Smoking May Be Discouraged By Population-Specific Community-Based Cancer Screening

Main Category: Smoking / Quit Smoking
Also Included In: Cancer / Oncology
Article Date: 17 Nov 2011 - 1:00 PST

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Large, population specific community-based screening may increase awareness of the dangers of smoking and reduce at-risk behaviors, according to a new study in the November 2011 issue of Otolaryngology-Head and Neck Surgery.

While the World Health Organizations estimates that 60 to 80% of head and neck cancers could be curbed by changing at-risk behaviors, such as tobacco use, our national programs to date have had little impact reducing these mortalities. To change this statistic and control costs, the June 2011 Affordable Care Act, (PL 111 - 148) mandated development of effective and achievable means for improvement in the U.S. health status. Contributing to the effort, The Centers for Disease Control and Prevention support community-based programs that pair the offering of healthcare such as tobacco control interventions with education. This study's authors, understanding that office-based screening programs may not benefit those at risk who do not receive routine healthcare, set out to determine if participation in community-based screenings could result in a reduction in tobacco use and if different factors in participants predict behavior change.

To target the study population, NASCAR fans at the Atlanta Motor Speedway, who fit the demographic identified by Institute of Medicine of the National Academy as most at risk, were recruited. These were screened for symptoms indicative of head and neck cancer, such as lumps or sores in the mouth. Of the 578 participants who received a full screening, 31% were further identified as smokers. During the screening, physicians discussed signs and symptoms of head and neck cancer, the risks of tobacco use, and tobacco cessation with all participants.

A telephone survey of study participants was conducted six months later. Of those reached for survey who had identified as smokers at the screening, 59% reported smoking fewer cigarettes per day than six months prior, and 15% reported quitting smoking entirely. Based on this evidence, the authors suggest that "the screening may have impacted tobacco cessation."

While the study's authors acknowledge that more research is needed, they state that community-based screening is likely useful, as it provides another source of tobacco-use education for an at-risk population. They write: "More must be done at national, state, and community level to support tobacco cessation in venues outside those funded government programs that historically have had little impact on tobacco use and head and neck cancer mortality. Physicians and healthcare workers must take the lead in developing creative avenues to teach their patients about tobacco cessation and its link to cancer and other diseases."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our smoking / quit smoking section for the latest news on this subject. Otolaryngology-Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF). The study's authors are Edie R. Hapner, PhD, CCC-SP; Kellie L. Bauer, Med, CCC-SLP; and Justin C. Wise, PhD
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American Academy of Otolaryngology - Head and Neck. "Smoking May Be Discouraged By Population-Specific Community-Based Cancer Screening." Medical News Today. MediLexicon, Intl., 17 Nov. 2011. Web.
8 Dec. 2011. APA

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Whilst Teen Binge Drinking, Driving After Cannabis Use Remain Concerns, Youth Smoking Is At All-Time Low

Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Pediatrics / Children's Health;  Smoking / Quit Smoking
Article Date: 30 Nov 2011 - 2:00 PST

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Survey of teens in Ontario, Canada, shows latest trends in drug use

Fewer Ontario teens are smoking cigarettes than ever before -- good news that is tempered by continuing concerns around binge drinking, and driving while under the influence of cannabis, according to the 2011 Ontario Student Drug Use and Health Survey released today by the Centre for Addiction and Mental Health (CAMH). The survey, which included 9,288 students across Ontario in grades 7 to 12, is the longest running student survey in Canada.

"We were pleasantly surprised to find that students' use of most of the substances tracked by this survey declined during the past decade, even for those substances that historically have been used at high rates," said Dr. Robert Mann, CAMH senior scientist and principal investigator on the survey. "Most notably, the proportion of students who smoke cigarettes dropped from 12 per cent in the previous 2009 survey to 9 per cent, an all-time low since 1977. Also, the proportion using cannabis dropped from 26 per cent to 22 per cent. However, pockets of real concern remain. For instance, one in eight students (13 per cent) reported symptoms of a drug use problem, and among those who drink, a third reported drinking hazardously or harmfully as measured by a validated screening instrument." One in six students (16 per cent) reported being drunk or high at school a least once in the past year.

