Tobacco.org

• Massachusetts' 'Model' Tobacco Cessation Benefit Spurs Unprecedented Drop in Smoking Rates, Heart Attacks, Asthma, and Birth Complications 

A "model" tobacco cessation benefit offered to Massachusetts' Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.

Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people -- a full 40% of MassHealth members who smoke -- have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

"It is clear from these latest findings that the Commonwealth's efforts to help people quit smoking is a sound investment," Executive Office of Health and Human Services Secretary JudyAnn Bigby said. . . .

"As the nation debates the future of its health care system, the national significance of this research cannot be understated," said Robert J. Gould, PhD, President and CEO of Partnership for Prevention, a national organization that advances policies and practices to prevent disease and improve the health of all Americans. "These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow."

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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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• Falmouth voters OK ban on beach smoking  

Voters at last night's town meeting gave a big thumbs down to those who like to light up on the town's public beaches.

Smoking is no longer allowed on any of the town's 11 public beaches, following a 128-60 vote that makes Falmouth the third community on the Cape to snuff out smoking on municipal beaches. Proponents of the ban cited litter in the form of errant cigarette butts in the sand, as well as the harm caused by secondhand smoke, as the main reasons to pass the smoking ban warrant item. . . .

In the end, a majority of town meeting voters said they were tired of "inconsiderate" people on the beach who refuse to move even after complaints and throw cigarette filters in the sand, where young children often find them while building sand castles.

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• Smoking Tied to Suicide Risk in Bipolar Disorder  

People with bipolar disorder who smoke appear to have a heightened risk of suicidal behavior -- possibly because they are generally prone to impulsive acts, a new study suggests.

Bipolar disorder, also known as manic depression, is marked by dramatic swings in mood -- ranging from episodes of debilitating depression to periods of euphoric recklessness. Previous studies have found that bipolar patients who smoke have a higher suicide risk than their non-smoking counterparts, but the reasons have not been clear.

The new findings suggest that high levels of impulsivity -- one of the symptoms of bipolar disorder -- may draw some patients to both smoking and suicidal behavior.

Dr. Michael J. Ostacher and colleagues at Massachusetts General Hospital in Boston found that among 116 bipolar patients they followed, current smokers generally scored higher on a standard measure of suicidal thoughts and behaviors.

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• Debate continues over diagnostic scans for lung cancer  

For the 42 percent of Americans who smoke cigarettes or once did, a ruling from the state's highest court last month seemed to offer hope that a simple screening tool could help them ward off advanced lung cancer.

The judges decided that Philip Morris USA may have to pay for lung scans for smokers so they can get early warning if they've developed cancer - and get treatment before it spreads into a deadly mass. (A federal court would have to affirm the state's decision before the company would have to pay.)

Even before the court weighed in, advocates had been pressing politicians for money to pay for CT scans for high-risk but asymptomatic people - insurers generally don't cover the test for screening - particularly since a group of New York researchers published results in 2006 suggesting that screening is saving the lives of smokers, former smokers, and people exposed to secondhand smoke and other hazards, such as asbestos. Some smokers are so convinced of the benefits of CTs they pay the $400 screening fee themselves.

"Our movement is really taking hold,'' said Joanne O'Connor, cochair of the Lung Cancer Alliance in Massachusetts, which is lobbying legislators for funding. "I wouldn't want to find out [I had lung cancer] like my sister did when she was already stage four. She died six months later.''

But even as pressure for CT scanning builds, many of the country's top cancer specialists are saying not so fast. . . .

The Massachusetts Supreme Court relied in part on Miller's expert testimony during the lawsuit brought against Philip Morris by two Massachusetts smokers. Since the 2006 study was published, however, the New England Journal has published three corrections, including one from Henschke revealing that some of the funding for the study came from cigarette-maker Liggett Tobacco.

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• Hazard in plain sight? 'Crossover products' may help hook kids on smoking, drugs 

Redford recently spoke about the products at a Marblehead Board of Health meeting, unloading for the board a bag of such products that she's collected throughout the year. Her presentation left most board members in disbelief.

"Are we the only ones who don't know about this stuff?" asked a bewildered Helaine Hazlett, the board's chairman.

Take a walk into the 7-11 store in Marblehead, and here is what you will find: "grinders" (small metal contraptions that are used to grind up tobacco or drugs), pipes, hookah pipes for smoking specially made flavored tobacco, flavored chewing tobacco, boxes of blunt wraps (tobacco-based rolling papers), cigarettes that are packaged like Chanel perfume boxes, and smokeless-tobacco gum that comes in a candy-mint-like container. The list goes on.

