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Menthol Perils: ‘Health Enemy #1 For African-Americans’

By Karen Weintraub
Guest Contributor

The FDA this week issued a “preliminary” report after more than two years of study, concluding that menthol isn’t inherently dangerous in cigarettes, but that by masking the harsh flavor, it induces more people to start smoking and makes it harder for them to stop. The report was seen as a step toward an eventual ban on menthol in cigarettes – the one flavoring not already prohibited by federal law.

Now, public health experts say, it’s time to take menthol out of cigarettes.

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“It makes smoking a blowtorch taste like rice pudding,” says Harvard School of Public Health Professor Gregory Connolly, director of the school’s Center for Global Tobacco Control. “And unfortunately, what’s in that rice pudding is very heavy toxins that go right to the lungs and you wind up with lung cancer, heart disease, stroke, emphysema, and so forth.”

Connolly, and several other local public health experts, says there’s no scientific doubt that menthol in cigarettes is a problem. And it’s one that disproportionately harms African-Americans and young people – who have a marked preference for menthol.

“If you ask me what is Public Health Enemy #1 for the African-American community in terms cancer: it’s Newport cigarettes – the menthol in cigarettes,” Connolly says. Continue reading

Mass. Blocks Higher Insurance Charges For Most Smokers

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.

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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.

The federal Affordable Care Act says insurers can 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 to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

Continue reading

Health Of The Nation: Obesity Up, But ‘Notable’ Decline In Physical Inactivity

In our house, when there’s good news and bad news, we usually start with the good. So here goes:

According to a new national health statistics report out today analyzing five key health behaviors among U.S. adults — sufficient sleep, smoking, drinking, obesity, and physical activity — there are several bright spots. For instance, the survey found that fewer young people (18-24) are smoking and the number of adults who report they’re completely aerobically inactive showed ‘notable’ declines in recent years, from 39.7% inactive between 2005-2007 to 33.9% in the years 2008-2010.

O.K., now the bad news: Heavy drinking has increased, except among the senior set over 75, smoking prevalence remains virtually unchanged (beyond the youngsters) and obesity is up.

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My first reaction is: Huh? Is anyone out there listening to Michelle Obama and all those other Get-Out-There-And-Move and Cut-The-Sugar advocates?

But then I talked to Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine and an assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, who insisted on highlighting the positive.

A little background: Dr. Phillips’ focus is on physical activity, the link between health and exercise and on educating physicians about how to more seamlessly incorporate physical activity into the practice of medicine.

His takeaway from the CDC report is this: “People are starting to move.” Continue reading

Northeastern U. Goes Smoke-Free — Inside And Out

WBUR’s Martha Bebinger reports that starting this fall, Northeastern University will join a growing number of college campuses that are smoke-free, both inside and out.

Northeastern Dean of Health Sciences Terry Fulmer says going smoke-free will save student’s lives.

“If you smoke when you’re younger, you’re more likely to be addicted for life,” Fulmer said. “So now is our opportunity to help them not get in a habit that will potentially be fatal.”

Northeastern will use peer pressure and a campus education campaign — as opposed to penalties — to enforce the new policy. There’s a free smoking cessation program for students and most faculty and staff can enroll through their insurance plan. Dean Fulmer says she does expect the ban on smoking to affect admissions.

(A partial list of Mass. colleges with some type of smoking ban. Source:  The Association of Independent Colleges and Universities of Massachusetts)

(A partial list of Mass. colleges with some type of smoking ban. Source: The Association of Independent Colleges and Universities of Massachusetts)

Here’s more on new smoke-free policy from Northeastern:

The deci­sion to go smoke-​​free dove­tails with Northeastern’s focus on solving global chal­lenges in health. According to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, some 443,000 people die each year from smoking or expo­sure to second-​​hand smoke. What’s more, tobacco use is the single most pre­ventable cause of dis­ease, dis­ability, and death in the United States. Continue reading

When Businesses Refuse To Hire Smokers

A number of employers, both health-related and not, have established policies of not hiring smokers, The New England Journal of Medicine reports today as part of a larger look at the ethics of such controversial measures. These businesses, including the Cleveland Clinic, Geisinger, Baylor and the University of Pennsylvania Health System and the Union Pacific Railroad and Alaska Airlines, have various rationales for their decision to exclude tobacco users. And in an NEJM perspective piece, authors David A. Asch, M.D., M.B.A., Ralph W. Muller, M.A., and Kevin G. Volpp, M.D., Ph.D., all of Philadelphia, lay out several reasons why these policies are taking hold:

