New Research on the Effects of Secondhand Smoke in Youth

Several new studies highlight the harmful effects of secondhand smoke in children. The researchers in the studies stress the need for parents to protect the health of their children and take measures to prevent exposure to secondhand smoke. These studies, while focused on secondhand smoke exposure in children, underscore the critical need for increasing consumer demand for cessation among parents and caregivers and highlight the importance of the work being done by NTCC and its members.

One new study found that children exposed to secondhand smoke often have levels of carbon monoxide in their blood that are similar to those of adult smokers, and frequently higher levels than adults exposed to secondhand smoke.

The study, presented this month at the American Society of Anesthesiologists annual meeting, found that the younger the child, the greater the potential level of exposure.

The study measured levels of carboxyhemoglobin, which is formed when carbon monoxide binds to the blood, in 200 children between the ages of 1 and 12. The exact ramifications of high levels of carboxyhemoglobin are not entirely known, but long-term, low-level exposure includes changes in heart and lung tissue as it hampers delivery of oxygen to body tissue.

While household and environmental factors such as stoves, heaters and automobiles are potential sources of carbon monoxide exposure, secondhand cigarette smoke is often the most likely source of elevated carboxyhemoglobin, the researchers said.

Dr. Branden E. Yee, of the anesthesiology department at Tufts Medical Center in Boston, said educating parents about the need to change their smoking habits, especially around children, is vital.

For more information on this study, please see the Washington Post, October 20, 2008.

Other new research suggests that exposure to second-hand smoke may actually lead to symptoms of nicotine dependence in youth who have never before had a cigarette.

The findings are published in the September edition of the journal Addictive Behaviors in a joint study from nine Canadian institutions.

Increased exposure to second-hand smoke, both in cars and homes, was associated with an increased likelihood of children reporting nicotine dependence symptoms, even though these children had never smoked," the researchers reported.

"According to conventional understanding, a person who does not smoke cannot experience nicotine dependence," says Mathieu Bélanger, the study's lead author and the new research director of the Centre de Formation Médicale du Nouveau-Brunswick of the Université de Moncton and Université de Sherbrooke. "Our study found that 5 percent of children who had never smoked a cigarette, but who were exposed to secondhand smoke in cars or their homes, reported symptoms of nicotine dependence."

"Like many other studies before, this one is giving a sign to parents not to smoke around their children," Belanger said.

For more information on this study, please see ScienceDaily, September 30, 2008.

Other new research supports the link between secondhand smoke exposure and asthma in children.

The study, published in the October 16 issue of the New England Journal of Medicine, found that certain genetic variations previously identified as putting people at higher risk for asthma apparently only increase the risk of so-called early-onset asthma, which is disease that appears at 4 years of age or younger. The risk is further increased by exposure to secondhand smoke in early life.

A previous, genome-wide association study found that certain genetic variations were linked to a heightened risk of asthma. This study found that was an even stronger association between six variants in a particular chromosome and asthma in people who had been exposed to secondhand smoke at an early age -- an almost threefold increase in risk in children with the genetic variant and early exposure to smoke.

Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City said "wat was interesting [about these findings] was the interlude between nature and nurture. It's clear that those kids exposed to secondhand smoke had much more of a flowering of the disease process than those who weren't. That illustrates that while something can be genetically determined, it can be amplified by environmental factors."

For more information on this study, please see U.S. News and World Report, October 15, 2008.

While these studies confirm and reinforce how harmful effects of secondhand smoke exposure in children, a study from Johns Hopkins Children's Center study suggests that pediatricians may be getting a skewed idea about their patients' exposure to secondhand smoke. A recent study found that the parents and caregivers of children with asthma often underestimate and underreport how much they smoke at home and around their children.

In a study of 81 children with persistent asthma who lived with a smoker, researchers found wide discrepancies between objective tests and parental reports. In addition, nearly one-third of parents and caregivers reported smoking in the car in the child's presence, a red flag that exposure to secondhand smoke occurs outside the home.

Because self-reporting inaccurately gauges exposure, pediatricians should use more reliable measures such as obtaining urine samples from children to check for secondhand smoke inhalation, researchers say.

"We want pediatricians caring for children with asthma to keep in mind that a child's symptoms could be brought on by secondhand smoke," said lead investigator Arlene Butz.

For more information on this study, please see the JHU Gazette, October 13, 2008.

The findings from these recent studies highlight the need for parents and caregivers to take measures to prevent exposure of secondhand smoke in children and underscore the need for increasing consumer demand for cessation.

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Cathy Backinger, Ph.D., Branch Chief, Tobacco Control Research Branch, Behavioral Research Program, National Cancer Institute

Dr. Backinger is Branch Chief of the Tobacco Control Research Branch (TCRB), NCI, and a scientific Program Director for the development and implementation of extramural behavioral and public health research programs in the research areas of prevention and cessation of tobacco use by youth, and smokeless tobacco. As Branch Chief, she provides overall leadership for TCRB tobacco-related initiatives and research, as well as dissemination of evidence-based findings to prevent, treat, and control tobacco use. TCRB is working toward a world free of tobacco use and related cancer and suffering. Dr. Backinger joined NCI in 1998 as a Health Scientist.

