Tobacco.org

• 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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• 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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• 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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• 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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• 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.

• Tomorrow’s regular customers? Stamping out tobacco use in the Middle East and Africa (PDF) 

Tomorrow’s regular customers? Stamping out tobacco use in the Middle East and Africa is a research paper written by the Economist Intelligence Unit and sponsored by Pfizer. . . .

The findings are based on more than 40 interviews with experts from government, academia, NGOs and the tobacco industry in the Middle East, Africa and elsewhere. We would like to thank the Economist Intelligence Unit’s extensive network of country analysts for organising and conducting most of these interviews. . . .

This report focuses on one portion of the developing world—the Middle East and Africa (MEA)— which has become a key battleground in the struggle over government policy and public attitudes.

Although the region can lay claim to adult smoking rates mostly on par or lower than those of many Western and developing nations, expanding populations mean that even if rates were to stay relatively steady, the absolute numbers of smokers would still rise.

The MEA region also poses other deeply entrenched challenges. These include rising youth smoking rates, particularly among girls, a prevailing culture of acceptance around tobacco, especially the water pipe, widespread governmental ambivalence and a strong tobacco industry lobby. But charities and other non-governmental organisations (NGOs) have gained a foothold in recent years. They often work on a shoestring, but are increasingly supported with much-needed financial lifelines from rich Western philanthropists.

“There is a change in mentality in our region. Ministries of health are working with the WHO and other NGOs—bringing together all the people working on tobacco control,” says Dr Jean-Pierre Baptiste, a regional adviser with the WHO’s Tobacco Free Initiative in Algeria. He is one of more than 40 experts from government, academia, NGOs and the tobacco industry interviewed for this report.

But are their efforts enough? In this paper, we investigate the progress that has been made, the challenges that remain, what lessons can be drawn from successful policies elsewhere and how the landscape could look in a decade or two. We examine ten major markets in-depth—four in North Africa: Egypt, Algeria, Morocco and Tunisia; two in Sub-Saharan Africa: Nigeria and South Africa; and four in the Middle East: Lebanon, Jordan, Saudi Arabia and the United Arab Emirates (UAE). The key findings of the report are highlighted below.

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• Stillbirths And Infant Deaths Related To Smoking During Pregnancy And Socioeconomic Inequalities 

New research published on bmj.com today reports that addressing the problem of smoking during pregnancy may help to reduce the socioeconomic inequalities in stillbirths and infant deaths by as much as 30 to 40 percent.

Without a doubt smoking during pregnancy has been associated with stillbirth. In addition, infant deaths and smoking rates during pregnancy vary strikingly with socioeconomic position. In order to find out more, a team of researchers began the task of measuring the effects of smoking during pregnancy and on the social inequalities gap in stillbirths and infant deaths.

They assessed the records of 529,317 live singleton births and 2,699 stillbirths delivered at 24 to 44 weeks' gestation in Scotland from 1994 to 2003.

Information on smoking during the pregnancy was gathered. A deprivation score was designated using postcode data from the 2001 population census.

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• Jobless found more likely to smoke  

A new federal report on tobacco use shows that unemployed people are more likely than workers to smoke.

Among those respondents who are working, the report says that people in the food service industry have the highest rate of smoking compared with other industries.

The report follows the June enactment of the Family Smoking and Prevention Tobacco Control Act, which authorizes the Food and Drug Administration to regulate tobacco.

The Substance Abuse and Mental Health Services Administration (SAMHSA) released a survey that shows 28.4 percent of workers ages 18 to 64 had smoked in the previous month. Among the unemployed, the rate was 45.4 percent.

The survey also asked respondents to list their occupation. The highest rate of smoking was in the food service and preparation industry, with a 44.7 percent smoking rate.

The next highest industry, with a rate of 42.9 percent, was construction.

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• EDITORIAL: Unhealthy business 

Once again the profit motive may trump the government in its efforts to improve the general health of the nation. The government had announced the introduction of pictorial health warnings on cigarette packs and had given the industry a six-month deadline to print them as from January 1st 2010; thus joining 30 other countries having similar warnings. . . .

It is reported that a series of meetings between industry representatives and senior officials of the health department has been held in an effort to slow down the implementation of the requirement for pictorial warnings on packets. . . .

We are a desperately unhealthy nation with a poor spread of primary healthcare services; and an even poorer spread of specialist oncology units. The causal linkage between smoking, cancers, and respiratory illness is well known. Our implementation of anti-smoking legislation has been patchy at best and as the tobacco producers are on the retreat in the developed world; they are increasingly focused on the undeveloped and developing world to extend their market footprint. We hope that the government will hold the line and not cave in to assorted pressures. This is sensible governance and clearly to the ultimate benefit of the entire population. Smoking kills - pictorial warnings on packets may lead to fewer of us dying of tobacco-related disease; and we have scant sympathy for the tobacco lobby.

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• Tobacco Use Worsens Malnutrition in Developing Countries 

But some economists find there's an fiscal risk as well. In many poor countries, in order to light up, smokers spend a significant amount of money to pay for cigarettes.

Economist Steven Block learned this by examining data from Indonesia about the household expenses of smokers. He says it turns out that tobacco is a surprisingly large expenditure in those households where there is a smoker.

"The percentage of men in Indonesia that smokes is over 60 percent," Block says. "A substantial number of households has one smoker, and it turns out that even among very poor households in rural central Java... when there is a smoker in the household, they spent approximately 10 percent of their household budget on tobacco products."

