Tobacco.org

Women and Smoking: An Interdisciplinary Examination of Socioeconomic Influences 

• Nonsmokers Top Smokers in Well-Being Across All Incomes 

Smokers trail nonsmokers in well-being, regardless of income bracket, according to Gallup-Healthways Well-Being Index data collected in 2008 and 2009. In every income group, smokers are less likely than nonsmokers to be "thriving" by at least 12 percentage points. . . .

In the case of emotional health, the connection between smoking and low well-being is especially pronounced for low-income respondents. While the emotional health gap between smokers and nonsmokers is 4 points for the highest income group, the gap for the lowest income group is 10 points.

The differences in the size of the smoking gap across income groups could mean that the emotional consequences of smoking are less pronounced for people in the higher income group. Another possibility is that people in different income groups smoke for different emotional reasons. . . .

Self-reported smoking status is, in fact, strongly linked to depression. . . .

Across all income groups, smokers also fare worse than nonsmokers in physical health as reflected in lower scores on the Physical Health Index. Consistent with medical research connecting smoking to premature mortality, people who are 85 years old or older are unlikely to be smokers.

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• With aid, Mass. poor cut smoking  

Lower income Massachusetts smokers have dramatically abandoned their habit amid a major state campaign that vigorously promotes and pays for tobacco addiction treatment, according to a report scheduled to be released this morning.

Smoking rates among the poor plummeted 26 percent in the first two years of the ongoing state program, a striking result that is already drawing national attention to the effort. Officials targeted a population that historically had the highest smoking rates in Massachusetts.

The study, issued by the Department of Public Health, found early indications that the tobacco cessation efforts - aimed at patients enrolled in the state’s medical insurance for the poor, MassHealth - are reaping immediate health benefits.

Once patients began receiving counseling and medications to help snuff out their habits, they made fewer trips to emergency rooms because of wheezing bouts of asthma, and there was a trend toward fewer life-threatening heart attacks.

The stop-smoking initiative, which covers virtually all the costs of cessation counseling and drugs, was ordered by the Legislature as part of the landmark health care overhaul in 2006 with a dual purpose: saving lives and money. National health leaders plan to point to the Massachusetts experiment to bolster efforts to expand tobacco cessation services as part of federal health care legislation.

“These findings are extraordinary - they have major public health implications as Congress is debating health care reform,’’ said Matthew Myers . . .

The expectation, based on the experience of other states and health plans, was that 5 to 10 percent of MassHealth patients who smoked might seek help in the first couple of years, Keithly said.

Instead, from July 2006 to May of this year, about 75,000 patients had used the services - two of every five MassHealth smokers.

“We wondered if this population would be interested in cessation,’’ said Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital. “It turns out they were interested - they just couldn’t afford it.’’

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EDITORIAL: Tighten laws on tobacco and public smoking 

It is a pity that when many developed countries have tightened laws to make smoking unacceptable or illegal in public places, in developing countries it is the reverse.

In the last 40 years, according to the ACS, smoking rates have fallen in rich countries like the United States, Britain and Japan but have been rising in most of the developing world. Statistics show that smoking will kill six million people worldwide as early as 2010 and 72% of those will be from low and middle-income countries. Uganda is a poor country whose health sector is grossly inadequate. . . .

According to the Uganda Heart Institute, respiratory diseases and lung cancer will be Uganda's leading killer by 2020.

Lung cancer is closely associated with smoking and is on the increase because anti-smoking laws are very weak or non-existent in poor countries. In 2004, the then environment minister Kahinda Otafiire imposed a smoking ban in all public places. However, since the public places were not gazetted, its enforcement became problematic. Clearly, there is need to discourage smoking.

The starting point is to help tobacco growers switch to alternative crops. The law on public smoking must be vigorously enforced and non-smoking areas clearly demarcated. Cigarettes should be sold in packets and not as individual sticks to make its cost prohibitive.

Churches, mosques and schools should play a role in sensitising people about the danger of smoking. With concerted effort, the deadly menace of smoking can be tackled.

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Internet bridges gap for rural residents who need anti-smoking programs 

The Internet may soon join nicotine chewing gum, the patch and behavioral counseling as a remedy for tobacco addiction, says a University of Florida researcher who participated in a study of rural residents using their computers to kick the habit.

Remote residents were chosen as subjects because they live far from clinical services that have helped many of their urban counterparts to quit smoking, said Jesse Dallery, a UF psychologist and one of the study’s authors.

“People who live away from cities face special challenges in kicking the habit because they are served by fewer clinics offering smoking cessation programs and they usually lack public transportation,” he said. “Capitalizing on the reach of the Internet is one way to help these otherwise inaccessible smokers.”

People who tried the virtual program were able to refrain from smoking at more than twice the rate of another group who did not use it

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• The Geography of Smoking  

One in five Americans continue to smoke cigarettes, according to a new survey by the Centers for Disease Control and Prevention. The smoking rate varies from low of 9.2 percent in Utah to a high of 26.6 percent in West Virginia. The map below, from the Wall Street Journal, shows the smoking rate by state.

