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The U.S. Centers for Disease Control and Prevention (CDC) has named groups of people at a high risk of developing serious complications from H1N1 Influenza.
In keeping with the last two subpopulation releases which were focused on pregnant women and breastfeeding moms, the Sedgwick County Health Department will continue to send monthly releases focused on different subgroups.
Currently, one of the highest-priority groups consists of persons with chronic respiratory conditions.
These types of conditions, including asthma and heart disease, often arise from smoking.
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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.
Watch your back, West Virginia. Indiana is now No. 2 -- and gaining -- when it comes to smoking.
More than 26 percent of all Hoosier adults smoked in 2008, according to a report released Thursday by the Centers for Disease Control and Prevention.
Indiana was sixth the previous year, but it has puffed past the national median of 20.6 percent -- not exactly something to celebrate.
"It saddens me tremendously," said state Rep. Charlie Brown, D-Gary, who sponsored legislation last spring for a comprehensive smoke-free workplace law. "I knew we were up there, but I didn't know we had inched our way up to No. 2. We need to turn that around."
Indiana has ranked in the top 10 in recent years for smoking prevalence. The difference between sixth and second is not statistically significant, and the top 10 clump closely together, said Karla Sneegas, executive director of Indiana Tobacco Prevention and Cessation. . . .
Experts recommend three measures to address a high rate of smokers: Passing a statewide, comprehensive smoke-free law, increasing state taxes and increasing the amount of money for tobacco prevention efforts.
"It's a trifecta," said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. "When you put those three things together, that's when you have the biggest impact."
Many of the states that have the lowest smoking rates -- California, Arizona and New Jersey -- are those that have been the most aggressive about indoor smoking laws and about state taxes that drive up the cost of cigarettes, said Dr. Thomas Frieden, the CDC's director.
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.
Cigarette smoking rose slightly for the first time in almost 15 years, dashing health officials' hopes that the U.S. smoking rate had moved permanently below 20 percent.
A little under 21 percent of U.S. adults said they smoked, according to a 2008 national survey by the U.S. Centers for Disease Control and Prevention. That's up slightly from the year before, when just 19.8 percent said they were smokers. It also is the first increase in adult smoking since 1994, experts noted.
The increase was so small, it could be just a blip, so health officials and experts say smoking prevalence is flat, not rising. But they are unhappy.
"Clearly, we've hit a wall in reducing adult smoking," said Vince Willmore, spokesman for the Campaign for Tobacco-Free Kids, a Washington, D.C.- based research and advocacy organization.
There's a general perception that smoking is a fading public health danger. Feeding that perception are indoor smoking laws, cigarette taxes and Congress' recent decision to allow the Food and Drug Administration to regulate tobacco.
But health officials believe gains have been undermined by cuts in state tobacco control campaigns. Some advocates believe tobacco companies are overcoming increasing obstacles. . . .
Many of the states that have the lowest smoking rates are those that have been the most aggressive about indoor smoking laws and about state taxes that drive up the cost of cigarettes, said Dr. Thomas Frieden, the CDC's director.
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).
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
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.
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.
Dr. Thomas Frieden has swung a big stick as New York City's top health official, pushing through bans on smoking and artery-clogging trans fats.
The New York Post called him "Dr. Buttinsky." Others attacked him as a wrong-headed crusader. But smoking plummeted and the city made admired inroads against cancer and other chronic diseases.
On Sunday, he heads to Atlanta. And on Monday he takes over the federal government's top public health agency, the Centers for Disease Control and Prevention - where he's going to have to try a different approach.
At the CDC, the 48-year-old physician will command a larger agency, but one with few regulatory powers and more political headaches. Any campaigns against smoking, obesity and other health dangers will have to be won more with carrots than sticks, public health experts say. . . .
In an interview this week with The Associated Press, Frieden acknowledged the challenge and said partnering with other agencies will be more crucial than it was in New York.
"It's really very different," he said of his new job.
He listed smoking as the nation's No. 1 health issue, and stressed the importance of fighting preventable illnesses. But in carefully worded responses, he did not reveal plans for any new campaigns, saying his initial goal is to work with CDC staff to build future plans.
For seven years, Dr. Thomas Frieden has been the nagging conscience of the nation's biggest city, the man who made sure New Yorkers couldn't smoke in bars or eat french fries cooked in artery-clogging trans fats.
