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Medical News Today: Graphic warnings on cigarette packets 'help smokers consider health risks'

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With 2016 just around the corner, many individuals will be gearing up to take on one of the most challenging New Year’s resolutions: to quit smoking. But a new study suggests this challenge could be made easier if graphic warning labels were put on cigarette packets, after finding such warnings trigger more negative feelings toward smoking than text warnings alone.
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Lead study author Abigail Evans, a postdoctoral researcher at Ohio State University, and colleagues publish their findings in the journal PLOS One.
In 2011, the Food and Drug Administration (FDA) published a final rule that required tobacco companies to include color graphics on cigarette packets that depict the negative health implications of smoking.
In 2012, however, a US federal appeals court overturned the ruling, claiming the images put forward by the FDA were “unconstitutional” and were “unabashed attempts to evoke emotion […] and browbeat consumers into quitting.”
According to Evans and colleagues, their findings suggest the decision to overturn the FDA’s rule based on these grounds was wrong; the team says the graphic images do not “browbeat” consumers, and though they do evoke emotion in smokers, the researchers say these emotions make people think more carefully about the health risks of smoking.
“What the court is missing is that without emotions, we can’t make decisions,” says study coauthor Ellen Peters, professor of psychology at Ohio State. “We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

Feelings produced by graphic images ‘acted as a spotlight’

The team reached their conclusion by assessing 244 adults of an average age of 34 who smoked between 5-40 cigarettes a day.
For 4 weeks, smokers were given their preferred brand of cigarettes in packaging that had been modified; some packets contained warning text only – such as “cigarettes cause fatal lung disease” – some contained warning text plus one of nine graphics depicting the dangers of smoking, while others consisted of warning text, graphics plus additional text detailing the risk of every cigarette smoked.
The warning graphics used were developed by the FDA and contained disturbing images, such as a man smoking through a hole in his throat, depicting a surgical procedure known as a tracheostomy that is a result of some smoking-related cancers.
Each week for the 4-week period, smokers collected their cigarettes from the lab and completed surveys detailing how the new packaging made them feel about smoking.
Compared with participants who received text-only packaging, those who received packaging with graphic warnings were more likely to read or look closely at the information, were more likely to remember the information, and were more likely to report that the packaging made them feel worse about smoking.
“The feelings produced by the graphic images acted as a spotlight,” notes Peters. “Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks.”
In addition, smokers who received packaging with graphic warnings were also more likely to view the information as more “credible” than those who received text-only packaging, and they were also slightly more likely to say they planned to quit smoking.
“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” says Peters. “The effect was small, but it was not unimportant.”
Overall, the researchers say their findings show graphic warnings are more effective than text-only warnings for getting consumers to consider the health risks of smoking. They add: “Policies requiring such labels have the potential to reduce the number of Americans who smoke. The effect induced by graphic warning labels appears to have utility in communicating more and more credible information, useful to promoting risk perceptions and quit intentions among smokers in the US and around the world.”
This research supports another study reported by Medical News Today earlier this year, which found a combination of health warning graphics and text on cigarette packets increased knowledge about the dangers of smoking among young adults, compared with text-only warnings.

http://www.medicalnewstoday.com/articles/304495.php

WDAY: Sheyenne students write letters to lawmakers asking them to raise tobacco tax

By Jordee Kalk

West Fargo (WDAY TV) – A creative collaboration for students at Sheyenne High School happened Friday.
Senior government students teamed up with a freshman health class to write letters to local legislators on the tobacco tax rate in North Dakota. Students thanked legislators who voted to increase the tobacco tax throughout the state in the last legislative session and encouraged ones who didn’t to think about doing so in the future.

