Helping Smokers Quit, or Not Start in the First Place

“Even 50 years after the first surgeon general’s report on smoking and health, we’re still finding out new ways that tobacco kills and maims people,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently told me. “It’s astonishing how bad it is.”

Dr. Frieden and public health specialists everywhere are seeking better ways to help the 44 million Americans who still smoke to quit and to keep young people from getting hooked on cigarettes. “Fewer than 2 percent of doctors smoke. Why can’t we get to that rate in society as a whole?” he wondered.

One reason: Smoking rates are highest among the poor, poorly educated and people with mental illness, populations hard to reach with educational messages and quit-smoking aids.

But when I mentioned to Dr. Frieden, a former New York City health commissioner, that the city’s streets are filled with young adult smokers who appear to be well educated and well dressed, he said television seems to have had an outsize influence.

Focus groups of white girls in New York private schools have suggested a “Sex in the City” effect, he said: Girls think smoking makes them look sexy. In the last two years, middle-aged men, too, have begun smoking in increasing numbers after a half-century decline. Dr. Frieden cited “Mad Men,” the popular TV series featuring admen in the early 1960s, when well over half of American men smoked.

Dr. Frieden said that an antismoking effort begun in 2008 by the World Health Organization “can make a huge difference in curbing smoking, and we should fully implement what we know works.” The program is called Mpower:

M stands for monitoring tobacco use and the effectiveness of prevention programs like antismoking videos on YouTube.

P for protecting people from secondhand smoke. Half the country still lacks laws mandating smoke-free public places. The latest national health survey found that about half of children from nonsmoking households have metabolites of tobacco in their blood, Dr. Frieden said.

O for offering help to the 70 percent of smokers who say they would like to quit. “Tobacco use remains egregiously undertreated in health care settings,” Dr. Helene M. Cole, associate editor of JAMA, The Journal of the American Medical Association, and Dr. Michael C. Fiore, a professor of medicine at the University of Wisconsin, wrote this month in the journal.

Medical aids for quitting smoking, which can triple the likelihood of success, should become available, without a co-pay, to many more people under the Affordable Care Act, Dr. Frieden said.

W for warning about smoking hazards through larger and more graphic messages on cigarette packs and paid advertising on radio and television.

E for enforcing bans on tobacco marketing, advertising, promotion and sponsorships. In bodegas throughout the country, Dr. Frieden said, “tobacco ads are used as wallpaper.” Smoking is freely depicted in movies and popular TV shows.

R for raising taxes, which studies have shown is the single most effective way to reduce smoking in the population, especially among teens.

“A higher cigarette tax is not a regressive tax, because it would help poor people even more than the well-to-do,” Dr. Frieden noted. President Obama has proposed an additional 94-cent-per-pack tax on cigarettes, which would yield $80 billion to fund universal prekindergarten.

Smokers ready to quit can choose from among a cornucopia of aids as wide-ranging as nicotine substitutes, low-dose antidepressants, hypnosis and acupuncture. While none by itself has a high rate of success, different methods have proved effective for different people. Many former smokers required several attempts before they managed to quit for good.

But quitting smoking does not necessarily require assistance. As two public health specialists, Andrea L. Smith and Simon Chapman at the University of Sydney in Australia, have pointed out, “The vast majority of quitters do so unaided.” A Gallup Poll conducted last year in the United States found that “only 8 percent of ex-smokers attributed their success to [nicotine replacement therapy] patches, gum or prescribed drugs,” these experts noted. “In contrast, 48 percent attributed their success to quitting ‘cold turkey’ and 8 percent to willpower, commitment or ‘mind over matter’.”

They added, “For many smokers, having a reason to quit (a why) was more important than having a method to quit (a how).”

For my husband, who smoked a pack a day for 50 years, the “why” was his distress at seeing two beautiful young nieces smoking; he made a pact with them to quit if they would, and he followed through.

Techniques that can help people trying to quit when troubled by the urge to smoke include waiting 10 minutes and distracting yourself; avoiding situations you associate with smoking, at least until you have become a committed ex-smoker; using stress reducers like physical activity, yoga, deep breathing, muscle relaxation and self-hypnosis; seeking moral support from a nonsmoking friend, family member or online stop-smoking program; and oral distractions like chewing sugarless gum or raw vegetables.

