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New Tobacco Research Institute to Focus on Social Marketing, Cessation and Harm Reduction
The Steven A. Schroeder National Institute for Tobacco Research and Policy Studies was recently established by NTCC member American Legacy Foundation (Legacy) to identify research opportunities linked to the nation's number-one cause of preventable death, tobacco-related disease. Named for Dr. Steven A. Schroeder, a founding board member and former board chairman of Legacy, the Institute will help advance the science related to social marketing, smoking cessation and tobacco control policies, as well as help translate scientific findings into practice. Specifically, the Institute will focus on three areas of research pertaining to emerging tobacco-related science, including:
Dr. David B. Abrams has been named Executive Director of the Institute, following a national search. Dr. Abrams, who has been closely involved in NTCC's Consumer Demand Initiative, most recently directed the Office of Behavioral and Social Sciences Research (OBSSR) in the Office of the Director at the National Institutes of Health (NIH). "Throughout his career, Dr. Abrams has demonstrated a remarkable passion for behavioral medicine and expertise in tobacco use research and cancer prevention," said Dr. Cheryl Healton, Legacy's President and CEO. "He will be invaluable to our mission to educate Americans about the serious toll of tobacco and tobacco-related disease in this country. Under his leadership, I am confident that the work of the Schroeder Institute will help make significant contributions to the public health field." Under Dr. Abrams's direction, the Institute will recruit a diverse team of prominent researchers and academic scholars skilled in obtaining external funding to conduct studies related to the efficacy of social marketing interventions, cessation initiatives, and harm reduction strategies. This group of researchers and scholars will also focus on understanding how social policy can help reduce the toll of tobacco use among youth and adults. The Institute also recently established a formal partnership with the Department of Health, Behavior and Society at the Bloomberg School of Public Health, Johns Hopkins University, which was named the Institute's academic affiliate. Through this partnership, resulting research will be shared through scientific meetings, reports and forums, all with the intent of advancing the knowledge base of tobacco use in terms of prevention and cessation, and translating the findings into public health applications to better address the health needs of the American public. The Institute will support Johns Hopkins by providing research opportunities for University faculty and fellows, and internships for recent graduates. "The level of scholarly pursuit at Johns Hopkins is exemplary," said Dr. Healton. "We are excited about partnering on state-of-the-art research and linking their scholars with those in tobacco control." Legacy is investing approximately $2 million in start-up costs for the Institute's first phase and strategic planning process. It will be located in Washington, D.C., to capitalize on the many surrounding academic, policy and research institutions that are located in and near the city. "This new Institute will continue to further the joint vision of the Foundation and the public health community to educate the public about tobacco cessation and the risks that tobacco poses to the day-to-day health of individual Americans," said Dr. Healton. For more information on the Institute, visit http://www.americanlegacy.org/. Dr. David Abrams, Founding Director, Steven A. Schroeder National Institute for Tobacco Research and Policy Studies at the American Legacy Foundation Dr. David B. Abrams is the Executive Director of the Steven A. Schroeder National Institute for Tobacco Research and Policy Studies at the American Legacy Foundation. Dr. Abrams previously directed the Office of Behavioral and Social Sciences Research (OBSSR) in the Office of the Director at the National Institutes of Health (NIH). He led the Office in its mission to stimulate and coordinate behavioral and social sciences research throughout NIH, with the ultimate goal of improving our nation's health. Prior to joining OBSSR, Dr. Abrams was Professor of Psychiatry and Human Behavior and Professor of Community Health at Brown University Medical School, Providence, Rhode Island and co-director of Transdisciplinary Research at Brown-affiliated Butler Hospital. Dr. Abrams holds a B.Sc. (honours) in computer science and psychology from the University of Witwatersrand, Johannesburg, South Africa and Masters and Doctoral degrees in Clinical Psychology from Rutgers University, New Jersey. He joined Brown University in 1978 and he was the founding Director of the Centers for Behavioral and Preventive Medicine for 16 years. Dr. Abrams is a licensed clinical psychologist, specializing in health psychology, behavioral and preventive medicine. Dr. Abrams has published over 220 scholarly articles, has been a Principal or Co-Investigator on over 65 research grant awards from various NIH Institutes, most recently including Principal Investigator of a NCI program project award -Transdisciplinary Tobacco Use Research Center and an R-25 Career Development Training Grant -Transdisciplinary Training of Scientists in Cancer Prevention, Control and Population Sciences. Dr. Abrams is the lead author of The Tobacco Dependence Treatment Handbook: A Guide to Best Practices: Guilford Press, 2003 - a recipient of a book of the year 2004 award from the American Journal of Nursing. Q1: You recently became Director of the Steven A. Schroeder National Institute for Tobacco Research and Policy Studies at the American Legacy Foundation. What was the impetus behind the creation of the Institute? The idea of creating the Schroeder Institute (SI) evolved over several years for many reasons. Legacy President Cheryl Healton, and the Board agreed to establish the SI to significantly enhance the core mission of Legacy. Moreover, Legacy anticipated significantly