Prior to joining NCI, Dr. Backinger was Director, Issues Management Staff in the Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration (FDA), Rockville, MD. She has also worked at the Centers for Disease Control and Prevention and the Ohio Department of Health.

Dr. Backinger received a Ph.D. in Health Policy from the University of Maryland, Baltimore County, an M.P.H. from the University of Michigan, and a B.S. in Health Education from the Ohio State University.

Q1: National Cancer Institute recently released Monograph 19 in their Tobacco Control Monograph series. The report, "The Role of the Media in Promoting and Reducing Tobacco Use," reaches the government's strongest conclusion to date that tobacco marketing and depictions of smoking in movies promote youth smoking. Can you talk a little about the findings and recommendations of the report and the impact on youth cessation?

One of the major conclusions of the monograph is that the total weight of the evidence from cross-sectional, longitudinal, and experimental studies indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The report found that depictions of cigarette smoking are pervasive in the movies, occurring in three-quarters or more of contemporary box-office hits, with Identifiable brand images appearing in about one-third of movies. And, smoking prevalence among contemporary movie characters is about 25 percent, almost twice the rate in the 1970s and 80s. The monograph relied on the totality of evidence from multiple studies using a variety of research designs and methods to understand the effects of media on tobacco promotion and tobacco control. Importantly, it is the first time that a government report has demonstrated that smoking in the movies is causally related to youth smoking initiation. Smoking in the movies has implications for both prevention and cessation because images of smoking in movies can influence both adolescent and adult viewers' beliefs about social norms for smoking, beliefs about the function and consequences of smoking, and personal intentions to smoke.

Given what we now know, it will be important to address proactively the influence of smoking in the movies. For example, research indicates that anti-tobacco advertisements shown prior to movies can counter the impact of their tobacco portrayals. And, we especially need to ensure that the general public, particularly parents and other care-givers, understand the effect watching smoking in movies has on children.

Q2: The revised PHS Guideline recognizes the need to address youth smoking and highlights, for the first time, that counseling is an effective treatment for helping youth smokers quit. Can you talk a little about this important milestone and the role YTCC can play in increasing consumer demand among youth and young adults?

The May 2008 PHS Clinical Practice Guideline, "Treating Tobacco Use and Dependence," is an update of the 2000 guidelines, which determined that counseling and behavioral interventions found effective for adults should be considered for use with children and adolescents. In 2000, the panel also found that clinicians may consider using medications to treat adolescents if there was evidence of nicotine dependence and a desire to quit tobacco use. The panel achieved consensus on these recommendations, despite the absence of randomized controlled trials, because of the clinical importance of improving treatment for adolescents. The big news is that, 8 years later, the 2008 update panel found that "counseling has been shown to be effective in treatment of adolescent smokers." I think that the advances we have made in youth smoking cessation have been driven, in large part, by the efforts of YTCC and its partner organizations.

Over the last 10 years, numerous studies have helped us sort out many of the challenges of youth cessation, but there is more research that is needed. For example, we need to expand behavioral approaches and explore different intervention settings where youth interact, as well as investigate whether cell phones, social networking sites, or other new technologies can help us reach and engage youth in smoking cessation. Also, only a small number of studies have examined whether medications can help youth quit smoking; we need to continue this line of investigation, especially as new medications for adults are approved by the FDA. And, understanding the impact on cessation of dual use of tobacco products such as smoking and using smokeless tobacco is important. We still have work to do to increase consumer demand among youth and young adults, just as we do to increase demand among adults generally. The NTCC's Consumer Demand Initiative has been making strides that will generate new strategies for increasing the demand for and use of evidence-based tobacco cessation products and services among many population groups.

Q3: YTCC recently conducted a brief analysis of tobacco cessation content in videos on YouTube that revealed that non-evidence-based treatments are most often depicted positively while evidence-based treatments, such as NRT and prescription medications, are often depicted negatively. To follow-up on these initial findings, NCI and YTCC are currently conducting a more rigorous and in-depth analysis of the cessation content on YouTube. What is the potential impact of the messages presented on new media channels, such as YouTube, MySpace, Facebook, etc., on youth and young adult tobacco use and cessation?

To build on the YTCC analysis, NCI performed a search of YouTube by relevance and view count using the search terms, "quit smoking," "stop smoking," and "smoking cessation." While we are primarily interested in tobacco cessation methods and the extent to which they were evidence-based or not, we are also coding for source of video, video setting, quality of video, and characteristics of the primary person delivering the message. Our preliminary analysis has found that videos tagged as "smoking cessation" were likely to be produced by professional health organizations, TV newsclips, and PSAs, and to describe evidence-based cessation methods. In contrast, the majority of videos tagged as "stop smoking" or "quit smoking" featured non-evidence-based methods. Multiple cessation methods were mentioned in the majority of "stop smoking" videos, yet only 9 of those methods were clearly evidence-based. Hypnosis was the most frequent non-evidence-based method mentioned; also featured were using snus as a cessation aid, "scare tactics," herbal supplements, reducing the body's acidity, an "emotional freedom technique," biorhythms, and throwing away cigarettes.

