FTC Reports Show Massive Spending on Tobacco Marketing

What would you do if you had just over $36.5 million to spend – every day? Could you do it? The tobacco industry can. In fact, this is the amount the tobacco companies spent every day in 2005 to market their products. This amount is equal to $13.4 billion for the year, or $44.33 on marketing for every man, woman and child in the United States.

According to the Federal Trade Commission’s latest report on cigarette and smokeless tobacco marketing, this total includes $13.1 billion in cigarette marketing and $250.8 million in smokeless tobacco marketing. While the total tobacco marketing expenditures declined slightly from 2003 to 2005, tobacco marketing is still at historically high levels and has nearly doubled since the 1998 state tobacco settlement. The majority of this marketing does not take the form of traditional advertisements, such as billboards or magazine ads. Rather, tobacco companies spend the bulk of their marketing dollars (85%) on price discounts that make cigarettes more affordable to the most vulnerable consumers: low SES groups and children. In 2005, $11.4 billion was spent on price promotions, including $9.8 billion on price discounts and $1.6 billion on coupons and free cigarette promotions (e.g. buy one, get one).

This massive spending on tobacco marketing may have been undermining public health efforts to reduce tobacco use. According to the latest survey of high school smoking by the CDC, 23% of high school students smoked in 2005, up from 21.9% in 2003. The adult smoking rate was stagnant at 20.9% in 2004 and 2005, the first time the rate has not declined since 1997.

It is clear that more needs to be done to counteract the effects of tobacco industry marketing and reverse the rising trend in smoking rates. One way to accomplish this is through policy. Several proposed bills have been introduced to Congress that would give the FDA the authority to regulate tobacco, including promotion of tobacco products. This legislation would immediately restrict tobacco advertising and promotions, especially to children. It would limit tobacco advertising in stores and in magazines with significant teen readership to black-and-white text only, eliminating the colorful, youth-oriented images that depict smoking as cool and glamorous. It would require stores to place tobacco products behind the counter; ban all remaining tobacco brand sponsorships of sports and entertainment events; and ban free cigarette samples and free giveaways of non-tobacco items with the purchase of a tobacco product. The legislation would also ban candy-flavored cigarettes that clearly are a starter product for young new smokers.

In addition to these specific restrictions, the legislation would ban misleading cigarette labels such as “light” and “low-tar” that mislead consumers into believing that certain cigarettes are safer than others. The legislation would also give the FDA authority to strictly regulate any health claims about so-called "reduced risk" products to ensure they are scientifically verified, do not encourage new users to start and do not discourage current tobacco users from quitting.

Another way to counteract tobacco marketing is at the state level. Currently, for every $1 that states spend to fight tobacco use, the tobacco companies spend more than $22 to market tobacco products. States are spending $597.5 million this year on tobacco prevention and cessation programs, compared to the $13.4 billion the tobacco companies are spending.

Less than 4% of the original MSA funds from the 1998 state tobacco settlement awarded to states have been allocated for tobacco control. In Fiscal Year 2007, states spent just 37% of the $1.6 billion needed to meet the CDC’s recommended minimum funding levels.

Beginning in 2008, however, as MSA bonus funds become available, state-elected officials will get a second chance to adequately fund tobacco control programs. These so-called “bonus payments” will total more than $900 million each year in new revenue for the 46 states, the District of Columbia and the U.S. territories that are part of the MSA.

With the tobacco settlement bonus payments, states will have even more tobacco-generated revenue to fund tobacco control. In fiscal 2007, states are projected to collect a record $21.7 billion from the tobacco settlement and tobacco taxes. However, states allocated only 2.8% of their tobacco revenue for tobacco prevention and cessation. Just 7.3% of this $21.7 billion can fund tobacco prevention and cessation programs in every state, at the minimum levels recommended by the CDC, and create significant public health improvements.

If states doubt the effectiveness of funding programs at the CDC-recommended levels, there is plenty of evidence to the contrary. Maine and Mississippi have each funded tobacco prevention programs at CDC-recommended levels for seven years in a row and are enjoying significant public health benefits as a result. From 1997 to 2005, Maine, which has the nation’s highest-funded prevention program for the fourth year in a row, reduced smoking by 64% among middle school students and by 59% among high school students. Between 1999 and 2004, Mississippi reduced smoking by 48% among public middle school students and by 32% among public high school students. Despite progress that has been made, there is still a long way to go. The Federal Trade Commission’s latest report on cigarette and smokeless tobacco marketing highlights the power of the tobacco industry. Much needs to be done on all levels to offset this. Tobacco use is still the nation’s leading preventable cause of death, killing more than 400,000 people and costing the nation more than $96 billion in health care bills each year.

