Tobacco.org

• Market Watch: Cigarette Trade Changing In Central America 

Now, more than ever, Central America is an ever-changing field of opportunities and obstacles. John Parker profiles the region and goes through the numbers market by market.

The combination of rising income, more influence of free trade policies, multinational business connections, and smokers seeking higher quality brands contributed to greater cigarette imports by countries in Central America in 2008. Estimated cigarette imports for countries in Central America in 2008 rose to about 11 bn pieces. That is an estimate for total imports tabulated by adding data for each of the seven countries. The net regional imports would be about half of that because of large shipments to other countries in Central America by Honduras and Guatemala. BAT and subsidiaries account for most of the cigarette output in Central America.

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• America’s Health Rankings™ Finds Advances in Disease Treatment, but Not Disease Prevention; Preventable Chronic Diseases Threaten Access and Affordability of Medical Care 

Many public health scholars believe that obesity has become equal to, and may overtake tobacco use, as the most significant risk factor for death and disease in the nation. That is in part because, while smoking has declined slightly in the past 20 years and it still exacts extraordinary health consequences on our nation, obesity is on a dangerous, and as yet unchecked, trajectory.

* Smoking -- Biggest Battle of Past 20 Years: Despite focused efforts, nearly one in five Americans still smoke. Over the past year, more than 3 million people have quit smoking, suggesting that interventions such as smoke-free laws, smoking bans, increased cigarette taxes, access to smoking cessation programs and other interventions may have a positive impact. . . .

This year, the Rankings not only provided an annual list of the healthiest and least healthy states, but also determined which states had improved the most over the past 20 years in overall health and how the states compared in their progress against smoking and obesity since 1990.

2009 State Rankings

The 2009 Anniversary Edition shows Vermont as the healthiest state this year. The state has had a steady climb in the Rankings for the past 12 years, moving up from 20th in 1990. Utah climbed from a ranking of fifth to second this year, followed by Massachusetts (3), Hawaii (4) and New Hampshire (5) to round out the Top 5 healthiest states for 2009. For the second year in a row, Utah leads the nation as the state with the lowest prevalence of smoking, and Colorado ranks as the state with the lowest prevalence of obesity. . . .

Over the past 20 years, New York has demonstrated the most improvement in the overall health of its population. This improvement has primarily been driven by a 60 percent reduction in violent crime and significant reductions in infant mortality and smoking rates.

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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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• EDITORIAL: Hoosiers burned in smoke study 

It is safe to say Hoosiers do not look forward to the release of national health rankings with quite the same eagerness folks in Florida and Texas harbor for the weekly round of football polls.

The latest survey, covering one of our several "strong" categories, is out. We ought to be more than disappointed to be number two.

Consistently in the top 10 year after year, Indiana trailed only West Virginia in the percentage of adults using cigarettes in 2008, according to a report released Thursday by the Centers for Disease Control and Prevention. . . .

The Indiana General Assembly couldn't muster the willpower this past session to join the 26 states with comprehensive smoking bans, but Rep. Charlie Brown, D-Gary, vows to renew his push next year.

The City-County Council is close to mustering enough votes to join more than 300 cities with total smoking prohibitions; but sadly, Mayor Greg Ballard says he would veto such a measure for the sake of local business. His stance ignores ample evidence that going smoke-free is not hazardous to the health of bars and eateries.

We do know that smoking -- and, critically important, secondhand smoke -- are killers. And that we arm them, as individuals, as communities and as governments.

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• State-Specific Secondhand Smoke Exposure and Current Cigarette Smoking Among Adults --- United States, 2008 

Secondhand smoke (SHS) causes immediate and long-term adverse health effects in nonsmoking adults and children, including heart disease and lung cancer, and SHS exposure occurs primarily in homes and workplaces (1). Smoke-free policies, including not allowing smoking anywhere inside the home (i.e., having a smoke-free home rule), are the best way to provide protection from exposure to SHS. To assess SHS exposure in homes and indoor workplaces and the prevalence of smoke-free home rules, CDC analyzed 2008 Behavioral Risk Factor Surveillance System (BRFSS) data from 11 states and the U.S. Virgin Islands (USVI). This report summarizes the results, which showed wide variation among states in exposure to SHS in homes (from 3.2% [Arizona] to 10.6% [West Virginia]) and indoor workplaces (from 6.0% [Tennessee] to 17.3% [USVI]). The majority of persons surveyed in the 11 states and USVI reported having smoke-free home rules (from 68.8% [West Virginia] to 85.7% [USVI]). This report also provides the 2008 results for CDC's annual BRFSS-based state-specific estimates of current smoking in 50 states, the District of Columbia (DC), and three territories (Guam, Puerto Rico, and USVI). As in previous years, the results showed substantial variation in self-reported cigarette smoking prevalence (range: 6.5%--27.4%; median for 50 states and DC = 18.4%). Additional legislation is needed to increase the number of smoke-free workplaces and other public places. Health-care providers should continue to encourage persons to make their homes completely smoke-free.

