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Helping Smokers Quit (PDF) 

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• Treating Tobacco Use and Dependence: 2008 Update (PDF) 

Treating Tobacco Use and Dependence: 2008 Update, a Public Health Service- sponsored Clinical Practice Guideline, is a product of the Tobacco Use and Dependence Guideline Panel (“the Panel”), consortium representatives, consultants, and staff. These 37 individuals were charged with the responsibility of identifying effective, experimentally validated tobacco dependence treatments and practices. The updated Guideline was sponsored by a consortium of eight Federal Government and nonprofit organizations: the Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); National Cancer Institute (NCI); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Drug Abuse (NIDA); American Legacy Foundation; Robert Wood Johnson Foundation (RWJF); and University of Wisconsin School of Medicine and Public Health’s Center for Tobacco Research and Intervention (UW-CTRI). This Guideline is an updated version of the 2000 Treating Tobacco Use and Dependence: Clinical Practice Guideline that was sponsored by the U.S. Public Health Service, U. S. Department of Health and Human Services. An impetus for this Guideline update was the expanding literature on tobacco dependence and its treatment. The original 1996 Guideline was based on some 3,000 articles on tobacco treatment published between 1975 and 1994. The 2000 Guideline entailed the collection and screening of an additional 3,000 articles published between 1995 and 1999. The 2008 Guideline update screened an additional 2,700 articles; thus, the present Guideline update reflects the distillation of a literature base of more than 8,700 research articles. Of course, this body of research was further reviewed to identify a much smaller group of articles that served as the basis for focused Guideline data analyses and review. This Guideline contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence. . . .

This Guideline concludes that tobacco use presents a rare confluence of circumstances: (1) a highly significant health threat;4 (2) a disinclination among clinicians to intervene consistently;5 and (3) the presence of effective interventions. This last point is buttressed by evidence that tobacco dependence interventions, if delivered in a timely and effective manner, significantly reduce the smoker’s risk of suffering from smoking-related disease.6-13 Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions. Although tobacco use still is an enormous threat, the story of tobacco control efforts during the last half century is one of remarkable progress and promise. In 1965, current smokers outnumbered former smokers three to one.14 During the past 40 years, the rate of quitting has so outstripped the rate of initiation that, today, there are more former smokers than current smokers.15 Moreover, 40 years ago smoking was viewed as a habit rather than a chronic disease. No scientifically validated treatments were available for the treatment of tobacco use and dependence, and it had little place in health care delivery. Today, numerous effective treatments exist, and tobacco use assessment and intervention are considered to be requisite duties of clinicians and health care delivery entities. Finally, every state now has a telephone quitline, increasing access to effective treatment.

The scant dozen years following the publication of the first Guideline have ushered in similarly impressive changes. . . .

The overarching goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health care systems, insurers, and purchasers assist clinicians in making such effective treatments available. 1. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.

2. It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting. 3. Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline. 4. Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in this Guideline. 5. Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt: • Practical counseling (problemsolving/skills training) • Social support delivered as part of treatment 6. Numerous effective medications are available for tobacco dependence, and clinicians should encourage their use by all patients attempting to quit smoking—except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). • Seven first-line medications (5 nicotine and 2 non-nicotine) reliably increase long-term smoking abstinence rates:

– Bupropion SR – Nicotine gum – Nicotine inhaler – Nicotine lozenge – Nicotine nasal spray – Nicotine patch – Varenicline

8 • Clinicians also should consider the use of certain combinations of medications identified as effective in this Guideline. 7. Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication. 8. Telephone quitline counseling is effective with diverse populations and has broad reach. Therefore, clinicians and health care delivery systems should both ensure patient access to quitlines and promote quitline use. 9. If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational treatments shown in this Guideline to be effective in increasing future quit attempts. 10. Tobacco dependence treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication identified as effective in this Guideline as covered benefits.

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Women Who Quit Smoking Lower Heart Risks Quickly  

New research shows that women who quit smoking have a 21 percent lower risk of dying from coronary heart disease within five years of extinguishing their last cigarette.

The risks of dying from other conditions also decline after quitting, although the time frame varies depending on the disease.

"The harms of smoking are reversible and can decline to the level of nonsmokers," said study author Stacey Kenfield, whose report is in the May 7 issue of the Journal of the American Medical Association. "For some conditions like chronic obstructive pulmonary disease, it can take more than 20 years, but there is a rapid reduction for others."

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Sleep Deficit Linked to Smoking, Drinking, Inactivity (Update1) 

People who slept less than six hours a night were more likely than well-rested people to smoke, drink heavily and avoid exercise, a U.S. government study found.

About 31 percent of adults who got that little sleep smoked cigarettes, compared with 18 percent who slept seven to eight hours, according to the survey by the U.S. Centers for Disease Control and Prevention. The agency couldn't tell whether the unhealthy habits caused a sleep deficit or was the result.

