Archive for the ‘tobacco and smoking’ Category

Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010

August 15, 2012 Comments off

Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010

Source: National Center for Health Statistics

Key findings

Data from the National Health and Nutrition Examination Survey

  • In 2009–2010, about 47% of adults had at least one of three risk factors for cardiovascular disease—uncontrolled high blood pressure, uncontrolled high levels of low-density lipoproteins (LDL) cholesterol, or current smoking.
  • Men were more likely than women to have at least one of the three cardiovascular disease risk factors.
  • From 1999–2000 through 2009–2010, a decrease was observed in the percentage of non-Hispanic white and Mexican-American adults who had at least one of the three risk factors for cardiovascular disease. However, this decrease was not found among non-Hispanic black adults.
  • The prevalence of uncontrolled high blood pressure and of uncontrolled high LDL cholesterol declined between 1999–2000 and 2009–2010, but no significant change occurred in the percentage of adults who smoke cigarettes.

Current Tobacco Use Among Middle and High School Students — United States, 2011

August 11, 2012 Comments off

Current Tobacco Use Among Middle and High School Students — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Tobacco use continues to be the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually because of cigarette smoking and exposure to secondhand smoke (1). Moreover, nearly 90% of adult smokers begin smoking by age 18 years (2). To assess current tobacco use among youths, CDC analyzed data from the 2011 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which indicated that, in 2011, the prevalence of current tobacco use among middle school and high school students was 7.1% and 23.2%, respectively, and the prevalence of current cigarette use was 4.3%, and 15.8%, respectively. During 2000–2011, among middle school students, a linear downward trend was observed in the prevalence of current tobacco use (14.9% to 7.1%), current combustible tobacco use (14.0% to 6.3%), and current cigarette use (10.7% to 4.3%). For high school students, a linear downward trend also was observed in these measures (current tobacco use [34.4% to 23.2%], current combustible tobacco use [33.1% to 21.0%], and current cigarette use [27.9% to 15.8%]). Interventions that are proven to prevent and reduce tobacco use among youths include media campaigns, limiting advertisements and other promotions, increasing the price of tobacco products, and reducing the availability of tobacco products for purchase by youths. These interventions should continue to be implemented as part of national comprehensive tobacco control programs and should be coordinated with Food and Drug Administration (FDA) regulations restricting the sale, distribution, and marketing of cigarettes and smokeless tobacco products to youths (2–4).

Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011

August 6, 2012 Comments off

Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011
Source: Morbidity and Mortality Weekly Report (CDC)

Smoking cigarettes and other combustible tobacco products causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases (1). A priority of the U.S. Department of Health and Human Services is to develop innovative, rapid-response surveillance systems for assessing changes in tobacco use and related health outcomes (2). The two standard approaches for measuring smoking rates and behaviors are 1) surveying a representative sample of the public and asking questions about personal smoking behaviors and 2) estimating consumption based on tobacco excise tax data (3). Whereas CDC regularly publishes findings on national and state-specific smoking rates from public surveys (4), CDC has not reported consumption estimates. The U.S. Department of Agriculture (USDA), which previously provided such estimates, stopped reporting on consumption in 2007 (5). To estimate consumption for the period 2000–2011, CDC examined excise tax data from the U.S. Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB); consumption estimates were calculated for cigarettes, roll-your-own tobacco, pipe tobacco, and small and large cigars. From 2000 to 2011, total consumption of all combustible tobacco decreased from 450.7 billion cigarette equivalents to 326.6, a 27.5% decrease; per capita consumption of all combustible tobacco products declined from 2,148 to 1,374, a 36.0% decrease. However, while consumption of cigarettes decreased 32.8% from 2000 to 2011, consumption of loose tobacco and cigars increased 123.1% over the same period. As a result, the percentage of total combustible tobacco consumption composed of loose tobacco and cigars increased from 3.4% in 2000 to 10.4% in 2011. The data suggest that certain smokers have switched from cigarettes to other combustible tobacco products, most notably since a 2009 increase in the federal tobacco excise tax that created tax disparities between product types.