As you might imagine, this analyses has been a fascinating project. Both researchers and the tobacco control community need to pay attention to the new technologies that youth and young adults are engaged in. If you have not spent much time on YouTube, I recommend checking out a random sample of smoking videos to get a sense of the kinds of videos being posted. I think you will find it eye opening!

Q4: You served as a co-facilitator at the YTCC course, "Strategies for Reducing Tobacco Use among Young Adults" at the 2008 Summer Institute in Phoenix, AZ. What were some of the highlights of the course?

It was exciting to interact with so many knowledgeable and dedicated tobacco control program staff. Over the 3 mornings of the course, we covered a wide range of topics including the unique population of young adults and young adult smokers, tobacco use patterns, tobacco industry marketing, evaluation considerations, prevention and cessation strategies, reaching and engaging young adults, and developing an action plan. The format provided participants time to interact, to talk about their own programs, and to get feedback in order to develop plans to intervene with young adults. A big highlight was having presenters from outside of tobacco control science; it is extremely useful for us to get outside of our own domains and listen to other perspectives. For example, we had a presentation from a marketing and communications firm that explained how food, clothing, and other companies reach young adults including understanding what magazines they read, what TV shows they watch, and what Internet sites they frequent. We also had a young adult presenter who shared her perspective on how we can engage young adults in interventions and programs. We are still in the early stages of developing effective prevention and cessation strategies specifically for young adults. I think the Summer Institute helped provide a framework to move forward.

Q5: The tobacco industry has been developing new products, such as flavored products and novel smokeless products, to encourage and sustain addiction. What has been the impact of this on cessation, particularly youth cessation?

We do not yet know the extent to which youth and young adults use these products. However, we are very concerned about the potential of these products to appeal to youth and young adults because of their flavorings and their novelty. For example, a recent study of college students found that flavored cigarettes elicited higher positive expectancies about smoking compared with non-flavored cigarettes among nonsmokers, regular smokers, and those susceptible to smoking. Additionally, tobacco industry document research has found that cigarette companies added flavorings to cigarettes in order to increase their appeal to both youth and women. Some new smokeless tobacco products contain flavorings as well, but these products have not been studied as yet. In particular, we need to examine dual use of tobacco products - cigarettes and smokeless tobacco - in light of advertising encouraging smokeless tobacco use in situations where smoking is not permitted. While it is not clear what the impact of these products will be, it is important to monitor their use, especially their impact on initiation and cessation.

Q6: How did you get involved in tobacco control?

I began my career as a dental hygienist, before transitioning into public health. In the 1980s, I worked in the dental program at the Centers for Disease Control and Prevention (CDC), where I was involved in tobacco issues, particularly smokeless tobacco, because of its impact on oral health. While at CDC, I worked on an evaluation of the "Comprehensive Smokeless Tobacco and Health Education Act of 1985," and also developed and evaluated a smokeless tobacco prevention curriculum for Alaska Native schoolchildren. When I came to NCI in 1998, I returned to tobacco control because I really wanted to make a difference on this issue. Frankly, it is the public health issue that I am most passionate about.

Q7: What has been the most challenging aspect of your work in tobacco control?

Without a doubt the most challenging aspect of our work is the immense financial resources of the tobacco industry; in 2005 alone, the U.S. tobacco companies spent more than $13 billion to market and advertise their products. The words of the World Health Organization's Expert Committee on Tobacco Industry Documents (July 2000) bear repeating: "Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists." Tobacco control researchers must better understand and counteract pro-tobacco messages. This will require a coordinated effort by local, state, national and international groups, from both the public and private sector. We can no longer address one issue at a time - like putting our finger in the dike and then running to fix a leak elsewhere. I know we are up to this challenge.

Q8: What has been the most rewarding aspect of your work in tobacco control?

It has been the opportunity to work with so many knowledgeable and committed people from the U.S, and around the world, all of whom are dedicated to improving public health. The partnerships and collaborations we have formed to move tobacco control forward is inspiring. The whole is greater than the sum of the parts; when we work together, we are truly a force to be reckoned with.

Q9: What, in your opinion, have been the most important developments in tobacco control in the past year?

We find ourselves at an exciting time in tobacco control in many areas. As of September 2008, 160 countries are parties to the World Health Organization's Framework Convention on Tobacco Control - the first ever global public health treaty. In the U.S., legislation to provide the Food and Drug Administration authority to regulate tobacco products, if enacted, would certainly be a major development. I also think the movement to pass smoke-free policies, not only among U.S. states, but in countries around the world, is an enormously important accomplishment. Not only do these policies protect nonsmokers from secondhand smoke, they make it easier for smokers to quit, and help change social norms about smoking. And finally, the 2008 update of the PHS guidelines with evidence to support youth smoking cessation is definitely a major development.

Q10: What, in your opinion, is the most important challenge facing tobacco control in the year ahead?