Drinking

The survey found alcohol was the substance used by the largest number of students, as 55 per cent of respondents reported drinking alcohol in the past year. While binge drinking rates have dropped from 28 per cent, seen a decade ago, to 22 per cent, this still represents 223,500 high school students in Ontario who are drinking five or more drinks on one occasion at least once a month. Five per cent reported binge drinking four or more times in the past month. "An important concern is that about one in 10 (9 per cent) students report harmful drinking patterns in conjunction with elevated psychological distress," Dr. Mann said.

Alcohol is the major contributor to injuries, trauma and death of young people through drinking and driving and other high risk behaviours. An estimated 175,600 students (18 per cent) reported hazardous or harmful drinking behaviours, and one in 10 students reported injuring themselves or someone else as a result of their drinking. These behaviours were highest amongst students in grades 11 and 12, with boys and girls equally likely to engage in dangerous drinking patterns.

Alcohol, drug use and driving

Seven per cent of adolescent drivers reported driving within an hour of consuming two or more drinks containing alcohol, representing an estimated 21,500 students. One in four students (24 per cent) reported getting into a car with a driver who had been drinking.

"Drinking and driving has dropped by five percentage points since the last survey. The drop has been even more significant since the late 1970s and early 1980s, when it peaked at 46 per cent," said Dr. Mann. "This substantial drop over the long-term shows that attitudes toward alcohol use and driving have changed."

For the first time, students were also asked whether they had ever operated a snowmobile, boat, Sea-Doo or all terrain vehicle after drinking alcohol, with seven per cent reporting that they had done so at least once in the past year.

Vehicles and drug use other than alcohol is another concern. Students were more likely to drive after consuming cannabis than alcohol. Twelve per cent of adolescent drivers reported driving within an hour of using cannabis and 16 per cent of students reported being a passenger in the car of someone who had been using drugs.

Regional differences

Students in Toronto were below the provincial average in the use of alcohol, cannabis, cocaine and in binge drinking behaviours. Students in the North were above the provincial average for those same substances. Students surveyed in the East showed no significant difference from the provincial average in the use of any substance.

Other highlights In Ontario, 8,900 students reported that they have been in a treatment program in the past year because of their or alcohol use. Measured for the first time this year, high-caffeine energy drinks were the second-most commonly consumed substance, with 50 per cent of youth using them. Use of opioid pain relievers has dropped to 14 per cent from 17.8 per cent in 2009. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Centre for Addiction and Mental Health. "Whilst Teen Binge Drinking, Driving After Cannabis Use Remain Concerns, Youth Smoking Is At All-Time Low." Medical News Today. MediLexicon, Intl., 30 Nov. 2011. Web.
8 Dec. 2011. APA
Centre for Addiction and Mental Health. (2011, November 30). "Whilst Teen Binge Drinking, Driving After Cannabis Use Remain Concerns, Youth Smoking Is At All-Time Low." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/238423.php.

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Quit Smoking Interventions Work For Some Smokers

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Main Category: Smoking / Quit Smoking
Article Date: 28 Nov 2011 - 15:00 PST

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The use of smoking cessation intervention programs and nicotine replacement therapy can be effective for some current smokers, researchers from the Medical University of South Carolina, Charleston, and the University of Minnesota, Minneapolis reported in two separate articles in Archives of Internal Medicine.

As background information to the first article, the authors wrote:

"Despite advances in clinical care and policy, rates of smoking cessation have held constant in the past decade, indicating a need for novel approaches."

Matthew J. Carpenter, Ph.D. and team carried out a randomized nationwide human study to see how effective smoking cessation interventions might be for current smokers who were not motivated to give up.

849 regular smokers who were not motivated to quit were randomly selected into two groups: PQA (practice quit attempt) only group - the aim here is to raise motivation, coping skills and confidencePQA + NT (nicotine replacement therapy) group - same as the group above, but with nicotine lozenges added to improve attitudes toward pharmacotherapy and promote the usage of extra cessation resources82% of those in the PQA+NT group and 85% in the PQA only group took part in at least one PQA.

