American Lung Association releases State of Tobacco Control 2009 report

The American Lung Association today released its State of Tobacco Control 2009 report, which grades the strength of federal and state laws to protect citizens from tobacco-caused illnesses. These illnesses are now at the heart of America's chronic disease crisis.

The report finds the federal government made major strides but still has significant room for progress. Most state governments, however, failed to enact critical measures to protect people from deadly tobacco products. Ten states made alarming cuts to their tobacco control programs.

Tobacco's toll continues to be devastating. Smoking-caused illness remains the number-one preventable cause of death in the U.S., killing more than 393,000 Americans each year and costing the economy more than $193 billion. Another 50,000 Americans die from exposure to secondhand smoke. The U.S. Surgeon General has declared there is no safe level of exposure to secondhand smoke.

"Our leaders in Washington have made a strong start in confronting the tobacco epidemic and taking steps that ultimately will save millions of lives and hundreds of billions of dollars for the American economy. Ending the epidemic, however, will require more hard work," said Charles D. Connor, American Lung Association President and CEO. "Forty-six million adults smoke, and political leaders in the states need to stand up to the tobacco industry and enact policies proven to reduce the devastating death and disease caused by tobacco use."

To arrive at the grades published in State of Tobacco Control 2009, the American Lung Association compared policies against targets based on the most current, recognized scientific criteria for effective tobacco control, or policies considered the best in the nation.

FEDERAL RESULTS

The federal government took major and meaningful steps to curb the enormous burden caused by tobacco use in 2009. For two decades the American Lung Association has advocated giving authority to the U.S. Food and Drug Administration (FDA) to regulate tobacco products. Congress finally passed this legislation early in 2009. President Obama signed it on June 22.

Congress also more than doubled the federal cigarette tax, from 39 cents to $1.01 per pack. In addition, both chambers of Congress passed healthcare reform legislation that could expand coverage under Medicaid and private insurance for helping smokers quit (called cessation). As the House and Senate passed bills are reconciled, the Lung Association urges Congressional leaders to require state Medicaid programs to offer comprehensive cessation benefits.

The American Lung Association gives federal tobacco control grades for these criteria:

"A" for FDA Regulation of Tobacco Products—The Family Smoking Prevention and Tobacco Control Act was signed into law in 2009 and already the FDA has begun to implement the law. It has tremendous potential to reduce death and disease caused by tobacco in the U.S.

"D" for Federal Cigarette Tax—Congress agreed in February 2009 to raise the federal government's cigarette tax by 62 cents per pack of 20 to $1.01 in order to fund the Children's Health Insurance Program (CHIP). This increase has led many smokers to attempt to quit. The tax still falls short, however, of the "A" standard of $2.68 per pack.

"F" for Cessation—The federal government continues to fail to help smokers quit—an effort that would save lives and money. However, the U.S. House of Representatives and Senate have approved different versions of healthcare reform legislation that include an expansion of cessation coverage under Medicaid, Medicare and private insurance plans. At press time, it was uncertain whether a final bill would include these policies, and whether it would be passed into law; the House version provided broader coverage.

"D" for Ratification of the Framework Convention on Tobacco Control—The Obama administration has not submitted the international tobacco control treaty to the Senate for ratification, leaving the U.S. unable to participate in negotiations to implement and enforce it. The treaty has been ratified by 168 nations representing 86 percent of the world's population.

STATE RESULTS

As states faced record budget deficits, many turned to cigarette taxes to increase revenues. Fourteen states and the District of Columbia raised cigarette taxes, a proven means to reduce smoking. These states are Arkansas, Connecticut, Delaware, Florida, Hawaii, Kentucky, Mississippi, New Hampshire, New Jersey, North Carolina, Pennsylvania, Rhode Island, Vermont and Wisconsin.

Disturbing trends emerged, however. Ten states and the District of Columbia took a step backward by sharply reducing funding for tobacco control and prevention programs. This trend undermines other advances because robust tobacco control programs help sustain and even expand the impact of higher cigarette taxes and smokefree workplace laws. Wisconsin, for example, increased its cigarette tax by 75 cents but also slashed funding for tobacco prevention and cessation programs by more than half. New Hampshire raised its cigarette tax by 45 cents, yet it spends not a single state dollar on tobacco prevention and cessation programs. In addition, the pace for states passing comprehensive smokefree air laws slowed dramatically.

"Increasing tobacco taxes and requiring smokefree workplaces are two important steps in reducing the leading cause of preventable death in the United States," said Mary H. Partridge, American Lung Association National Board Chair. "But that is still not enough. Comprehensive cessation programs must also be made available to support them in quitting."

No state received straight "A's" on its report card. Six received all "F's." They are Alabama, Kentucky, Missouri, South Carolina, Virginia and West Virginia.

States and the District of Columbia are graded on the following:

• State Cigarette Taxes—Facing record budget deficits, 14 states turned to higher cigarette taxes to increase revenues. Nonetheless, only four states qualified for an "A" grade by imposing cigarette excise taxes of $2.68 or more. Of states that raised cigarette taxes, three (Hawaii, Pennsylvania, Wisconsin) and the District of Columbia cut funding for tobacco control significantly – by more than 25 percent.
• Smokefree Air—Only three states, Michigan, South Dakota and Wisconsin, met the American Lung Association's Smokefree Air Challenge in 2009 by passing strong smokefree air laws. This was slightly higher than the two states meeting the challenge in 2008, but represents a slowdown from 2006-2007, when a total of 16 states and the District of Columbia met the challenge. Evidence has shown that in states with strong smokefree laws, fewer adults smoke. Twenty-two states and the District of Columbia received "A" grades for smokefree air policies for 2009.
• Tobacco Prevention and Control Programs—Only two states, Alaska and North Dakota, received "A" grades for funding tobacco prevention and control programs at 80 percent or more of the level recommended by the Centers for Disease Control and Prevention (CDC). Forty-one states and the District of Columbia received "F's" for spending at less than 50 percent of CDC-recommended levels. The District of Columbia and the following ten states slashed spending by 25 percent or more: Colorado, Hawaii, Indiana, Maryland, Massachusetts, New York, Pennsylvania, Tennessee, Washington and Wisconsin.
• Cessation Treatments—No state received an "A" for offering comprehensive tobacco cessation treatments to its Medicaid recipients and to state employees. Thirty-one states received an "F" in this category. The American Lung Association urged full coverage of clinically proven smoking cessation treatments in a November report entitled Helping Smokers Quit: State Cessation Coverage 2009.

