Age
The genetic risk for obesity rises as children age, according to a new study in the journal Obesity. Researchers analyzed data on 2,556 pairs of twins in England and Wales at ages 4 and 10, finding that the influence of genetic variants rose as they got older, with genes accounting for about 43 percent of the difference in size among the four-year-olds, but 82 percent of the difference at the age of 10. "Our results demonstrate that genetic predisposition to obesity is increasingly expressed throughout childhood," said study co-leader Clare Llewellyn, MD, of the department of epidemiology and public health at University College London, in a release. "This underlines the importance of intervening at an early age to try to counteract these genetic effects and reduce childhood obesity.” Read more on obesity.
CDC: Calls to Poison Centers for E-Cigarettes Has Jumped Dramatically Since 2010
Calls to poison centers involving e-cigarette liquids containing nicotine jumped from just one per month in September 2010 to 215 per month in February 2014, according to a new U.S. Centers for Disease Control and Prevention (CDC) study in the Morbidity and Mortality Weekly Report. There was no similar increase for conventional cigarettes. The study found that 51.1 percent of the e-cigarette calls involved children under age 5 and about 42 percent involved people ages 20 and older. “This report raises another red flag about e-cigarettes—the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, MD, MPH, in a release. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.” Read more on the FDA.
HHS Draft Report Would Strengthen Innovative Health IT, Help Patients
The U.S. Department of Health and Human Services (HHS) has released a draft report that includes a proposed strategy for a health information technology (health IT) framework to help promote product innovation while also ensuring patent protections and avoiding regulatory duplication. The congressionally mandated report was developed by the U.S. Food and Drug Administration in consultation with HHS’ Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC). “The diverse and rapidly developing industry of health information technology requires a thoughtful, flexible approach,” said HHS Secretary Kathleen Sebelius. “This proposed strategy is designed to promote innovation and provide technology to consumers and health care providers while maintaining patient safety.” Improved health IT could help lead to greater prevention of medical errors; reductions in unnecessary tests; increased patient engagement; and faster identifications of and response to public health threats and emergencies. Read more on technology.
Study: Fewer Cases of Smoking on TV Screens May Be Tied to Overall Drop in U.S. Smoking Rates
Fewer scenes of cigarette use in prime-time television shows may be linked to an overall reduction in the U.S. smoking rate, according to a new study in the journal Tobacco Control. Analyzing 1,800 hours of popular U.S. prime-time dramas broadcast between 1955 and 2010, researchers from the Annenberg Public Policy Center at the University of Pennsylvania in Philadelphia determined that scenes involving cigarette use on such shows fell from nearly five scenes per hour of programming (excluding commercials) in 1961 to about 0.3 scenes per hour in 2010. Based on this data they concluded that one less depiction of smoking per hour over two years of prime-time programming was associated with an overall drop of almost two packs of cigarettes, or 38.5 cigarettes, a year for every adult. The new findings support previous research showing that seeing other people smoke prompts cigarette cravings in adult smokers. Read more on tobacco.
Study: ‘White Coat Effect’ on Blood Pressure is Real
The “White Coat Effect” is real, according to a new study in the British Journal of General Practice. The effect, wherein a person’s blood pressure is higher when taken by a doctor than when taken by a nurse, has long been assumed, but this is the first study to confirm it. The study analyzed the results of more than 1,000 people who had their blood pressure taken by both a physician and a nurse, finding the results of the physician-administered tests were noticeably higher. "Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” said Christopher Clark, MD, of the University of Exeter Medical School, in a release. “The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects.” Clark also noted that researchers should also take these findings into account when performing studies on topics such as hypertension. Read more on heart health.
Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs, according to a new study in the Journal of Clinical Oncology. In a survey of 1,502 patients, researchers determined that 9 percent of whites, 15 percent of blacks, 17 percent of English-speaking Latinas and 10 percent of Spanish-speaking Latinas reported medical-related debt four years post diagnosis. The study said the findings should “motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.” Read more on health disparities.
