Category Archives: Smoking

Tobacco use among Asian and Pacific Islanders varies widely

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Cigarette SmokeBy Stephanie Stephens
Contributing Writer
Health Behavior News

While past research has shown that, as a whole, Asian Americans and Native Hawaiian/Pacific Islanders living in the U.S. smoke at a lower rate than the national average, a new study in American Journal of Health Behaviorfinds significant differences in tobacco use when analyzed by specific Asian or Pacific Islander ethnicity.

Dramatic social, demographic and behavioral differences exist between Asian American (AA) and Native Hawaiian/Pacific Islander (NHPI) groups, said lead study author Arnab Mukherjea, Dr.P.H., M.P.H., who was a postdoctoral scholar at the Center for Tobacco Control Research & Education at the University of California, San Francisco at the time of the study. Continue reading

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Smoking Mad: Tobacco users caught up in Obamacare “glitch”

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Cigarette Smokeby Charles Ornstein
ProPublica, March 24, 2014

Retired New Hampshire nurse Terry Wetherby doesn’t hide the fact that she smokes.

She checked the box on HealthCare.gov saying she uses tobacco and fully expected to pay more for her insurance policy under the Affordable Care Act. “It’s not a secret at all,” she said. 

Wetherby dutifully paid the premium Anthem Blue Cross and Blue Shield charged her for January and again for February — and believed she had coverage effective on Jan. 1.

Then when Wetherby went to pay her March premium, she was told she couldn’t. A check arrived in the mail refunding her February premium with a two-word explanation: “Contract cancelled.” Continue reading

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Something odd about your cigarette? FDA wants to hear about it

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Consumer Update from the FDA

Cigarette SmokeAre you using a tobacco product that you believe is defective or is causing an unexpected health problem?

Are you using a tobacco product that has a strange taste or smell?

The Food and Drug Administration (FDA) wants to hear from you and has a new online tool you can use to report your problem. Continue reading

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lesson one

Oregon schools use ‘behavioral vaccine’ to reduce smoking

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Blackboard with "Lesson one" written on it.

Photo: Krzysztof “Kriss” Szkurlatowski

By Kristian Foden-Vencil
Oregon Public Broadcasting

Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea.

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.”

Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a study that found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership that includes NPROregon Public Broadcasting and Kaiser Health News

Photo courtesy of Krzysztof “Kriss” Szkurlatowski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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As Washington delays, states move on e-cigarettes

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eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Seattle hookah bars violating laws banning public smoking, King County health officials say

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Public Health – Seattle & King County has found that six Seattle hookah bars are violating the state’s law banning public smoking and ordered them to stop allowing smoking on their premises.

Here’s the announcement from Public Health – Seattle & King County

Six Seattle hookah bars receive order for violating public smoking law

Six hookah bars in Seattle are on notice for violating Washington’s Smoking in Public Places law. Public Health – Seattle & King County sent each of the establishments a Notice and Order on Tuesday, October 1, requiring them to stop allowing smoking.

To protect public health, state law requires that all places of employment and public places are smoke-free.

Health inspectors visited the hookah bars multiple times. They found patrons smoking and each of the bars operating as a public place and/or place of employment.

“Our investigation shows that these hookah bars are violating the law, and endangering the health of their workers and patrons. We are forced to take this enforcement action because they haven’t been responsive to our previous warnings,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Secondhand smoke is a proven killer, and state law works to protect everyone from this health threat.”

Hookah bars have claimed that they are exempt from the indoor smoking law because they are private clubs. However, smoking is prohibited by law if a club has employees and/or the club is open to the public.

The investigation found that these six bars are all open to the public, operating similarly to night clubs that charge a cover for admission.

Each of the establishments received multiple warnings from inspectors, but they have not complied with Washington law. The Notice and Orders require immediate compliance plus payment of fines and fees.

The fine for each violation is $100, in addition to escalating re-inspection fees after the first warning. Subsequent violations will result in additional steps to ensure that state law is followed, including possible court action.

Hookah is a water pipe commonly used to smoke tobacco. Research shows that hookah smoking is at least as harmful as cigarette smoke, even when mixed with sweet fruit and candy flavors.

