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:
- Social marketing: Advancing the science related to evaluating
counter-marketing and other communication interventions.
- Cessation: Advancing research related to improving the quality
and access to, as well as consumer demand for, cessation services.
- Harm Reduction: Educating the public regarding the truth behind
reduced harm products.
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/.
 TOP
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.
TOP
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."
For more information, see web link:
American Journal of Preventive Medicine, 2008, Volume
34, Issue 5
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).
For more information, see web link:
BusinessWire, April 22, 2008
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."
For more information, see web link:
MedScape,
April 13, 2008
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.
For more information, see web link:
ScienceDaily,
April 3, 2008
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.
For more information, see web link:
Pediatrics,
2008, Volume 121, Number 4
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:
- Three-fourths of teens (74 percent) think tobacco companies
want them to smoke, and 70 percent think tobacco companies target
them with their advertising.
- Teens are twice as likely as adults to remember tobacco advertising.
While almost half (47 percent) of teens recalled tobacco advertising
from the last two weeks before the survey, only 24 percent of
adults did. Among teens who recalled tobacco advertising, the
most commonly mentioned source was "in or outside a store."
- Nearly two-thirds (65 percent) of teens think it is easy for
teenagers to buy tobacco products. Among 15-17 year olds, 76
percent think it is easy.
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.
For more information, see web link :
Campaign
for Tobacco Free Kids Press Release April 1, 2008
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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:
- Prevent nearly 240,000 Ohio kids alive today from becoming
smokers
- Prompt more than 120,000 current adult smokers to quit for
good
- Save more than 108,000 Ohioans from dying prematurely from
smoking
- Produce $4.6 billion in long-term health care savings, including
$835 million in the state Medicaid program alone.
"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:
- 56,700 more Ohio kids alive today becoming smokers
- 19,400 adult smokers who continue to smoke, rather than quit
- 23,200 more Ohioans who will die prematurely from smoking
- $992 million in additional, long-term health care costs, including
$175 million under Medicaid.
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:
Campaign
for Tobacco Free Kids Press Release April 23, 2008
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.
For more information, see web link:
New
York City Department of Health and Mental Hygiene Press Release
April 16, 2008
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.
For more information, see web link:
Campaign
for Tobacco Free Kids Press Release April 9, 2008
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:
- Prevent more than 46,000 Massachusetts kids from becoming
smokers;
- Spur 25,800 current adult smokers to quit for good;
- Save more than 21,500 Massachusetts residents from premature,
smoking-caused deaths;
- Raise more than $150 million in new revenue;
- Produce more than $1 billion in long-term health care savings.
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.
For more information, see web link:
Campaign
for Tobacco Free Kids Press Release April 7, 2008
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/
For more information, see web link:
AAFP
News Now, April 4, 2008
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.
For more information, see web link:
Kootenay
News, April 02, 2008
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