Tobacco prevention pays off in N.D.

Tobacco is a big problem in North Dakota. Each year it kills more than 800 people and costs the people of North Dakota more than $247 million in increased health care spending.
The Centre for Disease Prevention and Tobacco Control was established statewide measures initiated in 2008 to control tobacco-free policies that reduce secondhand smoke and promote tobacco-free in North Dakota. The people of North Dakota voted for the use of tobacco settlement dollars to prevent tobacco use and harm her.
Since 2009 we have achieved many positive results that save lives and save money for the people of North Dakota.
As a comprehensive program was put in place, the number of North Dakota school districts that have adopted comprehensive tobacco-free policies increased from 60 to 102.
In addition to K-12 schools, we are also working to promote tobacco-free colleges across North Dakota. Colleges and universities that enforce comprehensive tobacco-free policies increased from five to 12 campuses. These policies are a critical component, which prevent young adults from tobacco use.
And our work is bearing fruit.
According to the 2011 Youth risk behavior Review of North Dakota students, smoking among school children has decreased from 22.4 percent in 2009 to 19.4 percent in 2011. It’s not just smoking that down, either. The survey also reported a reduction in the use of other tobacco products such as chewing tobacco, snuff and fall, from 15.3 percent in 2009 to 13.6 percent in 2011.
The positive effect of our work can be felt all across North Dakota, and not just on school campuses. As an integrated program was launched, five communities were smoking regulations, banning smoking in public places, including bars, bringing the total number of smoke-free for up to seven communities in North Dakota.
There are more communities to the same purpose. “Smoke free” is becoming the norm in business, city, public and university campuses, which are, in fact, helped to reduce tobacco use among adults in North Dakota, with 18.1 percent in 2008 to 17.4 percent in 2010.
We also conducted a successful advertising campaign that educated people from North Dakota to high cost of tobacco, in both deaths and dollars spent.
In addition, the independent evaluation report commended our efforts, as well as the State Department of Health, local public health units and other partners to reduce health and social costs of tobacco use in North Dakota.
Dr. Kyle Muus Center for Rural Health and an author of the report said that our program and staff did a good job in working toward our goal, especially considering how early in the process we are.
We are extremely pleased by the positive results we’ve seen so far, but our work is not done until we help all smokers quit smoking and tobacco use in North Dakota is going to low single digits. Despite the success we have achieved, we still face some serious challenges as we continue to work to save lives and save money in North Dakota.
Although public opinion tells us that the people of North Dakota want and need to be tobacco-free policy, the influence of Big Tobacco is very strong. Every year the tobacco industry spends $ 12.8 billion nationwide marketing of its products. This is more than $ 35 million per day or about $ 25 promotion of tobacco for every $ 1 we spend to combat it.
But the fight against tobacco can win the battle. Science and experience give us proven, cost-effective strategies to prevent children from tobacco and help current users of tobacco smoke and to protect everyone from the harmful effects of passive smoking.
Thanks to the voters of North Dakota is one of two fully-funded tobacco prevention programs in the country. We are dedicated to continuing our efforts to save lives and money by reducing and preventing tobacco use in our sta

Two Maui Groups Get $150,000 Each for Tobacco Prevention

Two organizations in Maui County are among a list of the latest recipients to receive grant money from the Hawai’i Tobacco Prevention & Control Trust Fund.
The Lanai Community Health Center and Maui Family Support Services were awarded grants of $150,000 each over two years.
The funds are part of a larger, nearly $1 million in tobacco cessation community grants, awarded by the Hawai’i Community Foundation to a total of eight organizations throughout the state.
In Hawai’i, tobacco use claims the lives of 1,100 residents each year and costs the state $336 million annually in direct medical expenses, according to studies referenced by the Hawai’i Community Foundation.
The grants are aimed at developing and delivering cessation intervention programs specifically designed for low socioeconomic level tobacco users. The organizations were selected because of their ability to integrate cessation services into existing programs, and/or to design unique intervention to reach target populations.
The Lanai Community Health Center is the only health care provider on the island that serves residents who are uninsured or under-insured.
The LCHC is also the only federally qualified health center on the island, tailoring services to residents of low socioeconomic status.
The grant will allow the LCHC to add more intensive cessation interventions and support efforts to sustain services.
The Maui Family Support Services will use its grant funds to train staff, enhance infrastructure, and fully integrate cessation services into its existing service offerings.
The MFSS serves residents of low socioeconomic status and has been providing services to families in Maui County for more than three decades.
These new funding adds to cessation grants awarded in 2009 to address tobacco use throughout the State. Other recipients this year include:

  • American Lung Association of Hawaii, Freedom from Smoking Program: $150,000 over two years;
  • Waianae Coast Community Health Center, Ka Ha Ola (The Breath of Life): $150,000 over two years;
  • West Hawai’i Community Health Center, Comprehensive Tobacco Free Support in Collaboration with HOPE Services: $150,000 over two years;
  • Kokua Kalihi Valley Comprehensive Family Services, Sa Suu – Community Voices Leading to Community Action on Tobacco: $50,000 over one year;
  • Signs of Self, Smoking Cessation Program for Hawaii’s Deaf and Hard of Hearing: $26,300 over one year;
  • The Queen’s Medical Center, Smoking Intervention Guided Healing program: $150,000 over two years.

