Secondhand Smoke, Asthma Link Remains

By Cole Petrochko, Staff Writer, MedPage Today
Children with asthma were more likely to be exposed to secondhand smoke than those without the disease, researchers found.
From 1999 to 2010, the overall rate of exposure to secondhand smoke among children without asthma declined from 57.3% to 44.2%, but the exposure rate remained nearly constant over the same time period for children with asthma, only declining from 57.9% to 54%, according to Kenneth Quinto, MD, of the National Center for Health Statistics in Hyattsville, Md, and colleagues.
And the latest statistics, from 2007 to 2010, show that children with asthma who were female, Mexican-American, from families with income below 350% of the federal poverty line, and ages 6 to 11 had greater exposure to environmental tobacco smoke than those without asthma, they wrote in a National Center for Health Statistics data brief.
Past research has tied secondhand smoke exposure to exacerbated asthma symptoms in children and increased risk of mental illness in healthy adults. Other research has also tied neonatal smoke exposure from smoking mothers to hearing loss and behavior problems in the child.
Quinto and co-authors also cautioned that secondhand smoke exposure in all children was associated with risks of middle ear infection, bronchitis, pneumonia, coughing and wheezing, worse lung function, and the development of asthma. They added that in 2007 to 2010, one in 10 children had asthma.
The authors gathered data from the NHANES (National Health and Nutrition Examination Survey) from 1999 to 2010 to measure trends in environmental tobacco smoke exposure in children with and without asthma, and to stratify rates of exposure by sex, race, income, and age group. Income was broken down by earnings 350% or greater than the poverty line, 185% to less than 350% of the poverty line, and less than 185% of the poverty line.
Exposure to secondhand smoke was classified as serum cotinine levels between 0.05 ng/mL and 10 ng/mL in children who didn’t smoke themselves. Children were considered smokers if they were 12 to 19 years old and answered “yes” when asked if they had used tobacco in the 5 days prior to the survey or if their serum cotinine levels were greater than 10 ng/mL. “Serum cotinine is a breakdown product of nicotine,” the authors noted.
Children were considered to have asthma if a parent affirmed on the survey that a healthcare professional had diagnosed them with asthma and if they still had asthma.
By age group, there was no significant difference in secondhand smoke exposure for children with and without asthma ages 3 to 5 and 12 to 19 in the 2007 to 2010 data. However, children ages 6 to 11 with asthma were exposed to secondhand smoke significantly more often than those without asthma in that time (58.8% versus 44.7%, P<0.05).
In families with household incomes lower than 350% of the poverty line, children with asthma were significantly more likely to be exposed to environmental tobacco smoke than those without asthma (P<0.05 for both groups). There was no significant difference in smoke exposure in families earning 350% or more above the poverty line.
Mexican-American children with asthma were significantly more likely than those without asthma to have been exposed to secondhand smoke (38.2% versus 27.4%, P<0.05). White, black, and other race children had no significant differences in exposure between those with and without asthma.
Additionally, girls with asthma were more likely than girls without asthma to have been exposed to secondhand smoke (57.6% versus 43.6%, P<0.05), while there was no significant difference seen in boys.
The authors cautioned that future research should look to explain the reasons for group differences.

Study Says Smoking Bans Don't Hurt Bars, Restaurants

A new study suggests a statewide law banning smoking in public places would not harm the restaurant and bar industry and the people who work in it.
The study has been done in North Carolina, the nation’s leading state for tobacco production. It is the home of major tobacco companies including the nation’s largest one, Phillip Morris. It’s also the home of RTI International, a think tank that has explored various health issues including those that are smoking-related.
Missouri is one of eight states without anti-smoking laws that has been studied by RTI. The lead author of the study, Brett Loomis, says the findings are straightforward.
He says local smoking ban ordinances in Missouri “were unrelated to any changes in restaurant and bar employment in those communities and revenues in eating and drinking places also were unaffected by the law.”
RTI looked at eleven years of employment and revenue records for Missouri bars and restaurants, the businesses most often targeted by local ordinances approved in almost cities-and the businesses most likely to oppose local ordinances.
The study has been indirectly underwritten by Pfizer, which makes an anti-smoking drug. Loomis says the company attended no meetings, had nothing to do with gathering and analyzing information. He says it had no influence on the findings.
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Letter: Harm-reduction not best public policy for tobacco

