Category Archives: Tobacco
Tobacco featured prominently as a public health issue at the American Public Health Association (APHA) meeting this week, including a regulatory update from Mitch Zeller, JD, who became director of the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products earlier this year. Zeller previously worked on tobacco issues in government as associate commissioner and director of FDA’s first Office of Tobacco Programs, and also as a U.S. delegate to the World Health Organization (WHO) Working Group for the Framework Convention on Tobacco Control.
NewPublicHealth spoke with Zeller ahead of the APHA meeting.
Mitch Zeller: I think most broadly my goals are to help give the center and the agency the greatest chance of fulfilling the public health mission behind the law passed in 2009 giving the Food and Drug Administration authority over tobacco. This really is an important piece of legislation. It’s really stunning that in 2013—with everything that we know about the harms associated with tobacco use—that it remains the leading cause of preventable death and disease both in this country and globally.
There are some very powerful tools that Congress has given FDA to use wisely and supported by evidence. That’s where I think, the greatest opportunity lies: to use the tools relying on regulatory science to try to protect consumers and reduce the death and disease toll from tobacco.
There are two areas where I think these tools can make a profound positive impact on public health. The first is something called product standards, which is basically the power to ban, restrict or limit the allowable levels of ingredients in tobacco or tobacco smoke. We are exploring potential product standards in three areas: toxicity, addiction and appeal. And we are funding research in all three areas and working very hard behind the scenes to find out what our options are for potential product standards in those three areas.
Firearm Injuries Cost $16B in U.S. Health Care in Less than a Decade
Firearm injuries cost more than $16 billion in hospital care between from 2000 to 2008, according to new research to be presented today at the American Public Health Association’s 141st Annual Meeting in Boston. The 275,939 victims spent approximately 1.7 million days in the hospital, for an average stay of 6.7 days and an average cost of medical treatment of $59,620. About one in three patients did not have insurance. “The impact is probably much higher than $16 billion since the years of life lost, disability, lack of productivity, societal well-being and emotional turmoil associated with such injuries is far-reaching,” said Min Kyeong Lee, DMD, Annual Meeting presenter. “This is one of the foremost reasons why health care costs in this country have gotten out of control and underlies the need for better preventive policies.” Read more on violence.
Study: Secondhand Smoke in the Workplace Down Overall, But Certain Groups Still at Risk
While recent policies and regulations have helped reduce the overall exposure rates of secondhand smoke in the workplace, certain professions continue to experience high rates, according to new findings to be presented today at the American Public Health Association’s 141st Annual Meeting. The study looked at exposure rates in Massachusetts since 2004, when its Smoke-Free Workplace Law was enacted to require all enclosed workplaces to be smoke free. However, that means that workers in installation, repair and maintenance still experience an overall secondhand smoke exposure rate of 37.4 percent; the national rate in 2010 was 5.4 percent. “We’re seeing a steady decline in prevalence of exposure, but it’s clear that there are still specific groups of workers that deserve our attention,” said Kathleen Fitzsimmons, MPH, lead researcher of the study. “Findings like these that combine information about occupation and environmental tobacco smoke provide helpful information for evaluating comprehensive statewide smoke-free workplace laws and for targeting interventions to reduce risks.” Read more on tobacco.
Study: HPV Screenings Better than Pap Tests at Protecting Against Invasive Cervical Cancer
Human papillomavirus (HPV) screenings are both more effective than Pap tests when it comes to screening against invasive cervical cancer, according to a new study in the journal The Lancet. Researchers analyzed the results of four clinical trials in Europe covering more than 175,000 women ages 20 to 64. The studies tracked them women for an average of 6.5 years after one of the screening types, finding that they were about equal in protection levels for the first 2.5 years, but that following that short time frame HPV screening provided as much as 70 percent greater protection. The findings were particularly significant in women ages 30 to 35. Read more on cancer.