Tobacco use is responsible for approximately 440,000 deaths in the United States each year — about one death out of every five. This number is more than the annual number of deaths caused by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined1 and more than the number of American servicemen who died during World War II.

smokerA small but increasing number of employers…have established policies of no longer hiring tobacco users. These employers might justify such hiring policies in many ways — arguing, for instance, that they’re taking a stand against a habit that causes death and disability, that they’re sending an important message to young people and others within their communities about the harms of smoking, or that they’re reducing their future costs, given that smokers, on average, cost employers several thousand dollars more each year than nonsmokers in health care expenses and lost productivity.

But in a companion piece, doctor and health policy expert Ezekiel Emanuel and others write that it’s “paradoxical,” and even wrong to single out smokers by refusing them employment: Continue reading

Why Are There So Many Smokers Among The Mentally Ill?

For years, I’ve been practicing yoga at a studio situated right next to a rehab program for adults with psychiatric illnesses. The harsh irony of so many perky, hard-bodied, coconut-water chugging yogis rushing to their “hour of power” class past the chain-smoking, disheveled mentally ill men and women killing time outside the rehab center always makes me feel sad about the injustices of life. I think about the fact that people with a severe mental illness tend to die, on average, up to 25 years earlier than those in the general population, partly due to smoking-related health problems like lung or heart disease. Sometimes I just want to scream: “Stop smoking and do some yoga!” But of course, things aren’t that simple, and I never say a thing.

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. ZImmerman)

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. Zimmerman)

Today, I went to yoga with Pam Belluck’s excellent The New York Times piece on my mind. The story, about a Louisiana psychiatric hospital considering banning smoking, followed a related story yesterday on new findings that people with mental illness are 70 percent more likely to smoke cigarettes than those without such illnesses.

As I walked to my car after class, I asked a gentleman loitering outside the rehab place how long he’s been smoking. “Forever,” he said, “since birth.” An administrator inside the facility, who didn’t want to be identified, told me “everyone here smokes.” Then, he reconsidered. “Well, almost everybody.”

Indeed the new CDC report paints a grim picture:

Nationally, nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness, and 36% of these people smoke cigarettes. In comparison, 21% of adults without mental illness smoke cigarettes. (Mental illness is defined here as diagnosable mental, behavioral, or emotional conditions and does not include substance abuse.)

There are other troubling statistics from the report:
–31% of all cigarettes are smoked by adults with mental illness.
–40% of men and 34% of women with mental illness smoke.
–48% of people with mental illness who live below the poverty level smoke, compared with 33% of those with mental illness who live above the poverty level.

Here’s a bit of Belluck’s story. Maybe the trend is finally starting to turn? Continue reading

Study: One Hour Watching TV = Shorter Life By 22 Minutes

(Aaron Escobar/Wikimedia Commons)


I’m penitently thinking today about all the ways I’ve messed up in the last year. One is wasting too much of my life watching television — and this Australian study in the upcoming October issue of the British Journal of Sports Medicine brings it home. (Hat-tip to Tom Anthony for sending it over.)

The researchers used population surveys to try to calculate how TV-watching affects mortality. Their conclusions: On average, it cuts 1.8 years from Australian men’s lives and 1.5 years from Australian women’s lives. And “On average, every single hour of TV viewed after the age of 25 reduces the viewer’s life expectancy by 21.8 minutes.”

The study has all sorts of limitations, but here’s the basic message: “TV viewing time may have adverse health consequences that rival those of lack of physical activity, obesity and smoking.”  Of course, it may be mainly TV’s obvious links to sitting, eating and smoking that most account for those ill health effects. Still, I was struck that the study refers to TV as a public health problem, and even compares it directly to smoking, equating an hour of TV with two cigarettes:

The average loss of life due to the smoking of a single cigarette has been estimated at 11 minutes, though this may be an underestimate. Our findings suggest that half an hour of TV viewing above age 25 may shorten life to a similar degree.

