ASH Daily News for 30 September 2008

Exposure to secondhand smoke increases risk of childhood nicotine dependence

Young people who are regularly exposed to secondhand tobacco smoke at home and in vehicles face an increased risk of nicotine dependence, researchers warn.

Nicotine is the chemical component in tobacco that is primarily responsible for addiction to smoking, which is associated with an increased risk of many diseases and conditions, including chronic obstructive pulmonary disease, lung cancer and heart disease.

Dr Jennifer O'Loughlin, from Centre de recherche du Centre Hospitalier de l'Université de Montréal in Quebec, Canada, and team studied data on 1488 children, aged between 10 and 12 years, who were participating in a study of tobacco use and other behaviour associated with negative health effects.

All the children, who came from a wide variety of social backgrounds and who had never smoked themselves, completed questionnaires on the smoking habits of their patents and exposure to secondhand tobacco smoke in the home.

They were also assessed for signs of nicotine dependence and withdrawal, such as depressed mood, trouble sleeping, irritability, anxiety, restlessness, trouble concentrating and increased appetite.

In total, 69 of the participants showed signs of nicotine dependence.

Analysis revealed that exposure to secondhand smoke in the home was associated with a 10% increased risk of nicotine dependence symptoms, while exposure to secondhand smoke in a vehicle was associated with a 20% increased risk of such symptoms.

The findings remained true after accounting for peer and sibling smoking habits, notes the team.

"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," summarised Dr O'Loughlin.

She concluded: "These findings support the need for public health interventions that promote non-smoking in the presence of children, and uphold policies to restrict smoking in vehicles when children are present."

The research is published in the journal Addictive Behaviors
 

Source: Medwire News, 29 sept 2008
Link::http://tinyurl.com/3fh5mrte

Could the death toll have been lowered by offering nicotine replacement therapy on the NHS earlier?

In 1996, 28 per cent of UK adults smoked. The decline of smoking had started to level out since the early 1980s and it looked as though the habit was here to stay. Cigarettes were responsible for 120,000 deaths a year through smoking-related illness at an estimated cost to the health service of £1.7bn each year.

When Labour came to power in 1997, a stated health policy goal was to tackle smoking. In 1998 the white paper Smoking Kills summarised the evidence in favour of a national stop smoking policy and set out a raft of measures aimed at reducing the damage done by the habit. The government pledged £100m over three years to fund specialist stop smoking services on the NHS. These were to be set up by health authorities and health boards in line with local needs, with a particular focus on deprived areas.

Professor Robert West, director of tobacco studies at the Cancer Research UK Health Behaviour Research Centre at University College London, helped develop the stop smoking framework that was incorporated into the white paper. He says the evidence in favour of offering smoking cessation on the health service was overwhelming, although nothing of the kind had ever been introduced on a national scale before.

"There was a strong sense that a case for smoking cessation services had already been made. It was just that it hadn't been acceptable on a political level. But when New Labour got in to power everything fell into place," he said.

First targets

The white paper also set the first smoking cessation targets for England: by 2010 the percentage of adults aged over 16 who smoke should be reduced to 26 per cent; the number of children smoking should be cut from 13 to 9 per cent; and the number of pregnant women smokers should be down to 15 per cent from 23 per cent. These targets were revised in the 2000 NHS Cancer Plan to the current targets of 21 per cent in the general adult population and 26 per cent for manual groups.

The stop smoking services were launched in 1999. Providing access to treatment and support to groups of quitters, or on a one-to-one basis, they proved to be more popular than expected. It was estimated that around 2 per cent of smokers, or around 200,000 people in England, would be interested in making use of the service, but demand was found to be much higher.

Data from the NHS information service for 2001-02 shows that 119,834 people accessing a stop smoking service in England had successfully given up at their four-week follow-up. By 2006-07 this figure had risen to 317,720, with more than 600,000 smokers accessing the service and setting a quit date.

A major part of the stop smoking strategy has been to widen access to treatments, including nicotine replacement therapy, bupropion and varenicline. Although it has been available in the UK on private prescription since the 1980s, nicotine replacement therapy was not available on NHS prescription until April 2001.

In the 1990s when it came up before the Borderline Substance Committee, a precursor to NICE, it was ruled that this should not be made available on the health service.

"I think this was a unique case where a medicine that was known to be effective and was licensed was not made available on the NHS," says Professor West.

Nicotine therapy

In addition, there were widespread fears that allowing nicotine replacement therapy on prescription would break the bank. These fears have not been realised since most people are happy to buy nicotine replacement therapy themselves rather than go to the bother of getting a prescription, and in 2004 there were around two million prescriptions for it in England, at a cost of £44m.

The stop smoking services were one component of a wider strategy. Other measures included banning advertising, increasing the price of cigarettes year on year and introducing bans on smoking in the workplace. Arguably the most successful of these initiatives was the smoking ban introduced in Scotland in March 2006 and then rolled out in England, Wales and Northern Ireland in 2007, which brought to an end to smoking in enclosed public spaces.