Four weeks after treatment had ended: 22% of those in the PQA+NT group had made a 24-hour quit attempt13% of those in the PQA only group made a 24-hour quit attemptTwelve weeks after treatment had ended: 32% of those in the PQA+NT group had made a 24-hour quit attempt23% of those in the PQA only group made a 24-hour quit attemptAt final follow-up: 49% of those in the PQA+NT group had made some kind of attempt to quit40% of those in the PQA only group had made some kind of attempt to quit43% of those in the PQA+NT group had made a 24-hour quit attempt34% of those in the PQA only group made a 24-hour quit attemptThe researchers concluded:

"In summary, providing brief NT sampling to smokers who do not want to quit, when used within a behavioral exercise of a PQA, is efficacious to motivate unmotivated smokers toward quitting. Considering the stagnant incidence of quit attempts in the past decade, this novel and easy-to-use cessation induction strategy holds promise for translation to primary care settings."

Anne M. Joseph, M.D. and team set out to determine what impact a 12-month long telephone-based chronic disease management intevention can have on tobacco dependence compared to 8-week long evidence based treatment.

They carried out a randomized, controlled trial with 443 participants, all of them regular smokers at the time. Each participant was called by telephone five times for counseling; they also received nicotine replacement therapy (NRT) by post for four weeks. They were then split up into two groups: UC (usual care) group - they received no additional phone callsLC (longitudinal care) group - they received counseling and NRT for another 48 weeksAt 18 months, 30.2% of those in the LC group had not smoked for six months, compared to 23.5% in the UC group. Further analysis revealed that in the LC group, quit attempts during the previous 12 months, how many cigarettes they smoked per day at the start of the study, and cigarettes smoked in the past week were closely linked to prolonged abstinence at 18 months. The median percentage of days with no cigarettes was 57.1 in the LC group compared to 30.1 in the UC group.

Considerably more attempts at giving up smoking were made by those in the LC group than in the UC group.

Among those who continued smoking, cutting down on cigarettes was more prevalent in the LC group than the UC group - however, the difference was only statistically relevant at 12 months.

The authors concluded:

"This randomized controlled trial shows that a smoking intervention based on chronic disease management principles of care - targeting the goal of quitting smoking but incorporating failures, setting interim goals and continuing care until the desired outcome is achieved - is approximately 75 percent more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation."

First research letter - Yin Cao, M.P.H., from the Harvard School of Public Health in Boston and team set out to find out what the relationship might be between time since quitting plus age when quitting with total cause-specific mortality among US male doctors.

They gathered data on 19,705 male doctors from the Physicians' Health Study. 6.7% of them were smoking at the time of the study while 41.7% used to smoke. During the 386,772 person-years of follow up 5,594 of the doctors died.

Crude mortality rates were: 11.5% for lifetime non-smokers16.6% for ex-smokers26.1% for current smokers13.7% of current smokers who died were younger than 65 years of age, compared to 8.3% of lifetime non-smokers.

Ex-smokers had a considerably lower risk of death within ten years of giving up, compared to current smokers; this risk was further reduced after another ten years.

Even though the heavy regular smokers had the highest chances of dying compared to ex-smokers and light smokers, that risk goes down 44% within ten years of giving up.

Second research letter - G. David Batty, Ph.D., of University College London, England, and team followed up on the Whitehall Smoking Cessation Survey thirty years later. This was a study of male civil servants in London. They wrote to surviving participants with a questionnaire which asked them about their current smoking status as well as their health, in order to determine what long-term impact the smoking cessation intervention had.

1,445 males were randomly selected into two groups: Intervention group - a 15-minute session with one member of the study's clinical staff, smoking risks were explained comprehensively. A week later there was another session, during which a smoking record card was given. This card had to be completed daily for three weeks. Further sessions occurred at ten weeks and then again at six months.Normal care group - no smoking cessation intervention was given.After one year, 39% of those in the intervention group said they were not smoking any more, compared to just 9% in the normal care group. After six months, the figures were 36% and 14% respectively.

