Children of smokers and their parents

Children of smokers often beg their parents to quit. Now those children — many of them too young to speak for themselves — are getting an assist from their pediatricians.
Pediatricians aren’t just asking smoking parents to quit. In a program launching statewide in Massachusetts this month, they are helping parents quit — by writing prescriptions for nicotine gum and other quitting aides and by referring them to telephone counselors for continuing support.
BETTER LIFE: Secondhand smoke linked to cognitive impairment
“Anytime you can get a parent to quit, it’s a win-win situation,” says Jonathan Winickoff, assistant professor of pediatrics at MassGeneral Hospital for Children.
Parents who quit live longer, on average, he says. They are less likely to smoke during future pregnancies. And their children are less likely to suffer sudden infant death syndrome, impaired lung development, middle-ear infections and severe asthma. Those kids also are less likely to become smokers, says Winickoff, founder of the stop-smoking program Clinical Effort Against Secondhand Smoke Exposure (CEASE). It is sponsored by the American Academy of Pediatrics.
A nationwide study is underway to see how many parents CEASE helps to quit. But an earlier study found 40% of smoking parents set a quit date when asked by their child’s pediatrician, Winickoff says.
Every pediatrician in Massachusetts will get a CEASE start-up kit this month and a chance to test the concept.
It already has worked for Terri DiJoseph of Somerville, Mass. DiJoseph, 35, an attorney, quit smoking when she got pregnant with her son, now 2. But last summer, she says, “I thought I could have just one. It was poker night with the girls and I gave in. Suddenly, it was a full-blown thing.”
At her son’s next appointment with Winickoff, DiJoseph confessed she was smoking again. She knew from previous talks with the doctor that toxic residues from her cigarettes were getting into her clothes and hair and reaching her son, even if she never smoked in her house or near the toddler. (In a paper published in Pediatrics in January, Winickoff coined the term “third-hand smoke” to describe those toxins and reported that just 43% of smokers believed they were harmful to children.)
DiJoseph walked out of a follow-up appointment with a prescription for a stop-smoking drug. She smoked her last cigarette soon afterward and inspired her husband to stop smoking, too.
She says none of that would have happened so quickly if she had waited to see her own doctor. “I see the pediatrician all the time. I see my primary-care doctor once a year at best.”
Parents often grateful for the intervention
That’s why enlisting pediatricians in front-line smoking cessation efforts is a great idea, says Thomas Glynn, director of cancer science and trends at the American Cancer Society. “It’s such a golden opportunity,” he says. “No parent wants to harm their child.”
But persuading busy pediatricians to devote time to a parent’s problem could be tough, he says.
Winickoff acknowledges that pediatricians are often reluctant anti-smoking crusaders. They worry about finding the time, training and money to do an adequate job and about alienating smoking parents, he says. But, he says, those who raise the issue often learn that parents are grateful. And many parents who are not ready to quit will take other steps — such as banning smoking from their homes and cars — that improve children’s health, he says.