“Over the years, because of the commitment to invest Trust Fund resources in tobacco cessation programs, countless lives have been saved and youth and adult smoking rates in Hawai’i have decreased,” said Jennifer Schember-Lang, Hawai’i Community Foundation senior program officer.
Schember-Lang notes that despite this success, tobacco still causes more preventable disease, death and disability in Hawai’i than any other health issue.
“Now more than ever, there is great need to continue funding programs to help our residents quit tobacco,” she said.
By Wendy Osher

Va. slashes funding for tobacco prevention

Facing budget shortfalls, Virginia and other states have cut funding for tobacco-prevention programs, according to a report released Wednesday by a group of public health organizations.
The cuts have jeopardized reductions in youth smoking rates seen in recent years, according to the report by the Campaign for Tobacco-Free Kids, the American Cancer Society, the American Heart Association and other health groups.
Following a national trend, Virginia lawmakers cut funding for tobacco-prevention programs from $14.5 million in 2008 to $8.4 million this fiscal year, according to the report.
“Virginia has had an effective tobacco-prevention program, but the state has taken a big step backward and slashed funding by more than 40 percent,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, in a statement released by the group.
After the 1998 multibillion-dollar national tobacco settlement, Virginia dedicated 10 percent of its payments from the legal settlement to youth tobacco-prevention programs. A state budget shortfall in 2010, however, led state lawmakers to cut that amount to 8.5 percent.
As a result, the Virginia Foundation for Healthy Youth, a state-created foundation that is funded entirely with tobacco settlement money, saw its budget reduced 25 percent.
That led to cuts in some of the programs the foundation has financed since its creation in 2000, including an advertising campaign and grants to schools and civic groups for healthy lifestyle programs for children.
In 2010, about 70,000 children in Virginia participated in school or other youth organization tobacco-prevention programs funded by the foundation. This year, the number dropped to about 61,500.
Public health groups in Virginia have lobbied lawmakers to restore the funding at least to 10 percent of the settlement payments, said Keenan Caldwell, director of government relations for the American Cancer Society in Virginia.
“It is proven in the long run that if we keep kids from starting smoking, we can keep them from becoming lifelong smokers,” he said. “It saves us many costs associated with smoking.”
Caldwell noted that youth smoking rates dropped in Virginia during the 10-year period since a statewide tobacco-prevention campaign started. For high school students, the rate fell from 28.6 percent in 2001 to 19.7 percent in 2009. For middle school students, it dropped from 10.6 percent to 3.6 percent during the same period.
Most states are putting only a small percentage of their tobacco settlement payments or tax revenue into prevention, according to the report.
States will collect about $25.6 billion from the tobacco settlement and tobacco taxes in 2011, but they plan to spend just 1.8 percent of it — $456.7 million — on tobacco-prevention programs, or about 2 cents of every dollar collected, the report says.
Virginia is expected to collect about $299 million in revenue from the tobacco settlement and tobacco taxes this year, but the state will spend just 2.8 percent of it on tobacco-prevention programs, according to the report. That ranks Virginia 30th in the nation in tobacco-prevention spending.
By: John Reid Blackwell

How Does Smoking Affect Athletes?

