Deal reached on tobacco firm corrective statements

By MICHAEL FELBERBAUM, AP Tobacco Writer
RICHMOND, Va. (AP) — The nation’s tobacco companies and the federal government have reached an agreement on publishing corrective statements that say the companies lied about the dangers of smoking and requires them to disclose smoking’s health effects, including the death on average of 1,200 people a day.
The agreement filed Friday in U.S. District Court in Washington, D.C., follows a 2012 ruling ordering the industry to pay for corrective statements in various advertisements. The judge in the case ordered the parties to meet to discuss how to implement the statements, including whether they would be put in inserts with cigarette packs and on websites, TV and newspaper ads.
The court must still approve the agreement and the parties are discussing whether retailers will be required to post large displays with the industry’s admissions.
The corrective statements are part of a case the government brought in 1999 under the Racketeer Influenced and Corrupt Organizations. U.S. District Judge Gladys Kessler ruled in that case in 2006 that the nation’s largest cigarette makers concealed the dangers of smoking for decades. The companies involved in the case include Richmond, Va.-based Altria Group Inc., owner of the biggest U.S. tobacco company, Philip Morris USA; No. 2 cigarette maker, R.J. Reynolds Tobacco Co., owned by Winston-Salem, N.C.-based Reynolds American Inc.; and No. 3 cigarette maker Lorillard Inc., based in Greensboro, N.C.
Under the agreement with the Justice Department, each of the companies must publish full-page ads in the Sunday editions of 35 newspapers and on the newspapers’ websites, as well as air prime-time TV spots on CBS, ABC or NBC five times per week for a year. The companies also must publish the statements on their websites and affix them to a certain number of cigarette packs three times per year for two years.
Each corrective ad is to be prefaced by a statement that a federal court has concluded that the defendant tobacco companies “deliberately deceived the American public.” Among the required statements are that smoking kills more people than murder, AIDS, suicide, drugs, car crashes and alcohol combined, and that “secondhand smoke kills over 38,000 Americans a year.”
Tobacco companies had urged Kessler to reject the government’s proposed corrective statements; the companies called them “forced public confessions.” They also said the statements were designed to “shame and humiliate” them. They had argued for statements that include the health effects and addictive qualities of smoking.
A federal appeals court also rejected efforts by the tobacco companies to overrule Kessler’s ruling requiring corrective statements.
Representatives for Altria, R.J. Reynolds and Lorillard each declined to comment.
Several public health groups, including the American Cancer Society, American Heart Association and American Lung Association, intervened in the case. In a statement Friday, the groups said the corrective statements are “necessary reminders that tobacco’s devastating toll over the past 50-plus years is no accident. It stems directly from the tobacco industry’s deceptive and even illegal practices.”
The corrective statements include five categories: adverse health effects of smoking; addictiveness of smoking and nicotine; lack of significant health benefit from smoking cigarettes marked as “low tar,” ”light,” etc.; manipulation of cigarette design and composition to ensure optimum nicotine delivery; and adverse health effects of exposure to secondhand smoke.
Among the statements within those categories:
“Smoking kills, on average, 1,200 Americans. Every day.”
“Philip Morris USA, R.J. Reynolds Tobacco, Lorillard, and Altria intentionally designed cigarettes to make them more addictive.”
“When you smoke, the nicotine actually changes the brain — that’s why quitting is so hard.”
“All cigarettes cause cancer, lung disease, heart attacks, and premature disease, heart attacks, and premature death — lights, low tar, ultra lights, and naturals. There is no safe cigarette.”
“Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke.”
“Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function.”
“There is no safe level of exposure to secondhand smoke.”
http://www.seattlepi.com/news/article/Deal-reached-on-tobacco-firm-corrective-statements-5131393.php

