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More people die from lung cancer than any other type of cancer. In 2004,* lung cancer accounted for more deaths than breast, prostate, and colon cancer combined. The most important thing you can do to prevent lung cancer is to not start smoking or to quit if you currently smoke.
In 2004,*
* 108,355 men and 87,897 women were diagnosed with lung cancer.†
* 89,575 men and 68,431 women died from lung cancer.†
Smoking and Secondhand Smoke
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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.
Acute Myocardial Infarction Hospitalization Statistics: Apparent Decline Accompanying an Increase in Smoke-free Areas. Villalbi, J.R.; Castillo, A.; Cleries, M.; Salto, E.; Sanchez, E.; Martinez, R.; Tresserras, R.; Vela, E. Revista Espanola de Cardiologia. July 2009, 62(7): 812-815. Abstract Abstract at the National Library of Medicine Are Nicotine Replacement Therapy, Varenicline or Bupropion Options for Pregnant Mothers to Quit Smoking? Effects on the Respiratory System of the Offspring.
A Before-After Implementation Trial of Smoking Cessation Guidelines in Hospitalized Veterans.
Katz, D.A.; Vander Weg, M.; Fu, S.; Prochazka, A.; Grant, K.M.; Buchanan, L.; Tinkelman, D.; Reisinger, H.S.; Brooks, J.; Hillis, S.L.; Joseph, A.M.; Titler, M.
Implementation Science. September 10, 2009, 4(58): [Epub ahead of print].
Abstract Abstract at the National Library of Medicine
Complete Article: http://www.implementationscience.com/content/pdf/1748-5908-4-58.pdf
A Cross Sectional Study on Levels of Secondhand Smoke in Restaurants and Bars in Five Cities in China.
Alcohol-induced Increases in Smoking Behavior for Nicotinized and Denicotinized Cigarettes in Men and Women.
King, A.; McNamara, P.; Conrad, M.; Cao, D.
Psychopharmacology. September 16, 2009, [Epub ahead of print].
Anti-PGP or Anti-elastin Autoantibodies Are Not Evident in Chronic Inflammatory Lung Disease.
Greene, C.M.; Low, T.B.; O'Neill, S.J.; McElvaney, N.G.
American Journal of Respiratory and Critical Care Medicine. September 17, 2009, [Epub ahead of print].
Are Obstetricians Following Best-practice Guidelines for Addressing Pregnancy Smoking? Results From Northeast Tennessee.
Results: Around 50.3% of the increase from the un-lagged SAM estimate of 3859 deaths to the final SAM estimate of 8664 deaths in 2003 is attributable to the introduction of lag times. More robust estimates of risk accounted for a further 29.6% of the increase. While 21.2% is attributable to the inclusion of additional disease categories, only 1.5% was attributable to the widening of existing diseases categories.
Conclusion: This difference in estimates is attributable to expansion of the list of diseases included, updating the estimates of RR for smoking-attributable death, and the use of smoking prevalence from previous years to more accurately reflect the effect of tobacco use on disease occurrence. There is a need to establish an 'authority' to implement a multi-faceted intervention strategy to decrease the considerable burden from smoking in Israel.
When I directed the CDC's Office on Smoking and Health, we wanted to learn how to use marketing techniques to keep kids from starting to smoke and convened an expert panel of teen marketing experts from the private sector.
Experts from companies like Adidas, Levi-Straus, and Proctor and Gamble -- companies that sell products to teens -- advised us that if we wanted to be successful in competing with the tobacco industry's multibillion-dollar effort to get people to smoke, we needed to do more than educate teens on the harm of smoking, and rather create a "brand" . . .
This "brand" became known as the "Truth Campaign" . . .
The tobacco industry hates the truth and hates counter-marketing campaigns that tell the truth. Why? Because it works. Given the tobacco industry has recently been found guilty in a federal district court of racketeering and perpetuating a fraud on the American people, upheld in a May federal appeals court decision, it seems to be that there is a need for more "truth" and not less.
Statistical analysis that I've conducted shows that there is a very tenuous link between cigarette sales and state anti-tobacco spending. At best, spending large amounts of money on anti-tobacco programs seems to produce a trivial drop in cigarette sales -- less than a pack a year per capita. States would be better advised to put these resources toward other public health policies that produce larger results. . . .
The CDC is now arguing that state anti-tobacco programs are underfunded. Tobacco-control advocates -- many of whom receive money through these programs -- repeat the CDC under-funding claims when pleading their cases for spending increases. It will be truly unfortunate if states simply accept these claims and increase funding without investigating the programs' effectiveness. However difficult it is to look beyond noble intentions, appraisal of a program's effectiveness is vital -- particularly in these tight fiscal times -- if we truly want to improve public health effectively.