A Sensitive Approach to Studying ASDs: Teasing Out Relationships between Autism and Maternal Smoking

July 8, 2012 Comments off

A Sensitive Approach to Studying ASDs: Teasing Out Relationships between Autism and Maternal Smoking
Source: Environmental Health Perspectives

Both genetic and environmental factors have been implicated in autism spectrum disorders (ASDs), which affect an estimated 1 in 88 children. One such environmental factor, prenatal exposure to tobacco smoke via maternal smoking, has been associated with ASDs in some studies but not others. A new study reports evidence of a positive association between maternal smoking during pregnancy and higher-functioning ASD subtypes [EHP 120(7):1042–1048; Kalkbrenner et al.].

The authors collected information on maternal smoking and other factors from the birth certificates for 633,989 children born in 1992, 1994, 1996, and 1998 in 11 U.S. states. They linked these data with surveillance data from the U.S. Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring network and identified 3,315 of the children who were subsequently diagnosed with an ASD by age 8 years.

About 13% of all the mothers smoked during pregnancy, compared with about 11% of mothers with children diagnosed with an ASD. Maternal smoking has been associated with both lower education and reduced access to health care, factors that might increase the likelihood that ASDs go undiagnosed among children of women who smoked during pregnancy. When the authors corrected for this potential bias using outcome misclassification sensitivity analyses, a weak positive association emerged between maternal smoking and cases classified as “ASD not otherwise specified,” which were assumed to be higher-functioning ASDs such as Asperger’s disorder. The association was not found for lower-functioning (that is, more severe) ASDs.

The authors write that their findings concerning ASD subgroups should be interpreted with caution because the accuracy of subgroup classification may have varied depending upon mothers’ access to evaluation services, and because it was not bas ed on direct clinical observation. They also note that positive associations may reflect the presence in higher-functioning subgroups of children with co-occurring disorders (such as attention deficit/hyperactivity disorder) that can be affected by nicotine exposure.

Strengths of the study include the large sample size, the population-based design with standardized identification of ASD cases, and the use of sensitivity analyses to evaluate potential sources of bias. The authors conclude that the observed association between maternal smoking during pregnancy and higher-functioning ASDs warrants further research.

Youth Risk Behavior Surveillance — United States, 2011

June 25, 2012 Comments off

Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.

Reporting Period Covered: September 2010–December 2011.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.

Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.

Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.

Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Canada — Fewer Young People Smoking, Drinking and Using Drugs – New survey reveals encouraging trend

June 8, 2012 Comments off

Fewer Young People Smoking, Drinking and Using Drugs – New survey reveals encouraging trend
Source: Health Canada

According to the latest results of the Youth Smoking Survey, only three per cent of Canadian students in grades 6-12 said they smoked daily in 2010-2011, down from 4% in 2008-2009.

The school-based survey also found that fewer students have even tried cigarettes once; a decline among those who had ever tried little cigars; and a drop in the percent of students reporting using alcohol, cannabis and other drugs.

“After seeing smoking rates hit historic lows in Canada recently, these new statistics are encouraging,” said the Honourable Leona Aglukkaq, Minister of Health. “In particular, the drop in little cigar smoking suggests that the Cracking Down on Tobacco Marketing Aimed at Youth Act is having an impact on consumption of these products by youth.”

The Youth Smoking Survey, funded by Health Canada and conducted by the University of Waterloo’s Propel Centre for Population Health Impact, is a survey of Canadian youth in grades 6-12 that captures information related to tobacco, alcohol and drug use.