New York City Council Votes to Raise Tobacco-purchasing Age to 21
With studies repeatedly showing that the earlier someone begins smoking, the more likely they are to become addicted, the New York City Council has voted to raise the age minimum required to buy tobacco products from to 21 years, up from 18 years. The bill passed 35-11. Mayor Michael R. Bloomberg has already announced he will sign the bill. The law would apply to all tobacco products, including cigarettes, electronic cigarettes, cigars and cigarillos. “This is literally legislation that will save lives,” said Christine C. Quinn, the Council speaker, according to The New York Times. The Council also voted to increase the penalties for retailers who evade tobacco taxes; for a prohibition on discounts for tobacco products; and for a minimum price of $10.50 a pack for cigarettes and little cigars. Read more on tobacco.
Analysis: Sports-related Youth Concussion Diagnoses Climbing
The growing number of diagnosed concussions in young athletes and their reluctance to admit when they have suffered a head injury—despite ever-growing awareness of the dangers of concussions—demonstrates the need for sports leagues and government agencies to become more active in preventing traumatic brain injuries, according to a new report from the Institute of Medicine and the National Research Council. In 2009, about 250,000 youth ages 5-21 were treated for sports-related concussions and other brain injuries in U.S. hospitals, up from approximately 150,000 in 2001. The analysis pointed to Hannah Steenhuysen, a high school soccer goalie in Rehoboth, Massachusetts, as an example of why relying on youth to report their head injuries on their own is not always an effective strategy. "You don't tell anyone usually when you get a headache because you don't want to be out of the game," she said. "I couldn't watch TV or text or even read—it was really tough. When I tried to go back to school, I couldn't keep up and everything got jumbled in my head." Read more on injury prevention.
Tips for Kids with Food Allergies on Halloween
Trick-or-treating and Halloween parties can be difficult for kids with food allergies. However, there are steps both kids and parents can take to make sure kids with food allergies still have a full night of fun, according to Joyce Rabbat, MD, a pediatric allergy specialist with the Loyola University Health System, in Chicago. "The key is education,” she said. “Make sure your child knows what he or she can eat. When in doubt, throw it out." Among her tips:
- Plan parties and events that do not include food, candy or other edible treats.
- Inform the host of any Halloween party if your child has a food allergy. You can also provide a list of foods that may trigger an allergic reaction.
- Clean all cooking utensils, pans or other dishes if they have been in contact with a food allergen. Also make sure to wipe down surfaces.
- Read labels to find out whether foods contain allergens or have been made on the same machine as other products that contain an allergen.
- Carry self-injectable epinephrine.
Read more on food safety.
On First Anniversary, States Still Helping Residents Displaced and Impacted by Hurricane Sandy
Flags will fly at half mast in New York State and other regions of the Northeast today as residents mark the one year anniversary of the day that Hurricane Sandy made landfall. New York, New Jersey, and Connecticut—which saw dozens killed and hundreds injured—continue to help residents rebuild and recover from injuries, loss of homes and loss of businesses. Read more about Hurricane Sandy.
AAP: Parental ‘Media Use Plans’ Needed to Limit Kids’ Time in Front of TVs, Other Screens
Parents should create a “media use plan” that limits kids’ screen time to no more than two hours per day, as well as keeps television and Internet access out of their bedrooms, according to a new policy statement from the American Academy of Pediatrics (AAP) Council on Communications and Media. Marjorie Hogan, MD, one of the statement's lead authors, said the issue isn’t television and other media access overall, but the fact that excessive media use been linked to obesity, sleep problems, school problems and aggression; the average child spends about eight hours each day in front of various screens. The key is for parents to find a balance between the positives and negatives of media. "We're not media-bashers," said Hogan. "We love media…For teens, connectivity, being connected to your peers, having a chance to create your persona, can be a really positive thing.” Read more on pediatrics.
Study: Smokers Most Likely to Think About Quitting on Mondays
An analysis of online searches related to smoking cessation shows that smokers are most likely to think about quitting smoking on Mondays, which could give anti-tobacco efforts a new way to make anti-smoking campaigns more effective by enacting weekly cues to remind smokers to keep trying on Mondays, according to a new study in JAMA Internal Medicine. Researchers found the number of Monday searches was 25 percent higher than the combined average of the rest of the days of the week; the findings were the same for searches conducted in English, French, Chinese, Portuguese, Russian and Spanish. "Popular belief has been that the decision to quit smoking is unpredictable or even chaotic," said study lead author John Ayers, of San Diego State University."By taking a bird's-eye view of Google searches, however, we find anything but chaos. Instead, Google search data reveals interest in quitting is part of a larger collective pattern of behavior dependent on the day of the week." Read more on tobacco.
