President's Corner

Mass Media Campaigns, Like EX, Motivate Smokers to Quit

2011-02-21T09:30:00.001-05:00

As far back as the late 1960s, media campaigns have proven to be an effective means to reduce smoking in the United States. From 1967 through 1971, an unprecedented number of national anti-smoking advertisements ran on TV and radio under the Fairness Doctrine, a policy that required networks to air one anti-smoking public service message for every three cigarette ads they broadcasted. During this period, per capita cigarette sales decreased by 7% and youth smoking decreased by 3%. Studies report that smoking rates later rose shortly after the campaign ended. The effectiveness of the anti-smoking advertisements aired under the Fairness Doctrine dramatically illustrates the ability to change negative health behaviors through a well-funded media campaign.

Armed with evidence from subsequent effective mass media campaigns, Legacy worked to develop a national smoking cessation campaign. I am proud to announce that a new study published in the American Journal of Public Health (AJPH) used EX to demonstrate that a national mass media campaign can influence smokers who are making the decision to quit. Smokers aware of the EX campaign showed a 24 percent greater chance of making a quit attempt during the study period. These results suggest that quit rates could increase if federal and state governments provide funding for evidence based mass media campaigns on cessation. Since March 2008, more than 2 million people have visited BecomeAnEX.org and more than 350,000 users have registered to form 350 support groups. EX provides free resources on how to quit, rather than simply giving reasons why to quit. By utilizing peer to peer motivation and support, smokers in the EX program can help each other re-learn life without cigarettes.

Given the number of smokers struggling to quit and the promise of cessation media campaign efforts, I hope that we can one day continue reaching smokers on a national level through media. In addition to the items called for by HHS in the Healthy People 2020 initiative, a well-funded mass media campaign focused on cessation could have a major impact.

Movies continue to play a large role in the nation’s tobacco epidemic

2011-02-18T09:30:00.001-05:00

Movies are a powerful way to attract new youth smokers and to increase cravings among adult smokers. Research studies over the last 10 years have established that on-screen smoking influences young people to light up. As far back as 1972, one film industry representative told a tobacco company that "Film is better than any commercial that has been run on television or in any magazine, because the audience is totally unaware of the sponsor involvement."

A new study released in the Jan. 19 issue of The Journal of Neuroscience delves into how smokers’ brains process tobacco imagery on screen. The results were eye-opening: compared to nonsmokers, when smokers saw characters smoke on screen, they showed greater activity in the areas of the brain associated with planning and simulating hand gestures. In other words, for smokers, simply watching the familiar action of someone smoking evoked the brain responses of planning to make that movement too. We can now add movies to the long list of triggers that perpetuate nicotine addiction.

As Goes New York, So Goes the Nation?

2011-02-17T14:00:00.001-05:00

On February 2, 2011, the New York City Council took an important step in protecting the health of the City’s residents and visitors by voting to expand the Smoke Free Air Act to include parks, beaches and other public areas. Secondhand smoke contains more than 7,000 chemicals, including hundreds that are toxic and at least 69 that cause cancer. It is a proven cause of lung cancer, heart disease, respiratory infections and other serious illnesses. Additionally, many Americans already feel that smoking should be banned in public outdoor spaces.

In December, a Surgeon General’s Report reiterated that there is no safe level of exposure to secondhand smoke. Even low levels of exposure have an immediate effect on the body, leading to permanent health damage. Dr. Howard Koh, Assistant Secretary for Health at the U.S. Department of Health and Human Services, said that “every American deserves a healthier environment.” Yesterday's vote gave New Yorkers the right to breathe clean, smoke-free air - even in Central Park. As a New Yorker myself, I couldn’t be happier. Who likes walking or sitting behind someone who is smoking a cigarette or cigar while you’re enjoying a park or beach?

Mayor Bloomberg, Health Commissioner Dr. Thomas Farley and the City Council are to be applauded for championing this effort and safeguarding New Yorkers from toxic secondhand smoke exposure. From leading the charge by requiring tobacco vendors to post graphic warning messages at the point of sale as part of hard-hitting tobacco prevention and cessation campaigns to the passing of a comprehensive smoke-free air law, New York City is a global leader in the fight to reduce tobacco related disease.

In December, a federal judge ruled that New York City health officials violated of federal law by requiring retail outlets that sell cigarettes to post graphic warnings depicting the health consequences of smoking, along with information to help smokers find cessation services. Legacy issued a statement supporting the NYC requirement as a legally permissible and evidence-based intervention that will help reduce tobacco's devastating impact on the public health. Legacy took the lead on the public health amicus brief in the lower court and will do so again in support of New York City's appeal.

Black History Month— A Great Reason to Quit Smoking

2011-02-17T11:04:00.000-05:00

Since the 1960s, the tobacco industry has identified the African American community as a strategically important market, one whose search for recognition and empowerment made them a target for existing and new brands specifically marketed to help build their own identity. Once-secret tobacco industry documents suggest that tobacco companies specifically targeted African Americans with menthol cigarette advertising and now the numbers speak for themselves: approximately 80 percent of current black smokers choose to smoke menthol cigarettes.

African Americans have lower cessation rates compared to other smokers, and recent data confirms that menthol smokers, particularly African American menthol smokers, are less successful when they try to quit. One-fifth of all African American adults smoke cigarettes, and the most recent data available tells us that 45,000 African Americans die annually due to tobacco- related causes, adding more evidence to the notion that tobacco IS a social justice issue.

February marks Black History Month when we join together as a community to celebrate Black History, honoring past achievements while looking forward to new ones. Working with the African American community, public health leaders can make history by advocating for a ban on products like menthol cigarettes in order to reverse smoking trends and death rates.

Protecting Kids from Secondhand Smoke

2011-01-31T12:15:00.000-05:00

The issue of secondhand smoke (SHS) and its effects is rising as a top priority for public health officials, pediatricians and parents. The overwhelming body of evidence on secondhand smoke’s devastating consequences continues to grow, including SHS’ role in increasing the risk for asthma, heart disease and even heart attacks. However, decades after the Surgeon General first told us about the health risks of smoking, many smokers still may not grasp that their addiction is affecting those around them – especially our kids. Research shows us that a significant percentage of children bear this public health burden. Smokers simply may not understand the issue, and in some cases, parents are unable to protect their children from others’ deadly addiction.

In the February 2011 edition of Parents magazine, I was asked to weigh in on this topic for the “Judy on Duty” column, tackling the tough question of how to talk to relatives about smoking around your children. One mother was faced with the challenge of having a mother-in-law who smoked around her young kids. While this type of confrontation can be daunting, it is a necessary conversation to have in order to protect your children and give them the smoke-free environment that they deserve.

In just the last two weeks, two other studies have been released underscoring how damaging secondhand smoke can be to our youth. The Centers for Disease Control and Prevention (CDC) has found that 24.6 million Americans have asthma and that children, those living below the poverty line, as well those residing in the Northeast and Midwest, have higher than average asthma rates. Secondhand smoke, with its 4,000 chemical compounds, increases the severity of symptoms in those with asthma.