State Tobacco Revenues Compared with Tobacco Control Appropriations — United States, 1998–2010

May 30, 2012 Comments off

State Tobacco Revenues Compared with Tobacco Control Appropriations — United States, 1998–2010
Source: Morbidity and Mortality Weekly Report (CDC)

In 1999, CDC published Best Practices for Comprehensive Tobacco Control (1), which outlined the elements of an evidence-based state tobacco control program and provided a recommended state funding range to substantially reduce tobacco-related disease, disability, and death. Best Practices recommended that states invest a combined $1.6–$4.2 billion annually in such programs and subsequently updated that recommendation to $3.7 billion annually in 2007 (2). To analyze states’ historical investments in tobacco control and calculate the amount of funding necessary to achieve Best Practices recommendations, CDC tracked data from 1998 to 2010. During this period, states collected $243.8 billion in total tobacco revenues from tobacco industry settlement payments and cigarette excise taxes. State and federal appropriations for tobacco control totaled $8.1 billion, whereas CDC’s Best Practices recommended funding of at least $29.2 billion ($1.6 billion for 9 years plus $3.7 billion for 4 years). For the entire study period, the ratio of state tobacco revenues to state and federal tobacco control appropriations was approximately 30 to 1 ($243.8 billion to $8.1 billion); in 2010, the ratio was approximately 37 to 1 ($23.96 billion to $0.64 billion). If states allocated funding for tobacco control at Best Practices levels, they could achieve larger and more rapid reductions in smoking and associated morbidity and mortality (2,3).

Adult Awareness of Tobacco Advertising, Promotion, and Sponsorship — 14 Countries

May 28, 2012 Comments off

Adult Awareness of Tobacco Advertising, Promotion, and Sponsorship — 14 Countries
Source: Morbidity and Mortality Weekly Report (CDC)

According to the 2012 Report of the U.S. Surgeon General, exposure to tobacco advertising, promotion, and sponsorship (TAPS) is associated with the initiation and continuation of smoking among young persons. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires countries to prohibit all forms of TAPS (2); the United States signed the agreement in 2004, but the action has not yet been ratified. Many countries have adopted partial bans covering direct advertising in traditional media channels; however, few countries have adopted comprehensive bans on all types of direct and indirect marketing. To assess progress toward elimination of TAPS and the level of awareness of TAPS among persons aged ≥15 years, CDC used data from the Global Adult Tobacco Survey (GATS) collected in 14 countries during 2008–2010. Awareness of any TAPS ranged from 12.4% in Turkey to 70.4% in the Philippines. In the four countries where awareness of TAPs was ≤15%, three of the countries had comprehensive bans covering all nine channels assessed by GATS, and the fourth country banned seven of the nine channels. In 12 countries, more persons were aware of advertising in stores than advertising via any other channel. Reducing exposure to TAPS is important to prevent initiation of tobacco use by youths and young adults and to help smokers quit.

Substance Use during Pregnancy Varies by Race and Ethnicity

May 10, 2012 Comments off

Substance Use during Pregnancy Varies by Race and Ethnicity (PDF)
Source: Substance Abuse and Mental Health Services Administration

When pregnant women use alcohol, tobacco, or other drugs, they incur an increased risk for experiencing health problems themselves and poor birth outcomes for their infants. It is important for doctors, nurses, and midwives to discuss the risks of substance use with all pregnant women. Data from the National Survey on Drug Use and Health (NSDUH) indicate that substance use during pregnancy varies by race and ethnicity and suggest that health care providers may consider delivering targeted messages to make their discussions more effective.

According to NSDUH data, among women aged 15 to 44, pregnant black women were more likely than pregnant white and Hispanic women to have used any illicit drugs in the past month (Figure). Pregnant black and white women were more likely than pregnant Hispanic women to have used alcohol in the past month. Pregnant white women were more likely than pregnant black women to have smoked cigarettes in the past month, and both groups were more likely than pregnant Hispanic women to have smoked. Health care providers may want to consider using this information to deliver relevant health education to their patients about risks associated with illicit drug, alcohol, and tobacco use.

See: More Than One in Five Pregnant White Women Smoke Cigarettes (Science Daily)

Global ignorance of tobacco’s harm to cardiovascular health costing lives

April 26, 2012 Comments off

Global ignorance of tobacco’s harm to cardiovascular health costing lives
Source: World Heart Federation

A report released today at the World Heart Federation World Congress of Cardiology in Dubai reveals significant gaps in public awareness regarding the cardiovascular risks of tobacco use and secondhand smoke. The report, entitled “Cardiovascular harms from tobacco use and secondhand smoke”, was commissioned by the World Heart Federation and written by the International Tobacco Control Project (ITC Project), in collaboration with the Tobacco Free Initiative at the World Health Organization.