reduced support from the Master Settlement Agreement for its National Public Health Education. Legacy needed to leverage its shrinking resources by establishing the SI to obtain external funding through a variety of sponsored research avenues such as grants, contracts and through philanthropic support. The SI is also ideally positioned in Washington D.C. to play a leadership role in strengthening the national agenda for "next generation" research. Q2: What are the primary aims of the Schroeder Institute (SI)? What sorts of activities will the Institute engage in? The core vision of the SI is twofold: First, work collaboratively to identify research areas of extraordinary opportunity to reduce tobacco use prevalence more efficiently. Our aim is to serve a convening role as a "think-tank" to stimulate new research priorities. Science must keep pace with a rapidly changing landscape of discovery, communication technologies and with shifts in tobacco industry products and marketing schemes. The SI will identify pressing gaps, critical leverage points or emerging trends that need breakthrough research. The second part of the SI vision is to conduct sponsored research in key areas of extraordinary opportunity. SI goals revolve around Transdisciplinary and Translational research themes, including three broad domains: How can we improve the reach and impact of interventions and policies by strengthening the science of dissemination, social marketing, communications and health literacy. This program domain addresses the pressing challenge of reaching and motivating more smokers to quit successfully: a central recommendation of the Institute of Medicine (IOM) commissioned by Legacy, "Ending the Tobacco Problem: a Blueprint for the Nation", National Academies Press, 2007. Another program domain is the urgent need to improve behavioral and pharmacological cessation treatments and reduce relapse propensity among all smokers who do make a quit attempt. A third domain is the theme of harm minimization and its implications for health impact and policy. For example, little is known about the parameters involved in reducing the nicotine content of cigarettes to a level that minimizes their addiction liability on a population-wide basis. There is also a need to understand the challenges involved in several reduced harm products and their potential unintended consequences. The SI is not necessarily limited to these three domains of research focus. The three domains serve as a launching pad for the SI to contribute to the scientific enterprise along the continuum of discovery, development, delivery, dissemination and policy. At the end of the day the SI vision is driven the urgent need to save lives and money by finding new ways to efficiently curtail tobacco use behavior, and eliminate tobacco's devastating preventable burdens of suffering for our nation. Q3: You have been involved with the NTCC Consumer Demand initiative since its inception. Why is Consumer Demand so important? Understanding and harnessing the power within the field of Consumer Demand is at the heart of the central challenge for tobacco control research and practice over the next decade. We need to encourage many more tobacco users, especially the underserved, to make more, and more frequent, quit attempts and sustain cessation for the rest of their lives. We need more user-friendly cessation products and innovative delivery systems. We must improve their health literacy about evidence-based intervention efficacy. Q4: How did you become involved with Consumer Demand? Historically, my personal realization of the importance of what is now called Consumer Demand, stemmed from my work in the 1980's in worksite health promotion. One of my first grant projects, funded in 1984 by NCI under the late Joe Cullen's vision, was entitled "self-help smoking cessation at the worksite". The idea was to proactively reach all smokers in their workplace and not just those who were already motivated to quit. We also targeted the worksite context (e.g. social networks) and policies (e.g. enforcement of smoking bans) to create inescapable cues for smokers to consider cessation. The American Legacy Foundation has had a strong Consumer Demand focus from its very inception. A central feature of Legacy's Health Education mission since the early 2000's is embodied in Legacy's mass media campaigns such as the highly visible and successful TRUTH campaign targeted at youth prevention and the recently launched BECOME AN EX- campaign directed at adult cessation. These are two examples of Legacy's leadership in direct to consumer marketing. So, in retrospect, one can see a convergence of purpose in my own current and past research experiences, in Legacy's longstanding commitment to Public Education, in the establishment of the SI, and in my being a member of the Consumer Demand Initiative. Q5: The 2008 U.S. Public Health Service Clinical Practice Guideline Update will be released in May. Can you talk a little about the potential impact of the updated Guideline on cessation? These highly credible, rigorous evidence-based reports have been veritable national landmarks pointing the way to best practices and policies. This latest release is another watershed event with exciting updates of knowledge of what works and how it should be adopted and sustained within the fabric of our health and health care system in the U.S. The report begs for national legislative action to put best practices into policy. Most critical is to use the report to spearhead and to ensure financial incentives and resources are put in place and are aligned to provide our fellow U.S. citizens with the very best practices of preventive medicine in the world. The Guideline provides the strongest scientific consensus for what are the best practices and policies. I believe that health care accreditation systems (e.g. HEDIS and JACO) and their associated "report cards" should be updated to be compliant with these new guidelines. One might also argue that failure to fully adopt the guidelines in letter and in spirit should in fact be considered grounds for malpractice. Given