Healthcare Commission report on public health achievements

The Healthcare Commission has published a review assessing the impact of DH policies on health outcomes and inequalities since 1997. It includes an assessment of a wide range of health targets. 

On smoking cessation, the Healthcare Commission notes that although the national target for 800,000 four-week quitters was exceeded by March 206, there has been considerable variation across PCTs in recent years, with performance ranging from under 50% achievement of planned quitters to over 200% in 2005-06, and from under 40% to over 300% in 2006/07. The data suggest that the services are more effective in disadvantaged areas where smoking rates are highest.

The report notes that approximately £51 million was spent on stop smoking services in 2006-07, at a cost of about £4 per smoker or £160 per quitter (22% lower than the cost per quitter in 2001/02). Fifty three per cent of people setting a quit date with the stop smoking services successfully quit over the 2006-07 period.

On smoking cessation, the report concludes that: "Overall the Government's approaches to controlling tobacco and reducing smoking have been successful but it is important that the pressure is not reduced. Although it is encouraging that NHS stop smoking services are targeting those areas with higher need, the deterioration in performance seen in 2006/07 suggests that the target as well as funding and infrastructure was important to delivery. It is crucial that funding for effective programmes and services continues to build on the success to date, and ensure that those people who find its hardest to quit are adequately supported."

Source: Are we choosing health? The impact of policy on the delivery of health improvement programmes and services. Healthcare Commission, July 2008
Link: http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?widCall1=customWidgets.content_view_1&cit_id=6494  

NICE guidance on preventing smoking uptake by children

NICE has issued guidance on preventing smoking uptake by children and young people through the use of mass media and point-of-sale measures.

On mass media campaigns the guidance makes recommendations as to the nature of messages that might be included in mass media campaigns, including the recommendation that effective messages should be regularly updated and repeated.

On illegal sales, the guidance calls for better enforcement of existing legislation by working with various agencies to “make it as difficult as possible for young people under the age of 18 to get cigarettes and other tobacco products”.

The guidance notes that these measures should be combined with other prevention activities as part of a comprehensive tobacco control strategy.

Source: NICE
Link: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12020#summary  

Smoking rates among teenagers falls to record low

The proportion of 11-15 year olds in England who smoke regularly (at least once a week) has fallen from 9% in 2006 to 6% in 2007, the lowest rate recorded since surveys began in 1982. Although girls (8%) are still more likely than boys (5%) to be regular smokers, there was a decline in smoking in both sexes and significantly in the 14-15 age band: among 15 year old boys, 12% smoked in 2007 compared to 16% in 2006, while among girls the rates were 19%, compared to 24% in 2006. 

The data also shows that there has been a long-term decline in the proportion of pupils who have tried smoking, from 53% in 1982 to 33% in 2007.
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As in previous surveys, the report notes that regular smoking is associated with the use of alcohol and other drugs.

Source: Drug use, smoking and drinking among young people in England in 2007
Link: Information Centre for Health and Social Care, July 2008 www.ic.nhs.uk
 

PQ - Cigarette Smuggling

David Simpson: To ask the Chancellor of the Exchequer what the resale value of illegal cigarettes intercepted in England and Wales was in each of the last three years, broken down by region.

Angela Eagle: Once condemned as forfeit to the Crown cigarettes seized by HM Revenue and Customs are destroyed thus they have no resale value.

[Note: this will be the last Parliamentary news until Parliament returns in October.]

Source: Hansard Source – 21 July 2008, Column 715W

PQ – Smoking in Films

David Taylor: To ask the Secretary of State for Culture, Media and Sport 

(1) If he will discuss with those involved in the production of entertainment media the possible relationship between the on-screen depiction of smoking and rates of smoking among young people;

(2) Whether he has received recent representations on the classification of films which show positive images of smoking.

