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Archive for the ‘tobacco and smoking’ Category

Tobacco Product Use Among Adults — United States, 2012–2013

June 30, 2014 Comments off

Tobacco Product Use Among Adults — United States, 2012–2013
Source: Morbidity and Mortality Weekly Report (CDC)

Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed (1,2). Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased (3). This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012–2013 National Adult Tobacco Survey (NATS). The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely. Population-level interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States (4).

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New From the GAO

June 20, 2014 Comments off

New GAO Report and Testimony
Source: Government Accountability Office

Report

1. Tobacco Product Regulation: Most FDA Spending Funded Public Education, Regulatory Science, and Compliance and Enforcement Activities. GAO-14-561, June 20.
http://www.gao.gov/products/GAO-14-561
Highlights – http://www.gao.gov/assets/670/664278.pdf

Testimony

1. Export Controls: NASA Management Action and Improved Oversight Needed to Reduce the Risk of Unauthorized Access to Its Technologies, by Belva Martin, director, acquisition and sourcing management, before the Subcommittees on
Space and Oversight, House Committee on Science, Space, and Technology. GAO-14-690T, June 20.
http://www.gao.gov/products/GAO-14-690T
Highlights – http://www.gao.gov/assets/670/664274.pdf

Smokeless Tobacco Use Among Working Adults — United States, 2005 and 2010

June 16, 2014 Comments off

Smokeless Tobacco Use Among Working Adults — United States, 2005 and 2010
Source: Morbidity and Mortality Weekly Report (CDC)

Smokeless tobacco causes cancers of the oral cavity, esophagus, and pancreas (1). CDC analyzed National Health Interview Survey (NHIS) data to estimate the proportion of U.S. working adults who used smokeless tobacco in 2005 and 2010, by industry and occupation. This report describes the results of that analysis, which showed no statistically significant change in the prevalence of smokeless tobacco use among workers from 2005 (2.7%) to 2010 (3.0%). In 2010, smokeless tobacco use was highest among adults aged 25–44 years (3.9%), males (5.6%), non-Hispanic whites (4.0%), those with no more than a high school education (3.9%), and those living in the South (3.9%). By industry, the prevalence of smokeless tobacco use ranged from 1.5% in education services to 18.8% in mining industries, and by occupation from 1.3% in office and administrative support to 10.8% in construction and extraction. These findings highlight opportunities for reducing the health and economic burdens of tobacco use among U.S. workers, especially those in certain industries (e.g., mining) and occupations (e.g., construction and extraction) where use of smokeless tobacco is especially common. CDC recommends best practices for comprehensive tobacco control programs, including effective employer interventions, such as providing employee health insurance coverage for proven cessation treatments, offering easily accessible help for those who want to quit, and establishing and enforcing tobacco-free workplace policies.

Youth Risk Behavior Surveillance—United States, 2013

June 13, 2014 Comments off

Youth Risk Behavior Surveillance—United States, 2013 (PDF)
Source: Morbidity and Mortality Weekly Report (CDC)
From press release:

Cigarette smoking rates among high school students have dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, according to the 2013 results released today by the Centers for Disease Control and Prevention.

By achieving a teen smoking rate of 15.7 percent, the United States has met its national Healthy People 2020External Web Site Icon objective of reducing adolescent cigarette use to 16 percent or less.

Despite this progress, reducing overall tobacco use remains a significant challenge. For example, other national surveys show increases in hookah and e-cigarette use. In the YRBS, no change in smokeless tobacco use was observed among adolescents since 1999, and the decline in cigar use has slowed in recent years, with cigar use now at 23 percent among male high school seniors.

Burden of Total and Cause-Specific Mortality Related to Tobacco Smoking among Adults Aged ≥45 Years in Asia: A Pooled Analysis of 21 Cohorts

June 13, 2014 Comments off

Burden of Total and Cause-Specific Mortality Related to Tobacco Smoking among Adults Aged ≥45 Years in Asia: A Pooled Analysis of 21 Cohorts
Source: PLoS Medicine

Background
Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men’s smoking prevalence is among the world’s highest.