Fitful Progress in the Antismoking Wars

By THE EDITORIAL BOARD, New York Times
Fifty years ago this Saturday, on Jan. 11, 1964, a myth-shattering surgeon general’s report on smoking and health brushed aside years of obfuscation by tobacco companies and asserted, based on 7,000 scientific articles, that smoking caused lung cancer and was linked to other serious diseases. Those findings expanded as more data was gathered.
Research since then has shown that tobacco can cause or exacerbate a wide range of diseases, including heart disease, stroke, multiple kinds of cancer, chronic obstructive pulmonary disease, emphysema, asthma and diabetes, and can injure nonsmokers who breathe in the toxic fumes secondhand. The death toll from tobacco remains stubbornly high but can be driven down by using a range of new and proven tactics.
By some measures, the 50-year campaign to rein in tobacco use has been an enormous success. The percentage of American adults who smoke dropped from 42 percent in 1965 to 18 percent in 2012. A study published in the Journal of the American Medical Association this week estimated that tobacco control measures adopted since 1964 have saved eight million Americans from premature death and extended their lives by an average of almost 20 years.
Experts attribute the gains to vigorous campaigns to educate people about the dangers of smoking; increases in cigarette taxes; state and local laws that protect half the nation’s population from tobacco fumes in workplaces, bars and restaurants; restrictions on advertising; prohibition of sales to minors; and various prevention and cessation programs financed by states or private insurance.
Despite these gains, nearly 44 million American adults still smoke, more than 440,000 Americans die every year from smoking, and eight million Americans live with at least one serious chronic disease from smoking. Medical costs connected to smoking are nearly $96 billion a year, with an additional $97 billion lost in productivity because of illness.
On Wednesday, several health organizations, including the American Heart Association, the American Lung Association, the American Cancer Society, the American Academy of Pediatrics, and the Campaign for Tobacco-Free Kids called for a new national commitment to drive smoking among adults down to less than 10 percent over the next decade; protect all Americans from secondhand smoke within five years by having every state enact laws against smoking in all workplaces, bars and restaurants; and ultimately eliminate death and disease caused by tobacco.
It won’t be easy. The tobacco industry spends more than $8 billion a year to market cigarettes and other tobacco products in this country, with much of its marketing slyly aimed at young people.
The industry is also invading foreign markets, often in less developed countries, in an effort to make addicts of millions more customers to replace those in industrialized nations. Although smoking rates among adults around the globe have fallen sharply since 1980, the number of smokers has increased significantly along with population growth and will continue to increase as national incomes and populations rise. The United States government must help counter the tobacco industry’s efforts to spread its noxious products around the world.
http://www.nytimes.com/2014/01/10/opinion/fitful-progress-in-the-antismoking-wars.html?_r=0