The establishments have ten days from receipt of the Notice and Order if they wish to appeal or 30 days to pay the fines and re-inspection fees.

Hookah bars receiving a Notice and Order this week include:

 

Lounge Address
Casablanca Shisha Lounge 1221 S Main St

Da Spot Hookah Lounge

1914 Minor Ave
Medina Hookah Lounge 700 S Dearborn St
The Night Owl 4745 University Way NE
Sahara Hookah Lounge 7523 Lake City Way NE
Seattle Hookah Lounge 4701 Roosevelt Way NE

 

Hookah health threat

Tobacco use remains the number one cause of preventable death and disease in King County, costing nearly 2,000 lives and $343 million dollars in health costs and lost wages locally every year.

  • Tobacco is placed inside the bowl at the top of the hookah.

    Tobacco is placed inside the bowl at the top of the hookah.

    Hookah is a water-pipe commonly used to smoke tobacco, often mixed with sweet fruit and candy flavors.

  • Research shows that hookah smoking is not a safe alternative to cigarettes and that hookah smoke is at least as harmful as cigarette smoke.
  • During a typical 45-minute session of hookah use, a person may inhale as much smoke as smoking 100 cigarettes or more.
  • Hookah smoke contains the addictive drug nicotine, along with tar, carcinogens, and heavy metals.
  • Hookah smoking has been associated with lung cancer, oral cancer, heart disease, respiratory illness, periodontal disease, and low birthweight.
  • Sharing a hookah mouthpiece can transmit infectious diseases, including tuberculosis.

Hookah and youth

Hookah use has seen a rise in popularity, especially among youth. According to the 2012 Healthy Youth Survey, hookah use among King County high school seniors is higher than cigarette use (15% and 12%, respectively).

‘We are very concerned about the high hookah use rates among youth,” said Scott Neal, Tobacco Prevention Program Manager for Public Health – Seattle & King County. “Sweet fruit and candy flavors lure youth and help fuel the misperception that hookah smoking is safer than cigarettes.”

Report smoking law violations

To report violations, visit the Tobacco Prevention Program page for an online form; or text the establishment’s name, date of violation, and brief description of the violation to  206-745-2548.

 

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Schools Are Getting Healthier, says CDC

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school-busBy Marissa Evans

Nowadays, the hub for developing healthy habits isn’t just the gym or home. For kids, at least, it’s increasingly their schools, according to a study released this week by the Centers for Disease Control and Prevention.

School districts across the country are demonstrating a range of improvements in terms of nutrition, exercise and tobacco policies.

For instance, after years of efforts to phase out junk food like candy and chips, the percentage of school districts that prohibited such food in vending machines increased from 29.8 percent in 2006 to 43.4 percent in 2012, according to the CDC’s 2012 School Health Policies and Practices Study.

Also, slightly more than half of school districts – up from about 35 percent in 2000 — made information available to families on the nutrition and caloric content of foods available to students.

“Schools play a critical role in the health and well-being of our youth,” said CDC Director Tom Frieden, in the news release. “Good news for students and parents — more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free.”

Since 2000, the number of school districts that require elementary schools to teach physical education increased. In addition, the number of districts entering into agreements with local YMCAs, Boys & Girls Clubs or local parks and recreation departments went up, according to the study.

Meanwhile, the percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

The CDC study is a periodic, national survey that examines key components of school health at the state, district, school, and classroom level, including health education; physical education and activity; health services; mental health and social services; nutrition services; healthy and safe school environment; faculty and staff health promotion; and family and community involvement.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Lifestyle changes can lower heart attack, stroke risk in patients with coronary artery disease

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Salad in BowlBy Sarah Jorgenson, HBNS Contributing Writer
Research Source: American Journal of Preventive Medicine

Lifestyle modification programs that addressed at least two health behaviors lowered the risk of a fatal heart attack or stroke in people with coronary heart disease, finds a new systematic review in the American Journal of Preventive Medicine.

In a meta-analysis of nine studies, with population sample sizes ranging from 57 to 1,621 patients, the researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle programs while receiving standard care versus people who received standard care alone.

