Category Archives: Tobacco
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.
A study published in The Lancet yesterday by researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that the CDC’s 2012 first-ever tobacco cessation ad campaign, Tips From Former Smokers, can take credit for more than 200,000 U.S. smokers quitting immediately during a three-month ad blitz—with an estimated 100,000 of those former smokers predicted to quit permanently.
The study was done using a web survey with thousands of smokers and non smokers, most of whom had seen or heard the ads that were broadcast on radio, television and the Internet, as well as posted on billboards and in publications. The ads, which included quit-line phone numbers and quit-line web links, featured former smokers, many permanently disabled from the effects of years of smoking. Brandon, 31, one of the former smokers in the campaign, began smoking at 15. At 18, doctors diagnosed Buerger’s disease, a vascular condition that was linked to his tobacco use and resulted in the amputation of both legs and several fingertips.
Terrie, 52, whose video ad has been viewed more than any other CDC video, had her larynx removed after years of smoking caused both oral and throat cancer. Terrie speaks through an artificial voice box. Her “tip” to smokers is to record lullabies and stories for their children now, before they lose their voices to cancer and can no longer read a children’s book with their own voice.
In a conference call with reporters yesterday, Lisha Hancock, 38, said that she started smoking when she was 21 years old and was soon up to as many as two packs a day.
“I tried to quit many times. But it wasn't until I saw Terrie's ad on the Tips for Former Smokers campaign that I was really able to quit for good,” she said. “It broke my heart to see what Terrie was going through, but because of her, I will never smoke again. My son…had a lot to do with it. He was actually very interested in the ads himself. I'm not sure if it was because of her voice or because it was something different than what we normally see on television. But his question for me was why does she sound like that? And then when I replied because she smoked, he asked if mommy would sound like that…I could see myself in her shoes had I continued to smoke.”
CDC’s ‘Tips From Former Smokers’ Campaign Helped 200,000 Quit
The U.S. Centers for Disease Control and Prevention’s (CDC) three-month “Tips From Former Smokers” national ad campaign helped more than 200,000 Americans quit smoking immediately, with an estimated 100,000 expected to quit permanently, according to a new CDC study in The Lancet. About 1.6 million smokers attempted to quit because of the campaign, which featured powerful—and real—stories of former smokers living with smoking-related diseases and disabilities, which encouraging people to call the toll-free 1-800-QUIT-NOW. The results far exceeded CDC’s initial goals. “Quitting can be hard and I congratulate and celebrate with former smokers—this is the most important step you can take to a longer, healthier life,” said CDC Director Tom Frieden, MD, MPH. “I encourage anyone who tried to quit to keep trying—it may take several attempts to succeed.’’ Read more on tobacco.
White House Honors ‘Champions of Change’ in Public Health, Prevention
The White House this week is honoring eight “Champions of Change” in the world of prevention and public health. The weekly event is meant to highlight and honor Americans who “are doing extraordinary things in their communities to out-innovate, out-educate, and out-build the rest of the world.” This week focuses on people who are working in the field of public health on everything from childhood obesity to reducing health disparities to fighting healthcare-acquired infections. “These leaders are taking innovative approaches to improve the health of people in their communities—and showing real results,” said Jeffrey Levi, PhD, executive director of Trust for America’s Health. “Prevention is one of the most common-sense ways we can save lives and reduce healthcare costs, and the efforts of these champions show how to put prevention to work in effective ways.” Read more on faces of public health.
Small Changes to Kids’ Routines Can Reduce Childhood Obesity
Small changes in the home environment, such as limiting the time spent in front of the television and increasing the time spent sleeping, can help reduce childhood obesity, according to a new study in the journal Pediatrics. The simple routine changes led to a slower rate of weight gain in children ages 2 to 5 (the children obviously still gaining weight overall because they were growing). After six months on the new routine, participants saw their body mass index (BMI) drop, for a healthier rate of weight gain. About 17 percent of U.S. youth are obese, with lower-income kids at highest risk, according to the U.S. Centers for Disease Control and Prevention. Thomas Robinson, MD, a professor of pediatrics and medicine at Stanford University and Lucile Packard Children's Hospital at Stanford, who was not involved in the study, said the findings were significant for the fight against childhood obesity. "These behaviors and BMI have not been easy to change in a world where junk food and screen time are so heavily marketed, and families are dealing with tremendous financial and social challenges," he said. "I think it is exciting to see studies like this one showing positive results." Read more on obesity.