Local doctor’s view e-cigarettes

By Diane Miller, High Plains Reader, Fargo
Sales of electronic cigarettes are expected to reach $1.7 billion this year. Many smokers are turning to this odor-free, vapor-releasing instrument as a safer alternative to cigarettes, but many health experts are skeptical.
HPR turned to local e-cig expert Dr. Brody Maack from Family HealthCare to answer a few questions this new product.
HPR: Why are the FDA and health experts so concerned about a product that seems like a much safer alternative to cigarettes?
Dr. Brody Maack: The main concern revolves around the fact that e-cigarettes currently have no manufacturing standards and are unregulated. This means that there have been no well done, long term safety studies in which the products are tested to see if there are any harmful effects.
Also, as far back as 2009, the FDA did laboratory analysis of some e-cigarettes, which showed that they contained carcinogens (cancer-causing chemicals) as well as diethylene glycol (which is found in anti-freeze).
The FDA also found that quality control in manufacturing the e-cigarettes is either poor or non-existent in laboratory studies.
It is also unknown as to the risks of inhaling the “vapor” which is let off by the products, and we don’t know if there is a risk for second-hand exposure to the vapor. Because e-cigarettes all contain different amounts of their ingredients, including nicotine, in addition to these other safety concerns, we cannot say that they are “safer” than cigarettes.
Another concern is that we are seeing a rapid increase in the use of e-cigarettes in our youth, due to various flavors which are attractive to a younger crowd, and intensive marketing of the products. Also, there is no restriction to e-cigarette sales to minors in North Dakota. Minnesota, however, does prohibit the sale and possession of e-cigarettes to minors.
HPR: What would be your response to this statement made by Craig Youngblood, president of the InLife e-cigarette company:
In our product you have nicotine or no nicotine, PEG, and some flavoring. In cigarettes you have nicotine, PEG, and 4,000 chemicals and 43 carcinogens. There are 45 to 50 million people already addicted to nicotine.
Should they have the choice to satisfy their addiction by other means? … I am a proponent of harm reduction. People have rights and choices and should be allowed to make them.
BM: Mr. Youngblood states that his product contains various ingredients (i.e. “nicotine or no nicotine”), also admitting that his product includes “some flavoring.” As I stated before, there are no e-cigarette manufacturers that are currently being held to any manufacturing standards or regulations, so the InLife product, like other e-cigarette products, may contain various amounts of its stated ingredients.
Also, the fact that InLife is promoting its product as containing flavoring may be increasing exposure of this product with unknown safety to our youth. This is why the FDA has banned flavoring in cigarettes. The CDC released data in October of this year which showed that 40 percent of middle and high schoolers who smoke, smoke flavored tobacco products.
I agree with Mr. Youngblood when he states that “people have rights and choices and should be allowed to make them,” but I believe that people’s decisions should therefore be well-informed, and not subject them, or their children, to potential health risk. Also, the issue of “harm reduction” is typically promoted by tobacco product supporters, however it is felt by most of the tobacco cessation expert community that complete abstinence from tobacco is the only way to reduce the number of people who will die in the next 100 years from tobacco related disease, which is expected to be 1 billion!
HPR: Many community citizens are upset that the city of Fargo banned the use of e-cigs in indoor public places. Do you foresee this rule changing and why?
BM: The banning of e-cigarettes in Fargo is actually a statewide law, which went into effect December 6, 2012. I don’t see this changing, simply because of concerns we have discussed—lack of manufacturing standards, lack of safety proof, potentially harmful ingredients and concerns for turning our youth on to tobacco products. Considering that e-cigarettes look similar to regular cigarettes, prohibiting their use indoors also eliminates any confusion about what’s acceptable under the statewide law.
HPR: In your opinion, what is the best method to quitting smoking?
BM: The best method of quitting smoking has been proven countless times to be a method which includes behavioral counseling along with medications, such as the nicotine patches, gum or lozenges. This method is recommended by the US Public Health Service, and is available in many communities through doctors’ offices, pharmacies and through state telephone quitline services, such as ND Quits (1-800-QUIT-NOW) or internet quit services. Many of these programs are free!
HPR: Anything you’d like to add?
BM: As of right now, e-cigarettes are too much of an “unknown” with regards to safety and whether or not they help people to quit smoking, and with concerns for the products being a gateway to youth tobacco use, they simply cannot be recommended for use. There have been no respectable studies showing that e-cigarettes are better, or safer, than any of our seven FDA-approved medications for quitting smoking.
We have a large amount of safety data and data to show that the FDA-approved options work very well to help people quit tobacco. These options include three over-the-counter options (nicotine patches, gum and lozenges), and four prescription products (Chantix, Zyban, nicotine inhaler and nicotine nasal spray). In fact, the nicotine inhaler is a proven, safe option for people who want to quit in a similar way as e-cigarettes, without the unknown risks of “vapor” exposure and other potentially harmful ingredients.
Also, the nicotine inhaler, along with the other FDA-approved options, is legal to use in any indoor space in North Dakota. I personally recommend this option for patients of mine who show interest in e-cigarette products as a safe alternative to e-cigarettes.
Brody Maack, PharmD, CTTS, is a clinical pharmacist who provides medication management services, including tobacco cessation, at Family HealthCare in Fargo. He also serves as Assistant Professor of Pharmacy Practice at the NDSU College of Pharmacy, Nursing and Allied Sciences, where he teaches the subjects of heart and lung diseases, which includes tobacco related disease, prevention and cessation.
http://hpr1.com/wellness/article/local_doctors_view_e-cigarettes/