The data are interesting and they allow us to look at the extent to which smoking is associated with all sorts of things, from more obvious ones like cancer and heart disease to the economic and demographic characteristics of states with higher or lower levels of smoking and even the relationship between smoking and happiness. With a helpful analytical assist from my colleague Charlotta Mellander, we decided to take a quick look. We ran some simple correlations and scatter-plots between state smoking rates and these factors. As usual, we point out that correlation does not imply causality, but simply points to associations between variables. Still, a number of interesting things stand out.

It will come as little surprise that states with higher levels of smoking have significantly higher rates of death from cancer, heart disease, and cerebrovascular diseases like hypertension. There is a significant correlation between state smoking rates and death rates from cancer (.75), heart disease (.67), and cerebrovascular disease (.59). . . .

Smoking is negatively associated with state happiness (with a correlation of -44.71). Since these correlations only reflect associations between variables and not causality, it's hard to say whether this reflects the fact that happier people smoke less or unhappier ones smoke more, or that both smoking and happiness levels reflect something else. . . .

That said, smoking rate is associated with concentrations of artists, musicians, and entertainers. Contrary to the stereotypical image of cigarette-puffing bohemians or hipsters, smoking is less prevalent in states with more of these artistic types: The correlation is negative (-.450), and about the same as for education.

Lastly, smoking is negatively correlated with larger concentrations of gays and lesbians, as well as immigrants

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Ban on smoking: City to breathe easier  

If all goes well, Bhubaneswar will become "smoke-free" within the next six months. The state government on Tuesday announced to crack down on smokers in public places in the city. To ensure that the general public is not forced to become passive smokers, anyone found violating the rule will be fined up to Rs 200.

"Imposing fine on smokers in public places would definitely be a big step towards making the city smoke-free," Health minister Prasanna Acharya said. "It was due to several arrangements needed to implement the rule that led to the delay in imposing it," he added.

He further said that the rule should not be confined only to offices, hotels, market places and malls, but awareness must also be created among a larger section of the people who live in the city's slums.

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Q&A: Duncan Bannatyne 

The entrepreneur discusses his philanthropy and anti-smoking campaigning

Duncan Bannatyne, 60, the Dragons' Den star, is one of the UK's leading entrepreneurs with an estimated �320 million fortune. He is also a leading philanthropist and is a Trustee of Comic Relief. He is president of the charity No Smoking Day, as well as Quit's UK Children's Champion. Here he talks to Sean Carey about cigarette smoking in the UK and Africa.

Not everyone who is a former smoker becomes an anti-smoking activist. What's the motivation?

Well, although I used to smoke I now find that other people's smoking affects me quite a lot - it makes me cough, makes my eyes sting and all the rest of it. So I'm very aware of it at a personal level. But I have long been very concerned about the effect of cigarette smoke on young children's health. So when I was approached to become president of No Smoking Day in 2008, and earlier this year to become Quit's UK Children's Champion, I jumped at the chance. I'm just lucky that I have a public profile because of my television work. It comes in very useful for these sorts of campaigns. . . .

Do you think that the UK government has done enough in terms of anti-smoking initiatives?

No, it hasn't. The authorities in England were a year behind those in Scotland banning smoking in pubs and they're still lagging behind. . . .

In many African countries like Nigeria, Malawi and Mauritius, cigarette smoking is promoted through the use of advertising billboards and sponsorship of music concerts where free cigarettes are handed out. I found when I visited Malawi that often there is no age restriction on those attending these concerts or, if there is, there is no one on the door making sure that young people cannot get in.

What I have also observed in these countries is that among the very poor a single cigarette might be passed around by five or six children which means that they're all likely to develop the habit.

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• State Medicaid Coverage for Tobacco-Dependence Treatments --- United States, 2007 

The prevalence of tobacco use among adults in the United States has been reduced by half since the 1960s (1,2). Despite this progress, low-income populations, such as Medicaid enrollees, continue to smoke at substantially higher rates than the general population (33% versus 20%) (1). The Public Health Service's Clinical Practice Guideline (2) and the Partnership for Prevention's Call for ACTTION (3) recommend comprehensive insurance coverage of tobacco-dependence treatments without barriers such as copayments, limitations in duration of treatment, prior authorization, and stepped-care therapy. Healthy People 2010 aims to expand coverage of evidence-based treatments for nicotine dependency to all 51 Medicaid programs (objective 27-8b) (4). To monitor progress toward that objective, in 2007, the Center for Health and Public Policy Studies at the University of California, Berkeley, surveyed all 51 Medicaid programs. This report summarizes the results of that survey, which found that 43 (84%) programs offered coverage for some form of tobacco-dependence treatment to Medicaid enrollees in traditional fee-for-service (FFS) Medicaid, with four Medicaid programs adding coverage since 2006 and 20 programs adding coverage in the past decade. Only two states (New Mexico and New Jersey) reported access to tobacco-dependence treatments without any limitations or restrictions. Of the 25 states covering pharmacotherapy for Medicaid enrollees in both FFS and managed-care organizations (MCOs), only 13 covered the same tobacco-dependence treatments for enrollees in both populations. Research demonstrates that providing access to comprehensive tobacco-dependence treatments increases quit rates. Providing Medicaid coverage for these treatments would ensure that all enrollees can access and benefit from these treatments.