I think there are several, but perhaps the most important is to maintain momentum and not lose ground. I think there is a perception that we have all the tools we need to address tobacco use. Certainly, we know a lot about what works, and this information should be disseminated and acted upon. But, there is much more we need to know. About one in five Americans is a current smoker, and we continue to have glaring disparities in tobacco use rates among different populations, which will eventually translate in to glaring disparities in tobacco-caused disease rates. Despite decades of work to prevent tobacco use by youth, about half of all students have tried smoking by the time of high school graduation. Additionally, we are faced with a constantly adapting and evolving tobacco industry. For all of these reasons, and many more, a vigorous research enterprise is needed.

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Study Finds that Doctors Lack Smoking Cessation Training

Few doctors or other health-care providers have enough smoking cessation training to help their patients quit smoking, a U.S. study suggests.

It found that 87 percent to 93 percent of doctors and other health-care workers receive less than five hours of training on tobacco dependence, and less than 6 percent know the U.S. Agency for Healthcare Research and Quality (AHRQ) treatment guidelines for tobacco dependence, including the signs of nicotine withdrawal. This lack of knowledge about treating tobacco dependence may affect quit rates among smokers, suggested lead researcher Virginia Reichert and colleagues at the North Shore-LIJ Health System Center for Tobacco Control in Great Neck, NY.

They surveyed 322 prescribers (physicians, nurse practitioners, or physician assistants) and 278 nonprescribers (pharmacists, registered nurses, social workers, counselors, respiratory therapists, and students).

The researchers found that 87 percent of prescribers and 93 percent of nonprescribers received less than five hours of tobacco-dependence training. Only 6 percent of prescribers and 5 percent of nonprescribers knew the AHRQ treatment guidelines for tobacco dependence.

The study also found only 16 percent of prescribers and 8 percent of nonprescribers knew which U.S. Food and Drug Administration-approved medications were over-the-counter and which required a prescription.

The findings were to be presented at the American College of Chest Physicians (ACCP) annual meeting, in Philadelphia.

"Without appropriate training in tobacco dependence treatment, health- care providers may lack the knowledge and confidence to help their patients quit smoking," Reichert said in an ACCP news release. "Furthermore, providers may not recognize that tobacco dependence is a chronic relapsing condition and become frustrated when patients do not quit when advised to do so."

Previous studies have found that about 70 percent of smokers want to quit but believe it will be too difficult without assistance, and that smokers are 30 percent more likely to kick the habit if they receive help from their health-care provider.

For more information, see web link:
The Washington Post October 27, 2008

Smoking Cessation Interventions for Hospitalized Smokers: A Systematic Review

Hospital-sponsored stop-smoking programs for inpatients that include follow-up counseling for longer than one month significantly improve patients' ability to stay smoke-free. An analysis of clinical trials of programs offered at hospitals around the world finds that efforts featuring long-term support can increase participants' chances of success by 65 percent. The study - led by Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital (MGH) - appears in the October 13 issue of Archives of Internal Medicine and is one of several articles focused on smoking.

"While nobody looks forward to a hospital stay, it can really have an extra benefit for smokers" says Rigotti. "But this is only if the hospital helps them quit with counseling during and after their hospital stay. Hospitals really need to step up to the plate and offer this type of service routinely, and it also should be reimbursed by payers."

Entering the hospital poses a special challenge for smokers because all U.S. hospitals are now smoke-free, but it also can offer those ready to quit an important opportunity. Both the inability to smoke during their hospital stay and a determination to recover from their illness, particularly if it is tobacco-related, can encourage smokers to begin a serious effort to kick the habit. Many hospitals offer stop-smoking help to their patients, but questions remain about whether those programs are successful. The current study analyzed the results of 33 clinical trials of hospital-based programs in nine countries conducted between 1999 and 2007.

Analyzing hospital-based efforts according to their intensity - a single brief smoking-related contact, one or more extended contacts during hospitalization, hospital contact plus a month or less of post-discharge telephone support, and hospital contact followed by more than a month of post-discharge support - revealed that only programs with the highest intensity level were more successful than usual care in helping patients quit for six months or longer.

Including nicotine replacement products further increased patients' quit rates - probably by both relieving nicotine withdrawal symptoms and helping patients stay off cigarettes once they leave the hospital, the researchers note - but data were not sufficient to assess the impact of pharmaceuticals like bupropion and varenicline. Although the success rate for patients admitted with cardiovascular disease was a bit higher, intensive counseling was successful for all hospitalized smokers, regardless of their diagnosis.

The information analyzed in this study came from the trial register of the Cochrane Tobacco Addiction Review Group, which is supported by the National Health Service of the United Kingdom. Additional support came from the U.S. National Heart, Lung and Blood Institute. The study's co-authors are Marcus Munafo, University of Bristol, England, and Lindsay Stead, Cochrane Tobacco Addiction Review Group.

For more information, see web link:
Harvard University Gazette October 16, 2008

Smell Of Smoke Does Not Trigger Relapse In Quitters, New Research Shows

Research into tobacco dependence published in the November issue of Addiction, has shown that recent ex-smokers who find exposure to other people's cigarette smoke pleasant are not any more likely to relapse than those who find it unpleasant.