Working against tobacco

By Nick Smith, Bismarck Tribune
Members of an interim legislative committee heard testimony about tobacco prevention efforts on reservations throughout the state Wednesday.
The interim Health Services Committee heard from health department officials as well as tribal leaders and tobacco prevention coordinators from on and off the state’s reservations.
Krista Fremming, Tobacco Prevention and Control Program director for the state Health Department, said the department collaborates with tribal tobacco program officials and in some cases shares facilities.
“On Dec. 13, 2013, the North Dakota Department of Health coordinated a tribal tobacco strategic session to discuss effective processes to reduce tribal tobacco use,” Fremming said. “Attendees agreed formal tribal tobacco strategic planning is needed to identify the best strategy to address tobacco use on the reservations.”
She said the North Dakota Indian Affairs Commission will be taking the lead on the strategic planning process.
Fremming said due to cessation and prevention programs nearly all schools and colleges on reservations now have tobacco-free and smoke-free policies in place.
Smoke-free tribal buildings are now a staple on reservations, she said, but housing and casinos are another matter.
“The North Dakota Department of Health is partnering with the Intertribal Tobacco Abuse Coalition to address the issue of smoke-free casinos on a statewide level,” Fremming said.
The Sky Dancer Casino in Belcourt has a no-smoking policy and the Four Bears Casino in New Town has a designated room for smoking.
Fremming said the idea is in the planning stages and it would likely take a year or two for any implementation to take place.
Another area of note, Fremming said, is enrollment in the NDQuits program. The NDQuits program pushes to keep people from starting to smoke and help people quit, using online sources, counselors andother services.
“In fiscal year 2013, a total of 152 enrollees were American Indian. In fiscal year 2014 there have already been 125 enrollees who were American Indian during the months of July through November,” Fremming said.
Also testifying Wednesday was Beth Hughes. She serves as executive committee chairman for the North Dakota Center for Tobacco Prevention and Control Policy.
Hughes said two-thirds of its $15.8 million budget is spent on a trio of statewide and community grant programs.
“The policies are to serve all residents both on and off American Indian reservations,” Hughes said. “The Center requires that funded programs show policy and health outcomes that can be documented by adoption of model comprehensive policies and, over time, show reduction in tobacco use.”
Hughes said among the center’s recommendations are continued funding of programs using the federal Centers for Disease Control and Prevention’s recommended best practices.
Chairman Sen. Judy Lee, R-West Fargo, questioned the recommendation. Lee said she believes the center comes off at times as being focusing too explicitly on CDC recommendations and not working as collaboratively as it could with other departments.
“The center is viewed as being a bit heavy-handed,” Lee said.
Lee said the reservations are sovereign nations and cultural sensitivity also needs to be kept in mind.
Hughes said she understood the criticism and it was something she would relay to center staff. She added that there is already a level of collaboration with other departments.
“There is no way that the center could do the work that it does without the other entities in the state,” Hughes said.
http://bismarcktribune.com/news/state-and-regional/working-against-tobacco/article_6ba98b3e-78e6-11e3-a21c-001a4bcf887a.html

War on smoking, at 50, turns to teens: Our view

The Editorial Board, USATODAY

Want kids to quit? Raise cigarette taxes. It works.

The war on smoking, now five decades old and counting, is one of the nation’s greatest public health success stories — but not for everyone.
As a whole, the country has made amazing progress. In 1964, four in ten adults in the U.S. smoked; today fewer than two in ten do. But some states — Kentucky, South Dakota and Alabama, to name just a few — seem to have missed the message that smoking is deadly.
Their failure is the greatest disappointment in an effort to save lives that was kick-started on Jan. 11, 1964, by the first Surgeon General’s Report on Smoking and Health. Its finding that smoking is a cause of lung cancer and other diseases was major news then. The hazards of smoking, long hidden by a duplicitous industry, were just starting to emerge.
The report led to cigarette warning labels, a ban on TV ads and eventually an anti-smoking movement that shifted the nation’s attitude on smoking. Then, smokers were cool. Today, many are outcasts, banished from restaurants, bars, public buildings and even their own workplaces. Millions of lives have been saved.
The formula for success is no longer guesswork: Adopt tough warning labels, air public service ads, fund smoking cessation programs and impose smoke-free laws. But the surest way to prevent smoking, particularly among price-sensitive teens, is to raise taxes. If you can stop them from smoking, you’ve won the war. Few people start smoking after turning 19.
Long before health advocates discovered this, the tobacco industry knew that high taxes kill smoking as surely as cigarettes kill smokers. “Of all the concerns … taxation … alarms us the most,” says an internal Philip Morris document, turned over in a gaggle of anti-smoking lawsuits in the 1990s.
The real-life evidence of taxing power is overwhelming, too. The 10 states with the lowest adult smoking rates slap an average tax of $2.42 on every pack — three times the average tax in the states with the highest smoking rates.
New York has the highest cigarette tax in the country, at $4.35 per pack, and just 12% of teens smoke — far below the national average of 18%. Compare that with Kentucky, where taxes are low (60 cents), smoking restrictions are weak and the teen smoking rate is double New York’s. Other low-tax states have similarly dismal records.
Foes of high tobacco taxes cling to the tired argument that they fall disproportionately on the poor. True, but so do the deadly effects of smoking — far worse than a tax. The effect of the taxes is amplified further when the revenue is used to fund initiatives that help smokers quit or persuade teens not to start.
Anti-smoking forces have plenty to celebrate this week, having helped avert 8 million premature deaths in the past 50 years. But as long as 3,000 adolescents and teens take their first puff each day, the war is not won.
USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.
http://www.usatoday.com/story/opinion/2014/01/08/war-on-smoking-50th-anniversary-cigarette-tax-editorials-debates/4381299/

