Category Archives: Tobacco Control

Aug 26 2013
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Tobacco-Free Campuses on the Rise: Q&A with Dr. Howard Koh, HHS

Howard Koh, MD, MPH, the U.S. Assistant Secretary for Health Howard Koh, MD, MPH, the U.S. Assistant Secretary for 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.

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Aug 21 2013
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Recommended Reading: A Closer Look at E-Cigarettes

“Are they harm reduction or are they smoking cessation? It’s a tough situation because, on the one hand, you have what it does and on the other you have the claims are that are allowable under the law. It’s a strange situation where they are being regulated as tobacco products. But they are not tobacco products. There’s no tobacco in them.”

Many hard facts about e-cigarettes are still unclear. What is clear is that marketers are pushing hard to make the switch from smoking to “vaping” an ongoing trend. In the above quote from a TechCrunch article, Michael Siegel, MD, Professor at Boston University’s Public School of Health, mulled over some very real concerns about where we’re heading in terms of e-cigarette regulation.

The current debate between the manufactures and public health experts surrounds the health impacts of the nicotine product. The e-cigarette “boom” began around 2007, starting first with smaller companies. After making a dent in cigarette sales—unlike cessation therapies such as the patch and gums—tobacco companies took notice and are starting to jump onboard.

Today e-cigarettes are especially rising in popularity among what some may consider the “hip” crowd. From a recent article in The New York Times:

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Aug 14 2013
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Tobacco-Related Health Equity: What Will It Take?

Tomorrow from 12 p.m. to 2 p.m. EST Legacy will hold a special online panel discussion as part of the Kenneth E. Warner Lecture Series that puts a spotlight on the social influences on tobacco use and tobacco-related death and disease. The panel will discuss the disproportionate impact of tobacco by race, ethnicity, sexual orientation and socio-economic status to help identify strategies to tackle tobacco-related health inequities.

>>View the live webcast Thursday, August 15, from 12 p.m. to 2 p.m. EST.

Paula Braveman, MD, MPH, a panelist as well as director of the Center on Social Disparities in Health at the University of California San Francisco and Research Director of the Robert Wood Johnson Foundation Commission to build a Healthier America, spoke with NewPublicHealth about the upcoming discussion.

“The purpose of the discussion,” said Dr. Braveman, “is to give wider attention to disparities in tobacco-related health consequences, and to reach a wider audience on the issue of disparities so that it can be dealt with in a more focused way than it has been up until now.”

Dr. Braveman says that a targeted focus is important for ethical and economic reasons. “The consequences of disparities in smoking and tobacco-related illness take a huge economic toll in terms of lost worker productivity and medical expenses that otherwise would not have been needed and in terms of suffering and loss of life. Using the disparities frame helps us to see that the health condition of people who are best off should be possible for everyone.”

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Jun 12 2013
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Public Health News Roundup: June 11

Britain to Regulate, Improve Quality of E-Cigarettes
The British government plan to regulate electronic cigarettes as non-prescription medicine starting in 201, according to Reuters. E-Cigarettes are battery-operated devices that contain cartridges filled with nicotine, flavor, and other chemicals. They turn nicotine, which is highly addictive, and other chemicals into a vapor that can be inhaled. The U.S. Food and Drug Administration (FDA) has warned that, "As the safety and efficacy of e-cigarettes have not been fully studied, consumers of e-cigarette products currently have no way of knowing:

  • whether e-cigarettes are safe for their intended use,
  • how much nicotine or other potentially harmful chemicals are being inhaled during use, or
  • if there are any benefits associated with using these products."

The devices do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes. Currently, e-cigarettes that are marketed for therapeutic purposes are regulated by the FDA. According to Reuters, "Under the new British system, manufacturers will have to prove the quality of their products and demonstrate that they deliver the correct amount of nicotine. But they will not need to conduct clinical trials." Read more on tobacco and nicotine.