CONCLUSIONS
Empirical evidence does not generally support the cdc claim that states that spend more on tobacco control deter more tobacco use than states that spend less. Contemporaneous spending on tobacco control is never found to exert an inverse effect on sales, and at times is found to exert a significant and positive effect on sales, contrary to the claims of the cdc. The true effect, however, appears to be zero based on current and past spending discounted at various rates. There is limited support for cdc claims regarding its recommendations on funding adequacy when this spending measure is discounted at rates of 5 and 10 percent, but not at rates of 15 and 20 percent. When significant, however, these effects arise at fairly low levels of confidence and with trivial effects on cigarette sales, and therefore suggest very cautious support for the cdc recommendations concerning adequacy. These conclusions are based on a battery of tests that consider various measures of contemporaneous and past spending and adequacy and are conducted over an eight-year period in which over $5 billion (in 2005 dollars), or roughly $18 per capita, was spent on tobacco control.
This study raises questions about the process by which the cdc determines its spending recommendations and whether the process is designed to reach a particular conclusion about tobacco control policy rather than to uncover policies that may best allocate resources toward controlling tobacco use. There may be a similarity to what I noted in a 2008 Econ Journal Watch paper on why the cdc and various researchers conclude that indoor smoking bans exert either positive or no adverse economic effects on restaurants and bars when, in fact, published studies demonstrate that numbers of businesses harmed are not zero. Factors include biases by governments and researchers that favor government solutions to perceived smoking problems, ample funding for researchers that conclude that bans exert no economic harm, simply ignoring industry funded research that indicates some degree of harm, and tacit agreement between many researchers to not openly scrutinize the quality of colleagues’ published research on this topic. It would be interesting to explore whether any of those factors might be influencing the policy process whereby the cdc makes spending recommendations regarding tobacco control. Those factors might also explain why the cdc is not compelled to demonstrate the effectiveness of its recommendations.
On July 1, 1946 the Communicable Disease Center (CDC) came into being on one floor of a small building in Atlanta, Georgia. . . .
CDC is now focusing on achieving the four overarching Health Protection Goals to become a more performance-based agency focusing on healthy people, healthy places, preparedness, and global health.
CDC is one of the 13 major operating components of the Department of Health and Human Services (HHS).
e Control and Prevention (CDC) and administrator for the Agency for Toxic Substances and Disease Registry (ATSDR). He was named director of CDC by the White House and the Department of Health and Human Services on May 15.
Dr. Frieden, 48, has been the director of the New York City (NYC) Health Department since 2002. He is an infectious disease expert and has lead initiatives that support wellness and prevention. He replaces Dr. Richard Besser who has been the acting CDC director and acting ATSDR administrator since mid January. Dr. Besser returns to his role as director of CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response.
In a May 15 White House press release, President Obama praised Dr. Frieden for his efforts in NYC and stated: “Dr. Frieden is an expert in preparedness and response to health emergencies, and has been at the forefront of the fight against heart disease, cancer, obesity, and infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records. Dr. Frieden has been a leader for health care reform, and his experiences confronting public health challenges in our country and abroad will be essential in his new role." . . .
Dr. Frieden was a CDC Epidemic Intelligence Service Officer (EIS) from 1990 until 1992. He worked in NYC and investigated and fostered public awareness around tuberculosis, including strains of the bacteria with drug resistance. Along with then NYC Health Commissioner and current US Food and Drug Administration Commissioner Dr. Margaret Hamburg, Dr. Frieden led the effort that stopped the spread of drug-resistant tuberculosis in NYC in the mid 1990s. Following that, Dr. Frieden helped the Indian government establish a tuberculosis control program which has now saved more than one million lives. As NYC Health Commissioner, Dr. Frieden led efforts that reduced the number of smokers by 350,000 and cut teen smoking in half. NYC has also increased cancer screening, reduced AIDS deaths by 40%, improved collection and availability of information on community health, and implemented the nation’s largest community electronic health records project.
In recognition of National Poison Prevention Week, March 15-21, the (name of organization) is alerting the public about ways to prevent childhood poisoning. Cigarettes and cigarette butts may poison children who ingest them.
In 2006, the American Association of Poison Control Centers (AAPCC) received more than 6,100 reports of potentially toxic exposures to tobacco products among children younger than 6 years of age in the United States. Most cases of nicotine poisoning among children result from their ingestion of cigarettes or chewing tobacco.