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High tobacco prices not deterring smoking among the poor  

On Nov. 19, many people will throw away their cigarettes in honor of the American Cancer Society's Great American Smokeout. Jason Halford, 29, of Joliet probably will not be one of them.

In the nine years since he started smoking, Halford has quit twice, but he blames job and money-related stresses for lighting back up. Even the rising cost of cigarettes isn't enough to discourage him.

"I buy cheap brands and look for dollar-off specials," Halford said.

While some people might think the high cost of keeping the habit would discourage its use, recent research suggests the opposite may be true.

Dr. Bruce Christiansen of the University of Wisconsin's Center for Tobacco Research and Intervention (CTRI) discovered that half the adults in Milwaukee's poorest neighborhoods smoke, despite paying $9 for a pack of cigarettes on a household income below $15,000.

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An Unwanted, and Inconvenient, Car Wash  

Living in Georgia for the past 13 years, I get tired of the boasting about Southern hospitality and the inevitable comparisons to my hometown, New York, as a cold, uncaring place.

At those times, I think back to my days as an N.Y.U. scholarship student in the ’80s, perpetually broke and, at times, feeling sorry for myself.

On one such day, I was walking to class through Washington Square Park and was approached by a homeless man asking for spare change. “Sorry,” I told him. “I don’t even have enough money to buy a pack of cigarettes.”

“Aw, you want a cigarette?” he said. “I got cigarettes.” And he held out a battered pack of Pall Malls.

Ah, the kindness of strangers, New York style.

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• Roll-ups burn a hole in cigarette sales  

Roll-ups are making a comeback, as recession-hit smokers switch from expensive cigarettes to cheaper hand-rolled tobacco.

Customs officials cleared 159,605kg of rolling tobacco for distribution in the first nine months of this year, a 38% increase on 2008. They attributed the surge to a rise in the use of roll-your-own tobacco by smokers striving to cut costs.

A survey published last week found that Irish people are smoking more than ever, with one third of the population still lighting up, the highest rate in 11 years.

Despite hikes in tobacco tax, the ban on smoking in the workplace and a law against shops displaying cigarettes for sale, the number of smokers has risen since 2007, when 29% of the population smoked, the EU’s Help campaign found.

A 25g pack of rolling tobacco costs €8.74 but, according to Vincent Jennings, chief executive of the Convenience Stores and Newsagents Association, a thrifty smoker could roll as many as 150 cigarettes from it. Twenty cigarettes cost €8.45, though a preliminary ruling from the European Court of Justice last week found that Ireland’s policy of setting a minimum price for tobacco products distorts competition.

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Smoke Without Fire - Electronic Cigarettes Will Be Proven As A Healthier And Cheaper Alternative To Smoking 

Smokers around the globe have felt the price increase of smoking hit their wallets. Over the past ten years the price of 20 cigarettes has more than quadrupled in some areas, but the amount of people who still smoke isn't decreasing. Electronic Cigarettes are a revolutionary way to still smoke without actually smoking.

At only £26 the NUCIG Advanced Pro 2 USB Series is a cost effective way to try out electronic cigarettes to see if you get on with the technology.

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• Smoking Keeps Its Grip on Urban Poor  

A full 42 percent of people in Milwaukee's poorest neighborhoods smoke -- more than twice the national U.S. average -- sacrificing $9 on a pack of cigarettes even while most of the households reported earning less than $15,000 a year.

Even more troubling is the fact that a large number of these low-income smokers hold beliefs that make them less likely to quit, according to ongoing research from the University of Wisconsin-Madison.

Over the past 40 years or so, the overall smoking rate in the United States has decreased to about 20 percent, but those gains have taken place largely among people with resources, namely money and education, said Bruce Christiansen, an associate scientist with the University of Wisconsin Center for Tobacco Research and Intervention in Madison, who is one of the researchers on what's known as the "ZIP Code" project.

"With public health, we got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans. "Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people."

That select group includes people with mental health issues, which, according to the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA), smoke 44 percent of all cigarettes.

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[W]e got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough. Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people.
Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans.

Study of smoking among the poor reveals striking findings 

In some of Milwaukee's poorest neighborhoods, nearly half of all adults are addicted to cigarettes, despite the fact that prices are nearing $9 a pack while many household incomes are below $15,000.

A Wisconsin research project has revealed some surprising misconceptions that may reinforce tobacco's hold on the poor.

Dr. Bruce Christiansen of the University of Wisconsin-Madison's Center for Tobacco Research and Intervention (CTRI) set out to discover attitudes about smoking among a group of low-income people in Milwaukee, Wisconsin's largest city.

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