Electronic cigarettes are being promoted by some as a way to resist the real thing. E-cigarettes, invented in 2003 by a Chinese pharmacist, contain liquid nicotine that is heated to produce a vapor, not smoke. More than 200 brands are now on the market; they combine nicotine with flavorings like chocolate and tobacco.

But their contents are not regulated, and their long-term safety has not been established. In one study, 30 percent were found to produce known carcinogens. Dr. Frieden said that while e-cigarettes “have the potential to help some people quit,” the method would backfire “if it gets kids to start smoking, gets smokers who would have quit to continue to smoke, gets ex-smokers to go back to smoking, or re-glamorizes smoking.”

Nearly two million children in American middle and high schools have already used e-cigarettes, Dr. Frieden said. In an editorial in the Canadian Medical Association Journal last year, Dr. Matthew B. Stanbrook, an assistant professor of medicine at the University of Toronto, suggested that fruit-flavored e-cigarettes and endorsements by movie stars could lure teens who would not otherwise smoke into acquiring a nicotine habit.

A survey in 2011 of 75,643 South Korean youths in grades 7 through 12 by researchers at the University of California, San Francisco, revealed that four of five e-cigarette users also smoked tobacco. It could happen here: Stanton A. Glantz, the study’s senior author and a professor of medicine at the university, described e-cigarettes as “a new route to nicotine addiction for kids.”

Source: New York Times

Smoking during pregnancy could make your baby gay

Smoking and drinking during pregnancy could make your baby gay and stupid, if the claims of a neuroscientist are to be believed.

A controversial study has found that a pregnant woman’s lifestyle could influence their child’s IQ or sexuality.

Dr Dick Swaab – professor of neurobiology at Amsterdam University – claims that drinking, taking drugs or living in a area with high pollution levels have an impact on the development of foetuses and could affect children later in life.

Taking synthetic hormones and smoking while pregnant can increase the chances of girls becoming lesbian or bisexual, while drinking and drug-taking could lower a child’s IQ, Dr Swaab suggests.

And the more older brothers a boy has, the more it is thought to increase his chance of being gay, it is reported. The study claims this could be because the mother’s immune system develops stronger responses to male hormones with each son that is born.

Dr Swaab also believes living in an area of high pollution is linked with an increased risk of autism.

He told the Sunday Times: ‘Pre-birth exposure to both nicotine and amphetamines increases the chance of lesbian daughters.

‘Pregnant women suffering from stress are also more likely to have homosexual children of both genders because their raised level of the stress hormone cortisol affects the production of foetal sex hormones.’

He added: ‘In women who drink a lot, cells that were meant to migrate across the foetal brain can end up leaving the brain altogether.’

However, Dr Swaab recognised lifestyle factors were a small influence and added that genetics play the most important role in child development.

Source: Metro News

Anti-smoking efforts have saved 8 million American lives

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.

The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.

By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.

An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.

“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.

Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.

Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.

Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.

Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.

Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.

A spokesman for R.J. Reynolds Tobacco Company declined to comment.

David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.

“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”

Source: USA Today

E-cigarette vapor contains nicotine, not other toxins

People standing near someone using an e-cigarette will be exposed to nicotine, but not to other chemicals found in tobacco cigarette smoke, according to a new study.
E-cigarettes, or electronic cigarettes, create a nicotine-rich vapor that can be inhaled, or ‘vaped.’

Researchers and regulators have questioned whether e-cigarettes are a smoking cessation aid or may lure more young people toward smoking, as well as what effects they have on health.

“There is ongoing public debate whether e-cigarettes should be allowed or prohibited in public spaces,” study co-author Maciej Goniewicz told Reuters Health in an email.

Goniewicz is a cancer researcher in the Department of Health Behavior at the Roswell Park Cancer Institute in Buffalo, New York.

“E-cigarettes contain variable amounts of nicotine and some traces of toxicants. But very little is known to what extent non-users can be exposed to nicotine and other chemicals in situations when they are present in the same room with users of e-cigarettes,” Goniewicz said.