As reported in TIME Magazine last week, children whose parents are smokers are at an increased risk of developing hypertension.

High blood pressure in children can stay with them through adulthood, putting them at higher risk of heart attacks, stroke and heart disease.

The evidence is really unequivocal – there is no safe level of exposure to cigarette smoke, for smokers and for all those around them.

New Study: Smoking Damages DNA in Minutes

2011-01-24T13:34:00.000-05:00

Science from the University of Minnesota has uncovered new evidence of the ravages of tobacco on our bodies. Similar to the recent Surgeon General’s report in December, this study shows that cigarettes begin to destroy our bodies within minutes after inhaling, specifically affecting our DNA. Researchers focused on a group of chemicals in cigarette smoke called polycyclic aromatic hydrocarbons (PAHs) that damage DNA. The DNA mutations quickly formed from inhaling PAHs may cause lung cancer – American’s number-one cancer killer.

According to coverage in USA Today, “[They said] the speed with which the potentially lethal DNA assault began was comparable to having injected the PAH directly into an individual's bloodstream.”

The report’s findings suggest that because of smoking’s immediate damage to the core cells in our body, the short-term risk for cancer is increased, confirming what the U.S. Surgeon General told us in December: every cigarette does you damage. While many rationalize that smoking is simply an unhealthy habit, our nation must recognize it for what it is - a deadly addiction. Cigarettes are the only product that will kill you when used as directed, and for some, the progression of disease begins within minutes after lighting up.

For smokers, this should be a clarion call to quit. If you’ve tried and failed, try again. On average it takes a smoker 8-11 tries to finally quit successfully. You can increase your chances of quitting by having the right tools at your disposal: a plan, social support and information on nicotine replacement, recognizing your triggers and more. Try www.BecomeAnEx.org for an online community of smokers trying to quit.

Healthy People 2020: New Year's Message 2011

2010-12-29T11:57:00.000-05:00

“Create physical and social environments, which promote health for all.”

In December, the U.S. Department of Health and Human Services (HHS) announced the vision, mission and objectives for Healthy People 2020, providing evidence-based national goals for the next decade to improve public health in the United States. In short order, the U.S. Surgeon General then released her 2010 report, How Tobacco Smoke Causes Disease confirming why it is so critical that we be bold in addressing this issue – “every cigarette does you damage.”

Healthy People 2020 has set forth an ambitious but achievable ten-year agenda with a stated vision of building “a society in which all people live long, healthy lives.” Specific to tobacco, goals plan to “reduce illness, disability, and death related to tobacco use and secondhand smoke exposure.”

The Healthy People 2020 goals underscore that we know what works in driving down tobacco use, but we have to muster the will to do it. This is especially tough in times of economic downturn when budget shortfalls have routinely been addressed by cutting needed tobacco prevention and control programs from monies given to the states via the Master Settlement Agreement. The Healthy People 2020 target for adult smoking prevalence is 12 percent - ambitious given that the current smoking rate is nearly 21 percent. For youth, the goal is 16 percent and with the new Monitoring the Future data indicating that there is a continued stall in youth smoking declines and an uptick for 8^th and 10^th graders, we must act decisively. In order to stem the death and disease caused by tobacco, HHS has called for:

ü Fully funding tobacco control programs.

ü Increasing the price of tobacco products.

ü Enacting comprehensive smoke-free policies.

ü Controlling access to tobacco products.

ü Reducing tobacco advertising and promotion.

ü Implementing anti-tobacco media campaigns.

ü Encouraging and assisting tobacco users to quit.

We must also “create physical and social environments which promote health for all,” and that requires changing social norms around tobacco that demand tough, well-funded, evidence-based counter-marketing campaigns like truth®.

We applaud the many devoted public health leaders who contributed to this multi-year effort, two of whom are former and current Legacy Board members, Dr. Howard Koh, Assistant Secretary at HHS and Dr. Jonathan Fielding, Director of the Los Angeles County Department of Public Health who co-chaired the effort – as well as his co-chair, Shiriki Kumanyika. Congratulations!

Children Must Be Protected from Secondhand Smoke

2010-12-20T14:28:00.001-05:00

In 2006, the Surgeon General’s Report concluded that there is no safe level of exposure to secondhand smoke (SHS). The 2010 Surgeon General’s Report – released just last week – further details how even low levels of SHS exposure damages the circulatory system, increasing the risk for heart attacks and stroke.

It is widely known that children are vulnerable to secondhand smoke exposure. Current studies show that a majority of children – some of whom do not even live with a smoker – show measureable amounts of cotinine (a biomarker of tobacco smoke) in their blood. Thus, the most recent Surgeon General’s report has major implications for the public health forces around the country who are fighting for clean air policies in order to protect families.

One of those forces is the American Academy of Pediatrics (AAP) Julius B. Richmond Center for Excellence. Today, AAP’s journal, Pediatrics, released findings on children exposed to SHS, none of whom lived with someone who smokes inside the home. The authors found that among these children, those who lived in multiunit apartments had significantly higher levels of cotinine than those who lived in detached houses and mobile homes. The researchers speculated that children living in apartment units may be exposed to SHS through shared ventilation systems or even seepage through shared walls.

This study provides evidence for banning smoking in multiunit housing. However, as the authors note, public health advocates should also focus on coupling cessation programs alongside these restrictions, particularly within low socioeconomic communities where smoking rates are higher than the national average.

Until then, for any adult smoker who lives near children, please be aware of the consequences of your addiction – not just for your health, but for the health of your young neighbors who have no choice in the matter. Quitting smoking is ultimately one of the single most important lifestyle changes you can make to improve and extend your life as well as that of those around you.

Great News on Early Detection of Lung Cancer

2010-12-02T10:14:00.002-05:00

A few weeks ago, the National Cancer Institute (NCI) made the much anticipated announcement that the National Lung Cancer Screening Trial (NLST) has been halted because for high risk, heavy smokers, ages 55-74, low dose helical computed tomography (CT) scans have clearly demonstrated a statistically significant reduction in lung cancer mortalities. While this age group was the one studied, there is every reason to believe screening will help smokers 50 and up – possibly even those in their 40s.

This is wonderful news for tens of millions of Americans – many former smokers – at risk of developing lung cancer. For years, many of us have held out hope that this day would come and we took a lot of heat for it. We believed then -- and this announcement confirms -- that lung cancer screening will revolutionize the battle to detect tobacco-related lung cancers early enough to save countless lives and create a golden opportunity to help those who still smoke to quit.