Led by Dr Hayden McRobbie and Professor Peter Hajek of the Tobacco Dependence Research Unit at Barts and The London School of Medicine and Dentistry, researchers examined the hypothesis that those who find the smell of smoke pleasant are more likely to relapse than those who have a neutral or negative reaction to it. Surprisingly, they concluded that finding the smell of other people's cigarettes pleasant does not make abstaining smokers any more likely to relapse.

The researchers studied a group of over a thousand smokers receiving smoking cessation treatment at the East London Smokers Clinic. During their six weeks of treatment (two weeks prior to quitting and four weeks afterwards) the smokers completed a weekly questionnaire that measured the severity of their withdrawal discomfort, and also asked them to rate how pleasant they found the smell of other people's cigarettes during the past week.

The results showed that during their first week of abstinence, 23 percent of respondents found the smell of other people's cigarette smoke pleasant. Finding the cigarette smoke pleasant was not related to smoking status in the following week.

Lead author Dr Hayden McRobbie says, "Recent quitters can be reassured that finding the smell of cigarette smoke pleasant is not likely to lead them back to smoking."

For more information, see web link:
ScienceDaily October 18, 2008

Men Who Never Smoke Live Longer, Better Lives Than Heavy Smokers

Health-related quality of life appears to deteriorate as the number of cigarettes smoked per day increases, even in individuals who subsequently quit smoking, according to a report in the October 13 issue of Archives of Internal Medicine.

Smoking has been shown to shorten men's lives between seven and 10 years, according to background information in the article. It also has been linked to factors that may reduce quality of life, including poor nutrition and lower socioeconomic status.

Arto Y. Strandberg, M.D., of the University of Helsinki, and colleagues followed 1,658 white men born between 1919 and 1934 who were healthy at their first assessment, conducted in 1974. Participants were mailed follow-up questionnaires in 2000 that assessed their current smoking status, health and quality of life. Deaths were tracked through Finnish national registers. During the 26-year follow-up period, 372 (22.4 percent) of the men died. Those who had never smoked lived an average of 10 years longer than heavy smokers (more than 20 cigarettes per day). Non-smokers also had the best scores on all health-related quality of life measures, especially those associated with physical functioning. Physical health deteriorated at an increasing rate as the number of cigarettes smoked per day increased, with heavy smokers experiencing a decline equivalent to 10 years of aging.

"Although many smokers had quit smoking between the baseline investigation in 1974 and the follow-up examination in 2000, the effect of baseline smoking status on mortality and the quality of life in old age remained strong," the authors write. "In all, the results presented here are troubling for those who were smoking more than 20 cigarettes daily 26 years earlier; in spite of the 68.9 percent cessation rate during follow-up, 44.1 percent of the originally heavy smokers had died, and those who survived to the mean [average] age of 73 years had a significantly lower physical health-related quality of life than never-smokers."

The findings may add to the view of smoking as a burden on society and might also encourage individual smokers to quit, the authors note. "The argument of better quality of life may be especially meaningful for the aging smoker but, as our results show, for the best health-related quality of life, the habit should not be started at all," they write. "The highly addictive nature of nicotine is revealed by the persistence of the smoking habit in spite of the declining health-related quality of life among older heavy smokers. For those not able to quit smoking, reduction may also be beneficial because mortality [death] and health-related quality of life showed a dose-dependent trend according to the number of cigarettes smoked daily."

For more information, see web link:
ScienceDaily October 14, 2008

A Randomized Trial of a Pay-for-Performance Program Targeting Clinician Referral to a State Tobacco Quitline

A pay-for-performance program may increase referrals to tobacco quitline services, particularly among clinics who have not previously participated in quality improvement activities.

A study, appearing in the October 13 issue of the Archives of Internal Medicine, looked at programs that tie physician pay to the quality of care. The key measure was clinics' referrals of patients in Minnesota to a tobacco quit line. Researchers compared clinics that were paid bonuses for making such referrals to clinics that didn't have a financial incentive.

Lawrence C. An, M.D., of the University of Minnesota, Minneapolis, and colleagues randomly assigned 24 primary care clinics to participate in a program offering $5,000 for 50 quitline referrals and $25 for each referral beyond the initial 50.

Between Sept. 1, 2005, and June 31, 2006, these clinics in the pay-for-performance program referred 11.4 percent of eligible smokers, compared with 4.2 percent among 25 clinics offering usual care. "Quitlines are widely available, and application of pay-for-performance strategies to encourage health care provider referral should be strongly considered by health care organizations seeking to reduce the health and economic burden of tobacco-related disease," the authors write.

The researchers also noted some important factors for success beyond cold cash. For one, Minnesota health plans collaborated to make the referral process easy for the clinics. The clinics were also rewarded regardless of what health plan their patients belonged to, meaning that they could make the same recommendation to all smokers.