“When you look at healthy lifestyles, you should be comprehensive in doing it because it is not enough to quit smoking if you have very bad dietary habits. So, the combination of lifestyle interventions could be more beneficial,” said lead author Chiara de Waure, M.D., M.Sc., an assistant professor at the Institute of Public Health at the Catholic University of Sacred Heart in Rome, Italy.

Studies varied in program duration with follow-up periods from one to nineteen years. All of the lifestyle intervention programs included diet and nutrition advice and exercise advice or sessions. A number of the studies also provided smoking cessation advice or programs, while other studies also included stress management.

“These interventions that the authors discuss may also subsequently reduce the risk of cancer, respiratory disease, and diabetes, among other chronic diseases…If anything, they were likely to underestimate the potential benefit of lifestyle change in terms of chronic disease,” commented Barry Franklin, Ph.D., professor of physiology at Wayne State University School of Medicine and director of the cardiac rehabilitation program and exercise laboratories at William Beaumont Hospital in Royal Oak, Michigan.

Franklin added, “The study reiterates that the first line of defense for heart disease, that is, the most proximal risk factors, involves addressing poor diet, physical inactivity and cigarette smoking.”

Researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle program.

The review finds that lifestyle interventions are effective even in patients with established coronary heart disease, whether they had symptoms or not, and may lower the risk of non-fatal heart attack and stroke and hospital readmission.

“Sometimes when a patient develops a disease, he may think that his world is over, that there is no way to improve through lifestyles because he has already had the event, but we are showing that healthy lifestyles continue to be important even after the onset of disease,” said de Waure.
Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Local employers to team up with CDC to create “healthy worksites”

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Pierce CountyFifteen Pierce County employers will team up with the US Centers for Disease Control and Prevention (CDC) to promote employee health through worksite wellness programs.

A total of 104 small and mid-sized businesses in eight counties across the nation have volunteered to participate in the new initiative, called the National Health Worksite Program, which aims to help workers become healthier and reduce their risk of chronic disease.

CDC Director Dr. Tom Frieden said that the program “by making it easier for employees to be physically active, eat healthy foods, and not smoke” employers will be able to “cut health care costs and reduce the burden of heart disease, cancer, stroke, diabetes and other health problems in their workforce.”

The year-long program will be administered by Viridian Health Management, a Phoenix, Arizona-based company specializing in employee health promotion programs.

The communities were selected because they had high rates of chronic disease and health risk behaviors such as smoking and physical inactivity and because they had local resources to support workplace programs, such as existing community health promotion programs.

The seven other communities selected for the program are: Buchanan County, Mo.; Harris County, Texas; Kern County, Calif.; Marion County, Ind.; Philadelphia County, Pa.; Shelby County, Tenn.; and Somerset County, Maine.

Employers were selected to create a diverse group of businesses from different industries and varying in size, the  CDC said.

Participating employers will be given support to develop strategies and programs that will promote physical activity and good nutrition among their workers and to help those workers who smoke to quit.

Approaches they might choose include:

  • Nutrition counseling/education, worksite farmer’s markets, menu labels on healthy foods in vending machines and cafeterias, access to healthy foods in cafeterias and vending machines, and weight management counseling.
  • Tobacco-cessation counseling (including quit lines and health plans) and tobacco‐free campus policy.
  • Physical fitness/counseling, and walking clubs.

The program is supported through the Affordable Care Act’s Prevention and Public Health Fund. Upon completion, the program will be evaluated and the results will be used to create a document describing best practices and models on how to successfully implement workplace health programs in small worksites more broadly.

 

Fifteen Pierce County employers with 1,386 employers will participate in the program:

  • Roman Meal Company, Tacoma, small, wholesale
  • United Way of Pierce County, small, services
  • Tacoma Community House, Tacoma, small, services
  • Pierce County AIDS Foundation, Tacoma , small, services
  • Brown & Brown of Washington Inc., Tacoma Worksite, Tacoma, small, services
  • McConkey Company, Sumner, small, manufacturing
  • Pediatrics North West, Tacoma, small, services
  • APA- The Engineered Wood Association, Tacoma, small, services
  • Tacoma Housing Authority, Tacoma, mid-size, services
  • Pacific Alaska Freightways, Inc., Fife, mid-size, transportation
  • Metropolitan Development Council, Tacoma, mid-size, services
  • Greater Lakes Mental Healthcare, Lakewood, mid-size, services
  • Brown & Haley, Tacoma, mid-size, manufacturing
  • Tacoma-Pierce County Health Department, Tacoma, large, public administration
  • Tacoma Area Coalition of Individuals with Disabilities (TACID), Tacoma, small, services

A complete listing of the selected employers and more information about the program is located http://www.cdc.gov/NationalHealthyWorksite.