Legacy first came out in support of the promise of this technology back in 2004, before most in public health were willing to do so. For many years, we’ve funded the work of courageous radiologist, Dr. Claudia Henschke, who has been a stalwart and often embattled champion of CT scan technology. In fact, Legacy is funding an ongoing analysis of the pressing question of whether CT scans for lung cancer will encourage smokers to quit or make them delay cessation even longer – a concern many have raised.

We have been confident for many years that science would eventually find better ways to detect and treat lung cancers. A growing body of evidence both in and outside the U.S. has been mounting for years that lung cancer screening saves lives. This announcement from NCI now suggests that CT screening for lung cancer should be incorporated into evidence-based practice and reimbursed in the same manner as mammography screening. We hope the U.S. Preventive Services Task Force acts quickly to rate screening.

Costs for infrastructure and screening may be expensive and could be born in part by a tobacco product user fee given that tobacco is the leading cause of lung cancer. Also, smoking cessation counseling and referral ought to be a routine part of the screening to capitalize on this teachable moment and encourage smoking cessation. Public health leaders nationally are jubilant at this news and feel all our hopes for this technology have finally been realized.

Restore Your Health by Quitting Smoking

2010-11-18T12:28:00.000-05:00

Last month’s rally in Washington led by Jon Stewart, aptly titled Rally to Restore Sanity, reminded me that I attended the same high school as Jon Stewart where I was suspended for smoking. Stewart too was a smoker and like me, has quit.

At our high school – at least when I was there in 1969 – you were allowed to smoke as long as you smoked outside. The reason I was suspended was because my coat caught fire in the library after I put a cigarette butt in my pocket, mistakenly thinking it was out. So there I was… wearing my coat inside while it smoldered. Of course, I was caught “red handed” as it were and suspended for a day as a result.

This week on November 18th was the annual Great American Smokeout. I thought about the nearly 47 million Americans who smoke, 70% want desperately to quit but will try over and over again – 8 to 11 times – before they quit for good. Albert Einstein said the definition of insanity is “doing the same thing over and over again and expecting a different result.” Most smokers can empathize. It is so tough to quit and sometimes you question your sanity and ask yourself why it is that so many other people can quit but you can’t.

You’re not crazy – you share the company of millions of smart, strong people just like you, trying to battle back their nicotine addictions. My best advice is to “quit early and often.” Try to quit on the Great American Smoke Out. If you relapse, resolve to quit again on New Years, but whatever you do, don’t wait an entire year before you try to quit again. Keep trying and in this case, eventually the result will be different and it will save your life.

If I can do it, so can you. Good luck!

A Breath of Fresh Air for the Chilean Miners

2010-10-27T13:12:00.001-04:00

A few weeks ago while the whole world watched, the first miner was rescued from the Chilean mine where 33 men had been trapped for two months. Perseverance and tremendous effort made this historic rescue a present-day miracle. We continue to hope for the best outcome for these men, as their mental and physical health is of great concern.

One CNN live report focusing on the health of the miners pointed out that one miner had what is commonly referred to as the “black lung,” a condition that develops as a result of long exposure to coal dust, similar to the long-term effects of tobacco smoking. The reporter went on to say that at least 14 of the miners who were trapped were smokers.

As a former smoker myself, I could not help but imagine what these men were going through. As I hoped for the miners’ safe rescue, I also instinctively wondered how these miners who smoked had dealt with their considerable stress from being trapped in conjunction with simultaneous nicotine withdrawal.

A subsequent CNN story reported that nicotine patches were sent down to two of the miners who smoked. Later, apparently some of the miners requested cigarettes, and so they each received a ration of 11 cigarettes. The smokers had to hike a long way to the hottest part of the mine to separate themselves from their non-smoking co-workers.

Although the miners now face numerous issues related to their readjustment, including considerable weight loss and the strains associated with their two month entrapment, I can’t help but hope that the medical professionals who initially sent down nicotine patches are the same ones now tending to these rescued men. As they saw the light of day and took their first few breaths of fresh air, my wish for them is to take this opportunity to stay smoke-free, adding years back to their lives that were at such risk just weeks ago.

The Great E-Cigarette Debate

2010-10-15T16:02:00.002-04:00

Actress Katherine Heigl (Grey’s Anatomy) recently lit up an electronic cigarette (e-cigarette) on The Late Show with David Letterman, igniting a firestorm of conversation about this controversial product. (Watch it on YouTube here.)

E-cigarettes are about the size of a regular cigarette and operate by electronically vaporizing a solution that often contains nicotine, creating a mist which is then inhaled. They are available in various flavors and claimed strengths of nicotine cartridges.

Since electronic cigarettes were first introduced to the market, I’ve shared the same concerns as the U.S. Food and Drug Administration (FDA); these products appeal to teens and could increase tobacco use and nicotine addiction. They are available in an assortment of candy flavors like chocolate and strawberry that have been banned in regular tobacco cigarettes. I’m concerned that these products are readily available to consumers online and in shopping malls without any evidence regarding their safety and efficacy. At this point, no scientific support exists for the claims that these products are effective smoking cessation aids. The analysis conducted by the FDA found that e-cigarettes they tested contained detectable levels of toxic chemicals and known carcinogens.

The decision to quit smoking in the public eye gives stars like Katherine Heigl a powerful opportunity to lead by example and share experiences that will undoubtedly help people who are going through the same process. Choosing to smoke a product on-air without stating the risks is irresponsible.

There are a variety of safe alternatives available to smokers looking to quit. Using nicotine replacement therapies such as gum or lozenges can play an integral part in the quitting process and all smokers should talk with their doctor about prescription drugs that are available to smokers. I urge everyone to get the real facts about e-cigarettes before they take a puff. These products may hold promise but until the FDA approves them, they should not be on the market.

Braving the cancer battle

2010-09-08T12:23:00.000-04:00

It is with great sadness that I recently learned about three internationally renowned public figures who are suffering from cancer, all of whom were long-term smokers.

Last month, CBS News’ Bob Scheiffer announced that he is battling bladder cancer for which he openly blames heavy smoking. Smoking is linked to 50 percent of bladder cancers.

Christopher Hitchins, columnist and literary critic for The Atlantic and Vanity Fair, revealed that he is fighting esophageal cancer – a battle his own father fought and lost. In an interview with CNN’s Anderson Cooper, Hitchins said “If you smoke, which I did for many years very heavily with occasional interruption, and if you use alcohol, you make yourself a candidate for it in your sixties.”

And of course it would be hard to have missed the news that actor Michael Douglas has been diagnosed with what doctors have said may be stage four oropharyngeal cancer – a type of throat cancer. Risk factors for throat cancer include smoking and drinking and Douglas is an admitted long-term smoker who quit several years ago, according to People magazine.

We wish them all the very best with their treatment and recovery.

The swarm of media coverage surrounding Michael Douglas specifically reminds me of his father, Kirk Douglas, whom we presented with an award at our first Legacy Honors ceremony in 2003. The Douglas family has a long history of smokers - Kirk Douglas’s father was a Russian immigrant who smoked for years until his doctor warned him that he might lose his life to it if he didn’t quit.