For more information, see web link:
Archives of Internal Medicine Vol. 168 No. 18, October 13, 2008

Predictors of Smoking Cessation After a Myocardial Infarction The Role of Institutional Smoking Cessation Programs in Improving Success

Hospital-based smoking cessation programs, along with referrals to cardiac rehabilitation, appear to be associated with increased rates of quitting smoking following heart attack.

Nazeera Dawood, M.D., M.P.H., at Emory University School of Medicine, Atlanta, and colleagues found that individual counseling after a heart attack is not particularly effective at getting patients to quit smoking. Hospital-based smoking-cessation programs, as well as referral to cardiac rehabilitation, are much more successful.

Dawood and his colleagues enrolled patients with myocardial infarction (heart attack) from 19 US centers participating in the Prospective Registry Evaluating Outcomes After Myocardial Infarction Events and Recovery (PREMIER) between January 2003 and June 2004. Smoking behavior was assessed by self-report during hospitalization and six months after MI.

Among 834 patients who smoked at the time of MI hospitalization, 639 were interviewed and reported their smoking habits at six months post-MI. Of these, 297 (46 percent) were not smoking at six months.

Ten of the 19 hospitals offered smoking-cessation programs. While those who did and did not quit smoking were equally likely to have had medical-chart-based individual-level counseling to stop smoking (75 percent and 72 percent respectively), those who did quit were significantly more likely to be admitted to a hospital offering smoking-cessation programs (69 percent vs 56 percent). And those who stopped smoking were also more likely to have been referred to cardiac rehabilitation at discharge (63 percent vs 47 percent).

"These findings extend the current understandings of smoking habits after an MI and have important implications for current quality-assessment efforts," say the researchers.

For more information, see web link:
Archives of Internal Medicine Vol. 168 No. 18, October 13, 2008

Do 'Light' Cigarettes Deliver Less Nicotine To The Brain Than Regular Cigarettes?

For decades now, cigarette makers have marketed so-called light cigarettes - which contain less nicotine than regular smokes - with the implication that they are less harmful to smokers' health. A new UCLA study shows, however, that they deliver nearly as much nicotine to the brain.

Reporting in the current online edition of the International Journal of Neuropsychopharmacology, UCLA psychiatry professor Dr. Arthur L. Brody and colleagues found that low-nicotine cigarettes act similarly to regular cigarettes, occupying a significant percentage of the brain's nicotine receptors.

Light cigarettes have nicotine levels of 0.6 to 1 milligrams, while regular cigarettes contain between 1.2 and 1.4 milligrams.

The researchers also looked at de-nicotinized cigarettes, which contain only a trace amount of nicotine (0.05 milligrams) and are currently being tested as an adjunct to standard smoking-cessation treatments. They found that even that low a nicotine level is enough to occupy a sizeable percentage of receptors.

Fifteen smokers participated in the study. Each was given positron emission tomography (PET) scans, a brain-imaging technique that uses minute amounts of radiation-emitting substances to tag specific molecules. In this case, the tracer was designed to bind to the nicotine receptors in the brain.

The researchers could then measure what percentage of the tracer was displaced by nicotine when the research subjects smoked. In total, 24 PET scans were taken of participants' brains before and after three different conditions: not smoking, smoking a de-nicotinized cigarette and smoking a low-nicotine cigarette.

The PET data showed that smoking a de-nicotinized cigarette and a low-nicotine cigarette occupied 26 percent and 79 percent of the receptors, respectively, which was very close to what the researchers had originally estimated.

"The two take-home messages are that very little nicotine is needed to occupy a substantial portion of brain nicotine receptors," Brody said, "and cigarettes with less nicotine than regular cigarettes, such as 'light' cigarettes, still occupy most brain nicotine receptors. Thus, low-nicotine cigarettes function almost the same as regular cigarettes in terms of brain nicotine-receptor occupancy.

"It also showed us that de-nicotinized cigarettes still deliver a considerable amount of nicotine to the brain. Researchers, clinicians and smokers themselves should consider that fact when trying to quit."

For more information, see web link:
ScienceDaily September 29, 2008

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Panel Calls for Vaccine for Adult Smokers

For the first time, an influential government panel is recommending a vaccination specifically for smokers. The panel decided recently that adult smokers under 65 should get pneumococcal vaccine. The shot -- already recommended for anyone 65 or older -- protects against bacteria that cause pneumonia, meningitis and other illnesses.

Federal officials usually adopt recommendations made by the panel, the Advisory Committee on Immunization Practices. The vote means more than 31 million adult smokers probably will soon be called on to get the shot.

Studies have shown that smokers are about four times more likely than nonsmokers to suffer pneumococcal disease. Also, the more cigarettes someone smokes each day, the higher the odds they'll develop the illnesses.

Why smokers are more susceptible is not known for sure, but some scientists believe it has to do with smoking-caused damage that allows the bacteria to more easily attach to the lungs and windpipe, said Dr. Pekka Nuorti, a medical epidemiologist with the Centers for Disease Control and Prevention.

Pneumococcal infections are considered the top killer among vaccine-preventable diseases. It's a common complication of influenza, especially in the elderly, and is considered responsible for many of the 36,000 annual deaths attributed to flu.

