New applications for tobacco

Faced with an eventual long-term decline in smoking, the trade journal, World Tobacco, explores alternative uses of tobacco. Tobacco is considered to be a plant that is easy to genetically modify and also has the advantage of producing millions of seeds per plant and grows quickly. 

One of the most unusual potential new uses for tobacco is that of land-mine detection. A Danish bio-technology company has created a tobacco plant that turns red when it grows near landmines. The tobacco plant’s leaves change colour when it detects nitrogen dioxide leaching from mines buried in the soil. The company behind the research is currently setting up trials to establish its viability for use in the more than 80 countries plagued by the explosives.

Other innovative uses of tobacco include turning tobacco pulp into paper and as a source of biofuel. Meanwhile, scientists in Australia are investigating extracting vitronectin, a protein that promotes cell growth, which has the potential to be used in cancer therapy and wound healing.

Aside from the irony of producing anti-cancer drugs, scientists in the USA have also genetically engineered tobacco plants to produce a vaccine against the virus that causes severe acute respiratory syndrome (SARS), while another team has produced immunising proteins from tobacco for a plague vaccine.

Tobacco has other attributes such as the fact that it is rich in citric acid at a level comparable with lemons, and its seeds and leaves could potentially be a source of food.

Many of these positive applications of tobacco will take years to become viable. In the meantime it will be business as usual, ie the growing of tobacco solely for smoking. As World Tobacco concludes: “… the foreseeable future of cigarettes, cigars and other related tobacco products is still looking bright” [ie grim - Ed].

Source: World Tobacco, September 2008
Link: www.worldtobacco.co.uk

Socio-demographic differences in triggers to quit smoking: Findings from a national survey

Abstract

OBJECTIVE: Reasons for quitting smoking and triggers that finally precipitate a quit attempt are not necessarily the same thing. We sought to assess variation in reported triggers of attempts to stop smoking as a function of age, gender and socioeconomic status. 

DESIGN: Cross sectional Household Survey. SETTING: England.

PARTICIPANTS: 2441 smokers and ex-smokers aged 16 and over, who reported making at least one serious quit attempt in the last 12 months.

MAIN OUTCOME MEASURE: Participants' responses to the question 'What finally triggered your most recent quit attempt?' Respondents selected from a list of options or specified a trigger not on the list.

RESULTS: In the event, smokers typically reported as triggers, similar factors as have previously reported as 'reasons'. 'A concern about future health problems' (28.5%) was the most commonly cited trigger followed by 'health problems I had at the time' (18%) and then 'a decision that smoking was too expensive' (12.2%). The most common external trigger was advice from a health professional (5.6%). Future health concern was more common in smokers with higher socio-economic status (SES)whereas cost and current health problems were more often cited by lower SES smokers. Younger smokers were more likely to report their quit attempt being triggered by a TV advertisement while older smokers were more likely to cite advice from a health professional. Concern about future health problems was cited least often by 16-24 year olds and by those aged 65 than those aged 25 to 64 years.

CONCLUSIONS: There are significant differences in reported triggers for quit attempts as a function of socio-demographic factors. Most notably, smokers with higher SES are more likely to report concern about future health whereas those from lower SES are more likely to cite cost and current health problems.

Source: Vangeli E, West R. Socio-demographic differences in triggers to quit smoking: Findings from a national survey. Tobacco Control. 2008 Sep 10.
Link: http://tiny.cc/cgQ6U

Picture warnings to appear on cigarette packs from 1 October

Graphic pictures of throat cancer and rotting teeth are to appear on cigarette packets from October to illustrate the health risks of smoking. Among the other images smokers will see are rotting lungs, a corpse in a morgue and a body cut open during surgery. 

The UK is the third country in the EU to introduce the photo warnings but the first to require them on all tobacco products, not just cigarettes. The warnings will have to be in place on all cigarette packets by October 2009 and on other tobacco products by October 2010.