According to the report, half of all Chinese smokers and one-third of Indian and Vietnamese smokers are unaware that smoking causes heart disease. Across a wide range of countries, including India, Uruguay, South Korea and Poland, around half of all smokers – and over 70 per cent of all Chinese smokers – do not know that smoking causes stroke. Awareness of the risk of secondhand smoke is even lower. In Vietnam, nearly 90 per cent of smokers and non-smokers are unaware that secondhand smoke causes heart disease. In China, 57 per cent of smokers and non-smokers are unaware of the link. Even in countries with well-developed health systems and tobacco control regulation – such as Canada, the United Kingdom, the United States, and Australia – between a third and a half of smokers do not know that secondhand smoke can damage cardiovascular health.

Professor Geoffrey T. Fong at the University of Waterloo, Canada, and Chief Principal Investigator of the ITC Project, commented, “This report shows a broad correlation between poor knowledge of the risks of tobacco use and high levels of smoking prevalence. To break this link and reduce the deadly toll of tobacco, more needs to be done to increase awareness of the specific health harms. Our research shows that the risks of tobacco use to lung health are very widely accepted. But we need to attain the same level of knowledge and awareness that tobacco use and secondhand smoke can cause heart disease, stroke, and peripheral vascular disease. Health warning labels are known to be an effective method for educating the public on the health harms of tobacco products. A number of countries have introduced warnings about the increased risk of heart disease or heart attack, but no country has yet implemented a label to warn people that secondhand smoke causes heart disease. Increasing knowledge of these specific health risks will help encourage smokers to quit and help non-smokers protect themselves, so raising awareness is an important step in reducing people’s exposure to tobacco smoke.”

Cardiovascular disease (CVD) is the world’s leading cause of death, killing 17.3 million people every year. Eighty per cent of these deaths occur in low- and middle-income countries, which are increasingly being targeted by the tobacco industry. Tobacco use and secondhand smoke exposure causes about one-tenth of global deaths from CVD. Even smoking a few cigarettes a day significantly increases the risk of heart disease. Smokeless tobacco products have also been linked to an increased risk of heart disease and stroke. Secondhand smoke exposure increases the risk of heart disease by 25–30 per cent and more than 87 per cent of worldwide adult deaths caused by secondhand smoke are attributable to CVD.

+ Full Report (PDF)

Prevalence and co-use of marijuana among young adult cigarette smokers: An anonymous online national survey

April 23, 2012 Comments off
Source:  Addiction Science & Clinical Practice
There is elevated prevalence of marijuana use among young adults who use tobacco, but little is known about the extent of co-use generated from surveys conducted online. The purpose of the present study was to examine past-month marijuana use and the co-use of marijuana and tobacco in a convenience sample of young adult smokers with national US coverage.
Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited online between 4/1/09 and 12/31/10 to participate in an online survey on tobacco use. We examined past 30 day marijuana use, frequency of marijuana use, and proportion of days co-using tobacco and marijuana by demographic characteristics and daily smoking status.
Of 3512 eligible and valid survey responses, 1808 (51.5%) smokers completed the survey. More than half (53%, n = 960) of the sample reported past-month marijuana use and reported a median use of 18 out of the past 30 days (interquartile range [IR] = 4, 30). Co-use of tobacco and marijuana occurred on nearly half (median = 45.5%; IR = 13.1, 90.3) of the days on which either substance was used and was more frequent among Caucasians, respondents living in the Northeast or in rural areas, in nonstudents versus students, and in daily versus nondaily smokers. Residence in a state with legalized medical marijuana was unrelated to co-use or even the prevalence of marijuana use in this sample. Age and household income also were unrelated to co-use of tobacco and marijuana.
These results indicate a higher prevalence of marijuana use and co-use of tobacco in young adult smokers than is reported in nationally representative surveys. Cessation treatments for young adult smokers should consider broadening intervention targets to include marijuana.