HHS: $8M in Research Grants to Support Hurricane Sandy Recovery
The U.S. Department of Health and Human Services (HHS) has awarded more than $8 million in research grants to support the long-term recovery of areas of the country damaged by Hurricane Sandy in late 2012. The grants, which are part of the Hurricane Sandy Recovery and Rebuilding Supplemental Appropriation Act of 2013, will go toward research on issues such as community resilience; risk communications and the use of social media; health system response and health care access; evacuation and policy decision making; and mental health. “We hope the grants provide a catalyst for the scientific community to put more emphasis on the study of recovery from disasters; much more research is needed to support decision making in the long-term recovery process and ultimately to improve resilience,” said Nicole Lurie, MD, HHS assistant secretary for preparedness and response. “We anticipate that the findings not only will help community leaders make evidence-based decisions about recovery plans and policies in affected areas but also that the knowledge gained can improve resilience across the entire country.” Read more on disasters.
NIH, CDC Launch National Registry on Sudden Deaths in the Young
The U.S. National Institutes of Health (NIH) and the U.S. Centers of Disease Control and Prevention have come together in the launch of the Sudden Death in the Young Registry. The registry will catalogue conditions such as heart disease and epilepsy in order to help researchers better understand the issues and establish future research priorities. According to the NIH, up until now there have not been agreed upon standards or definitions for reporting these deaths, which has impeded efforts to determine the best prevention efforts. "The sudden death of a child is tragic and the impact on families and society is incalculable," said Jonathan Kaltman, MD, chief of the Heart Development and Structural Diseases Branch within the Division of Cardiovascular Sciences at the NIH's National Heart, Lung, and Blood Institute. "This registry will collect comprehensive, population-based information on sudden unexpected death in youths up to age 24 in the United States. It is a critical first step toward figuring out how to best prevent these tragedies." Read more on research.
Mother’s Smoking During Pregnancy Increases Infant’s Risk of Infections, Death
Mothers who smoked during pregnancy are more likely to have children who are at increased risk for hospitalization and death during infancy, according to a new study in the journal Pediatric Infectious Diseases. The study analyzed hospital records and death certificates of approximately 50,000 Washington state infants born between 1987 and 2004. Researchers say a weakening of the child’s immune system may be responsible for the heightened risk. "We've known for a long time that babies born to mothers who smoke during pregnancy are at high risk for serious medical problems relating to low birth weight, premature delivery and poor lung development," said lead author Abigail Halperin, MD. "While respiratory infections have been recognized as a common cause of these sometimes life-threatening illnesses, this study shows that babies exposed to smoke in utero [in the womb] also have increased risk for hospitalization and death from a much broader range of infections—both respiratory and nonrespiratory—than we knew before.” Read more on tobacco.
GAO Recommends FDA Set Schedules for Decisions on New Tobacco Products
The General Accounting Office issued a report yesterday recommending that the U.S. Food and Drug Administration (FDA) establish performance measures for the Center for Tobacco Products that include time frames for making decisions on the approval of new tobacco product submissions. The FDA has had authority over tobacco for more than four years, but a backlog remains on new tobacco products the agency must approve. New tobacco products applications submitted to the agency include devices that may deliver less nicotine to people who smoke. In a response to a draft of the GAO report, the FDA noted that the GAO report recognized that “the length of time from the end of jurisdiction review to the end of completeness review decreased from 8 months in FY2011 to 2 months in FY2012. This constitutes considerable progress and is a reflection of CTP’s ongoing commitment to shortening review times.” Read more on tobacco.
