Category Archives: Tobacco cessation
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.
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.”
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.
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.
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.
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.