For more information on this, please contact Jessica Nadeau at jnadeau@aed.org or visit http://www.tobacco-cessation.org.

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Doctors Ill-Equipped to Confront Parent Smoking

Almost 60% of U.S. children ages 3 to 11 -- approximately 22 million children -- are exposed to secondhand smoke daily. The June 2006 U.S. Surgeon General’s report indicates that urban children suffer the highest rates of exposure.

However, minimal formal medical training exists regarding how pediatricians can effectively speak to their patients about secondhand smoke-related issues, according to an article in the May issue of The Journal of Pediatrics. “Part of the issue is teaching medical residents (physicians in training) to advise smoking parents at every patient visit,” said Brad Collins, PhD, the lead author and assistant professor of public health at Temple University. “Consider every message as a ‘dose’ of advice that in the long run could promote lasting changes in parental smoking behavior and children’s exposure.”

Collins and his co-authors surveyed physician training needs and attitudes towards improving secondhand smoke reduction efforts at a Philadelphia hospital. Sixty-six residents across all years of training and 27 preceptors (resident supervisors) responded to the survey. Most pediatricians surveyed believed second-hand smoke exposure was a serious health concern for children, but they also believed they were not equipped to help. Almost all respondents (93%) reported that they received less than two hours of smoking cessation training during residency. Survey participants cited key barriers to addressing patients’ second-hand smoke exposure, including lack of training, time, confidence in their tobacco intervention skills, and knowledge about appropriate tobacco intervention resources.

For more information, see external PDF:
The Journal of Pediatrics Volume 150, Issue 5, May 2007

Effectiveness of an Elderly Smoking Cessation Counseling Training Program for Social Workers

A study published last month in the journal Chest reports that a smoking cessation counseling training program for social workers who work with the elderly is effective. To achieve greater coverage of the elderly smoking population, Gabriel M. Leung, MD, and colleagues felt that the provider/client interface should be broadened to include other professional groups who work with the elderly. The research evaluated the effectiveness of a 9-hour smoking cessation counseling training program for social workers.

Researchers recruited 177 social workers and used a preintervention/postintervention longitudinal design, taking measurements at baseline, 3 months, 6 months, and 12 months after training of knowledge level, attitudes, self-perceived competence and use of the 4 A’s (ask, advice, assist, arrange as per the Agency for Healthcare Research and Quality framework). Overall, knowledge, attitude, and self-perceived competence improved from baseline to the 12 month point. Also, three of the four A’s registered significant gains from baseline to 12 months overall, although "advice" did not show any appreciable change.

The findings demonstrate that the smoking cessation training program achieved sustained effectiveness in the first year after training in enhancing knowledge, positively shifting attitudes, boosting self-perceived competence, and increasing the self-reported frequency of practicing three of the four A’s in their routine interaction with elderly clients.

For more information, see web link:
Chest Volume 131, Number 4, April 2007

The Effects of Exercise and Nicotine Replacement Therapy on Smoking Rates in Women

In a study from Addictive Behavior, researchers reported that exercise, combined with NRT, facilitates smoking cessation, improves functional exercise capacity, and delays weight gain in women smokers. To examine the individual effects of supervised and intensive exercise as well as the combined effects of exercise and nicotine replacement therapy (NRT) on (a) smoking cessation and reduction rates and (b) psychological and physiological processes during withdrawal, researchers randomized 142 inactive female smokers into four groups: exercise + nicotine patch; exercise + no nicotine patch; cognitive behavior therapy (CBT) + nicotine patch and CBT + no nicotine patch. Smoking abstinence, cessation self-efficacy, and physical fitness and body weight were assessed at baseline (week 1), quit date (week 6), program termination (week 12), and 3- and 12-month follow-up.

There were significant differences in a 7-day point prevalence between treatment groups across targeted end points. Consistently higher cessation rates were seen when NRT was added to both treatment programs. Compared with CBT participants, exercise participants had significantly increased functional exercise capacity and had gained significantly less weight during program end points, but these differences did not hold at a 12-month follow-up. Compared with exercise participants, CBT participants felt greater cessation efficacy and reported greater knowledge, coping and support resources across all end points. The study authors recommend that physicians and health care professionals encourage highly motivated women interested in quitting smoking to use exercise and NRT together.