States continued to fail to enact these critical policy measures in 2009. Instead, state-level political candidates took in more than $7 million in campaign contributions from the tobacco industry in the 2007-2008 election cycle and more than $675,000 through the first 11 months of 2009, generally an off year for state elections.

The Tobacco Epidemic Persists

Despite a perception that smoking is a dying public health danger, the tobacco epidemic persists. It causes tragedy, staggering costs and devastation. In 2008, the latest year for which data is available, smoking in the U.S. failed to decline for the first time in years, staying right around 20 percent. Forty-six million adults smoke. The nation's progress in ending the epidemic has halted, according to the CDC.

The tobacco companies, meanwhile, continue exerting powerful influence and targeting kids in order to replace their dying customers. To hook a new generation of children, these companies have launched products that critics label "tobacco candy." Camel, for example, debuted its Camel Orbs, Strips, and Sticks in Columbus, Ohio; Indianapolis, Indiana; and Portland, Oregon in 2009. Camel Orbs, the size of Pez candies, are mint- and honey-flavored. Facing new regulations that could cut their profits, Reynolds American, Lorillard and some smaller tobacco companies also sued to overturn many marketing restrictions in the Family Smoking Prevention and Tobacco Control Act, a lawsuit that is still pending as of press time.

The failure of the federal government and each state government to get all "A" grades for enacting strong and effective tobacco control laws comes at a critical time. Tobacco control policies are extraordinarily popular. But the tobacco industry is not letting up on its aggressive marketing and promotion strategies to spur increased smoking. Until elected officials overcome their fears of standing up to the tobacco industry, hundreds of thousands of lives will be tragically lost and billions of dollars will continue to be wasted.]

Source: The Medical News - 12 January 2010
Link: http://bit.ly/8GbkvP

Effects of exercise on cravings to smoke: The role of exercise intensity and cortisol

Abstract Research consistently demonstrates that a bout of moderate exercise alleviates cravings to smoke among abstaining smokers. The aims of this study were to examine whether doses of exercise (moderate or vigorous) reduced cravings differently, and whether reductions in cravings were associated with changes in cortisol concentration. Using a within-participant, crossover design, 18 participants conducted three 15-min treatment sessions on separate days: passive, walking (45-50% heart rate reserve), and running (80-85% heart rate reserve) conditions. Participants rated cravings at baseline, mid-treatment, and 0, 10, 20, and 30 min after each treatment. Salivary cortisol samples were collected at baseline, immediately after, and 30 min after each condition. Significant group X time interactions were identified, demonstrating significant reductions in craving items after the walking and running conditions compared with the passive control. No significant differences in craving reductions were found between walking and running conditions. Post hoc comparisons found that running condition cravings to smoke scores were reduced for a longer duration post-treatment than post-walking condition scores. The decline in cortisol concentration was attenuated in the running group only. Vigorous exercise has a similar effect to moderate exercise in terms of the magnitude of craving reduction. However, performing bouts of moderate-intensity exercise may be a better recommendation for reducing cravings.

Scerbo, f. et al., Effects of exercise on cravings to smoke: The role of exercise intensity and cortisol. Journal of Sports Sciences, Volume 28, Issue 1 January 2010 , pages 11 - 19

Source: InformaWorld - January 2010
Link: http://bit.ly/68V5bU

Rise of the part-time smoker

It's tough to be a hard-core chain-smoker these days.

Half of the U.S. population lives in areas where smoking is banned in workplaces, bars and restaurants.

More than 70% of Americans don't allow smoking in their homes, including about 50% of current smokers.

Taxes have pushed the cost of smoking ever higher ($10 per pack in New York City) and the social costs—in disgusted looks and lectures from friends and family members—have escalated too.

Such inconveniences are forcing a sea change in smoking habits and upending traditional approaches to smoking cessation. For one thing, there's a growing group of intermittent and secret smokers who seem to smoke as much for psychological and emotional reasons as nicotine addiction. In addition to breaking the physical addiction, smokers who want to quit today need to understand why, when and where they smoke, and challenge some of the thinking that goes along with it, cessation experts say.

" 'Sneaking one in' has become a smoker's pastime and avocation," says Timothy Stephens, a 40-year-old Manhattan lawyer who started smoking cigarettes in high school. Nowadays, with a wife and baby, he doesn't smoke at home. He takes five-minute smoking breaks outside his office building ("four minutes if it's cold") and he drives to work from the suburbs instead of using public transit so he can get more smoking in.

Even though the percentage of American adults who smoke has stalled at about 20% in recent years, smokers are smoking fewer cigarettes than they used to (an average of 13 per day, down from 21 in 1980). And a growing proportion of smokers—roughly 25%—don't smoke every day. One government study found that as many as half of American smokers either don't smoke daily or smoke fewer than six cigarettes a day.

[...]

Researchers used to think light and intermittent smoking was a transitional phase for smokers on their way to quitting or ramping up to a more serious habit. But a few recent studies suggest that it's a new, stable pattern particularly among young, college-educated smokers. An analysis of smoking patterns during the 1990s, published in the journal Nicotine & Tobacco Research last year, found that 18-to-29-year-olds were twice as likely as those aged 50 to 64 to be nondaily smokers. Many experts expect that pattern to continue. "Young people who have grown up with a smoke-free home, school and workplace environment may stabilize at a much lower dependence level than those without such restrictions," the researchers wrote.