Currently, North Dakota’s tax is 44 cents per carton [sic] of cigarettes.
“For our state we have very strict laws as far as tobacco in public buildings, nut as far as tobacco tax, we are one of the lowest in the nation and that’s what we are trying to deter,” Sheyenne High School Teacher Tom Kirchoffner said.
According to the Campaign For Tobacco Free Kids, the average tobacco tax in the U.S. is $1.60 per pack. The campaign claims North Dakota has the third lowest tax rate.
Read more or watch the video: http://www.wday.com/news/3902095-sheyenne-students-write-letters-lawmakers-asking-them-raise-tobacco-tax

AP: Higher cigarette taxes could save babies' lives, study finds

CHICAGO — When it costs more to smoke, fewer babies die, according to a new study that links rising cigarette taxes with declines in infant mortality, especially among blacks.
With nearly 4 million annual births nationwide, the results suggest that a $1 increase in cigarette taxes would be expected to lead to 750 fewer infant deaths each year, the researchers said.
Smoking during pregnancy can lead to complications including sometimes dangerous premature births and sudden infant death syndrome. U.S. smoking rates declined during years examined in the study – 1999 to 2010. The research, paid for by the National Institutes of Health, was published online Tuesday in the journal Pediatrics.
The study
Cigarettes are subject to state and federal excise taxes. Dr. Stephen Patrick of Vanderbilt University and colleagues examined data on changes in those taxes and cigarette prices from every state over 11 years. They also analyzed federal data on infant mortality in each state.
Taxes per cigarette pack increased from 84 cents to $2.37 on average, adjusted for inflation. Infant mortality per 1,000 births decreased from about 7 deaths to 6 deaths on average. Among blacks, deaths declined from about 14 to 11 per 1,000 births.
The researchers considered factors other than smoking that influence infant mortality, including family income and education, but still found a link with rising taxes.
The context
Almost 11 percent of U.S. women smoke during pregnancy, federal data show. Previous studies have linked higher cigarette taxes with declines in smoking during pregnancy and with better newborn health. The researchers say their work is the first examining these taxes and U.S. infant mortality rates.
Raising tobacco taxes is among strategies the Centers for Disease Control and Prevention supports to reduce smoking. A U.S. Surgeon General report last year said reducing smoking among pregnant women and women of reproductive age “remains a critical component of public health efforts to improve maternal and child health.”
The researchers say the taxes could have negative consequences for pregnant smokers who don’t quit and can’t afford to buy necessities because of high cigarette prices – a possibility the study didn’t examine. The study lacked information on all variables that could affect infant mortality. Still, they say their study adds to evidence for policymakers to consider in seeking ways to reduce infant deaths.
http://www.cbsnews.com/news/higher-cigarette-taxes-save-babies-lives-study-finds/

New York Times: U.S. Smoking Rate Declines, but Poor Remain at Higher Risk

By SABRINA TAVERNISE

WASHINGTON — Smoking, the leading cause of preventable death in the United States, continued to decline last year, federal health authorities reported Thursday, with the share of American adults who smoke dropping to 16.8 percent, down from 17.8 percent in 2013.

Smoking has been one of the brightest public health successes of recent history. Nearly half of all Americans smoked in the 1960s, but a broad push against the habit, starting with the surgeon general’s warning in 1964, helped bring rates down. The rate has dropped by about a fifth since 2005, when it was 21 percent.

But the national numbers mask deep trouble spots within the American population. About 43 percent of less educated Americans smoked in 2014, compared with just 5 percent of those with a graduate degree. About a third of Americans insured by Medicaid, the health insurance program for the poor, smoked, compared with 13 percent of Americans with private insurance.

The figures, reported by the Centers for Disease Control and Prevention, underscored the extent to which smoking in America has become a problem of the poor. Nearly six million Americans covered by Medicaid smoke, as well as almost nine million uninsured Americans, or about a third of the uninsured population.

Smoking-related diseases accounted for more than 15 percent of annual Medicaid spending from 2006 to 2010, or about $39 billion a year, according to the American Lung Association.

“Disparities are the single most important issue in smoking,” said Kenneth E. Warner, a professor of public health at the University of Michigan School of Public Health.

Dr. Warner added: “The people who are politically influential believe the smoking problem has been solved. It’s not in their neighborhoods. Their friends don’t smoke. Those who still smoke are the poor, the disenfranchised, the mentally ill. That’s who we need to focus on.”

On Thursday, the federal government appeared to take aim at that problem by proposing a rule that would prohibit smoking in public housing nationwide.