There has been a good deal of talk about “harm-reduction” strategies (promoting alternative tobacco products, such as chewing tobacco or e-cigarettes, as safer alternatives to smoking cigarettes) as being good options for tobacco users to reduce the risk of using tobacco while maintaining the addiction to nicotine.
Reducing-harm strategies can be an option for an individual who wants to try to reduce his or her own risk of harm while maintaining an addiction. However, when it comes to tobacco use, harm-reduction strategies are not the best public policy to use to address the population-based well-being that public health strategies must address.
• How would it be if the public health professionals advocated for food handlers to wash their hands most of the time after using the bathroom rather than every time? After all, it would reduce the chances of contracting disease from someone who never washed his/her hands. One could say it is better than never washing one’s hands. The public policy must continue to be the best method of preventing disease transmission, that is: wash one’s hands every time, not just sometimes.
• I hear a lot about smokeless tobacco being a good alternative for adult smokers who don’t want to quit using tobacco. Consider this: It is not just adults who use chew. The sweeteners added and new products that have come on the market make it an easy way to addict our next generation to tobacco. North Dakota’s youth consume smokeless tobacco at a rate almost twice the national average (N.D., 13.6 percent, U.S., 7.7 percent). In addition, smokeless tobacco is not without its health hazards.
• E-cigarettes are often touted as a good alternative to tobacco use. We are told by some that the vapor is harmless. This is not true. It has not been regulated or studied enough to know how dangerous it is, but it is not harmless. There is another issue to consider. Have you ever noticed how candy cigarettes and now e-cigarettes mimic the activity a smoker would do with a cigarette? It models the smoking behavior and should not be discounted as harmless.
One of the core functions of public health is to promote strategies that protect the health and safety of the community. Public health providers are accountable to the community to provide up-to-date information and advocate for tried-and-true strategies to improve or maintain a community’s health status.
As a public health nurse, I cannot support harm-reduction policies that supports maintaining one’s addiction to tobacco. Harm- reduction policy is not sound public health policy.
The rationale that was brought up recently in a letter to the editor, that the tobacco user who is not willing or able to quit should have chewing tobacco or e-cigarettes researched and funded with tobacco prevention dollars in the state of North Dakota, falls short. The evidence is readily available regarding what works and how to gain access to help. The options are available, and they are FDA-approved and researched for safety and effectiveness. They are called nicotine replacement therapy and NDQuits at (800)-QUIT-NOW.
Knox, RN, is master of public health and certified tobacco treatment specialist with the Grand Forks Public Health Department Tobacco Prevention Program.

Smoking Ban Tilts Odds Against Ambulance Calls From Casinos

Public health advocates have lobbied hard in recent years to clear restaurants, bars and other workplaces of tobacco smoke, and the winds seem to be at their back.
Already, 36 states and the District of Columbia have enacted some version of an indoor smoking ban to protect the health of workers and patrons, and many local communities in other states have followed suit.
But state-regulated casinos are often exempted from such restrictions (as are, of course, the casinos on tribal lands).
“It’s politics,” says the University of California, San Francisco’s Stanton Glantz, who has spent decades tracing the damaging effects of secondhand smoke to the heart and lungs. “Tobacco and gaming interests really fight for these exemptions,” he tells Shots.
To get a rough measure of whether those exemptions for casinos actually hurt health, Glantz and a colleague scrutinized 13 years’ worth of ambulance call data from Colorado. In particular, they focused on Gilpin County — the high-country home to more than two dozen casinos within about three square miles. The researchers compared the number of calls for ambulances in the county before and after Colorado extended its workplace smoking bans to include casinos in 2008.
The effect seemed “surprisingly strong,” Glantz says of his finding published online this week in the journal Circulation. After the smoking ban in restaurants, bars and most other workplaces was initially enacted in 2006, the number of ambulance-summoning phone calls that were made from any location but casinos dropped by 22.8 percent.
But the number of such calls made from casinos stayed as high as it had been the year before. Then, two years later — after casinos banned smoking, too — the number of such emergency calls made from the grounds of a casino dropped by a little over 19 percent. Such calls from all locations have continued to stay down, years after the implementation of the smoking ban.
Considered in isolation the findings confirm only a correlation, not a causal link, Glantz says. Other factors, such as high gas prices, for example, or tough economic times could have slightly reduced the number of patrons who visited casinos during some of the years studied. Fewer patrons might need fewer emergency calls.
Plus, the database Glantz looked at didn’t reveal the nature of each emergency. Surely some childbirths, dizzy spells and panic attacks were mixed in with the heart attacks, asthma attacks and strokes.
But a study of nine other states, published last week and covering much the same time period, suggests that, contrary to the fears of some business owners, “smoke-free laws did not have an adverse economic impact on restaurants or bars in any of the states studied,” according to the authors.
And in the context of what’s known about how smoke affects physiology, the way the number of calls decreased after each ban makes it “very likely,” Glantz says, that curtailing smoking inside the casinos was what reduced the phone calls about health emergencies.
“All the pieces fit together,” he says.
Many other studies have shown that, in addition to aggravating lung conditions, inhaled smoke can very quickly make platelets stickier and irritate the lining of blood vessels in ways that can lead to the sudden formation of artery-clogging clots that can cause strokes or heart attacks, Glantz says. Last fall two other studies showed that once smoking was banned in bars and workplaces, the number of deaths from heart attacks dropped within months.