Tax may cut smoking rates

A big hike in the federal tax on cigarettes taking effect on April 1 may prompt 1 million U.S. smokers to quit, according to public health experts.
Expansion of a popular public health insurance program for lower income children is being financed by an increase in the federal excise tax on a pack of cigarettes of about $1.01 per pack, up from the current 39 cents on a $4.35 pack.
Smoking kills about 440,000 Americans annually and costs the nation $193 billion in medical expenses and lost productivity, said Dr. Terry Pechacek of the U.S. Centers for Disease Control and Prevention’s Office on Smoking and Health.
“There is almost unanimous agreement across the scientific community and policymakers that raising the price of cigarettes in whatever fashion has a consistent effect on reducing smoking rates, increasing the quit rate among adult smokers and preventing the initiation of regular smoking by children and young adults,” Pechacek said in a telephone interview.
Danny McGoldrick, the Campaign for Tobacco-Free Kids advocacy group’s vice president for research, said the formula is simple: as prices rise, fewer people buy cigarettes.
McGoldrick forecast the tax hike will persuade just over 1 million current smokers to quit and prevent 2 million children from starting. These changes will avert about 905,000 smoking-related deaths and save $44.5 billion in healthcare expenses over time, McGoldrick predicted.
President Barack Obama signed the expansion of the State Children’s Health Insurance Program on February 4. President George W. Bush had twice vetoed the bill, which also raises federal taxes on cigars and other tobacco products.
The industry is unhappy. Higher prices will lead to at least a 10 percent decline in cigarette sales and could put 117,000 people out of work, said Thomas Briant, executive director of the National Association of Tobacco Outlets.
Briant, whose group represents the operators of 2,500 retail stores, tobacco wholesalers, cigarette manufacturers and others, decried “the single largest tax increase on a product in the history of the United States.”
“There’s going to be an immediate drop-off in sales because of that tax increase as of April 1,” Briant said. “We expect the fall-out from that in terms of job losses to take about six to nine months from that date.”
Retail store clerks and cashiers, truck drivers who deliver cigarettes, warehouse workers, sales representatives and others may lose jobs, Briant said.
U.S. smoking rates have been declining slowly for decades. The CDC’s most recent data showed about 19.8 percent of U.S. adults — 43.4 million people — were smokers in 2007.
Smoking rates vary by state — from a high of 28 percent in Kentucky to a low of 12 percent in Utah. Rates are often higher where state tobacco taxes are lower. The average state tax is $1.32 per pack, ranging from a low of 7 cents in South Carolina to a high of $2.75 in New York state.
State taxes have more than doubled in the past six years and more states and localities are banning smoking from public places like office buildings, restaurants and bars.
Daniel Smith, president of the American Cancer Society’s Cancer Action Network, said the next important step is for Congress to give the U.S. Food and Drug Administration power to regulate tobacco products. The FDA already oversees drugs, medical devices, most foods, cosmetics and animal drugs.
A House of Representatives panel approved the long-stalled measure on March 4. It still needs passage by the full House and Senate. “This is the year to make it happen,” Smith said.
Source:   Reuters

Britons 'in denial' over heart risk from obesity and smoking

Britons at high risk of heart attack are ‘in denial’ and ignoring doctors’ advice to change their lifestyle, says a new survey.
More than three-quarters are obese or overweight – with dangerously big stomachs – and most smokers have refused to give up.
More than half have out-of-control blood pressure and 40 per cent have high cholesterol levels.
Two out of three refuse to accept they are more at risk than other people their age – despite being given warnings by their GP and lots of prescription drugs.
The findings from a major European survey are published today in the European Journal of Cardiovascular Prevention and Rehabilitation.
Around one in three middle-aged Britons is at high risk of heart disease because of factors such as obesity, diabetes, family history, high cholesterol and blood pressure levels.
This means they have a one in five chance of suffering a fatal heart attack unless they change their lifestyle.
The new survey of 12 countries looked in detail at 381 high risk patients in the UK, who had been diagnosed as ‘high risk’ at least six months earlier by their GPs.
In many cases they were taking medication as a result.
Almost 80 per cent of those who were smokers at the time had not given up despite smoking being a major cause of heart disease.
Four out of five high risk patients were overweight or obese with dangerously large waists containing deposits of abdominal fat that raise the chances of diabetes and heart problems.
The EUROASPIRE survey showed two out of five patients said they did not take regular exercise and had no plans to do so.
Around half had diabetes, including seven per cent whose condition was detected when they were taking part in the survey and having various tests.
In total, 57 per cent of patients had raised blood pressure despite three-quarters of them being on antihypertensive drugs.
At least 40 per cent of patients had high blood cholesterol, even though the UK uses more statin drugs than any other European country except Italy.
But there was an alarming level of ignorance among British patients about their state of health.
Altogether two-thirds said they did not think their risk of heart disease was higher than a person in the general population of the same age and sex, including 16 per cent who thought it was lower.
Just 33 per cent believed it was higher – as their doctors had told them.
Professor David Wood, an expert in cardiovascular medicine at the National Heart and Lung Institute, Imperial College, London, said the survey raised concerns that many Britons were in denial about their heart health.
He said ‘These figures are quite shocking.
‘This is high risk population, diagnosed by their GPs and started on treatment. They should be managed much more rigorously and their lifestyle should be changing.’
‘Therapeutic control of their conditions is poorer compared with that achieved by specialists caring for patients with coronary disease,’ he added.
He said one in three people aged between 40 and 75 years were at higher risk of heart disease, although many had not been diagnosed.
He said European research showed that nurse-led programmes in GP surgeries were the best way to help high risk heart patients change their lifestyle – and that of their partners.
Four out of five families ate more fruit and vegetables when nurses got involved, and the number doing physical activity doubled, he said.
‘We have the evidence to back this and we must do better at helping people change their lifestyle and adhere to their medication’ he added.
The survey used trained technicians to question 381 patients who had been told they were at high risk of heart disease before developing any symptoms.
They were prescribed drugs or being treated with dietary advice.
The fact that so few smokers had quit goes against the national trend, with more people giving up since the ban on smoking in public.
However, many of these patients in their 40s, 50s and 60s will have been smokers for decades.