According to a study by the Centers for Disease Control and Prevention and the Rhode Island Department of Health, children in households where cigarettes are smoked in their presence were four times more likely to ingest cigarettes or cigarette butts than in households where smoking does not occur around children. Most ingestions happen in homes where children are exposed to secondhand smoke and where cigarettes and ashtrays are kept within the reach of children.
Adults who smoke in the home may not be aware of the danger of cigarettes and cigarette butts to children,"
Even before the 62-cent-per-pack federal tax took effect April 1, nicotine was losing its grip on a growing number of Ohioans. Recent data from the U.S. Centers for Disease Control and Prevention show 20 percent of Ohio adults called themselves smokers in 2008. That's the lowest level anyone can remember, certainly the lowest since the government began annual state surveys on smoking in 1995.
One out of five Ohioans who smoked just four years earlier, in 2004, has quit.
This downward trend is pinned on a variety of causes -- the escalating cost of cigarettes, Ohio's two-year-old workplace smoking ban, anti-smoking programs and social pressure.
The drop-off in smoking has big implications for public health and the costs of treating tobacco-related illnesses. Annual health-care costs directly related to smoking in Ohio are said to be more than $4 billion, and taxpayers pick up about $1.4 billion of that through the state Medicaid program.
But whether the trend can be sustained is open to question. Abboud's wish that cigarettes be outlawed speaks as loudly as anything to the addictive power of nicotine. . . .
But some are warning that Ohio's progress is threatened by cuts in anti-tobacco programs and legislative challenges to the state indoor smoking ban. State leaders last year diverted $230 million in anti-smoking money for a jobs program, and abolished the tobacco prevention foundation that controlled it. The money is still tied up in a court battle in Franklin County.
"A lot of things we've done to get to this point are now being reversed," said Shelly Kiser, director of advocacy for the American Lung Association of Ohio. "We're winning. We're in the playoffs and now [our progress is] going to stop."
As far as Guam is concerned, the latest Centers For Disease Control report on smoking nationwide (1998-2007) tells the same old story -- our island sparks up even more than "Light My Lucky" Kentucky, which leads all 50 states. At 31.1%, one in every three adults smokes on Guam, 11.3% higher the national average (see WebMD story on the CDC report). Coupled with other bad habits like poor diet, high alcohol consumption and lack of exercise, it isn't hard to imagine why Guam also suffers from a high incidence of smoking-related illnesses such as heart disease, stroke and cancer.
Observing the progression in 2007, Lt. Governor Mike Cruz launched the Healthy Guam Initiative to reduce smoking and overconsumption and to encourage exercise and healthy family activity. . . .
A May 2002 United Nation's World Health Organization (WHO) statistical report lists incidence of male smoking at 51% of men and 10% of women in Japan, 67% of men in China, and as many as 86% of men in rural Cambodia.
According to WHO's report, high rates in Asia are attributable to many factors, including a lack of knowledge about health risks, hard-won social privilege, weak tobacco laws, heavy advertising by American tobacco concerns, accessibility to young people, and government involvement in the tobacco industry -- such as the Japan Finance Ministry's major stake in a multinational called Japan Tobacco.
Those who read between the lines will draw parallels to faintly similar conditions on Guam. But compared to its Asian brothers, Guam is most decisively ahead of the quitting curve. And we have even our Administration's fits and starts to thank for that!
Imagine the worldwide alarm if over a year's time 443,000 of the metropolitan Boise population of 587,000 died. Such a massive death toll of 75 percent of the city's people would be twice the 220,000 killed by atomic bombs at Hiroshima and Nagasaki in 1945.
Yet, without much statistical change from year to year and with scant public outcry, more than 400,000 Americans died each year between 2000 and 2004 from tobacco use, inflicting a stunning $97 billion in lost human productivity and $96 billion in health care costs.
Help is on the way, however.
President Obama has picked Dr. Thomas Frieden, New York City's health commissioner, to take over the main federal public health agency, the Centers for Disease Control and Prevention.
The physician-trained Frieden is the right person at the right moment. His record in New York City was awesome. He pushed through smoking bans in restaurants. The city now claims it has 300,000 fewer smokers as a result. . . .
Timing is everything. With Dr. Frieden's appointment, President Obama has fortified his commitment to a national health care policy designed not only to provide insurance coverage for illnesses, but a campaign to step up wellness and preventive medicine programs that reduce costs dramatically.
Vital as Dr. Frieden and organized medicine are to health care, the ultimate provider, of course, is the individual, who can avoid illness-inducing habits and lessen the chances of becoming a health burden to family and society.