The committee voted 11 to 3 to pass the recommendation, with one member abstaining. The panel also added a call for smoking cessation counseling.

Some members said it might be more cost effective to recommend the vaccine for smokers who were at least age 40, because pneumococcal disease is relatively uncommon in younger smokers.

For more information, see web link:
The New York Times October 22, 2008

Smoke Stinks in a Slow Real Estate Market: 76 Percent of Potential Home Buyers Say Cigarette Smoke Odor Would Be a Deal Breaker

As "For Sale" signs dot yards throughout Florida, plummeting sales and home prices and soaring foreclosures signal that the housing crisis continues to deepen. When the real estate market is competitive, a home with a pungent odor such as cigarettes can make or break the deal. According to a 2008 Home Features Survey done by Zip Realty, 76 percent of respondents say that bad odors, such as cigarette smoke, would sway their decision against purchasing a home. Tobacco Free Florida wants to help Floridians maintain their edge in a competitive market and live healthier lives.

The stale, lingering odor of cigarette smoke seeps into and sticks on furniture, carpets, walls, curtains and just about every surface it comes in contact with. Household cleaners alone won't get the job done, therefore professionals need to be hired to deep clean the stubborn odors and remove stains. Smokers incur extra costs when selling a house that non-smokers do not. Homes may require new paint and professional carpet and drapery cleaning. For an average sized home this could run a homeowner approximately $3,000 in additional expenses.

Think smoking outside is the answer? "It is not," says Kim Berfield, Deputy Secretary of the Florida Department of Health. "Smoking outside helps reduce tobacco odor, but does not eliminate it. Clothes absorb the smell, dragging it back into the home and undoubtedly finding its way to closets and drawers. Quitting smoking is the only way to completely rid a home of the smell."

In addition to the effect that cigarette smoke can have to a home's interior, smoking inside puts others at risk of the dangers of second-hand smoke. There is no safe level of exposure to secondhand smoke and there is no ventilation (i.e., an open window) that can eliminate the exposure.

For more information, see web link:
PRNewsWire October 21, 2008

Virginia Ad Campaign: No Matter the Time of Day, Lung Cancer Shouldn't be on the Menu

Secondhand smoke is dangerous no matter the time of day, and Virginia needs a law requiring restaurants to be smoke-free at all times and not just at certain times as some leaders have proposed, according to a newspaper advertising campaign launched today by a coalition of public health organizations.

The newspaper ad states, "No matter the time of day, lung cancer shouldn't be on the menu." The advertisement further states, "All Virginians deserve the right to breathe clean air. Every hour. Every day." To view the ad, go to http://www.tobaccofreekids.org/campaign/va2008/everyhour.pdf

News reports indicate that some state officials are considering a plan that would still allow smoking in Virginia restaurants after 10 p.m. Leading public health organizations have criticized the plan, which would be difficult and costly to enforce and - most importantly - would continue to put workers' and customers' health at risk. Secondhand smoke contains more than 4,000 chemicals, including 69 known to cause cancer - and those toxins can linger long after the last cigarette is put out. Secondhand smoke is a proven cause of lung cancer, heart disease and other serious illnesses.

"No one should have to risk their health in order to earn a paycheck or enjoy a night out in a restaurant," said William V. Corr, Executive Director of the Campaign for Tobacco-Free Kids. "Virginians deserve a real smoke-free law that protects all workers and customers at all times of the day and night. Everyone has the right to breathe clean, smoke-free air, free from the proven dangers of secondhand smoke."

Virginians strongly support a comprehensive smoke-free law. In a January 2008 poll, 75 percent of Virginia voters said they support a statewide law that makes all restaurants completely smoke-free. And 88 percent of voters agreed that all workers in Virginia should be protected from exposure to secondhand smoke in the workplace.

The ad campaign is sponsored by Virginians for a Healthy Future, American Lung Association of Virginia, American Cancer Society, American Heart Association, Robert Wood Johnson Foundation, Americans for Nonsmokers' Rights and Campaign for Tobacco-Free Kids.

More Colleges Stamp Out Smoking

College campuses are going smoke-free in rapidly growing numbers across the USA.

More than 140 campuses now are completely smoke-free, more than triple the number that had banned smoking as recently as March 2007, said Frieda Edgette, of the lobbying group Americans for Nonsmokers' Rights.

An additional 30 campuses are smoke-free with a few exceptions, such as designated smoking outdoor areas, and at least 500 campuses have smoke-free policies in residential housing, she said.

The most recent major development came last month, when the Pennsylvania State System of Higher Education (PASSHE) announced a smoking ban at all state-owned universities, after the state passed a ban prohibiting smoking in most work and public places in June. That made the state's 14 universities, attended by more than 110,000 students, smoke-free.

"The evidence and recognition that secondhand smoke is a really big risk to health" is a major reason for the increase, said Erika Sward, the American Lung Association's director of national advocacy.

PASSHE spokesman Ken Marshall said the system examined the state law and decided to ban smoking both indoors and outdoors on its campuses.