Drugs to Stop Smoking Better Given Together?

By Crystal Phend, Senior Staff Writer, MedPage Today
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Doubling up on tobacco cessation drugs helped smokers quit at first, but didn’t significantly improve longer-term abstinence, a trial showed.
Quit rates at 12 weeks were a relative 36% to 49% better with the addition of sustained-release bupropion (Zyban) to varenicline (Chantix), Jon O. Ebbert, MD, MSc, of the Mayo Clinic in Rochester, Minn., and colleagues found.
One year after the 12-week treatment course, though, abstinence had fallen to where the relative 39% to 40% advantage of combination treatment lost significance, the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
“Further research is required to determine the role of combination therapy in smoking cessation,” they concluded.
Bupropion and varenicline both tackle cravings and “rewards” from smoking but through somewhat different routes to nicotinic acetylcholine receptors, leading to hopes for additive or synergistic effects, such as with the combination of bupropion and the nicotine patch, the group noted.
Their study randomized 500 adult smokers desiring to quit to take open-label varenicline along with blinded placebo or sustained-release bupropion for 12 weeks.
For the primary outcome, abstinence rates at week 12 were significantly better with the combination in terms of prolonged cessation with no smoking from 2 weeks after the target quit date (53% versus 43.2%, odds ratio 1.49, P=0.03), although not by point-prevalence of no smoking in the prior 7 days (56.2% versus 48.6%, OR 1.36, P=0.09).
By 26 weeks, prolonged abstinence rates had fallen to 36.6% and 27.6% in the two groups, respectively (OR 1.52, P=0.03), and 7-day point-prevalence abstinence to 38.2% and 31.9% (OR 1.32, P=0.14).
At 52 weeks, neither measure showed a significant difference between groups, although the odds ratios remained roughly the same as before (OR 1.39 and 1.40).
Prolonged abstinence rates at that point were 30.9% with combination therapy and 24.5% with varenicline alone (P=0.11); 7-day point-prevalence abstinence rates were 36.6% and 29.2%, respectively (P=0.08).
However, individuals with high levels of baseline nicotine dependence did achieve a significant impact on both measures of abstinence at 52 weeks with the combination versus monotherapy in a sensitivity analysis.
Combination therapy was associated with more adverse events in terms of both anxiety (7.2% versus 3.1%, P=0.04) and depressive symptoms (3.6% versus 0.8%, P=0.03). No serious adverse events in either group were judged treatment related.
Weight gain was similar between groups through the end of follow-up (4.9 kg [11 lbs], and 6.1 kg [13 lbs], P=0.23).
The researchers cautioned that the study was limited by the 38% rate of dropout and limited generalizability “because patients with serious medical and psychiatric illnesses including those with active substance abuse were excluded.”
http://www.medpagetoday.com/PrimaryCare/Smoking/43680?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Smoking Rates Still High Among the Mentally Ill

