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• Massachusetts' 'Model' Tobacco Cessation Benefit Spurs Unprecedented Drop in Smoking Rates, Heart Attacks, Asthma, and Birth Complications 

A "model" tobacco cessation benefit offered to Massachusetts' Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.

Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people -- a full 40% of MassHealth members who smoke -- have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

"It is clear from these latest findings that the Commonwealth's efforts to help people quit smoking is a sound investment," Executive Office of Health and Human Services Secretary JudyAnn Bigby said. . . .

"As the nation debates the future of its health care system, the national significance of this research cannot be understated," said Robert J. Gould, PhD, President and CEO of Partnership for Prevention, a national organization that advances policies and practices to prevent disease and improve the health of all Americans. "These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow."

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• Study raises concerns about outdoor second-hand smoke 

Indoor smoking bans have forced smokers at bars and restaurants onto outdoor patios, but a new University of Georgia study in collaboration with the Centers for Disease Control and Prevention suggests that these outdoor smoking areas might be creating a new health hazard.

The study, thought to be the first to assess levels of a nicotine byproduct known as cotinine in nonsmokers exposed to second-hand smoke outdoors, found levels up to 162 percent greater than in the control group. The results appear in the November issue of the Journal of Occupational and Environmental Hygiene.

"Indoor smoking bans have helped to create more of these outdoor environments where people are exposed to secondhand smoke," said study co-author Luke Naeher, associate professor in the UGA College of Public Health. "We know from our previous study that there are measurable airborne levels of secondhand smoke in these environments, and we know from this study that we can measure internal exposure.

"Secondhand smoke contains several known carcinogens and the current thinking is that there is no safe level of exposure," he added. "So the levels that we are seeing are a potential public health issue."

Athens-Clarke County, Ga., enacted an indoor smoking ban in 2005, providing Naeher and his colleagues and ideal environment for their study.

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• Dose-dependent Effects of Second-hand Smoke on Vascular Function  

Purpose

The purpose of this study is to determine the vascular effects of brief second-hand smoke exposure on normal healthy individuals. . . .

Despite evidence to suggest that secondhand smoke contributes to adverse cardiovascular outcomes, little is known about the dose-dependent vascular effects of brief secondhand smoke exposure at low doses commonly encountered in the community. This study will investigate the acute vascular effects and dose-dependent biological mechanisms of secondhand smoke on endothelial function and oxidative stress.

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• New dementia risk factors study findings reported from University of Minnesota 

Fresh data on dementia are presented in the report 'Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study.' According to recent research published in the Journal of Neurology, Neurosurgery, and Psychiatry, "Cardiovascular risk factors are associated with a higher risk of developing dementia. Studies in older populations, however, have often failed to show this relationship."

"We assessed the association between cardiovascular risk factors measured in midlife and risk of being hospitalised with dementia and determined whether this association was modified by age and ethnicity. We studied 11 151 participants in the population-based Atherosclerosis Risk in Communities cohort, aged 46-70 (23% African-Americans) in 1990-2, when participants underwent a physical exam and cognitive testing. Hospitalisations with dementia were ascertained through December 2004. During follow-up, 203 cases of hospitalisation with dementia were identified. Smoking (hazard ratio (HR), 95% CI 1.7, 1.2 to 2.5), hypertension (HR, 95% CI 1.6, 1.2 to 2.2) and diabetes (HR, 95% CI 2.2, 1.6 to 3.0) were strongly associated with dementia, in Caucasians and African-Americans. . . .

The researchers concluded: "Our results emphasise the importance of early lifestyle modification and risk factor treatment to prevent dementia."

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Smoking bans linked to cut in heart risk 

In Pennsylvania, it's been more than a year since a smoking ban took effect in most businesses and public places and the law's supporters welcome evidence that it will result in better health conditions.

A major report, released by the Institute of Medicine last month, confirmed what health officials long have believed: Bans on smoking in restaurants, bars and other gathering spots reduce the risk of heart attacks among nonsmokers. . . .

"The evidence is clear," said Dr. Thomas Frieden, head of the federal Centers for Disease Control and Prevention, which requested the study. "Smoke-free laws don't hurt business ... but they prevent heart attacks in nonsmokers."