Lawsuit Challenges New York City’s Ban on E-Cigarettes
A “smoker’s rights” group called New York City Citizens Lobbying Against Smoker Harassment has filed a legal challenge to the city’s ban on electronic cigarettes—or e-cigarettes—in restaurants, parks and certain other public places. The group contends that since e-cigarettes do not contain tobacco or produce smoke, they should not be subject to New York City’s Smoke-Free Air Act. The city council expanding regulations to include e-cigarettes last year and the U.S. Food and Drug Administration has announced its intention to propose government regulations over their use. In the lawsuit, the group wrote that "E-Cig regulation is, even in the Council's words, at best, tangentially related to the subject of smoking, in much the same way that toy water guns are at best tangentially related to authentic firearms.” However, city council spokeswoman Robin Levine said by email to Reuters that "Our legislation ensures the goals of the Smoke-Free Air Act are not undermined and protects the public against these unregulated substances.” Read more on tobacco.
Today is the 19th annual Kick Butts Day. Organized by the Campaign for Tobacco-Free Kids and sponsored by the United Health Foundation, Kick Butts Day is a day of activism to empower young adults to help decrease tobacco use in the United States. According to Tobacco-Free Kids, tobacco use is the number one cause of preventable death in the United States, killing 480,000 people and costing the nation at least $289 billion in health care bills and other economic losses each year.
This year, Kick Butts Day comes just weeks after the 50thanniversary of the first Surgeon General’s Report on Smoking and Health. A new Surgeon General’s report found that smoking is even more hazardous than previously thought—without urgent action to prevent kids from starting to smoke, 5.6 million U.S. children alive today will die prematurely from smoking-caused deaths.
Nationwide, tobacco companies spend $8.8 billion a year—one million dollars each hour—to market cigarettes and smokeless tobacco products, according to Tobacco-Free Kids. In particular, tobacco companies target youth with magazine ads; store ads and discounts; and fruit- and candy-flavored small cigars that look just like cigarettes.
The United States has cut high school smoking rates by more than half since 1997, but 18.1 percent of high school students still smoke and more than 3,000 kids try their first cigarette each day.
In observance of Kick Butts Day, more than 1,000 events will be held in schools and communities across the country, including:
- A walking tobacco audit in Bellingham, Washington, which lets young people chart how many tobacco retailers and ads they see on their way to school.
- A numbers campaign in Howe, South Dakota to visually display how many people die of tobacco-related causes.
- “They put WHAT in a cigarette?” event in Limestone, Maine to display products such as batteries and hair spray that also contain some of the 7,000 chemicals found in cigarettes.
Actions that encourage young people and adults to stop or never start smoking can happen all year, not just on Kick Butts Day. for Tobacco-Free Kids has a range of activities schools and communities can prepare and present, most at little cost.
>>Bonus Link: A tobacco timeline from the Robert Wood Johnson Foundation highlights important milestones in the fight against tobacco since the release of the first Surgeon General’s report on Smoking and Health fifty years ago.
Under Tobacco Control Act Authority, FDA Orders Stop to Sale, Distribution of Four Tobacco Products
For the first time the U.S. Food and Drug Administration (FDA) has used its authority under the Family Smoking Prevention and Tobacco Control Act to order a stop to the continued sale and distribution of four tobacco products. The FDA ruled that Sutra Bidis Red, Sutra Bidis Menthol, Sutra Bidis Red Cone, and Sutra Bidis Menthol Cone were not “substantially equivalent” to products commercially available as of Feb. 15, 2007. The FDA determined that Jash International did not identify a product by which to assess substantial equivalence, as well as other required information. “Companies have an obligation to comply with the law—in this case, by providing evidence to support an SE application,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products, in a release. “Because the company failed to meet the requirement of the Tobacco Control Act, the FDA’s decision means that, regardless of when the products were manufactured, these four products can no longer be legally imported or sold or distributed through interstate commerce in the United States.” Read more on tobacco.