The photos will appear on the back of packets accompanied by a written health warning. They replace the previous warnings introduced in January 2003, although the messages 'Smoking kills' and 'Smoking seriously harms you and others around you' will continue to appear on the front of packets.

New figures showed written warnings had motivated more than 90,000 smokers to call the NHS Smoking Helpline, according to the Department of Health.

However smoking is still the biggest killer in England where it causes the premature death of more than 87,000 people each year.

The photos are expected to be more effective than text, and research suggested that warnings should be changed periodically to maintain their effectiveness, the DH said.

Chief Medical Officer Sir Liam Donaldson said: "I welcome the introduction of picture warnings on tobacco product packaging, which show smokers the grim reality of the effects smoking can have on their health.

"This will help to maintain the momentum of the increasing number of people who have given up smoking following England going smoke free in 2007.

"Written health warnings have encouraged many smokers to stop smoking. These new stark picture warnings emphasise the harsh health realities of continuing to smoke. I hope they will make many more think hard about giving up, and get the help they need to stop smoking for good."

The smokers' lobby group Forest criticised the new warnings as "unnecessarily intrusive" and "gratuitously offensive".

Action on Smoking and Health (ASH) Director Deborah Arnott said: "The stark images in the picture warnings on tobacco products are a call to action to smokers to quit, and the evidence is that they work.

"The evidence also shows that picture warnings work better on plain packs, so we are urging the Government to also implement legislation to require the removal of pack branding to maximise the impact of the these images."

ASH said an obvious disadvantage was that the picture warnings would only appear on the back of packs, and said there was a strong case for increasing the area devoted to health warnings.

Tobacco Manufacturers' Association chief executive Christopher Ogden said: "While we welcome any sensible measures that will assist in achieving public health objectives, any new initiative should be supported by credible evidence that it will address the Government's stated goals. We do not believe that this is the case with regard to pictorial health warnings.”

Canada was the first country to introduce picture warnings in 2001.
Research a year later found 31 per cent of ex-smokers said the images had motivated them to quit the habit while 27% said they had helped them to remain non-smokers, according to the DoH.

Graphic images are now used on tobacco products sold in Australia, Brazil, Canada, India, New Zealand, Singapore, Venezuela, Thailand and Uruguay.

Source: The Independent, 27 September 2008
Link: http://tiny.cc/8dNN6

Effectiveness of OTC NRT therapy

Abstract

Despite optimistic predictions when nicotine replacement therapy (NRT) was switched to over-the-counter (OTC) availability, population surveys have failed to demonstrate a positive impact on long-term smoking cessation. This review examined the strength of the evidence from randomised trials and comparison group studies supporting the effectiveness of OTC NRT. 

Twelve eligible studies were identified: OTC NRT was compared with placebo in four studies and with health professional-delivered NRT in four studies, and four studies involved community-based minimal intervention NRT. These studies were assessed systematically to determine their methodological quality and generalisibility to 'real-world' conditions of NRT use.

The review found a number of issues including provision of free NRT, heavy cigarette intakes (average 25 daily), high levels of personal interactions (7.6 per subject), lack of blindness assessment and failure of most studies to actively follow-up all subjects seriously limit the degree to which studies' results can be applied to non-research OTC NRT users. In addition, several important limitations affecting the meta-analyses of OTC NRT by Hughes et al. were highlighted.

The review concluded that the superiority of OTC NRT over unaided smoking cessation has not been demonstrated convincingly. Future directions for research involve more innovative, rigorous controlled trials and prospective cohort studies where nicotine dependence is assessed adequately.

Source: Walsh RA. Over-the-counter nicotine replacement therapy: a methodological review of the evidence supporting its effectiveness. Drug Alcohol Rev. 2008 Sep;27(5):529-47.
Link: http://tiny.cc/XuvQr

Global Health Strategy

A new strategy which sets out the way that the UK Government will work with the World Health Organisation, the EU and a number of other partners to improve the health of the world's population has been launched by the Health Secretary Alan Johnson.