+ Full Paper (PDF)

New From the GAO

April 18, 2012 Comments off

New GAO Reports and Testimonies
Source: Government Accountability Office

+ Reports

1. Tobacco Taxes: Large Disparities in Rates for Smoking Products Trigger Significant Market Shifts to Avoid Higher Taxes. GAO-12-475, April 18.
Highlights –
Podcast –

2. Housing Choice Vouchers: Options Exist to Increase Program Efficiencies. GAO-12-300, March 19.
Highlights –

3. Intelligent Transportation Systems: Improved DOT Collaboration and Communication Could Enhance the Use of Technology to Manage Congestion. GAO-12-308, March 19.
Highlights –
Podcast –

+ Testimonies

1.  Department of Energy:  Budget Trends and Oversight by Frank Rusco, director, before the Subcommittee on Oversight and Investigations, House Committee on Energy and Commerce.  GAO-12-659T, April 18.
Highlights –

2.  DOD Financial Management:  Challenges In Attaining Audit Readiness and Improving Business Processes and Systems by Asif Khan, director, financial management and assurance, before the Subcommittee on Readiness and Management Support, Senate Committee Armed Services.  GAO-12-642T, April 18.
Highlights –

State Cigarette Excise Taxes — United States, 2010–2011

April 8, 2012 Comments off

State Cigarette Excise Taxes — United States, 2010–2011
Source: Morbidity and Mortality Weekly Report (CDC)

Increasing the price of cigarettes reduces the demand for cigarettes, thereby reducing youth smoking initiation and cigarette consumption and decreasing the prevalence of cigarette use in the United States overall, particularly among youths and young adults (1,2). The most common way governments have increased the price of cigarettes is by increasing cigarette excise taxes (1,2), which currently are imposed by all states and the District of Columbia (1). To update data on state cigarette excise taxes in 2009 (3), CDC conducted a survey of changes in state cigarette excise taxes during 2010–2011. During that period, eight states increased their cigarette excise taxes, and one state decreased its tax; as a result, the mean state tax increased from $1.34 in 2009 to $1.46 in 2011. Previous evidence indicates that further increases in cigarette excise taxes would be expected to result in further reductions in demand for cigarettes, decreasing smoking and associated morbidity and mortality (1,2).

Smoking and Oral Health in Dentate Adults aged 18–64

February 10, 2012 Comments off

Smoking and Oral Health in Dentate Adults aged 18–64
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2008

  • Current smokers (16%) were twice as likely as former smokers (8%) and four times as likely as never smokers (4%) to have poor oral health status.
  • Current smokers (35%) were almost one and one-half times as likely as former smokers (24%) and more than two times as likely as never smokers (16%) to have had three or more oral health problems.
  • Current smokers (19%) were about twice as likely as former smokers (9%) and never smokers (10%) to have not had a dental visit in more than 5 years or have never had one.
  • Cost was the reason that most adults with an oral health problem did not see a dentist in the past 6 months; 56% of current smokers, 36% of former smokers, and 35% of never smokers could not afford treatment or did not have insurance.

There is a vast body of literature documenting the adverse effects of cigarette smoking on health (1–5). In 2000 the Surgeon General’s report on oral health noted that lifestyle behaviors such as smoking affect oral health as well as general health. It also emphasized the importance of oral health to overall health (6). This report examines differences among current smokers, former smokers, and never smokers in terms of oral health status, number of oral health problems, and the utilization of dental services. The study is limited to dentate adults aged 18–64.