American Heart Association: Unlock School Gates
A new policy statement from the American Heart Association (AHA), published in the American Journal of Public Health, says school districts can increase physical activity among children and young adults by opening playgrounds, gyms and playing fields to the community outside of school hours, especially in low-income areas. AHA recommends that school districts enter shared-use agreements with community organizations to allow supervised activities such as sports leagues and unsupervised playing on school grounds. When previously locked schoolyards in two lower-income communities in New Orleans were opened and activities supervised, children’s outdoor physical activity was 84 percent higher than in a community with closed schoolyards, according to research cited in the statement. A U.S. Centers for Disease Control and Prevention survey finds that 61.6 percent of 800 school districts surveyed have a formal agreement for use of their facilities. Increasing shared use agreements is a key goal of Voices for Healthy Kids, a collaboration of the American Heart Association and the Robert Wood Johnson Foundation to reverse the current levels of childhood obesity by 2015. Read more on physical activity.
DOT Announces Funding to Improve Transit Safety and Preparedness
The U.S. Department of Transportation has announced the availability of $29 million in research funds for innovative projects to help transit agencies strengthen operational safety; better withstand natural disasters and other emergencies; and improve emergency response capabilities. “For the first time in FTA’s history, we’re calling on the transit industry, the private sector, universities and others to work with us to develop and implement innovative solutions…bringing transit facilities into a state of good repair,” said Federal Transit Administration (FTA) head Peter Rogoff. “This will translate into real-world improvements…ranging from reducing transit-related injuries to making transit systems less vulnerable to flooding and severe weather.” Funding proposals will be considered in three areas: operational safety; resiliency; and all-hazards emergency response and recovery. Read more on transportation.
Administration: Half a Million Have Applied for Health Insurance Under Affordable Care Act
Despite problems with the Healthcare.gov online portal, approximately half a million people have applied for health insurance under the Affordable Care Act. Enrollment for all 50 states and the District of Columbia opened on October 1. As many as 7 million uninsured Americans are ultimately expected to receive coverage through the program. However, as soon as the site launched users began to experience error messages and other technological glitches; the administration pointed to the unexpectedly high volume of visitors as the reason for the problems. "The website is unacceptable, and we are improving it, but the product is good and across the country people are getting access to affordable care starting January 1," said an administration spokesperson, according to Reuters. On the other hand, an article in Politico points out that the numbers being reported are only a piece of the puzzle because the number of people who applied does not equate to the number of people who "actually completed the process of choosing and enrolling in a health plan." And, according to Politico, "Extensive 'glitches'...with the online marketplaces known as exchanges have made it impossible for most people to get all the way through the signup process, even after filling out the initial online application."Read more on the Affordable Care Act.
Study: Friendships Formed on Social Networking Sites Can Help Smokers Quit
The strong supportive bonds formed on social networking sites can help people in their efforts to quit smoking, according to a new study in the Journal of Communication. "I found that people who join health-based social networking sites are able to quit smoking and abstain for longer periods of time because of the sense of community they build with other members," said study author Joe Phua, an assistant professor in the department of advertising and public relations at the University of Georgia's Grady College of Journalism and Mass Communication. Researchers surveyed 252 members of six health-centric websites, finding that the friendships formed online “seemed to boost users' sense of empowerment with respect to their ability to stop smoking for good,” according to HealthDay. Phua said the online support sites are effective because they are cheap and easy to access, while also providing a connection to “a larger and credible community” of people working to quit tobacco. Read more on tobacco.
Study: Spankings Tied to More Behavior Problems in Elementary School
Spankings of five-year-old children are tied to increased behavior problems in elementary school, according to a new study in the journal Pediatrics. Led by Michael MacKenzie, from Columbia University in New York, the researchers analyzed long-term data on approximately 1,900 children, finding that spankings by moms at least twice a week were tied to a two-point increase on a 70-point scale of problem behavior. They also found that regular spankings by fathers were tied to lower scores on vocabulary tests. Elizabeth Gershoff of the University of Texas at Austin, who was not a part of the study, said that while the findings are difficult to interpret, "There's just no evidence that spanking is good for kids. Spanking models aggression as a way of solving problems, that you can hit people and get what you want,” she said. “When (children) want another kid's toy, the parents haven't taught them how to use their words or how to negotiate." Read more on violence.