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Should smokers have to pay more for health insurance?

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Cigarette thumbBy Martha Bebinger, WBUR

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S. And it’s expensive.

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

That’s why the federal Affordable Care Act permits insurers to charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. ”In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether smokers should pay more for health insurance has created unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

“First of all there is very little evidence that financial incentives or disincentives through premiums change behavior,” says Amy Whitcomb Slemmer, executive director at Health Care for All, a Massachusetts group that advocates for affordable health care access.

Health Care for All and the group’s allies in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says higher insurance premiums could lead many smokers to drop their coverage.

“We were concerned that more would pay the penalty to not be insured,” Whitcomb Slemmer continues. “And, specifically, we’d be concerned that they (smokers) wouldn’t have access to what has been demonstrated to be very effective smoking cessation programming.”

In Massachusetts, Vermont, Rhode Island and the District of Columbia, this public health perspective has won the debate, for now. Insurers will not be allowed to add a surcharge for smokers. California is moving in the same direction.

But aides to Massachusetts Gov. Deval Patrick says he’s open to allowing the surcharge in the future — if insurers find accurate ways to determine who smokes and who doesn’t.

The largest insurers in the Bay State are mostly on the sidelines in this controversy. Here’s one reason why: They’ve had the option of hiking premiums for smokers since the state passed its landmark health care act in 2006, and they haven’t done it.

“We try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors,” says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.

The Massachusetts legislature will likely need to amend state law so that a ban on higher charges for smokers takes effect.

And just to make things a little more complicated — it won’t apply to everyone. Large employers, who are self-insured and follow federal insurance rules, will be able to target smokers, if they choose.

This story is part of a partnership that includes WBURNPR and Kaiser Health News. 

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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TIPS-campaign-logo

CDC’s new antismoking campaign: Tips from Former Smokers

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This week the US Centers for Disease Control and Prevention (CDC) launches a new ad campaign featuring the stories of former smokers living with smoking-related diseases and disabilities.

“Tips from Former Smokers” ads will run for at least 12 weeks on television, radio, and billboards, online, and in theaters, magazines, and newspapers nationwide.

The education campaign seeks to provide motivation, information, and quit help to those who want it, CDC officials said.

  • The ads feature smoking-related health conditions— including chronic obstructive pulmonary disease or COPD, more severe adult asthma, and complications from diabetes, such as blindness, kidney failure, heart disease, and amputation—and candidly describe the losses from smoking and the gains from quitting
  • Despite the known dangers of tobacco use, nearly one in five adults in the United States still smoke.  Almost 90 percent of smokers started before they were 18, and many of them experience life-changing health effects at a relatively early age. Smoking harms nearly every organ in the body.
  • More than 440,000 Americans each year lose their lives to smoking-related diseases, and for every one death 20 more continue living with one or more serious illnesses from smoking.  Nearly 70 percent of smokers say they want to quit.

For more information on the campaign, including profiles of the former smokers, links to the ads, and free quit help, visit www.cdc.gov/tips.

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Illustration of the lungs in blue

Understanding and preventing lung cancer – from MedlinePlus magazine

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From MedlinePlus magazine

What is Lung Cancer

Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

  • Small cell: The cells of small cell lung cancer look small under a microscope. About 1 of every 8 people with lung cancer has small cell lung cancer.
  • Non-small cell: The cells of non-small cell lung cancer are larger than the cells of small cell lung cancer. Most (about 7 of every 8) people diagnosed with lung cancer have non-small cell lung cancer. It doesn’t grow and spread as fast as small cell lung cancer, and it’s treated differently.

