ASH Daily News for 31 July 2008

Twenty percent of British adult survivors of childhood cancer smoke despite hazards

According to a study in the Journal of the National Cancer Institute, twenty percent of British adult survivors of childhood cancers are current smokers, and nearly a third have been regular smokers at some point in their lives.

Adult survivors of childhood cancer are at increased risk of developing cardiovascular disease, lung problems, and second malignancies, relative to the general public. These increased risks are due to long-term effects of the original cancer and its treatment, as well as to genetic conditions that predispose the survivors to multiple cancers.

To learn what fraction of adult survivors are current smokers or have smoked regularly in the past, Clare Frobisher, Ph.D., of the University of Birmingham, UK, and colleagues sent surveys to all those who could be contacted from among 14,836 eligible survivors of childhood cancer in the National Registry of Childhood Tumors.

Of the respondents, 20 percent were current regular smokers and 29.8 percent were regular smokers at some time in their life prior to the completion of the survey. When the researchers analysed the responses, they found that survivors of central nervous system cancers or heritable retinoblastoma were least likely to smoke, while survivors of Wilms tumor, Hodgkin lymphoma, or soft tissue sarcomas were most likely to report being a regular current smoker. Individuals who had been treated with radiation or chemotherapy were less likely to smoke than those who had not received that type of therapy. Also, those who did not have regular hospital follow-up appointments were more likely to smoke than those who did.

The rate of current smoking in the survivors was approximately half of the rate in the general British population. The socioeconomic factors that are associated with an increased risk of smoking in the general public, though, are the same as those in the adult survivor group, including manual occupations compared with managerial or professional work, lower educational attainment, and being widowed, divorced, or separated.

The researchers conclude that although the rate of smoking in adult survivors of childhood cancer is lower than in the general public, further efforts are needed to reduce the smoking prevalence in this group. In general, any program of clinical follow-up for survivors of childhood cancer should include advice on the health risks of smoking.

Karen Emmons, Ph.D., of the Dana-Farber Cancer Institute and Harvard School of Public Health in Boston notes that the new findings are remarkably similar to data from the U.S. Childhood Cancer Survivor Study, in which 17 percent of adult survivors reported being current smokers and 28 percent reported being ever smokers. The good news is that the rates are lower than the general public. The bad news, according to Emmons, is that for the survivors who do smoke, the habit is likely to exacerbate the already negative long-term effects of cancer treatment.

Source: News-Medical.Net, 29 July 2008
Link: http://tinyurl.com/5aeea5

USA: Study supports health benefits of smoking ban.

A new study from Scotland provides what public-health experts say is the strongest evidence yet that public bans on smoking improve health by reducing exposure to secondhand smoke.

According to the study, which appears in the New England Journal of Medicine, hospital admissions for heart attacks and acute coronary problems fell 17% overall, and even more for non-smokers, in the year after Scotland banned smoking in public places.

When Scotland prohibited smoking in enclosed public areas and workplaces after March 2006, researchers found:
• A 14% reduction in admissions for acute coronary syndrome among smokers.
• A 19% reduction among former smokers.
• A 21% reduction among people who had never smoked.

The study found that non-smokers accounted for 67% of the overall reduction in heart-disease hospitalisations, said Jill Pell, the University of Glasgow professor who led the study. Non-smokers saw a 20% reduction in their hospital admissions following the ban. Smokers' admissions were down 14%.

Unlike past studies, researchers took blood and saliva samples from patients as they were admitted to the hospital. Then they searched for cotinine which is a molecule that's the product of cigarettes. The presence of cotinine can definitively classify patients as smokers or non-smokers instead of relying on self-reporting by patients.

Researchers found that non-smokers with heart disease had higher levels of cotinine than the general population but lower levels than before the ban, a sign that their exposure to secondhand smoke had decreased but was still a factor in their heart damage.

Inhaled smoke makes blood platelets stickier, thus more likely to clot and clog arteries -- after even brief exposure to low levels of smoke. But the increased stickiness can wear off after just a few days. These effects make heart disease the most immediate health risk of tobacco smoke, and reducing these effects provides the most immediate benefit of smoking bans, according to public-health experts.