In a New York Times’ opinion editorial dated May, 16, 2003, Douglas wrote: “Here’s how he did it: he always carried one cigarette in the breast pocket of his shirt. When he felt the urge to smoke, he’d take the cigarette out and look at it fiercely. With a growl, he would say, in his Russian accent, “Who’s stronger? You – me?” He would glare at the cigarette: “I stronger.” And he’d put the cigarette back in his pocket. He did that for years, but it was too late. He died of cancer at age 72.” In 1950, Kirk Douglas used the same method to quit.

We applaud Michael Douglas’s courage in openly discussing his throat cancer and its risk factors of smoking and drinking. The two often go hand in hand and impact millions of American lives. I’ve had a long-term interest in harnessing mass media campaigns to induce social norm change regarding both tobacco and alcohol addiction. To that end, last month I joined the board of directors of Phoenix House, the nation’s leading nonprofit provider of substance treatment and prevention services so that I can continue to address addiction through my work there.

As someone who struggled with tobacco addiction for nearly 25 years and one who has lost numerous family members, I can’t help but be moved by the bravery shown by all three of these individuals to come forward and share their stories. Their plights underscore the importance of our work to address addictions of all kinds and shed light on the often fatal damage they do.

McDonald's Recalls 13.4 Million Shrek Glasses Containing Cadmium

2010-07-01T17:17:00.001-04:00

Last month, McDonald's was forced to issue a recall throughout the United States and Canada for over 13 million drinking glasses promoting the new Shrek Forever After film. Why? The designs painted on the glasses contain higher than acceptable levels of cadmium, a heavy metal found in batteries and a well known carcinogen.

I always find these recalls interesting. Since January 2010, the Consumer Product Safety Commission has recalled over a million cribs because of the risk of strangulation or suffocation to the young children who sleep in them.

It is critical that these cribs and glasses be recalled because they pose such a deadly public health threat to the nation’s youth. And yet the deadliest product of all – tobacco – remains on the market while simultaneously causing the death of over 400,000 Americans every year.

Just last week, the Center for Disease Control and Prevention (CDC) released a new study whose findings revealed that cigarettes in the US have more cancer-causing toxins than those manufactured in Australia, Canada and the UK. The study revealed that US-made cigarettes contain higher levels of nitrosamines compared to cigarettes from the other countries. Other chemicals found in all cigarettes include arsenic, cadmium and ammonia.

This double standard as it relates to tobacco products is appalling. I hope no children are harmed by the Shrek glasses, but I also think it is a teachable moment to remind Americans what we’re willing to tolerate when it comes to smoking. Social norms may have shifted, the US Food and Drug Administration may now be able to regulate tobacco, but it will never be safe.

Father’s Day - Smoking Toddler

2010-06-25T14:00:00.000-04:00

It is hard to have been online in the last two weeks and not seen the disturbing image of a two-year old Sumatran boy, Ardi Rizal, smoking a cigarette. The world around, parents have been appalled by this video.

According to MSNBC, the boy’s father, Mohammed Rizal, was quoted as saying “I'm not worried about his health, he looks healthy. He cries and throws tantrums when we don't let him smoke. He's addicted."

Apparently, this is not the first video to surface on YouTube of Indonesian children smoking. It is apparently a growing problem there, prompting the Chairman of Indonesia's child protection commission, Seto Mulyadi, to assign blame for the spike in young children smoking on aggressive advertising and parents who are smokers. He has said that "a law to protect children and passive smokers should be introduced immediately in this country."

Tragically, the tobacco industry worldwide has a long record of aggressive and disproportionate marketing to minority communities and youth. Tough anti-tobacco regulations are required to restrict it in order to educate the public and encourage a shift in social norms around tobacco.

Parents are also responsible because their children look to them as role models and as long as they smoke, it doubles the odds of their children following suit. This Father’s Day, we encourage parents to use this as a teachable moment. If you are a parent who smokes, you not only set a deadly example for those you love most, you also expose them to dangerous secondhand smoke, to which we know from the US Surgeon General that there are no safe levels of exposure.

For information on the top ten things you can do as a parent to keep your children from smoking, please see this handy list: http://www.legacyforhealth.org/3585.aspx.

Adding years to your life and safeguarding your family’s health is the single best thing you can do for your children. I quit smoking myself on Mother’s Day and if you’re a father who wants to use Father’s Day to do the same, please visit www.BecomeAnEX.org for all the free tools you’ll need to do it successfully. Happy Father’s Day!

Quitting for Mother's Day

2010-05-06T10:07:00.000-04:00

With Mother’s Day just around the corner, I think, once again, about my own mother, who lost her life to smoking much too young at 62 years old. She was my best friend, and I have a wonderful picture of her in my office that I often glance at as I work. It has been more than 20 years since her passing, but I still think of her every day.

Mother’s Day is also the day, in 1992, when I finally quit smoking for good. Like many Americans, I am both a former smoker, and I have lost numerous loved ones to smoking. I have several aunts, uncles and loved ones who too died prematurely from smoking. If I were to ask all the readers of this blog post for a show of hands, sadly, I believe most of us have similar stories to tell.

Tobacco is the No. 1 preventable cause of death in the United States, and it robs us of more than 400,000 American lives annually – many of whom are our sisters and brothers, mothers, fathers and grandparents. The 46 million Americans who still smoke are joined by the 45 million of who have quit and, alarmingly, all of us are at risk of a lung cancer diagnosis.

This chart visualizes the ripple effect tobacco has had on our nation during the past century, resulting in hundreds of thousands of lung cancer diagnoses.

It may be one of the least-known facts about cancer: lung cancer is the No. 1 cancer killer in this nation. We lose far more women to lung cancer than to breast cancer. In fact, in a new report entitled Out of the Shadows: Women and Lung Cancer, released just last month from the Lung Cancer Alliance and Brigham and Women’s Hospital stated:

“Lung cancer is the leading cause of cancer death in women and men in the United States, taking more lives each year than breast, prostate, colon and pancreatic cancers – combined. In 2010, alone, approximately 70,500 women will die from the disease. The financial toll of lung cancer is significant – about $9.6 billion is spent in the United States each year treating the disease, mostly during late stages when survival is highly unlikely.”

About 90 percent of those diagnosed with lung cancer have at some point smoked. What can we do to reverse these statistics? We can help smokers quit. They really need our help, because nicotine addiction is not a moral failing – it is a disease.

It isn’t just critical to the health of the women you love but also the longevity of those in her household. Whether it is firsthand smoke, secondhand smoke or third-hand smoke, smoking will not only rob her of 12 years of life if she smokes throughout her life-cycle, but it will also affect everyone in her house, whether they are infants, children, teens, young adults – and even pets. If she continues to smoke, her children are twice as likely to follow in her footsteps and smoke.