Quitting Smoking Among Adults — United States, 2001–2010

January 13, 2012 Comments off

Quitting Smoking Among Adults — United States, 2001–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Quitting smoking is beneficial to health at any age, and cigarette smokers who quit before age 35 years have mortality rates similar to those who never smoked (1,2). From 1965 to 2010, the prevalence of cigarette smoking among adults in the United States decreased from 42.4% to 19.3%, in part because of an increase in the number who quit smoking (3). Since 2002, the number of former U.S. smokers has exceeded the number of current smokers (4). Mass media campaigns, increases in the prices of tobacco products, and smoke-free policies have been shown to increase smoking cessation (5,6). In addition, brief cessation advice by health-care providers; individual, group, and telephone counseling; and cessation medications are effective cessation treatments (5). To determine the prevalence of 1) current interest in quitting smoking, 2) successful recent smoking cessation, 3) recent use of cessation treatments, and 4) trends in quit attempts over a 10-year period, CDC analyzed data from the 2001–2010 National Health Interview Surveys (NHIS). This report summarizes the results of that analysis, which found that, in 2010, 68.8% of adult smokers wanted to stop smoking, 52.4% had made a quit attempt in the past year, 6.2% had recently quit, 48.3% had been advised by a health professional to quit, and 31.7% had used counseling and/or medications when they tried to quit. The prevalence of quit attempts increased during 2001–2010 among smokers aged 25–64 years, but not among other age groups. Health-care providers should identify smokers and offer them brief cessation advice at each visit; counseling and medication should be offered to patients willing to make a quit attempt.

The Toxic Effects of Cigarette Additives. Philip Morris’ Project Mix Reconsidered: An Analysis of Documents Released through Litigation

December 23, 2011 Comments off
Source: PLoS Medicine

In 2009, the promulgation of US Food and Drug Administration (FDA) tobacco regulation focused attention on cigarette flavor additives. The tobacco industry had prepared for this eventuality by initiating a research program focusing on additive toxicity. The objective of this study was to analyze Philip Morris’ Project MIX as a case study of tobacco industry scientific research being positioned strategically to prevent anticipated tobacco control regulations.
Methods and Findings
We analyzed previously secret tobacco industry documents to identify internal strategies for research on cigarette additives and reanalyzed tobacco industry peer-reviewed published results of this research. We focused on the key group of studies conducted by Phillip Morris in a coordinated effort known as “Project MIX.” Documents showed that Project MIX subsumed the study of various combinations of 333 cigarette additives. In addition to multiple internal reports, this work also led to four peer-reviewed publications (published in 2001). These papers concluded that there was no evidence of substantial toxicity attributable to the cigarette additives studied. Internal documents revealed post hoc changes in analytical protocols after initial statistical findings indicated an additive-associated increase in cigarette toxicity as well as increased total particulate matter (TPM) concentrations in additive-modified cigarette smoke. By expressing the data adjusted by TPM concentration, the published papers obscured this underlying toxicity and particulate increase. The animal toxicology results were based on a small number of rats in each experiment, raising the possibility that the failure to detect statistically significant changes in the end points was due to underpowering the experiments rather than lack of a real effect.
The case study of Project MIX shows tobacco industry scientific research on the use of cigarette additives cannot be taken at face value. The results demonstrate that toxins in cigarette smoke increase substantially when additives are put in cigarettes, including the level of TPM. In particular, regulatory authorities, including the FDA and similar agencies elsewhere, could use the Project MIX data to eliminate the use of these 333 additives (including menthol) from cigarettes.

See: New analysis casts doubt on results of tobacco industry studies into safety of cigarette additives (EurekAlert!)

Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows

December 15, 2011 Comments off

Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows (PDF)
Source: Monitoring the Future Study (University of Michigan)

Among the more important findings from this year’s Monitoring the Future survey of U.S. secondary school students are the following:

  • Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors.
  • “Synthetic marijuana,” which until earlier this year was legally sold and goes by such names as “K2” and “spice,” was added to the study’s coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months.
  • Alcohol use—and, importantly, occasions of heavy drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011.
  • Energy drinks are being consumed by about one third of teens, with use highest among younger teens.