For more information, see web link:
Addictive Behaviors Volume 32, Issue 7, July 2007

A Randomized Controlled Trial of a Smoking Cessation Intervention Delivered by Dental Hygienists: a Feasibility Study

Helping patients to quit smoking is part of the preventive role of all health professionals. There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking. Research published online in BioMed Central Oral Health aimed to determine the feasibility of undertaking a randomized controlled smoking cessation intervention, utilizing dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients.

One hundred and eighteen patients were recruited into the trial. The intervention group received smoking cessation advice based on the 5As (ask, advise, assess, assist, arrange follow-up) and were offered nicotine replacement therapy (NRT), whereas the control group received usual care. Outcome measures included self-reported smoking cessation, verified by salivary cotinine measurement and CO measurements. Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking.

At 3 months, 15% of the intervention group had quit compared to 9% of the controls. At 6 months and one year, 10% and 7% of the intervention group respectively quit compared to 5% and 4% of the controls. In participants who described themselves as smokers, at 3 and 6 months, a statistically higher percentage of intervention participants reported that they had a quit attempt of at least one week in the preceding 3 months (37% and 47%, for the intervention group respectively, compared with 18% and 16% for the control group). These results show the potential that trained dental hygienists could have in delivering smoking cessation advice.

For more information, see web link:
BMC Oral Health Volume 7, Issue 5, May 2007

Are Smokers Interested in Smoking Cessation Interventions in the Emergency Department?

A survey of adult emergency department (ED) smoking patients at a university-affiliated teaching hospital showed that more than half of the smokers in the ED believe that an intervention provided during an ED visit would help them quit smoking. Patients in the ED were surveyed 24/7 for six consecutive weeks. Smokers were defined as patients who smoked more than 100 lifetime cigarettes and had used any cigarettes in the 28 days prior to study enrollment.

Of the 148 smokers that completed the study, 54% of all smokers were interested in an ED Smoking Cessation Intervention (EDSCI). Specifically, 16% showed interest in prescription and medication information, 15% showed interest in written smoking cessation information, 8% showed interest in referral to a smoking cessation program, 5% showed interest in referral to a smoking quit line, 5% were interested in an ED counseling session, and 3% wanted an ED clinician to call their primary care doctor.

For more information, see web link:
Academic Emergency Medicine Volume 14, Number 5, Supplement 1, May 2007

Support for Spirituality in Smoking Cessation: Results of Pilot Survey

A study by Oregon Health & Science University (OHSU) Smoking Cessation Center researchers reveals that many smokers are receptive to and may benefit from their own spiritual resources when attempting to quit. Patient spiritual resources are increasingly included in the treatment of medical conditions such as cancers and alcohol and drug dependence, but use of spiritual resources is usually excluded from tobacco dependence treatment. "We theorized the absence of spiritual resources in smoking cessation programs may be due to perceived resistance from smokers” said David Gonzales, PhD, principal investigator of the study.

Researchers conducted a pilot survey to assess whether current smokers would consider spiritual, including religious, resources helpful if they were planning to quit. Smokers at least 18 years of age at Oregon Health & Science University in Portland, Oregon, (N = 104) completed a brief survey of smoking behaviors and spiritual beliefs. None were attempting to quit. Of these individuals, 92 (88%) reported some history of spiritual resources (spiritual practice or belief in a Higher Power), and of those respondents, 78% reported that using spiritual resources to quit could be helpful, and 77% reported being open to having their providers encourage use of spiritual resources when quitting. "Our findings suggest that although not all clinicians want to talk about spirituality with their patients, those who do feel comfortable doing so will likely find most patients who smoke are receptive. Asking smoking patients if they have a spiritual practice or belief may be important to their care," Gonzales explained.

For more information, see web link:
Nicotine & Tobacco Research Volume 9, Issue 2, February 2007

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Hollywood Kicks the Habit, Rules that Movies with Smoking Could Go From PG to R Rating

Depictions of smoking in movies will now be a factor when deciding what a film's rating will be, possibly making a PG-13 movie R-rated, the Motion Picture Association of America announced. Along with violence, depictions of sex, adult language and other content considerations, ratings organizations will examine new releases to determine if they glamorize smoking or if it is pervasive through the films, even among adults. Underage smoking has always been considered when rating a film. The new policy for the movies only affects new movies and allows for mitigating circumstances in which smoking may not affect a rating, the trade group said. For instance, the rating on historical films, such as 2005's "Good Night, and Good Luck," set in 1953, when smoking was more prevalent and more socially acceptable, would not be affected.