NJ considers smoking ban for Atlantic City casinos

ATLANTIC CITY, N.J. (AP) — New Jersey is considering a ban on smoking in all of Atlantic City’s 11 casinos — something the city itself has been unable to impose.
A state Senate committee is considering a bill to remove the casino exemption to the statewide smoking ban in public places. That’s something the Atlantic City Council has tried — and failed — to do three times.
Under a compromise that seems to be pleasing no one, smoking is restricted to no more than 25 percent of the casino floor. That has smokers fuming that there’s not enough space for them, and many casino workers angry they still have to breathe second-hand smoke, even in non-smoking areas.
Don Salsburg, a craps dealer in Atlantic City casinos for 25 years, said he never would have gotten into the industry if he knew then what he knows now about the dangers of second-hand smoke.
“The shortness of breath, the burning of my eyes and nose, and the headaches are par for the course for me,” he said. “The city and state have told me there’s a significant probability I will have to die younger for money.”
But Tom Scully, a dealer at the Borgata Hotel Casino & Spa, said a total smoking ban could cost him and thousands of his colleagues their jobs and their ability to support their families.
“This is not about smoking, but remaining gainfully employed,” he said. “If all things were equal, of course I would want to work in a smoke-free environment. But all things are not equal; people have other options than Atlantic City.”
Atlantic City is in its third year of a revenue drop that began when Philadelphia-area slots parlors opened, offering gamblers the opportunity to play — and smoke — much closer to home.
The global economic crisis is also hitting the Atlantic City casinos hard. Thousands of jobs have been lost, three casinos are in bankruptcy, a fourth is headed there in a week or two, and still another is fighting off foreclosure.
“To (enact a total smoking ban) at this time of tremendous economic strife and uncertainty for our industry would be very damaging to our entire industry and particularly to those of our casinos and their thousands of employees which are struggling to survive,” said Joseph Corbo, president of the Casino Association of New Jersey, the industry’s trade group.
“Without question, these have been the most difficult circumstances that New Jersey’s casino industry has faced in its 30-year history, both in terms of duration and impact,” he said. “What is even more concerning is that there is no light at the end of the tunnel as there are no indications that the economy will improve anytime soon.”
State Sen. Joseph Vitale, chairman of the Senate committee that heard testimony on Tuesday, said the casinos will never willingly accept a total smoking ban.
In 2006, New Jersey enacted a statewide smoking ban but conspicuously exempted the casinos from it. Otherwise, there would not have been enough votes to pass the measure, Vitale said.
Atlantic City’s local government has tried three times since January 2007 to enact a total smoking ban but backed off each time in the face of fierce opposition from the casinos.
A bill passed the Senate 35-0 in 2007 but was never voted on by the Assembly. No votes have been scheduled in either chamber this year.
Dr. Fred Jacobs, New Jersey’s former health commissioner, said there is no excuse for continuing to allow smoking in casinos.
“Are the casino workers less worthy of protection than all other workers in our state?” he asked. “What price do we put on the health of the casinos? How much revenue is each worker’s life worth? Do we legally ignore workers’ safety and health in any other industry in America? The answer is no.”

Obama's smoking habit

US President Barack Obama has come under attack at the 14th World Conference on Tobacco or Health here for smoking in public – and urged to kick the habit.
Obama was singled out at the meet among successful men with a smoking habit.
Anti-smoking activists, doctors and experts described Obama’s smoking as an “irresponsible” act taking into account his influential public persona.
“I was not aware that Obama smokes. It was shocking for me to know this,” a public health activist from Jordan, Kawkab Shishani, told IANS.
Shishani, a delegate, said smoking by a world leader like Obama sends a wrong message. “What would the young learn from him? Obama should give up smoking sooner than later.”
“It is better if Obama did not smoke in public. After all he is a role model for others,” said Monique Lalonde, a health promotion agent from the Montreal Public Health Department in Canada.
Another anti-smoking activist, Omar El Shahwy from Egypt, said Obama should stop smoking immediately. “He should join the tobacco control campaign as he must be aware of the harmful effects of smoking.”
Obama has been described as a moderate smoker who puffs up to 10 cigarettes a day. During the presidential campaign, he was under pressure to set an example by giving up his reportedly two-decade-old habit.
The 14th World Conference on Tobacco or Health – a meeting of anti-tobacco advocates, health experts, scientists and educators – began in Mumbai Sunday. It is the first time the event is being held in India.
More than 2,000 delegates from the world are attending the five-day conference at the National Centre for Performing Arts. It will end March 12.

