NTCC at the National Conference on Tobacco or Health

Less than one month after Minnesota's new smoke-free law took effect, more than 3,000 scientists and health advocates attended the biennial National Conference on Tobacco or Health (NCTOH) on October 24-26 in Minneapolis. The nation's largest and longest-lasting gathering of the U.S. tobacco control movement, NCTOH aims to improve and sustain the effectiveness and reach of tobacco control programs and activities in the United States. Approximately 1,200 experts presented on topics ranging from the latest evidence on health impacts and new treatments in cessation, to secondhand smoke policy approaches for youth and priority populations advocacy.

NTCC contributed to the conference by convening three conference sessions that promoted and addressed several NTCC strategic initiatives.

Health Literacy

Todd Phillips and Melissa Otero, both of AED, conducted a workshop on behalf of NTCC entitled, "Improving Health Literacy in Tobacco Cessation." Low health literacy may play a role in cessation related behaviors, including misperceptions about nicotine, misuse of NRT products, and inability to read/use cessation materials. Recent data show that those with lower socioeconomic status are more likely to have limited health literacy skills. This same group is also more likely to smoke.

This workshop was designed to help participants understand the importance of incorporating health literacy principles into tobacco cessation materials. The workshop highlighted some recent research on health literacy and introduced a health literacy checklist created by NTCC. This checklist, based on recommendations from several sources, including CDC and IOM, contains health literacy principles and guidelines for developing print materials. The checklist covers content, language, organization, and appearance of materials.

Using this checklist, participants took part in exercises applying these principles to current cessation materials. During the first exercise, participants assessed the readability of a passage from a cessation fact sheet and discussed techniques for improving readability of print materials. In the second exercise, participants examined the design of several existing cessation materials. Using the principles they had just learned, participants assessed various elements of design, including use of color, bullets, and illustrations, and were able to distinguish between poor design elements and effective design elements.

Participants said they enjoyed the interactive session, learned a lot, and that it provided a "big wake-up call" for them with regard to the readability levels and design of their current and planned cessation materials.

Consumer Demand

Two conference sessions focused on Consumer Demand. More than 300 participants filled the convention center auditorium to learn about taking a consumer perspective on cessation in the sub-plenary, "Building Consumer Demand for Tobacco Cessation Products and Services." The panel for this session, including Carlo C. DiClemente, PhD, University of Maryland, Baltimore County; Cheryl Healton, DrPH, American Legacy Foundation; Michael J. Renner, JD, Ohio Tobacco Prevention Foundation; and Mary Anne Bright, Office of Communications, National Cancer Institute, provided a consumer point of view on successful tobacco cessation marketing strategies and approaches.

DiClemente highlighted the smokers' journey to permanent cessation and outlined strategies that attract and engage the smoker while attempting to motivate them to engage in effective cessation activities. He explained that smokers are not only consumers of tobacco products but also consumers of cessation products and services. If providers begin to think of them as consumers, then perspectives, strategies and approaches will change.

Healton discussed the "Become an EX" campaign, a new public-private partnership recently piloted in four cities. She described the campaign and showed examples of the television ads. She also presented findings from the multi-pronged public education program. She summarized the impact on the pilot cities on smoker self-efficacy, calls to quitlines and internet traffic. EX increased quit line call volume five- to ll-fold and approximately 27,000 unique visitors came to www.BecomeAnEx.org website during the campaign.

Renner gave an overview of Ohio's strategies for cessation approaches targeting special populations. He described partnerships that the state has with employers, health plans and a hospital system to reach hard-to-reach and low-SES audiences with cessation services. Renner also discussed the balance of cost versus demand for quality services, explaining that cost per reach and cost per quit need to be evaluated.

Bright described social marketing strategies used in a national promotion campaign aimed at 18- to 29-year-olds. The "Be a Quitter" campaign aimed to increase awareness of the 1-800-Quit-Now hotline and to increase the number of smokers reached and counseled. The campaign incorporated many elements, including direct-to-consumer marketing, outreach to health professionals, collaborative partnerships and media. After the campaign, there was a 97% increase in calls from January to April 2006 compared to the same period in 2007.

