Category Archives: Tobacco Control
Parents know how difficult it can be to find kid-friendly supermarket checkout counters without candy or magazines. Now a new mobile-friendly website from the Campaign for Tobacco-Free Kids offers parents a way to find retailers who don’t sell tobacco. Public health experts applaud its debut:
- Tobacco companies spend more than 90 percent of their annual $8.8 billion marketing budget at the point-of-sale in stores, and this marketing has been shown to increase youth tobacco use.
- Every day, more than 2,800 U.S. kids try their first cigarette. That’s more than one million kids who take their first puff each year.
- 5.6 million children alive today will die prematurely from smoking unless current trends are reversed.
- An estimated 375,000 U.S. retail stores sell tobacco products. That sends a terrible message to kids that tobacco use is normal, acceptable and appealing.
The new website includes an interactive map that shows the locations of Tobacco-Free Retailers across the country. All CVS Pharmacies have just gone tobacco-free and other retailers who don’t sell tobacco include Wegmans and Target. As part of a new national campaign, stores that are tobacco-free can also display stickers from Tobacco-Free Kids.
With Classes Well Underway, It’s a Good Time for Colleges and Universities to Think about their Campus Tobacco Policies
Just a few weeks ago the Bloomberg School of Public Health at Johns Hopkins University announced that it had launched the Tobacco-Free Campus Initiative, which prohibits the use of any tobacco product—not just cigarettes—in all buildings, facilities and vehicles. The initiative also forbids e-cigarettes and discourages the use of tobacco products on all outdoor campus grounds. Organizers of the initiative say that deterring the use of tobacco in all forms is crucial to protect the health of the students and workforce of the campus community.
“By keeping out all tobacco products, the initiative ensures that the School doesn’t unintentionally encourage or reinforce tobacco addiction among students, faculty and staff,” according to a statement released by the school.
However, the rest of the university won’t be taking the same steps, at least for now. In 1991, all Johns Hopkins campuses followed the example first set by the School of Public Health in becoming smoke-free, said Dennis O’Shea, a spokesman for the university, adding that the “school could follow the new initiative, but no decision has been made.”
Hopkins is not the only college deliberating. While there are a few states that require state campuses to adopt smoke-free policies most campuses voluntarily adopt them, according to Cynthia Hallett, the executive director of Americans for Non-Smokers Rights (ANR). According to ANR, there are a little more than 4,000 colleges and universities in the United States, and as of July 2014 there were 1,372 smoke-free campuses in the United States, of which 938 are 100 percent tobacco-free and 176 prohibit the use of e-cigarettes anywhere on campus. That’s up from 446 smoke-free campuses in 2010; reporting on tobacco-free campuses began in 2012, when there were 608.
Credit some of that change to the Tobacco-Free College Campus Initiative (TFCCI) of the U.S. Department of Health and Human Services (HHS), launched two years ago to promote and support the adoption and implementation of tobacco-free policies at colleges and universities. TFCCI is a partnership of HHS, the American College Health Association and the University of Michigan, with sponsorship from the American Legacy Foundation.
While support for making campuses smoke- and even tobacco-free is growing, it’s hardly a slam dunk, especially when the move requires students to vote. Universities say opposition can come from foreign students who are sometimes more likely to smoke than their U.S. counterparts or contract employees who don’t want to be barred from smoking on campus. It can even come from the media. Two years ago, when UCLA announced its campus-wide tobacco free policy, the Los Angeles Times published an editorial titled “A Smoke Free UC Goes too Far” which said that “[s]moking is a detestable, dangerous habit—but it's also a legal one, and there is plenty to say in defense of allowing adults to make bad decisions if they're not breaking the law or harming others.”
Hoping to get the initiatives to pick up steam, TFCCI has launched challenges aimed at getting more campuses—and their students, faculty and employees—to give up their smokes.
- Read a NewPublicHealth interview with former HHS Assistant Secretary Howard Koh on the goals for Tobacco-Free College Campus Initiative.
- Download TFCCI resource toolkits on how to make campuses tobacco-free.
Helping the Homeless Quit Smoking: Q&A with Michael Businelle and Darla Kendzor, The University of Texas School of Public Health
Not surprisingly, a recent study in the American Journal of Public Health found that homeless smokers struggle with quitting more than economically disadvantaged smokers who have their own housing. The study compared homeless smokers receiving treatment at a shelter-based smoking cessation clinic to people enrolled in a smoking cessation program at a Dallas, Texas, safety-net hospital.
“On average, homeless people reported that they found themselves around about 40 smokers every day, while the group getting cessation care at the hospital reported that they were more likely to be around three to four smokers every day,” said Michael S. Businelle, PhD, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health Dallas Regional Campus, and the lead author of the study. “Imagine if you had an alcohol problem and were trying to quit drinking—it would be almost impossible to quit if you were surrounded by 40 people drinking every day. That is the situation homeless folks have to overcome when they try to quit smoking.”
Businelle said research shows that about 75 percent of homeless people smoke and that smoking is a leading cause of death in this population. And although homeless smokers are just as likely to try to quit smoking as are other smokers, they are far less successful at quitting, according to Businelle’s work. He said tailored smoking cessation programs are needed for homeless people, including smoke-free zones in shelters.