The follow up after thirty years showed that 81% of the survivors in the intervention group were not smoking, compared to 79% in the normal care group. The authors also reported a slightly lower chance of dying in the intervention group than in the normal care group - just a 0.4 life year difference.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our smoking / quit smoking section for the latest news on this subject. Arch Intern Med. 2011;171[21]:1901-1907; 171[21]:1894-1900; 171[21]:1956-1958; 171[21]:1950-1951. Please use one of the following formats to cite this article in your essay, paper or report:

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Christian Nordqvist. "Quit Smoking Interventions Work For Some Smokers." Medical News Today. MediLexicon, Intl., 28 Nov. 2011. Web.
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posted by Joseph E de Borja on 28 Nov 2011 at 4:50 pm

Based on my personal experience, I have tried to quit smoking for eight years until I had lung cancer. At that point in time, I had a strong desire that if I quit smoking, my body may regenerate to fight the disease. To my amazement, the moment I crumpled the pack of cigarettes I had, the cravings to smoke disappeared as though I have not smoked before. After my surgery 28 years ago, I figured that the reason I could not stop smoking is that I still do not really like to quit smoking because of the pleasure I derived from it. You just have to have a genuine desire to quit to rid yourself of this nasty habit. JUST QUIT and save yourself the money to cover quitting for after all that is what you intend to do.

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Targeted Financial Incentives For Patients Can Lead To Health Behavior Change

Main Category: Preventive Medicine
Also Included In: Obesity / Weight Loss / Fitness;  Smoking / Quit Smoking;  Public Health
Article Date: 23 Nov 2011 - 0:00 PST

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Financial incentives work for doctors. Could they work for patients, too? Could they encourage them to change unhealthy behaviors and use preventive health services more? In some cases, yes, according to Dr. Marita Lynagh from the University of Newcastle in Australia, and colleagues. Their work, looking at why financial incentives for patients could be a good thing to change risky health behaviors, indicates that incentives are likely to be particularly effective at altering 'simple' behaviors e.g. take-up of immunizations, primarily among socially disadvantaged groups. Their article is published online in Springer's International Journal of Behavioral Medicine.

Following the proliferation of pay-for-performance programs for health care providers, the application of the same principles for individual behavior change is becoming an attractive option. But is it fair and does it work? To answer these questions, Lynagh and colleagues reviewed recent research looking at the effectiveness of personal financial incentives aiming to change health behavior, principally in the fields of smoking cessation and weight loss.

They found that the effectiveness of incentives depends on the types of behaviors targeted. Incentives appear to be most effective at altering behaviors which are simple, discrete and time-limited such as take up of immunization and attendance at health and education services, and less effective for complex and entrenched behaviors such as smoking, diet and exercise. However, in the case of these more complex behaviors, supporting the financial incentive with social support and skill training significantly increases the likelihood of success.

Financial incentives are also more likely to work with socially disadvantaged groups, particularly when the incentives address real barriers to change such as transport, medication and child-care costs. However, there is currently little evidence for long-term behavior change with one-time incentives. Regular reinforcement with a measured schedule of incentives (i.e. escalating size of incentive with frequent monitoring and rewards) is more effective at both initiating and maintaining behavior change. This especially applies in the case of more complex behaviors like drug treatment and smoking cessation, where long-term change is the real challenge.

The authors conclude: "We need effective public health interventions that clinicians can adopt easily to encourage people to change their health behaviors, to produce improved health outcomes for populations and a reduced burden on health care systems. Financial incentives are not the panacea to all health risk behaviors, but do hold promise for encouraging certain population groups to modify particular health behaviors."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our preventive medicine section for the latest news on this subject. Lynagh MC (2011). What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change. International Journal of Behavioral Medicine. DOI 10.1007/s12529-011-9202-5
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Economic Savings With Tobacco Control Programs

Main Category: Smoking / Quit Smoking
Also Included In: Public Health;  Medicare / Medicaid / SCHIP
Article Date: 29 Nov 2011 - 0:00 PST

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States that have shifted funds away from tobacco control programs may be missing out on significant savings, according to a new study co-authored by San Francisco State University economist Sudip Chattopadhyay.