National Tobacco Bill: 400,000 jobs on the line

If passed into law, the National Tobacco Bill which is currently on the floor of the National Assembly will lead to at least 400,000 Nigerians being thrown into the unemployment market.
This was the view expressed by the Chairman, Senate Committee on Industries, Senator Kamorudeen Adedibu while speaking with reporters recently in Iseyin, Oyo State at the 2008 Farmers’ Productivity Day/Award Ceremony.
Describing the bill as a “misplaced priority” for the country, Adedibu who represents Oyo South in the Senate also vowed to mobilize his colleagues in the upper legislative chamber to ensure that the bill is defeated.
“The bill is actually more than regulation. It is more than that. The bill if it goes through and Insha Allah, it won’t, will render the tobacco companies useless. It is going to increase smuggling and most especially, it is going to stop the necessary means of livelihood for over 400,000 people,” the Senator stated.
He also hinted that the Senate should concern itself more with bills that will “help people, put money in their pockets, put food on their tables, boost education and not bills that will lead to unemployment.”
Adedibu commended BATN for its CSR initiatives which he said has helped to create wealth in the rural areas of the state, and urged it not to relent. He congratulated the award winners, and assured the farmers of his commitment to fight for their cause at the national assembly.
Speaking in the same vein, the Oyo State Commissioner for Commerce and Cooperatives, Dr. Kola Balogun, commended BATN for creating jobs for the rural population in the state, saying that this has helped in no small way in reducing the rural-urban drift among the population, with the attendant increase in crimes in urban cities. He urged other players in the private sector to emulate the BATN example by establishing bob-creating industries in the rural areas.
According to him, the current administration in the state has observed with pleasure the direction of BATN’s policy objectives as they relate to the development objectives of the state government.
He pointed out that the company has never disappointed the state government as it has made major impacts in the areas of employment generation, opening up of rural communities for wealth creation, job skill acquisition, and payment of taxes to the government.
He noted that the company’s community development programme, which is the core thrust of its corporate social responsibility has reduced drastically the rural-urban drift of semi-skilled and unskilled labour, a group that has become a menace to urban cities in terms of an increase in the crime rate.
Balogun commended BATN for the farmers’ award initiative because of its complimentary contents to the objectives of good governance. “The most insightful of this initiative lies in its focus on the grassroots rural population for capacity building through appropriate exposure to modern farming method and technique that is geared towards ensuring high product quality and productivity,” he said, adding that “the process has provided employment to the rural dwellers with its accompanying wealth creation potentials, which also constitutes a deliberate reward approach that recognizes integrity in labour.”
He expressed the support of the government and people of the state to BATN, describing the company as a shinning example to other private sector operators in Nigeria. He also congratulated the winners for demonstrating exceptional skills in their productivity while still operating within the confines of the Growers’ Agreement which frowns upon child labour in tobacco growing activities.
Speaking also, BATN’s Area Corporate and Regulatory Affairs Director, Mr. Alistair Hide said that the Farmers’ Award which was instituted in the 2004 crop season through its 100 per cent owned subsidiary, BATN Iseyin Agronomy, was directed at rewarding tobacco farmers for attaining the criteria set by the company with the objective of delivering an improved yield.
In addition, he said, the award plays an even more important role in facilitating a mutually beneficial relationship between the company and the farmers with a particular emphasis on sustainable social and environmental practices around tobacco growing. The result of the initiative, he disclosed, has been an increase in the income of the farmers. For instance, he said, the farmers’ income in 2008 increased approximately to N526 million from about N494 million in 2007.
During this period, he added, the farmers were encouraged to imbibe the tenets of socially responsible tobacco production which include integrated crop management, soil and water conservation, reducing the use of agrochemicals, observing environmental and safety standards in green leaf threshing, eliminating exploitative child labour, as well as encouraging alternatives to the use of wood in curing and sponsoring and promoting reforestation.
He said the company was immensely proud that of all the major tobacco companies, the BAT Group has the closest links to farmers who grow tobacco worldwide, adding that the company trains, advises and supports farmers on all aspects of crop production.
“This is or own little way of complementing the efforts of the federal government to create jobs and alleviate poverty by assisting farmers to achieve livelihood through tobacco and other agricultural cultivation. As partners in progress, this can only get better with time and we are proud in equal measure in associating with the one key programmes of the 7-Point Agenda of President Umaru Musa Yar’Adua,” Hide said.