He and his colleagues conducted two studies of secondhand exposure to e-cigarette vapors in a laboratory. Their results were published in Nicotine and Tobacco Research.

In the first study, the researchers used an electronic smoking machine to generate vapor in an enclosed space. They measured the amount of nicotine as well as carbon monoxide and other potentially harmful gases and particles in the chamber.

The second study included five men who regularly smoked both tobacco cigarettes and e-cigarettes. Each man entered a room and smoked his usual brand of e-cigarette for two five-minute intervals over an hour while the researchers measured air quality. The room was cleaned and ventilated and the experiment was repeated with tobacco cigarettes.

The researchers measured nicotine levels of 2.5 micrograms per cubic meter of air in the first study. Nicotine levels from e-cigarettes in the second study were slightly higher at about 3.3 micrograms per cubic meter. But tobacco cigarette smoking resulted in nicotine levels ten times higher at almost 32 micrograms per cubic meter.

“The exposure to nicotine is lower when compared to exposure from tobacco smoke. And we also know that nicotine is relatively safer when compared to other dangerous toxicants in tobacco smoke,” Goniewicz said.

E-cigarettes also produced some particulate matter, but regular cigarettes produced about seven times more. E-cigarettes didn’t change the amount of carbon monoxide or other gases in the air.

“What we found is that non-users of e-cigarettes might be exposed to nicotine but not to many toxicants when they are in close proximity to e-cigarette users,” said Goniewicz.

“It is currently very hard to predict what would be the health impact of such exposure,” he added.

He said more research is needed to find out how the current findings correspond to “real-life” situations, when many people might be using e-cigarettes in a room with restricted ventilation.

Source: Ahram online

Strict parenting may reduce teen smoking

Parents who set limits are less likely to have kids who smoke, regardless of their ethnic and racial backgrounds, according to a new U.S. study.

Researchers surveyed middle schoolers from diverse backgrounds and found those whose parents had an “authoritative” and “structured” parenting style were also more likely to be discouraged from smoking by their parents and less likely to become smokers.

“Many past studies have examined broad parenting styles, however this study looked at how specific parenting strategies may help protect youth from cigarette smoking initiation,” said Cassandra Stanton, an assistant professor in the oncology department at Georgetown University, who led the study.

“We also note that unlike many studies in the area that are conducted in largely white middle class samples, this study was conducted in an urban multi-ethnic low-income school district,” Stanton told Reuters Health.

It’s important to identify ways of helping parents prevent kids from starting to smoke, Stanton’s team writes in the Journal of Pediatric Psychology, because the majority of lifetime smokers begin before the age of 18.

Although the number of teenage smokers has declined significantly, one in three young adults reports smoking at least once in the past 30 days, according to a 2012 report by the U.S. Surgeon General.

Past research has found links between low discipline, parental disengagement and increased risk of smoking, Stanton’s team notes. Rates of smoking vary among ethnic groups, with white students smoking daily at a rate twice that of African American and Latino students. However, African Americans and Latinos experience significantly higher rates of smoking-related health complications later in life compared with whites.

To delve deeper into which parenting strategies are effective among a diverse set of families, the researchers recruited 459 eighth graders from two low-income inner-city schools in the Northeast. The students averaged 13-years-old, with 29 percent identifying themselves as Hispanic, 34 percent as African American, 17 percent as non-Hispanic white and 20 percent as other/mixed ethnicity.

The students took a comprehensive survey in class with parental consent. The survey asked about the student’s smoking history and whether the student’s parents smoked. It also asked questions about parenting styles, such as discipline and warmth, and whether the student would receive punishments and discussion of the dangers of tobacco if caught smoking.

The researchers then followed up four years later to assess whether students had smoked.

Stanton’s group found that what they called controlling parenting, which was associated with rule enforcement, curfews and set bedtimes, was more likely than a less strict, more understanding parenting style to go hand in hand with so-called anti-tobacco parenting strategies.

Those anti-tobacco strategies include punishing a child if he or she has been caught smoking and discussing with the child the motivations behind smoking and why smoking is so dangerous. Being on the receiving end of such anti-tobacco strategies was in turn linked to a lower likelihood of lifetime smoking for the student.