This sort of study is open to all sorts of challenges on the data, but doesn’t it ring metaphorically true? When I watch junk TV, I really do feel as if I’ve just thrown away many minutes of my life…

iVillage: How The Obama Girls Got Their Dad To Quit Smoking

At lunch today my kids were pretending to smoke with baby carrots and it freaked me out. Of course they’ve internalized all of the anti-smoking messages surrounding them — they equate smoking with early death, black lungs and general stupidity. Still, as they glamorously puffed on those little carrots I realized that the decades-old, cigarette-maker driven allure of smoking hasn’t totally been snuffed out.

So when I saw this piece featuring Michelle Obama on how her daughters got the president to finally quit smoking, it moved me (despite its women’s magazine-y sappiness). Here’s iVillage:

We knew President Obama had ultimately quit smoking but we never really knew what motivated him to finally kick the habit. First Lady Michelle Obama, during our exclusive interview surrounding her week as iVillage’s first-ever Guest Editor, said it wasn’t pressure from her. It wasn’t pressure from 1600 Pennsylvania Avenue either or concerns about his own health. The motivation came from two young women: daughters Malia, 14, and Sasha, 11.

“I know that his ability to ultimately kick the habit was because of the girls, because they’re at the age now where you can’t hide,” Mrs. Obama told me, as we chatted on her couch in her East Wing office, after she pushed off her shoes and got comfy. “I think that he didn’t want to look his girls in the eye and tell them that they shouldn’t do something that he was still doing.”

Cigarette Use Down But Cigars, Other Smokes Are Up. Blame Taxes.

By Karen Weintraub
Guest contributor

Higher taxes drove a significant number of Americans away from cigarettes last year, according to a new study from the federal Centers for Disease Control and Prevention. But instead of quitting, many of those smokers shifted to other sources of tobacco that are not taxed as heavily.

Cigarette use declined by 2.5% between 2010 and 2011, the new study reveals, while consumption of other forms of smoked tobacco such as cigars and homemade cigarettes rose more than 17%. Since 2000, cigarette use has dropped by 33% while use of non-cigarette products rose 123%, with the biggest increase coming since a 2009 hike in federal cigarette taxes – which exempts cigars and loose tobacco.

The lobbying arm of the American Cancer Society responded to the numbers by calling yesterday for the government to close that tax loophole, which the society said undermines cessation efforts and deprives the government of money.

“The CDC’s data clearly demonstrate that the disparity in tax treatment of tobacco products is undercutting our ability to effectively reduce tobacco use and save lives,” Chris Hansen, president of the American Cancer Society Cancer Action Network, said in a statement. Continue reading

P.S. On Nicotine Gum And Patches: This Study ‘Shakes Up The Field’

You know the old joke: “I’m great at quitting smoking: I’ve done it more than a dozen times!” That’s what I thought of when I saw the Harvard/UMass study earlier this week questioning the hundreds of millions of dollars spent on nicotine gum, patches and other forms of “nicotine replacement therapy.”

I caught up a bit late with Boston University School of Public Health professor Michael Siegel, a leading tobacco control researcher whom I’ve seen quoted in the Boston Globe dozens of  times. So mea culpa for tardiness, but I still want to put his considered perspective on the record. Some of the coverage made it sound like the new study is just the latest salvo in a long debate over whether nicotine replacement therapy is worthwhile, but my impression from Prof. Siegel — who, granted, has long been a skeptic of nicotine replacement — is that this may be more of a game-changer.

His take on the study, lightly edited:

Strictly speaking, what this study looked at was smoking relapse. These were smokers who had quit, so from a strict perspective, this study can only conclude that nicotine replacement was not effective in helping prevent relapse.

‘In the field, generally there’s a dogma that nicotine replacement therapy is the state of the art.’

However, when you think about it, the smoking cessation process almost always involves relapse, so in a sense, you can infer from the study that nicotine replacement is not effective for quitting because quitting involves being sustained. If you took a bunch of quitters at a given time and you wanted to predict whether they were going to sustain their quitting, those on nicotine replacement therapy were no more likely to sustain their quitting. I do think that this study does provide evidence that in general, nicotine replacement therapy is not effective for quitting.

Is this new, did we know this? Yes and no. Continue reading