Category Archives: Tobacco
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.
FDA’s ‘The Real Cost’ Multimedia Campaign to Graphically Depict the Health Consequences of Smoking
The U.S. Food and Drug Administration (FDA) has launched a new national public education campaign combating youth tobacco use. “The Real Cost” multimedia campaign—with television, radio, print, online and out-of-home advertising—brings together vivid imagery and compelling facts to graphically depict the health consequences of smoking, such as tooth loss and skin damage. The new campaign, which will run in 200 U.S. markets for at least 12 months, targets the 10 million kids ages 12 to 17 who have never smoked, but are at risk, as well as kids who have experimented with smoking. “We know that early intervention is critical, with almost nine out of every ten regular adult smokers picking up their first cigarette by age 18,” said FDA Commissioner Margaret A. Hamburg, MD. Each day, more than 3,200 youth under ages and younger try their first cigarette and more than 700 become daily smokers. Read more on tobacco.
HHS Expands Patient Access to Lab Records
The U.S. Department of Health and Human Services (HHS) is expanding patient access to health records by allowing patients, or their designated “personal representative,” access complete test reports from laboratories. The final rule also eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 Privacy Rule to a patient’s right to access protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory. “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” said HHS Secretary Kathleen Sebelius. “Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.” Read more on access to health care.
Study: Climate Change Could Mean Significantly More Heat-related Summer Deaths
The combination of climate change and the growing elderly population could mean a dramatic increase in the number of heat-related summer deaths over the next decades, according to a new study in the Journal of Epidemiology and Community Health. Using data on weather patterns and death rates from 1993 to 2006, researchers at the London School of Hygiene and Tropical Medicine, and Public Health England, concluded that if no preventive measures are taken then the number of 2,000 annual heat-related deaths in England and Wales will climb 257 percent by the 2050s, while the number of 41,000 deaths related to cold will fall two percent. People ages 75 and older are at the greatest risk. Preventive measures could air conditioning, as well as more sustainable options such as shading and changes in building insulation and construction materials. Read more on the environment.
Study: HPV Vaccine Doesn’t Lead to More, Riskier Sex for Young Women
Despite the concerns of some parents, being vaccinated against the human papillomavirus (HPV)—which causes cervical cancer—does not increase young women’s sexual behavior, either in terms of the number of partners or the decision not to use condoms, according to a new study in the journal Pediatrics. Researchers studied 339 women between the ages of 13 and 14, finding that after receiving the first vaccine most agreed it was still necessary to generally practice safe sex. On a scale from zero to 10, where lower scores indicate better understanding of risks, they scored an average of 1.6 on knowledge about safe sex practices. They also scored a 3.9 on their perceptions of the risk of sexually transmitted infections. "To me, the issue is laid to rest," said Jessica Kahn, MD, of the Cincinnati Children's Hospital Medical Center in Ohio. "As clinicians and researchers, we have no concerns that vaccination will lead to riskier sexual behaviors." The U.S. Centers for Disease Control and Prevention recommends HPV vaccinations for both boys and girls. Read more on sexual health.
CDC Set to Launch 2014 ‘Tips From Former Smokers’ Campaign
The U.S. Centers for Disease Control and Prevention (CDC) is set to launch the 2014 phase of "Tips From Former Smokers" (Tips), its annual television, radio and print campaign. The campaign will include Terrie Hall, the then 52-year-old Lexington, N.C., woman shown in a previous ad who had ultimately had her voice box removed as a result of throat cancer caused by a two-pack-a-day habit for 23 years. She since died of tobacco-related illness. "Over 20 million Americans have died because of smoking since 1964...But when you talk about a number that big, people have no way to put their hands around it,” said Tim McAfee, MD, the Atlanta-based director of the CDC's office on smoking and health."So we thought that for smokers and non-smokers, we needed to put a face on this. Because we felt that if we gave the American people an opportunity to get to know the suffering one person has had to go through because of smoking, it could have an enormous impact." Read more on tobacco.
FDA Proposes New Sanitation Rules for Food in Transport
The U.S. Food and Drug Administration (FDA) has proposed new regulations to improve sanitation and prevent contamination of human and animal food during transportation by both motor vehicles and rail. The new rule would be the final major rule in the FDA Food Safety Modernization Act’s central framework. “We are now one step closer to fully implementing the comprehensive regulatory framework for prevention that will strengthen the FDA’s inspection and compliance tools, modernize oversight of the nation’s food safety system, and prevent foodborne illnesses before they happen,” said Michael R. Taylor, the FDA’s deputy commissioner for foods and veterinary medicine. The new criteria would address areas such as properly refrigerating food, adequately cleaning vehicles between loads and properly protecting food during transportation. Read more on food safety.
A tobacco history timeline published today by the Robert Wood Johnson Foundation showcases a decrease in smoking among adults, from 42.2 percent in 1965, shortly after the release of the first Surgeon General’s Report on Smoking and Health in 1964, to about 18 percent today. More than just a repository of changes in smoking rates over the years, 50 Years of Tobacco Control is an interactive look at the events and actions that have prevented more than eight million premature deaths in the ongoing fight to keep communities safe from the dangers of tobacco.
The timeline offers interviews with today’s tobacco control leaders—people such as John Sefrin, the Chief Executive Officer of the American Cancer Society, and Matthew L. Myers, President of the Campaign for Tobacco-Free Kids—who have made enormous strides in tobacco control and have a bold vision for tobacco reduction in the future. While scrolling through the major tobacco control milestones of the last 50 years, viewers can examine historical cigarette advertisements, reports and photos.
The Tobacco Timeline is an excellent resource for understanding the last 50 years of tobacco control, as well as the ambitious goals that health advocates have set for the future. While eight million premature tobacco-related deaths have been prevented by tobacco control efforts, up to 20 million have been lost in the same time frame.
Although smoking rates have dramatically declined, there is much more to the story. At a White House event to release the new Surgeon General’s report, U.S. Secretary of Health and Human Services Kathleen Sebelius shared some urgent facts from the report, including the projection that “approximately 5.6 million American children alive today—or one out of every 13 children under age 18—will die prematurely from smoking-related diseases unless current smoking rates drop.”
The new report ticks off new hazards of smoking in the last fifteen years, including new findings that show more diseases linked to smoking than previously reported including diabetes, colorectal cancer, liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration and strokes caused by secondhand smoke. Additionally, according to the report, cigarettes themselves are more lethal than they were fifty years ago.
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 firstname.lastname@example.org 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.