Study: E-cigarettes May Be as Effective as Nicotine Patches at Aiding Tobacco Cessation
E-cigarettes may be as effective as nicotine replacement therapy patches at helping people to reduce or quit smoking, according to a new study in the journal The Lancet. E-cigarettes are a hotly contested subject, with some seeing them as a “gateway” to nicotine use, and others seeing them as a way to actually help smoking cessation efforts. Researchers put participants who wanted to quit smoking on e-cigarettes, nicotine patches or placebo e-cigarettes for 13 weeks. After the time period they found that 7.3 percent of the e-cigarette users had successfully quit smoking, followed by 5.8 percent for the nicotine patch users and 4.1 percent for participants on the placebo e-cigarettes. "While our results don't show any clear-cut differences... in terms of quit success after six months, it certainly seems that e-cigarettes were more effective in helping smokers who didn't quit to cut down," said study leader Chris Bullen of New Zealand's University of Auckland. "It's also interesting that the people who took part in our study seemed to be much more enthusiastic about e-cigarettes than patches, as evidenced by the far greater proportion of people...who said they'd recommend them to family or friends." For more information on e-cigarettes, read the recent NewPublicHealth post, "Recommended Reading: A Closer Look at E-Cigarettes." Read more on tobacco.
HHS: $69.7M to Bolster Maternal, Infant, Early Childhood Services in 13 States
The U.S. Department of Health and Human Services (HHS) is providing approximately $69.7 million in grants to 13 states under the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. The funds will expand on each state’s efforts under the program, which helps deliver critical health, development, early learning and family support services to children and families. The program began in 2010 and has since served approximately 15,000 families in all 50 states, the District of Columbia and five territories. “This program plays a crucial role in the national effort to build comprehensive statewide early childhood systems for pregnant women, parents and caregivers, and children from birth to 8 years of age – and, ultimately, to improve health and development outcomes,” said Mary Wakefield, PhD, RN, Administrator, Health Resources and Services Administration. Read more on maternal and infant health.
Most Breast Cancer Deaths in Younger Women, Calling into Question Screening Guidelines
While in 2009 the U.S. Preventive Services Task Force revised its recommendations to say that women ages 50 to 74 should receive screening mammograms once every two years and women under 50 should decide on a schedule only after talking over all the details with their doctors, the American Cancer Society and other organizations continued to recommend screening beginning at age 40. A new study in the journal Cancer seems to support the need to start earlier for women of even average risk. Researchers found that half of all breast cancer deaths occur in women under the age of 50, and 71 percent of all deaths are among unscreened women. About 40,000 U.S. women die of breast cancer each year. One factor in the earlier deaths is that young women tend to have faster-growing, more aggressive tumors. "[The study] presents a very compelling argument in favor of screening beginning at age 40 on an annual basis. It corroborates what we have known for a long time," said Barbara Monsees, MD, chairwoman of the American College of Radiology Breast Imaging Commission, who was not involved in the study, adding “Screening doesn't reduce the risk of getting breast cancer, but it does reduce the risk of dying from it." Read more on cancer.
E-cigarette Use Doubled for Middle, High School Students from 2011 to 2012
The use of e-cigarettes by U.S. middle and high school students more than doubled from 2011 to 2012, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). All told about 10 percent of the students used an e-cigarette in 2012; about 2.8 percent of students reported using one within the past 30 days; and a total of 1.78 million middle and high school students tried e-cigarettes in 2012. Curbing tobacco use early is critical because its addictive qualities can lead to a life time of use, which in turn can lead to a lifetime—and a shortened lifetime, at that—of severe health problems. “About 90 percent of all smokers begin smoking as teenagers,” said Tim McAfee, MD, MPH, director of the CDC Office on Smoking and Health. “We must keep our youth from experimenting or using any tobacco product. These dramatic increases suggest that developing strategies to prevent marketing, sales, and use of e-cigarettes among youth is critical.” Read more on tobacco.