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Smoking rates among Americans with mental illnesses didn’t budge from 2004 to 2011, a period during which rates in the rest of the population fell 14%, researchers said.
Data from the federal Medical Expenditure Panel Survey (MEPS) found that, among respondents with mental illnesses, 25.3% reported current smoking in 2004-2005 (95% CI 24.2%-26.3%), versus 24.9% in 2010-2011 (95% CI 23.8%-26.0%, P=0.50) after adjustments for other predictors of smoking such as income and education, according to Benjamin Le Cook, PhD, MPH, of Harvard Medical School in Cambridge, Mass., and colleagues.
Over the same interval, adjusted smoking rates in other MEPS respondents declined from 19.2% (95% CI 18.7%-19.7%) to 16.5% (95% CI 16.0%-17.0%, P<0.001), the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
On the other hand, individuals with mental illnesses who were undergoing treatment showed somewhat greater quit rates than those who were untreated (37.2% versus 33.1%, P=0.005), Cook and colleagues found from a different data set, the 2009-2011 National Survey of Drug Use and Health (NSDUH).
“The mechanisms that support persistently higher rates of smoking among individuals with mental illness are complex and remain understudied,” they wrote. “Patients with mental illness may attribute greater benefits and reward value to smoking compared with patients without psychiatric disorders or may experience more difficult life circumstances, higher negative affect, or a relative lack of alternative rewards.”
Other experts contacted by MedPage Today offered differing views on the high smoking rates among the mentally ill.
John Spangler, MD, MPH, of Wake Forest Baptist Medical Center in Winston-Salem, N.C., said in an email that the nicotine in cigarettes “is very effective at relieving stress and improving mood. You can ask any smoker about that. It also can increase concentration in those with ADHD, and it improves memory as well.”
But Joseph McClernon, PhD, of Duke University, told MedPage Today that smoking as self-medication is not very effective. “Among dependent smokers, much of the relief or improvement in cognitive performance they experience from smoking likely has as much to do with reversing the effects of withdrawal,” he said in an email, which appears to be more severe in patients with some mental illnesses.
A similar viewpoint was expressed by Glen Getz, PhD, of Allegheny Health Network in Pittsburgh. The positive subjective effect of smoking “is only briefly effective and ultimately has counterproductive effects on mood, anxiety, and other emotional problems,” he said.
There was general agreement, however, that it may be more difficult for the mentally ill to quit smoking.
Among the factors cited by Cook and colleagues is a “smoking culture” that has long pervaded the mental health community, including clinicians as well as patients.
They noted that psychiatric inpatients historically were allowed and even encouraged to smoke “to decrease agitation and encourage patient adherence.” Even today, they suggested, many mental health professionals shy away from encouraging their patients to quit smoking for a variety of reasons, ranging from concern that it may distract from other therapeutic efforts to “lack of confidence” that patients can succeed in quitting.
But although such a culture did exist in the past, that’s changing, Douglas Ziedonis, MD, MPH, of the University of Massachusetts Medical School in Worcester, told MedPage Today.
“Nowadays we’re much more focused on wellness in recovery and also looking at the physical health of individuals who have mental illnesses,” he said in an email. “Mental health treatment providers are now realizing that they need to better address tobacco and wellness issues in mental health treatment.”
Said Martin Mahoney, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and director of New York state’s smoking quitline, “I don’t think there’s anything more important than helping a patients who is addicted to nicotine to get off of that addiction.”
For the current study, Cook and colleagues analyzed data on more than 32,000 MEPS respondents with mental illnesses and some 133,000 without. Participants were considered to have mental illness if they met any of several criteria: having a healthcare visit linked to a psychiatric ICD-9 code, receiving psychotherapy or mental health counseling, filling a prescription for a behavioral health disorder, or having scores on neuropsychiatric tests indicating severe psychological distress or at least moderate depression.
The data on quit rates associated with mental health treatments covered some 14,000 participants in the NSDUH from 2009 to 2011 whose responses indicated at least mild mental illness according to criteria established by the Substance Use and Mental Health Administration.
Differences in smoking prevalence in the MEPS data between those with and without mental illnesses were most pronounced among respondents with apparent depression or distress, for whom the gap was consistently around 15 percentage points through the 8-year study period.
Cook and colleagues acknowledged that the ascertainment of mental illness in both surveys could be faulty because they didn’t use structured diagnostic interviews. Also, as in most federal surveys, persons in institutional settings (including psychiatric inpatients) were excluded.
Another limitation was that the NSDUH did not include data on the timing of smoking cessation versus provision of mental health treatment, leaving open the possibility that some respondents may have quit smoking before receiving treatment. The researchers cautioned that “reverse causality” could therefore have occurred: patients may be more likely to seek mental health treatment after they quit smoking.
Primary source: Journal of the American Medical Association
Source reference: Cook B, et al “Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation” JAMA 2014; 311: 172-182.
http://www.medpagetoday.com/PrimaryCare/Smoking/43690?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Anti-smoking efforts have saved 8 million American lives

Liz Szabo, USA TODAY

A new analysis says smoking rates have dropped from 42% in 1964 to 18% in 2012.