Study: Top Athletes Endorse Junk Food More Often Than Healthy Food
A new study of professional athletes’ food and beverage endorsements found that more often than not their paid support is given to products that are energy-dense and nutrient-poor, according to a new study in the journal Pediatrics. The study looked at 512 brands endorsed by 100 different athletes, finding that “Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense” and “93.4% of the 46 advertised beverages had 100% of calories from added sugar.” Denver Broncos player Peyton Manning and Miami Heat player LeBron James had the most endorsements for the energy-dense, nutrient-poor food and beverages. "I hope this paper inspires some reflection on the part of America's athletes and professional sports leagues, as well as all other celebrities for that matter,” said Center for Science in the Public Interest Executive Director Michael F. Jacobson, in a statement. Read more on nutrition.
U.S. Task Force Recommends Against Blood Pressure Screening for Kids, Teens
Despite recommendations from several expert groups, the U.S. Preventive Services Task Force is not recommending that health care professionals respond to the growing obesity crisis by screening children and teens for high blood pressure. The panel concluded that more study into the issue is needed, and that in the mean time there are other, known avenues toward lowering youth obesity and improving cardiovascular health. "We don't know if lowering blood pressure in youth leads to improved cardiovascular health in adulthood,” said panel member Kirsten Bibbins-Domingo, MD. “We also don't know the long-term benefits and harms for children and adolescents who initiate blood pressure medications when they are young. While there is much we don't know, we do know that eating a healthy diet, being active, and maintaining a normal weight are ways children and teens can improve their cardiovascular health." Read more on heart health.
Study: Tobacco Advertisements Connecting with Young Kids in Many Low-, Middle-income Countries
The global pervasiveness of tobacco advertisements means that most very young children in many low-and middle-income countries are familiar with cigarette brands, and nearly 70 percent of kids ages 5 and 6 can identify at least one cigarette logo, according to a new study in the journal Pediatrics. The study is from the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. The findings demonstrate the significant steps countries and public health organizations still need to take to limit the influence of tobacco ads. “Evidence-based strategies exist to reduce the ability of tobacco companies to market their products to children, such as implementing and enforcing bans on tobacco advertising, promotion and sponsorship,” said Joanna Cohen, PhD, co-author of the study and director on the institute. “Putting large picture warnings on the front and back of cigarette packs and requiring plain and standardized packaging, as Australia has done, also helps to reduce the attractiveness of cigarette packs among young children.” Read more on global health.
State AGs Urge FDA to Adopt New Regulations Covering E-cigarettes
The Attorneys General of 41 states are urging the U.S. Food and Drug Administration (FDA) to follow through on a pledge to issue regulations that would expand its oversight to include e-cigarettes. In a letter to FDA Commissioner Margaret Hamburg, they asked “the FDA to move quickly to ensure that all tobacco products are tested and regulated to ensure that companies do not continue to sell or advertise to our nation's youth.” The FDA was given authority to regulate cigarettes, cigarette tobacco and roll-your-own tobacco in 2009, as well as the authority to expand its authority after it issued new regulations. Last week a similar plea related to FDA authority was made to President Obama by the American Academy of Pediatrics and 14 other public health organizations, including the American Lung Association and American Heart Association. E-cigarettes continue to increase in sales (a projected $1.7 million in 2013) even while dropping in price. At the same time, there are no advertising restrictions for e-cigarettes. "Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes,” according to the Attorneys General’s letter. Read more on tobacco.
Expert: People Should Get Now-available Flu Vaccine As Soon As Possible
This season’s influenza vaccine is now available and people shouldn’t hesitate to go ahead and get it, according to Stephen Russell, MD, associated professor in the general internal medicine division at the University of Alabama at Birmingham and a lead physician at the university’s Medicine Moody Clinic. This year’s vaccine protects against four types of flu viruses (as opposed to the three of previous vaccines) and comes as either a traditional shot or a nasal spray. "Contrary to some beliefs, getting the flu shot in September is a good thing and will offer protection for the entirety of the flu season," he said. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people ages 6 months and older, particularly for seniors, pregnant women, caregivers and people with chronic medical conditions. "Many people will say they do not need the vaccine, as they have never had the flu before, but that is like saying you don't need to wear your seatbelt because you have never had a wreck," Russell said. "You may have been fine in the past, but that should not offer security or protection for future exposures to the flu." Read more on influenza.