Lung Health
One of the main impacts of smoking on athletic performance is a decrease in lung function. The lungs consist of delicate membranes which are able to filter oxygen out of the air and send it into the bloodstream. Oxygen is essential for muscle function, especially during exercise, when muscles demand more oxygen. Smoking breaks down tiny hairs called cilia which are meant to prevent foreign bodies, such as dust and other particles, from interfering with respiration. Eventually the lungs become less efficient in drawing oxygen from the air, which can lead to asthma, bronchitis and other lung ailments. For athletes, this means a decrease in stamina and performance, as muscles that get inadequate oxygen become fatigued more quickly. Smokers also tend to suffer from shortness of breath more often than nonsmokers, as their muscles and heart demand more oxygen than their lungs are able to supply.
Circulatory Health
Another impact smoking has on athletes is its effect on heart and circulatory health. Smoking causes the blood vessels to constrict and become blocked with plaque, and it can also increase blood pressure. Constricted blood vessels reduce blood flow to the muscles, further limiting the amount of oxygen the muscles receive. Loss of blood flow can significantly reduce muscular endurance, while the heart itself may also tire more quickly, as it works harder than it should to pump blood through clogged blood vessels.
Another disadvantage of smoking for athletes is that it can lead to greater chance of injury. When the muscles, heart and brain do not receive enough oxygen, mental and physical acuity can drop. This can cause athletes to make poor decisions, use bad form when exercising, or even become dizzy or faint. Smoking can also reduce the strength of bones and inhibit the body’s ability to repair skin, ligaments and tendons. This means that any injuries a smoker does sustain may take longer to heal, which means more time sitting on the bench.

Safety of dissolvable tobacco products disputed

Tobacco company rep David Howard waxes enthusiastic when he talks about a new product his employer, R.J. Reynolds Tobacco Co., has developed: a pellet of finely cured tobacco, binders and flavoring that dissolves in the mouth in 10 minutes.
Under test market in two U.S. cities — Denver and Charlotte, N.C. — Camel Orbs will join two dissolvable tobacco lozenges already on the market if it graduates to broader distribution. And Howard is optimistic it will.
“These products provide smokers with an option to enjoy the pleasure of nicotine without bothering others,” Howard said. “No secondhand smoke. No spitting. No cigarette butt.”
Dissolvable tobacco consists of small pieces of compressed, finely ground tobacco powder, binders and flavorings that are shaped into pellets, sticks or strips. When placed in the mouth, they dissolve within minutes, providing a nicotine hit.
The tobacco industry says that the products contain far fewer cancer-causing chemicals such as tobacco-specific nitrosamines and are a “harm reduction” strategy that, like electronic cigarettes, might help people turn to less risky tobacco habits or eventually quit smoking.
But public health officials and anti-smoking advocates fear that the products will help initiate a new generation of smokers. The flavoring and packaging appeal to children, they argue, and teenagers will gravitate toward a product they can easily hide.
On Thursday, the Food and Drug Administration will take up the issue with an advisory committee hearing on the effect of dissolvable tobacco products on public health.
“Tobacco companies are always one step ahead of the sheriff,” said Sen. Sherrod Brown (D-Ohio), one of several senators who asked the FDA to review the products. “They have found ways to evade the rules and regulations and public health warnings.”
The first dissolvable tobacco product, a lozenge called Ariva, debuted in 2001. But in the last year the number of products on sale or in test marketing has jumped and major tobacco companies have entered the arena. Reynolds is market-testing two other products, Camel Strips and Camel Sticks, in addition to Camel Orbs. Philip Morris is test marketing a dissolvable tobacco stick.
At the same time, use of smokeless tobacco — snuff, chew, electronic cigarettes and, increasingly, dissolvable tobacco — is growing at a rate of about 7% per year, according to a 2010 report by Research and Markets, an international market research and data company.
In some states, use of smokeless tobacco products among men is almost as high as the national prevalence of cigarette smoking among adults, which stands at 20.8%, according to the Centers for Disease Control and Prevention. Across the U.S., 7% of U.S. adult males use smokeless tobacco, the CDC said.