U.S. Preterm Birth Rate at Lowest Point in 15 Years in 2012
The U.S. preterm birth rate was down to just 11.54 percent in 2012, its lowest point in 15 years and the sixth consecutive year the rate has fallen, according to a new preliminary date from the U.S. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. The pre-term rate reached a high of 12.8 percent in 2006. Jennifer L. Howse, MD, president of the March of Dimes, attributed the impressive drop to the efforts of the many state and local health departments; hospital partners; and physicians and nurses. “This sustained improvement over these past six consecutive years shows that when infant health becomes a priority, babies benefit,” she said, adding “We will continue to implement proven interventions and accelerate our investment in new research to prevent preterm birth so one day every baby will get a healthy start in life.” Infants who are born preterm (defined as 3 of more weeks before their due date) are at increased risk for health problems such as intellectual disabilities, cerebral palsy, respiratory problems, visual problems, hearing loss and digestive problems, according to the CDC. Read more on maternal and infant health.
Water Sanitation-based Outbreaks Still a Problem for Many Americans
Despite overall improvements, U.S. water sanitation is still a problem in some areas, with bacteria-laden drinking water leading to 1,040 illnesses, 85 hospitalizations and nine deaths in 17 states from 2009 to 2010, according to the U.S. Centers for Disease Control and Prevention. Legionella-tainted plumbing systems, untreated groundwater and problems with distribution systems were the leading causes of the 33 identified outbreaks. California, Florida, Georgia, Idaho, Illinois, Maine, Maryland, Minnesota, Missouri, Montana, Nevada, New York, Ohio, Pennsylvania, South Carolina, Utah and Vermont all reported drinking water-related outbreaks during that period. According to the CDC report, more research is needed into controlling Legionella, and more must be done to improve early detection and correction of problems with water-distribution systems. Read more on water and air quality.
Public Health Summer Fellowship Gives College Student a Close-Up Look at Public Health Campaigns and Messaging
Mina Radman was one of seven college students who spent their summer in Washington, D.C. as part of the Frank Karel Fellowship Program in Public Interest Communications. The program, coordinated by the Nonprofit Roundtable, an alliance of 300 nonprofits and community partners, places high-potential undergraduate students in hands-on summer fellowships with leading nonprofit organizations that promote the public interest.
The Karel Fellowship honors and advances the legacy of Frank Karel, who established, led and nurtured the field of strategic communications during his 30 years as chief communications officer for the Robert Wood Johnson Foundation and the Rockefeller Foundation. Among Karel’s strong beliefs was that racial and ethnic minorities were underrepresented in the public interest communications field, and so foundations and public interest organizations must be proactive in recruiting and nurturing broader participation and leadership in public interest communications and advocacy.
NewPublicHealth spoke with Mina Radman, a 2013 Karel fellow, about her summer spent working and learning at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Did you learn about Frank Karel’s professional history and legacy as part of the fellowship?
Mina Radman: Yes, we did. People who had known Mr. Karel, such as Andy Burness of Burness Communications, spoke about him at the opening dinner for the fellowship program, and his name came up many times during the summer whenever we would speak with people who knew Mr. Karel and his work. We also have sessions as a group at the conference room at Burness in Bethesda, Maryland, and that room is named for Frank Karel. And Mr. Karel’s wife, Betsy, came by to say hello at a recent fellowship session.
NPH: You’re journalism major. What do you hope to do once you graduate?
Radman: That's the “million dollar” question. I’m still figuring that out and that was part of my reason for applying for and accepting the Karel fellowship—in order to explore potential fields of interest. I definitely want to work in communication, but what avenue I’ll take is something I’m still discovering.
Rotavirus Vaccinations for Babies Also Reduce Disease in Older Children, Adults
Regular rotavirus vaccinations for babies have also helped lower the rate of rotavirus-related hospitalizations for older children and adults since 2006, according to a new study in the Journal of the American Medical Association. Rotavirus can cause gastroenteritis, leading to severe diarrhea, vomiting, fever and abdominal pain. Ben Lopman, who worked on the study at the U.S. Centers for Disease Control and Prevention, told Reuters that the improved rates for older children and adults was an unexpected benefit of the vaccinations. An oral form of the vaccination became routine in 2007, after which rotavirus-related hospital discharges dropped by 70 percent for children ages 5-14, by 53 percent for people ages 15-24 and by 43 percent for adults ages 25-44. "This is one example of what we call herd immunity," he said. "By vaccinating young children you prevent them from getting sick, but you also prevent them from transmitting (rotavirus) to their siblings and their parents." Read more on vaccines.
