American Journal of Public Health Highlights Young Adult Cessation Research

The August 2007 issue of the American Journal of Public Health (AJPH) is a theme issue focused on young adult cessation. The issue is now available online. Sponsored by the Youth Tobacco Cessation Collaborative (www.youthtobaccocessation.org), this issue contains newly published research articles that address various issues related to cessation among this often overlooked population.

This age group, often defined as adults aged 18 to 24 years, has the highest smoking prevalence among all adults at a rate of 24 percent. The young adult population has not responded to the cessation treatment and delivery methods that have been shown to work for the older adult population. Innovative strategies are needed to improve delivery of cessation services to young adult smokers.

The special issue focuses on the results of young adult tobacco cessation programs in recent years and highlights research identifying the hidden challenges to quitting. Included in this special issue is a report from University of Illinois at Chicago public health researchers indicating that young adults do not utilize proven smoking cessation treatments that can double their chances of quitting. The issue also includes new findings about what young adults who have been unable to quit smoking have in common, and suggests how this new analysis can be used to improve tobacco cessation programs.

Highlights from the issue include:

• Use of Tobacco Cessation Treatments Among Young Adult Smokers: 2005 National Health Interview Survey (Curry, et al).

  This study compared use of smoking cessation treatments and factors associated with treatment use among young adult smokers and other adult smokers. Data from the 2005 National Health Interview Survey core and cancer control supplement was used in the analysis. Young adult smokers aged 18-24 years were compared to other smokers in the sample. Young adult smokers were less likely than other smokers to use pharmacotherapy (18 percent vs 32 percent). Correlates of pharmacotherapy use for young adult smokers were receiving advice from a health care provider, heavier smoking, and higher educational attainment. Compared with other smokers, young adult smokers were also less likely to have received advice to quit from a health care provider (49 percent vs 60 percent).

• Quit Attempts and Intention to Quit Cigarette Smoking Among Young Adults in the United States (Fagan, et al).

  This study investigated variables associated with quitting behaviors among current, daily, and non-daily young adult smokers in the United States. Daily smokers who smoked 20 or more cigarettes per day, had their first cigarette within 30 minutes of waking, and smoked no usual type were less likely than were their comparison groups to have 1 or more quit attempts. Non-daily smokers who were male, Hispanic, and smoked no usual type of cigarette were also less likely than were their comparison groups to report 1 or more quit attempts. Although unemployed non-daily smokers were more likely than were the employed to report intention to quit, non-daily smokers with an annual family income of $25,000 to $49,000 were less likely than were higher-income families to report intention to quit.

• Barriers to Smoking Cessation in Inner-City African American Young Adults (Stillman, et al).

  The prevalence of tobacco use among urban African American persons aged 18 to 24 years not enrolled in college is alarmingly high and a challenge for smoking cessation initiatives. Recent data from inner-city neighborhoods in Baltimore, MD, indicate that more than 60 percent of young adults smoke cigarettes. This study sought to describe community-level factors contributing to this problem. Data from focus groups and surveys indicate that the sale and acquisition of "loosies" are ubiquitous and normative and may contribute to the high usage and low cessation rates.

• Receptivity to Tobacco Advertising and Promotions Among Young Adolescents as a Predictor of Established Smoking in Young Adulthood (Gilpin et al).

  This study investigated whether receptivity to tobacco advertising and promotions during young adolescence predicts young adult smoking 6 years later. Two longitudinal cohorts of adolescents drawn from the 1993 and 1996 versions of the California Tobacco Surveys were followed 3 and 6 years later. At baseline, adolescents were aged 12 to 15 years and were not established smokers. The outcome measure was established smoking at final follow-up. The rate of established smoking at follow-up was significantly greater among members of the 1993 through 1999 cohort (21.0 percent) than among members of the 1996 through 2002 cohort (15.6 percent). However, in both cohorts, having a favorite cigarette advertisement and owning or being willing to use a tobacco promotional item showed nearly identical adjusted odds of future adult smoking (1.46 and 1.84, respectively).

