Category Archives: Tobacco
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus link: Mobile Health and FDA Guidance
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
Tobacco featured prominently as a public health issue at the American Public Health Association (APHA) meeting this week, including a regulatory update from Mitch Zeller, JD, who became director of the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products earlier this year. Zeller previously worked on tobacco issues in government as associate commissioner and director of FDA’s first Office of Tobacco Programs, and also as a U.S. delegate to the World Health Organization (WHO) Working Group for the Framework Convention on Tobacco Control.
NewPublicHealth spoke with Zeller ahead of the APHA meeting.
Mitch Zeller: I think most broadly my goals are to help give the center and the agency the greatest chance of fulfilling the public health mission behind the law passed in 2009 giving the Food and Drug Administration authority over tobacco. This really is an important piece of legislation. It’s really stunning that in 2013—with everything that we know about the harms associated with tobacco use—that it remains the leading cause of preventable death and disease both in this country and globally.
There are some very powerful tools that Congress has given FDA to use wisely and supported by evidence. That’s where I think, the greatest opportunity lies: to use the tools relying on regulatory science to try to protect consumers and reduce the death and disease toll from tobacco.
There are two areas where I think these tools can make a profound positive impact on public health. The first is something called product standards, which is basically the power to ban, restrict or limit the allowable levels of ingredients in tobacco or tobacco smoke. We are exploring potential product standards in three areas: toxicity, addiction and appeal. And we are funding research in all three areas and working very hard behind the scenes to find out what our options are for potential product standards in those three areas.
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.”
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 (CTFK).
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.
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.
“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:
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.
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.
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.