Poor Diet, Tobacco Use and Lack of Physical Activity Taking Toll on Nation's Health

By Derek Yach, executive director, The Vitality Institute, and a former executive director of the World Health Organization (WHO), and Will Rosenzweig, institute commission chair and managing partner, Physic Ventures
While we’re living longer, poor diet, tobacco use and inadequate physical activity are negatively impacting our health. These are some of the findings of research released this week by the U.S. Burden of Disease Collaborators, prompting much discussion and debate. To those of us on the front lines of promoting workplace health this comes as no surprise. This study should only add to the sense of urgency that we as a nation must have in solving this crisis.
There is a direct link between the health of the U.S. workforce and the overall wellbeing of the U.S. economy. Currently, greater than 50 percent of Americans live with one or more chronic disease. With this rising burden of chronic disease comes rising costs within the health care system, and increased premiums at a cost to employers. Compounding this, employees with chronic disease take more sick days and are less productive on the job. Workplace health is of significant importance to the economic productivity of the nation and critical to reducing the national debt. The U.S. is slipping behind its major Organization for Economic Co-operation and Development Countries (OECD) competitors regarding improvements in population health. Specifically, the U.S. falls in the bottom 20 percent of the 34 OECD countries for the following chronic diseases: ischemic heart diseases (rank: 27), lung cancer (28), COPD (32), diabetes (31), cardiomyopathy (31), chronic kidney disease (31), and hypertensive heart disease (27). Poorer health today could translate into lower productivity tomorrow.
This is the first major analysis of the health status of the U.S. population in more than 15 years, led by a global collaborative of scientists from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The study found that while Americans are showing progress in reducing death rates (adjusted for age, across a variety of diseases), we aren’t living healthier. Additionally, death rates from illnesses associated with obesity, such as diabetes and kidney disease, as well as neurological conditions like Alzheimer’s disease, are on the rise. Poor diet, tobacco use and physical inactivity are driving the disease burden.
The negative impact on our health care system cannot be understated as people who live longer and unhealthier lives are costly — not only in terms of health care spend, but the impact on the productivity of our workforce and the ability of U.S. businesses to compete in a global economy. A point made recently in the Bipartisan Policy Center’s recent report.
None of this is news to The Vitality Institute, a global health think tank focused on reducing chronic disease risk. In fact, we recently released new data indicating a dangerous gap in the chronological age of Americans and their risk adjusted Vitality Age, as calculated based on a variety of factors including those cited in this new report.
So now that we so clearly understand the problem, what are we going to do about it? To that end, we’ve recently assembled The Vitality Institute Commission. We’re bringing together prominent thinkers in health and business including: Dr. Rhonda Cornum, with deep expertise from the Department of Defense; Susan Dentzer, with Robert Wood Johnson Foundation; Ginny Ehrlich, with the Clinton Health Matters Initiative; Jeff Levi, with Trust for America’s Health; Ellis Rubinstein, with the New York Academy of Sciences; Dr. Dennis Schmuland, with Microsoft; and Dr. Kevin Volpp, from the University of Pennsylvania. All with the urgent goal of placing the power of evidence-based prevention at the center of health care policies and actions in the U.S. Better evidence, smarter laws and higher levels of innovation we believe could make a difference.
There is strength in numbers, and we are working with corporations, associations, federal, state, and local government to identify multi-stakeholder solutions that will address the issues facing our nation’s health in bold and transformative ways.
For the U.S. to maintain its economic competitiveness, our health policy efforts need to address the risk factors of preventable chronic diseases that disproportionately affect the U.S. population (e.g., physical inactivity, diet, and alcohol and tobacco consumption) by effectively investing resources to ensure that each individual has the opportunity to make beneficial contributions to society and therefore progress the economy. We will soon issue a call for wide participation to harness the myriad of great ideas and actions already making a difference at the community, city or state level to ultimately improve America’s health.