Now, the city's health commissioner will be taking his crusade against unhealthy living national as the head of the U.S. Centers for Disease Control and Prevention. . . .
New York's health commissioner is not usually a household name, but many New Yorkers quickly got to know Frieden after his appointment in 2002, when he began a series of not-so-gentle campaigns to get the city to live healthier.
In 2003 he pushed through a ban on smoking in almost all workplaces, a rule that instantly transformed nightlife in the big city.
Big increases in cigarette taxes followed, aimed at making the habit so expensive people would give it up. . . .
Smokers were outraged, but the backlash was short-lived and the city claims the effort is working: About 350,000 fewer adult New Yorkers smoke now than in 2002.
"There is probably nothing any person will ever do to save as many lives as that one act of our legislature getting together here in the city and passing the smoking ban, and Tom deserves the credit," Mayor Michael Bloomberg said Friday. . . .
New York magazine's Web site greeted the news of Frieden's appointment with the headline, "Health Commissioner Thomas Frieden to Take Fun-Hating National."
The Center for Consumer Freedom, a group funded by restaurants and food companies, put out a statement decrying his selection, saying he was "an overzealous activist who doesn't give any consideration to the importance of personal responsibility or privacy."
President Obama will announce on Friday that he has chosen Dr. Thomas R. Frieden, the New York City health commissioner, as the next director of the Centers for Disease Control and Prevention, administration officials said Thursday.
Dr. Frieden, a 48-year-old infectious disease specialist, has cut a high and sometimes contentious profile in his seven years as New York's top health official under Mayor Michael R. Bloomberg. He led the crusade to ban smoking in restaurants and bars, pushed to make H.I.V. testing a routine part of medical exams, and defended a program that passes out more than 35 million condoms a year. . . .
"I think the administration selected Tom Frieden because he can take public health to a new place," said Jeffrey Levi, executive director of Trust for America's Health, a nonprofit public health advocacy organization. "He's a transformational leader."
Dr. Frieden is expected to take office next month. With his appointment, which does not require Senate confirmation, New York City will have former commissioners in two of the nation's most visible health positions; Dr. Margaret A. Hamburg, who held the job in the 1990s, is nearing confirmation as commissioner of the Food and Drug Administration. . . .
Dr. Frieden has a history of focusing on health threats that endanger large numbers of people, sometimes at the expense of more popular causes. This put him in marked opposition to the Bush administration, which spent more than $50 billion on bioterrorism initiatives and paid far less attention to problems like smoking.
State: Smoke everyday / Smoke some days / Former smoker / Never smoked
Nationwide (States, DC, and Territories) 13.3 4.8 25.0 55.5
Nationwide (States and DC) 13.4 4.8 25.2 55.3
Alabama 17.2 4.8 21.9 55.9
Alaska 15.1 6.4 28.4 50.0
Arizona 10.7 5.1 27.4 56.6
In recent weeks across the country, telephone "quit lines" have registered a jump in calls in advance of this week's biggest-ever increase in federal tobacco taxes.
If the past is any guide, the sizable tax boost should have an immediate impact in getting many smokers to quit, and anti-smoking advocates were making the most of the moment yesterday. Much research has shown that smoking is an extremely "price sensitive" habit, with fewer people taking up cigarettes and more people putting them down every time a pack becomes more expensive.
The 62-cent tax increase was adopted this year as a way to fund the expansion of the State Children's Health Insurance Program. On Wednesday, the day the increase took effect, the District's quit line got 131 calls, a record. The same day a week earlier, it had 44 calls; a month earlier, 19.
"I'm in shock, quite frankly," said Debra Annand, director of health education services for the American Lung Association's District of Columbia office, which contracts with the local health department to provide smoking-cessation services.
"Obviously something happened to drive that call volume up," Annand said. "Lots of research has shown the number one thing that helps people quit is increasing the price."
"Several measures are proven to reduce tobacco use. Foremost is taxation," wrote the author of a report two years ago in the Morbidity and Mortality Weekly Report . . .
A national telephone number, 1-800-QUITNOW, connects callers to programs in all 50 states and the District. In March, it registered 203,374 calls, more than twice February's 91,316. In January, it got 76,685.