None of these products are illegal to sell, although in most states, including Massachusetts, to buy any tobacco-related product a person must be 18 or older. In fact, as a local tobacco-control officer, Redford's job is to conduct "compliance checks," . . .

Cigarette companies spent approximately $13 billion on advertising and promotional expenses in 2005 for those tobacco-specific products, nearly double what was spent in 1998, according to statistics from the Centers for Disease Control and Prevention.

Of that money, Redford says advertisers are more often targeting women and teens.

In 2008, tobacco company Philip Morris USA unrolled its sleek "purse pack" cigarette packaging containing ultra-slim cigarettes; the packaging is made to look as if it is a cosmetics case.

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• Smoking ban in Ayer covers the great outdoors  

It was a recent trip to the park that finally did it.

Jason Mayo watched as a father pushed his child on a swing, cigarette clenched between his teeth. On every upswing, the child got a face full of exhaled smoke.

"We can't tell people how to parent,'' said Mayo, a member of the Ayer parks and recreation committee, which has banned smoking in the town's recreation areas. "But all the other kids around him were inhaling that cigarette too.''

As antismoking sentiment sweeps across the country, nonsmokers are taking back bars, restaurants, and workplaces, snuffing smoking out of its indoor havens. And now some of them are turning their sights on the great outdoors.

Holliston and Upton have enacted similar outdoor smoking bans. And in another example of the widespread public crackdown on smoking, Needham has outlawed the sale of cigarettes in pharmacies and Newton and Framingham are trying to do the same.

Ayer's parks and recreation committee implemented its outdoor ban in August, and the panel may also pursue a bylaw at the spring Town Meeting. In a more sweeping stroke, the town's Board of Health is pursuing a regulation that would apply the prohibition to all town-owned property and land and impose a $100 fine on offenders. The board has set a public hearing on the subject for January.

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• DONOVAN v. PHILIP MORRIS USA, INC.  

In this case, it is not merely the risk of cancer of which the plaintiffs have notice, but the substantial increase in the risk of cancer, as reflected in their complaint. Because the harm involves subclinical changes that only will be discovered by a physician, notice most likely will take the form of advice by a physician, together with a recommendation for diagnostic testing conformably with the medical standard of care. In short, the statute begins to run when (1) there is a physiological change resulting in a substantial increase in the risk of cancer, and (2) that increase, under the standard of care, triggers the need for available diagnostic testing that has been accepted in the medical community as an efficacious method of lung cancer screening or surveillance.

As previously discussed, medical monitoring expense is the plaintiffs' only arguably provable damages. They could not have sued for pain and suffering or lost earning capacity. This is not a case where plaintiffs recovered damages for pain and suffering, lost earning capacity, but only some medical expenses based on existing medical technology. These plaintiffs, or so they allege, had absolutely no remedy until LDCT technology appeared. If they can establish these circumstances, which are unusual and perhaps unique to medical monitoring claims, then their claims are timely. This is a question that cannot be resolved on the record before us; it must be resolved on a motion for summary judgment or, if genuine issues of material fact remain, by a jury. The plaintiffs also must show that the standard of care of the reasonable physician did not call for monitoring of any precancerous condition prior to the statute of limitations period, not just that the technology at that time was less effective for monitoring.

We answer the second certified question in the negative, subject to determination as we have outlined it.

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• SJC: Philip Morris may have to pay for diagnostic tests for smokers  

Massachusetts' high court said today that cigarette maker Philip Morris USA may have to pay for diagnostic chest exams so smokers can get early warning they have developed lung cancer.

In a unanimous ruling, the Supreme Judicial Court said that Massachusetts law has an antiquated definition of negligence that must be updated. Historically, plaintiffs had to show explicit injury -- such as a broken leg -- before the other party can be ordered to pay for diagnostic tests. Writing for the court, Justice Francis X. Spina said that legal thinking had to change.

"Modern living has exposed people to a variety of toxic substances," Spina wrote. "Illness and disease from exposure to these substances are often latent, not manifesting themselves for years or even decades after the exposure."

Spina added, "Our tort law developed in the late 19th and early 20th centuries ...We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury which should be compensable even if the full effects are not immediately apparent." . . .