Among the report's conclusions: While heavier exposure to secondhand smoke is worse, there's no safe level. It also cited "compelling" if circumstantial evidence that even less than an hour's exposure might be enough to push someone already at risk of a heart attack over the edge. . . .

Pennsylvania's Clean Indoor Air Act went into effect Sept. 11, 2008, and monitoring its effect on people is one local group, Tobacco Free Allegheny. The group's executive director, Cindy Thomas, commented on the IOM report:

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Heart attacks dip after smoking ban in Starkville 

In the three years after the ban was enacted in 2006, Starkville had 27 percent fewer heart attacks than in the three years preceding the ban, based on the results of a Mississippi State University Social Science Research Study released Monday.

“We are excited about the finding,” said researcher Robert McMillan, who with Dr. Robert Collins, director of MSU Health Services, conducted the study.

Researchers analyzed the number of heart attacks diagnosed at Oktibbeha County Hospital in Starkville, McMillen said.

The data also included people who were transferred to other hospitals for a higher level of care, McMillen said.

Researchers are working with hospitals to gather data from Tupelo and Hattiesburg, which enacted their own indoor smoking bans after Starkville. Tupelo’s ban took effect in October 2006.

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Study: Heart attacks down since smoking ban  

A Mississippi State University study released Monday shows a 27 percent decrease in heart attacks among Starkville residents since the city passed its no-smoking ordinance in 2006.

The study by Robert McMillen and Dr. Robert Collins focused on Starkville residents in the three years since the city's Board of Aldermen passed the indoor smoking ban compared to the three prior years. Oktibbeha County Hospital and North Mississippi Medical Center in Tupelo treated a combined 51 Starkville residents for heart attacks in the three years before the smoking ban was enacted, but only 37 in the three years since, the study revealed.

Researchers see a correlation between the no-smoking policy and the decrease in heart attacks.

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Study: Smoking bans, heart attack reduction linked  

Health advocates have received some ammunition in their arguments for more comprehensive anti-smoking legislation in the Shoals.

The nationally-renowned Institute of Medicine released a report, based on nearly a dozen studies from across the United States, Canada, Italy and Scotland, that says smoking bans decrease the risk of heart attacks. . . .

Florence just completed its first month under a smoking ordinance, which required owners to choose between designating their restaurant as entirely smoking or nonsmoking.

And while it's too early to determine its health imprint, business owners already have noticed where it impacts them the most - their wallets.

Initial observations seem to affirm Frieden's belief.

"Business has gotten a little better,"

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State issues warning on secondhand smoke 

Based on a major new report issued by the Institute of Medicine that concludes avoiding exposure to tobacco smoke reduces heart attack deaths, the Oklahoma State Department of Health is warning Oklahomans with heart disease or with elevated risk for heart disease to avoid places where smoking is allowed indoors.

"The Institute of Medicine points out that even relatively brief exposures to tobacco smoke have adverse effects on the heart and cardiovascular system and that these effects can contribute to heart attacks and deaths," said State Health Commissioner Dr. Terry Cline. "About 700 deaths each year in Oklahoma are attributable to secondhand smoke exposure, and the majority of these deaths are from heart attacks and cardiovascular disease."

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EDITORIAL: The Importance of Extinguishing Secondhand Smoke 

This issue of Circulation includes a meta-analysis of the impact of smoking bans on hospitalization for acute myocardial infarction.2 The findings further attest to the power of government interventions. . . .

A systematic review of 26 studies showed that smoke-free workplaces reduced smoking prevalence by 3.8% and the amount smoked by 3.1 cigarettes daily in those continuing to smoke, together constituting a 29% decrease in total cigarette consumption.19 One of the studies included in the meta-analysis2 found that acute coronary syndrome admissions were decreased in smokers as well as nonsmokers.7 Furthermore, rather than having a negative impact on businesses, smoking bans can increase patronage of restaurants and drinking venues.

Clinicians should advise their patients to avoid public places that permit smoking, and families should be counseled not to smoke at home or in a vehicle with patients. Healthcare professionals can also be powerful advocates, and research such as that described in this issue2 strengthens the case for government action.