what we know it is not acceptable for health care delivery systems, third party payers or individual health care providers to fail to follow the Guideline at every step of the way from initial identification of all tobacco product users until the tobacco user has permanently stopped using tobacco products (provide continuity of comprehensive care and increasing stepped-up care if initial success is not obtained in much the same way as one would treat a chronic disease like diabetes or hypertension). Best practices cannot and should not be ignored by any health care practitioner or their delivery systems, their practice settings and their financial reimbursement codes from third party insurers. The Guideline provides solid scientific evidence to bolster the recommendations of the recent IOM report that systems integration and developing a comprehensive system of continuity of care for all tobacco users, especially the underserved and uninsured, is arguably the single biggest barrier and greatest missing ingredient to dramatically reducing population smoking prevalence rates and the devastating burdens of diseases (see Appendix A: Ending the Tobacco Problem: a Blueprint for the Nation", National Academies Press 2007). The aligned policies and financial incentives to support comprehensive tobacco control interventions that are recommended in the Guideline and are also reinforced in the IOM report ought to be mandated, monitored and enforced at every level of the health care delivery at local, state and national levels. Q6: One of the areas NTCC is focused on for 2008 is health literacy. Can you talk a little about the importance of health literacy in tobacco cessation? As we learn more about motivation and behavior change, as well as communications and message framing, heath literacy will be key to empowering tobacco users to use the best change methods available to quit. Consumers, health care providers, administrators of health plans and health care systems, third party payers and policymakers all need health literacy training around tobacco control evidence-based practices. Users need to know about the best treatments available and to ask for, expect and receive comprehensive, evidence-based interventions tailored and targeted to their individual profiles of risk (our version of Personalized Medicine). Health literacy is key if we are to capitalize on new treatments emerging from pharmacogenomics and communications technologies in real-time (e.g. the Internet, Personal Digital Devices, telephone Quitlines). The 2008 USPHS Clinical Practice Guideline and the IOM report and other well researched documents and guidelines such as from the National Cancer Institute (NCI) and the National Institute of Drug abuse (NIDA), The Centers for Disease Control (CDC), The American Cancer Society, The American Heart and Lung Associations and the U.S. Surgeon General's reports all provide strong content for what a tobacco user ought to know about their smoking and its negative effects on health and longevity but less information is provided about cessation programs, processes and services to help them stop. We don't yet have a sufficient, clear and consumer friendly set of guidelines akin to the "consumer reports" or "good housekeeping seal of approval" for specific programs and services that adhere fully to best practices. Health literacy is not simply the sole responsibility of an individual to educate themselves, it is also up to the health care and public health systems as well as other government and NGO's to aggressively spread the word and improve the nation's health literacy about tobacco cessation practices. Q7: The American Legacy Foundation and NTCC have been collaborating with the XPRIZE Foundation to develop a potential tobacco cessation XPRIZE. What does the XPRIZE Foundation bring to tobacco control? What could be more important and exciting than using the XPRIZE philosophy for developing new tools to change behavior on a large scale? The single largest preventable cause of premature death disability, suffering and excess cost to society deserves to be a top priority for an XPRIZE dedicated to solving this societal dilemma that has up to now resisted all attempts to find a sustainable, economically viable solution. This XPRIZE could be the most meaningful one of all because it is about health and quality of life and about saving millions of human lives on a massive scale. However, as exciting as an XPRIZE may be, there are still many details to be worked out to translate this from the concept stage to an action plan and implementation. Q8: How did you get involved in tobacco control? My father and mother both smoked heavily. I was passionate about getting them to quit ever since I was a child and overheard a radiologist friend of my father describing what smoker's lungs looked like and then urging him to quit. He did quit eventually but died at age 64 and he had no other risk factors besides smoking. My mother smoked three packs a day and clearly was addicted until she died of colon cancer. I became interested in addictions again at Rutgers University during my graduate school training. I began to study both alcohol and tobacco addiction and completed my doctorate under Dr. Terry Wilson, an amazing mentor and teacher. I have always been the most interested in tobacco use behavior throughout my career. Perhaps this was due to my parents smoking and my trying to understand "self-control" and how an addiction undermined the rational ability to control one's behavior, favoring a small immediate reward despite knowing about its long term and hugely devastating negative consequences. Q9: What has been the most challenging aspect of your work in tobacco control? Despite knowing so much about the basic and applied science of tobacco use behavior, so many millions of people still use it and have trouble stopping. The most challenging issue for me is having all this scientific knowledge and yet having to live with the frustration and feelings of helplessness and anger, knowing that so many hundreds of thousands of people will die and suffer needlessly every day (over 1200 every day will die; the equivalent of three jumbo jets crashing every day of the year including weekends and holidays) because of their use of tobacco products. The products have lethal addictive properties and I have a strong sense of social justice. I see many tobacco users as victims of their addiction and in need of treatment for their condition just as is the case with other serious medical or mental health conditions. We must put what we know into action to make a difference in the real world with real people. The tobacco industry continues to use its vast power and financial resources to innovate and market new products so we cannot rest for one minute. Q10: What has been the most rewarding aspect of your work in tobacco control? Over my thirty plus years in this field I am gratified at seeing how very small changes at the individual level (and in our knowledge base at any given time and usually over a short time period) can in fact lead to huge decreases in population prevalence of tobacco use behaviors in the long run. So even though we as individuals may often feel we are not really making much of a difference within a year or two, in reality as a team effort we are collectively and cumulatively making an impact over two to four decades. The recent statistic that over 40% of the reversal in overall cancer death rates in the U.S. has come from cutting smoking prevalence in half among men is very gratifying indeed. It means we can change a whole population's behavior in less than one generation. That massive change in behavior can then have a huge national benefit in quality and quantity of life years lived. Most of all I have enjoyed being part of a very special group of researchers and practitioners involved in tobacco control research, practice and policy in a collaborative team effort. The members of our tobacco control research, practice and policy community are very special to me. There has been an extraordinary sense of camaraderie, support and collaboration among us. I have developed some lifelong friendships in working with this extraordinary group of professionals and students as we unite in a common cause for the greater good. It has been doubly rewarding to know that our friendship and trust and our work as a team has indeed helped in some small way to better understand and to know how to reduce the burden of disease and death among so many of our fellow human beings who are addicted to tobacco products. Study Finds Racial Disparities in Smoking Cessation Treatment A new study from the American Cancer Society finds black and Hispanic smokers are less likely than whites to receive and use smoking cessation advice and aids. The study, published in the May issue of the American Journal of Preventive Medicine, also finds men and those without a usual source of medical care were less likely to be screened for tobacco use and receive advice to quit. For their study, American Cancer Society researchers analyzed survey results from 4756 smokers (aged 18 and older) who visited a healthcare provider within the past year. All were participants in the 2005 National Health Interview Survey (NHIS). The analysis found that compared to white smokers, black and Hispanic smokers were less likely to have been asked about tobacco use (85 percent in whites versus 77 percent in blacks and 72 percent in Hispanics); less likely to have been advised to quit (63 percent in whites versus 55 percent in blacks and 48 percent in Hispanics); and less likely to have used tobacco-cessation aids during the past year in a quit attempt (38 percent in whites versus 24 percent in blacks and 21 percent in Hispanics).These racial/ethnic differences in the use of smoking cessation remained significant even after controlling for various other factors (for example, health insurance coverage, or socio-economics status of smokers). "The good news is the number of smokers who are
getting advice to quit is rising, from 53 percent in 2000 to 61
percent in 2005, with increases across racial and ethnic groups,"
said Otis W. Brawley, M.D., chief medical officer of the American
Cancer Society. "The bad news is the gap between races still exists.
We need to ensure there is broad and consistent application of
proven tobacco cessation interventions if we are to sustain the
overall progress documented in this study."
New Peer Review Publications Support Nymox Saliva Smoking Test Nymox Pharmaceutical Corporation announced the publication of new independent studies finding that the Company's NicAlert Saliva product provides an accurate, convenient and cost-effective way to verify self-reported smoking status with broad potential applications both in the clinic and in large research trials and surveys. In the study, researchers collected saliva samples from 41 smokers and 45 nonsmokers and tested the samples with both NicAlert Saliva test strips and with gas chromatography (GC), a complex and sophisticated laboratory testing method in order to verify smoking status. The researchers found that NicAlert Saliva testing was "both valid and reliable compared with the GC saliva cotinine test" despite being one-third the cost and concluded that "studies that evaluate disease outcomes related to smoking or new smoking cessation methods should consider testing participants' saliva using [NicAlert] to verify self-reported smoking status." They also noted that NicAlert Saliva has "the potential for use in large population-based trials of smoking cessation interventions, for evaluating the effectiveness of a cessation service, and in population prevalence surveys to measure rates of smoking and quitting over time" and "also may be of value in cessation practice" as a point-of-care test that can provide immediate feedback. The study was conducted by researchers at Clinical
Trials Research Unit, University of Auckland, Auckland, New Zealand
and is published in the latest issue of Nicotine & Tobacco
Research. NicAlert Saliva is increasingly being reported
used in a wide range of research studies where there is a need
to verify or monitor smoking status or nicotine replacement therapy
(NRT).