Use among children is growing too. According to a 2010 survey by Monitoring the Future, an annual nationwide study funded by the National Institute on Drug Abuse, 8.5% of 12th-graders said they had used a smokeless tobacco product in the last 30 days compared with 6.7% in 2003.
“Because it has a mild taste, we’re concerned dissolvable tobacco will be a starter product for kids,” said Matthew Myers, president of the Washington-based anti-smoking group Campaign for Tobacco-Free Kids. “Traditionally, girls have not used smokeless tobacco products. But this product does not have a substantial smell or require spitting. There is a real concern that this product will appeal to adolescent girls, particularly those concerned about weight.”
Public health officials also have expressed concern about the effect on teeth and gums of holding the product in the mouth for 10 to 20 minutes and the effect on the stomach from swallowing the tobacco chemicals.
Few studies have been done specifically on the potential health risks of dissolvable tobacco.
One study, published in March in the Journal of Agricultural and Food Chemistry, tested four dissolvable tobacco products, three of which were being test-marketed, and found they contained mostly nicotine and a variety of flavorings, sweeteners and binders.
Some products contained coumarin, which has been banned as a flavoring agent in foods because of its link to liver damage, said study author John V. Goodpaster, an assistant professor in the forensic and investigative sciences program at Indiana University-Purdue University Indianapolis.
Studies on other smokeless tobacco products show they are considerably less risky than smoking cigarettes and cigars, which raises the risk of lung and a variety of other cancers, respiratory illness and heart disease. However, smokeless products still increase the risk of oral, pancreatic and esophageal cancer as well as heart disease. They can cause gum disease and can be unsafe for a fetus, health experts say.
The lowered risks of dissolvable products should be seen as a positive development, said Brad Rodu, a professor of medicine and chairman of tobacco harm reduction research at the University of Louisville in Kentucky.
“One cannot call any tobacco product absolutely safe,” said Rodu, who said he received funds from tobacco companies to do his research but had no personal ties to any company. “But the health risks of using smokeless tobacco products over the long term are so low that they are barely measurable by modern epidemiological evidence.”
Rodu added that smoking-cessation aids such as nicotine gum and the medication Chantix have limited success and that people who can’t quit should be urged to try safer products.
“We have 45 million smokers in the United States,” he said. “If we had almost any other activity in society that was this dangerous, we would welcome products that were safer.”
Sara Troy Machir, vice president of communications and investor relations at Star Scientific Inc., maker of Ariva and another dissolvable tobacco product called Stonewall, said the Glen Allen, Va.-based company is developing two new products, Ariva BDL and Stonewall BDL, with lower levels of tobacco-specific nitrosamines (BDL stands for “below detection limits”).
Machir said the company was founded with the mission of reducing harms associated with tobacco use and that “we have absolutely no interest in recruiting another generation of tobacco users.”
Star Scientific applied to the FDA last year for approval to market its two new products as “modified risk tobacco products.” To the chagrin of anti-smoking advocates, the FDA announced in March that the products were not subject to regulation under the 2009 Family Smoking Prevention and Tobacco Control Act, which gives the agency the authority to regulate tobacco products.
Twelve senators, including Brown, Jeff Merkley (D-Ore.) and Barbara A. Mikulski (D-Md.), have asked the FDA to reverse its decision.
In April, the FDA announced it was developing a strategy to regulate additional categories of tobacco products and that it would review information on dissolvable tobacco from published studies, manufacturers’ research and the advisory committee meeting this week. The agency is expected to eventually close any loopholes that might prevent dissolvable tobacco products from escaping its jurisdiction.
“It’s very clear dissolvable products are here to stay, and I believe the FDA will have to deal with them,” Rodu said.
By Shari Roan, Los Angeles Times