Following the sub-plenary, the second Consumer Demand session discussed innovations and various strategies that the Consumer Demand Roundtable and IDEO, the nation's leading product design firm, are using to develop more engaging and effective tobacco cessation products and services. Presenters included Carlo C. DiClemente, PhD, University of Maryland, Baltimore County; and Peter Coughlan, Transformation Practice, IDEO.

Fewer than 30% of those who try to quit use evidence-based treatments that could improve their quit rates. Leading experts have concluded that to increase use of these treatments, new strategies for building demand are needed. The Consumer Demand Roundtable has been working to identify innovations and breakthroughs that increase the appeal and use of evidence-based products and services.

DiClemente described the differences between viewing smokers as consumers and viewing them as patients. He also highlighted key recommendations for developing cessation products and services resulting from three Roundtables and the national conference. These recommendations include:

• Using a consumer perspective to transform design and delivery of existing products and services and to develop effective promotion and marketing strategies
• Capitalizing on policies; and
• Creating better surveillance and research.

Peter Coughlan described a design framework, including a set of design principles, to guide tobacco cessation product innovations and build demand for cessation. He highlighted the eight design principles that the Roundtable developed, including:

• Kick the tires
• Make it look and feel good
• Facilitate transitions
• Make progress tangible
• Foster community.

Using examples from the work IDEO did with Caroline Renner from the Alaska Native Tribal Health Consortium and Myra Muramoto from the University of Arizona, Coughlan illustrated how providers of cessation treatments integrate knowledge about consumers and their perspectives into the actual design of these products and services.

In addition to NTCC's presence at NCTOH, YTCC also presented a session to a standing-room-only crowd on "The Future of Youth Tobacco Cessation Research." This session discuss the current challenges, implications, and future directions of youth tobacco cessation research. Presenters included Cathy Backinger, PhD, National Cancer Institute; Cindy Tworek, PhD, West Virginia University (on behalf of Dianne Barker, Barker Bi-Coastal Health Consultants, Inc,); and Sue Curry, PhD, University of Illinois at Chicago.

Backinger presented on the highlights from the May 2007 national meeting, "The Future of Youth Cessation Research Workshop: Challenges and Recommendations," convened by the American Cancer Society (ACS), National Cancer Institute (NCI), and the National Institute on Drug Abuse (NIDA), on behalf of the Youth Tobacco Cessation Collaborative (YTCC).

Tworek discussed the National Youth Smoking Cessation Survey results and highlighted the groundbreaking research published in the YTCC-sponsored August 2007 American Journal of Public Health (AJPH) theme issue.

Curry presented an overview and discussed the data from the 2005 National Health Interview Survey examining the use of evidenced-based cessation treatments among young adult smokers in the U.S.

Conference presentations from the NTCC and YTCC sessions will soon be available on the NTCC (www.tobacco-cessation.org), YTCC (www.youthtobaccocessation.org) and Consumer Demand (www.consumer-demand.org) websites.

For more information on the conference, visit http://www.tobaccocontrolconference.org/2007/conference/index.cfm.

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New CASA Report: Teen Cigarette Smoking Linked to Brain Damage, Alcohol and Illegal Drug Abuse, Mental Illness

The nicotine in tobacco products poses a significant danger of structural and chemical changes in developing brains that can make teens more vulnerable to alcohol and other drug addiction and to mental illness, according to Tobacco: The Smoking Gun, a new white paper released by The National Center on Addiction and Substance Abuse (CASA) at Columbia University and commissioned by The Citizens' Commission to Protect the Truth, a group of all former U.S. Secretaries of Health, Education, and Welfare and of Health and Human Services, all former U.S. Surgeons General, and all former Directors of the Centers for Disease Control and Prevention.