Smoking Cessation, Diet, and Exercise May Influence Survival in Cancer Survivors Smoking, exercise, and diet are behavioral aspects of health that are of increasing interest, because they might influence survival and disease risk in cancer survivors, researchers reported in San Diego, CA at the American Association for Cancer Research (AACR) 2008 Annual Meeting. The nature and role of health habits and lifestyle is an emerging area of translational research. Translational medicine is the continuum often referred to as "bench to bedside" because it refers to the process of applying molecular insights from laboratory discovery to clinical care. "The topics covered in this symposium are of particular interest to cancer survivors," said Jimmie C. Holland, MD, Wayne E. Chapman Chair in psychiatric oncology at Memorial Sloan-Kettering Cancer Center, in New York, New York, who moderated the symposium at AACR. "We need this interdisciplinary approach to cancer to provide us with the kind of resources that, in the long run, are going to serve us best." There are now more than 10 million cancer survivors in the United States; from a research standpoint, this represents an opportunity to study the emotional and long-term management of this population. In terms of tobacco use, although some patients see a cancer diagnosis as an impetus for quitting, others feel that because they already have cancer, there is no reason to stop, explained Jamie S. Ostroff, director of the smoking cessation program at Memorial Sloan-Kettering Cancer Center. "Many cancer patients are also older adults, so they may feel that the damage is done," said Dr. Ostroff. "But it is never too late to quit and there are many health benefits associated with quitting. Our patients often know the risks, but we need to be equally cognizant about the benefits of quitting." There are many benefits of smoking cessation that are cancer-specific. Patients who stop smoking have improved survival and fewer treatment complications, particularly those diagnosed at an early stage who are undergoing curative resections. However, Dr. Ostroff pointed out, there are a number of barriers to smoking cessation in this population. These include heavy nicotine dependence, withdrawal symptoms, inadequate coping strategies, treatment factors, and the presence of smokers in the social network. Clinicians have a number of opportunities to promote cessation, such as when the patient transitions from the inpatient to outpatient setting. "We have to do more than just give them advice," she said. "The field has begun to look at rates of smoking cessation after cancer diagnosis, and it varies tremendously." To be successful, a comprehensive approach must be taken - one that will not only educate patients but will also provide them with referrals and smoking-cessation tools. Staff members might need training to successfully implement smoking-cessation programs. "There are promising translational research opportunities
in smoking cessation in cancer patients," Dr. Ostroff. "One is
the use of biomarkers to help us better understand risk profiles
and disease outcomes; we need a more direct measurement of tobacco
exposure and its effect on disease outcome."
Smokers with Lung Disease Need More Than 'Brief' Intervention Smokers with lung disease require more than brief smoking cessation interventions to successfully quit, researchers in the Oregon Health & Science University Smoking Cessation Center report. "Most clinicians who treat their patients for smoking cessation provide only brief interventions, often just three short steps: asking about tobacco at every visit, advising all smokers to quit and referring them to other resources, such as quit lines for assistance and follow-up," said David Gonzales, Ph.D., lead author and co-director of the OHSU Smoking Cessation Center in the OHSU School of Medicine. "When we reviewed the data, we found that brief intervention is often insufficient for the more dependent, high-risk patients with pulmonary disease." Patients with respiratory disease have more difficulty quitting, are more nicotine-dependent and need more intensive treatment, Gonzales and colleagues explained. They may require higher doses of medications, longer periods of treatment and more frequent follow-up than smokers in general. And, although most try to quit on their own without assistance from their health care provider, 95 percent fail, and patients with respiratory disease have even poorer success. To help clinicians improve tobacco cessation treatment for these patients, the OHSU research team reviewed current evidence-based treatment guidelines for smoking cessation medication and behavioral support and OHSU's own programs for treating patients in the hospitals and clinics. They advise that when consistent, evidence-based smoking cessation treatment is tailored to the needs of patients and integrated into ongoing respiratory care, smokers can significantly improve their odds of quitting. And the key to accomplishing this, they advise, is to distribute the responsibility for enhanced treatment among several clinic staff members. Beginning with new patient intake and continuing with review of vital signs, review of systems, treatment planning and check-out, the researchers recommend nurses, medical assistants, clinicians and clinic support staff all have roles in helping the patient stop smoking. Including tobacco cessation treatment in each part of the clinic visit reduces demands on any one member of the clinic staff, they explained. This approach makes it easier for busy clinics to provide effective treatment. "Providing patients with pulmonary disease with ongoing smoking cessation treatment as part of their regular respiratory care will greatly improve their odds of quitting," said Gonzales. Their recommendations are in the online edition
of Pulmonary and Critical Care Update, a publication of the American
College of Physicians, at http://www.chestnet.org/education/online/pccu/vol22/index.php.