Firing Up Tobacco Sales—Without the Smoke

As cigarette smoking continues to decline in the U.S., Reynolds American Inc. Chief Executive Daniel Delen wants Americans to consider new ways to consume tobacco.
Reynolds, the maker of Camel cigarette and Pall Mall smokes, is trying to shift its consumers to its smokeless brands, including moist snuff and Swedish-style snus, a type of spitless oral tobacco that comes in pouches. The company is about to have some new competition in that market. Last month, smokeless-tobacco giant Swedish Match AB, the dominant maker of snus in Scandinavia, announced plans to begin a major push into the category in the U.S. in coming months.
Reynolds can’t easily market the smokeless products as less-harmful alternatives to cigarettes. Federal law bars tobacco makers from making such claims unless they can furnish scientific evidence that a product would both reduce risk for individuals and provide a net benefit to the nation’s health.
Reynolds’s efforts to become less dependent on cigarette sales began under Mr. Delen’s predecessor, Susan Ivey, who was responsible for turning around the company after years of sales declines and market-share losses. Mr. Delen, 45 years old, worked with Ms. Ivey for years and had a hand in her success, running Reynolds’s main cigarette unit until he was tapped to replace her in March following her retirement. Winston-Salem, N.C.-based Reynolds ranks a distant No. 2 in the U.S. by sales after Altria Group Inc., maker of Marlboro.
Mr. Delen has smoked since he was 28, but now mostly uses Camel Snus, he says. He recently spoke to The Wall Street Journal about smokeless tobacco, regulatory challenges and what keeps him up at night. Excerpts:
WSJ: What impact is the still-sluggish economy having on cigarette sales?
Mr. Delen: The [unit] volume trends that we would expect have held constant, but people are shopping the category a little bit differently. We have seen down-trading [to cheaper brands]. It kind of makes sense if you think about it from a shopper’s point of view. Where do they mostly buy their tobacco? It’s gas and convenience stores. If there’s sticker shock at the pump, when they walk inside to buy their cigarettes, they are in a price-sensitive moment of the day.
WSJ: What’s driving growth of moist-snuff products like your Grizzly brand?
Mr. Delen: Increasingly more of our effort and focus is in the smokeless category. We see some organic growth in smokeless in general, but we also see consumers opting to switch between [the cigarette and smokeless] categories.
WSJ: Grizzly has gained market share in the face of tough competition from Copenhagen and Skoal.
Mr. Delen: Largely what we did there was we upgraded the packaging. It used to be an all-plastic kind of puck. We did a metal lid on the tin. Then, in the third quarter [of 2010], we asked R.J. Reynolds Tobacco Co. [the company’s main cigarette unit] to take over the [sales] activity. By bringing more feet on the street, we’ve seen significant gains. Historically you had somewhere over 300 people working in the American Snuff field force. Today that’s playing about 2,100.
WSJ: Tobacco companies have grappled with smoking-related suits for more than a decade. How would you characterize the company’s current level of financial risk from litigation?
Mr. Delen: The risk is coming down. Having said that, we still have a lot of work to do to successfully defend ourselves from some of the historic litigation that’s out there. There are fewer new cases, but more importantly, no new legal theories. So, I’m very confident in our ability to successfully defend the existing types of cases out there.
WSJ: You’ve used price promotions to help propel the growth of Pall Mall, your largest cigarette brand. Now that it’s better-established, will you promote it less? [Pall Mall, the third-largest U.S. cigarette brand by sales volume after Marlboro and Newport, boosted its market share to 8.5% in the first quarter from 6.5% a year earlier.]
Mr. Delen: We take different opportunities over time to make sure that we get some good trial and inflows, [cigarette] brand-switching. But over the long run, yes, we look at the bottom line very clearly and we’re continuing to look for opportunities to grow profitability on a per-unit basis as well as overall.
WSJ: [The FDA began regulating tobacco in 2009.] How challenging has FDA regulation been so far?
Mr. Delen: They are still busy organizing themselves, so it isn’t so well embedded yet. From a company point of view, there’s a lot of work and effort going on to bring all the aspects of the business into compliance. I tend to be optimistic about how this will end up, because the FDA certainly has told us—and it’s consistent with other product categories—that they are going to be a science-based decision maker.
WSJ: For snus to garner wider appeal, will you need regulators to let you promote it as a safer alternative?
Mr. Delen: Any help that comes from that side is welcome, but it’s not critical.
WSJ: What are the advantages for Reynolds of moving consumers to smokeless tobacco?
Mr. Delen: We have about a 30% [operating] margin on cigarettes and about 50% on smokeless, so there are benefits that way. But it’s not just about the bottom line. You start looking at long-term sustainability.
WSJ: What sort of challenges keep you up at night?
Mr. Delen: I’m a good sleeper. But it’s actually the things that are actually out of our direct control. We are a newly regulated industry. Litigation, you never quite know where that’s going day-to-day.
Write to David Kesmodel at