The association held regardless of race or ethnicity, which the researchers say should be reassuring because other cultural differences don’t seem to alter the effectiveness of this approach.

It is important for parents to take an active role in protecting their children from developing an addiction to tobacco, Stanton said.

“Setting and enforcing clear standards of behavior and actively monitoring and supervising a teen’s activities are important strategies for protecting youth from risky behavior,” she said.

“To protect youth from experimenting with tobacco and ultimately developing an addiction to tobacco, it is important to talk about the risks of tobacco, as well as set and enforce clear rules and consequences that are specific to tobacco.”

Heather Patrick at the Health Behaviors Research Branch of the National Cancer Institute, who was not involved in this study, believes structure and authority in parenting is an important tool in preventing teens from smoking. However, she cautions, “heavy-handed” parenting can often cause stress and strain in the relationship.

Patrick said smoking cessation interventions should be tailored to different groups to be more effective. “It’s helpful for intervention materials to have images that show a diversity of racial and ethnic groups,” she wrote in an email.

It’s also helpful, she said, for anti-smoking messages to provide examples, “like how to deal with cravings, how to be smoke free when all of your friends are smoking, or how to deal with conflict at home, to connect with the kinds of experiences real teen smokers face.”

Source: US web daily

Report Warns Future Smoking Epidemic Among African Youth

A new report from the American Cancer Society warned that Africa will face a severe health threat from the fast-growing increase in tobacco use.  The report combines African smoking rates and cigarette consumption with population trends, and found that without aggressive intervention, the continent will experience a significant increase in smoking in the near future.

The report, “Tobacco Use in Africa: Tobacco Control through Prevention,” reveals that Africa as a region has the smallest number of smokers and smallest rate of tobacco use in the world.  About two percent of all cigarettes are consumed by smokers in Africa, but they make up about six percent of the world’s smokers.

While the numbers are small for now, Evan Blecher, a Cape Town, South Africa based senior economist for the American Cancer Society said these small numbers also provide the greatest for growth.

“That means along with it will come an increase among tobacco-related, smoking-related diseases in an environment where health systems are already significantly over-stretched because of infectious diseases like malaria and HIV,” said Blecher.

While adult smoking among both among men and women is low in Africa, he pointed out that’s not the case with youth.

“We found that African children smoke at comparable levels, and sometimes even higher than other developing regions of the world, particularly Asia.  What’s driving this is unclear, but it must be because of significantly more aggressive tactics from the tobacco industry itself.  But, also it’s in an environment where children aren’t protected from advertising, marketing… in the way that they are in places like the United States,” explained Blecher.

In addition he said,–that while smoking rates are lower in Africa than other regions, it doesn’t mean there is no variation in smoking patterns within the continent.

“On the one hand, we’ve got a lot of countries with really low smoking prevalence, like Ghana for instance, or Nigeria,” said Blecher. “And that’s compared to countries of very high smoking prevalence like South Africa or Mauritius, which have prevalence more similar to what we see in the developed world.

“But, what we do know is that smoking is declining in those markets like South Africa and Mauritius, and increasing in markets like Ghana and Nigeria.

“These other markets which have smaller smoking prevalence are more concerning to us because these are places with much larger populations, which creates a situation where we expect both the number of smokers and smoking prevalence to increase dramatically over the next generation or two,” explained the senior economist.

Blecher attributes the decline in smoking in countries such as South Africa and Mauritius to very strict tobacco control policies like advertising bans, smoke free areas, and very aggressive tax policies.

“Tax policies are critically important in environments where incomes are growing rapidly, because as incomes grow, everything becomes cheaper and more affordable, including cigarettes.  So you need for tax policies to be able to ensure that tobacco products are not becoming more affordable.  So in a country like South Africa where we’ve seen tax rates increase dramatically over the last 20 years–we’ve also seen smoking prevalence plummet.  Twenty years ago, 33 percent of South African adults smoked, and nowadays only 20 percent of them smoke.  It’s a result of deliberate action, rather than luck,” said Blecher.

There is a broader movement in Africa towards comprehensive tobacco control policies like advertising bans and smoke free areas, be said, but these efforts are not enough.