For more information, please see American Journal of Public Health 2007 97: 1348-1349 or contact Jessica Nadeau at jnadeau@aed.org.

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Not Enough Doctors Advise Smokers to Quit

Doctors and other health-care professionals seem to be missing chances to help patients quit smoking, according to a report based on a large Canadian survey.

The 2005 government survey concluded that although 88 percent of smokers visited health-care providers in the preceding 12 months, only half (51 percent) of smokers got advice about quitting. Rates of advice to reduce or quit smoking by a physician were lowest among the youngest smokers (i.e., aged 15--19 years) (38 percent) and increased by age group. The editors suggest that doctors, dentists and pharmacists need to take greater advantage of opportunities to provide such advice.

The report was published in the Morbidity and Mortality Weekly Report. Its findings are based on a Health Canada survey of the smoking habits of more than 20,000 people aged 15 and older that suggested 19 percent of Canadians smoked in 2005.

For more information, see web link:
MMWR Weekly July 20, 2007 / 56(28);705-708

Hospitalized Smokers May Accept Help to Quit

Smokers who require admission to the hospital, regardless of the reason, may be receptive to smoking cessation efforts and, with the right intervention, can and often do succeed in kicking the habit, a review of published reports indicates.

Dr. Nancy A. Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, Boston, and her colleagues reviewed the effectiveness of smoking cessation programs initiated in hospitalized smokers.

In a total of 33 trials, 14,500 hospitalized men and women smokers received advice to quit smoking or behavioral counseling or both by a research nurse or trained smoking cessation counselor. In-hospital anti-smoking interventions ranged from less than 5 minutes to 60 minutes with or without follow-up support after discharge, usually in the form of telephone calls.

The results indicate that intensive counseling programs that provide smokers with at least 30 minutes of counseling during the hospital stay, along with supportive calls for at least a month after discharge, increase the odds of quitting by 65 percent after discharge. In a subgroup of smokers entering the hospital due to heart disease, intensive anti-smoking counseling with follow-up support increased the odds of quitting by 81 percent.

Adding nicotine replacement therapy or the antidepressant bupropion to counseling and follow-up boosts the odds of quitting by 47 percent, the data suggest. The "totality of the evidence" clearly shows that drug therapy should be part of in-hospital anti-smoking programs when indicated, Rigotti and colleagues conclude.

For more information, see weblink:
Cochrane Database of Systematic Reviews 2007, Issue 3

National TV Promotion Triples Calls to Smoking Cessation Hotline

A study published in the July/August issue of the American Journal of Health Promotion found that calls to a national smoking-cessation hotline more than tripled in the wake of news anchor Peter Jennings' death from lung cancer.

In November 2005, ABC News promoted the national 1-800-QUIT-NOW phone number during a series of World News Tonight stories called "Quit to Live: Fighting Lung Cancer." The study found that overall call volume in the United States (49 states and D.C.) increased markedly in November; 37,049 calls compared to 16,145 in October. Although there was large variability across states, there was an average of 317 calls pre-promotion, 726 calls during the promotion, and 397 calls post-promotion.

For more information, see web link:
American Journal of Health Promotion, July/August 2007

New Yorkers are Breathing Easier, Thanks to The State's Comprehensive Smokefree Law

A study published in the July 20, 2007 edition of MMWR highlights the research to assess changes in a biological marker of secondhand smoke (SHS) exposure in the general population of nonsmokers following implementation of a comprehensive state smoke-free law. The study shows that saliva cotinine levels (an objective biological measure of SHS exposure) among nonsmoking participants in the New York Adult Tobacco Survey (NYATS) who submitted saliva samples fell by 47 percent in the year after the smoke-free law took effect. The study also shows that the percentages of NYATS respondents reporting exposure to SHS in restaurants and bars decreased significantly after the law took effect, from 19.8 percent to 3.1 percent among restaurant patrons and from 52.4 percent to 13.4 percent among bar patrons over the same period. This report adds to the evidence that comprehensive smoke-free air laws substantially reduce nonsmokers' exposure to secondhand smoke.