CASA's original analysis of data from the National Survey on Drug Use and Health (NSDUH) finds that teens who smoke are nine times likelier to meet the medical criteria for past year alcohol abuse or dependence and 13 times likelier to meet the medical criteria for abuse and dependence on an illegal drug than teens who don't smoke. The CASA analysis also found that among teens ages 12 to 17, twice as many smokers as nonsmokers suffered from symptoms of depression in the past year. Teens who reported early initiation of smoking were more likely to experience serious feelings of hopelessness, depression and worthlessness in the past year.

"These findings sound an alarm for parents, teachers, pediatricians and others responsible for children's health that smoking by teens may well signal the fire of alcohol and other drug abuse and mental illnesses such as depression and anxiety disorders," said Joseph A. Califano, Jr., chairman and president of CASA and speaking on behalf of The Citizens' Commission as its chairman.

Based on the findings of the white paper, CASA and the Commission recommend sharply restricting all tobacco advertising, marketing and promotion; stepping up evidence-based prevention and cessation efforts, including counter-advertising programs; giving the FDA comprehensive authority to regulate tobacco; and mandating evidence-based tobacco cessation in substance abuse treatment and mental health care settings

For more information, see web link:
CASA Press Release October 23, 2007

Mechanism Behind Nicotine Dependency Revealed

A new study reveals that, in rats, chronic nicotine use recruits a major brain stress system, the extrahypothalamic corticotropin releasing factor (CRF) system, which contributes to continued tobacco use by exacerbating anxiety and craving upon withdrawal.

While nicotine can produce mildly pleasurable effects, the Scripps Research scientists believe a more important factor in the difficulty in quitting is the brain's adaptation to that reward, which produces an intense discomfort upon withdrawal.

"The key in nicotine addiction is that the positive pleasurable effects of nicotine are instantaneous and short lasting, while the negative effects are delayed and long lasting," says Olivier George, a research associate in the Scripps Research Koob lab who conducted the study with Sandy Ghozland and other colleagues.

When the researchers induced nicotine withdrawal in rats, the nicotine-deprived group exhibited severe anxiety-like behavioral symptoms of withdrawal. In addition, withdrawal whetted the rats' appetite for even greater quantities of the drug, a result the researchers call the "nicotine deprivation effect." Measurements showed that this behavior was indeed matched by hyperactivity in the CRF system, and that these withdrawal effects lasted a surprisingly long time. In addicted rats, these effects developed in under a week and maintained a hold for at least two months. "That's a long time for a rat, considering its life expectancy is two years," says George. "These results suggest long-lasting neuroadaptations of the CRF system, possibly through gene regulation, that may help explain why many cigarette smokers relapse even after a long abstinence from smoking."

The researchers found that administering a compound that blocked the CRF-1 receptors involved in this stress system alleviated withdrawal symptoms. When addicted rats were injected with a CRF receptor antagonist, the injected rats showed less anxiety-like behavior during withdrawal and self-administered less nicotine compared with an addicted controls.

"We reduced the need to take nicotine by blocking CRF-1 receptors in the brain," says George. "We were surprised by the compound's dramatic effectiveness. We don't know yet if the same mechanism is involved in humans with tobacco dependence, but it is very promising."

For more information, see web link:
The Scripps Institute News Release October 1, 2007

Patterns and Correlates of Tobacco Control Behavior among American Association of Pediatric Dentistry Members

According to a survey among a national, random sample of 1500 American Academy of Pediatric Dentistry members, most pediatric dentists feel unprepared to help their adolescent patients quit tobacco use. Only 12 percent of survey respondents had prior training in tobacco use prevention and cessation. Over one-half agreed pediatric dentists should engage in tobacco control behaviors, but identified patient resistance as a barrier. Moreover, 64 percent identified feeling they could not effectively help patients quit as a major barrier. Lacking resources, reflected in not knowing where to send patients for counseling and not having materials to distribute, was identified as a major barrier by over half the respondents.