NGA Releases Report on Prescription Drug Abuse Epidemic
As part of the National Governors Association’s (NGA) 2014 Winter Meeting, NGA Vice Chair Colorado Gov. John Hickenlooper and Alabama Gov. Robert Bentley have released a report, Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy, detailing their year-long look on how to reduce the growing epidemic; prescription drug abuse is the United States’ fastest growing drug problem and the second most-common type of drug abuse for youth ages 12-17. Among the findings:
- Leadership matters
- Prescribing behavior needs to change
- Disposal options should be convenient and cost-effective
- Prescription drug monitoring programs are underused
- Public education is critical
- Treatment is essential
- Data, metrics and evaluation must drive policy and practice
“The abuse of prescription drugs continues to be seen in communities across the nation,” said Hickenlooper. “This initiative helped states develop effective strategies to help decrease the number of individuals who are misusing or abusing prescription drugs and the resulting number of people who are harmed or die.” Read more on prescription drugs.
HHS Issues Proposals for Next Edition of EHR Technology Certification Criteria
The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) has issued proposals for the next edition of the electronic health record (EHR) technology certification criteria. “The proposed 2015 Edition EHR certification criteria reflect ONC’s commitment to incrementally improving interoperability and efficiently responding to stakeholder feedback,” said Karen DeSalvo, MD, MPH, national coordinator for health IT. “We will continue to focus on setting policy and adopting standards that make it possible for health care providers to safely and securely exchange electronic health information and for patients to become an integral part of their care team.” Compliance with the 2015 Edition would be voluntary (if EHR developers are in compliance with the 2014 Edition, they would not need to recertify) and the final rule will be issued later this summer. Read more on technology.
Health care professionals who smoke often represent a significant obstacle to getting patients to stop smoking. Among registered nurses (RNs) in particular—whose population historically has a high percentage of smokers—smoking limits their ability to be strong advocates for cessation interventions. In 2003, Robert Wood Johnson Foundation (RWJF) grantee Linda Sarna, PhD, RN, FAAN, began a study at the UCLA School of Nursing to monitor smoking rates among health care professionals, with an emphasis on RNs. The study showed a significant drop in smoking rates among registered nurses and the results were featured in the January special issue of the Journal of American Medicine, which commemorated the 50th anniversary of the U.S. Surgeon General’s landmark report on the health consequences of smoking.
The UCLA study found that the proportion of registered nurses who smoke dropped by more than a third from 2003 to 2011. While RN smoking rates held relatively steady between 2003 and 2007, they fell from 11 percent in 2007 to 7 percent in 2011. The drop represents a 36 percent decrease in smoking rates among RNs—more than double the 13 percent decline among the general U.S. population during the same time period. The study also found that RNs were more likely to quit smoking than the general population.
Tobacco Free Nurses, an RWJF-funded national campaign led by Sarna and Stella Aguinaga Bialous, DrPH, RN, helped to reduce the prevalence of smoking among RNs. Founded in 2003, the nurse-led program aimed to dissuade nurses from smoking in order to prevent smoking-related health issues among RNs and their patients. Tobacco Free Nurses works by supporting smoking cessation efforts among nurses and nursing students; encouraging nurses to advocate for a smoke-free society; and giving nurses tobacco control resources to help patients with cessation efforts.
In addition to the significant decline among registered nurses, the UCLA study found that smoking rates also fell for most other health care professionals. However, licensed practical nurses (LPNs) did not see any significant decreases. Approximately 25 percent of the LPN population still smokes, which is the highest percentage of smokers among health care professionals.
>>Bonus Link: Learn more about the last 50 years of tobacco control in RWJF’s interactive timeline.
Minimum Alcohol Prices Could Help Low-income, High-risk Drinkers
Setting a minimum price for alcohol would have a positive impact on low-income, high-risk drinkers, but little effect on low-income, moderate drinkers, according to a new study in The Lancet. British researchers at the University of Sheffield utilized a computer model to assess the impact of a 73 cents per unit of alcohol minimum on different demographics, finding it would have the greatest positive impact—reducing the amount of alcohol consumption—on the 5 percent of the population defined as high-risk drinkers. "Our study finds no evidence to support the concerns highlighted by government and the alcohol industry that minimum unit pricing would penalize responsible drinkers on low incomes,” said study co-author Petra Meier, director of the Sheffield Alcohol Research Group. “Instead, minimum unit pricing is a policy that is targeted at those who consume large quantities of cheap alcohol. By significantly lowering rates of ill health and premature deaths in this group, it is likely to contribute to the reduction of health inequalities." Read more on alcohol.