Light smokers are still putting their health at risk, however. "People shouldn't fool themselves that just a couple of cigarettes won't kill you," says Thomas R. Frieden, director of the Centers for Disease Control and Prevention, who helped bring smoking rates in New York City down to 15% from 21% when he was the city's health commissioner from 2002 until last year. "The bad news here is that really good studies show that just a very small number—three, for example—drastically increases the likelihood of heart attack and stroke."

Why keep smoking at all, then?

Some experts blame the addictive power of nicotine, even at low levels, that leaves some smokers struggling to kick the habit. But others note that some intermittent smokers can go for days without a fix, particularly if they are accustomed to smoking only in certain circumstances. And some may be using nicotine patches, gum or lozenges to help quell their cravings. A study of 6,500 smokers in the U.S., U.K., Canada and Australia, published in the journal Addiction last year, found that one-third of those who used nicotine-replacement products were not attempting to quit, but to abstain temporarily or cut down.

"While we haven't got the full picture, what's clear is that there are multiple types of smokers that we need to better understand," says Saul Shiffman, a professor of psychology and pharmaceutical science at the University of Pittsburgh. As part of his research, Dr. Shiffman is equipping 200 daily and 200 nondaily smokers with personal-digital assistants to record their cravings, triggers and motivations.

For most smokers, the desire to smoke is a complex mix of physical addiction, behavorial conditioning and psychological factors, says Daniel F. Seidman, director of Smoking Cessation Services at Columbia University Medical Center and author of a new book, "Smoke-Free in 30 Days." He notes that smoking just a few cigarettes a day can be even harder to give up than a heavier habit, since each one carries more reward. "I think it's a trap—you're never learning other ways to cope."

The article goes on to list some of the most common smoking triggers (and suggestions for counteracting them)  such as Social Smoking, Secret Smoking, Stress Smoking, Emotional Smoking, Worried-About-Weight Smoking, Scared to Stop.

Source: The Wall Street Journal - 12 January 2010
Link: http://bit.ly/545pcA

Tobacco sales light up Booker’s third quarter

Bumper tobacco sales have helped Booker to a rise in like-for-like sales of 6.7% for the third quarter.

The cash & carry giant said sales of tobacco rose 7.9% in the 16 weeks to 1 January 2010, as UK customers staying at home instead of travelling abroad bought more duty-paid tobacco.

Sales of non-tobacco items were up 6% over the period.

The wholesaler said its performance in India, where Booker launched its first depot in September and plans to open up to 20 – had been “encouraging” with an “excellent” response from customers.

“Booker continues to make good progress, with both customer numbers and customer satisfaction improving further,” said chief executive Charles Wilson, pointing to the group’s “continued focus on choice, price and service”.

“We look forward to continuing to help our customers compete in the months ahead."

Source: The Grocer - 14 january 2010
Link: http://bit.ly/7EOpwA

Nicotine patch vs. nicotine lozenge for smoking cessation

Abstract

Background Nicotine replacement therapies are efficacious for treating nicotine dependence. However, limited data exist on benefits of different NRTs and predictors of treatment outcome. This study compared the effectiveness of transdermal nicotine vs. nicotine lozenge for smoking cessation and identified predictors of treatment response.

Methods A randomized, open-label effectiveness trial was conducted at 12 medical sites participating in the National Cancer Institute's Community Clinical Oncology Program. The sample consisted of 642 treatment-seeking smokers randomized to 12 weeks of transdermal nicotine or nicotine lozenge.

Results Smoker characteristics were assessed at baseline, and 24-h point prevalence abstinence confirmed with breath carbon monoxide (CO) was evaluated at end of treatment (EOT) and at a 6-month follow-up. There was a trend for higher quit rates for transdermal nicotine vs. nicotine lozenge at EOT (24.3% vs. 18.7%, p = .10) and 6 months (15.6% vs. 10.9%, p = .10). A logistic regression model of EOT quit rates showed smokers who preferred transdermal nicotine, were not reactive to smoking cues, and did not use nicotine to alleviate distress or stimulate cognitive function had higher quit rates on transdermal nicotine. A logistic regression model of 6-month quit rates showed smokers who preferred transdermal nicotine had higher quit rates on transdermal nicotine, and smokers who used nicotine to alleviate distress or stimulate cognitive processes had lower quit rates on nicotine lozenge.

Conclusions Transdermal nicotine may be more effective than nicotine lozenge for smokers who prefer transdermal nicotine and do not smoke to alleviate emotional distress or stimulate cognitive function.

Schnoll, R. et al. Nicotine patch vs. nicotine lozenge for smoking cessation: An effectiveness trial coordinated by the Community Clinical Oncology Program. Drug and Alcohol Dependence. doi:10.1016/j.physletb.2003.10.071

Source: Science Direct - December 2009
Link: http://bit.ly/7mF4ZP

New Zealand: Battle lines drawn in final push to get rid of tobacco

Health reporter Martin Johnston begins a series on the state of smoking in New Zealand and efforts to reduce it.

The number of teenagers who have never lit up a cigarette is rapidly increasing, leading some to conclude a sea change is occurring in young people's attitudes to tobacco.

Surveys for the Ministry of Health show that just over half of teenagers aged 15 to 19 have never tried smoking - "not even one puff". This is markedly higher than in 2006, when the figure was 39 per cent.

The trend, attributed to the increasing "denormalisation" of smoking through changes like the 2004 ban on smoking in bars, is even more marked among 14- and 15-year-olds. A survey of them in 2008 found that 61 per cent reported never having smoked - a figure that has nearly doubled in nine years.

The possibility of a radical shift in youth behaviour and attitudes to smoking coincides with a two-pronged push to plot the demise of tobacco.