For more information, see web link:
MMWR Weekly July 20, 2007 / 56(28);705-708

Youths Become Hooked on Cigarettes Within Two Days of Inhaling

A disturbing new study of youth smokers finds that it only takes two days from when they first start inhaling cigarettes to become addicted to nicotine. And, children need only smoke seven cigarettes a month to report symptoms of dependence.

The findings of the study, which looked at the smoking habits of 1,246 sixth-grade Massachusetts public school students, were published in the July issue of The Archives of Pediatrics and Adolescent Medicine. The study, conducted by a team of physicians from the University of Massachusetts Medical School, contradicts the belief that long-term smoking is necessary to develop an addiction.

The student volunteers were interviewed 11 times over a four-year period. They also took saliva samples to determine blood levels of nicotine and link them to addictive behavior. Almost a third of the children smoked a cigarette, more than 17 percent inhaled, and about 7.5 percent used tobacco daily. The researchers limited their analysis to the 217 inhalers in the group. Most of the youths began inhaling at just under age 13 (average age of 12.8 years), 38 percent developed tobacco dependence, and 70 percent had cravings that were difficult to control before they were smoking every day.

The study's authors urged that teenagers be warned that it might only take "one cigarette to initiate a life-long dependence on tobacco."

For more information, see web link:
Archives of Pediatric and Adolescent Medicine 2007;161:704-710

Another Study Confirms that LGBs Are More Likely to Smoke

A large, new telephone survey from California offers new details on the smoking patterns of gays and new insights into the very question of self-identity in terms of sexual orientation. It was published in the August issue of the American Journal of Public Health.

The survey was somewhat unusual in that it differentiated between those who self-identified as gay/lesbian, bisexual, or who identified as heterosexual but engaged in some same-gender sexual activity after the age of 18.

Among the general population, 68 percent of women had never smoked, while in the study population those numbers were 43 percent of lesbians, 51.3 percent of bisexual women, and 21.5 percent of women who have sex with women (WSW).

Gay men were more likely to smoke than the general population (27.3 percent versus 19.7 percent), while the smoking rates for bisexual and men who have sex with men (MSM) did not differ significantly from the general population, though that may be due in part to the relatively small number of men in each category.

When data from the males and females were combined, the study participants were much more likely to be heavy daily smokers than the general population (G/L 22.2 percent, bi 22.6 percent, same-sex partners 29.7 percent).

The study noted the association within the LGB community between tobacco use and comorbidities such as depression and substance abuse. It may be that treating those other conditions can lead to reduced use of tobacco products, or vice versa. The study could be useful in directing tobacco cessation funds toward organizations serving the LGB community.

For more information, see web link:
American Journal of Public Health 2007 97: 1348-1349

Manitoba Teens Smoking More Than Their Peers

The Canadian Tobacco Use Monitoring Survey, released by Statistics Canada, reveals that across Canada smoking rates are steadily declining, particularly among youths aged 15 to 19. Nationally, the number of teens smoking dropped from 19 percent to 15 percent from 2005 to 2006.

But in Manitoba, the youth smoking rate has remained stable and is well above the national average -- nearly 20 percent of teenage boys and girls age 15 to 19 are still smoking.

Dr. Dhali Dhaliwal, CEO of CancerCare Manitoba, said the statistics are very troubling and the province should be more aggressive with its anti-smoking education and programs. Dhaliwal said a high number of aboriginal youths who smoke and the continued availability of cigarettes to underage children can help explain why Manitoba lags behind the rest of the country. He said the province needs to ensure small stores and parents, friends and family of underage youths aren't contributing to the problem by selling or giving cigarettes to young people.