Methods and Findings
We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan—accounting for ~71% of Asia’s total population. An approximately 1.44-fold (95% CI = 1.37–1.51) and 1.48-fold (1.38–1.58) elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%–17.2%) and 3.3% (2.6%–4.0%) of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ~1,575,500 (95% CI = 1,398,000–1,744,700). Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y.

Conclusions
Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented.

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

May 21, 2014 Comments off

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study
Source: Addiction

Background And Aims
Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomised controlled trials have suggested that e-cigarettes can aid smoking cessation but there are many factors that could influence their real-world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over-the-counter and with unaided quitting in the general population.

Design And Setting
A large cross-sectional survey of a representative sample of the English population.

Participants
The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n=464), NRT bought over-the-counter only (n=1922) or no aid in their most recent quit attempt (n=3477).

Measurements
The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence.

Findings
E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter (odds ratio 2.23, 95% confidence interval 1.70 to 2.93, 20.0% vs. 10.1%) or no aid (odds ratio 1.38, 95% confidence interval 1.08 to 1.76, 20.0% vs. 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% confidence interval 1.17 to 2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% confidence interval 1.19 to 2.18) times higher compared with those using no aid.

Conclusions
Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.

E-Cigarettes: A Scientific Review

May 21, 2014 Comments off

E-Cigarettes: A Scientific Review
Source: Circulation

Electronic cigarettes (e-cigarettes) are products that deliver a nicotine-containing aerosol (commonly called vapor) to users by heating a solution typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents (Figure 1) invented in their current form by Chinese pharmacist Hon Lik in the early 2000s.1 The US patent application describes the e-cigarette device as “an electronic atomization cigarette that functions as substitutes [sic] for quitting smoking and cigarette substitutes” (patent No. 8,490,628 B2). By 2013, the major multinational tobacco companies had entered the e-cigarette market. E-cigarettes are marketed via television, the Internet, and print advertisements (that often feature celebrities)2 as healthier alternatives to tobacco smoking, as useful for quitting smoking and reducing cigarette consumption, and as a way to circumvent smoke-free laws by enabling users to “smoke anywhere.”

There has been rapid market penetration of e-cigarettes despite many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health. E-cigarette products are changing quickly, and many of the findings from studies of older products may not be relevant to the assessment of newer products that could be safer and more effective as nicotine delivery devices. In addition, marketing and other environmental influences may vary from country to country, so patterns of use and the ultimate impact on public health may differ. The individual risks and benefits and the total impact of these products occur in the context of the widespread and continuing availability of conventional cigarettes and other tobacco products, with high levels of dual use of e-cigarettes and conventional cigarettes at the same time among adults and youth. It is important to assess e-cigarette toxicant exposure and individual risk, as well as the health effects, of e-cigarettes as they are actually used to ensure safety and to develop an evidence-based regulatory scheme that protects the entire population—children and adults, smokers and nonsmokers—in the context of how the tobacco industry is marketing and promoting these products. Health claims and claims of efficacy for quitting smoking are unsupported by the scientific evidence to date. To minimize the potential negative impacts on prevention and cessation and the undermining of existing tobacco control measures, e-cigarette use should be prohibited where tobacco cigarette use is prohibited, and the products should be subject to the same marketing restrictions as tobacco cigarettes.

Cardiology: Patient Page — Electronic Cigarettes

May 16, 2014 Comments off

Patient Page — Electronic Cigarettes
Source: Circulation

The claim that e-cigarettes emit only harmless water vapor is not true.1 Although e-cigarette aerosol delivers lower levels of many toxins than cigarette smoke, the aerosol still contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens. Users inhale a heated propylene glycol or glycerin-based solution for which there are no long-term studies. A short-term exposure study showed that 5 minutes of e-cigarette use resulted in a significant increase in airway flow resistance, which, although of unknown clinical significance, does not support the claim the product is harmless.

