Tobacco.org

• 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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• Even A Few Cigarettes A Day Reduces Artery Health In Young Adults 

A new study from Canada suggests that even light smoking in otherwise healthy young people damages the arteries, reducing their bodies' ability to deal with physical stress such as exercise, running to catch a bus or climbing stairs.

The study was led by Dr Stella Daskalopoulou, an internal medicine and vascular medicine specialist at McGill University Health Centre (MUHC) in Montreal, Quebec, who presented it at the Canadian Cardiovascular Congress 2009 that is taking place 24 to 29 October in Edmonton, Alberta. The event is co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

In fact, Daskalopoulou and colleagues showed that even one cigarette led to serious adverse effects in young adults: it increased the stiffness of the arteries of otherwise healthy 18 to 30 year olds by 25 per cent, she told the conference.

Smoking helps plaque accumulate in the arteries, leading to a higher risk of blood clots, less oxygen in the blood, and higher blood pressure. It also makes the heart work harder and nearly doubles the risk of ischemic stroke . . .

"Young adults aged 20-24 years have the highest smoking rate of all age groups in Canada."

"Our results are significant because they suggest that smoking just a few cigarettes a day impacts the health of the arteries. This was revealed very clearly when these young people were placed under physical stress, such as exercise," she explained. . . .

For the study, Daskalopoulou and colleagues compared the arterial stiffness of young smokers who smoked about five or six cigarettes a day to that of non-smokers. The median age of the participants was 21.

They measured the participants' arterial stiffness in three arteries

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• Use An E-Cigarette, Reduce Risk of Heart Disease 

E-CigaretteDirect.com recommends that smokers switch to electronic cigarettes to protect themselves and their loved ones from secondhand smoke and heart disease. You don't have to be a smoker for smoke to harm you. Secondhand smoke is known to be even more dangerous than first hand smoke.

The recent study titled Secondhand Smoke Exposure and Cardiovascular Effects assess the relationship among second hand smoke and acute coronary events. The scientists found that smoking regular cigarettes increases the risk of heart disease by 25-30%. The Surgeon General agrees with this conclusion in his 2006 report.

To avoid second hand smoke for others, smokers have a few options: Quit, leave the premises to smoke, or try an electronic cigarette. "The e-cigarette produces ZERO second hand smoke. None. The 'smoke' that is expelled is actually water vapor", states Gina King of E-CigaretteDirect. "People can use this smoking alternative to decrease the risk of smoking for them and their loved ones. This study only proves that regular cigarettes are dangerous for more people than just the smoker".

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• SULLUM: A CDC second-hand smokescreen 

Six years ago, when I asked an epidemiologist about a report that a smoking ban in Helena, Mont., had cut heart attacks by 40 percent within six months, he thought the idea was so ridiculous that no one would take it seriously.

He was wrong. . . .

a closer look at the IOM report, which was commissioned by the US Centers for Disease Control and Prevention, suggests its conclusions are based on a desire to promote smoking bans rather than a dispassionate examination of the evidence. . . .

The largest study of this issue, which used nationwide data instead of looking at cherry-picked communities, concluded that smoking bans in America "are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction."

It also found that "large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature."

That study, published by the National Bureau of Economic Research in March, suggests that publication bias -- the tendency to report positive findings and ignore negative ones -- explains the "consistent" results highlighted by the IOM committee. But even though the panelists say they tried to compensate for publication bias by looking for relevant data that did not appear in medical journals, they ignored the NBER paper, along with analyses that found no declines in heart attacks following smoking bans in California, Florida, New York, Oregon, England, Wales and Scotland. . . .

Even while taking refuge in imprecision, the IOM committee tries to make transparently absurd claims seem plausible by intimating that spending a half-hour in a smoky bar just might kill you, even if you were completely healthy when you went in. If so, where are the bodies? The report concedes that "there is no direct evidence that a relatively brief exposure to secondhand smoke can precipitate an acute coronary event."

Siegel, who faults the IOM committee's "sensationalistic" approach, is a longtime backer of smoking bans who nevertheless tries to separate his political advocacy from his scientific analysis.

It's too bad the authors of the IOM report, who immediately used it as an excuse to demand strict smoking regulations throughout the country, did not follow his example.

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• Adults in Malta smoking less, young people more  

The number of adults in Malta who smoke is appreciably on the decline but young people, particularly girls, are smoking more, a news conference yesterday was told. The news conference was given to promote World Heart Day, being held on Sunday, when radio and television stations will be running an advert to raise awareness regarding the dangers of cardiovascular diseases.

Health parliamentary secretary Joe Cassar said that not enough people in Malta are knowledgeable enough about the dangers their lifestyles can pose.