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One cig puts young at risk  

ONE cigarette can put young people at greater risk of a heart attack or stroke, a study has warned.

It increases the stiffness of the arteries in 18 to 30-year-olds by an alarming 25 per cent -- increasing resistance in the blood vessels and making the heart work faster.

Leading medic Dr Stella Daskalopoulou claimed smoking just a few sneaky cigarettes could have a significant impact on the heart.

The doctor, a vascular medicine specialist at McGill University Health Centre in Edmonton, Canada, said: "Our results are significant because they suggest smoking just a few cigarettes a day impacts the health of the arteries.

Stress

"This was revealed very clearly when these young people were placed under physical stress, such as exercise."

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Smoking's Damage Swift, Irreversible 

Cigarette smoking starts inflicting “very significant” damage on the arteries with the very first puffs taken by otherwise healthy young smokers, new research shows.

The damage worsens as time passes and is impossible to reverse, says researcher Stella Daskalopoulou, MD, of the McGill University Health Centre.

The study found that smoking just one cigarette increases the stiffness of the arteries in 18- to 30-year-old smokers by 25% after a treadmill exercise test. It was presented at the Canadian Cardiovascular Congress 2009 in Edmonton, Alberta.

As arteries stiffen, she says, the heart must work harder, increasing the risk for heart disease or stroke.

“Our results are significant because they suggest that smoking just a few cigarettes a day impacts the health of the arteries,” Daskalopoulou says in a news release. “This was revealed very clearly when these young people were placed under physical stress, such as exercise.”

She tells WebMD that the study compared the arterial stiffness of 10 young smokers, who puffed five to six cigarettes a day, to 10 nonsmokers. The median age of the participants was 21 years. Researchers, who included R.J. Doonan and other medical students under her supervision, measured arterial stiffness at rest and after exercise.

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EDITORIAL: More medical support for smoking ban 

Greenwood's ban on smoking in restaurants and bars is being vindicated by yet another scientific study.

A recent report from the Institute of Medicine found that in locales around the world where smoking bans have been enacted, the number of heart attacks has dropped by 6 percent to 47 percent.

The report underlines what the U.S. surgeon general warned of in 2006: There's really no safe level of exposure to secondhand smoke.

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Even Light Smoking Affects Young Adults' Arteries  

Smoking just one cigarette stiffens the arteries of young adults by 25 percent, says a new study.

The stiffer a person's arteries, the greater their risk for heart disease or stroke, noted researcher Dr. Stella Daskalopoulou, an internal medicine and vascular medicine specialist at McGill University Health Center in Montreal.

She measured arterial stiffness in smokers and non-smokers, ages 18 to 30, at rest and after exercise. To establish a baseline measurement, the smokers, who smoked five to six cigarettes a day, were asked to refrain from having a cigarette for 12 hours before their first exercise test. Before the second exercise test, smokers were allowed to have one cigarette. Before the final test, they were asked to chew a piece of nicotine gum.

After exercise, arterial stiffness in non-smokers decreased 3.6 percent. But the smokers' arterial stiffness increased 2.2 percent after exercise. In smokers, arterial stiffness increased 12.6 percent after they chewed nicotine gum and 24.5 percent after they had one cigarette.

There was no difference in arterial stiffness between smokers and non-smokers at rest. . . .

The study was to be presented Oct. 27 at the Canadian Cardiovascular Congress 2009.

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Clinical Trials Update: Oct. 28, 2009  

COPD (Chronic Obstructive Pulmonary Disease)

This 10-week study is for people aged 40 to 80 who have been diagnosed with COPD.

The research site is in Phoenix, Ariz.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/copd.aspx.

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Congestive Heart Failure (CHF)

This study is for people who have chronic stable heart failure and have an ejection fraction of less than 40 percent. Participants will have an echocardiogram and will be asked to stay overnight. Compensation for time and travel is available up to $2,750 if you qualify.

The research site is in Tustin, Calif.

More information

Please see http://www.clinicalconnection.com/clinical_trials/condition/heart_failure.aspx.

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