Pediatric Practice-Based Intervention May Be Effective Against Adolescent Smoking A pediatric practice-based intervention delivered by pediatric providers and older peer counselors was feasible and effective in discouraging smoking initiation and increasing abstinence rates among smokers, according to the results of a study reported in the April issue of Pediatrics. "A recent review of adolescent cessation trials concluded that there are no proven programs to help teens stop smoking but suggested interventions based on cognitive behavioral therapy and sensitive to stages of change seem promising," write Lori Pbert, PhD, from the University of Massachusetts Medical School in Worcester, and colleagues. "The American Academy of Pediatrics suggests that pediatricians are well positioned to take an active role in addressing this issue. Because of their credibility and long-term relationships with patients, pediatric clinicians have many opportunities to intervene with adolescent smokers, as well as with nonsmokers to prevent initiation." The goal of this study was to assess whether a pediatric practice-based smoking prevention and cessation intervention would improve abstinence rates in adolescents. Eight pediatric primary care clinics were randomized to a usual care control condition or to a provider-delivered and peer-delivered intervention based on the 5A model recommended by the U.S. Public Health Service clinical practice guidelines and the American Academy of Pediatrics. This intervention involved brief counseling by the pediatric provider, followed by one visit and four telephone calls by older peer counselors aged 21 to 25 years. The study sample consisted of consecutive patients, regardless of smoking status, who were aged 13 to 17 years and who were scheduled for an office visit. Of 2711 patients who agreed to participate in the study, 2709 completed baseline evaluations, 2700 (99.6 percent) completed 6-month evaluations, and 2690 (99.2 percent) completed 12-month evaluations. Compared with nonsmokers assigned to the usual care condition, those assigned to the intervention condition were significantly more likely to report having remained abstinent at 6-month and 12-month follow-up. Compared with smokers assigned to the usual care condition, those assigned to the intervention condition were more likely to report having quit at the 6-month, but not at the 12-month, follow-up. Factors that were predictive of abstinence at follow-up included age, peer smoking, tobacco dependence, and susceptibility. "A pediatric practice-based intervention delivered
by pediatric providers and older peer counselors proved feasible
and effective in discouraging the initiation of smoking among
nonsmoking adolescents for one year and in increasing abstinence
rates among smokers for six months," the study authors write.
New Poll: Teens Still Feel Targeted By Tobacco Ads & Find It Easy to Buy Cigarettes Ten years after the 1998 state tobacco settlement, a new poll conducted for the Campaign for Tobacco-Free Kids finds that kids still feel targeted by tobacco advertising and still find it easy to buy tobacco products. The poll was released to coincide with the 13th annual Kick Butts Day, sponsored by the Campaign for Tobacco-Free Kids on Wednesday, April 2, 2008. The national telephone survey of 507 teens (12-17 year olds) and 1,008 adults found:
A report about the poll findings and the impact of tobacco marketing on youth can be found at: http://www.tobaccofreekids.org/kbd2008poll. To protect kids from tobacco addiction and save lives, health advocates are urging Congress to pass the legislation granting the FDA authority to regulate tobacco products. In addition to cracking down on tobacco marketing and sales to kids, the bill would also grant the FDA authority to ban candy-flavored cigarettes; require that tobacco companies disclose the contents of their products and reduce or remove harmful ingredients; stop tobacco companies from misleading the public about the health risks of tobacco products; and require larger, more effective health warnings on tobacco products. At the state level, health advocates are urging
governors and legislators to adopt proven measures to reduce tobacco
use and exposure to secondhand smoke, including higher tobacco
taxes, smoke-free workplace laws, and well-funded programs to
prevent kids from smoking and help smokers quit.
New Report: Increasing Ohio's Tobacco Tax Would Fund Economic Stimulus Plan And Preserve Highly-Successful Tobacco Prevention Program Ohio leaders should fund a proposed economic stimulus plan by increasing state tobacco taxes instead of raiding tobacco prevention funds, recommends a new report released by the Campaign for Tobacco-Free Kids. In addition to raising revenue, this tobacco tax alternative would reduce smoking, save lives and save money by reducing health care costs, while the proposed raid of tobacco prevention funds would have the opposite effect - in fact, it would result in 23,200 more Ohioans dying prematurely from smoking and nearly $1 billion more in health care costs, according to the report. A 75-cent per pack increase in the cigarette tax, combined with a parallel increase in the tax on other tobacco products, would raise $390.8 million in the first year alone. That's enough to replace both the $230 million that Governor Ted Strickland and legislative leaders have proposed taking from the Ohio Tobacco Prevention Foundation to help pay for the economic stimulus plan and to increase annual funding for the Foundation's tobacco prevention programs to the amount recommended by the Centers for Disease Control and Prevention ($145 million a year, compared to current funding of $44.7 million). The report, titled "A Win-Win Solution for Ohio's Health and Economy: Raise the Tobacco Tax to Fund Job Creation and Preserve Tobacco Prevention Programs," finds that this tobacco tax plan would also:
"This report shows that Ohio's leaders have presented a false choice between creating jobs and fighting the state's leading killer, tobacco use," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "By increasing tobacco taxes, Ohio can fund both the economic stimulus plan and tobacco prevention programs. This is truly a win-win solution for Ohio's economy and Ohio's health." In contrast to the benefits from increasing Ohio's tobacco taxes, the report found significant harm from reducing the Ohio Tobacco Prevention Foundation's programs. Taking the $230 million from the Foundation would result in:
The report's projections are based on scientific studies estimating the benefits of increasing tobacco taxes and funding tobacco prevention and cessation programs. Studies have found that every 10 percent increase in the price of cigarettes reduces youth smoking rates by 6.5 percent, adult smoking rates by 2 percent and total cigarette consumption by 4 percent. Governor Strickland himself has cited tobacco tax increases as an effective way to reduce smoking. Studies have also found a direct correlation between the amounts states spend on tobacco prevention and cessation programs and declines in youth and adult smoking. For more information, see web link:
NYC Health Department Launches Nicotine Patch & Gum Giveaway; New TV Ads Feature Marie, A Bronx Smoker Who Quit by Calling 311 New York City Department of Health and Mental Hygiene launched a Nicotine Patch and Gum Program by rolling out a new series of anti-tobacco ads. The ads feature Marie, a former smoker from the Bronx whose smoking-related illness led to nearly 20 amputations. "I don't smoke anymore," Marie says in the ads, "but the damage is done." Nicotine replacement helped Marie kick the habit in 2006, preventing further damage to her health. The Health Department is now urging all NYC smokers to follow her lead by calling 311 today. Nicotine replacement doubles the chances of quitting for good, and the City is offering them at no cost for 16 days - from now until May 1st. Because of an increase in the state tax, the price of a pack of most cigarettes will jump to about $8.50 in June, making this giveaway the perfect opportunity to quit. Marie tells her story in the new ad campaign, which
debuted on April 16, 2008 on television, radio and the Internet,
in taxi cabs, and in the New York City subway cars. Subway riders
will also encounter the ads in Brooklyn's Atlantic Avenue station,
where Marie's message will cover every available ad space. The
full campaign can be seen online at www.nyc.gov/health.