Opinions on labels vary among local smokers, doctors

When you pick up your favorite cigarette pack next year, you could find a photo of a diseased lung staring you down and challenging your decision to smoke.
Last month, the Food and Drug Administration announced it will begin requiring tobacco companies to cover the top half of cigarette boxes and 20 percent of tobacco advertisements with graphic anti-smoking images starting late next year.
Local residents said they doubt the warnings and their grisly pictures, which include trachea holes and rotting teeth and gums, will persuade them to stop smoking.
But local doctors say they hope the visual impact of seeing the health effects of smoking day after day will be enough to convince some residents.
“People who smoke already know the risks,” said Brett Badgerow, a Houma resident. “We see it on television. We saw it in school. We see it everywhere. Seeing it on a cigarette pack is just another friendly reminder. If it hasn’t worked anywhere else, why would it work for stubborn Americans?”
About one in four adults in Terrebonne and Lafourche smokes cigarettes, according to County Health Rankings 2011, a report that ranks the overall health of every county in the U.S. The report, released in March, is compiled by the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation in New Jersey. In Louisiana, 23 percent of adults smoke, compared to 15 percent nationwide.
About one in five Louisiana high school students smoke, a state Health Department survey found in 2008.
Dr. Greg Chaisson, an internal medicine doctor at Thibodaux Regional Medical Center, said many patients know some of the risks of smoking but are in denial about how it will affect their personal health. He said he thinks many people also don’t understand the varied and numerous health problems smoking causes.
“They do know it’s bad, but they think it will probably happen to someone else and not to them,” Chaisson said. “A picture is very vivid — it sticks with you.”
He said he hopes it will persuade some not to smoke, especially young people.
“I’d support anything that would dissuade patients from starting or continuing to smoke, but my guess is that it wouldn’t be very effective,” said Dr. Harry McGaw, a medical oncologist at Terrebonne General Medical Center.
Dr. Laura Campbell, chairwoman of the cancer committee at Thibodaux Regional Medical Center, said she doesn’t think the current text-only warnings for cigarettes are effective enough. She asks each of her smoking patients what they think the number one cause of death is for smokers. Most guess cancer.
“They haven’t got a clue, and it’s on every pack they light up,” she said. “People exercise some serious denial when it comes to cigarette smoking.”
The top cause of death for smokers is cardiovascular disease and strokes, Campbell said. That’s because smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.
“They say, ‘I won’t get cancer, because all people don’t get cancer,’ ” Campbell said. “But you will get vascular disease.”
Chaisson said many people think that because they’re healthy now, they can just keep smoking and quit later.
“Then 10 years pass by, and 20 years pass by, and a serious illness hits them,” Chaisson said.
McGaw said if you can name a type of organ cancer, it’s probably been linked to smoking.
“Cancer of the mouth and throat — which I think is one of the worst, because of the misery it causes patients,” he said. “Cancers of the esophagus, colon and kidney.”
Smoking can also cause a number of serious lung illnesses, including emphysema, chronic obstructive pulmonary disease and asthma, all of which will make it difficult for you to breathe.
“There is nothing good about smoking tobacco,” Campbell said. “If these warnings work, I will happily lose a big part of my business.”
If the health warnings do have you thinking twice, Campbell had a few suggestions for your campaign to quit. She advises her patients to think about behavioral modifications, changing and avoiding places and actions they associate with smoking.
“It might be as simple as sitting on the opposite side of the table when you have your morning coffee,” Campbell said.
Put a calendar in a place you see every day and mark the day you plant to quit smoking about three weeks ahead of time with a bold marking.
Nicotine withdrawal, which can cause anxiety, irritability, headaches and other physical and mental symptoms, lasts about a week and can be curbed with nicotine supplements or antidepression medications, she said.
Most of all, she tells patients that they have to quit for the right reasons.
“No one can make you quit,” Campbell said. “You have to decide for yourself to quit.”
Most locals interviewed randomly said they don’t think the advertisements will cause smokers to quit.
Wendy Picou, a Houma smoker, said the graphic pictures won’t affect her habit.
“Whenever — if ever — I do quit, it won’t be because of those pictures,” she said. “It’s just a waste of money.”
But Sara Peltier of Houma said if the warnings help one person quit smoking, they’ve done their job. And she’d take the warnings a step further.
Yes, we would all love to see everyone quit, but cigarettes are an addiction,” she said. “I also think they should put gruesome drinking-and-driving accidents on bottles of alcohol.”
By Nikki Buskey

Hidden risks of chewing tobacco ‎

More than 80% of chewing tobacco products sold in England do not comply with legislation, according to a report seen by BBC News.Chewing_tobacco
The Race Equality Foundation together with the Action on Smoking and Health (ASH) foundation found that only 15% of such products are sold with relevant health warnings or adequate labelling.
Many chewing tobacco products do not even state if they contain tobacco.
People may be consuming harmful ingredients without knowing it.
Amanda Standford, head researcher at ASH, says there needs to better regulation of the products.
”We need there to be an audit of all the products that are out there and then they need to be labelled according to current legislation.
“That way consumers are at least better informed about whether it is safe or not to use them.”
Health risk
Chewing tobacco is a popular form of smokeless tobacco and use is prevalent among South Asian communities.
The products, typically imported from India and Bangladesh, traditionally contain a mix of areca nut, betel leaf, various flavourings and spices along with tobacco.
The ingredients may be combined together and sold pre-packaged.
Products that are popular among South Asians include ‘gutkha’ and ‘paan masala’ – which is usually used as a mouth freshener, and is available both with or without tobacco.
They are inexpensive and easily accessible in areas with large Asian communities.
However, there is little regulation surrounding chewing tobacco products as compared to cigarettes.
Hard to quit
Chewing tobacco is highly addictive and has been associated with an increased risk of mouth cancer, gum disease, and heart disease amongst users.
Farhana Rejwan, from east London, has been chewing tobacco wrapped in betel leaf for over 50 years and has struggled to give it up.
“My teeth have turned black from all the tobacco and my gums are really painful. I tried to quit a few years ago, but it was really difficult and I started up again,” she says.
Farhana has now enrolled on a programme with the Bangladeshi Stop Tobacco project to help her quit.
“I’m trying to stay busy, because I mostly chew when I’m bored. I’ve been doing it all my life so it’s going to be difficult to stop, but I’m trying.”
Many Bangladeshi women like Farhana are addicted to chewing tobacco.
In England, the highest proportion of self-reported use of chewing tobacco is among Bangladeshi women, at 19%, followed by Bangladeshi men at 9%.
Chewing tobacco is embedded in many aspects of South Asian culture and traditions.
However, there are many misconceptions regarding the health risks associated with using chewing tobacco products.
Jabeer Butt, Deputy Chief Executive of the Race Equality Foundation, hopes that the findings of the report will lead to better regulation of smokeless tobacco products.
“There is an urgent need to improve both compliance and enforcement of regulation.
“It is important that we protect minority ethnic communities from the health risks associated with using these products.”
By Divya Talwar BBC Asian Network