Lung cancer is the leading cause of cancer death in both men and women. Lung cancer is the second most common cancer in the United States, after skin cancer. The number of new cases and deaths from lung cancer is highest in black men.

cancerdiagram_large

Risk Factors

Smoking is the main cause of lung cancer, especially non-small cell lung cancer. Exposure to secondhand smoke and environmental exposures, such as radon and workplace toxins, also increase your risk.

The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer. If a person has stopped smoking, the risk becomes lower as the years pass.

When smoking is combined with other risk factors—such as secondhand smoke, asbestos and arsenic exposure, and air pollution—the risk of lung cancer is increased. A family history of cancer can also be a risk factor for lung cancer.

Dusty Donaldson

Lung cancer survivor Dusty Donaldson helps to spread the word about the importance of screening and early detection.
Photo: Courtesy Dusty Donaldson

In 2005, Dusty Donaldson experienced tenderness and pain in her neck that didn’t go away over several months. When her doctor couldn’t detect any physical cause, and the pain continued, Donaldson decided more had to be done. “The pain was persistent, and so was I.”

Today, she’s thankful for her persistence. Ultrasound and CT scans found something suspicious in her right lung. That turned out to be a five-centimeter cancerous tumor between the upper and middle lobes of her lungs. It was an early-stage cancer and had not spread to other parts of her lungs or her body.

Donaldson, who had quit smoking 26 years before her diagnosis, had not even considered that she might have lung cancer.

“I was really surprised at the time to find out that lung cancer is the number one cause of cancer deaths in men and women. More people die from lung cancer than from all the others combined,” Donaldson says. “Lung cancer death rates are the equivalent of a 747 jumbo jet crashing to the ground every single day.”

Surgeons removed almost two-thirds of her lung and treated her with chemotherapy for three months. Today, she remains cancer free and has made a commitment to help others understand lung cancer and the need for early detection.

Donaldson volunteers with the nonprofit LUNGevity Foundation to help the organization educate the public about lung cancer.

“I’m compelled to find others and share with them information regarding screening,” she says. “Early detection is key to survivorship,” she adds. “There’s not a single soul on this earth who doesn’t need to know about lung cancer. People who don’t know they are at risk, need to know that there are other risk factors—genetics, radon, and other things that can cause lung cancer.”

“If I could tell the world one thing about lung cancer, it’s that anyone can get it and no one deserves it.”
—Dusty Donaldson, 58, High Point, NC.

The 2011 National Cancer Institute’s National Lung Screening Trial showed the importance of detecting lung cancer early. The trial also showed for the first time an effective screening approach for a high-risk population.

“Now thanks to the National Lung Screening Trial, we know screening can be more effective than anything else,” says Donaldson. “People who are at great risk don’t have to consider themselves doomed to lung cancer. They can have early detection, get treated early, and hopefully live a long and healthy life.”

Symptoms

Lung Cancer

Chest x-ray showing lung cancer.

X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

Possible signs of non-small cell lung cancer include a cough that doesn’t go away and shortness of breath. Check with your doctor or other health professional if you have any of the following problems:

  • Chest discomfort or pain.
  • A cough that doesn’t go away or gets worse over time.
  • Trouble breathing.
  • Wheezing.
  • Blood in sputum (mucus coughed up from the lungs).
  • Hoarseness.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Feeling very tired.
  • Trouble swallowing.
  • Swelling in the face and/or veins in the neck.

Diagnosis

Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer. Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. Some of the following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
  • Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
  • Chest X-ray: An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine, which takes X-ray pictures of the inside of the body. The X-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.
  • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Treatments

Certain factors affect prognosis (chance of recovery) and treatment options.

  • The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
  • The type of lung cancer.
  • Whether there are symptoms such as coughing or trouble breathing.
  • The patient’s general health.

For patients with advanced non-small cell lung cancer, current treatments do not cure the cancer. The treatment that’s right for you depends mainly on the type and stage of lung cancer. You may receive more than one type of treatment.

Surgery

Surgery may be an option for people with early-stage lung cancer. The surgeon usually removes only the part of the lung that contains cancer. Most people who have surgery for lung cancer will have the lobe of the lung that contains the cancer removed. This is a lobectomy. In some cases, the surgeon will remove the tumor along with less tissue than an entire lobe, or the surgeon will remove the entire lung. The surgeon also removes nearby lymph nodes.