Report: Fewer Kids Illegally Buying Tobacco Products
The Synar Amendment Program was started 16 years ago in an effort to prevent the sale of tobacco products to people under the age of 18. A new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) shows that it’s working, with only about 9 percent of retailers violating the ban, the second lowest rate since the law was enacted and far better than SAMHSA’s goal of 20 percent. In addition, 33 states and the District of Columbia now have local violation rates below 10 percent; and nine states have statewide violation rates below 5 percent. Still, Frances Harding, director of SAMHSA's Center for Substance Abuse Prevention, said that "Far more needs to be done to prevent kids and young adults from using tobacco, which is still the nation's leading cause of preventable death.” Read more on tobacco.
High Cholesterol Levels Dramatically Increases Heart Attack Risk in Middle-aged Men
While high cholesterol levels are dangerous for both men and women, middle-aged men with high levels have three times the risk of heart attack, according to a new study in the journal Epidemiology. Lead researcher Erik Madssen, MD, of the department of circulation and medical imaging at the Norwegian University of Science and Technology, said this means men with high cholesterol levels should be receiving more aggressive treatment than is currently common. The reason for the difference in risk still isn’t known, though Madssen said one possibility is the positive effects of estrogen. Both men and women can reduce the risk of heart attack by making lifestyle changes such as improved diet and exercise, as well as through medication; preventative efforts are especially important for people with a family history of heart disease. Read more on heart health.
Many students staring or returning to college this fall may find something missing—exposure to tobacco products.
Last September the U.S. Department of Health and Human Services (HHS), together with several key partners, launched the National Tobacco-Free College Campus Initiative to promote and support the adoption and implementation of tobacco-free policies at universities, colleges, and other institutions of higher learning across the U.S. Initiative partners include the American College Health Association and the University of Michigan. Initiative staff members work closely with academic leaders, public health advocates, students, researchers, and others to help speed up the elimination of tobacco use on college campuses. “This is a lofty goal, but an attainable one, as we are witnessing exponential growth in the adoption of these policies by academic institutions in all regions of the country,” says Howard Koh, MD, MPH, the U.S. Assistant Secretary for Health who helped launch the initiative last year at the University of Michigan, which included an internationally webcast symposium at the University of Michigan School of Public Health.
The initiative includes a website created to serve as a clearinghouse of key information to assist educational communities in establishing tobacco-free environments. The University of Michigan’s comprehensive smoke-free policy went into effect in 2011.
Smoke-free and tobacco-free policies are not the same, according to HHS. Smoke-free policies refer to any lighted or heated tobacco or plant product intended for inhalation—including cigars, cigarettes and pipes. Tobacco-free policies cover these and all other forms of tobacco (although e-cigarettes are still exempt on some campuses due to the still-evolving nature of the regulations). HHS officials point out that although some campuses are smoke-free while others are tobacco-free, the ultimate goal is for all campuses to eventually be 100 percent tobacco-free.
With the start of the fall college imminent or already underway at most universities, NewPublicHealth spoke with Dr.Koh about the success of the Tobacco-Free College Campus Initiative so far, and what’s ahead in tobacco control efforts for young adults by the Department of Health and Human Services.
NewPublicHealth: What success has the initiative seen since it was launched last year?
Dr. Koh: We’re very proud that the Tobacco-Free College Campus Initiative has accelerated rapidly. When we formally announced this in September of 2012, there were 774 colleges and universities that were tobacco or smoke-free and as of right now, the number has risen to 1,159—that’s an increase of more than one-third in less than a year. We are gratified by the positive response from colleges and universities and leaders from across the country who want to make their environments healthier.
NPH: What are the short-term and long-term goals for the initiative?
Dr. Koh: The ultimate goal is to have all colleges and universities in the U.S. choose to become 100 percent tobacco-free and we’re making steady progress towards that goal because we fully understand that prevention efforts must focus not just on children, but also young adults. The number of smokers who are starting to smoke after age 18 has increased. That number was a million in 2010 when it used to be 600,000 in 2002. We have figures that show that one out of four full-time college students were current smokers in 2010, which is higher than the national prevalence of 19 percent. These numbers underscore why college is a critical age to influence health habits of young adults.