There is poor correlation between labeled and actual nicotine content, as well as varying levels of other chemicals and toxicants in the e-liquid and aerosol.1 Nonsmokers (persons who do not use tobacco cigarettes or e-cigarettes) who are exposed to the exhaled, or secondhand, e-cigarette aerosol have measurable levels of the nicotine metabolite cotinine in their blood.

If someone switched completely from tobacco cigarettes to only using e-cigarettes, he or she would inhale fewer toxic chemicals to get the same dose of nicotine. However, most e-cigarette users continue to smoke tobacco cigarettes (dual use). Because the effects of smoking on the heart, blood, and blood vessels occur at very low levels of smoking (and even secondhand smoke),3 e-cigarette users are unlikely to experience any benefit in terms of reduced rates of cardiovascular disease. Even cancer risk, which depends to some extent on smoking intensity (cigarettes per day), depends in large part on duration (years of smoking). Thus, use of electronic cigarettes to cut down on number of cigarettes smoked per day is likely to have much smaller beneficial effects on overall survival than quitting smoking completely.

FDA proposes to extend its tobacco authority to additional tobacco products, including e-cigarettes

April 24, 2014 Comments off

FDA proposes to extend its tobacco authority to additional tobacco products, including e-cigarettes
Source: U.S. Food and Drug Administration

As part of its implementation of the Family Smoking Prevention and Tobacco Control Act signed by the President in 2009, the U.S. Food and Drug Administration today proposed a new rule that would extend the agency’s tobacco authority to cover additional tobacco products.

Products that would be “deemed” to be subject to FDA regulation are those that meet the statutory definition of a tobacco product, including currently unregulated marketed products, such as electronic cigarettes (e-cigarettes), cigars, pipe tobacco, nicotine gels, waterpipe (or hookah) tobacco, and dissolvables not already under the FDA’s authority. The FDA currently regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco.

Cigarette Smuggling: A National Problem and Lucrative Criminal Enterprise

April 24, 2014 Comments off

Cigarette Smuggling: A National Problem and Lucrative Criminal Enterprise
Source: Tax Foundation

Increased excise taxes on cigarettes have created lucrative incentives for black market trafficking between states, with illegal sales on the rise nationwide, according to the latest report from the nonpartisan Tax Foundation.

Released this morning, the report’s key findings include:

  • Large differentials in cigarette taxes across states create incentives for black market sales.
  • Smuggled cigarettes make up substantial portions of cigarette consumption in many states, and greater than 25 percent of consumption in twelve states.
  • The highest inbound cigarette smuggling rates are in New York (56.9 percent), Arizona (51.5 percent), New Mexico (48.1 percent), Washington (48 percent), and Wisconsin (34.6 percent).
  • The highest outbound smuggling rates are in New Hampshire (24.2 percent), Wyoming (22.3 percent), Idaho (21.3 percent), Virginia (21.1 percent), and Delaware (20.9 percent).
  • Cigarette tax rates increased in 30 states and the District of Columbia between 2006 and 2012.

CBO — Presentation on Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget

April 9, 2014 Comments off

Presentation on Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget
Source: Congressional Budget Office

Presentation by James Baumgardner, CBO’s Deputy Assistant Director for Health, Retirement, and Long-Term Analysis, to the 30th International Congress of Actuaries

New From the GAO

April 8, 2014 Comments off

New GAO Reports and Testimonies
Source: Government Accountability Office

Reports

1. Medicare: Second Year Update for CMS’s Durable Medical Equipment Competitive Bidding Program Round 1 Rebid. GAO-14-156, March 7.
http://www.gao.gov/products/GAO-14-156
Highlights - http://www.gao.gov/assets/670/661475.pdf

2. 2014 Annual Report: Additional Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits. GAO-14-343SP, April 8.
http://www.gao.gov/products/GAO-14-343SP
Podcast - http://www.gao.gov/multimedia/podcasts/662283

3. Aviation Safety: FAA Should Improve Usability of its Online Application System and Clarity of the Pilot’s Medical Form. GAO-14-330, April 8.
http://www.gao.gov/products/GAO-14-330
Highlights - http://www.gao.gov/assets/670/662388.pdf