If these programs were funded at the levels recommended by the Centers for Disease Control and Prevention (CDC), states could save an astonishing 14-20 times more than the cost of implementing the programs. The costs of smoking are felt by the states, mostly through medical costs, Medicaid payments and lost productivity by workers.

The evidence is clear that state tobacco control programs have a "sustained and steadily increasing long-run impact" on the demand for cigarettes, Chattopadhyay and his colleague David R. Pieper at University of California, Berkeley write in a paper published online today in the journal Contemporary Economic Policy. Chattopadhyay is the chair of the Economics Department and professor of economics.

The study uses data from 1991 to 2007, during which time the states paid for the programs with the help of the tobacco tax, public and private initiatives and funds from the Tobacco Master Settlement Agreement between the nation's four largest tobacco companies and 46 states.

Unfortunately, says Chattopadhyay, funding for the programs has been declining steadily since about 2002. In 2010, states on average were spending 17 percent of the total investment recommended by the CDC for the programs. And in tough economic times, many states have turned to cigarette taxes to raise revenue.

Chattopadhyay said the shift in spending priorities was part of his motivation for examining the benefits and costs behind the programs. "Almost all states are facing financial crisis, and they are really diverting their funds, possibly moving funds from productive use."

Unless the benefits of fully funding the programs are shown to outweigh the costs, the researchers suggest, states may continue to divert revenue away from the programs.

After accounting for multiple factors, the researchers determined that tobacco control programs do reduce the demand for cigarettes. It's a trend that grows over time, in part because it takes smokers time to quit and because the programs become more efficient at delivering their services.

Unlike earlier studies, Chattopadhyay and Pieper even examined the effects of different state tobacco taxes, and how the differences might affect cigarette demand. Smokers in a state with a high tobacco tax could be more easily tempted to buy cigarettes if they share a border with a low-tax state, for instance. Tobacco taxes can range from less than 20 cents per pack in some states to nearly $5 in others.

In 2007, the CDC revised its recommendations on how much states should spend on tobacco control programs to make them successful. If individual states would follow the new CDC guidelines, they could realize future savings of 14-20 times what the programs cost, the study concluded. Chattopadhyay said he would like to deliver the results of the study to the states, "to convince them that they can use that money for more productive purposes" and to encourage them not to let their past investments in tobacco control programs go to waste.

"They would save money in terms of reduced Medicaid, and reduced medical and productivity costs," he said. "Those kinds of costs are only going to go up."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our smoking / quit smoking section for the latest news on this subject. "Does spending more on tobacco control programs make economic sense? An incremental benefit-cost analysis using panel data" was published online Nov. 28 in the journal Contemporary Economic Policy.
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Some Older Adults May Turn To Alcohol, Smoking When Under Financial Strain

Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Smoking / Quit Smoking;  Anxiety / Stress;  Seniors / Aging
Article Date: 11 Nov 2011 - 0:00 PST

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During financial hard times, some older adults may turn to alcohol or cigarettes as a way to cope, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs.

The study, of more than 2,300 older Americans, found that some -- particularly men and people with less education -- were at risk of boosting their drinking if their finances took a hit.

The same correlation was seen when it came to smoking, especially among relatively younger study participants (those who were age 65 at the study's start).

The findings do not prove that financial strain, per se, was the reason for the changed drinking and smoking habits. But it is known that some people use alcohol and cigarettes as a way of coping with stress, says lead researcher Benjamin A. Shaw, Ph.D., of the State University of New York at Albany.

"When you have a stressor that's not very controllable, people may focus on something to help control their emotional response to the stressor," Shaw says.

And financial woes may be particularly stressful for older adults, he notes.

"They are out of the workforce, and they might feel like they have less time to recover or generally have less control over their financial situation," Shaw says.

The older adults in the study were surveyed periodically between 1992 and 2006, when the world was in stronger financial shape than it is now. The ongoing financial crisis, coupled with the aging population, means that the number of older adults facing money problems will probably only grow, Shaw's team says.

Overall, 16% of study participants reported increasing financial strain over the study period. Three percent reported increases in heavy drinking (more than 30 drinks a month), and 1% said they'd started smoking more.