'Health is Global: a UK Government Strategy' is underpinned by £12 million over the next five years. It highlights the critical global health challenges that the UK and the rest of the world faces and provides a clear set of actions to respond to them.

The strategy contains ten principles and five areas for action. The principles set out aspirations for consideration across Government when setting or implementing domestic and foreign policy that may affect global health.

It highlights new and neglected areas - the challenges of climate change, emerging diseases, the links between health and foreign policy and national security and the increasing importance of non-communicable diseases in low and middle income countries - and identifies areas for action.

The areas for action are:

- health security;

- strong and fair systems for health;

- more effective international health organisations;

- freer and fairer trade; and

- strengthening the way we develop and use evidence to improve policy and practice.

Mr Johnson said:

"Health is a global issue; it is one that transcends borders and boundaries. We have already received praise from the World Health Organisation for our work on pandemic preparedness, and we want to build on that success to work with other countries to address such vital issues as health inequalities and the health impacts of climate change. We will be looking more closely at the problem of health inequalities in November.

"This strategy sets out a clear course of action for the way we will work with others - both nationally and internationally - to improve the health of the world's population, including that of the UK."

The Chief Medical Officer, Sir Liam Donaldson said:

"I very much welcome this UK Government strategy, developed following the publication of my 2007 discussion paper, Health is Global, which made the case for developing a global health strategy.

"The clear plan set out in this strategy will tackle important global health issues, such as new and emerging infections, and safer delivery of healthcare. It sets out actions that can be taken right across government to take account of the importance of global health."

The strategy will also enable Government to use existing funds more effectively. The Government plans to spend 0.7 per cent of gross national income on international development by 2013. Earlier this year the Government made a commitment that the Department for International Development (DfID) would spend a £6 billion on health systems and services up to 2015, with a further £1 billion invested into the Global Fund to Fight AIDS, TB and Malaria. In addition the Government is investing around £400 million going into global health research over the next five years.

Source: Department of Health press release: 30 Sept 2008
Link: http://tiny.cc/EHJZa

A healthy lifestyle halves the risk of premature death in women

Over half of deaths in women from chronic diseases such as cancer and heart disease could be avoided if they never smoke, keep their weight in check, take exercise and eat a healthy diet low in red meat and trans-fats, according to a study published on the BMJ’s website: www.bmj.com.

It is well known that diet, lack of physical activity, being overweight, alcohol consumption and smoking increase the risk of disease including cancer and diabetes, but little research has examined combinations of lifestyle factors in younger populations and women.

Dr Rob van Dam and his team from the Harvard School of Public Health and Brigham and Women’s Hospital, recruited nearly 80 000 women aged 34 to 59 years in 1980 who were part of the Nurses’ Health Study in the US. They analysed the data of over 1.5 million person-years follow up over a 24 year period.

Participants completed detailed follow-up questionnaires every two years about their diet, frequency of physical activity, alcohol intake, weight, how much they smoked, and disease history. Deaths were confirmed by next of kin and the National Death Index.

Over the follow-up period the authors documented 8 882 deaths including 1 790 from heart disease and 4 527 from cancer.

The authors estimated that 28% of these deaths could have been avoided if women had never smoked and that 55% could have been avoided if women had combined never smoking, regular physical activity, a healthy diet and maintaining a healthy weight. Alcohol intake did not substantially change this estimate, although heavy alcohol consumption is linked to an increased risk of dying from cancer.

Smoking was found to be the biggest cause of premature death but all the other factors also contributed.

Interestingly, women with light-to-moderate alcohol consumption (up to 1 drink a day) were less likely to die from cardiovascular diseases than alcohol abstainers.

The authors believe the results of this research indicate that more needs to be done to eradicate smoking and to encourage individuals to take regular exercise and eat healthily.

They conclude that “even modest differences in lifestyle can have a substantial impact on reducing mortality rates”.

Source: BMJ Press Release September 17 2008
Research paper: van Dam, R. Combined impact of lifestyle factors on mortality: a prospective cohort study in US women. BMJ 2008;337:a1440
doi:10.1136/bmj.a1440