Nationally, success of the antismoking campaign has been striking. Progress among the poor and less educated, however, has been far slower.

About 43 percent of people with only a high school equivalency diploma smoke, virtually unchanged from 2005. In comparison, smoking declined by about 26 percent among people with college degrees, to 8 percent from 11 percent. For people with a high school diploma only, smoking declined by about 12 percent, to 22 percent.

Smoking among people who live at or above the poverty line declined by about 26 percent, to 15 percent from about 21 percent in 2005. Those below the poverty line declined by about 12 percent, to 26 percent from 30 percent, the report found.

American Indians and Alaskan Natives had the highest smoking rate, about 29 percent, followed by Americans of more than one race, about 28 percent of whom smoked.

Whites and blacks smoked at about the same rate in 2014 — about 18 percent — while Hispanics had a much lower rate, 11 percent.

http://mobile.nytimes.com/2015/11/13/health/us-smoking-rate-cdc-report.html?_r=0

The Washington Post: Who still smokes in the United States — in seven simple charts

By Brady Dennis
Cigarette smoking among U.S. adults has fallen to the lowest rate in generations, according to data released Thursday by the Centers for Disease Control and Prevention. That’s good news, considering that smoking still accounts for about 480,000 deaths annually in the United States, along with an estimated $300 billion in health costs and lost productivity.
But the CDC numbers also offer an interesting glimpse at the 17 percent of adults who continue to light up. People in the Midwest, for instance, smoke more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.
Here are seven charts, based on CDC data, that detail the current landscape of smoking in the United States:
1) Half a century ago, more than two of every five adults were smokers. But that has fallen steadily over time. From 2005 to 2014, the adult smoking rate declined from 20.9 percent to 16.8 percent. Public health officials are hoping to to drive that rate below 12 percent by 2020.
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2) Cigarette smoking has fallen sharply among 18- to 24-year-olds. In fact, the percentage of smokers in that age group dropped by nearly a third over the past decade, CDC data show,  the sharpest decline of any group. But that striking change might be attributable, at least in part, to the growing popularity of e-cigarettes, hookahs and other “non-cigarette tobacco products,” CDC officials said.
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3) People with lower levels of education tend to smoke at higher rates. The new data also show that smoking among people with graduate and undergraduate degrees has fallen more sharply over the past decade than among most other groups.
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4) Smoking among multiracial people and those classified as American Indian or Alaska Natives (AI/AN) far outpaces that of other ethnic groups. Notably, Asians continue to have the lowest rate of smokers and, along with Hispanics, have cut their smoking rates steeply over the past decade. CDC officials said the disparities across ethnic groups, which are consistent with previous research, might partly be due to cultural differences related to the acceptability of tobacco use.
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5) Midwesterners still smoke at higher rates than anyone else in the country. This was true a decade ago. But Thursday’s data show that while other regions have cut smoking rates by 20 percent or more since 2005, the Midwest’s dropped only 14.4 percent.
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6) U.S. adults who are uninsured or on Medicaid smoke at rates more than double that of people who have Medicare or private insurance. There could be many factors at play here. But health officials said one contributing factor is likely the “variations in tobacco-cessation treatment coverage and access to evidence-based cessation treatments” across different insurance types.
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7) The number of heavy smokers seems to be declining. Between 2005 and 2014, the number of daily smokers dropped from 36.4 million to 30.7 million. Those daily smokers also reported smoking fewer cigarettes over time, from an average of 16.7 a day in 2005 to 13.8 a day in 2014. The number of people smoking more than 30 cigarettes a day fell by almost half.
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https://www.washingtonpost.com/news/to-your-health/wp/2015/11/12/smoking-among-u-s-adults-has-fallen-to-historic-lows-these-7-charts-show-who-still-lights-up-the-most/