Block used data collected by the not-for-profit Helen Keller International a group that gathers information about household consumption patterns around the world every few months.

Block says the data show the relatively high percentage of money spent on tobacco held true in the poorest families where food budgets take up between 60 to 70 percent of total income. . . .

What's more, Block says, the data was able to show that having a smoker in the family resulted in the children having physical changes.

"Because these tobacco expenditures are displacing food expenditures we can document that the children are slightly shorter on average in those households," Block says.

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• Tobacco Takes Toll on Environment 

A group of anti-cancer organizations have compiled information and data about smoking and its effects into a new online resource — the Tobacco Atlas.

Doctor Thomas Glynn heads the international cancer control section at the American Cancer Society. He says they compiled the Atlas because they wanted to present information about the health effects of tobacco in a new way… and get the word out to the billion men and about 250 million women around the world who light up every day.

"There is no one who smokes for very long who is not going to become sickened by it in one way or another, either from a lung disease such as chronic bronchitis or emphysema, or from a cancer, or from heart disease," Glynn says.

"There is virtually no one who is immune from becoming sick from it. We also know that as many as half of people who use tobacco over a lifetime will die because from their tobacco use."

The Tobacco Atlas is available both online and as a book. . . .

"As an example, in China, about 4… 5… 6 percent of women across China are using tobacco," he says.

"But yet in places like Shanghai where tobacco companies are focusing we are starting to see figures like 20 or 25 percent."

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• Tobacco sales down in wake of new tax 

Cigarette sales have plunged, and smokers have been streaming across the border since Florida's $1-a-pack tax went into effect July 1.

The latest figures from the Department of Business and Professional Regulation show a 28-percent drop in the sale of cigarette packs from July 2008 to July 2009 — 76.8 million packs sold this year compared to 106.6 million packs a year ago.

Sales are also down from June, the month before the buck-a-pack increase was added, 17 percent less in July than June, when 92.9 million packs were sold.

The state's convenience stores, where most cigarettes are sold, and where tobacco makes up 34 percent of non-gasoline sales, are already feeling the sting, said Jim Smith, head of the Florida Petroleum Marketers and Convenience Store Association.

Some owners are working longer hours behind the counter and cutting employee hours to make ends meet, Smith said. Layoffs are inevitable, he said.

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• Adult Smoking Drops Again, Saving Lives and $2.8 Billion in Future Health Care Costs 

Washington's adult smoking rate has hit a new low for the sixth consecutive year. Results from the state's most recent survey show the smoking rate has dropped to 15.3 percent -- down from 16.5 percent the previous year. Washington has the sixth lowest smoking rate in the nation and remains well below the national rate of 18.4 percent.

"Tobacco prevention and control is a priority in our state, and it's paying off. Fewer people who smoke means fewer people suffering or dying from tobacco-related diseases. It also means our state will save billions of dollars in future health care costs," said Governor Chris Gregoire. "We must continue to look for ways to reach people who are addicted to this deadly habit, and keep kids from ever starting so they'll live longer, healthier lives."

The adult smoking rate in Washington has dropped more than 30 percent since the state began its Tobacco Prevention and Control Program in 2000. There are now 295,000 fewer people smoking in the state and an estimated 98,000 people will be spared early, tobacco-related deaths. The decline in smoking will save an estimated $2.8 billion in future health care costs. The state has reached its 10-year goal of reducing the adult smoking rate to 16.5 percent or less by 2010. With that the Department of Health has established a new goal of reducing adult smoking to 14 percent or less by 2013.

The department is refocusing efforts to help groups still smoking at higher rates. There are 770,000 adults who smoke in Washington; the majority are from either lower income or lower educational backgrounds. The smoking rate for people with low income is 31 percent; that's more than three times as high as the 10 percent smoking rate for people with higher income.

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• Tobacco use among India's street children raises concern 

The Academy Award winning British film Slumdog Millionaire attracted global attention for presenting a romanticised story of life in the slums of Mumbai. However, the real-life problems of street children in India are far more serious, with new surveys indicating an alarmingly high use of various tobacco products among street children.

India has over 360 million children aged under 15 years. Although there are no official data on the number of street children, conservative estimates put the figure at over 10 million, most of whom earn a living through activities like rag picking, begging, vending, shoe shining, and sometimes petty crime.

A recent, unpublished survey of marginalised children in Mumbai and two other cities in north eastern India—Guwahati and Amsong—showed that over a quarter of children aged 5—19 years consumed tobacco in various forms. The survey—funded by the International Union Against Cancer (UICC)—was done by the Cancer Patients Aid Association (CPAA) in Mumbai. It noted that the average age at which children started using tobacco was 11·3 years for both boys and girls. In Mumbai, the most frequently used products were raw tobacco, gutkha (a blend of tobacco and flavourings), and cigarettes. . . .

The Delhi-based group Health-Related Information Dissemination Amongst Youth (HRIDAY) has noted that interventions through schools result in positive changes in behaviour and help prevent tobacco use. Now the group is collaborating with the University of Texas in the USA to conduct a community-based randomised trial among youths in seven low income communities in Delhi to see if the same interventions work with street children. . . .

The government has taken several steps to curb tobacco use, but their impact is yet to be felt. Selling tobacco products to children younger than 18 years of age is prohibited, but retailers openly flout this regulation, and maximum fines only amount to the cost of a couple of packets of cigarettes. If this law is enforced and retailers penalised, it could cut out a major source of tobacco products to youth. Increased use of pictorial warnings and higher tax rates might also help to discourage the use of tobacco products.

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