About 50 million to 70 million people in the U.S. suffer from chronic sleep loss and sleep disorders, which studies by the CDC have associated with obesity and depression.

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French tobacco shipments drop 10.2 percent in April - industry association  

Deliveries of tobacco products to French tobacconists fell 10.2 percent in April from the year-earlier period, the Federation of tobacco industries said

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Governor OKs tobacco fund liquidation; state moves to dismiss suit  

The Ohio legislature is hoping a second time's the charm with an effort to secure more than $200 million from the state Tobacco Prevention Foundation for a jobs initiative.

Gov. Ted Strickland on Tuesday signed House Bill 544, introduced a week ago by Rep. Jay Hottinger, R-Newark. The bill liquidates all $270 million of the foundation's funding and dissolves its board, allocating $230 million for a $1.57 billion state economic stimulus plan.

The remaining $40 million will be directed to the Ohio Department of Health to pay off the foundation's outstanding obligations and fund tobacco-cessation initiatives with what's left over.

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• Northlich to lay off 27 

Northlich, the downtown Cincinnati-based public relations, media and branding agency, said Monday it will lay off 27 people after it lost a key account, the state's Stand youth anti- tobacco campaign and OhioQuits cessation campaigns.

Ohio legislators last week moved to abolish the Ohio Tobacco Prevention Foundation, which funded the campaign.

The layoffs are split between Northlich's Columbus and Cincinnati offices. Northlich will employ 120, or 18.3 percent fewer people after the reconfiguration. . . . "It's a tragedy that such a successful program may not continue," Northlich CEO Kathy Selker said. The agency had a $13 million contract for this year for the campaign, which included billboards, television and Web advertising, public relations and grass-roots organizing.

The Stand strategy was to debunk myths among teens that "everyone" smokes

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New Guidelines Show Smokers Have More Tools to Quit Than Ever, But Elected Officials Must Do More to Help  

The guidelines for smoking cessation released today by the U.S. Public Health Service provide an important reminder to the nation's 45 million smokers that they have more scientifically proven tools available to help them quit smoking and protect their health than ever before, including safe and effective medications, counseling and telephone quitlines. Combining counseling and medication is especially effective in helping smokers quit. These findings are based on a thorough review of the evidence and have critical implications for policymakers as well as medical providers.

Unfortunately, while most smokers want to quit, and millions try each year, most do not avail themselves of the evidence-based treatments that improve success rates. While the guidelines address actions clinicians can take, policy makers at all levels, as well as employers, also need to take action to prevent kids from smoking in the first place, encourage smokers to quit, enhance awareness of the treatments available and provide affordable access to these live-saving interventions. As the guidelines emphasize, providing insurance coverage for these evidence-based treatments increases both the rates that smokers use these treatments and the rates that smokers quit.

Federal government: Congress and the Administration should implement the National Action Plan for Tobacco Cessation

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New Smoking Cessation Guideline Confirms That Now is the Time to Quit Smoking 

Today the U.S. Department of Health and Human Services published an update to its 1996 Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, which contains revised and improved recommendations to providers and clinicians so that they can better assist smokers in quitting. The guideline also confirms that there has never been a better time for smokers to quit than right now.

With the release of these new guidelines, smokers can receive improved strategies from physicians and other health care providers to help successfully quit smoking. The guidelines definitively state that combining FDA-approved pharmacotherapies and counseling is the most effective way for smokers to end addiction to tobacco products. The Public Health Service also finds that cessation treatments are cost-effective and that providing these treatments through healthcare systems will increase the number of people who seek treatment for smoking, attempt to quit and successfully quit.

"These new guidelines underscore how important it is for smokers to receive assistance quitting," said Bernadette Toomey, President and CEO, of the American Lung Association. "The American Lung Association stands ready to help smokers quit through our different smoking cessation programs and resources."

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It's Time for Truth in Ohio. Opponents of Ohio Bans Weigh In. 

Shelly Kiser, advocate for the American Lung Association, stated she doesn't think the smoking ban has lowered liquor sales and that there may be an orchestrated campaign to allege receipts are off 30%. She further stated "hundreds and hundreds of studies" show there's no harm to liquor sales or the economy from smoking bans. It has become clear that smoking bans do harm Ohio business. When state government acknowledges that truth, anti-smoking advocates predictably cry "liar."

The smoking ban in Ohio is hurting businesses.

-- In 2006, Ohio Department of Job and Family Services projected a 10,000 job gain for the hospitality and leisure industry for 2007. The first 12 months of the smoking ban saw 5,400 lost jobs for that industry. . . .