The smoking rate among aboriginal youths is about five times higher than non-aboriginal youths, and last year the federal government slashed $11 million from its stop-smoking programs on reserves.

For more information, see weblink:
The Canadian Tobacco Use Monitoring Survey

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Disney-Branded Films to Ban Depictions of Smoking

Walt Disney Company became the first major Hollywood studio to ban depictions of smoking, saying there would be no smoking in its family-oriented, Disney-branded films and it would "discourage" it in films distributed by its Touchstone and Miramax labels.

Disney Chief Executive Robert Iger also said in a letter to U.S. Rep. Edward Markey, whose committee last month held hearings on the effects of movie images on children, that the studio would place anti-smoking public service announcements on DVDs of any future films that feature cigarette smoking.

He said the company would encourage theater owners to show anti-smoking public service announcements, or PSAs, before such films.

Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, commended Disney's move but said the studio left "some ambiguity about what would happen in relation to Touchstone and Miramax." Research cited by American Legacy Foundation indicates that children with the highest exposure to smoking in movies were nearly three times more likely to start smoking.

For more information, see web link:
Reuters, July 25, 2007

Statewide Contest to Promote Quitting Tobacco

Indiana is holding a contest giving smokers who quit a chance to win thousands of dollars in cash and other prizes.

Phase Two of the statewide tobacco cessation campaign titled "QUIT 2 WIN" kicks off with a contest that awards smokers for quitting. The contest encourages eligible Hoosiers to enroll by Sept. 5 and stay smoke-free from Sept. 15 to Oct. 15, officials representing INShape Indiana and Indiana Tobacco Prevention and Cessation announced.

Those verified as successful - all randomly selected winners will be tested by blood, urine or breath analysis, official said - have a chance at a number of prizes donated by sponsors. First prize is $2,500 in cash.

"We want to make sure to align incentives with the right actions," said Dr. Judy Monroe, State Health Commissioner. Smokers can enter online through the INShape Indiana Web site, www.inshape.in.gov, by clicking on the Quit2Win icon. Registration forms will also be available through the Indiana Black Expo and at many of this summer's fairs and festivals.

For more information, see web link:
Indiana Quit2Win

Public Health Officials Release Action Steps Against Tobacco Use

"Joint Policy Action Steps Toward Tobacco Use, Prevention, and Control" was released by the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the National Association of Local Boards of Health (NALBOH). The release of this document represents an aggressive push by the public health community toward preventing tobacco use, promoting tobacco use cessation, protecting the public from secondhand smoke, and eliminating tobacco-related health disparities.

ASTHO President and Commissioner of the Virginia Department of Health Robert B. Stroube, MD, MPH, said, "Protecting the public from the dangers of tobacco use and the inevitable disease that follows is an important goal of every state health department. By working toward the action steps in this document, we can all pave the way towards a healthier United States."

The paper, which was funded by the American Legacy Foundation and which supports the mission of the Centers for Disease Control and Prevention's Office on Smoking and Health and the Healthy People 2010 objectives, focuses on the various action steps, including:

• Support strong legislative and regulatory autonomy to control tobacco.
• Advocate for effective, hard-hitting media campaigns that educate the public about the health effects of tobacco use, tobacco policy, cessation resources, and tobacco industry marketing tactics.
• Increase tobacco product prices to reduce consumption.
• Enhance access to and availability of cessation services and remove structural barriers to tobacco use cessation.
  
  
  For more information, see external PDF:
  Joint Policy Action Steps Toward Tobacco Use, Prevention, and Control
  

Bonanza for Nicotine Gum and Patches as Millions Try to Quit

The number of smokers trying to quit increased to an estimated 7.5 million people as the ban on smoking in public places in England went into effect.

The surge in would-be quitters has brought windfalls for pharmacists and other retailers who have enjoyed massive surges in sales of nicotine replacement therapy products, including patches, chewing gums and inhalers, since July last year.