Radiation Therapy

Radiation therapy is an option for people with any stage of lung cancer:

  • People with early lung cancer may choose radiation therapy instead of surgery.
  • After surgery, radiation therapy can be used to destroy any cancer cells that may remain in the chest.
  • In advanced lung cancer, radiation therapy may be used with chemotherapy.

The NCI booklet Radiation Therapy and You (www.cancer.gov/cancertopics/coping/radiation-therapy-and-you) has helpful ideas for coping with radiation therapy side effects.

Chemotherapy

Chemotherapy may be used alone, with radiation therapy, or after surgery.

Chemotherapy uses drugs to kill cancer cells. The drugs for lung cancer are usually given directly into a vein (intravenously) through a thin needle. Newer chemotherapy methods, called targeted treatments, are often given as a pill that is swallowed.

You’ll probably receive chemotherapy in a clinic or at the doctor’s office. People rarely need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired.
  • Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your healthcare team can give you medicines and suggest other ways to help with these problems.

The NCI booklet Chemotherapy and You (www.cancer.gov/cancertopics/coping/chemotherapy-and-you) has helpful ideas for coping with chemotherapy side effects.

Targeted Therapy

People with non-small cell lung cancer that has spread may receive a type of treatment called targeted therapy. Several kinds of targeted therapy are used for non-small cell lung cancer. One kind is used only if a lab test on the cancer tissue shows a certain gene change. Targeted therapies can block the growth and spread of lung cancer cells.

Depending on the kind of drug used, targeted therapies for lung cancer are given intravenously or by mouth.

Lung Cancer Research

  • The large-scale National Lung Screening Trial, supported by the National Cancer Institute (NCI), has shown that screening current or former heavy smokers with low-dose helical computed tomography (CT) decreases the risk of dying from lung cancer. That finding was only for heavy smokers.
  • Another recent study showed that low-dose nicotine does not enhance lung cancer development. This suggests that nicotine replacement therapy is safe for former smokers.
  • Results of a 2011 research trial revealed that annual chest X-ray screening of people ages 55 to 74 years does not reduce lung cancer deaths compared with usual care.
  • Researchers have identified genetic regions that predispose Asian women who’ve never smoked to lung cancer. The finding provides evidence that lung cancer between smokers and never-smokers can differ on a fundamental level.

Tests

  • What type of lung cancer do I have?
  • Has the cancer spread from the lung? If so, to where?
  • May I have a copy of test results?

Surgery

  • What kind of surgery do you suggest for me?
  • How will I feel after surgery?
  • If I have pain, how can we control it?
  • How long will I be in the hospital?
  • Will I have any lasting side effects?
  • When can I get back to my normal activities?

Radiation Therapy

  • When will treatment start? When will it end? How often will I have treatments?
  • How will I feel during treatment? Will I be able to drive myself to and from treatment?
  • What can I do to take care of myself before, during, and after treatment?
  • How will we know the treatment is working?
  • What side effects should I expect? What should I tell you about?
  • Are there any lasting effects?

Chemotherapy or Targeted Therapy

  • Which drug or drugs do you suggest for me? What will they do?
  • What are the possible side effects? What can we do about them?
  • When will treatment start? When will it end? How often will I have treatments?
  • How will we know the treatment is working?
  • Will there be lasting side effects?

To Find Out More

  • Be Tobacco Free: www.BeTobaccoFree.gov brings together information on the health effects of tobacco, quitting smoking, and more.
  • The What You Need To Know About Lung Cancer booklet (www.cancer.gov/cancertopics/wyntk/lung) provides information about lung cancer diagnosis, staging, treatment, and comfort care. Information specialists also can answer questions about cancer at 1-800-4-CANCER.
  • The NCI Lung Cancer Home Page provides up-to-date information on lung cancer treatment, prevention, genetics, causes, screening, testing, and related topics. (www.cancer.gov/cancertopics/types/lung)
  • Information on treatment options for non-small cell lung cancer and small cell lung cancer is available from PDQ, NCI’s comprehensive cancer database. (www.cancer.gov/cancertopics/pdq)
  • Clinical trials for non-small cell lung cancer and small cell lung cancer can be found in NCI’s list of clinical trials. (www.cancer.gov/clinicaltrials)

Because most people who get lung cancer were smokers, you may feel that doctors and other people assume that you are or were a smoker (even if you aren’t or weren’t). Whether or not you were a smoker, it’s important for you to protect your body now from smoke. Avoid secondhand smoke from smokers near you.