Source: The Wall Street Journal, 31 July 2008
Link: http://tinyurl.com/5qf9gj

Link to the full article: http://content.nejm.org/cgi/content/short/359/5/482

Kenya: Tobacco industry challenge new smoking laws

Hardly a month after parliament passed a law seeking to curtail the use of tobacco in the country, tobacco firms have gone to court and effectively frustrated enactment of the new rules. These firms have argued that the law had 'criminalised smoking', making it hard for them to operate.

The firms wanted the enactment of the laws put on hold, saying that the provisions of the rules were unrealistic and denied them a constitutional right to make a living.

As a result the high court in Nairobi has suspended the law after an application by 2 firms mastermind Tobacco and multinational British American Tobacco (BAT) until after the case is heard.

The law which came into force in July banned the sale of single sticks of cigarettes and only allows the sale of  20 stick packets, bans smoking in all public places including bars, restaurants, homes bus stops and offices.

The law demanded that cigarettes makers display in bold writing words to the effect that smoking was harmful to health as opposed to the past when the warning was printed in small hardly noticeable print.

It also sought to ban sale of cigarettes to persons under 18 and advertising of tobacco products and sponsorship of any activities by tobacco companies.

The law will now remain suspended after court action and based on past experience of Kenyan courts the suit may drag on for years before it is determined.

The frustration of the government is palpable for this is not the first time attempts to control use of tobacco is being resisted by the companies concerned.

The industry went to court and effectively scuttled any attempts at curbing use of tobacco when an attempt was made by the Public Health Ministry two years ago.

Even more scandalously when the current law was first mooted in parliament 4 years ago, backbenchers were treated to a 4 day retreat in the resort city of Mombasa by Mastermind Tobacco and British American Tobacco.

It is not that the country has been spared the burden of treating ailments linked to smoking passive of active, health officials say that Kenya spends no less than Ksh 5 billion annually managing tobacco related complications.

Dr James Nyikal , Public Health Secretary said, "The country spends five times the revenue it gets from growing tobacco treating patients of the malaise making it totally impossible to make a case of any advantage we are getting from the whole industry."

“Annually the public health system treats some 12,000 patients from tobacco illnesses out of which 4,000 are non smokers thus the need to tighten rules to protect non-smokers,” he added.

Even though many African countries have come with measures to curtail use of tobacco, enforcement according to World Health Organisation (WHO) has been poor and multinationals escaping strict laws in developed countries have been moving their operations to the continent to take advantage of weak and hardly enforced laws.

Source: Africa News, 30 July 2008
Link: http://tinyurl.com/5pw3dc

Australia: Teen anti-smoking push succeeds

Australian teenagers are finally getting the message that smoking is expensive and unattractive.

Two major surveys of teenagers in Western Australia reveal a dramatic re-think in attitudes towards smoking between 1999 and 2005.

Results showed a substantial increase over time in the number of teenagers who thought smoking was costly, unattractive and affected fitness levels.

Dr Michael Rosenberg, a population health expert at the University of Western Australia, said the results showed the short-term effects of smoking were now a powerful deterrent.

Dr Rosenberg said, "The good news is that there is evidence that the view of smoking has changed in youth culture."

"It's important to keep continually reinforcing those messages on the short-term effects, because they obviously work."

The study, published in the Health Promotion Journal of Australia, found that the number of teenagers who are put off by smoker's breath increased from 61 per cent in 1999 to 90 per cent in 2005.

The number who thought smoking made you less fit increased from 86 to 94 per cent, and there was a similar increase in those who thought smoking wastes money.

On the downside, there was no significant change to attitude to other statements like 'quitting is difficult' and 'smoking can ruin your life'.

Of the 650 teenagers questioned in 2005, five per cent had tried smoking by the age of 15.

By the age of 17, ten per cent had smoked in the past week.

Females were almost twice as likely as males to say it was easy to refuse a cigarette, Dr Rosenberg said.

The researchers said the short-term effects of smoking should be the centrepiece of anti-smoking campaigns targeting teenagers, and used alongside other measures like reducing point of sale advertising and increasing smokefree public places.

Source: The Age, 31 July 2008
Link: http://tinyurl.com/6rec4r