Asda stores have reported a 415 percent rise in purchases of nicotine patches compared with July last year, and made five weeks' worth of sales in 24 hours when the ban went into effect. Also compared against sales figures for July last year, Tesco said sales had tripled. Lloyds Pharmacy has doubled sales of stop-smoking products as well as bookings for its cessation clinics, which are run in conjunction with the National Heath Service. At Boots, sales have risen 195 percent since July 2006. "We have experienced a significant growth in customers taking up the free smoking consultations with our trained pharmacists and health advisers since the ban came into force," a spokesman said.

Market analysts Mintel say that £100 million has already been spent on smoking cessation products this year, and the market will be worth £140 million by 2011.

For more information, see web link:
The Independent, July 8, 2007

Cleveland Clinic to Include Nicotine Testing in Pre-Employment Physicals as Part of Enhanced Wellness Initiative

Pre-employment health evaluations for Cleveland Clinic job applicants now include Cotinine testing, in addition to the existing health and wellness screenings. The testing for Cotinine, a nicotine metabolite, is being incorporated as part of Cleveland Clinic's efforts to make the institution a healthy place to work and visit.

"As a leading healthcare organization dedicated to fighting disease and advocating healthy living, our policies and procedures must reflect that commitment," said Delos M. "Toby" Cosgrove, M.D. CEO and President of Cleveland Clinic. "Having banned smoking from our campuses and launched a communitywide program to promote smoking cessation, incorporating Cotinine testing is a natural extension of our efforts to highlight the perils of tobacco use."

An incremental rollout of the new policy, lasting through Sept. 1, will allow job applicants who test positive for Cotinine access to free, smoking cessation services. During this time, a positive test will not affect a person's employment status.

Effective Sept. 1, applicants will be informed of the policy when they apply for a job. The presence of Cotinine will be confirmed during the post-offer required physical exam. Applicants who test positive for tobacco products will not be considered for employment and will be referred to tobacco cessation resources paid for by Cleveland Clinic. After 90 days, applicants successful in quitting will be encouraged to reapply.

This policy does not apply to current employees. The Clinic will continue to provide a full range of free cessation options to help employees stop using tobacco, including cessation classes, nicotine replacement aids, seminars and forums.

For more information, see web link:
PRNewswire, June 28, 2007

FDA Approves Over-The-Counter THRIVE Gum For Cessation Of Smoking

Novartis Consumer Health, Inc., has announced that the U.S. Food and Drug Administration (FDA) has given approval of ThriveTM (Nicotine Polacrilex Gum USP) 2mg and ThriveTM (Nicotine Polacrilex Gum USP) 4mg to help smokers quit smoking in 12 weeks. The unexpectedly bold, mint-flavored nicotine replacement gum will be available as an over-the-counter (OTC) product nationwide beginning in late 2007 to help smokers double their chances of kicking the habit. When used as directed, Thrive gum delivers low, controlled levels of nicotine to the bloodstream to help reduce cravings and other withdrawal symptoms associated with the cessation of smoking. Thrive gum 2mg is designed for those who smoke fewer than 25 cigarettes each day, and Thrive gum 4mg is designed for those who smoke 25 or more cigarettes each day.

"Thrive will help smokers to conquer smoking in just 12 weeks, while continuing to lead the fulfilling lifestyle they've always enjoyed," said Brian McNamara, Senior Vice President and General Manager, Novartis Consumer Health OTC. "As a global health care leader with a tradition of delivering innovative, self-medication treatments, Novartis applauds the efforts of those who are taking steps toward leading a smoke-free life." Through a 12-week program with the Thrive user's guide and available audio CD, those interested in quitting smoking can gradually reduce nicotine levels in their body to help conquer their smoking habit in 12 weeks.

For more information, see web link:
Medical News Today, June 27, 2007

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