The public health community and Maori Party MP Hone Harawira are campaigning for the eventual elimination of what they call an addictive poison that should no longer be considered a normal consumer product.

The National-led Government refused - in line with storekeepers' wishes - to implement the recommendation to put tobacco out of public view in shops. Yet it is convinced of the importance of reducing the smoking rate, so much so that it is holding district health boards to account on their smoking-cessation support to hospitalised smokers.

This is because smoking is so destructive - to individuals and to the economy. By causing serious illnesses like lung cancer, cardiovascular disease and other breathing and circulation conditions, it kills 4200 people a year, and secondhand smoke is estimated to take another 300.

And it costs the economy more than $1.6 billion, of which $1.5 billion is spent on healthcare.

Smokers spend about $1.6 billion a year on tobacco products, of which more than $1 billion is taken by the government in excise tax and GST.

Campaigning by the Maori Party has led to Parliament's Maori affairs committee deciding to hold an inquiry aimed at forcing the tobacco industry to reveal the methods it has used to promote smoking among Maori.

The committee is likely to recommend radical tobacco-control policies to the Government.

Smokefree campaigners such as Ben Youdan, the director of Action on Smoking and Health, are excited about the inquiry, which they see as a turning point in the history of smoking - and not just for Maori.

"This is a major opportunity to get tobacco manufacturers, who are the ones responsible for promoting tobacco and getting people addicted, to be publicly held to account.

"Traditionally, New Zealand has been a leader in tobacco control, for example banning advertising and introducing smokefree environments.

"Now we need to look at some of the end-game solutions for tobacco. The inquiry is a great opportunity to do that, to make tobacco a highly controlled product by 2020."

Maori Party co-leader Tariana Turia, who holds portfolio responsibility for tobacco control as Associate Minister of Health, last year put pressure on the Government by strongly suggesting that she favoured banning retail tobacco displays and increasing the excise tax, particularly on roll-your-own tobacco.

An acting deputy director-general at the ministry, Ashley Bloomfield, said discussions were ongoing with Mrs Turia and Health Minister Tony Ryall over displays, and a licensing regime for tobacco retailers was "on our radar".

He asserted that the evidence from the surveys of 14- and 15-year-olds was compelling, that youth attitudes and behaviour had swung firmly against tobacco.

Although the adult smoking rate, currently around 20 per cent, was declining only slowly, Dr Bloomfield said he was confident the youth change would flow through into a lower adult rate.

But Otago University marketing expert Professor Janet Hoek said the increasing proportion of never-smokers among young people did not automatically translate into reduced adult smoking prevalence.

She said the fact that smoking prevalence remained quite high among those aged 18 to 24 indicated the initiation age of smoking had simply been deferred because of the restrictions that applied to younger people.

Dr Bloomfield accepted there had been some deferral, but said the increase in youth who had never smoked was critically important.

"The longer you delay initiation the better, because they are less likely to take it up the older they get - once you get over 18 and get through those teenage years with their very strong peer pressure to try these things.

"In the past, 80 to 90 per cent [of smokers] have been addicted by the time they turn 18."

Smokefree Coalition director Prudence Stone said Ireland's retail display ban, introduced in July, had led to a sharp change in youth attitudes.

"They were asked to recall tobacco products on display. Their recall dropped dramatically, from 80 per cent before the ban to just over 20 per cent after. And less of them had confidence they could purchase cigarettes from a retailer after the ban."

Banning retail displays and applying progressive tax increases are key measures the Maori affairs committee will be asked to support.

Others include killing off tobacco brands, allowing tobacco packets to carry only generic text and health warnings, and capping the volume of tobacco released for sale, which would force up the price.

SMOKE TAX
Excise and sales tax as a percentage of retail tobacco prices:
* New Zealand 70 per cent
* Australia 62 per cent
* Canada 76 per cent
* New York City 77.4 per cent
* Britain 80 per cent
* France 80 per cent

Source: New Zealand Herald - 04 January 2010
Link: http://bit.ly/7wEEVT

Spain split on smoking ban

Originally set to be implemented on the 1st of January this year, the smoking ban is still being debated in the halls of power in Spain with opposition parties failing to agree and Madrid setting its own rules.

Spain’s Health Minister Trinidad Jiménez has stated that she wants a new tobacco ban prohibiting smoking in all public places throughout Spain to go into effect as soon as the ruling Socialist Party can gather cross party support for its ratification by Congress.

TheUnited Left (IU) and Catalan Nationalist (CiU) approve the across-the-board ban but the major opposition Popular Party has not officially said whether it will support it. However, Madrid regional health chief Juan José Güemes, a member of thePP, said Monday he didn’t believe that the ban would work in the capital. “You never get good results from banning something,” Güemes said. “Restrictions mean curtailing freedoms and you have to be very careful about limiting individual guarantees.”

Deputy leader of the Madrid region, Ignacio González, also of the PP, said that his government would defend smokers’ rights “I believe that when it comes to the tobacco issue, one has to maintain some degree of respect — of course, at the same time looking at the legality of the legislation, but also ensuring that there is freedom to choose.”

It was in 2005, that the government introduced a tobacco law that has been poorly enforced. Under the regulations, public places more than 100-square-meters had to have a separate area for smokers. But a year later, a survey showed that more than half of the businesses around the country didn’t stick to the ban.

Madrid is different and the Madrid regional government issued its own decree, giving more freedom to smokers, such as allowing them to light up at certain areas at work and eliminating the 100-square-meter rule in the capital.

Source: The Leader - 05 January 2010
Link: http://bit.ly/6NmZ10

South Africa: BAT challenges communication ban

British American Tobacco (BAT) said it wanted the high court to lift a ban on "one-to-one" communication with smokers.