+ Data tables and figures

United Health Foundation’s America’s Health Rankings® Finds Preventable Chronic Disease on the Rise; Obesity, Diabetes Undermining Country’s Overall Health

December 12, 2011 Comments off

United Health Foundation’s America’s Health Rankings® Finds Preventable Chronic Disease on the Rise; Obesity, Diabetes Undermining Country’s Overall Health</strong>
Source: United Health Foundation

United Health Foundation’s 2011 America’s Heath Rankings® finds that troubling increases in obesity, diabetes and children in poverty are offsetting improvements in smoking cessation, preventable hospitalizations and cardiovascular deaths. The report finds that the country’s overall health did not improve between 2010 and 2011 – a drop from the 0.5 percent average annual rate of improvement between 2000 and 2010 and the 1.6 percent average annual rate of improvement seen in the 1990s.

For the fifth year in a row, Vermont is the nation’s healthiest state. States that showed the most substantial improvement include New York and New Jersey, both moving up six places, largely because of improvements made in smoking cessation. Idaho and Alaska showed the most downward movement. Idaho dropped 10 spots, from number nine to 19 in this year’s Rankings, and Alaska dropped five places.

+ Full Rankings

The future of death in America

December 7, 2011 Comments off

The future of death in America
Source: Demographic Research

Population mortality forecasts are widely used for allocating public health expenditures, setting research priorities, and evaluating the viability of public pensions, private pensions, and health care financing systems. Although we know a great deal about patterns in and causes of mortality, most forecasts are still based on simple linear extrapolations that ignore covariates and other prior information. We adapt a Bayesian hierarchical forecasting model capable of including more known health and demographic information than has previously been possible. This leads to the first age- and sex-specific forecasts of American mortality that simultaneously incorporate, in a formal statistical model, the effects of the recent rapid increase in obesity, the steady decline in tobacco consumption, and the well known patterns of smooth mortality age profiles and time trends. Formally including new information in forecasts can matter a great deal. For example, we estimate an increase in male life expectancy at birth from 76.2 years in 2010 to 79.9 years in 2030, which is 1.8 years greater than the U.S. Social Security Administration projection and 1.5 years more than U.S. Census projection. For females, we estimate more modest gains in life expectancy at birth over the next twenty years from 80.5 years to 81.9 years, which is virtually identical to the Social Security Administration projection and 2.0 years less than U.S. Census projections. We show that these patterns are also likely to greatly affect the aging American population structure. We offer an easy-to-use approach so that researchers can include other sources of information and potentially improve on our forecasts too.

+ Full Paper (PDF)

Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study

November 9, 2011 Comments off

Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study
Source: BMC Public Health


Cigarette smoking is a tough addiction to break. Therefore, improved approaches to smoking cessation are necessary. The electronic-cigarette (e-Cigarette), a battery-powered electronic nicotine delivery device (ENDD) resembling a cigarette, may help smokers to remain abstinent during their quit attempt or to reduce cigarette consumption. Efficacy and safety of these devices in long-term smoking cessation and/or smoking reduction studies have never been investigated.


In this prospective proof-of-concept study we monitored possible modifications in smoking habits of 40 regular smokers (unwilling to quit) experimenting the ‘Categoria’ e-Cigarette with a focus on smoking reduction and smoking abstinence. Study participants were invited to attend a total of five study visits: at baseline, week-4, week-8, week-12 and week-24. Product use, number of cigarettes smoked, and exhaled carbon monoxide (eCO) levels were measured at each visit. Smoking reduction and abstinence rates were calculated. Adverse events and product preferences were also reviewed.


Sustained 50% reduction in the number of cig/day at week-24 was shown in 13/40(32.5%) participants; their median of 25 cigs/day decreasing to 6 cigs/day (p < 0.001). Sustained 80% reduction was shown in 5/40(12.5%) participants; their median of 30 cigs/day decreasing to 3 cigs/day (p = 0.043). Sustained smoking abstinence at week-24 was observed in 9/40(22.5%) participants, with 6/9 still using the e-Cigarette by the end of the study. Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day. Mouth (20.6%) and throat (32.4%) irritation, and dry cough (32.4%) were common, but diminished substantially by week-24. Overall, 2 to 3 cartridges/day were used throughout the study. Participants’ perception and acceptance of the product was good.


The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit ( webcite number NCT01195597).


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