4. Military Capabilities: Navy Should Reevaluate Its Plan to Decommission the USS Port Royal. GAO-14-336, April 8.
http://www.gao.gov/products/GAO-14-336
Highlights - http://www.gao.gov/assets/670/662377.pdf

5. Information Security: IRS Needs to Address Control Weaknesses That Place Financial and Taxpayer Data at Risk. GAO-14-405, April 8
http://www.gao.gov/products/GAO-14-405
Highlights - http://www.gao.gov/assets/670/662372.pdf
Podcast - http://www.gao.gov/multimedia/podcasts/662350

Testimonies

1. Paid Tax Return Preparers: In a Limited Study, Preparers Made Significant Errors, by James R. McTigue Jr., director, strategic issues, before the Senate Committee on Finance. GAO-14-467T, April 8.
http://www.gao.gov/products/GAO-14-467T
Highlights - http://www.gao.gov/assets/670/662357.pdf

2. Tobacco Products: FDA Spending and New Product Review Time Frames, by Marcia Crosse, director, health care, before the Subcommittee on Health, House Committee on Energy and Commerce. GAO-14-508T, April 8.
http://www.gao.gov/products/GAO-14-508T
Highlights - http://www.gao.gov/assets/670/662361.pdf

3. Government Efficiency and Effectiveness: Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits, by Gene L. Dodaro, Comptroller General of the United States, before the House Committee on Oversight and Government Reform. GAO-14-478T, April 8.
http://www.gao.gov/products/GAO-14-478T
Highlights - http://www.gao.gov/assets/670/662367.pdf

CDC Grand Rounds: Global Tobacco Control

April 8, 2014 Comments off

CDC Grand Rounds: Global Tobacco Control
Source: Morbidity and Mortality Weekly Report (CDC)

During the 20th century, use of tobacco products contributed to the deaths of 100 million persons worldwide (1). In 2011, approximately 6 million additional deaths were linked to tobacco use, the world’s leading underlying cause of death, responsible for more deaths each year than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis, and malaria combined (1). One third to one half of lifetime users die from tobacco products, and smokers die an average of 14 years earlier than nonsmokers (2,3). Manufactured cigarettes account for 96% of all tobacco sales worldwide. From 1880 to 2009, annual global consumption of cigarettes increased from an estimated 10 billion cigarettes to approximately 5.9 trillion cigarettes (Figure 1), with five countries accounting for 58% of the total consumption: China (38%), Russia (7%), the United States (5%), Indonesia (4%), and Japan (4%). Among the estimated 1 billion smokers worldwide, men outnumber women by four to one. In 14 countries, at least 50% of men smoke, whereas in more than half of these same countries, fewer than 10% of women smoke (4). If current trends persist, an estimated 500 million persons alive today will die from use of tobacco products. By 2030, tobacco use will result in the deaths of approximately 8 million persons worldwide each year (4). Yet, every death from tobacco products is preventable.

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014

April 4, 2014 Comments off

Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014
Source: Morbidity and Mortality Weekly Report (CDC)

Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1).* In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults (2,3), its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity (4). To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

An e-cigarette exposure call was defined as a call regarding an exposure to the e-cigarette device itself or to the nicotine liquid, which typically is contained in a cartridge that the user inserts into the e-cigarette. A cigarette exposure call was defined as a call regarding an exposure to tobacco cigarettes, but not cigarette butts. Calls involving multiple substance exposures (e.g., cigarettes and ethanol) were excluded. E-cigarette exposure calls were compared with cigarette exposure calls by proportion of calls from health-care facilities (versus residential and other non–health-care facilities), demographic characteristics, exposure routes, and report of adverse health effect. Statistical significance of differences (p<0.05) was assessed using chi-square tests.

During the study period, PCs reported 2,405 e-cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E-cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).