"Clearly, smoking is increasingly an unacceptable behavior in our society," Dan Glickman, chairman of the motion picture association, said in a statement. "There is broad awareness of smoking as a unique public health concern due to nicotine's highly addictive nature, and no parent wants their child to take up the habit."

The American Legacy Foundation and other groups, such as the American Medical Association and the World Health Organization, have called for films with smoking to receive an automatic R rating unless the smoking is historically necessary or portrayed in an unfavorable fashion. The Foundation called the new policy "wholly inadequate" because it falls short of assigning an automatic R on films that contain smoking. In a March interview on National Public Radio, Stanton A. Glantz, a University of California at San Francisco professor of medicine who started the Smoke Free Movies campaign, said research shows that children who see a great deal of smoking in movies are three times more likely to start smoking than children who do not.

For more information, see web link:
Ahrens, F. (11, May 2007). Washington Post

U of Maryland Professional Students Promote Smoking Cessation

Though smoking is the single biggest cause of disease and premature death in the United States, the average medical student obtains just one hour of tobacco cessation training. Kevin Ferentz, M.D., associate professor at the University of Maryland School of Medicine, calls the lack of smoking education among the country's future health care professionals "frightening." A student-run organization at the University of Maryland School of Pharmacy is trying to do more. Students Promoting Awareness (SPA) is using a $25,000 state grant to conduct tobacco cessation and education programs across the campus. Amy Houtchens, a first-year pharmacy student who has taken the lead in the smoking cessation campaign, says she wants to target UMB students who still smoke, while helping all students become familiar with smoking cessation programs for their future patients and clients. Among the programs SPA is promoting is the state's quitline telephone number (1-800-QUIT-NOW) and website (www.MDQuit.org).

For more information, see web link:
Raymond, J. A Prescription for Quitting (26, April 2007)

$4.5M National Anti-Tobacco Campaign Focusing on Blacks to Begin Second Phase This Summer

The American Legacy Foundation, which three years ago granted $4.5 million to six organizations seeking to curb tobacco use in the black community, now is preparing to launch the second phase of its national smoking cessation campaign. The six organizations, called the African American Partners for a Tobacco-Free Society, are the National Newspaper Publishers Association; the NAACP; the National Urban League; the National Conference of Black Mayors; the Congressional Black Caucus Foundation; and the National Association of Neighborhoods. Efforts under the first phase of the Priority Populations Initiative focused on youth smoking, secondhand smoke and cessation techniques and included educational forums, public service announcements and a media campaign. Helen Lettlow, assistant vice president of the Priority Population Department at the American Legacy Foundation, said, "By this collective group of partners, we were able to raise public awareness. We were able to showcase and spotlight the importance and the impact of tobacco use in the black community." Phase two of the campaign -- which will begin in July and also run for three years -- will focus primarily on smoking among substance users and will support rehabilitation programs, reducing secondhand smoke in the home and integrating smoking cessation campaigns with other health initiatives, such as diabetes and cardiovascular health education


For more information, see web link:
Kaiser Network Daily Report (2007, April 11)

New Poll: Americans Overwhelmingly Support FDA Regulation of Tobacco Products

A new national poll of registered voters finds that 77% of American voters support Congress passing a bill to give the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. The poll was conducted by Public Opinion Strategies and the Mellman Group on behalf of the Campaign for Tobacco-Free Kids. FDA regulation of tobacco is supported across political lines, geographic regions and even by a majority of smokers. The poll found the legislation is supported by:

• Strong majorities of Republicans (76%), Democrats (80%) and Independents (69%);
• Voters in the Northeast (85%), Midwest (79%), South (73%) and West (71%); and
• Both smokers (70%) and non-smokers (78%).

Among other things, the legislation would crack down on tobacco marketing and sales to kids; require that tobacco companies disclose the contents of tobacco products and remove harmful ingredients; stop tobacco companies from misleading the public about health risks of their products; and require larger, more effective health warnings on cigarette packs.

For more information, see web link:
Campaign for Tobacco Free Kids News Release (2007, April 24)

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