Study: Losing 10 Percent of Weight Can Greatly Reduce Arthritic Knee Pain, Put Off Knee Replacement
Losing just 10 percent of their weight could go a long way toward easing the knee pain from osteoarthritis in overweight and obese people ages 55 and older, according to a new study in the Journal of the American Medical Association. That would mean better knee function, improved mobility, enhanced quality of life…and reducing the odds of needed a knee replacement. "We've had a 162 percent increase in knee replacements over the last 20 years in people 65 and over, at a cost of $5 billion a year," said lead author Stephen Messier. "From our standpoint, we think this would be at least a good way to delay knee replacements and possibly prevent some knee replacements." The study tracked 454 overweight and obese people in three groups—diet-only, exercise-only and a combination—finding that people who did the combination were the most successful at losing weight and thus reducing knee pain. "We're not talking about people getting down to ideal body weight," said Patience White, MD, the Arthritis Foundation’s vice president of public policy and advocacy. "They just have to lose 10 percent of their total weight. Someone who is 300 pounds only needs to lose 30 pounds. I think that's within reach for people." Read more on obesity.
CDC: ‘Tips From Former Smokers’ Campaign Created Spikes in Quitline Calls, Website Visits
An additional 150,000 U.S. smokers called the tobacco cessation helpline 1-800-QUIT NOW as a direct result of the U.S. Centers for Disease Control and Prevention's (CDC) 2013 “Tips From Former Smokers” campaign, which ran for 16 weeks, according to CDC’s latest Morbidity and Mortality Weekly Report. That’s an increase of about 75 percent. It also generated approximately 2.8 million visits to the campaign website, or a nearly 38-fold increase. "The TIPS campaign continues to be a huge success, saving tens of thousands of lives and millions of dollars; I wish we had the resources to run it all year long," said CDC Director Tom Frieden, MD, MPH. "Most Americans who have ever smoked have already quit, and most people who still smoke want to quit. If you smoke, quitting is the single most important thing you can do for your health – and you can succeed!" A recent study in The Lancet concluded that the campaign helped as many as 100,000 people quit smoking permanently. Read more on tobacco.
FDA, NIH Award as Much as $53M for 14 Tobacco Regulation Research Centers
The U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) have joined together to award as much as $53 million in funding to create 14 Tobacco Centers of Regulatory Science (TCORS). The first-of-its-kind program will bring together a diverse array of scientists, public health experts, communications veterans and marketing experts to generate research to inform the regulation of tobacco products to protect public health. “While we’ve made tremendous strides in reducing the use of tobacco products in the U.S., smoking still accounts for one in five deaths each year, which is far too many,” said NIH Director Francis S. Collins, MD, PhD. “FDA/NIH partnerships like the Tobacco Centers of Regulatory Science keep us focused on reducing the burden and devastation of preventable disease caused by tobacco use.” Read more on research.
Overweight, Underweight Pregnant Women See More Complications and Longer Hospital Stays
Pregnant women who are either too thing or too heavy as measured by body-mass index (BMI) are at increased risk for complications and additional hospitalization, according to a new study in BJOG: An International Journal of Obstetrics and Gynaecology. Women with higher BMIs saw increased complications; severely obese women were three times as likely as normal weight women to have high blood pressure and gestational diabetes, as well as longer overall hospitalizations. Lower-weight women also had higher rates of additional hospitalization (8 percent) compared to normal-weight women, though not as high as the rates for overweight and obese women. The findings indicate the need to fine and implement new approaches to combating obesity. "Longer-term benefits of reducing maternal obesity will show improvements, not only in the health outcomes of mothers and their babies, but the workload and cost to current maternity services," said study co-author Fiona Denison, MD, of Queens's Medical Research Institute in Edinburgh. Read more on maternal and infant health.