E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls, increasing from 0.3% in September 2010 to 41.7% in February 2014. A greater proportion of e-cigarette exposure calls came from health-care facilities than cigarette exposure calls (12.8% versus 5.9%) (p20 years (42.0%). E-cigarette exposures were more likely to be reported as inhalations (16.8% versus 2.0%), eye exposures (8.5% versus 0.1%), and skin exposures (5.9% versus 0.1%), and less likely to be reported as ingestions (68.9% versus 97.8%) compared with cigarette exposures (p<0.001).

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014

March 30, 2014 Comments off

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014
Source: Morbidity and Mortality Weekly Report (CDC)

Medicaid enrollees have a higher smoking prevalence than the general population (30.1% of adult Medicaid enrollees aged <65 years smoke, compared with 18.1% of U.S. adults of all ages), and smoking-related disease is a major contributor to increasing Medicaid costs (1,2). Evidence-based cessation treatments exist, including individual, group, and telephone counseling and seven Food and Drug Administration (FDA)–approved medications (3). A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments.* However, most states do not provide such coverage (4). To monitor trends in state Medicaid cessation coverage, the American Lung Association† collected data on coverage of all evidence-based cessation treatments except telephone counseling§ by state Medicaid programs (for a total of nine treatments), as well as data on barriers to accessing these treatments (such as charging copayments or limiting the number of covered quit attempts) from December 31, 2008, to January 31, 2014. As of 2014, all 50 states and the District of Columbia cover some cessation treatments for at least some Medicaid enrollees, but only seven states cover all nine treatments for all enrollees. Common barriers in 2014 include duration limits (40 states for at least some populations or plans), annual limits (37 states), prior authorization requirements (36 states), and copayments (35 states). Comparing 2008 with 2014, 33 states added treatments to coverage, and 22 states removed treatments from coverage; 26 states removed barriers to accessing treatments, and 29 states added new barriers.¶ The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use (3,5–8).

Cigarette smoking prevalence in US counties: 1996-2012

March 27, 2014 Comments off

Cigarette smoking prevalence in US counties: 1996-2012
Source: Population Health Metrics

Background
Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action.

Methods
We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011.

Results
Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile.

Conclusions
County-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.

Active or Passive Exposure to Tobacco Smoking and Allergic Rhinitis, Allergic Dermatitis, and Food Allergy in Adults and Children: A Systematic Review and Meta-Analysis

March 14, 2014 Comments off

Active or Passive Exposure to Tobacco Smoking and Allergic Rhinitis, Allergic Dermatitis, and Food Allergy in Adults and Children: A Systematic Review and Meta-Analysis
Source: PLoS Medicine

Background
Allergic rhinitis, allergic dermatitis, and food allergy are extremely common diseases, especially among children, and are frequently associated to each other and to asthma. Smoking is a potential risk factor for these conditions, but so far, results from individual studies have been conflicting. The objective of this study was to examine the evidence for an association between active smoking (AS) or passive exposure to secondhand smoke and allergic conditions.

Methods and Findings
We retrieved studies published in any language up to June 30th, 2013 by systematically searching Medline, Embase, the five regional bibliographic databases of the World Health Organization, and ISI-Proceedings databases, by manually examining the references of the original articles and reviews retrieved, and by establishing personal contact with clinical researchers. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk (RR) estimates and confidence intervals of smoking and allergic conditions, first among the general population and then among children.

We retrieved 97 studies on allergic rhinitis, 91 on allergic dermatitis, and eight on food allergy published in 139 different articles. When all studies were analyzed together (showing random effects model results and pooled ORs expressed as RR), allergic rhinitis was not associated with active smoking (pooled RR, 1.02 [95% CI 0.92–1.15]), but was associated with passive smoking (pooled RR 1.10 [95% CI 1.06–1.15]). Allergic dermatitis was associated with both active (pooled RR, 1.21 [95% CI 1.14–1.29]) and passive smoking (pooled RR, 1.07 [95% CI 1.03–1.12]). In children and adolescent, allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24–1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04–1.14]). Allergic dermatitis was associated with active (pooled RR, 1.36 [95% CI 1.17–1.46]) and passive smoking (pooled RR, 1.06 [95% CI 1.01–1.11]). Food allergy was associated with SHS (1.43 [1.12–1.83]) when cohort studies only were examined, but not when all studies were combined.