Study: Companies Pay Almost $6,000 Extra Per Year for Each Employee Who Smokes

Employers Can Use Cost Estimates to Develop Tobacco Policies

COLUMBUS, Ohio – A new study suggests that U.S. businesses pay almost $6,000 per year extra for each employee who smokes compared to the cost to employ a person who has never smoked cigarettes.
Researchers say the study is the first to take a comprehensive look at the financial burden for companies that employ smokers.
By drawing on previous research on the costs of absenteeism, lost productivity, smoke breaks and health care costs, the researchers developed an estimate that each employee who smokes costs an employer an average of $5,816 annually above the cost of a person who never smoked. These annual costs can range from $2,885 to $10,125, according to the research.
Smoke breaks accounted for the highest cost in lost productivity, followed by health-care expenses that exceed insurance costs for nonsmokers.
The analysis used studies that measured costs for private-sector employers, but the findings would likely apply in the public sector as well, said lead author Micah Berman, who will become an assistant professor of health services management and policy in The Ohio State University College of Public Health on Aug. 21. Berman began this work while on the law faculty of Capital University in Columbus.
“This research should help businesses make better informed decisions about their tobacco policies,” said Berman, who also will have an appointment in the Moritz College of Law at Ohio State. “We constructed our calculations such that individual employers can plug in their own expenses to get more accurate estimates of their own costs.”
The study focuses solely on economics and does not address ethical and privacy issues related to the adoption of workplace policies covering employee smoking. Increasingly, businesses have been adopting tobacco-related policies that include requiring smokers to pay premium surcharges for their health-care benefits or simply refusing to hire people who identify themselves as smokers.
The researchers acknowledge that providing smoking-cessation programs would be an added cost for employers.
“Employers should be understanding about how difficult it is to quit smoking and how much support is needed,” Berman said. “It’s definitely not just a cost issue, but employers should be informed about what the costs are when they are considering these policies.”
The research is published online in the journal Tobacco Control.
The Centers for Disease Control and Prevention (CDC) estimated a decade ago that productivity losses and medical costs amount to about $3,400 each year per smoker. However, the report looked at overall costs to the American economy from smoking-related deaths and did not try to identify those costs that would be borne by an employer, Berman noted.
The CDC says smoking accounts for nearly one in every five deaths – or about 443,000 – in the United States each year and increases the risk for such illnesses as coronary heart disease, stroke, lung cancer and other deadly lung illnesses.
The researchers used multiple studies that calculated a variety of specific costs to develop an estimate of the overall annual extra cost of each employee who smokes.
According to their annual estimates per smoker, excess absenteeism costs an average of $517 per year; “presenteeism,” or reduced productivity related to the effects of nicotine addiction, $462; smoke breaks, $3,077; and extra health care costs (for self-insured employers), $2,056.
The analysis also took into consideration a so-called death “benefit” in terms of economics. For employers who provide defined benefit plans, meaning they pay retirees a set amount in pension each year, a smoker’s early death could result in an annual cost reduction of an estimated $296. This occurs when smokers pay more into the pension system than they receive in retirement – in effect, subsidizing nonsmokers’ pensions because they live longer.
“We tried to be conservative in our estimates, and certainly the costs will vary by industry and by the type of employee,” Berman said. “Several of these estimates are based on hourly employees whose productivity can be tracked more easily.”
He noted that the analysis takes into account the known disparity in pay for smokers versus nonsmokers. In the calculations, smokers’ salaries were discounted by 15.6 percent to reflect their lower wages.
The researchers describe their findings as “needed factual context to discussions about workplace policies” intended to inform the debate over whether such policies should exist.
“Most of the places that have policies against hiring smokers are coming at it not just from a cost perspective but from a wellness perspective,” Berman said. “Many of these businesses make cessation programs available to their employees.
“Most people who smoke started when they were kids and the vast majority of them want to quit and are struggling to do so. This is a place where business interests and public health align. In addition to cutting costs, employers can help their employees lead healthier and longer lives by eliminating tobacco from the workplace.”
Co-authors of the study include Rob Crane of the College of Medicine and Eric Seiber of the College of Public Health, both at Ohio State, and Mehmet Munur of the Columbus law firm Tsibouris & Associates.