If you smoke, talk with an expert about quitting. It’s never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.

To get help with quitting smoking…

  • Call NCI’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Sign up for the free mobile service SmokefreeTXT to get tips and encouragement to quit. To sign up, text the word QUIT to IQUIT (47848) from your mobile phone. Or, go to www.smokefree.gov/smokefreetxt/Signup.aspx.

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Fewer students smoking and drinking alcohol in Washington state

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Picture of a table after a party with wine and beer bottlesFewer students in Washington state are smoking cigarettes or drinking alcohol, according to the state’s latest Healthy Youth Survey.

The survey is taken every two years by students in grades 6, 8, 10, and 12 in more than 1,000 Washington public schools.

 

Among the findings:

Tobacco:

  • Cigarette smoking is down in all grades. About 10 percent of 10th graders reported smoking a cigarette at least once in the past 30 days —  down from nearly 13 percent in 2010 and from 25 percent in 1999.
  • Nearly as many 10th graders smoked tobacco from a hookah pipe as from a cigarette, and about 7 percent said that they smoked a cigar in the last month.
  • Statewide, about 50,000 youth smoke – and 40 start smoking every day.

Alcohol:

  • Nearly 11,000 fewer students are using alcohol compared to 2010. Still, more than 115,000 youth currently drink.  Twelve percent of 8th graders, 23 percent of 10th graders, and 36 percent of 12th graders used alcohol in the past 30 days.

Marijuana:

  • The  number of secondary school students who believe using marijuana is risky dropped to the lowest level since the state started collecting data and the percentage of Washington 10th and 12th graders who smoke marijuana is nearly double the percentage of cigarette smokers.

Suicide and Depression:

  • About 8 percent of 8th and 10th graders attempted suicide in the past year.
  • Over 100,000 youth, ages 12-17, seriously considered suicide – about one in every six students.
  • More than one in four teens surveyed said they felt so sad or hopeless for two weeks in a row that they stopped doing usual activities: 26 percent in 8th grade, 31 percent in 10th grade, and 30 percent in 12th grade.
  • These numbers haven’t changed much over the past 10 years.

Sex:

  • Nearly one third (32 percent) of 10th graders and more than half (55 percent) of 12th graders reported having ever had sexual intercourse.
  • About 7 percent of 10th graders and 16 percent of 12th graders reported they had four or more sexual partners.
  • About 6 percent of 10th graders and 5 percent of 12th graders reported having sex for the first time at age 12 or younger.

To learn more:

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About one in five US adult cigarette smokers have tried an electronic cigarette

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eFrom the CDC

In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as e-cigarettes, up from about 10 percent in 2010, according to a study released today by the Centers for Disease Control and Prevention.

Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010.  This study is the first to report changes in awareness and use of e-cigarettes between 2010 and 2011.

During 2010–2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic Whites, those aged 45–54 years, those living in the South, and current and former smokers and current and former smokers.

In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers.  Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.

“E-cigarette use is growing rapidly,” said CDC Director Tom Frieden, MD, MPH. “There is still a lot we don’t know about these products, including whether they will decrease or increase use of traditional cigarettes.”

Although e-cigarettes appear to have far fewer of the toxins found in smoke compared to traditional cigarettes, the impact of e-cigarettes on long-term health must be studied.

Research is needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people.

“If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative,” said Tim McAfee, MD MPH, director of the Office on Smoking and Health at CDC.

  • For quitting assistance, call 1-800-QUIT-NOW (1-800-784-8669) or visit www.smokefree.gov.
  • Also, visit www.BeTobaccoFree.gov for information on quitting and preventing children from using tobacco.
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