Margaret Hodge: The depiction of smoking in films is covered by the guidelines for the British Board of Film Classification, which was reviewed in 2005 after extensive public consultation and was updated accordingly. Any films which are found to be (1) aimed at children and (2) "Works which promote or glamorise smoking" receive a restricted rating. We have no plans at present to examine the impact on screen depiction of smoking but we do of course, keep these matters under constant review.

Source: Hansard – 21 July 2008 Column 807W

Suppression of information about Polonium 210

Tobacco companies have suppressed research and information on the presence of the deadly radioactive poison, polonium 210 (PO-210), in tobacco and tobacco smoke, new research has found. Estimating that polonium-210 in cigarettes may annually cause the deaths of some 11,700 people from lung cancer worldwide, the study finds that for more than four decades, tobacco companies have known PO-210 is present in tobacco and tobacco smoke. The industry suppressed information about PO-210 out of concern that it would cause public relations and litigation problems and to avoid “waking a sleeping giant,” as one industry official stated.

Summarizing prior research, the study states, “It is estimated that smokers of 1.5 packs of cigarettes a day are exposed to as much radiation as they would receive from 300 chest X-rays a year. PO-210 has been estimated to be responsible for 1% of all U.S. lung cancers…. PO-210 may be responsible for more than 1,600 deaths in the United States and 11,700 deaths in the world each year.”

Polonium-210 received significant media attention in 2006 when it was found to have been used in the fatal poisoning of former KBD agent and Russian dissident Alexander Litvinenko. That poisoning sent health officials across Europe and the former Soviet states to isolate the source and contain potential areas of deadly contamination.

“This study provides another important example of how tobacco companies wilfully mislead the public about the dangers of their deadly products and cannot be trusted to tell the truth about their products,” said Damon Moglen, International Advocacy Director for the Campaign For Tobacco-Free Kids. “The bottom line is that smoking kills and before taking a puff, people deserve accurate information about the many poisons in cigarettes, including radioactive polonium-210, and the many diseases caused by tobacco use. Governments must take action to protect their citizens from this deception.”

Source: Campaign for Tobacco-Free Kids press release, 16 July 2008.
Muggli, M et al. Waking a sleeping giant: the tobacco industry’s response to the Polonium-210 issue. Am J Public Health 2008; 98.. Early online issue: doi:10.2105/AJPH.2007.130963
Link: http://www.ajpm-online.net/webfiles/images/journals/amepre/AMEPRE2259.pdf

Targeting youth with menthol cigarettes

A US study of tobacco industry internal documents has revealed that menthol brands were used as a marketing strategy to recruit and addict young smokers. They did this by adjusting menthol to create a milder experience for the first time smoker. Menthol masks the harshness and irritation of cigarettes, allowing delivery of an effective dose of nicotine. 

“For decades the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers,” said Professor Howard Koh, one of the researchers.

A 2006 national survey showed that a significantly greater proportion of adolescent and young adult smokers used menthol brands compared to older smokers: 43.8% of smokers aged 12 to 17, compared to 30.6% of smokers older than 35 years.

The authors of the study suggest that the rapid introduction of new milder menthol brands in the past decade is a violation of the Master Settlement Agreement of 1998 that prohibits the companies from directly or indirectly targeting youths. 

Source: Kreslake, JM et al. Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults.
AJPH First Look, published online ahead of print Jul 16, 2008
Link: http://www.ajph.org/cgi/content/abstract/AJPH.2007.125542v1

Industry alternative to FCTC

Abstract

Between 1999 and 2001, British American Tobacco, Philip Morris, and Japan Tobacco International executed Project Cerberus to develop a global voluntary regulatory regime as an alternative to the Framework Convention on Tobacco Control (FCTC). They aimed to develop a global voluntary regulatory code to be overseen by an independent audit body and to focus attention on youth smoking prevention.

The International Tobacco Products Marketing Standards announced in September 2001, however, did not have the independent audit body. Although the companies did not stop the FCTC, they continue to promote the International Tobacco Products Marketing Standards youth smoking prevention as an alternative to the FCTC. Public health civil society groups should help policymakers and governments understand the importance of not working with the tobacco industry.