The findings are limited by the potential for confounding and bias given that most of the individual studies used a cross-sectional design. Furthermore, the studies showed a high degree of heterogeneity and the exposure and outcome measures were assessed by self-report, which may increase the potential for misclassification.

Conclusions
We observed very modest associations between smoking and some allergic diseases among adults. Among children and adolescents, both active and passive exposure to SHS were associated with a modest increased risk for allergic diseases, and passive smoking was associated with an increased risk for food allergy. Additional studies with detailed measurement of exposure and better case definition are needed to further explore the role of smoking in allergic diseases.

Achieving appropriate regulations for electronic cigarettes

February 7, 2014 Comments off

Achieving appropriate regulations for electronic cigarettes
Source: Therapeutic Advances in Chronic Disease

A growing body of scientific studies show that e-cigarettes may serve as an acceptable substitute for smoking tobacco cigarettes, thereby reducing or eliminating exposure to harmful elements in smoke. The success of e-cigarettes is such that sales of these products are rapidly gaining on traditional cigarettes. The rapidly evolving phenomenon is raising concerns for the health community, pharmaceutical industry, health regulators and state governments. Obviously, these products need to be adequately regulated, primarily to protect users. Depending on the form and intended scope, certain regulatory decisions may have diverse unintended consequences on public health and may face many different challenges. Ideally, before any regulations are enacted, the regulatory body will require sufficient scientific research to verify that a problem does exist, quantify the problem, explore all potential solutions including making no change at all, determine the possible consequences of each, and then select the solution that is best for public health. Here we present an overview on the existing and deeming regulatory decisions for electronic cigarettes. We challenge them, based on the mounting scientific evidence with the ultimate goal of proposing appropriate recommendations while minimizing potential unintended consequences of ill-informed regulation.

Ending Sales of Tobacco Products in Pharmacies

February 5, 2014 Comments off

Ending Sales of Tobacco Products in Pharmacies
Source: Journal of the American Medical Association

The new emphasis on restricting availability and reinforcing the social unacceptability of smoking casts a harsh light on pharmacies’ sale of cigarettes and other tobacco products. Advocates have long questioned the juxtaposition of the distribution of medications for promoting health with the sale of the single most deadly consumer product.5 Making cigarettes available in pharmacies in essence “renormalizes” the product by sending the subtle message that it cannot be all that unhealthy if it is available for purchase where medicines are sold. The argument that pharmacies also sell tobacco-cessation products only heightens the paradox. This is primarily a US problem: pharmacies in other developed countries do not sell cigarettes.

Current Cigarette Smoking Among Adults — United States, 2005–2012

January 24, 2014 Comments off

Current Cigarette Smoking Among Adults — United States, 2005–2012
Source: Morbidity and Mortality Weekly Report (CDC)

Despite significant declines during the past 30 years, cigarette smoking among adults in the United States remains widespread, and year-to-year decreases in prevalence have been observed only intermittently in recent years (1,2). To assess progress made toward the Healthy People 2020 objective of reducing the proportion of U.S. adults who smoke cigarettes to ≤12% (objective TU-1.1),* this report provides the most recent national estimates of smoking prevalence among adults aged ≥18 years, based on data from the 2012 National Health Interview Survey (NHIS). The findings indicate that the proportion of U.S. adults who smoke cigarettes fell to 18.1% in 2012. Moreover, during 2005–2012, the percentage of ever smokers who quit increased significantly, from 50.7% to 55.0%, and the proportion of daily smokers who smoked ≥30 cigarettes per day (CPD) declined significantly, from 12.6% to 7.0%. Proven population-level interventions, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and barrier-free access to help quitting, are critical to decreasing cigarette smoking and reducing the health and economic burden of tobacco-related diseases in the United States (3).

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