Before it was introduced in England, there was resistance to the notion of a total ban, particularly from the health secretary at the time, John Reid. "There was strong popular support for it, even among smokers, but John Reid and the hospitality industry put up a big fight and I don't think we would have got a comprehensive smoking ban that covered all bars and restaurants if John Reid had not been replaced by Patricia Hewitt," Professor West recalls.

The effect of the ban on smoking prevalence to date has been dramatic, with a 4 per cent drop in England over the first nine months and an increase of around 20 per cent in the number of smokers accessing NHS stop smoking services.

Professor West says: "The ban is having a huge effect on smoking. The drop in prevalence in the months following the introduction of the ban is the biggest decrease this country has ever seen."

The cumulative effect of the strategies to curb smoking in the UK has been very successful, and the chances of meeting the adult 2010 smoking prevalence targets look good, with prevalence in England already down to 22 per cent in 2006. In some places, the targets have been significantly overshot, with smoking prevalence in London, for instance, currently at 15 per cent despite many areas of deprivation in the capital.

Looking to the future, Professor West says that more ambitious targets will have to be set: "The UK has the capacity with everything it is doing to really move the goal posts quite a bit. At the moment we're aiming for smoking prevalence in the region of 20 per cent. I think that 15 per cent is a very realistic goal within 10 years. London is already there, despite areas of significant deprivation, and if London can do it, so can the rest of the country."

But he is amazed at how far the UK has already come in tackling smoking. "In the early 1980s none of us ever thought that we'd see the day when there would be a national stop smoking service, or that nicotine replacement therapy and these other smoking cessation treatments would be available on prescription. It's all been very surprising." 
 

Source: Health Service Journal, 18 Sept. 2008
Link: http://tinyurl.com/3n6pfh

Ireland: Anti-smoking body urges €1 hike in cigarette prices

The State's anti-smoking body has called for €1 to be put on the price of a packet of cigarettes in the budget to help people pack in the habit.

The Office of Tobacco Control (OTC) proposes raising the price of 20 cigarettes to about €8.50, with similar price rises on cigars and "roll-your-own tobacco". The group has also called for the VAT to be dropped on nicotine-replacement therapy products.

The OTC said €5m could be generated under the plans, some of which would be used to fund anti-smoking initiatives.

The anti-smoking group's chief executive, Eamonn Rossi, said the move would also allow more smokers to pay for patches to help them give up their addiction. He said the extra cost of a packet of cigarettes would also work as a deterrent against smoking.

"It is estimated that over 95 percent of smokers who quit before the age of 30 years will avoid a tobacco-related death," he said.

Source: The Independent (Ireland), 30 Sept 2008
Link: http://www.independent.ie/national-news/antismoking-body-urges-83641-hike-in-cigarette-prices-1485895.html

40% of India's health problems linked to smoking

Forty percent of India's health problems are linked to smoking, Health Minister Anbumani Ramadoss says, defending the stringent measures to ban smoking in public places from Oct 2. 

"According to a WHO survey, the (size of the) tobacco industry is Rs 35,000 crore (Rs 350 billion/$8 billion). Government as well as individual expenditure on preventing and treating tobacco-related health ailments as well as loss of production due to these diseases is Rs.36,000 crore (Rs.360 billion)," Ramadoss said in an interview.

He also pointed out that of the five million people the world over who have health problems because of tobacco use, one million are Indians.

Ramadoss denied suggestions that he was playing the moral policeman due to the health ministry's banning smoking in public places from Oct 2.

"I am not trying to play a moral policeman or guardian. I am just doing my job. As health minister it is my responsibility to create awareness in the general population and to save every youth from everything that can harm their health.

"What happens in India impacts global figures. One sixth of humanity lives in India. As many as 600 million people here are below 30 years of age. We consider them as the high-risk group when it comes to tobacco, alcohol, drugs use, HIV infection and junk food consumption. It is the responsibility of the government to highlight the ill effects of these to the naive, illiterate and the youngsters," Ramadoss contended.

"If I, as health minister, can't do it who can? We don't want the young people to become a liability for our society," he contended.

He also spoke of the resistance to his anti-smoking measures from the cigarette and bidi lobby.

"Surprisingly, also from politicians. The chief ministers of (West) Bengal, Andhra Pradesh, Tamil Nadu and Madhya Pradesh wrote to lobby against these measures. More than 80 Members of Parliament made a representation against the ban and pictorial warning," Ramadoss said.

At the same time, he pointed out that India was obligated to imposing the measures because it was one of the 152 signatories to WHO's Framework Convention on Tobacco Control 2004.

He was also confident that smokers would be deterred by pictures of a skull or damaged lungs on a pack.

"Canada, Brazil and Singapore saw a three to five percent drop in smokers after such a measure. In the UK, 45,000 people quit smoking after smoking in public places was banned. Besides, the effect of pictorial warning on packs will be reviewed by a health ministry committee after one year.

Ramadoss also contended that the government would draw huge political capital from the anti-smoking measures.

"I feel there is going to be a huge gain for the Manmohan Singh government in the vote bank," the minister said.

Source: The Times of India, 30 Sept. 2008
Link: http://timesofindia.indiatimes.com/40_of_Indias_health_problems_linked_to_smoking_Ramadoss/rssarticleshow/3543790.cms