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• Cigarette Smoking Among Adults and Trends in Smoking Cessation --- United States, 2008 

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States (1). Full implementation of population-based strategies (2) and clinical interventions can educate adult smokers about the dangers of tobacco use and assist them in quitting (3,4). To assess progress toward the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to <12% (objective 27-1a) (5), CDC analyzed data from the 2008 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that during 1998--2008, the proportion of U.S. adults who were current cigarette smokers declined 3.5% (from 24.1% to 20.6%). However, the proportion did not change significantly from 2007 (19.8%) to 2008 (20.6%). In 2008, adults aged ≥25 years with low educational attainment had the highest prevalence of smoking (41.3% among persons with a General Educational Development certificate [GED] and 27.5% among persons with less than a high school diploma, compared with 5.7% among those with a graduate degree). Adults with education levels at or below the equivalent of a high school diploma, who comprise approximately half of current smokers, had the lowest quit ratios (2008 range: 39.9% to 48.8%). Evidence-based programs known to be effective at reducing smoking should be intensified among groups with lower education, and health-care providers should take education level into account when communicating about smoking hazards and cessation to these patients. . . .

Although comprehensive tobacco control programs have been effective in decreasing tobacco use in the United States, they remain underfunded. . . .

Effective population-based strategies for preventing tobacco use and encouraging tobacco use cessation (including enforcing bans on advertisement) are outlined in the World Health Organization's MPOWER package.� Despite partial bans on some forms of advertisement, the tobacco industry continues to conduct targeted marketing toward socially disadvantaged subgroups and vulnerable populations, such as persons with low socioeconomic status and youths (10).

Offering and providing effective cessation counseling and treatments are integral to reducing the smoking epidemic, especially in subpopulations with high rates of smoking. Because persons with lower educational attainment generally have higher rates of smoking, are less likely to quit, and have less knowledge about the health effects of smoking but are interested in quitting, health-care providers should take education level into account when communicating with such patients (3,4).

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• Roll your own smokes popular but no safer, research finds  

The number of tobacco smokers currently in Thailand has reached 14.3 million, the latest Global Adult Tobacco Survey revealed yesterday.

Meanwhile, the Public Health Ministry is considering a proposal to the Finance Ministry to increase the tax level on hand-rolled cigarette products after finding over 7.4 million people smoke this style of cigarette. The remainder smoke manufactured cigarettes.

The Global Adult Tobacco Survey is a national household survey launched in February 2007.

Sixteen countries, home to more than half the world's smokers and bearing the highest tobacco use, were involved in the study: Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Vietnam.

Thailand was the first country to complete and release its survey . . .

He said most cigarette manufacturers are now producing more smokeless cigarettes after noting an increasing trend in smokeless tobacco use among teenagers worldwide.

To reduce the number of hand-rolled cigarette smokers, Prakit has asked the government to increase the tax level on hand-rolled cigarette products and collect tax excise to 70 per cent of product price from the current rate.

Deputy Minister of Public Health Manit Nopamornbodee said he will consult with the Finance Ministry about increasing the tax level on hand-rolled cigarette products and ya nat - traditional medicine that contains hand-rolled cigarette products. . . .

Meanwhile, Thai Network Against Tabinfo Asia 2009, led by Dr Hatai Chitanont, has submitted an open letter to Deputy Finance Minister,Prasit Pattaraprasit asking him to withdraw from the tobacco industry event he is due to open on Wednesday at Impact Arena Moung Thontani Exhibition Centre.

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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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• Survey shows most NZ smokers want to quit 

The 2008 New Zealand Tobacco Use Survey: Quitting Results published today shows overwhelmingly most smokers want to quit, Associate Minister of Health Hon Tariana Turia said.

Minister Turia said that helping smokers to quit was a priority for the Government and was one of the six health targets.

This report presents the quitting results of 15 to 64 year olds from the 2008 New Zealand Tobacco Use Survey, including where possible, in comparison with the previous survey (2006).

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• 29 Businesses In Violation of Selling Tobacco to Minors 

Guam Public Law No. 24-278 (also known as the Tobacco Control Act of 1998) mandates the conduct of random, unannounced tobacco vendor compliance inspections each year.� The Department of Mental Health and Substance Abuse (DMHSA) in partnership with the Department of Revenue and Taxation (DRT) completed its island wide 2009 monitoring activity.

For this current year, 347 businesses were inspected throughout the nineteen villages on the island; twenty-nine (29) were found to be in violation for selling tobacco products to minors and were cited by DRT officers.� P.L. 24-278 prohibits vendors from selling tobacco products to persons under the age of 18 and if found to be in violation, must pay a graduated penalty of anywhere from $500 up to $5,000 per violation.