Source: Hadii M. Mamudu, Ross Hammond, Stanton A. Glantz . Project Cerberus: Tobacco Industry Strategy to Create an Alternative to the Framework Convention on Tobacco Control. American Journal of Public Health.
AJPH First Look, published online ahead of print Jul 16, 2008
Link: http://www.ajph.org/cgi/content/abstract/AJPH.2007.129478v1

Spousal smoking and incidence of first stroke

Abstract

Background: Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke.

Methods: Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged >= 50 years and married at baseline (n = 16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse’s smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birth state; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease.

Results: Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio = 1.42, 95% CI =1.05, 1.93) and former smokers (hazard ratio = 1.72, 95% CI =1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked.

Conclusions: Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.

[Note: Full text PDF freely available from link below.]

Source: Glymour M et al Spousal Smoking and Incidence of First Stroke. The Health and Retirement Study Am J Prev Med 35(3), 2008. Online Early July 29, 2008
Link: http://www.ajpm-online.net/webfiles/images/journals/amepre/AMEPRE2259.pdf  

Family meals and substance use among adolescents

Purpose
To examine 5-year longitudinal associations between family meal patterns and subsequent substance use in adolescents.

Methods
A total of 806 Minnesota adolescents were surveyed in public schools in 1998–1999 (mean age, 12.8 years) and again by mail in 2003–2004 (mean age, 17.2 years) as part of a longitudinal population-based study. Logistic regression was used to estimate the odds of tobacco, alcohol, and marijuana use at follow-up for adolescents reporting regular family meals at baseline compared with those without regular family meals, adjusting for family connectedness and prior substance use.

Results
Family meal frequency at baseline was associated with significantly lower odds of cigarette smoking, alcohol use, and marijuana use at follow-up among female adolescents, even after adjusting for baseline substance use and additional covariates. Family meals were not associated with use of any substance at follow-up for male adolescents after adjusting for baseline use.

Conclusions
Results from this study suggest that regular family meals in adolescence may have a long-term protective association with the development of substance use over 5 years among females. Parents should be encouraged to establish a pattern of regular family meals, as this activity may have long lasting benefits.

Source: Eisenberg, ME et al. Family meals and substance use: Is there a long-term protective association? Journal of Adolescent Health 2008; 43 (2); 151-156
Link: http://www.sciencedirect.com/science/journal/1054139X  

Budgetary impact of varenicline on the NHS

Abstract

Objectives: To estimate the budgetary impact of varenicline in the United Kingdom (UK) in the first 5 years after its introduction to the smoking-cessation aid market, from the National Health Service (NHS) pharmacy perspective. 

Methods: The economic impact of varenicline to the national health budget is estimated in a population of current, former, and new smokers. The analyses are based on data from a variety of secondary sources including national health data, clinical trials, and meta-analyses of smoking-cessation aids. The number of patients seeking aid and the treatment patterns are estimated using 2004 national health surveys, costs for medications from national prescription drug pricing tariffs, and efficacy of the various smoking-cessation aids from clinical trial data. Sensitivity analyses were performed to evaluate the impact of varying the patient parameters and costs.

Results: Model estimates suggest that the budgetary impact of varenicline would be £3.6 million in the second year after its introduction, with a 95% confidence interval of £0.63 to £7.2 million, and a resultant increase of 0.05% to the total NHS pharmacy budget. The model predicts that the addition of varenicline to the market would result in an additional 162,000 successful smoking-cessation attempts and 103,000 fewer smokers over 5 years, when compared to the world without varenicline.

Conclusion: The introduction of varenicline is likely to result in greater numbers of individuals succeeding at smoking cessation, with an approximately £3.6 million (0.05%) increase in the NHS pharmacy budget.
 

Source: Taylor, Dc et al. Budgetary Impact of Varenicline in Smoking Cessation in the United Kingdom. Value Health. 2008; Jul 11. [Epub ahead of print]
Link: http://www3.interscience.wiley.com/journal/120756799/abstract