Tobacco.org

EDITORIAL: Regulation was overdue for tobacco products 

The effort to give the Food and Drug Administration authority to regulate tobacco has been about as difficult as a typical person's battle to quit smoking.

But it was a major breakthrough when President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act . . .

It would be nice to celebrate this breakthrough as the death knell for all the evil deeds of the tobacco companies. The manufacturers have been elusive, deceptive and uncaring about the effects of their products on unsuspecting customers. Sadly, the companies long ago began to see their viability in foreign markets. But at least it can be said that the United States has begun to see enough of this health hazard. Tobacco won't be eliminated, but it will be heavily regulated. The tougher regulation was a long time coming. It's a welcome sight.

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BREHM: Legislation snuffs Big Tobacco's marketing mayhem  

I applaud Obama's effort to tighten tobacco laws because I, too, share his regret of becoming a smoker as a teen. I tell my three children constantly that starting to smoke is the single biggest regret of my life, and I have struggled to quit numerous times over the past 20 years. I am ashamed to admit that I still find it hard to stop completely.

So I cannot help but commiserate with Obama when he talked about his continuing efforts to stop smoking. . . .

I wish this law would have been approved 30 years ago. I don't remember being influenced as a teen by tobacco marketing, but I see the power a McDonald's commercial has over my own children, and don't doubt my friends and I were impacted by clever ads featuring kid-friendly characters such as Joe Camel.

If this new law prevents teens from starting to smoke, it will go a long way toward making our next generation healthier. And a lot less stinky.

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• HUGHES: You can escape the ciggy siren's song, not its silence 

I have a confession to make. Ten years after giving up smoking I have started the wretched habit again. And it's not just the occasional puff. Rather, it's the full-on 15-a-day craving-led nicotine addiction that I swore blind to rid myself of forever a decade ago.

I kept my promise faithfully for more than 3,600 days so why did I relapse? Why have I gone back to almost kippering myself on a daily basis when just a few weeks ago I found the smell chokingly repugnant?

Quite simply, Beijing seduced me like a sexy siren.

Within one week of stepping off the plane, I tentatively, guiltily accepted the offer of a splendidly-branded Craven A from a colleague after watching him inhale with an almost beatific look of pleasure following a fine meal washed down with plenty of thirst-quenching beer. I must admit when I lit up it felt good. It was as if I had breathed new life into the ghost of my old addiction. . . .

discovering how incredibly cheap they are here. My chosen brand cost 5 yuan. Back home in the UK they are more than 10 times that. Only a serious addict would fork out so much at that price.

Then there is the near ubiquitous tolerance of smoking here. . . .

In London, I didn't smoke at home because I had young children. A smoking ban in bars and restaurants was rigidly enforced. At work you had to leave the office . . .

However, the government, despite receiving mountains of excise revenue from the habit, has been trying to discourage it.

Smoking is banned inside all public buildings in Beijing. Just this week, it was announced the government had raised consumption tax on cigarettes by between 6 and 11 percent both to curb smoking and add revenue to state coffers.

But there has not yet been a seismic shift in society's laissez-faire attitude to smokers and smoking and, until there is, it is a habit that will not be stubbed out.

Now, excuse me, sucker that I am, while I nip out to satisfy my craving.

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New Report on Billion Dollar Burden of Substance Abuse and Addiction Shows Need for Change in How Services Are Provided, Says Leading Expert 

A new report detailing the $467.7 billion burden that substance abuse and addiction place on federal, state and local governments, means that the delivery of treatment therapies must be reformed so that providers are licensed to offer same time, same place treatment that will stop the repeated cycles of failure and personal destruction suffered by those in need, according to Jacqueline Dawes, founder and president of Brookhaven Retreat, America's premier treatment center for emotional trauma and addiction that offers female-specific treatment.