"Cardiovascular diseases are still the world's largest killers, claiming 17.5 million lives a year, even though the risk factors for heart diseases and strokes are well known.

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• SULLUM: CDC-Commissioned Report Says More Evidence Is Needed to Decide Whether Smoking Bans Are Good 

Just kidding. The report, which an Institute of Medicine committee issued yesterday, concludes, per the press release, that "smoking bans reduce the risk of heart attacks associated with secondhand smoke." The committee's chairwoman, Lynn Goldman, a professor of environmental health sciences at Johns Hopkins, sums up the report's findings this way:

It's clear that smoking bans work. . . .

As with the 2006 surgeon general's report on secondhand smoke, the press release goes farther than the report itself, which in turn draws conclusions that are not justified by the evidence it presents. The judgment about the effectiveness of smoking bans is based on 11 studies that looked at heart attack rates in eight jurisdictions after smoking bans took effect. "None was designed to test the hypothesis that secondhand-smoke exposure causes cardiovascular disease or acute coronary events," the report concedes. Furthermore, "only two of the studies distinguished between reductions in heart attacks suffered by smokers versus nonsmokers." Even so, the report concludes that smoking bans reduce heart attacks, at least partly by reducing nonsmokers' exposure to secondhand smoke.

To accomplish that impressive feat, the report underplays two major problems with attempts to measure the impact of smoking bans through observational studies. First, in recent decades there has been a general decline in heart attack rates, driven mainly by improvements in preventive medication and treatment. A decrease in heart attacks seen after a smoking ban takes effect could be part of this pre-existing trend. . . .

Second, random variation means that some jurisdictions with smoking bans are bound to see significant drops in heart attacks purely by chance, while others will see no real change or significant increases. . . .

That study, published by the National Bureau of Economic Research in March, suggests that publication bias can explain what the IOM panel describes as the "consistent" results of the studies it considered . . .

The NBER paper was mysteriously excluded from the IOM report, even though the authors say they bent over backward to compensate for publication bias by looking for relevant data that did not appear in medical journals. They also ignored analyses that found no declines in heart attacks following smoking bans in California, Florida, New York, Oregon, England, Wales, and Scotland. . . .

The report is slippery in addressing the biological plausibility of attributing immediate, dramatic reductions in heart attacks to smoking bans. . . .

Although the authors work hard to make patently ridiculous claims seem plausible, they never settle on an explanation of how, exactly, these reductions in heart attacks are accomplished. . . .

Assuming that smoking bans do reduce heart attacks, that result could be due to declines in smoking, declines in secondhand smoke exposure, or some combination of the two. The report settles on that last explanation, even though only two of the 11 studies bothered to distinguish between smokers and nonsmokers. . . .

The main goal of this project, which was commissioned by the CDC, seems to have been producing a document that could be waved around at city council meetings and state legislative hearings. If so, the authors have succeeded. . . .

My own view is that the scientific findings are not relevant to the policy question, which is a matter of property rights. . . .

Yet the people conducting these reviews are not neutral observers either; as reflected by Benowitz's comments, they are committed partisans in the push to extend strict smoking bans across the country.

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• Smoking Bans Reduce the Risk of Heart Attacks Associated With Secondhand Smoke 

Smoking bans are effective at reducing the risk of heart attacks and heart disease associated with exposure to secondhand smoke, says a new report from the Institute of Medicine. The report also confirms there is sufficient evidence that breathing secondhand smoke boosts nonsmokers' risk for heart problems, adding that indirect evidence indicating that even relatively brief exposures could lead to a heart attack is compelling.

"It's clear that smoking bans work," said Lynn Goldman, professor of environmental health sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, and chair of the committee of experts that wrote the report. "Bans reduce the risks of heart attack in nonsmokers as well as smokers. Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects. However, there is no question that smoking bans have a positive health effect."

About 43 percent of nonsmoking children and 37 percent of nonsmoking adults are exposed to secondhand smoke in the United States, according to public health data. Despite significant reductions in the percentages of Americans breathing environmental tobacco smoke over the past several years, roughly 126 million nonsmokers were still being exposed in 2000. . . .

The report also provides a detailed discussion of the evidence from animal research and epidemiological studies showing a cause-and-effect relationship between secondhand smoke exposure and heart problems. The committee was not able to determine the exact magnitude of the increased risk presented by breathing environmental tobacco smoke, but noted that studies consistently indicate it increases the risks by 25 percent to 30 percent. Although there is no direct evidence that a relatively brief exposure to secondhand smoke could precipitate a heart attack, the committee found the indirect evidence compelling. Data on particulate matter in smoke from other pollution sources suggest that a relatively brief exposure to such substances can initiate a heart attack, and particulate matter is a major component of secondhand smoke.