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.
The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.
By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.
An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.
“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.
Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.
Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.
Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.
Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.
Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.
A spokesman for R.J. Reynolds Tobacco Company declined to comment.
David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.
“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”
http://www.usatoday.com/story/news/nation/2014/01/07/anti-smoking-efforts-saved-lives/4355227/

Are e-cigarettes dangerous?

By Harold P. Wimmer
Editor’s note: Harold P. Wimmer is the president and CEO of the American Lung Association.
(CNN) — For the makers of electronic cigarettes, today we are living in the Wild West — a lawless frontier where they can say or do whatever they want, no matter what the consequences. They are free to make unsubstantiated therapeutic claims and include myriad chemicals and additives in e-cigarettes.
Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap’n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes.
Many e-cigarettes look like Marlboro or Camel cigarettes. Like their old-Hollywood counterparts, glamorous and attractive celebrities are appearing on TV promoting specific e-cigarette brands. Free samples are even being handed out on street corners.

A report from the Centers for Disease Control and Prevention shows the promotion of e-cigarettes is reaching our children with alarming success. In just one year, e-cigarette use doubled among high school and middle school students, and 1 in 10 high school students have used an e-cigarette. Altogether, 1.78 million middle and high school students nationwide use e-cigarettes.

The three largest cigarette companies are all selling e-cigarettes. Because tobacco use kills more than 400,000 people each year and thousands more successfully quit, the industry needs to attract and addict thousands of children each day, as well as keep adults dependent to maintain its huge profits.
Nicotine is a highly addictive substance, whether delivered in a conventional cigarette or their electronic counterparts. The potential harm from exposure to secondhand emissions from e-cigarettes is unknown. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. We commend New York City recently for banning the use of e-cigarettes indoors.
No e-cigarette has been approved by the FDA as a safe and effective product to help people quit smoking. Yet many companies are making claims that e-cigarettes help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.
According to one study, there are 250 different e-cigarette brands for sale in the U.S. today. With so many brands, there is likely to be wide variation in the chemicals — intended and unintended — that each contain.
In 2009, lab tests conducted by the FDA found detectable levels of toxic cancer-causing chemicals — including an ingredient used in anti-freeze — in two leading brands of e-cigarettes and 18 various e-cigarette cartridges.
There is no safe form of tobacco. Right now, the public health and medical community or consumers have no way of knowing what chemicals are contained in an e-cigarette or what the short and long term health implications might be.
Commonsense regulation of e-cigarettes by the U.S. Food and Drug Administration is urgently needed. In the absence of meaningful oversight, the tobacco industry has free rein to promote their products as “safe” without any proof.
A proposal to regulate e-cigarettes and other tobacco products has been under review at the White House Office of Management and Budget since October 1, 2013. The Obama administration must move forward with these rules to protect the health of everyone, especially our children.
The opinions expressed in this commentary are solely those of Harold P. Wimmer.
http://www.cnn.com/2014/01/06/opinion/wimmer-ecigarette-danger/

Fargo City Commissioners look to update tobacco ordinances

Fargo, ND (WDAY TV) – Fargo city commissioners are taking a step to stop the increase of e-cigarette use among minors.
Right now, electronic cigarettes are not regulated by the FDA, meaning there are no laws about their use.
In the last year, the percentage of US middle and high school students who reported using them has doubled.
Even though most Fargo businesses have their own rules prohibiting minors, legally anyone can buy them.
Monday night the city council plans to update its tobacco ordinances to include e-cigarettes and all its parts; so that no one can sell to anyone under 18, and minors cannot purchase them.
Holly Scott/Tobacco Prevention Coordinator: “I would venture a guess that most places would not sell to a minor, but by having it written in city ordinance, that way we just ensure that all businesses are following the same set of rules, in that, kinds can’t have access to these products.”
http://www.wday.com/event/article/id/92153/