If it did not get that, it wanted the court to declare the ban to be an infringement of the company's constitutional rights. "The company seeks for the (law) to be amended to allow one-to-one communication with its consenting adult smokers," it said.

A judgment in BAT's favour could reverse amendments to the Tobacco Products Control Amendment Act proclaimed in August. These further curtailed the room companies such as BAT have to market their products. Conventional advertising channels were closed to tobacco producers in 2001 and they have since had to rely on other measures.

There is dispute, however, about exactly what "one-to-one" communication means. The National Council Against Smoking, a lobby group, said BAT wanted to use the challenge to overcome restrictions on advertising and promoting cigarettes to young people, through word-of- mouth invitations to parties promoting smoking.

"In practice, this means that the industry will be able to use techniques known as 'viral', 'buzz' or guerrilla marketing to target teens," said spokesman Yussuf Saloojee.

BAT denied this.

"This form of communication has absolutely nothing to do with interacting in any shape or form with children or nonsmokers for that matter. Any reference to parties or any other form of mass gathering is totally misleading and disingenuous as all forms of mass communication have been banned," it said.

Source: Tobacco Journal - 04 December 2009
Link: http://bit.ly/8rDZFR

Comparison of emissions from narghile waterpipe and cigarette smoking

Abstract The lack of scientific evidence on the constituents, properties, and health effects of second-hand waterpipe smoke has fueled controversy over whether public smoking bans should include the waterpipe. The purpose of this study was to investigate and compare emissions of ultrafine particles (UFP, <100 nm), carcinogenic polyaromatic hydrocarbons (PAH), volatile aldehydes, and carbon monoxide (CO) for cigarettes and narghile (shisha, hookah) waterpipes. These smoke constituents are associated with a variety of cancers, and heart and pulmonary diseases, and span the volatility range found in tobacco smoke.

Sidestream cigarette and waterpipe smoke was captured and aged in a 1 m3 Teflon-coated chamber operating at 1.5 air changes per hour (ACH). The chamber was characterized for particle mass and number surface deposition rates. UFP and CO concentrations were measured online using a fast particle spectrometer (TSI 3090 Engine Exhaust Particle Sizer), and an indoor air quality monitor. Particulate PAH and gaseous volatile aldehydes were captured on glass fiber filters and DNPH-coated SPE cartridges, respectively, and analyzed off-line using GC–MS and HPLC–MS. PAH compounds quantified were the 5- and 6-ring compounds of the EPA priority list. Measured aldehydes consisted of formaldehyde, acetaldehyde, acrolein, methacrolein, and propionaldehyde.

We found that a single waterpipe use session emits in the sidestream smoke approximately four times the carcinogenic PAH, four times the volatile aldehydes, and 30 times the CO of a single cigarette. Accounting for exhaled mainstream smoke, and given a habitual smoker smoking rate of 2 cigarettes per hour, during a typical one-hour waterpipe use session a waterpipe smoker likely generates ambient carcinogens and toxicants equivalent to 2–10 cigarette smokers, depending on the compound in question. There is therefore good reason to include waterpipe tobacco smoking in public smoking bans.

Daher, N. et al. Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors. Atmospheric Environment. Volume 44, Issue 1, January 2010, Pages 8-14

Source: Science Direct - October 2009
Link: http://bit.ly/8cjSRa

Australia: 'Arrogant' BAT tried to remove a judge

British American Tobacco, one of the UK's most powerful companies, has been accused of "breathtaking arrogance" after one of its subsidiaries pushed for the removal of a judge hearing a cancer compensation lawsuit being brought against it.

The company, which each year produces 715 billion cigarettes in 41 countries and employs more than 50,000 people, claimed an Australian judge, Jim Curtis, would not have "an impartial and unprejudiced mind'' over the case brought by Claudia Jean Laurie, the widow of a smoker.

The company, which last year made global profits of almost £2.7bn, said this was because in a separate case in 2006 Curtis had branded BAT Australia "dishonest" for its role in the destruction of documents relating to the potentially harmful effects of its products.

Curtis said the company destroyed documents in anticipation of legal action and "dishonestly concealed this purpose by pretence of a rational non-selective housekeeping policy".

A former senior BAT executive, Fred Gulson, admitted the purpose of the policy was "to get rid of all the sensitive documents… under the guise of an innocent housekeeping arrangement".

BAT Australia's application to have Curtis dismissed in the latest case has been rejected by two judges.

The court of appeal in New South Wales said that BAT had caused "a real risk of a diminution of public confidence in the administration of justice'' by seeking to have Curtis removed.

In a damning summary, it said that upholding BAT's challenge would lead the public to believe the company had "manipulated the system in the hope of obtaining a more favourable outcome from a different judge".

A spokeswoman for the anti-tobacco campaign group Ash said that BAT had a reputation for defending itself robustly in Australia.

"For BAT to think that it could succeed in this approach is breathtakingly arrogant yet at the same time symptomatic of its past behaviour in Australia and elsewhere," she said.

BAT has been fighting lawsuits in Australia for almost a decade. On 11 April 2002, a jury ordered BAT Australia to pay Rolah McCabe A$700,000 (£390,000) in damages, the first award of its kind.

McCabe was a 51-year-old woman dying of lung cancer who was said to have started smoking at the age of nine. She alleged that BAT Australia knew cigarettes were addictive and dangerous, and that, through its advertising, the company had targeted children.

McCabe died six months after the initial ruling in her case, which first revealed evidence of BAT Australia's policy of destroying documents.

BAT Australia was not immediately available for comment. But its parent company has pledged to vigorously contest all lawsuits brought against it.

The company states on its website: "The tobacco industry has a strong record of winning these cases and we, along with many analysts, believe this will continue, although it's always possible that sometime, somewhere, a smoking and health case will be lost."

Source: The Guardian - 3 January 2010
Link: http://bit.ly/4SnOLX

Smokers who quit should take diet advice to avoid diabetes

People who give up smoking are prone to developing diabetes because they gain weight, scientists warn.