Smoking Linked to Most Common Type of Breast Cancer
Adding yet another health risk to the use of tobacco, smoking is linked to an increased risk for the most common type of breast cancer, according to a new study in the journal Cancer. Researchers at the Fred Hutchinson Cancer Research Center in Seattle conducted a population-based study of 778 patients, ages 20-44, with estrogen receptor positive breast cancer (the most common type) and 182 patients with triple-negative breast cancer; there were 938 cancer-free controls. They found that women who were current or recent smokers and had been smoking a pack a day for at least 10 years had a 60 percent increased risk of estrogen receptor positive breast cancer. "The health hazards associated with smoking are numerous and well known. This study adds to our knowledge in suggesting that with respect to breast cancer, smoking may increase the risk of the most common molecular subtype of breast cancer but not influence risk of one of the rarer, more aggressive subtypes," said Christopher Li, MD, PhD. Read more on cancer.
Low Testosterone Drugs Can Double Heart Attack Risk in Some Men
Ads asking men about their “low T”—or low testosterone levels—have become so common of late that in 2013 sales of the testosterone gel Androgel exceeded those of Viagra. However, a recent study indicates that men under the age of 65 with a history of heart disease see their heart attack risk double shortly after beginning testosterone therapy. The joint study from the UCLA Fielding School of Public Health, the National Institutes of Health and Consolidated Research Inc. appears in the journal PLOS ONE. Researchers decided to perform this larger study after three smaller studies raised concerns about the connection. "We decided to investigate cardiovascular risks of this therapy in a large health care database since these previous studies were modest in size and only focused on men 65 and older," said the study's senior author, Sander Greenland, MD, a professor of epidemiology at the UCLA Fielding School of Public Health and a professor of statistics in the UCLA College of Letters and Science. "Our study allowed us to examine cardiovascular risk in men under the age of 65 and to replicate the findings in men over 65." Read more on heart health.
The announcement by CVS Caremark this morning that it will stop selling cigarettes and other tobacco products at its more than 7,600 CVS pharmacy stores across the United States by October 1, 2014, does more than just end an outlet for smokers. It also removes a highly effective marketing tactic from those stores, the tobacco "power wall," which is aimed at enticing current and would-be smokers—especially children and teens—to smoke.
Most retail food and sundry stores include the colorful display walls, which are usually designed by tobacco companies who also often provide financial incentives to store owners to keep the walls stocked. A report, updated in 2012, by the Center for Public Health and Tobacco Policy which is funded by the New York State and Vermont departments of Health, says the power walls “are highly engineered by tobacco companies to maximize visual intrusiveness and instigate impulse purchases.” The report adds that the walls “function as a subtle kind of advertising, conveying the message that cigarettes are popular and desirable."
A 2006 study in the journal Heath Education Research found that “[t]he presence of cigarette displays at the point-of-sale... has adverse effects on students’ perceptions about ease of access to cigarettes and brand recall, both factors that increase the risk of taking up smoking.”
And, according to a November report on point of sale displays by the Campaign for Tobacco-Free Kids, exposure to point of sale tobacco product displays “influences youth smoking, promotes the social acceptability of tobacco products, increases impulse tobacco purchases and undermines quitting attempts.”
While San Francisco and a few other cities have passed laws that ban cigarette sales in pharmacies, and the advocacy group Americans for Nonsmokers' Rights is working to expand that ban, no U.S. jurisdictions have ended displays of tobacco products according to tobacco control legal experts, generally because of concern that they might be sued by tobacco companies claiming an infringement of the companies’ right to commercial free speech under the U.S. Constitution. Recently, tobacco control legal experts have said tobacco company suits likely have less merit since the 2009 law giving regulation of most U.S. tobacco products to the Food and Drug Administration.
But tobacco control advocates hope other major pharmcies will follow the CVS example, since leveraging the power of private companies to support a culture of health may be a far more effective way to bring down those walls.
>>Read a statement by Robert Wood Johnson Foundation president Risa Lavizzo Mourey on the CVS Caremark decision to stop selling cigarettes in its stores.