Those odds were higher among older men who were under growing financial strain: they were 30% more likely to take up heavy drinking than men who'd remained financially stable.

The findings were similar when the researchers compared older adults with low education levels (less than high school) with their more-educated counterparts.

In contrast, older women tended to cut down on drinking when they hit financial hard times -- as did those with higher education levels.

The reasons for those differences are not clear. But Shaw speculates that older men may tend to have a harder time facing financial woes -- because they are used to being the "breadwinner," for example, or because they tend to have less social support than women do.

It's also possible that for older generations, drinking and smoking are considered less appropriate responses to stress for women.

The bottom line, according to Shaw, is that people should be aware that some older adults may respond to financial problems by turning to alcohol or smoking. Older people do often keep money difficulties to themselves, he notes; but if family members know that an older relative is in financial trouble, they can be on the lookout for possible problem drinking or increases in smoking.

In addition, Shaw says, human service agencies, and even local health departments, could play a role by setting up programs to help older adults find better ways to deal with the stress that originates from experiencing financial difficulties.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alcohol / addiction / illegal drugs section for the latest news on this subject. Shaw, B. A., Agahi, N. & Krause, N. (November 2011). Are changes in financial strain associated with changes in alcohol use and smoking among older adults? Journal of Studies on Alcohol and Drugs, 72(6), 917-925.
Available at: http://www.jsad.com/jsad/link/72/917
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Australia Passes Law Bringing In Plain Packaging For Cigarettes

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Main Category: Smoking / Quit Smoking
Also Included In: Regulatory Affairs / Drug Approvals;  Public Health
Article Date: 10 Nov 2011 - 9:00 PST

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The Australian Senate, the upper house of parliament, voted on Thursday in favour of new legislation that from December 2012 will force tobacco companies to package their cigarettes in plain olive green, with no branding. The packaging will continue to display, as it does now, graphic pictures and warnings of the harmful effects of cigarette smoking.

This is nearly the last stage of legislation whose progress has been closely watched by New Zealand, Canada and some European countries, who are considering similar steps.

The bill is expected to be rubber stamped by the lower house in the next two weeks before its final stage of Royal Asssent.

Earlier in the day, British American Tobacco Australia (BATA), who own nearly half of the market in Australia, confirmed that if the Senate were to pass the bill they would start proceedings against Australia's Federal Government in the High Court, immediately after the bill gained Royal Assent.

Britain's Imperial Tobacco and Philip Morris in Australia have also threatened legal action. The industry says it will also pursue compensation.

The industry's argument includes the claim that plain packaging takes away a tobacco company's right to compete, that there is no evidence it improves public health, and it will promote the sale of illegal tobacco by making it easier to copy the packaging.

Some tobacco producing and exporting countries have also threatend to take Australia to the World Trade Organization.

Health Minister Nicola Roxon told reporters in Melbourne that "big tobacco has been fuming since day one" and the government will not allow itself to be bullied by them. She said "we hope that they don't" go ahead with legal action, but "we're ready for that". She said the industry would do better by communities if they invested in something that was not so harmful.

In 2005, on releasing figures that showed there were more than 1 billion regular smokers around the globe, with 4 out of every 5 being in poorer nations, the World Health Organization urged countries to adopt plain packaging.

Ten years ago, 23% of Australian adults were smokers: now that figure has dropped to 15%. The government wants to reduce this to 10% b 2018.

Written by Catharine Paddock PhD
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Visit our smoking / quit smoking section for the latest news on this subject. Sources: "New Australia smoking law bans brand labels", Reuters Thu 10 Nov 2011; "New laws take away glamour from smoking" AAP in The Australian, 10 Nov 2011; British American Tobacco Australia press release 10 Nov 2011; "Australia passes plain-packaging cigarette law", The Guardian, Thu 10 November 2011.
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Catharine Paddock PhD. "Australia Passes Law Bringing In Plain Packaging For Cigarettes." Medical News Today. MediLexicon, Intl., 10 Nov. 2011. Web.
8 Dec. 2011. APA

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