New York Cigarette Tax Increase Delivers Victory for Kids and Taxpayers New York's leaders have taken historic action to protect the state's kids and taxpayers from the devastating toll of tobacco use by increasing the state cigarette tax by $1.25 to $2.75 per pack. This is the single largest state cigarette tax increase ever enacted and gives New York the highest state cigarette tax in the nation. By supporting a high cigarette tax, New York legislators and Governor David Paterson have taken commendable action that will improve the health of New Yorkers for generations to come and continue the state's national leadership in the fight against tobacco use, the number one cause of preventable death in the United States. New York is one of only a few states that have implemented all three of the most effective measures to reduce tobacco use -- a higher cigarette tax, a comprehensive smoke-free workplace law and well-funded programs to prevent kids from smoking and help smokers quit. New York City also has implemented all of these measures. The next step is for New York to increase funding for its tobacco prevention and cessation programs to levels recommended by the Centers for Disease Control and Prevention so it can have the greatest impact in preventing and reducing tobacco use. The evidence is clear that increasing the cigarette tax is one of the most effective ways to reduce smoking, especially among kids. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent. New York can expect the $1.25 cigarette tax increase to prevent more than 243,000 New York kids alive today from smoking; spur 140,000 New York smokers to quit for good; save more than 37,000 New York residents from smoking-caused deaths; produce more than $5 billion in long-term health care savings; and raise about $436 million a year in new state revenue. Tobacco use is the leading preventable cause of death and disease in New York, claiming more than 25,500 lives each year and costing the state $8 billion annually in health care bills, including $5.4 billion in Medicaid payments alone. Government expenditures related to tobacco amount to a hidden tax of $904 each year on every New York household. While New York has made significant progress in reducing youth smoking, 16.3 percent of New York high school students smoke, and 27,700 more kids become regular smokers every year. With New York's tax increase, the average state
cigarette tax is now $1.13 per pack. Since January 1, 2002, 44
states have increased cigarette taxes, some more than once. New
York is one of 10 states with cigarette taxes of $2 or more. Twenty-five
states and the District of Columbia have taxes of $1 or more.
New Report: Increasing Massachusetts' Cigarette Tax Will Reduce Smoking, Save Lives and Save Money As Massachusetts' leaders work to resolve a projected budget deficit, a new report released finds that a proposed $1 cigarette tax increase would raise more than $150 million in new revenue and also drastically reduce youth smoking, cause many smokers to quit, reduce tobacco-related health care costs and save thousands of lives. The 30-page report by the Campaign for Tobacco-Free Kids - titled "Tobacco Tax Benefits for Massachusetts: Reducing Smoking, Saving Lives, and Saving Money" - finds that a $1 cigarette tax increase would:
In addition, a $1 cigarette tax increase enjoys strong voter support. A statewide poll of Massachusetts voters released in January found that 63 percent support a $1 increase in the cigarette tax, with support from a majority of Democrats, Independents, Republicans, men, women, nonsmokers and former smokers. Voter support increases to 74 percent when a portion of the new revenue is allocated to tobacco prevention and health care programs. State Representative Rachel Kaprielian has introduced legislation to increase the state cigarette tax by $1 per pack with some of the revenue earmarked for health care reform and tobacco prevention and cessation programs. "This report provides powerful evidence that increasing the cigarette tax by $1 will improve both the physical and financial health of Massachusetts for generations to come," said William V. Corr, Executive Director of the Campaign for Tobacco-Free Kids. "We strongly urge Massachusetts' leaders to pass this life-saving measure and dedicate a portion of the new revenue to the state's tobacco prevention efforts and other vital health care initiatives." Massachusetts' current cigarette tax is $1.51, with the last increase approved in 2002. Since then, 42 other states and the District of Columbia have increased their cigarette excise taxes more than 70 times. Nine states currently have a cigarette tax of $2 or more, and New York is expected to approve an increase of $1.25 per pack to give it the highest state cigarette tax at $2.75 per pack. The evidence is clear that increasing the price
of cigarettes is one of the most effective ways to reduce smoking,
especially among children. Studies show that every 10 percent
increase in the price of cigarettes reduces youth smoking by about
7 percent and overall cigarette consumption by about 4 percent.