A large American study found that people who quit were twice as likely as continuing smokers and up to 70 per cent more likely than non-smokers to have type 2 diabetes within six years.

The researchers from Johns Hopkins University, Baltimore, said that people attempting to quit should be offered advice on diet and exercise to avoid gaining weight.

But the dangers of developing lung cancer or other health problems from smoking outweigh the short-term risks from quitting and should not be used as an excuse not to kick the habit, they said.

The study enrolled 10,892 middle-aged adults who did not yet have diabetes, from 1987 to 1989. They were monitored for up to 17 years and data about diabetes status, glucose levels and weight were collected.

More than 1.5 million people in Britain have type 2 diabetes, which normally occurs in middle age and is associated with being overweight.

It is distinct from the type 1 form of the condition, which is usually diagnosed in children and is managed with daily insulin injections.

In the study, scientists found that people who quit smoking had a higher risk of developing type 2 diabetes in the first six years without cigarettes compared with people who never smoked. The risks were highest in the first three years after quitting and returned to normal after ten years.

On average, over the first three years of the study, people who stopped smoking put on nearly 8½lbs (3.8kg) and saw their waist bulge by about 1¼in (3.17cm).

Hsin-Chieh Yeh, assistant professor at Johns Hopkins and the lead author of the study, published in the journal Annals of Internal Medicine, pointed out that cigarette smoking was also a risk factor for type 2 diabetes.

Among those who continued smoking, the risk was lower than in those who quit, but the chance of developing diabetes was still 30 per cent higher compared with those who had never smoked.

“The message is: don’t even start to smoke,” she said. “If you smoke, give it up. That’s the right thing to do. But people have to also watch their weight.”

Heavy smokers who give up should be offered lifestyle counselling to set up an exercise regime, monitor weight, use nicotine replacement therapy and more frequent blood glucose screening to detect the onset of diabetes, she said.

Natasha Marsland, care adviser at the health charity Diabetes UK, said: “On no account should people use the theoretical results of this study as an excuse not to give up smoking. The health benefits of giving up smoking far outweigh the risk of developing type 2 diabetes from modest, short-term weight gain.

“There is every reason you can be successful at both giving up smoking and keeping to a healthy weight if you combine daily physical activity with a diet rich in fruit and vegetables and low in sugar, salt and fat.”

Source: The Times - 05 January 2010
Link: http://bit.ly/5A0kwV

Zimbabwe: Tobacco output increases

The 2009/10 tobacco output is projected to surpass 80 million kilogrammes, compared to the 56 million kilogrammes of the crop that went through the auction floors last season, an official has said.

Zimbabwe Commercial Farmers Union (ZCFU) president, Wilson Nyabonda, said this year there was an increase in the number of farmers registering to grow tobacco due to the introduction of foreign currency.

According to the Tobacco Industry and Marketing Board (Timb), at least 17 000 tobacco farmers countrywide registered to grow tobacco in the 2009/2010 agricultural season.

In the previous agricultural season, 10 000 registered to plant the golden leaf.

“This year there has been an upsurge of farmers registering to put their land under tobacco farming. As a result, 65 000 hectares are under tobacco farming, which is a significant increase if compared to 50 000 hectares that were put under tobacco in the previous season,” he said.
Zimbabwe realised more than US$168 million from last year's crop with prices averaging US$3,02 per kg between April and August.

Commenting on the tobacco crop situation countrywide, the ZCFU president said both rain-fed and irrigated tobacco growing well.

However, he said the expected target may not be reached because of a number of challenges tobacco farmers in the country were facing this farming season.

“The projected target may not be met because of a number of challenges tobacco farmers are facing right now. The availability of inputs such as ammonium nitrate and Compound C fertilizer in the country is limited. The country's fertilizer manufacturing companies are faced with operational constraints to produce ammonium nitrate in abundance for farmers in the country. As a result, the targeted tobacco output for 2009/10 farming season may not be achieved,” said Mr Nyabonda.

The 100 percent retention of tobacco proceeds for farmers that was introduced under a new liberalised agricultural marketing framework this year, the Government said, meant that income directly benefited farmers.

Meanwhile, Timb and Agribank assistance schemes have seen A2 farmers commit 20 000 hectares to the crop while small-scale growers have planted 15 000 hectares.

Over the years, Zimbabwe used to produce 200 million kg of tobacco.

Source: The Zimbabwean - 05 January 2010
Link: http://bit.ly/8TYzlw

The association between smoking and low back pain: A meta-analysis

Abstract

Objective To assess the association between smoking and low back pain with meta-analysis.

Methods We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses.

Results In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32).

Conclusions Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.

Shiri, R., et al. The association between smoking and low back pain: A meta-analysis. The American Journal of Medicine. Volume 123, Issue 1, January 2010, Pages 87.e7-87.e35

Source: Science Direct - 24 December 2009
Link: http://bit.ly/6s4aCT

It's never too late to quit smoking and save your vision, UCLA study of elderly women finds

Need a little extra incentive to kick the habit?

Just in time for New Year's resolutions, a UCLA study finds that even after age 80, smoking continues to increase one's risk for age-related macular degeneration (AMD), the leading cause of blindness in Americans over 65.

The American Journal of Ophthalmology publishes the findings in its January edition.

"The take-home message is that it's never too late to quit smoking," said lead author Dr. Anne Coleman, professor of ophthalmology at the Jules Stein Eye Institute at UCLA. "We found that even older people's eyes will benefit from kicking the habit."

AMD causes progressive damage to the macula, the center of the retina, which allows us to see fine details. When the macula degenerates, people experience darkness or blurring in their central vision, preventing them from being able to read, drive and recognize faces.

After age, smoking is the second most common risk factor for AMD. This study sought to determine whether age influences the effects of smoking on AMD risk.