Even Hands-Free Devices Create Unsafe, Distracted Driving Conditions
A new report from AAA finds that even hands-free mobile devices create mental distractions that can drain attention away from focusing on the road and safe driving. The study found that mentally-distracted drivers—those who may not have even taken their eyes off the road but were distracted by speaking with someone through a hands-free device—missed visual cues, had slower reaction times, and even exhibited a sort of "tunnel vision" by not checking side- and rear-view mirrors or actively scanning the full roadway for potential hazards. Activities like listening to the radio or an audio book was mildly distracting (but likely not enough to effect driving safety); conversing with others (whether with fellow passengers, with someone via hand-held device or with some via hands-free device) was moderately but significantly distracting; and using a device with speech-to-text technology to send text messages or e-mails was highly distracting. Researchers hope these findings can be used to help craft science-based policies on driver distraction. Read more on safety.

CDC Partners with 104 Businesses to Improve Employee Health
The Centers for Disease Control and Prevention (CDC), through its partner Viridian Health Management, has identified 104 employers in eight counties across the nation that have voluntarily chosen to participate in the National Healthy Worksite Program, a new initiative aimed at reducing chronic disease and building a healthier, more productive U.S. workforce—while also cutting health care costs. The initiative primarily focuses on small and mid-sized employers. a national evaluation will document best practices and models on how to successfully implement workplace health programs in small worksites more broadly. Read more on what businesses are doing to create healthier communities.

May 17 2013
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Public Health News Roundup: May 17

Psychiatrist "Bible" Gets a Numeric Overhaul
The American Psychiatric Association will release the latest version of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) this Saturday at its annual meeting, according to Reuters. The current version is the DSM-IV, which was released a full 10 years ago -- the new version will be recast as DSM-5 (not DSM-V), with an eye toward updating the catalog of psychiatric conditions much more frequently with intermediate versions (DSM-5.1, DSM-5.2 and so on). The newest version also aims to introduce more scientific rigor and clinical confirmation of mental illness, such as, "using neuroscience in particular to tell the difference between, say, normal sadness and major depression." Though some criticize that the science just isn't there yet, and that the current version could lead to overdiagnosis. Read more on mental health.

Most Adults Enforce Smoke-Free Rules in Homes, Cars
Four out of five U.S. adults report having voluntary smoke-free rules in their homes and three out of four report having voluntary smoke-free rules in their vehicles, according to a study published in the journal Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention. Despite the high prevalence of voluntary smoke-free rules in homes and vehicles, the study found that almost 11 million non-smoking adults continue to be exposed to secondhand smoke in their home, and almost 17 million non-smoking adults continue to be exposed to secondhand smoke in a vehicle. The study also showed that voluntary smoke-free rules were more prevalent in states with comprehensive smoke-free laws and tobacco control programs. Read more on tobacco.

Living Near Fast-Food Outlets Might Boost Obesity Risk
Black Americans who live within two miles of a fast food outlet have a higher body-mass index than those living farther away -- and that link especially holds true for those with lower incomes, according to a new study published in the American Journal of Public Health. The study involved more than 1,400 black adults divided into two groups: those making less than $40,000 per year and those making $40,000 or more per year. Read more on what it takes to create healthy communities.

Apr 29 2013
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Public Health News Roundup: April 29

Past Decade's Poor Economy Drove Health Declines
More than a decade of research points to the negative impact of the austerity that accompanies a flagging economy on the population's health, according to Reuters. The studies will be detailed in a new book to be released by an interesting research pairing including a political economist from Oxford University and a professor of medicine and epidemiology at Standford University. the researchers say more than 10,000 suicides and up to a million cases of depression have been diagnosed during what they call the "Great Recession" and its accompanying austerity across Europe and North America. For example, more than five million Americans have lost access to health care during the latest recession. Researchers also tie cuts in governmental public health programs to excess disease rates. "In Greece, moves like cutting HIV prevention budgets have coincided with rates of the AIDS-causing virus rising by more than 200 percent since 2011—driven in part by increasing drug abuse in the context of a 50 percent youth unemployment rate," according to the Reuters article. Read more on poverty and health.