"The overwhelming majority of federal and state courts have rejected class certification of smokers' claims, including those seeking medical monitoring," Murray Garnick, Altria senior vice president and associate general counsel, said in a statement. "Six of the last seven state supreme courts to consider the issue have refused to recognize claims for medical monitoring based on the risk of future injury.''

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Modern living has exposed people to a variety of toxic substances. Illness and disease from exposure to these substances are often latent, not manifesting themselves for years or even decades after the exposure. Our tort law developed in the late 19th and early 20th centuries . . . We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury which should be compensable even if the full effects are not immediately apparent.
MA Supreme Court Justice Francis X. Spina, writing for the court in the Donovan medical monitoring suit.

• Cancer-Free Smokers Can Sue Philip Morris, Court Says (Update1)  

Philip Morris USA can be sued by cancer-free smokers seeking a court order that the company pay for medical monitoring for signs of the illness, the highest court in Massachusetts ruled.

Answering two state-law questions referred to it by a federal court where the smokers proposed a group lawsuit is pending, the Massachusetts Supreme Judicial Court today ruled that the long-term yet cancer-free smokers can pursue their monitoring claim according to state law.

“We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury which should be compensable even if the full effects are not immediately apparent,” the high court said.

Philip Morris USA, the maker of Marlboro cigarettes, is a unit of Richmond, Virginia-based Altria Group Inc. In a statement issued by an in-house attorney, the company disagreed with the court’s findings.

The smokers’ suit was filed in 2006 by Massachusetts resident Kathleen Donovan and two other people living in the state.

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• So you've tried, and tried, and tried, AND TRIED to quit  

Somehow, this time - maybe it was the nicotine-replacement patch, maybe the counseling - Collins resisted the call of the cigarette. But there is no denying: The stranglehold nicotine places on smokers can sometimes prove insurmountable.

Ask Jerry Remy, the Red Sox TV analyst who acknowledged last month that, despite enduring lung cancer, he still falls prey to the occasional impulse to smoke.

Ask Barack Obama . . .

The failure to quit, research has shown, has nothing to do with weakness of will. Nicotine, the primary addictive agent in tobacco, steals into the brain, setting on fire circuitry that regulates our sense of pleasure. At the same time, cigarettes acquire a sort of social permanence in smokers' lives - a way to start the day, to end a meal, to celebrate good times, to muddle through bad times.

So specialists who treat smokers now emphasize a double-barreled approach that combines counseling and medication, including patches, gum, and other nicotine substitutes along with drugs designed to thwart nicotine's addictive effects. There's even a nicotine vaccine being tested that would prevent the substance from reaching the brain.

Still, it's estimated that while roughly 70 percent of smokers want to quit, fewer than 10 percent succeed each year. . . .

Her first major attempt to quit was in 2000, when she went to group counseling at Mass. General. "I'd go there and I'd talk. And I'd leave immediately and have a cigarette.'' She tried again and again to stop smoking for good. Finally, last year, she decided, "This is ridiculous.'' She again sought counseling and wore the most potent nicotine patch available.

Her last drag on a cigarette, she said, was last October.

"No one can tell you to quit smoking. No one can make you feel like a social miscreant to make you quit smoking,'' said Collins, who lives in Belmont. "You have to summon it up from inside. You really, really do.''

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• Indoor Concentrations of Nicotine in Low-Income, Multi-family Housing: Associations with Smoking Behaviors and Housing Characteristics 

Background: This paper presents an analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area.

Methods: Nicotine concentrations were determined using passive monitors placed in homes over a one-week sampling period and air exchange rates (AER) were sampled using the perfluorocarbon tracer technique. Residents were surveyed through a questionnaire about smoking behaviour and a visual inspection was conducted to collect information on housing characteristics contributing to secondhand smoke (SHS) exposure. . . .

The results of this study suggest that questionnaire reports can provide a valid estimate of residential exposure to tobacco smoke. In addition, this study found evidence that tobacco smoke contamination in low-incomehousing developments is not limited to homes with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming from other apartments or hallways resulted in increased levels of nicotine concentrations and SReff in nonsmoking homes, suggestive of SHS infiltration from neighbouring units.

Conclusion: These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents. . . .