"We hold events and classes outside, so we thought it was appropriate to ban outdoor smoking," he said.

Many of the campuses that have gone smoke-free in the past two years have been community and smaller colleges and universities, Edgette said. In addition to Pennsylvania, the latest include Bergen (County, NJ) Community College, Montgomery (MD) College, Fullerton (CA) College, the University of North Dakota and Indiana University-Purdue University Indianapolis.

For more information, see web link:
USAToday October 13, 2008

The National Cancer Institute Receives CEO Cancer Gold Standard™ Accreditation

The National Cancer Institute (NCI) was recently accredited with the CEO Cancer Gold Standard™ certification. NCI joins twenty six other organizations, including two NCI-designated Cancer Centers, that have achieved Gold Standard accreditation, recognizing their efforts to meet an exceptionally high standard of cancer prevention, screening and care guidelines for their employees and family members.

William C. Weldon, chairman and chief executive officer of Johnson & Johnson chairs the CEO Roundtable on Cancer, the nonprofit organization of cancer-fighting CEOs that created the CEO Cancer Gold Standard™, in collaboration with the American Cancer Society, NCI-designated comprehensive cancer centers and leading corporate health professionals.

"It is both appropriate and inspirational that the preventative health and wellness guidelines and unparalleled cancer care for which the National Cancer Institute and its director, Dr. John Niederhuber stand for are provided for NCI's own employees and their family members who are on the frontlines of our nation's battle against cancer each and every day," said Weldon.

The CEO Cancer Gold Standard™, calls for companies to evaluate their benefits and culture and take extensive, concrete actions in five key areas of health and wellness to fight cancer in the workplace. To earn Gold Standard accreditation, a company must establish programs to reduce cancer risk by discouraging tobacco use and encouraging physical activity, healthy diet and nutrition; detect cancer at its earliest stages; and provide access to quality care, including the availability of clinical trials. The NCI's accreditation is coincident with the implementation of a tobacco-free policy on the entire National Institutes of Health (NIH) campus in Bethesda, MD, where the NCI is headquartered. NCI will increase availability to tobacco cessation programs for its employees and their families and support increased efforts through the HealthierFeds program, to encourage physical activity, nutritious diet, disease prevention, and overall healthy decision-making for federal government employees.

The most recent President's Cancer Panel report, "Promoting Healthy Lifestyles: Policy, Program, and Personal Recommendations for Reducing Cancer Risk," identified the CEO Cancer Gold Standard™ as an initiative that is helping reverse negative, unhealthy lifestyle trends and creating hope in the fight against cancer for America's workers and their families.

Joining NCI in this workplace-based effort to eliminate cancer as a public health threat are: American Cancer Society, American Legacy Foundation, AstraZeneca, C-Change, Duke Medicine, Edelman, Enzon Pharmaceuticals, GHI, GlaxoSmithKline, Jenner & Block, Johnson & Johnson, The Lance Armstrong Foundation, MD Anderson Cancer Center, H. Lee Moffitt Cancer Center and Research Institute, Novartis, OSI Pharmaceuticals, Pfizer, PhRMA, PPD, Quintiles Transnational, SAS Institute, The University of North Dakota, US Oncology, Valeant Pharmaceuticals, Virtua Health and The Wistar Institute.

For more information, see web link:
MarketWatch October 1, 2008

North Carolina Health and Wellness Trust Fund Announces 'Breathe Easy, Live Well' Program

The North Carolina Health and Wellness Trust Fund (HWTF) announces the creation of a new statewide tobacco cessation program for mental health consumers called "Breathe Easy, Live Well." Approximately 70 percent of individuals with serious mental illness smoke cigarettes, and individuals with mental illness or addiction consume nearly half of all cigarettes purchased in the United States.

The program, which will be implemented in psychosocial treatment centers across the state, aims to reduce the harmful effects that tobacco has on individuals with mental illness by providing them with equal access to smoke-free environments and cessation programs, in addition to increasing their awareness about overall wellness.

The project is funded by the HWTF as part of its overall tobacco cessation initiative. To date, HWTF has spent $54.3 million to address tobacco use in the state since its efforts began in 2003.

"The NC Health and Wellness Trust Fund is committed to reducing the health effects of tobacco use in our state for all populations," said Lt. Governor Bev Perdue, HWTF chair. "Through this initiative, the Commission is intensifying its efforts to reach out to this particularly vulnerable population with specialized services designed to better meet their unique needs."

HWTF has awarded $505,000 to the NC Evidence Based Practice Center, part of Southern Regional AHEC, to pilot the program in mental health community/day treatment centers, also known as clubhouses.

The first four pilot programs include Adventure House in Shelby, Atlantic House in Morehead City, Sanctuary House in Greensboro, and Threshold Clubhouse in Durham.

The clubhouses are non-profit, psychosocial rehabilitation programs serving North Carolina adults with severe and persistent mental illness. The clubhouses will begin training in November/December 2008, and wellness and cessation courses will launch in January 2009. For more information, please visit http://www.healthwellnc.com.

For more information, see web link:
The Raleigh Chronicle September 26, 2008

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