According to The National Center on Addiction and Substance Abuse (CASA) at Columbia University's Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets, which is based on three years of research and analysis and the most conservative assumptions, the federal government spent $238.2 billion; states, $135.8 billion; and local governments, $93.8 billion, in 2005 (the most recent year for which data were available over the course of the study) dealing with tobacco, alcohol and illegal and prescription drug abuse.

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Letting go of the 'stress' excuse: How smokers like President Obama can kick the habit for good 

BILL: One result of our “War on Drugs” is the U.S. has the highest jail rate in the world. And now, thanks to the new anti-tobacco laws just signed by President Obama amid a lot of fanfare about his own nicotine struggles, cigarette smokers are the next drug outlaws. Are we about to see cops on the 6 o’ clock news, writing “smoking in public” citations? Drug Enforcement Agents transferred from the Mexican border to the lawless wilderness of the Virginian tobacco fields?

DR. DAVE: Since I know you never went in for cigarettes or pot, why are you are so worked up about this, Bill?

BILL: Alcohol is at least as harmful as either cigarettes or marijuana, but just as Prohibition didn’t stop people drinking, these puritanical anti-cigarette laws are going to get more kids smoking than ever.

DR. DAVE: And the evidence on which you base this no doubt scientific observation is? . . .

BILL: Dave, I’m embarrassed to ask this. Would you recommend Obama try nicotine replacements - for instance, Nicorette gum?

DR. DAVE: Bill, aren’t you being a bit puritanical yourself? If Nicorette works, sure, why not? I’d also recommend that he no longer share his story with the public until he has gone the last 5% into tobacco cessation.

BILL: I have to say amen to that. You know, Dave, I wish you didn’t always win these arguments!

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Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence from the 2001-2002 Wave of the National Epidemiologic Survey of Alcoholism and Related Conditions  

Objectives. We examined the roles of gender and poverty cigarette use and nicotine dependence among adults in the United States. . . .

Conclusions. Despite recent declines in cigarette use, the prevalence of nicotine dependence has increased among some groups and has remained steady overall, which may be hampering public health initiatives to reduce cigarette use. Efforts to study or curb cigarette use should therefore take nicotine dependence into account.

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Nicotine dependence remains prevalent despite recent declines in cigarette use 

Despite recent declines in cigarette use in the U.S., nicotine dependence has remained steady among adults and has actually increased among some groups. The finding by researchers at Columbia University Mailman School of Public Health suggests that public health initiatives have been far more successful in preventing Americans from taking up smoking than in persuading hard-core smokers to stop. The study is available online in the American Journal of Public Health and will be published in the August 2009 issue.

Previous studies have found that since the 1964 U.S. Surgeon General report, the number of people who smoke cigarettes has declined. The Mailman School of Public Health study takes this research a step further by distinguishing occasional smokers from heavy smokers. "Regular, heavy cigarette use frequently characterizes nicotine dependence and is the pattern of use thought to be the most detrimental to health and longevity, but it has not been addressed in previous estimates of the decline in smoking prevalence," says Renee Goodwin, PhD, associate professor of Epidemiology at the Mailman School of Public Health and principal investigator of the study. "Rather, earlier research mainly addressed tobacco use or cigarette smoking per se rather than examining the frequency and duration of cigarette use in detail."

The new study finds not only that the number of nicotine-addicted Americans has held steady over the past several decades, but also that the proportion of cigarette smokers who are addicted to nicotine nowadays is greater than in previous generations. Dr. Goodwin cites a possible explanation for this latter finding. She suggests that fewer people are taking up smoking, perhaps because of anti-cigarette campaigns, leaving the ranks of current smokers filled with the nicotine dependent.

Another factor that has changed dramatically in the epidemiology of tobacco consumption and dependence over the past several decades is gender. Smoking has been far more common among men than among women for most of the past forty years, though recent evidence suggests that the gender gap has narrowed, and the current study finds increases in smoking among women in several recent generations.

It is also thought that socioeconomic status is a factor in cigarette use. The current study finds that younger women living in poverty had the highest rates

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LETTER: Tobacco regulation  

Smoking and other addictions are misunderstood by the public and distorted by those in authority. Any addiction is genetic and hereditary with painful origins. The Food and Drug Administration cannot change a disease. It is not God.