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• Smoking Bans Protect Nonsmokers' Hearts  

A major report confirms what health officials have long believed: Bans on smoking in restaurants, bars and other gathering spots reduce the risk of heart attacks among nonsmokers.

More than 126 million nonsmoking Americans are regularly exposed to someone else's tobacco smoke. The surgeon general in 2006 cited "overwhelming scientific evidence" that tens of thousands die each year as a result, from heart disease, lung cancer and a list of other illnesses.

Yet smoking bans have remained a hard sell, as lawmakers and business owners debate whether such prohibitions are worth the anger of smoking customers or employees.

Thursday's hard-hitting report from the Institute of Medicine promises to influence that debate here and abroad.

"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 IOM report's conclusions: While heavier exposure to secondhand smoke is worse, there's no safe level. And it 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 -- as the smoke's pollution-like small particles and other substances can quickly affect blood vessels.

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• Smoking Bans' Effects on Heart Disease Risks -- IOM Report Releases Oct. 15 

Secondhand-Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence, a new report from the Institute of Medicine, provides a comprehensive evaluation of studies exploring the impacts of smoking bans in the United States and abroad and the relationship between secondhand smoke and heart disease. Based on this review, the report offers conclusions about the effectiveness of smoke-free policies. The report will be released with a one-hour public briefing.

Details:

11 a.m. to noon EDT Thursday, Oct. 15, Room 201 of the National Academies Keck Center

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• Exposure to ambient particulate matter and cigarette smoke linked with increased mortality risk 

Low levels of fine particulate matter from either cigarette smoke or other air pollution may be associated with an increased risk for mortality from CVD.

The researchers examined an analytic cohort of approximately 1 million participants from the American Cancer Society Cancer Prevention Study II (217,000 were current smokers at the time of enrollment). Using a Cox proportional hazard regressions model, they adjusted for education, body mass, increments of cigarette smoking, occupational exposure to particulate matter and other variables. The researchers then integrated the data with data from other studies of secondhand smoke and air pollution and plotted the adjusted relative mortality risk against the estimated daily average dose of fine particulate matter from cigarette smoke and other air pollution.

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• Autoimmune Condition, Especially Combined With Smoking And Oral Contraceptive Use, Massively Increases Risk Of Stroke And Heart Attack In Young Women 

The autoimmune condition antiphospholipid syndrome mainly affects young women. An Article published Online First and in the November edition of The Lancet Neurology shows that women with a particular subtype of antibody called lupus anticoagulant (LA) have a more than 40-fold increased risk of stroke and 5-fold increased risk of heart attack compared with the general population (of young women). Smoking and oral contraceptive use increase the risk of these events even more. The Article is written by Dr Rolf Urbanus and Dr Philip de Groot, University Medical Centre Utrecht, Netherlands, together with colleagues from the Leiden University Medical Centre.

Antiphospholipid syndrome occurs when autoantibodies* bind to cell membranes, interfering with the regular clotting mechanism of the blood. Diagnosis occurs when young women (under 50 years) suffer a thrombotic event such as a stroke or heart attack, and antiphospholipid antibodies are tested. Although it is known that this condition causes thrombosis, bleeding, and repeat miscarriage in women, the extent of the increased risk for stroke and heart attack was unknown before this study. . . .

In an accompanying Reflection and Reaction, Dr Kathryn Kirchoff-Torres and Dr Steven R Levine, Stroke Center, Mount Sinai School of Medicine, New York, NY, USA, say that the most important aspect of the study is its conclusion that young women with LA need to be warned about the dangers of smoking and use of oral contraceptives.

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• Smoking And Heart Disease Risks Can Cut Life Span By 10 Years 

Middle aged men who smoke, have high blood pressure and raised cholesterol levels can expect a 10-15 year shorter life expectancy from age 50 compared with men without these risk factors.

The Oxford University study published in the British Medical Journal reports data from the Whitehall study, in which the health of 19,000 male civil servants has been followed for almost 40 years since 1970, when they were aged 40-69.

'We've shown that men at age 50 who smoke, have high blood pressure and high cholesterol levels can expect to survive to 74 years of age, while those who have none of these risk factors can expect to live until 83,' says Dr Robert Clarke of the Clinical Trial Service Unit at the University of Oxford, who led the research team. . . .

Dr Clarke says: 'The results give people another way of looking at heart disease risk factors that can be understood more readily. If you stop smoking or take measures to deal with high blood pressure or body weight, it will translate into increased life expectancy.

'It also provides support for existing public health policies. Bans on smoking in public places, efforts to lower saturated fats and salt, combined with medications for those at high risk of cardiovascular disease, when taken together will result in substantial improvements in life expectancy across the population.'

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