KX News: Less Students Smoking Cigarettes, More Students Smoking E-Cigarettes

By Alicia Ewen
North Dakota kids smoke cigarettes less than they used to…far less.
But they are dabbling in some other risky behaviors.
The state asked high school students across the state about their habits. It found that fewer kids smoke.
In fact, 80% of kids said they hadn’t smoked or used smokeless tobacco in the previous month.
Only 3% of high school students say they smoke cigarettes daily.
For the first time though electronic cigarette use was surveyed.
22% of students surveyed say they tried an e-cigarette in the month before they took the survey…
“That’s another misconception, that kids think they are safer than traditional smoking but really there are still chemicals in these vaping products that will harm your body. There hasn’t been as much research done on them as we should have so I’ll be really excited to see what comes out in the next couple of years about these vaping products,” says Hannah Rexine, CHS student and member of the tobacco policy board.
Rexine is the only youth member on the state tobacco policy board. She’s a senior at Century High School in Bismarck.
http://www.kxnet.com/story/30467318/less-students-smoking-cigarettes-more-students-smoking-e-cigarettes

Bismarck Tribune: E-cigarettes more popular than tobacco among teens, survey finds

By Amy R. Sisk, Bismarck Tribune
Although tobacco use is down among North Dakota’s teenagers, nearly double the number of youngsters are using e-cigarettes, according to a survey of students.
The 2015 Youth Risk Behavior Survey shows that 12 percent of high school students statewide reported smoking at least once in the month before the survey. That’s down from 22 percent in 2005.
Meanwhile, 22 percent of students report having used an e-cigarette in the past month.
The statistics come from a survey overseen by the U.S. Centers for Disease Control and Prevention given to middle school and high school students in every state. In North Dakota, the Department of Public Instruction and the Department of Health administer it to 10,000 high school students.
The prevalence of e-cigarettes marks an area of concern for school and health officials who spoke Monday at a news conference at the state Capitol in Bismarck. E-cigarettes convert nicotine liquid into aerosols that are inhaled, said Jeanne Prom, director of the North Dakota Center for Tobacco Prevention and Control Policy.
Hannah Rexine, a senior at Century High School, said she and her friends became aware of the vaping devices two or three years ago when they began to grow in popularity.
“E-cigarettes are becoming more popular because kids think they are more safe than an actual cigarette,” she said.
Rexine, who sits on the board of directors for the tobacco prevention center, said not enough research has been done to verify that claim.
Prom said using nicotine at a young age causes lasting harm to the brain.
“Nicotine is one of the most highly addictive drugs,” she said. “A curious experiment with an e-cigarette could lead kids into an addiction into any form of nicotine.”
Teens often buy e-cigarettes off the Internet or from friends and don’t know the nicotine content, Rexine said.
E-cigarettes come in a variety of flavors. Some believe the product can help them quit smoking.
“It’s all these rumors going around,” Rexine said.
The Students Against Destructive Decisions group at Century has educated freshmen during orientation each of the past two years about the risks associated with e-cigarettes.
The state and local governments have also jumped on board to combat the popularity of the vaping devices.
Prom said the 2015 North Dakota Legislature passed a bill prohibiting youth from using e-cigarettes and vendors from selling them to minors. Bismarck also approved an ordinance that requires stores selling the products to have a tobacco license and place the items behind the counter.
Though the percentage of teens smoking traditional cigarettes has dropped, Prom said there’s still work to do.
She said 42 percent of the state’s K-12 students attend a school that has a comprehensive policy banning tobacco. She aims to bring that number up to 100 percent by working with county public health units and school districts. Money from North Dakota’s settlement with tobacco companies in the 1990s is funding that effort.
In addition to cigarette use, the survey asks about a number of issues affecting teens, including suicide, drinking, drug use and diet.
State Superintendent Kirsten Baesler outlined efforts to address mental health issues.
The percentage of North Dakota high school students who report having attempted suicide in the past year is 9 percent. The number of students who felt sad or hopeless daily for two or more weeks in the past year is climbing from 20 percent in 2005 to 27 percent this year, according to the survey.
“We need to work to change those numbers,” Baesler said.
She said DPI is preparing training for teachers to identify early signs of mental health issues. She said the 2015 Legislature passed a bill requiring such training annually for high school and middle school administrators, teachers and instructional staff.
She said another new law requires that new teachers receive mental health training before they receive their teaching license.
http://bismarcktribune.com/news/local/education/e-cigarettes-more-popular-than-tobacco-among-teens-survey-finds/article_513c5759-69a0-5f26-8452-d296bca6b03f.html