This vendor monitoring activity is federally mandated by the U.S. Center for Substance Abuse Prevention for all states and territories who receive substance abuse prevention and treatment block grant funds.� Guam must provide assurances that the island’s tobacco vendors do not sell tobacco products to individuals below the age of 18.

“Guam has the highest tobacco use rates nationwide among youth and adults. Vendor compliance to not sell tobacco products to minors is an effective strategy for reducing tobacco use among youth and eventual health-related consequences.” said David L. G. Shimizu, Director of the Department of Mental Health & Substance Abuse.

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• Austria tops teen smokers ranking  

Austria has the highest percentage of 15-year-old smokers, 25 per cent, in Europe, according to a Vienna doctor. Manfred Neuberger, the head of the preventive-medicine division at Vienna Medical University, added the number of Austrian youth who smoked had been steadily increasing since 1997 and that 145,891 Austrians aged 11 to 17 smoked.

Noting the average age at which young people began smoking had fallen to 11, he said: "The younger one begins, the worse the consequences will be.”

Neuberger claimed the government had been doing too little to get young people not to smoke. "It is easier to buy cigarettes than groceries,” he said, adding the government should use the 60 million Euros in cigarette taxes that young smokers paid annually to pay for a prevention campaign.

Neuberger called protection of non-smokers in Austria "a health and political time bomb” and said the country was on the level of the Czech Republic, Slovenia, Hungary, Albania and Serbia in that regard. The doctor cited polls in Styria and Upper Austria that had shown 91 per cent of people who visited nightspots felt harmed by secondary smoke and 60 per cent of them wanted the law on smoking toughened.

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• State's smoking rate still high  

Smoking by women is one of the gravest preventive health concerns in Kentucky. While numerous smoking cessation and public health programs have been initiated to address the problem, Kentucky women continue to smoke in numbers that lead the nation and they are not quitting or even trying to quit, according to health experts at the University of Kentucky.

The median state prevalence of current smoking was 22.4 percent, but Kentucky prevalence is 34.7 percent (the next highest was West Virginia at 34 percent), while the median percent of daily smokers who quit is 39.8 percent - in Kentucky, it's only 28.9 percent, according to data from the Center for the Advancement of Women's Health at the University of Kentucky in Lexington.

Further, the median percent of daily smokers who made a quit attempt was 58 percent, but in Kentucky it was only 43.4 percent.

"So we are not quitting in Kentucky," said Dr. Leslie Crofford, the center's director. "We're not even trying to quit."

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• More Scottish women die of lung cancer 

Soaring numbers of Scottish women are dying of lung cancer despite survival rates among men improving significantly, new figures show.

The increase also bucks the trend for death rates from other types of cancer north of the Border, all of which are going down.

Lung cancer deaths in men plummeted by 21 per cent in the 10 years to 2008, but increased by more than 11 per cent among women. . . .

However, the figures also reinforced major health differences across Scotland, with those living in the poorest areas 40 per cent more likely to have cancer than those in the wealthiest neighbourhoods.

Death rates in the most deprived communities are 75 per cent higher than those in the richest areas.

Dr Richard Simpson, Scottish Labour health spokesman, said: "I welcome the general improvement in cancer survival rates, but I am both disappointed and deeply concerned that more women are dying of lung cancer.

"This mainly reflects the increase in smoking among women over the past 20 years."

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• Tobacco use in Saskatchewan costs economy $1.1 billion: study 

Tobacco use in Saskatchewan comes at a hefty price in terms of lives lost to tobacco-related diseases and an annual $1.1 billion hit to the province’s economy, says a new study.

The study commissioned by the Canadian Cancer Society Saskatchewan Division, which was obtained by the Leader-Post on Monday, noted that the direct and indirect costs of tobacco are costing every man, woman and child an estimated $1,063.

“And only 18 per cent of these costs are offset through tobacco tax revenue,’’ Janet Rhymes, author of the Genuine Progress Index (GPI) Atlantic report, said Monday.

Using the most recent provincial data, the report costed out the socio-economic toll tobacco use has on the province’s population.

“Although this is an economic exercise, we can never forget the profound life-changing impact for individuals and families who are affected by things like lung cancer, COPD and heart disease,’’ Rhymes said.

The Cost of Tobacco Use in Saskatchewan report found that smoking and exposure to second-hand smoke killed 1,561 people in 2005, accounting for about one out of every five deaths in the province.

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• Smoking rate soars up to one third despite ban  

A THIRD of the Irish population now smokes, a new survey reveals.

A survey of 4,082 people this summer revealed that 33pc of the Irish population had taken up or continued to smoke.

It is the highest smoking rate recorded here in the past 11 years, according to the EU's 'HELP -- For A Life Without Tobacco' campaign.

Despite hikes in tobacco tax, the smoking ban and a new law against the public display of cigarettes for sale, the number of smokers has steadily risen since 2007 when 29pc of the population smoked.

The survey, which was conducted between March and September, revealed the largest group of smokers -- 45pc -- is aged between 16 and 30.

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