So, do the most important thing to improve the health of a woman you know this Mother’s Day; help her quit.

Encourage the women in your life to visit BecomeAnEX.org for all the tools needed to quit for good and if you’ve lost loved ones to tobacco, please share their stories with us at MyLegacyStory.org, or make a donation to support our important work.

First – Do No Harm: Why the Cleveland Clinic Should Hire Smokers

2010-04-30T10:58:00.000-04:00

In the April 18 New York Times magazine, the well-respected Cleveland Clinic purchased an advertising supplement titled An Invitation to Wellness. In it, they set out their policies on smoking, which include going smoke-free in 2005 and offering free smoking cessation counseling and resources to their employees and the Cleveland community in 2006 – both for which they should be applauded. However, in 2007, they made the decision to stop hiring smokers altogether.

At first blush, you might think that a president and CEO of an anti-tobacco organization would be shouting from the rooftops why the rest of the nation should be following suit. In fact, Legacy takes the opposite view; we believe that this decision of a nationally renowned medical institution is fundamentally misguided. The deserved esteem in which the Cleveland Clinic is held creates a dangerous precedent.

Smoking is a highly addictive behavior – not a moral failing. Research tells us that although 70 percent of smokers want to quit, only about 5 percent are successful in any given year. With the vast majority of smokers starting before they turn 18, it is hardly an “adult choice” to enter into what becomes for so many a lifetime struggle with addiction.

In years gone by, people at all levels of society smoked. Not so long ago, doctors were active in promoting smoking. Today, however, the demographics of smokers are very different. Most smokers are less educated, hold lower-paying jobs and have the least access to smoking cessation services that would help them quit. In Ohio, for example, the highest rate of smoking (38.5 percent) was among those with less than a high school education. Let us be perfectly clear about who this policy will hurt. The Cleveland Clinic isn’t making a tough choice not to hire a prestigious neurosurgeon or top hospital administrator because it is so unlikely that he or she smokes. It is far more likely that it is the nurse’s aid or orderly who will be turned away. Yet, it is these people who have the fewest job options and need the work the most to support themselves and their families.

The problem is badly exacerbated by the fact that tobacco control programs in Ohio have been decimated by the state’s effort to defund the Ohio Tobacco Control Trust Fund and divert the trust funds for other purposes. Legacy is fighting in the courts to protect those funds, which had supported a wide array of effective tobacco prevention and cessation programs, but the outcome of that litigation is uncertain. In the meantime, there are precious few resources at all in Ohio to help smokers successfully quit smoking.

As companies of all types consider how they can decrease healthcare costs and contribute to the well-being of their employees, they are absolutely right to implement policies to foster smoking cessation. We urge them to adopt the proven strategies of covering smoking cessation services and implementing smoke-free workplaces, but refusing to hire smokers at all is not the right answer.

Go Green this Earth Day and Quit Smoking

2010-04-19T11:26:00.000-04:00

From recycling and carrying reusable grocery bags to taking public transit, we are all becoming increasingly more aware of the need to be environmentally responsible. And if you’re a smoker, there’s another very important step that would be a win for your health and for the environment: Quit smoking this Earth Day.

Surprisingly, though, many of us don’t know that quitting smoking is another way to help combat climate change, or to significantly reduce exorbitant waste cleanup costs made far higher due to carelessly discarded cigarettes butts in streets, waterways, and public areas like parks and beaches. While tobacco is the No. 1 cause of preventable death, responsible for over 400,000 deaths each year in the United States, it is less known that cigarettes play a major role as toxic, hazardous waste in our already-overburdened environment. Astonishingly, the remnants of cigarette smoking represent the most prevalent form of litter found on Earth.

According to recent data from the Ocean Conservancy, more than 3 million cigarettes or cigarette filters/butts were removed internationally from beaches and inland waterways as part of the annual International Coastal Cleanup in 2009, including more than 1 million from the United States alone, making it by far the most littered item. We know that tobacco kills people, but do we ever wonder about the fragile ecosystems that can also be affected by the toxins in these tobacco products? Tobacco growing leads to soil degradation, and the wood used in the curing of tobacco can also contribute to deforestation. Pesticides used in tobacco production can also be harmful to the environment. And returning to climate concerns, which many believe to be the biggest environmental threat facing the planet, all stages of cigarette production and consumption potentially contribute to global warming, from the growing and curing of tobacco, to manufacturing and promotion and to the smoking and disposal of tobacco products.

Smokers may be tossing their butts without even realizing the impact it has on the environment. It’s possible that smokers think that because tobacco is organic, so its waste is harmless. However, that is not the case, because it is poisonous both to children and other living organisms, due to the nicotine, ethylphenol and heavy metals in its contents. Tobacco industry research reveals that there might be misconceptions that cigarette filters are readily biodegradable or inconsequential as waste because of their small size. In reality, the filters are made from cellulose acetate, a type of plastic that can take years to decompose.

The sure-fire way to combat this growing problem is to help people quit smoking. Quitting is a great way to live a longer, healthier life, akin to wanting clean air in our homes, neighborhoods, work places, towns and cities. It is a tough addiction to break, but, with help and a plan, one can succeed. This year, we hope that Earth Day – Thursday, April 22nd -helps to educate smokers about cigarettes’ impact on the environment, as well as serve as a motivator to redouble their efforts to stop, and by doing so to contribute to a legacy of a beautiful, healthy planet for future generations.

truth® Ten-Year Anniversary

2010-03-25T10:22:00.006-04:00

A bright orange truck traveling the country each summer. 1200 bodies falling to the ground. A “singing cowboy” with a hole in his throat. An online game called Addictor Click. Funky t-shirts with educational facts.

Those are just some of the iconic images associated with the truth^® youth smoking prevention campaign – a campaign that celebrates its tenth anniversary in 2010. A campaign that has rung up accolades from the public health and creative communities. A campaign I am so proud to have been a part of since its earliest days. And most importantly – a campaign I am so proud to say has been research-proven to save the lives of hundreds of thousand of teenagers.

The campaign was born out of the November 1998 Master Settlement Agreement (MSA) between Legacy and the nation’s largest tobacco companies, and 46 states and five U.S territories. Funds from the MSA were directed to create a national public health organization devoted to reducing youth smoking rates and preventing tobacco-related disease. truth became the key driver of the prevention side of our foundation’s mission.

In those early days, we didn’t need to look far for inspiration. Colleagues in the State of Florida had launched a successful youth smoking prevention campaign, called truth. Tapping into the latest social science, marketing and public health research, we sought to build on the great work our colleagues in Florida had begun by expanding the campaign and bringing it to a national audience.

Over the course of the last decade, we’ve created hundreds of truth ads, brought campaign PSAs to cinema screens nationwide, met hundreds of thousands of teens through a series of summer tours, and even issued grants to community-based groups across the country to grow their own youth prevention initiatives. And we’ve persevered in the court of law – prevailing in a nearly five-year lawsuit with a tobacco company over the content of our truth ads.