Why we need a ban on menthol cigarettes

No action the Food and Drug Administration and the Obama administration could take would do more to save lives, reduce menthol cigaretteshealth-care costs and curb the tobacco industry’s exploitation of children and minority teens than to ban menthol flavoring in cigarettes.
Consider these findings from a March report by an FDA panel:
Eighty percent of adolescent African American smokers use menthol cigarettes.
Most adolescent Hispanic American smokers use menthol cigarettes.
Most Asian American middle-school smokers use menthol cigarettes.
Almost half of 12- to 17-year-old smokers use menthol cigarettes (and, as other research has found, more than 90 percent of adult smokers are hooked as teens).
The Family Smoking Prevention and Tobacco Control Act, enacted in 2009, bans flavoring a cigarette with any herb or spice, or strawberry, grape, orange, clove, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry or coffee flavor — except for menthol. Why was menthol flavoring not prohibited as we and many public health professionals urged when Congress considered the bill?
Here’s what senior members of Congress told us: If the bill bans menthol flavoring, Philip Morris will withdraw its support and the legislation will not pass. After all, Philip Morris and the other tobacco companies have spent about $20 million a year lobbying for the past 12 years. The tobacco companies also sprinkle campaign contributions to legislators across party lines; last year alone, it gave $1.5 million to Republican members and $800,000 to Democratic members.
The 2009 law did establish a scientific advisory committee to evaluate health issues and make recommendations to the FDA. At our urging, it required the committee to act promptly on menthol flavoring in cigarettes. The committee’s recently issued reportputs the ball of banning such flavoring in the FDA’s court because it concluded that menthol cigarettes have an “adverse impact on public health by increasing the numbers of smokers with resulting premature death and avoidable morbidity.”
Thanks to the committee’s work, we know why Philip Morris, R.J. Reynolds and the rest of the tobacco industry fought so fiercely to keep menthol flavoring in cigarettes. The committee found that menthol reduces “the harshness of smoke and the irritation from nicotine, and may increase the likelihood of nicotine addiction in adolescents . . . who experiment with smoking.” The committee charged the industry with exploiting teens and children: “[I]ndustry documents . . . confirm that the industry developed menthol marketing to appeal to youth.” While aiming this charge specifically at the Newport brand, the committee found “that strategy was also adopted by other tobacco companies. Marketing messages positioned menthol cigarettes as an attractive starter product for new smokers who are unaccustomed to intense tobacco taste. . . .” The committee noted that “adolescent menthol cigarette smokers are more dependent on nicotine than adolescent non-menthol cigarette smokers.”
The committee also found that the tobacco industry cynically targeted black people and “developed specialized brands and tailored marketing strategies to promote menthol cigarettes to African Americans”; that “menthol cigarettes are disproportionately marketed per capita to African Americans”; as a result, “menthol cigarettes are disproportionately smoked by African American smokers.”
More than 80 percent of black smokers use menthol cigarettes, compared with 24 percent of white smokers. More than 47,000 black Americans die each year from smoking-related diseases. More black women get lung cancer than get breast cancer, and black men are 50 percent more likely to get lung cancer than white men are.
Lorillard (maker of Newport, Kent and others) and R.J. Reynolds have gone to court to block the FDA from considering the committee’s report. They allege that the membership of the committee “lacks fair balance.” That the tobacco companies would question the integrity of committee members after having been found by a U.S. district judge to have lied to the American public for 50 years about the health hazards of smoking is beyond chutzpah.
The FDA response to the committee’s recommendation will be a test of the Obama administration’s commitment to health care and reducing its costs. In the Tobacco Control Act, Congress found: “Reducing the use of tobacco by minors by 50 percent would prevent well over 10 million of today’s children from becoming regular, daily smokers,” and “Such a reduction in youth smoking would also result in approximately $75 billion in savings attributable to reduced health care costs.”
A ban on menthol flavoring in cigarettes would be a slam-dunk for an administration that trumpets its commitment to cutting health-care costs and protecting children.
Joseph A. Califano Jr. is founder and chairman of the National Center on Addiction and Substance Abuse at Columbia University. He was secretary of health, education and welfare during the Carter administration. Louis W. Sullivan is president emeritus of the Morehouse School of Medicine. He was secretary of health and human services under President George H.W. Bush.
By Joseph A. Califano Jr. and Louis W. Sullivan