What Influences Kids to Smoke (or Not to) Changes Over Time
Peer pressure may have a bigger influence on middle school-aged kids in starting to smoke, but that influence may wane as they get older. On the other hand, researchers said parents seem to remain influential over their children's smoking behavior throughout high school, as reported by HealthDay. Researchers looked at data from  the Midwestern Prevention Project, the longest-running substance abuse prevention, randomized controlled trial in the United States, which includes 1,000 teens. Read more on tobacco use

Facebook Could Help Predict, Track and Map Obesity
The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area's obesity rate, according to a new study. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. The study was conducted by Boston Children's Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys. 

"Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level," said study author John Brownstein, PhD, from the Boston Children's Hospital Informatics Program. "The tight correlation between Facebook users' interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns." The study was published in PLOS ONE. Read more on obesity.

Apr 24 2013
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Scholars Pose Endgame Strategies for Tobacco Use

file Kenneth Warner, University of Michigan School of Public Health

Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.

Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.

>>Read the articles in the tobacco endgame supplement.

Some of the strategies in the supplement include:

  • Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
  • A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
  • A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.

"What we are doing today is not enough," says Warner.  "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”

NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.

NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?

Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.

NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?

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Apr 16 2013
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Recommended Viewing: No Butts

What’s the number one littered item on U.S. roadways? Cigarette butts.

And that’s not much of a surprise given a new survey from Legacy, an advocacy group focused on ending youth smoking, and Leave No Trace Center for Outdoor Ethics, which found that more than 44 percent of those polled who’ve smoked admit to having dropped a cigarette on the ground. And nearly 32 percent of responders who’ve smoked have dropped a cigarette out of a car window.

Cigarette butts do way more harm than simply adding to unsightly litter. The butts include the cigarette’s plastic filter, which pose risks to animals and biodegrade only under extreme conditions. And cigarette butts contain carcinogens that can leach into soil, as well as chemicals that are poisonous to wildlife and can contaminate water sources.

Legacy and Leave No Trace have developed a suite of materials to help push people to action and reduce the butt litter.

Watch the PSA "Toxic Litter Everywhere" below.

Mar 26 2013
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State Laws Needed to Help Reduce Sales of E-Cigarettes to Minors

While twelve states currently have laws regulating sales of electronic cigarettes (known as e-cigarettes) to minors, a new post on the Network for Public Health Law blog calls on more states to restrict sales to minors while the Food and Drug Administration continues their review of the device.

E-cigarettes contain nicotine, but no tobacco and often come in kid-alluring flavors such as chocolate and vanilla. According to the Network post, one small FDA study found carcinogens and toxins in e-cigarettes. Health experts are concerned that the electronic devices may also be a gateway tool for young adults to actual, cancer-causing, tobacco-filled cigarettes.

E-cigarette use has skyrocketed among adults, according to a recent study by researchers funded by the Centers for Disease Control and Prevention. In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, up from about 10 percent in 2010. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011. 

>>Read the post.

Mar 20 2013
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Kick Butts Day! 2013: The Fight Against Youth Tobacco Use Continues

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Today is “Kick Butts Day!”—an annual Campaign for Tobacco-Free Kids effort to emphasize the dangers of tobacco while empowering kids to lead the fight against its use by encouraging their peers, family and community members to stay tobacco-free.

The United States continues to make great strides when it comes to combating youth smoking. According to the Tobacco-Free Kids report “America’s Most Wanted Tobacco Villains: The Usual Suspects, New Villains and Emerging Threats,” about 18.1 percent of high school students smoked in 2011, down from a high of 36.4 percent in 1997. Even still, about 1,000 kids become regular smokers each day. The report highlights the biggest tobacco threats and how they’re working to get kids addicted to the deadly substance.

As part of Kick Butts Day 2013, Tobacco-Free Kids created two infographics.

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