In addition, while 80 percent reported that trying to reduce adolescent tobacco use was worth the time, less than one-quarter of respondents (24 percent) reported always asking adolescents if they used tobacco and only 37 percent of respondents always assisting adolescent patients with stopping tobacco use. While nearly two-thirds of respondents reported being personally responsible for asking patients about tobacco use and nearly two-thirds felt very well or well prepared to ask patients if they used tobacco and to advise users to quit, only 17 percent felt prepared to actually assist users in quitting.

Researchers suggest that this low involvement may be a result of pediatric dentists' lack of preparedness in relation to tobacco control.Researchers recommend training programs on tobacco use and dependence treatment in the pediatric dental setting to promote tobacco control behaviors for adolescent patients.

For more information, see external PDF:
BMC Oral Health, 2007, Volume 7, Issue 13

Parental Smoking Associated with Teens' Below-Par Test Scores

Teenage exposure at home to second-hand tobacco smoke seems to go hand in hand with poor performance on standardized academic tests, investigators recently found.

If either parent smoked, a child had 25 percent to 30 percent higher failure rate compared with children of nonsmokers, Bradley Collins, Ph.D., of Temple University, and colleagues, reported in the October issue of the Journal of Adolescent Health. The higher failure rate held up for either ordinary or advanced-level examinations.

Researchers found that parental smoking significantly increased the likelihood of test failure on either test, as did the family's socioeconomic status. Maternal smoking increased the likelihood of ordinary-level test failure by 29 percent and paternal smoking by 30 percent. Male sex and smoking by the teenager also increased the likelihood of test failure. In the advanced-level tests, maternal smoking increased the risk of test failure by 24 percent and paternal smoking increased the risk by 27 percent. The only other significant predictors of failure were female sex and smoking by the teenager.

"Our study supports growing evidence that environmental tobacco smoke is an environmental toxin that affects academic performance," the authors concluded. "Evidence herein should further encourage multipronged efforts to reduce adolescents' environmental tobacco smoke exposure."

For more information, see web link:
Journal of Adolescent Health, 2007, Volume 41, Issue 4

Teens Who Add Part-Time Jobs to School More Likely to Start Smoking

High-school students who take part-time jobs for pocket money may be more likely to start smoking than teens who don't join the after-school and weekend workforce, a study suggests.

The study of Grade 10 and 11 students in Baltimore shows that those who took jobs, often in retail outlets and fast-food or other restaurants, had a greater propensity to begin lighting up - and that trend was strongest among teens who worked the most hours per week.

Lead author Rajeev Ramchand, a psychiatric epidemiologist, says teens who began working were at least three times more likely to start smoking than kids who didn't start working. He found the teens who worked more than 10 hours a week on average started to smoke at an earlier age than their peers. The researchers say it could be that working teens are exposed to older youth or adults who are more likely to smoke.

The researchers suggest the tasks teens typically are asked to do are often repetitive and monotonous, and taking a smoke break might be a means of escaping boredom.

Dr. Roberta Ferrence, executive director of the Ontario Tobacco Research Unit, said she is not surprised at the findings. Besides providing income to pay for smokes, having a job also offers an opportunity to indulge the habit.

For more information, see web link:
American Journal of Public Health, 2007, Volume 97, Issue 11

Smoking Rates Highest Among People with Disabilities

Smoking prevalence among people with disabilities is nearly 50 percent higher than among people without disabilities (29.9 percent vs. 19.8 percent), according to a new study from the Centers for Disease Control and Prevention. The study found that in 2004, smoking prevalence for people with disabilities was highest in Delaware (39.4 percent) and lowest in Puerto Rico (16.5 percent).

The study found that about 70 percent of people with disabilities who smoke and had visited a doctor in the last year had been advised to quit smoking. However, more than 40 percent of those advised to quit reported not being told about the types of tobacco-cessation treatment available.