NewPublicHealth recently spoke with Businelle and his wife, Darla Kendzor, PhD, who is a co-author of the recent study on smoking and the homeless, as well as an assistant professor at The University of Texas.
NPH: Why did you embark on the study?
Michael Businelle: The smoking prevalence in this population is so high and homeless people are not enrolled in clinical trials so we don’t know what will work best for them. We’ve developed, over the last 50 years, really good treatments for the general population of smokers, but there are very few treatments that have been tested in homeless populations.
Darla Kendzor: And cancer and cardiovascular disease, which are in large part due to tobacco smoking, are the leading causes of death among homeless adults. So quitting smoking would make a big difference for them.
The public comment period for rules regulating the sale and use of e-cigarettes proposed in April by the U.S. Food and Drug Administration (FDA) ends on August 8, after which the agency is expected to release final rules governing the products. Experts say the timing is critical because sales of the products—which weren’t even on the market a decade ago—are heating up, with revenues approaching $1 billion a year, according to Forbes Magazine.
Last week, Health Affairs and the Robert Wood Johnson Foundation (RWJF) released a health policy brief about e-cigarettes that sets out key issues concerning the products and provides important background, particularly for people poised to comment on the FDA’s proposed rules.
Among the issues the policy brief addresses are e-cigarette safety; whether the devices ought to be regulated as a medical (smoking cessation) device or as a cigarette; and whether e-cigarettes pose a risk as a “gateway” drug to tobacco products. It notes that the FDA is currently funding close to 40 studies on e-cigarettes.
The issue is especially critical because sales to kids and teens are increasing, and there is still insufficient information on whether the vapor emitted by the devices pose a cancer risk. A 2013 study of 40,000 middle and high school students around the country by researchers at UC San Francisco found that e-cigarette use in that group doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.
Read the policy brief from Health Affairs and RWJF.
>>Bonus Link: Read a NewPublicHealth post on initiatives by major cities to regulate the sale and use of e-cigarettes.
Citylab—formerly Atlantic Cities—reported recently on an architectural award bestowed by Residential Architect on the Corinthian Gardens Smokers Shelter, a 275-square-foot structure in Des Moines, Iowa. It was created by local architectural firm ASK Studio for smokers who live in a nearby apartment building. “This project serves as a reminder that smokers aren’t extinct by quietly celebrating an activity that has gone from banal to banned,” reads the description on the publication’s online portal.
“It’s the sort of structure that has the feel of a private clubhouse for the tobacco-initiated,” according to award juror Cary Bernstein, whose comments were published by Residential Architect. “It makes you want to smoke so you can be in it.”
Wisely, the materials used to construct the shelter are nonflammable. Smokers get benches to sit on while they smoke and lighting for security after dark.
Corinthian Gardens is hardly the only such smoking shelter in the United States. An online search finds several companies that make the shelters, although none seem as glitzy as the one in Des Moines. And late last year a judge in Great Falls, Montana, ruled that smoking shelters that also house gambling machines don’t violate the city’s Clean Indoor Air Act.
So far, it seems, the shelters are legal so long as they adhere to rules governing smoking in the state or city they’re in, such as being built the requisite distance away from a building to avoid blowing second hand smoke at non-smokers. But tobacco- control advocates worry that the shelters, especially the recent award winner, can hurt the goals of completely eradicating smoking as a social norm—especially when 19 percent of U.S. adults still smoke.
“The fact that people are being protected from the elements is fine, we support the design perspective, but we worry about anything that normalizes or glamorizes smoking,” said Robin Koval, president and CEO of tobacco control advocacy group Legacy.
“We don’t’ hate smokers, we love smokers, what we hate is tobacco,” said Koval, “and so you have to call the structure what it is: a waiting room for the cancer ward because one out of two people who use it will die of tobacco-related diseases. To us that’s really the issue.”
Data on thirdhand smoke—tobacco smoke left on surfaces, walls and floors—was first published in 2009. The data has raised significant concerns that the smoke can linger for months or longer, as well as combine with indoor air compounds to possibly form new carcinogens. In the last few months researchers from the California Thirdhand Smoke Consortium, funded by the University of California’s Tobacco-Related Disease Research Program (TDRP), have been presenting and publishing data that indicates that thirdhand smoke is linked to serious health risks in animals and humans—though more research is needed to better measure thirdhand smoke constituents and their health impact.
Consortium researchers published the first animal study on thirdhand smoke in January in the journal PLOS One, finding that mice exposed to thirdhand smoke developed a range of medical conditions, including liver damage and hyperactivity. Research published last year, as well as presented at the annual meeting of the American Chemical Society a few weeks ago, finds that thirdhand smoke likely causes damage to human DNA.
And last month several of the Consortium scholars presented their findings at a tobacco conference n California.
“The potential health risks of what we call thirdhand smoke are only now being studied. This is a new frontier,” said Georg Matt, a Consortium member and psychology professor of at San Diego State University who focuses on policies to protect nonsmokers. “We don’t yet know the degree of risk, but we are already finding that indoor smoking leaves a nearly indelible imprint. We need to find out what risk this pollution poses.”
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.
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.
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.
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.