One Drug May Help People Put Out The Cigarette

A popular smoking cessation drug dramatically reduced the amount a heavy drinker will consume, a new Yale School of Medicine study has found. Heavy-drinking smokers in a laboratory setting were much less likely to drink after taking the drug varenicline compared to those taking a placebo, according to a study published online in the journal Biological Psychiatry.
The group taking varenicline, sold as a stop-smoking aid under the name Chantix, reported feeling fewer cravings for alcohol and less intoxicated when they did drink. They were also much more likely to remain abstinent after being offered drinks than those who received a placebo, the study found.
Additionally, there were no adverse effects associated with combining varenicline with alcohol in the doses studied. When combined with low doses of alcohol, varenicline did not change blood pressure or heart rate, nor did it seem to induce nausea or dizziness.
“We anticipate that the results of this preliminary study will trigger clinical trials of varenicline as a primary treatment for alcohol use disorders, and as a potential dual treatment for alcohol and tobacco use disorders,” said Sherry McKee, associate professor of psychiatry at the Yale School of Medicine and lead author of the study. Smokers are more likely to drink alcohol and to consume greater quantities of alcohol, and they are four times more likely to meet criteria for alcohol use disorders. Diseases related to tobacco use are the leading causes of death in alcoholics.
“A medication such as varenicline, which may target shared biological systems in alcohol and nicotine use, holds promise as a treatment for individuals with both disorders” according to McKee.
McKee said that 80% of participants receiving varenicline did not take a drink at all, compared to 30% of the placebo group. The findings suggest that varenicline has the potential to be at least as effective in reducing drinking as naltrexone, another drug found to reduce alcohol consumption in heavy drinkers. Unlike naltrexone, varenicline is not metabolized by the liver and may be safe to use by those with impaired liver function, a frequent consequence of heavy alcohol use, McKee said.

New Anti-Smoking Ads

State Health Commissioner Richard F. Daines, M.D., said, “We want to challenge clinicians across the state to take time at every office visit to talk to their patients who smoke.” Data show that when healthcare providers talk to their patients about smoking and offer assistance with quitting, long- term success can be dramatically increased.
“Studies show that many clinicians think they will alienate smokers by addressing the issue, but we have found that smokers expect doctors to ask them about smoking and are actually more satisfied with their care when offered assistance to quit,” added Commissioner Daines.
“Your Patients Are Listening” is the second phase of the award-winning “Don’t Be Silent About Smoking” campaign launched last year by the State Health Department’s Tobacco Control Program and its 19 Cessation Centers across the state. The campaign reached nearly 4 in 10 physicians in New York State.
“Among doctors, nurse practitioners, and physician assistants who saw the campaign, 80 percent said the ads grabbed their attention and 65 percent reported the ads made them think about doing more to help their patients stop using tobacco,” said Jeff Willett, Director of the state Tobacco Control Program. “Clinicians who saw the campaign were significantly more likely to ask their patients about smoking, advise them to quit, and provide medication to assist them. We expect the new ads to have an even greater impact on providers’ behavior.”
The ads for the $1.2 million campaign will run today in medical journals, major daily newspapers, and other publications in New York, as well as on medical websites. The campaign’s offers easy-to-access information and resources to help healthcare providers assist their patients who smoke.
Campaign materials will be distributed by the state’s 19 Tobacco Cessation Centers, whose staff provides free assistance, training and consultation to clinicians and healthcare organizations to improve the delivery of tobacco cessation services.
Tobacco addiction is the leading preventable cause of death in New York. Approximately 25,500 New Yorkers die every year from smoking. While most anti- smoking efforts target smokers, this campaign speaks directly to doctors, nurse practitioners, nurses, and physician assistants.
Two-thirds of smokers in New York State have visited a health care provider in the past year. “This presents a tremendous opportunity for doctors to intervene and give patients the help they need to quit successfully,” Dr. Daines said.
In 2007, 60 percent of New York’s 2.6 million smokers attempted to quit. Most smokers try to quit without effective treatment and, as a result, the majority will relapse to smoking. Evidence suggests that helping patients to overcome chronic tobacco dependence is one of the most cost-effective interventions clinicians can provide to improve their patients’ health.
In 2008, the “Don’t Be Silent About Smoking” campaign won the E-Healthcare Solutions award for Best Public Service Campaign as well as an American Graphic Design Award.