Looking to the future, truth will continue to evolve to meet the needs of the teen audience, as their patterns of how they receive and process information continue to change. Throughout the decade, we’ve built our online presence to include a popular Web site and a series of affiliated social networking sites. As always, our efforts remain focused directly on teens that are most likely to smoke and need information most.

We’ll also continue to constantly re-evaluate what we are doing, and ensure it remains effective. Over the past decade, a growing body of research has illustrated the efficacy of the campaign. Research published in the American Journal of Preventive Medicine found that truth is responsible for keeping 450,000 teens from starting to smoke between 2000-2004. A second study published in that same journal in April 2009 found that the campaign not only paid for itself in its first two years, but also saved between $1.9 and $5.4 billion in medical care costs to society. We will continue to look to benchmarks like this to ensure our life-saving work remains on track.

I would be remiss if I did not mention that the campaign now faces a serious funding challenge. According to the latest figures from the Federal Trade Commission, the tobacco industry spends more than 34 million dollars each day on marketing efforts in the U.S. alone. That’s more than we can spend on truth in a year. Well aware of this significant challenge, we have evolved the campaign to extend the truth message in even more efficient and cost-effective ways, through partnerships with like-minded brands, value-added opportunities and grant funding from such partners as the Centers for Disease Control and Prevention. Indeed, our online efforts have been a key part of this tremendous effort - allowing us to spread truth messages virally and cost-effectively.

In the coming years, the campaign will also depend on generous financial support from all those who care about protecting children from tobacco addiction. Over the past month, we have shared truth’s most impactful videos with our supporters to show how the campaign works, and how their contributions make a difference. You can click here to see the video recently voted our supporters’ favorite, “Singing Cowboy,” or show your support for the campaign. We will continue to seek help from Americans who want to keep truth’s legacy alive and keep teens from smoking. And that’s something worth celebrating!

Women’s History Month Clouded with Tobacco Smoke

2010-03-15T17:09:00.001-04:00

The April 2010 issue of the journal, Pediatrics, features an article, Camel No. 9 Cigarette-Marketing Campaign Targeted Young Teenage Girls, by John Pierce and colleagues, which shows sadly, despite all we know about the deadly toll of smoking, tobacco companies continue to successfully find ‘replacement smokers’ among our nation’s young girls. R.J. Reynolds is the same company that brought the American people Joe Camel, which at one time was recognizable to 90 percent of six year olds. The release of this new research coincides with Women’s History Month and underscores the fact that the tobacco industry first began to aggressively market to women in the 1920s and continues to do so today.

Since 1920, the percentage of women who smoke has nearly quadrupled. The tobacco industry has been marketing to women for over 80 years using popular female entertainers and Hollywood stars as spokespersons in ads that have appealed to liberated women with slogans like "You've Come A Long Way Baby!" Virginia Slims’ “Purse Packs” and Camel No. 9 have been dressed in pink to appeal to young women.

Despite public awareness about the deadly toll of tobacco, in the US nearly 20 percent of women still smoke and each year 174,000 women lose their lives to tobacco-related disease. Women today are both more knowledgeable about health risks and are health conscious, yet lung cancer is the leading cancer killer of women. In addition, smoking affects a woman’s reproductive health and increases the risk of infertility, ectopic pregnancy, miscarriage, preterm labor, stillbirth and SIDS.

At Legacy, we are dedicated to building a generation of longer healthier lives for everyone, including a generation of strong women who have the knowledge and power to live a tobacco-free lifestyle. For more than a decade, our foundation has worked to empower women to quit smoking and use their positions as change agents to help others do the same. This month - and every day - women have a chance to make history and create their own Legacy by quitting smoking or helping someone else who does.

Links to News Articles on this Topic:
USA Today via @LizSzabo
The New York Times (Well blog) via @NYTimesWell
HealthDay (US News & World Report) via @HealthDayEditor
Health.com via @GoodHealth
WebMD via @WebMD

Promoting a Set Change

2010-01-28T17:05:00.002-05:00

Kudos to CBS Sunday Morning film critic David Edelstein for taking the bold position yesterday to endorse the most important of the four smoke-free movies policy positions - to label any new movie that has smoking in it with an R rating.

http://www.cbsnews.com/stories/2010/01/24/sunday/main6136082.shtml

Anyone who has seen Avatar will instantly recall Sigourney Weaver's character, Dr. Grace Augustine, demanding her "godamned cigarette" in an oxygen-rich laboratory setting so completely out of context that it couldn't help but raise questions. This film is now well on its way to being the top grossing film of all time and meanwhile, the nation's youth are waiting in lines in theatres from coast to coast to witness a world, decades from now, that still has smoking in it! What was James Cameron thinking?

Clearly he wasn't thinking that the federal government has confirmed a causal link between smoking in the movies and youth smoking initiation. He also wasn't thinking about the fact that other peer-reviewed studies have found a similar effect. We know that 200,000 youth start smoking every year as a direct result of actors they idolize smoking on screen or off and there are simple ways to address it if we could simply marshal the will to do the right thing.

Together with an R rating, if movie makers would require strong anti-smoking ads to run in theatres before any film with tobacco in it, stop identifying tobacco brands and certify that they have received no funds or anything of value in exchange for tobacco appearing in films, we'd go a long way toward saving young lives from lifelong tobacco addictions, disease and premature death. The public health community has long championed these four principles and it is high time the studios did as well. To that end, last week we joined our colleagues in public health in sending a letter (see attachment) to Twentieth Century Fox's owner, Rupert Murdoch, demanding that he take a leadership role on this issue in his subsidiary and at the Motion Picture Association of America.

The tobacco industry claims that product placement no longer occurs but many in public health have long suspected that it still does. And the prohibitions against product placement are as full of holes as a piece of swiss cheese. While most U.S. cigarette manufacturers are prohibited from product placement by the Master Settlement Agreement reached between 46 state attorney generals and the tobacco industry in 1998, companies such as Altria, the parent company of Philip Morris USA, and international companies such as Philip Morris International are not part of the agreement. And while the Federal Trade Commission requires reporting of expenditures for product placement by cigarette companies and their corporate parent companies and subsidiaries, it has exempted information from those corporate “relatives” that are not involved in the manufacture or marketing of cigarettes. A case in point: a recent letter to the editor of the New York Times from the VP, Corporate Affairs, Altria Client Services, (January 16, 2010) denying engaging in product placement carefully limited the denial to the activities of PM-USA. Our concern is not about squelching creative license or free speech, it s about battling down a world-wide industry whose products claim the lives of over 400,000 Americans every year. How would the American public feel if they were to learn that paid product placement of smoking and cigarette brands still occurs and reaches millions of kids in the United States?

Cheers to David Edelstein for his courage. We hope his respected voice is being heard in Hollywood and will result in a set change that will ultimately save countless young lives. Let's tell Big Tobacco "that's a wrap.