“Tax policy is something that hasn’t really been pursued by African governments with respect to tobacco, partly because the tax systems aren’t as developed as they are in places like South Africa and Mauritius.  So the technical capacity to implement, enforce and administer tax policies is just not where it needs to be at the moment,” stated Blecher.

In addition, he said more needs to be done to educate Africans on the dangers of smoking.  While most Americans are aware of the risk of disease and even death caused by smoking, the idea that smoking is harmful is mostly not known in Africa, especially in rural areas.

As more African countries pursue tobacco control policies, Blecher said people will become more knowledgeable about the harmful effects of smoking. It is not by accident that people in the United States are aware of the dangers of smoking, it is through deliberate action, he said.

Source: Voice Of America


Exercise may help pregnant women quit smoking

For pregnant women who want to quit smoking, a brisk walk can temporarily stave off tobacco cravings, says a Canadian study.

Previous research has shown that exercise can interrupt nicotine cravings for both men and women. Whether the same was true for expecting mothers was unclear because pregnant women have increased metabolism, which can intensify longings for a cigarette, the researchers write in the journal Addictive Behaviors.

“This was the first time we have been able to replicate the findings with pregnant smokers,” Harry Prapavessis said.

Prapavessis, director of the Exercise and Health Psychology Laboratory at Western University in Ontario, Canada, led the research.

According to his team’s results, 15 to 20 minutes of walking at a mild to moderate pace is sufficient to ward off cravings.

For the study, researchers recruited 30 pregnant women in their second trimester in Canada and England. All of the women smoked more than five cigarettes a day and were not regular exercisers.

Half of the women were assigned to walk on a treadmill and the rest to watch a home gardening video for 20 minutes. Both groups did not smoke for between 15 and 19 hours before entering the lab.

The walkers reported an average 30 percent reduction in the desire to smoke based on a seven-point scale. But the cravings returned. Thirty minutes after exercising, the same group of women reported only a 17 percent craving reduction.

The exercising women also reported less irritability, restlessness, tension and other withdrawal symptoms. But because of the study’s small size, those results could have happened by chance.

“This translates not as a cure for quitting, but it can be part of a strategy,” said Dr. Sharon Phelan, who was not involved in the study.

Phelan is a fellow with the American Congress of Obstetricians and Gynecologists (ACOG) and professor at the University of New Mexico School of Medicine in Albuquerque.

“The challenge is that there isn’t one reason why pregnant women have an addiction,” Phelan said.

“I think it’s a very positive study,” said Dr. Raul Artal of Saint Louis University School of Medicine in Missouri. Artal helped write exercise and pregnancy guidelines for ACOG.

He said the new study will need to be repeated according to medicine’s gold standard of testing – a randomized, controlled trial. “But, based on common sense, the message is good,” he said.

Prapavessis said his team’s results can only be applied to women about 25 years old, the average age in the study. But, “I would like to think that we can repeat the findings with older or younger pregnant smokers.”

Prapavessis pointed out that because of the social stigma associated with smoking while pregnant, recruiting pregnant women for such studies can be extremely difficult.

The next step, he said, would be to repeat the results with women walking in natural environments outside of their homes. “We want to see if this craving effect can be reproduced when women go for a brisk walk for about 15 minutes in their natural setting,” he said.

Pregnant women also have the option to try nicotine replacement therapy drugs, like skin patches or lozenges, but more evidence is needed to know if these are completely safe during pregnancy, Phelan said.

To help pregnant smokers quit, Phelan stressed the importance of understanding the underlying reasons why a pregnant woman smokes. “It’s like when someone has a fever. You can treat it with an aspirin, but you haven’t gotten to the underlying cause.”

“One therapy for everyone isn’t going to fit all,” Phelan noted. Still, regardless of whether a woman has stopped smoking, exercise offers positive benefits, like improved circulation and muscle tone she said.

ACOG supports 30 minutes of light exercise like walking three or four times a week during pregnancy, Phelan said, but pregnant women should always talk with their healthcare provider before beginning exercise.

To beat cigarette cravings, she said, “This is a valid option to suggest to women and it may be helpful for some, but not to others.”

Source: Zee news