"Ohio is not unique. Bar owners and clubs across the U.S. are crying foul. Pubs in Germany, Ireland, the UK are closing. Hospitality business owners in Germany are angry because they were told their pubs had nothing to fear from the smoking ban and how commercially successful bans have been in Ireland, the UK and the USA, where bars were allegedly teeming with 'new' customers," said Debi Kistner, Opponents of Ohio Bans.

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British American Tobacco: Quarterly Report to 31 March 2008 

- The reported profit from operations was 18 per cent higher at GBP807 million with a similar increase if exceptional items are excluded. All regions contributed to this strong result. Profit from operations, excluding exceptional items, would have been 10 per cent higher at comparable rates of exchange.

- The reported Group revenue increased by 14 per cent to GBP2,541 million as a result of favourable exchange, improved pricing and a better product mix. Revenue would have increased by 6 per cent at comparable rates of exchange.

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• New Evidence Provides Clinicians With Better Tools to Help Smokers Quit 

An updated clinical practice guideline released today by the U.S. Public Health Service has identified new counseling and medication treatments that are effective for helping people quit smoking. In addition, the May 7 issue of JAMA includes a commentary that urges clinicians to use the updated guideline to accelerate progress in reducing the use of tobacco.

Treating Tobacco Use and Dependence: 2008 Update was developed by a 24-member, private-sector panel of leading national tobacco treatment experts that reviewed more than 8,700 research articles published between 1975 and 2007. The review found that there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting. The medications are: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.

. . .

The 2008 PHS guideline update and its companion products, which include a consumer guide and a pocket guide for clinicians, are available online at http://www.surgeongeneral.gov/tobacco/default.htm. Copies of the 2008 PHS guideline update products are also available by calling 1-800-358-9295.

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Ruyan America's Electronic Smoking Substitutes Win Two Awards at 2008 Tobacco Plus Expo Held in Las Vegas 

Ruyan America, Inc., Minneapolis, announced today that its products won two of the six awards presented at the 2008 Tobacco Plus Expo held at the Las Vegas Convention Center April 24th and 25th. The Company's E-cigarette was named 2008 Most Innovative Product and its Ruyan Vegas E-cigar was named Most Marketable New Product of the Year.

Both products are cigarette alternatives/smoking substitutes that allow users to satisfy their cravings for nicotine in places and situations where they otherwise cannot smoke. The Ruyan E-cigarette and the Ruyan Vegas E-cigar use ultrasonic atomization technology to create nicotine infused water vapor that users draw as if it were smoke. Additionally, the products allow users to effectively simulate the physiological and psychological attributes of smoking without creating any harmful second hand smoke.

Donald J. Bores, Chairman of Tobacco Outlet Business magazine, one of the Expo's sponsors, stated, "The Ruyan products represent a great opportunity for tobacco retailers to expand their product offerings, provide their customers with convenient smoking alternatives and allow them to choose when and where they are able to satisfy their desire to smoke

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• Award Winning Smoking Alternatives to Be Featured at 'Cigar Night' at Twin Cities' Nightspot 

Ruyan America, Inc., Minneapolis, announced today that it will be previewing its award-winning and ground-breaking smoking substitutes on Thursday, May 22, 2008, at Neisen's Sports Bar and Grill, 4851 West 123rd Street, Savage, Minn., from 6:00 pm to 9:00 pm. The preview will feature the Ruyan Vegas E-cigar, recently awarded the honor as Most Marketable New Product at the 2008 Tobacco Plus Expo held in Las Vegas on April 24th and 25th, 2008. Ruyan will also have its E-cigarette available that night; the Ruyan E-cigarette was given the 2008 Most Innovative Product award at the same Las Vegas Expo. Products will be available for sampling and for sale.

The Ruyan Vegas looks and feels like a premium cigar, five and one-half inches in length with a circumference of approximately 50 ring size. The Ruyan Vegas uses a microchip, airflow sensor, ultrasonic atomizer and nicotine-infused cartridges to produce a vapor that provides its user with the experience of smoking, without producing dangerous second hand smoke and without endangering the health of associates or bystanders. The Ruyan Vegas has approximately 1800 mouthfuls of vapor, nearly the equivalent vapor to the mouthfuls of smoke produced in a carton of conventional cigarettes, and is meant to be disposed after it ceases to produce vapor. Smokers who use it to replace all of their smoking activity report it lasts as long as a carton of cigarettes

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Legislators delay action again on smoking ban  

Members of a House-Senate conference committee tasked with hashing out a final compromise on a statewide indoor smoking ban gave themselves another extension today.

The delay, likely to next week, came at the request of Sen. Chuck McIlhinney, R-Bucks, who has been leading efforts to find a compromise between conflicting Senate and House versions. McIlhinney said the extra time is needed to work out technical questions the governor's office has raised about enforcement.

Since conference committee reports receive only final votes in the House and Senate and cannot be amended, "we want to make sure that we do get it right," McIlhinney said.

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