Disparities in smoking prevalence, in addition to barriers to the use of preventive services (such as traveling to a doctor's appointment) put people with disabilities at risk for declining health. Researchers are unsure why the smoking prevalence is higher in people with disabilities, but it is an area for further examination. However, research confirms that people with disabilities are less likely than people without disabilities to receive preventive health care and therefore are more subject to illness and disease.

For more information, see web link:
CDC Press Release October 4, 2007

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State-Specific Prevalence of Cigarette Smoking Among Adults and Quitting Among Persons Aged 18 - 35 Years -- United States, 2006

The September 28th issue of Morbidity and Mortality Weekly Report provides state-specific smoking prevalence and quit data based on the 2006 Behavior Risk Factor Surveillance System. According to the report, in 2006 the median prevalence of current cigarette smoking among adults in the 50 states and DC was 20.2 percent. The adult current smoking prevalence varied considerably across 50 states, with prevalence ranging from 9.8 percent (Utah) to 28.6 percent (Kentucky). The median percentage of ever smokers aged 18--35 years who had quit was 34.0 percent for the 50 states and DC. The states with the highest percentages of ever smokers who had quit in this age group were Utah (47.9 percent) and Minnesota (43.7 percent). The editors note that present rate of decline in current smoking rates is not fast enough for most states to achieve the Healthy People 2010 objective of 12 percent or less. Fully implementing evidence-based strategies that decrease initiation of tobacco use and increase cessation rates would accelerate progress in reducing rates of smoking and other tobacco use.

The editors also suggest that although quitting at any age substantially reduces risk of disease, the longer people smoke, the more likely they are to develop adverse health effects that are not completely reversible. Early cessation should be encouraged because smokers who quit as young adults have a life expectancy similar to that of never smokers. Diverse strategies are needed to motivate these different groups to quit smoking, such as conducting sustained mass media campaigns, increasing the price of tobacco products, providing brief counseling by health-care professionals at every clinic visit, reducing out-of-pocket costs of smoking-cessation treatments, and offering telephone quitlines.

For more information, see web link:
MMWR September 28, 2007 56(38);993-996

Sales Drop Follows Cigarette Tax Increase

Iowa's $1-a-pack cigarette tax increase has cut sales by up to 30 percent and has tripled the volume of calls from smokers trying to kick the habit since the price spike took effect more than six months ago, state officials said.

"All the information we've gotten is that virtually everything that we thought would happen has happened," said Chuck Reed of the American Cancer Society's Iowa chapter. "I think that just shows that people do want to quit smoking, and the tax has brought about a lot of that because it's very expensive now to buy a carton of cigarettes."

Mike Lipsman of the state Department of Revenue said the number of packs of cigarettes sold in the last three months has declined by an average of about 30 percent, with much of that attributed to a drop in demand.

"That's about what we estimated," said Lipsman, who noted that 246.3 million packs of cigarettes were sold in Iowa last year, a figure that is projected to drop to 190.5 million this year and to 186.6 million in 2008.

State receipts from the $1.36 tax on a pack of cigarettes that has been collected since March 16 have jumped dramatically, with the first three months of the fiscal year that started July 1 posting a 157 percent upward spike. Also, calls to the quitline operated by the Iowa Tobacco Research Center at the University of Iowa have increased from 1,515 during the March-to-August period of 2006 to 5,050 for the same six-month period this year. That's a monthly average increase that's gone from 252 to 842.

Iowa Gov. Chet Culver, who campaigned hard to raise Iowa's 36-cent-per-pack cigarette tax by $1, said he was "thrilled" by the prospects that up to 20,000 Iowans could quit using tobacco products as a result of the Legislature's action and his signature.

"If people quit smoking entirely, that would be a great thing," he said.

For more information, see web link:
The Gazette, October 3, 2007

State Mental Health Hospitals to Go Tobacco Free November 15

Beginning November 15, 2007, Missouri's state-operated mental health hospitals will be tobacco free in buildings and on grounds. The health of patients and improving the treatment environment are important reasons for the change.