In recent years, every state that has significantly increased
its cigarette tax has enjoyed significant increases in revenue
even while reducing smoking.
California AFP Has Key Role in Ambitious Effort to Fight Tobacco Use The California AFP is partnering with eight other organizations in a multi-year CME initiative designed to significantly reduce the number of Americans who smoke. The initiative's primary goal is to educate at least 46,000 physicians and other health care professionals about effective ways to help patients quit. Hand-in-hand with that goal will be providing useful tools to help clinicians implement what they've learned. Primary care physicians are a key target group for the Continuing Education Aimed at Smoking Elimination, or CEASE, initiative, which is supported by a three-year, $12 million unrestricted educational grant from Pfizer Inc. CEASE's core curriculum is being built around the 2000 revision of the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence. The curriculum will be modified if needed when the 2008 update to the guideline is released. "The CEASE initiative is unprecedented," said CEASE lead George Mejicano, M.D., associate dean for continuing professional development at the University of Wisconsin medical school. "More than three partners in a collaboration is rare, and we have nine. Then there's the diverse nature of the partners, bringing to the table expertise in CME, measurement, evaluation and quality. CEASE partners include California Academy of Family Physicians, CME Enterprise, Healthcare Performance Consulting, Interstate Postgraduate Medical Association, Iowa Foundation for Medical Care, Physicians' Institute for Excellence in Medicine, Purdue University School of Pharmacy and Pharmaceutical Sciences, University of Virginia School of Medicine, and University of Wisconsin School of Medicine and Public Health. According to Mejicano, CEASE will use a "serial education" approach, reaching multiple clinicians multiple times during a three-year period to reinforce what they've learned. He said the most innovative aspect of CEASE is the use of four different practice improvement models in order to determine their effectiveness in getting doctors to improve their practices. Other CEASE innovations include a tobacco cessation registry and an online platform that will track progress as practices participate in CEASE educational offerings on an ongoing basis. The California AFP will use one of the four practice improvement models in a 16-month practice improvement program done collaboratively with Academy chapters in Texas, Georgia, West Virginia and Ohio, said CAFP Deputy EVP Shelly Rodrigues, C.A.E. The program will teach the chronic care model -- which employs group visits, open-access scheduling and a team approach to care -- using smoking cessation as a way to incorporate the model into the practices that participate. The CAFP also is developing the curriculum for CEASE's
live CME offerings. The first live CEASE presentation will debut
at CAFP's annual meeting in April. CEASE presentations also are
scheduled at the meetings of 17 other AAFP chapters and several
other CME meetings. For more information on CEASE, see http://www.ceasesmoking2day.com/
New Smoking Bans Take Effect in British Columbia New regulations restricting the promotion and sale of tobacco products and banning smoking in indoor public spaces and workplaces went in effect in British Columbia earlier this month. "The new regulations bring significant and positive chance to BC and are a great step toward our goals of reducing tobacco use and the effects of second-hand smoke on British Columbians," Health Minister George Abbott said. The new regulations are part of the Tobacco Control Act and state that smoking will be banned in all indoor public spaces and workplaces as well as within three meters of doorways, open windows and air intakes. The only exceptions are made for the ceremonial use of tobacco by Aboriginal people. Tobacco sales in public buildings such as hospitals, colleges, recreational facilities and government buildings are no longer allowed. In places where tobacco products are sold and accessible for youth under 19, they can no longer be displayed or promoted. Health authorities in BC will have jurisdiction to enforce the new regulations. Gretchen Komick, Health Protection Planner for Interior Health, says the organization already has tobacco enforcement officers and established relationships with retailers and businesses. She is not expecting any issues with ensuring the rules are followed. "Interior Health is expecting compliance because of the important health initiative it is," Komick states. She points out the enforcement will be based firstly on education and voluntary compliance. "It's not about being punitive, it's about education and providing a smoke-free community," she says. Komick adds, however, that tickets will be issued if the problem persists and enforcement officers will make decisions on a case by case basis. Komick emphasizes Interior Health is fully supportive
of these new laws as they support the organization's goal of encouraging
people to lead active and healthy lives. One aspect of this, Komick
feels, is to reduce tobacco use and second-hand smoke. Smoking,
she points out, is recognized as the most preventable cause of
serious illness and death in Canada and second-hand smoke is lined
to diseases such as breast cancer.
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