If children see their parents or friends suppressing their inner pain by smoking, this modeling is followed. The family or friends support each others' pain. If they do not stop the emotional pain with smoking, it will be other drugs, prescriptions, gambling, eating, shopping, coffee, chocolate, pop, sex or any other addiction to replace it that you can name. People just substitute one addiction for another.

Addiction was declared a disease in 1995 by the American Medical Association. The current paradigm does not usually address a spiritual answer. I healed seven addictions. I know from my experience stopping smoking was harder than alcohol and some prescription drugs. However, with a daily spiritual program like that found in the 12-step programs, addictions can be arrested.

This is a perfect example of too much government ["Big tobacco finally loses," Opinion, editorial, June 12]. Walking away from the cigarette, alcoholic drink or gambling are all personal choices. Everyone has the right to learn healthy alternatives, receive solutions that work and not be treated like a child.

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NCTOH: Addiction is addiction is addiction 

This is a series of special reports from the National Conference on Tobacco or Health in Phoenix, AZ.

Erik Augustson, PhD, MPH for the National Cancer Institute said that tobacco dependence is a complex issue and there is no accepted definition but that the process is influenced by a variety of factors:

* Compulsive use despite adverse consequences.

* The drug reinforces behavior.

* There is a predictable pattern of withdrawal.

* Relapse--quitting is hard.

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• Nicotine Receptors Could Be Lung Cancer Treatment Target 

In a study of mice with lung cancer, a treatment that targeted nicotine receptors more than doubled the animals' survival time, Italian researchers say.

Nicotine plays a dual role in lung cancer. Changes in genes encoding nicotine receptors not only drive the urge the smoke, but also increase susceptibility to lung cancer. Exposure to nicotine boosts the expression of nicotine receptors, which leads to increased cell proliferation and inhibits the programmed cell death known as apoptosis.

In the new study, published in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine, the compound α-CbT dampened the expression of nicotine receptors and increased apoptosis, prolonging the lives of the mice.

"This research clearly has profound clinical implications regarding the role of nicotine in stimulating lung cancer and nicotine receptor antagonists in treating the disease," said Dr. John Heffner, past president of the American Thoracic Society, in a news release from the society. Heffner, who was not involved in the research, added, "The highly addictive nature of nicotine, however, complicates patients' ability to quit smoking and avoid ongoing nicotine exposure."

Previous research has shown that it's possible to dampen the response of nicotine acetylcholine receptors (nAChRs) using an antagonist called d-tubocurarine/α-Cobratoxin (α-CbT), which specifically targeted the area most linked to increased cell growth.

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• Christopher Caldwell - Addicts have made a choice 

We have a justice system that treats drug use as a malevolent act of will (to be punished) and a medical profession that treats it as an unfortunate disease (to be cured). Who is right? In a magnificent new book, Addiction: A Disorder of Choice , Gene M. Heyman, a lecturer in psychology at Harvard Medical School, argues that it is not his fellow medical professionals.

Addiction is voluntary. The idea that addiction is a “chronic, relapsing brain disease” may be well-meaning but it is false. “Everyone,” Mr Heyman writes, “including those who are called addicts, stops using drugs when the costs of continuing become too great.” We need to make clear, though, what Mr Heyman means by “voluntary”. He does not deny that addiction is an enormous problem that can wreck a life, or several. If you drive drunk or embezzle money to pay for your coke habit when you ought to be studying, the consequences can be permanent and devastating.

But addiction is not the kind of problem that most people think it is. It is not so very far from setting interest rates, devising depreciation schedules and other economic problems of “intertemporal choice”. It involves weighing the value of a current good (intoxication) against the value of various future ones that are shrouded in uncertainty. . . .