Coleman and her colleagues followed a group of 1,958 women who underwent retinal photographs at five-year intervals, starting with a baseline exam at age 78. Four percent, or 75 of the women, smoked.

The researchers compared the retinal images at ages 78 and 83 to check for the appearance of AMD and evaluate whether smoking affected the women's likelihood of developing the disease.

"Age is the strongest predictor for AMD, yet most of the research in this field has been conducted in people younger than 75," Coleman said. "Our population was considerably older than those previously studied. This research provides the first accurate snapshot of how smoking affects AMD risk later in life."

Overall, women who smoked had an 11 percent higher rate of AMD than other women their age. In women over 80, however, those who smoked were five-and-a-half times more likely to develop AMD than women their age who did not smoke.

"We saw a slightly higher rate of AMD in women after age 80, but the rate was dramatically higher in older women who smoked," Coleman said. "The bottom line is that AMD risk increases with age. And if you smoke, your risk of developing the disease rises even more."

It has been hypothesized that cigarette smoking increases AMD risk by reducing serum antioxidant levels, altering blood flow to the eyes and decreasing retinal pigments.

"This study provides yet another compelling reason to stop smoking and suggests that it is never too late to quit," said Dr. Paul Sieving, director of the National Eye Institute.

The National Eye Institute and the National Institute on Aging funded the research.

About 1.75 million U.S. residents suffer from advanced AMD with vision loss; the number is expected to grow to almost 3 million by 2020.

Source: UCLA Newsroom - 7 January 2010
Link: http://bit.ly/78lcoH

Parliamentary questions

Question: Smoking cessation
Tom Levitt (High Peak, Labour): To ask the Secretary of State for Health what steps his Department is taking to encourage people to stop smoking.

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour): This Government have given active encouragement to people to stop smoking through setting up NHS Stop Smoking Services, smokefree legislation, banning tobacco advertising, raising the age of sale and effective information campaigns.

A new tobacco control strategy will soon be published to help further reduce the damage caused by smoking.
Hansard source (Citation: HC Deb, 12 January 2010, c899W)

Question: Prevention
Brian Jenkins (Tamworth, Labour): To ask the Secretary of State for Health what steps are being taken to encourage people to take up preventative health services.

Gillian Merron (Minister of State (Public Health), Department of Health; Lincoln, Labour): High Quality for All: NHS Next Stage Review Final Report' (2008) committed primary care trusts to work in partnership with local authorities to commission comprehensive well-being and prevention services particularly covering obesity, alcohol harm, drug addiction, smoking, sexual health and mental health. A copy has already been placed in the Library. The Department has also sponsored guidance to improve commissioning of preventative services which was published by the Royal Society of Public Health in December 2009, and this is part of a programme of work to improve commissioning of health and well-being services.

Community pharmacies already play a key role providing local services such as stopping smoking, weight management and supporting drug misusers. A range of other initiatives and approaches are also being introduced to encourage the take up of preventative services and to offer support, such as the Lets Get Moving initiative which screens for physical inactivity. Other screening programmes include those for breast, cervical and bowel cancer. Hansard source (Citation: HC Deb, 13 January 2010, c1026W)

Question: Tobacco excise
John Pugh (Southport, Liberal Democrat): To ask the Chancellor of the Exchequer how much revenue has been generated by duty on (a) alcohol and (b) tobacco in each of the last 10 years.

Sarah McCarthy-Fry (Parliamentary Secretary, HM Treasury; Portsmouth North, Labour): Historical alcohol duty revenue figures can be found in Table 2 of any of HM Revenue and Customs Alcohol Bulletins, copies of which can be found at: https://www.uktradeinfo.com/index.cfm?task=bulletins&hasFlashPlayer=true

The latest available annual data relate to 2008-09.

Historical tobacco duty revenue figures can be found in Table 3 of the HM Revenue and Customs Tobacco Bulletin, a copy of which can be found at: https://www.uktradeinfo.com/index.cfm?task=bulltobacco

The latest available annual data relate to 2008-09.
Hansard source (Citation: HC Deb, 13 January 2010, c1051W)

Africa's struggle to be smoke free

Africa is set to see a big increase in tobacco use over the coming decades, as the tobacco industry continues unduly influenced anti-smoking policies in the region. Adele Baleta reports.

Smokers watching teams slug it out on the field in pursuit of 2010 FIFA World Cup glory will have to think twice before lighting up. The South African Government has slapped an outright ban on smoking in all the stadiums where games are to be played.

South African director of Health Promotion Vimla Moodley says that stadiums will be 100% smoke free and that means there will be no designated areas for smokers. Regulations that will restrict smoking in outdoor areas are being finalised. Earlier, Jirí Dvorák, the chief medical officer of FIFA, told The Lancet that smoking will not be allowed in the technical areas or in spectator stands, but suggested there would be places set aside for smoking.

In 2002, an agreement between the world soccer governing body and WHO was supposed to have blown the final whistle on smoking during World Cup matches, but in 2006—much to the chagrin of anti-tobacco lobbyists—FIFA lifted the ban after consultations with the German Government.

But, with assurances from FIFA and the health ministry and the fact that South Africa has strong anti-smoking laws in place, this is unlikely to happen in this year's World Cup tournament. Moodley says the department will run a campaign to educate the public and help enforce the law. At present the country does allow smoking in designated areas (limited in size) in workplaces and the hospitality sector.

South African anti-tobacco lobbyists support moves to prevent second-hand smoke from drifting onto the pitch during the 2010 FIFA World Cup, saying that it sends out the right message particularly for the continent where 90% of Africans are unprotected by smoke-free laws.

Yussuf Saloojee, executive director of the National Council Against Smoking of South Africa says anti-tobacco legislation allows for the regulation of smoking in any area where people gather. “We are pushing for smoke-free fan parks where games will be televised and for adequate anti-smoking signs, so people get the message loud and clear”.