Your Life is a Gift

2009-12-21T12:03:00.000-05:00

Just imagine that you could give your loved ones thousands of hugs and kisses, a hundred pieces of advice in a moment of need, seemingly endless holidays, anniversaries, birthdays and graduations. Imagine being there as new family members are born. Imagine too, that you could end the worry your loved ones have -whether spoken or unspoken - about what the future may hold. Imagine a healthy person - you - starting the day you quit smoking and continuing as you get stronger and healthier as each day passes. Imagine the greatest gift of all during this holiday season - the gift of life, your life, the very best present your loved ones could ever have -YOU!

The Great American Smokeout, US Smoking Rates and Tobacco Control in Healthcare Reform

2009-12-03T10:08:00.001-05:00

Dr. Cheryl Healton on ABC News Radio from ABC News Radio on Vimeo.

'Desperate Housewife' Makes Desperate Plea for Lung Cancer Awareness

2009-11-20T17:35:00.001-05:00

Lung cancer is the leading cause of cancer death both for men and for women as well as every major racial/ethnic group in the United States. Among women, about 30,000 more die from lung cancer than breast cancer each year. More women are diagnosed with breast cancer but because of advances in early detection and treatment, the vast majority of these women survive. The inverse is true for lung cancer. The overwhelming majority of those diagnosed die, many soon after diagnosis. One form of cancer creates a legion of survivors to advocate for research and access to care while the other form of cancer leaves only fifteen percent to fight on. Many of these survivors blame themselves for their illness or soon tire of everyone else blaming them with the provocative question, “Were you a smoker?”

I was recently reminded of this fact when I had the honor of filming a TV segment with actor, Kathryn Joosten, the former star of “West Wing” (the President’s executive assistant) and now of “Desperate Housewives” (the crotchety neighbor). Martin Sheen’s character was a smoking President, and now President Obama has been vocal about his own very real struggle to quit. The nation needs the real-life occupants of 1600 Pennsylvania Avenue to do as much as possible to stem the tide of the leading cause of cancer death, through equity in research funding, advances in early detection or prevention and cessation services. Indeed, of the ten recommendations proposed in 2003 by the government’s own Inter-Agency Committee on Smoking and Health, only one -- the establishment of telephone quit lines in every state -- has been implemented.

And as for “Desperate Housewives?” There are plenty of really desperate housewives being diagnosed with the leading cancer killer every day and they are joined in their desperation by their partners and children, many of whom are left motherless. Then there are the desperate housewives caring for a spouse or other loved ones dying of lung cancer. The time for action was 50 years ago and the carnage keeps on coming, thanks in large part to the tobacco industry’s’ relentless marketing of their products to our nation’s youth. [since Congress just passed the FDA bill, the last part of this sentence doesn’t seem quite right]

There is light on the horizon though, with the recent enactment of legislation giving FDA authority to regulate tobacco. This law will address many critical issues, but it will not find a cure for lung cancer. Parity in the NIH budget for this dreaded disease will help do that. During the 2008 fiscal year, lung cancer research received $169,000,000, less than a fourth of the $726,000,000 that breast cancer research received. No matter where you land on the personal responsibility issue, the fact is that 60 percent of lung cancer is diagnosed in former or never smokers.

Even if everyone were to quit smoking tomorrow, we would still face an avalanche of lung cancer deaths. Nonetheless, the fact remains that quitting smoking is one of the most important ways to improve your health and reduce your risk of a lung-cancer diagnosis. Every November we observe Lung Cancer Awareness Month, and there’s no time better than the present to commit to quit for good. Visit BecomeAnEX.org to learn how.

Does Obama’s Smoking Habit Change Your View of the President?

2009-09-28T10:10:00.002-04:00

A CNN poll conducted earlier this summer reported that Obama’s smoking habit does not change most Americans’ view of the President and I agree that it should not. Smoking is a powerful addiction whether you are a waitress, a truck driver, a college student or the President of the US. We should be proud of him for telling the truth and trying to quit. If he is like most who have smoked he may need to try to quit more than once before it sticks.

New iPhone App a Gateway for Smoking?

2009-09-16T12:24:00.018-04:00

We recently came upon this story about a new Apple iPhone application that allows young people (the game is rated 17 and up) to blow virtual smoke rings. The game: better the smoke rings, the better the points.

Having young people model smoking is just one step away from actually smoking. It would be interesting to know whether a corporate entity is underwriting this application and, if so, which one. Smoking in the movies has for decades and still does glamorize smoking in a big way so I am not surprised young people are attracted to such a “game.” It is irresponsible to have an application where young teens “play” smoking for rewards.

FDA, Health Reform and a New American Way

2009-07-31T17:19:00.021-04:00

Recently after years of hard work by advocates for public health and congress a bill giving the Food and Drug Administration (FDA) regulatory control over the tobacco industry has passed. It gives the FDA broad authority to require the disclosure of the ingredients in cigarettes and to regulate their marketing to both adults and children. Of great importance, it will eliminate one of the greatest consumer frauds in the modern history of the United States and indeed the world; that smoking “light” or “low tar’ cigarettes confers lower risk.

Millions of U.S. smokers gravitated to these new light products instead of trying to quit smoking lured by the false belief that they were at least doing something positive to reduce their risk. The law is a great public health victory, but the work now begins to make it all that it can be. Important issues will include consumer disclosure and marketing restrictions. Further research will be needed to define the impact of lowering nicotine levels because the evidence is sparse and contradictory. Users of lights did compensate by smoking their cigarettes further (e.g. to the filter) and smoking more. Smaller studies have found little increase in smoking to compensate for lower nicotine levels but these have been small in scale and cannot be extrapolated to the broad population of smokers. This research will be crucial. If it turns out that lower nicotine levels can be managed to eliminate the phenomenon of compensation, we could gradually reduce the number of smokers as we reach points in nicotine levels at which smokers can’t be bothered to continue. Already we know that non-nicotine cigarettes cannot maintain a market based on tobacco industry reports.

Lately we have had some other real victories too. The federal excise tax has been increased and this has led to more smokers trying to quit. Combined with the soon-to-be seen FDA-induced graphic warning labels, the disappearance of light cigarettes and the potential in the U.S. Justice Department case for the tobacco companies to have to publicly correct the fraudulent misrepresentations they have made to the public for several decades, we have good cause to believe that we’re on the road to real progress. These activities will all markedly increase quit attempts but sadly most Americans lack insurance coverage to support the medical and counseling interventions which give them the greatest chance of quitting successfully. Smoking is a chronic, relapsing behavior and the typical smoker tries many times before they are ultimately able to quit. With all these measures aimed at stimulating quit attempts it would be a sad day indeed were health reform to pass without substantive provisions to enable the 70% of smokers who want to quit to do so. No single action has a greater potential for curbing health care costs. The medical care cost alone associated with smoking cost is nearly 100 billion dollars a year. This EXCLUDES lost productivity which nearly doubles the tab.