"It's about the well-being of people. Many of the people we serve die from illnesses related to smoking," said Joe Parks, M.D., Director of the Division of Comprehensive Psychiatric Services in the Department of Mental Health. "We are operating hospitals and we should promote health all we can. Private hospitals have similar policies."

The change officially will occur November 15, in conjunction with the Great American Smokeout sponsored each year by the American Cancer Society. However, the Department of Mental Health has been preparing staff and patients for the change since July of this year. Patients are being offered nicotine replacement treatment and smoking cessation programs.

Parks said most patients and staff have been receptive and are prepared for the change to a tobacco-free campus. Parks said that in addition to the health risk, smoking promotes coercion and violence in facilities among patients and between patients and staff. This usually means negative outcomes for the mental health treatment and recovery process. "Smoking also occupies a surprising amount of staff and patient time that could be better used for therapeutic activities," he said. "It is a poor substitute for practice in decision-making and relationship building."

The Department of Mental Health operates 11 mental health hospitals around the state, with approximately 1,500 patients and 4,300 staff. About 41 percent of public mental health facilities in the nation are tobacco free.

For more information, see web link:
Missouri Department of Mental Health News Release October 17, 2007

BMJ Group, United Health Foundation Publish Practical, Evidence-Based Guidelines to Promote Smoking Cessation in U.S. Adult Populations

BMJ Group, publisher of the British Medical Journal, and United Health Foundation, a nonprofit private foundation established by UnitedHealth Group, are distributing important new guidelines regarding smoking cessation interventions to more than 500,000 U.S. physicians. The report, entitled "Putting Evidence into Practice: Smoking Cessation," examines the current medical evidence for interventions that best help adults quit smoking and provides a practical toolkit for putting the evidence into everyday clinical practice.

Cigarette smoking remains the number one avoidable cause of death and disability within the United States today. And although most smokers want to quit, most attempts at cessation fail. Encouraging smoking cessation is now recognized as a critical component of medical care and public health. To address this critical gap in knowledge, United Health Foundation commissioned BMJ Group to review the currently available medical evidence regarding the effectiveness of various smoking cessation interventions and develop a practical set of guidelines and tools that physicians can use in their interactions with patients who want to quit smoking. Highlights of the findings include:

• Personal motivation to quit smoking is important, but it's not enough - most smokers need encouragement, assistance and guidance
• Smoking should be thought of as a chronic disease, with exacerbations and remissions
• Medications can successfully treat the addiction component of smoking
• Behavioral counseling must address the habit
• A primary care systems approach can help identify and successfully treat smokers

U.S. Cancer Death Rate Continues to Fall

A new report from the nation's leading cancer organizations shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002. The findings are in the "Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives" published in the recent issue of Cancer.

Overall, incidence rates for all cancers decreased slightly from 1992 through 2004, after increasing between 1975 and 1992. Among the general population, the report shows that long-term declines in cancer death rates continued through 2004 for both sexes and, despite overall higher death rates for men, the declines from 2002 through 2004 were 2.6 percent per year among men and 1.8 percent per year among women. Death rates decreased for the majority of the top 15 cancers in men and women. Important declines were noted for the three leading causes of cancer deaths in men: lung, prostate and colorectal cancers. In women, deaths rates from colorectal cancer and breast cancer decreased, while the rate of increase for lung cancer deaths slowed substantially.

This year's report also gives a detailed view of cancer in American Indians and Alaska Natives across the United States. American Indians and Alaska Natives (AI/AN) generally had lower rates of most cancers than non-Hispanic whites between 1999 and 2004, but they had a higher incidence of cancers of the stomach, liver, kidney, gallbladder and cervix.

The report, which appears annually, is a joint effort from the American Cancer Society, the U.S. Centers for Disease Control and Prevention, the U.S. National Cancer Institute, and the North American Association of Central Cancer Registries.

For more information, see web link:
Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives

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