The centrepiece of the disease theory of addiction is philosophical, not scientific. It is that nothing that produces sub-optimal outcomes as consistently as addiction does can be freely chosen. “No one chooses to be an addict,” as the saying goes. Mr Heyman shows that this is wrong – or at least that this is the wrong way of getting at the problem.

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Nicotine's Double Role In Lung Cancer 

A lung cancer treatment that inhibits nicotine receptors was shown to double survival time in mice, according to Italian researchers.

The results of the early phase animal model study were reported in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Changes in genes encoding nicotine receptors are strongly associated not only with the tendency to smoke, but with susceptibility to lung cancer. Nicotine exposure also heightens the expression of the nicotine receptors, which leads to increased cell proliferation and inhibition of apoptosis, further setting the stage for cancer.

Patrizia Russo, Ph.D. and Laura Paleari, Ph.D. of the Lung Cancer Unit of the National Cancer Research Institute in Genoa, Italy and colleagues from San Raffaele Pisana Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Catholic University, Campus Biomedico University in Rome, Mario Negri Institute in Milan and CEA Gyf sur Yvette in France showed in past research that an antagonist of nicotine acetylcholine receptors (nAChRs), may serve as an anticancer agent. The antagonist, called d-tubocurarine/α-Cobratoxin (α-CbT), specifically targeted the α7 subunit of nAChRs, the area primarily associated with increased cell proliferation.

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Defeating Nicotine's Double Role In Lung Cancer 

A lung cancer treatment that inhibits nicotine receptors was shown to double survival time in mice, according to Italian researchers.

The results of the early phase animal model study were reported in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Changes in genes encoding nicotine receptors are strongly associated not only with the tendency to smoke, but with susceptibility to lung cancer. Nicotine exposure also heightens the expression of the nicotine receptors, which leads to increased cell proliferation and inhibition of apoptosis, further setting the stage for cancer.

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Inhibition of Nonneuronal {alpha}7-Nicotinic Receptor for Lung Cancer Treatment  

Rationale: Studies strongly suggest that the nicotinic acetylcholine receptors for nicotine (nAChRs) play a significant role in lung cancer predisposition and natural history. The nAChR {alpha}7 subunit has been found to be pivotal in the control of nicotine-induced lung cancer development and in growth signal transduction induced by nicotine binding to nAChRs. . . .

Conclusions: We report the prolonged survival of {alpha}-CbT–treated animals in our mouse model of NSCLC, which is most likely the result of multiple mechanisms, including various antiproliferative and antiangiogenic effects.

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• People with Intellectual or Developmental Disabilities Particularly Vulnerable to Effects of Tobacco Use and Dependence 

While tobacco use is an ongoing health hazard for the entire population, its consequences for people with developmental or intellectual disabilities can be especially severe. And the medical community often tends to overlook the tobacco-related burdens these people face. An extensive review of published research on this topic appears in the June edition of the journal Intellectual and Developmental Disabilities.

“This is too important an issue to ignore,” said Dr. Marc L. Steinberg, an assistant professor of psychiatry at the UMDNJ-Robert Wood Johnson Medical School and the article’s lead author. “Health care professionals often do not ask these individuals about tobacco use or exposure.”

Steinberg and his co-authors report that they were able to identify several negative implications of tobacco use that are unique to this population group: . . .

• People with developmental or intellectual disabilities are three times more likely to live in poverty, making them more susceptible to financial distress from tobacco use.

• Tobacco use may decrease the effectiveness of some medications commonly prescribed to this population group.

• Ironically, many of these individuals became addicted to tobacco at the hands of the very institutions that are meant to help them. In the past, hospitals and facilities treating vulnerable populations have even given cigarettes as good behavior ‘rewards’ to mentally ill patients and to those with developmental or intellectual disabilities.

• On the rare occasions when individuals in this population gain access to tobacco treatment programs, they still may “fall through the cracks” because they have difficulty understanding the health information presented to them.

“Like any other patients, this population should be offered resources for quitting if they smoke and offered protection from environmental tobacco smoke if they do not,” said Steinberg.

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