Patient-centered care helps patients overcome mental illness and tobacco use

By Chizimuzo Okoli, Contributing columnist, Lexington Herald-Leader

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

http://www.kentucky.com/2015/10/24/4103534/patient-centered-care-helps-patients.html

Study: Teens using e-cigs much more likely to start smoking cigarettes

By Lena H. Sun, Washington Post
More bad news for young people who smoke e-cigarettes.
Doing so makes them much more likely to start smoking traditional cigarettes within a year than peers who don’t smoke e-cigarettes, according to a new analysis published online Tuesday and scheduled for the November issue of JAMA Pediatrics.
The latest news about e-cigarettes comes at a time when their use is soaring among youngsters. The number of middle school and high school students using electronic cigarettes tripled from 2013 to 2014, according to government figures released this spring, a startling increase that public health officials fear could reverse decades of efforts combating the scourge of smoking.
The popularity of e-cigarettes among teenagers now eclipses that of traditional cigarettes, the use of which has fallen to the lowest level in years.
In the latest study, researchers analyzed data from a national sample of nearly 700 nonsmokers who were between ages 16 and 26 in 2012, and again in 2013. All of them said “definitely no” when they were asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.
Only 16 of the participants used e-cigarettes when they were initially surveyed, but six of them had progressed to cigarette smoking by the next year, or about 38 percent. By contrast, only 10 percent of the youths who were not e-cigarette users  started smoking traditional cigarettes.
The study was conducted by the University of Pittsburgh Center for Research on Media, Technology and Health and the Dartmouth-Hitchcock Norris Cotton Cancer Center.
In the past, few studies looked at whether e-cigarette users who initially did not smoke were at risk for taking up both the use of e-cigarettes and traditional cigarettes, or the exclusive use of cigarettes. Previous studies could not determine whether e-cigarette use preceded cigarette use, researchers said. Those studies also looked at different youngsters over different time periods.
The latest study analyzed the same individuals over time.
“This is the first longitudinal, national study to show that e-cigarette use among youth directly leads to regular cigarette use, even among people who insist at baseline that they never will smoke regular cigarettes,” said lead author Brian Primack, who is assistant vice chancellor for health and society at Pittsburgh’s Schools of the Health Sciences. “It is also the first to include young adults, as opposed to strictly teenagers.”
Researchers said one limitation was the relatively small number in the sample size. The findings need to be replicated with larger samples. Even so, after controlling for well-known risk factors, such as age, sex, socioeconomic status and risk-taking, “we think the effect is real,” said Samir Soneji, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and one of the authors.
E-cigarettes accelerate the progression to traditional cigarette smoking, he said.
The quandary for public health officials is this, he said. “Are they more dangerous for kids than they are helpful for adults who are trying to quit smoking?”
http://www.washingtonpost.com/news/to-your-health/wp/2015/09/08/study-teens-using-e-cigs-much-more-likely-to-start-smoking-cigarettes/

Number of cigarette smokers drops to 15%: CDC

The number of cigarette smokers in the United States has dropped to about 15 percent of the population, its lowest point in decades, U.S. health authorities said Tuesday.
“The prevalence of current cigarette smoking among U.S. adults declined from 24.7 percent in 1997 to 15.2 percent in January-March 2015,” said the report by the Centers for Disease Control and Prevention’s National Center for Health Statistics.
The figures will be updated once the entire year’s data is available.
Smoking continues to be more common among men (17.4 percent) than women (13.0 percent), the report found.
Smoking is most common among African Americans (18.1 percent), followed by whites (17.1 percent) and Hispanics (10.4 percent).
According to the U.S. surgeon general, smoking is known to cause “a host of cancers and other illnesses and is still the leading preventable cause of death in the United States, killing 480,000 people each year.”
Smokers made up 42 percent of the U.S. population in 1965, a fraction that has dropped steadily over the years, according to the CDC.
http://www.nydailynews.com/life-style/health/number-cigarette-smokers-drops-15-cdc-article-1.2344374