What this Paper Adds: Limited research has investigated SHS exposure in low- income, multi-unit housing; however, residents may be exposed to elevated levels of SHS due to higher smoking rates and building factors such as smaller units, poor ventilation, and infiltration between units. This study examines the relationship between indoor nicotine concentrations, air exchange rates, home volume, and sorption and re-emission of nicotine on indoor surfaces, in order to determine the prevalence of SHS exposure in low-income, multi-unit residences. The results of this analysis indicate that SHS is not limited to residences with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming fromother apartments or hallways resulted in increased levels of nicotine concentrations in nonsmoking homes, suggestive of SHS infiltration from neighbouring units. Thisstudy also demonstrates that effective smoking rates may be an important and valid measure that can be used to improve our understanding of the variability of nicotine concentrations in the residential environment. These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents.

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• LETTER: Insurance-Industry Investments in Tobacco (PDF) 

The Obama administration is proposing a major overhaul of the U.S. health care system, and the insurance industry is poised to play a major role in the process. . . .

In case there is any doubt that insurers place profit above health, consider their investments in tobacco. The U.S.-based Prudential Financial provides life insurance and long-term disability coverage and is also a major owner of tobacco stocks, with total tobacco holdings of $264.3 million (Table 1). The U.K.-based Prudential offers life, health, disability, and long-term care insurance. Prudential’s stake in tobacco totals $1.38 billion. Standard Life, which is also based in the United Kingdom and offers both life and health insur ance, owns nearly $950 million of tobacco stock. Canada-based Sun Life, which offers life, health, disability, and long-term care insurance, owns just over $1 billion of tobacco stock. Northwestern Mutual and Massachusetts Mutual Life Insurance Company (MassMutual) both offer life, disability, and long-term care insurance. MassMutual owns more than $585 million of tobacco stock, and Northwestern Mutual’s stake exceeds $235 million. (These figures are accurate as of March 26, 2009, but given the current economic climate, they are subject to change.)

Although investing in tobacco while selling life or health insurance may seem self-defeating, insurance firms have figured out ways to profit from both. Insurers exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit — and smokers lose — twice over.

These facts should discomfit Canadian and British readers as their countries consider further privatization of health insurance. For those of us in the United States, these data are a reminder of the true priority of the insurance industry, which is making money, not ensuring health and wellbeing. These data raise a red flag about the prospect of opening vast new markets for private insurers at public expense, as has happened in our state of Massachusetts, whose recent health care reform is often cited as a model for national reform.

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• Gov. Deval Patrick seeks to snuff out fake butts 

Millions of taxpayer dollars are going up in smoke as the Patrick administration moves to buy a pricey high-tech cigarette tax-stamping system despite little evidence of counterfeit butts in the Bay State, lawmakers charged yesterday.

Gov. Deval Patrick - who has wrangled with the state's two major zoos over $4 million in state funding - plans to shell out nearly $5 million over the next three years for the new digital stamper.

"I've looked at this issue, and quite frankly (administration officials) don't seem to have made the case that we need to move to this technology," said Rep. Antonio Cabral (D-New Bedford), who co-chairs the legislative committee on bonding.

"The money would be better spent somewhere else on local aid or restoring any of the services we had to cut," Cabral said.

Sicpa, a Swiss company, has been awarded a $4.7 million contract for digital equipment to stamp cigarette packs instead of the stickers used now. The state is expected to spend $800,000 in fiscal year 2010 because the system won't be implemented until midway through the year.

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• Smoker who lost job loses in court 

Rodrigues's smoking was not a protected privacy interest because he never kept his puffing a secret.

In granting Scotts's motion for summary judgment, US District Court Judge George A. O'Toole Jr. said that Rodrigues admitted in a deposition that he smoked while walking down the street and in a restaurant parking lot and was caught by a Scotts supervisor with a pack of cigarettes on his dashboard.

"It is clear from those admissions that Rodrigues has not attempted to keep the fact of his smoking private,'' O'Toole wrote.

The judge also rejected Rodrigues's contention that his firing violated the 1974 federal law that protects employees' rights to their benefits. O'Toole said that law did not protect Rodrigues because he was not yet a bona fide employee and was only working on the condition that he passed the urinalysis.

Rodrigues, 32, said the ruling was stunning and accused O'Toole of bias in favor of corporations. . . .

Rodrigues's appeal, Schwartz said, will address "an important fundamental legal question, which is whether an employer can fire an employee who smokes on his own time away from work because the employer wants to save on medical insurance costs.''

Edward L. Sweda Jr., a senior attorney for the Tobacco Products Liability Project at Northeastern University School of Law, said he was not surprised by O'Toole's ruling because "there is no inherent right to both smoke and have a particular job.''

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