In its global tobacco epidemic report released at the end of last year, WHO said only 5·4% of the world's population was covered by comprehensive smoke-free laws in 2008, up from 3·1% in 2007. Additionally, seven countries—Colombia, Djibouti, Guatemala, Mauritius, Panama, Turkey, and Zambia—implemented comprehensive smoke-free laws in 2008, bringing the number of smoke-free nations to 17.

Although this shows a positive trend, tobacco use continues to be the leading preventable cause of death, killing more than 5 million people a year, WHO's report states. Unchecked, it will kill more than 8 million people a year by 2030, with more than 80% of those deaths occurring in developing countries. To prevent this trend the UN body has announced that it will expand its efforts to increase tobacco control in Africa.

Ala Alwan, WHO's Assistant Director-General for Non-communicable Diseases and Mental Health said: “Urgent action is needed to protect people from the death and illness caused by exposure to tobacco smoke.” In the 46 countries of WHO's African region, non-communicable diseases—for which tobacco use is a major risk factor—are expected to account for 46% of deaths by 2030.

The report focuses on the WHO Framework Convention on Tobacco Control's (FCTC) Article 8, which addresses protection from exposure to tobacco smoke. The convention, which took effect in 2005, is ratified by nearly 170 countries. The guidelines state that smoke-free laws must cover all enclosed public places, workplaces, and public transport without exemption, include other places as appropriate and avoid designated smoking rooms, ineffective ventilation, and air filtration schemes.

According to a 2009 smoke-free status report, Global Voices: Rebutting the Tobacco Industry, Winning Smokefree Air, Africans are set to experience the highest increase in the rate of tobacco use among developing countries.

Published by the multipartner Global Smokefree Partnership, the report's authors, like WHO, are optimistic about the future, saying that several African countries had taken up the fight against the tobacco industry's “aggressive efforts” to stop public health efforts against smoking. Smoke-free public places were one example of a low cost and extremely effective intervention that must be implemented now to protect health.

Evan Blecher, a South African economist in the International Tobacco Control Research Program at the American Cancer Society predicts that tobacco consumption will double in the next 12 to 13 years in sub-Saharan Africa without major policy interventions. Consumption, was mainly driven by economic development, he says. “As income rises, so does tobacco consumption (nearly on a one-to-one basis) and developing countries are growing rapidly, China and India are growing at more than 8% a year and the average economic growth in Africa is 5% a year.” These figures could be compared with Europe and the USA, where economic growth has been around 2% a year.

Mozambique, one of the fastest growing economies, has seen a 220% growth in cigarette consumption over the past 16 years and its disease and cancer burden is expected to double. Nigeria's consumption has rocketed by 60%. Blecher told The Lancet that there was greater effort from tobacco multinational organisations to market their products in Africa in the face of a relatively weaker policy environment in terms of taxes, advertising bans, and smoke-free policies when compared with developed countries.

Taxing cigarettes has had a direct bearing on consumption. In South Africa, he says consumption fell by a third (33%) between 1993 and the mid-2000s as a result of substantial tax increases during that period. In the past few years, consumption has remained relatively flat because of more moderate tax increases, which have only kept up with inflation and economic growth.

The Global Voices report says that companies try to influence African governments, particularly in countries that grow tobacco, to believe that tobacco is important to economic activity and that raising taxes on cigarettes will lead to revenue and job losses. It calls on governments to continue to act if they are to meet the goal of protecting people from second-hand smoke by 2012. It adds that most countries will need to bolster existing smoking restrictions to meet this target.

Within the past year, Kenya and Niger have enforced national smoke-free policies, and South Africa, which has been smoke-free since March, 2007, “continues to play an important role in the region, demonstrating that smoke-free laws can work in Africa”, the report states. These countries, however, fall short of the robust anti-smoking FCTC standard in that they allow designated smoking rooms. Mauritius is the first country in Africa to adopt a comprehensive smoke-free law—which excludes designated smoking rooms— bringing it the closest to meeting the standards set by the FCTC.

Implementation of smoke-free legislation remains a challenge in many countries including Uganda, Ghana, and the Democratic Republic of the Congo. The Nigerian Parliament is considering tobacco control legislation. Meanwhile, local legislation is currently in force in the capital of Abuja where 55% of school students are not aware that second-hand smoke is harmful to health. Proposals for a new national law are also being developed in Burkina Faso.

The greatest obstacle to smoke-free air is multinational tobacco companies that stand to lose billions of dollars if anti-tobacco laws are implemented, the report says. It accuses the companies of resorting to using fake science and scare stories and buying influence in an attempt to keep Africans puffing away or breathing in second-hand smoke.

In Kenya, for example, industry has issued a legal challenge to a strong smoke-free law passed by the parliament. In Zambia, British American Tobacco's (BAT) political influence has helped dilute proposals for smoke-free legislation. In the most recent challenge to South Africa's recently amended anti-smoking laws—BAT South Africa which controls 95% of the cigarette market in the country—is fighting for its “constitutional right” to market cigarettes. BAT wants the court to lift a ban on one-to-one communication with smokers. If BAT does not succeed it wants the court to declare the ban an infringement of its constitutional rights to market. If it does succeed, it could reverse the Tobacco Control Amendment Act passed in August last year, which effectively curtails the marketing opportunities for tobacco companies. Usual advertising methods were banned in 2000, forcing companies there to find other ways to reach their audience.

The South African National Council Against Smoking says that BAT South Africa is going to court to try to overturn laws that restrict them from advertising cigarettes to young people by word-of-mouth invitations to smoking parties where free cigarettes are handed out. BAT has denied this saying that the communication they were seeking had nothing to do with children or non-smokers and that references to parties or any other gatherings were disingenuous since all forms of mass advertising had been banned in the country.

Source: The Lancet - 09 January 2010
Link: http://bit.ly/8TBoPa