Chewing tobacco sends heart pounding

NEW DELHI: You thought that puffing away on cigarettes only could result in a racy heart?Chewing Tobacco for Kids
A new research by doctors from India’s premier All India Institute of Medical Sciences has found that even chewing tobacco – as less as one gram – significantly raised heart rate.
What was most significant among the findings was that when doctors asked patients with normal coronary arteries to chew tobacco in the catheterization laboratory, a striking transient narrowing of normal coronary arteries were visible even with the slightest chewing tobacco.
This, doctors say may not be such a major worry for youngsters, but when adults with already some amount of narrowed arteries continue to chew tobacco, further constriction of arteries would mean a significant decrease in amount of blood reaching the heart. This raises the chances of a heart attack.
Also, for the first time, the study showed that chewing tobacco could lead to peripheral vasodilation which means the blood instead of reaching the brain would remain at peripheral arteries like hands and feet
This could be the reason why most first-time users of chewing tobacco suffer giddiness and vertigo.
The study has now been published in the American Journal of Cardiovascular Drugs.
Speaking to TOI, Dr Balram Bhargava, senior author of the study said “Never before has it been shown that chewing even a slight amount of tobacco could cause narrowing of major heart arteries by over 14%. For people already having narrow arteries with fat deposit, this would mean a further constriction and angina or pain everytime the person runs or is anxious.”
Twelve habitual tobacco chewers undergoing elective coronary angiography were included in the study. Changes in the heart were calculated at baseline and at 15 minutes, 30 minutes, and 60 minutes following the start of tobacco consumption.
Following coronary angiography, a continuous cardiac output pulmonary artery catheter was used to measure the right heart pressures and cardiac output. Having obtained baseline blood pressure data, 1 gram of tobacco was given to be chewed. Subsequently, data were obtained periodically over a period of 60 minutes.
Around 10 minutes after tobacco was given, doctors estimated the diameter of the left anterior descending (LAD) artery – one of the main arteries of the heart, by a coronary angiography.
The results showed that chewing tobacco led to a significant increase in heart rate (from 68.3-12.4beats/min to 80.6-14.6 beats/min) – the highest being at 10 minutes after consuming chewing tobacco. And cardiac output from 3.8-0.45L/min to 4.7-0.64 L/min, peaking at 15 minutes.
Chewing tobacco was associated with coronary vaso-constriction (LAD diameter change from 3.17-0.43mm to 2.79-0.37 mm).
One reason for this, doctors say could be the higher amount of nicotine in India chewing tobacco products like khaini and zarda.
The researchers estimated that Indian smokeless tobacco products for chewing contain more nicotine (13.8-65.0 mg/g) than American smokeless tobacco products.
Dr Ambuj Roy, associate professor of cardiology at AIIMS and one of the authors said although the ill effects of cigarette smoking is known to cause acute hemodynamic effects, there was a lack of data concerning such effects of chewing tobacco.
“Chewing tobacco not only increases the workload on the heart and makes in pump faster causing it to stress but it also reduces the diameter of heart arteries acutely,” Dr Roy added.
According to the recently released Global Adult Tobacco Survey (GATS), 21% of Indian population is addicted to smokeless tobacco alone and another 5% percent smoke as well as use smokeless tobacco. Around 75% of the 275 million Indians consume smokeless tobacco products. A large number of children and youth in India are addicted to smokeless tobacco. Smokeless tobacco contains nicotine, which is highly addictive. There are 3095 chemical components in tobacco, among them 28 are proven carcinogen.
Smokeless tobacco causes oral cancer, pancreatic cancer, increased blood pressure and heart rate and adverse reproductive outcomes. One third of males use smokeless tobacco products. Khaini is used the most, followed by gutkha. Around 91% of female tobacco users use smokeless products like betel quid with tobacco is used the most, followed by gutkha and khaini.
Some hard facts:
One third of Indian adult men smoke while one half consume tobacco in smoke or smokeless forms.
Nearly 7 lakh deaths are attributable to tobacco use in India per year.
Chewing is the most common form of smokeless tobacco use in India.
Smoking cigarettes is shown to increase the blood pressure and heart rate.
Nicotine levels remain elevated for a longer duration from smokeless tobacco compared with smoking tobacco.
In India, smokeless tobacco use is higher among adult men and women than smoking.
Smokeless tobacco use was found among 38.1% of men and 9.9% of women, while 33.3% of the men and 1.6% of women smoked.
Kounteya Sinha, TNN