While flavored cigarettes will soon disappear from the shelves, the controversial issue of menthol flavored cigarettes remains. The new FDA law contains a provision that addresses menthol as a flavoring. Once appointed, a new Tobacco Products Scientific Advisory Committee is charged with examining "the impact of the use of menthol in cigarettes on the public health, including such use by children, African Americans, Hispanics and other racial and ethnic minorities." The committee's recommendations on these critical topics to the Secretary of Health and Human Services are to be made within one year of the committee being established.

Legacy is very concerned about menthol and sees this as one of the FDA's early priorities. As this process unfolds, we will join other major organizations, including federal agencies, in hosting a conference in Washington, DC, on October 19 and 20 to discuss new research on the menthol issues to inform and provide context for the FDA as it tackles this subject.

We are now at a historic cross road. Will we keep taxing cigarettes, under-funding state tobacco control from the Master Settlement Agreement funds made available by 46 states AG’s and make what little goes to help curb our leading cause of preventable first on the chopping block for state cuts. Or will we acknowledge that millions of Americans, smokers and non-smokers alike have lost their lives, lost their quality of life and lost their loved ones to a man-made epidemic, one we lack only the political will to end. Fully incorporating tobacco prevention and cessation public education and comprehensive treatment services into to health reform with the goal of driving smoking below 5% by 2020 will save a great deal of money, countless lives and spur the United States’ productivity. Can we as a nation really afford to take a pass on this? Some cynics point out that fully funding tobacco control will drive up social security costs because people will live longer. Are other health services subjected to this odd test? If they were, might we just as well stop providing health services altogether?

Higher Taxes on Cigarettes: A Social Injustice?

2009-06-25T12:25:00.039-04:00

In 2001, I spoke at the National Conference on Tobacco or Health on the topic of social justice and the tobacco epidemic. Then I said, “We must also say to the states that raising taxes on tobacco products is right because it reduces consumption. But higher taxes take a much bigger bite out of the budget of the poor smoker than the well-off smoker. Higher taxes on cigarettes should not be a form of social injustice. States that raise taxes have a moral obligation to use these funds to expand prevention and cessation programs.” I went on to calculate the cost to a family of four, living at the poverty line, where both parents have a two-pack-a-day habit. The cost of their cigarettes amounted to roughly 40% of their monthly income.

On April 1, a significant increase in the federal excise tax occurred bringing the total federal tax on a pack of cigarettes to $1.01 -- an increase of 62 cents per pack. In a significant breakthrough, the tax also covers little cigars with a tax increase of 97 cents per pack to $1.01. The sales of little cigars have risen 240% from 1997 to 2007, and there is evidence of their growing popularity in the African-American community. The revenues from these new taxes will go to expand the Children’s Health Insurance Plan which will cover 3 million more uninsured children. What the tax will not support is an expansion of services for low-income smokers among whom the rates of smoking are highest. In fact, the level of coverage for cessation services among Medicaid plans and private insurance -- as well as support to public education about quitting -- remains quite dismal. Indeed, as states are facing record deficits some are sharply curtailing their services. In a rather extraordinary move, the Washington State legislature reduced its tobacco control program by about 39% and explicitly stated that the public education advertising program should cease. Such campaigns are a principal means of alerting smokers to services that exist and help them to be motivated to use them. The nation’s network of telephonic quit lines, which is designed to coach individual callers through a quit attempt, is so starved for funds that it has been thoroughly overwhelmed by the onslaught of callers resulting from the increase in the federal excise tax. In fact, the only national paid advertising campaign to encourage smoking cessation supported by the public health community is BecomeAnEX, a campaign created by the American Legacy Foundation® and backed by the National Alliance for Tobacco Cessation. It cannot nationally advertise the quit lines because their capacity is too low to absorb the millions of potential callers.

The Master Settlement Agreement resulting from the negotiations between the states’ Attorneys General and the tobacco industry led to a large increase of funds going to states. While a few states have spent the minimum amount the CDC recommends to support a tobacco control program, the vast majority have not done so, leaving countless addicted smokers nowhere to turn. Many who read this may believe that anyone can quit on their own, if they just try hard enough. Unfortunately, science has taught us that this simply isn’t so. The result then is each time we raise the tax and fail to set aside funding for services, we sentence people to a lifetime of addiction and for half of them, tobacco-related death. There is always another call on public money more urgent than supporting tobacco control -- this despite the fact the tobacco use is the leading behavioral cause of preventable death. There are likely many causes of this phenomenon, among them disdain for smokers and a love of Big Tobacco’s campaign contributions.

Hopefully America’s brand of health reform will address the fact that public education on quitting smoking and access to services to succeed in quitting are crucial if we are to continue to reduce smoking, which currently claims the lives of 440,000 Americans each year.

E-Cigarettes

2009-05-21T15:30:00.015-04:00

When I first heard about e-cigarettes, I wondered how I myself would have responded to their appearance on the scene back when I was a chain smoker trying periodically to quit. Ironically, I think I would have definitely tried them at least once, more if I found them to be satisfying. I did not know then what I know now, and on top of that, the whole landscape has changed a great deal. Back then, when I was a chain-smoking 20-year-old, there were no medical treatments available for quitting smoking, the early medical trials on the efficacy of nicotine replacement therapy were just beginning. Today, we now have a variety of cessation treatments which can be tailored to a wide variety of individual circumstances. These treatments have been rigorously studied so we know their success rates, and they have come down in price so that they are now more affordable than smoking. This is even more important as the cost of a pack of cigarettes has risen most recently by the increase in the federal excise tax. This price increase alone is likely to lead to millions of smokers attempting to quit and a million actually succeeding.

So where do e-cigarettes fit in? The blogosphere is now filled with testimonials from people who perceive e-cigarettes to be meeting their needs. What could be the downside to this? Unfortunately e-cigarettes are unlikely to be a panacea and in fact, already their importation is being stopped at the border. Why? As of this writing, these products -- which have proliferated under a variety of brand names and forms -- have not been subjected to rigorous testing with regard to their safety or efficacy.

These products ought to come under FDA authority for two key reasons. First, the FDA is in the position to determine whether the product is safe for its users, for those who breathe the second hand fumes created by its use and for children who might be attracted to and ingest the nicotine delivery vials flavored with apple, banana and vanilla (www.puresmoker.com) or cherry, mint-chocolate and strawberry (www.johnsoncreeksmokejuice.com). Second, only clinical trials can determine whether these products lead to cessation success. Many of the products claim to not have cessation as a goal in what I believe is a thinly veiled effort to try to escape regulation as a nicotine delivery device.

What are the problems with these products beyond the fact that we do not know whether they are safe or work? In the real world, they could produce some pretty ugly consequences. There is every reason to believe they could rapidly become a gateway smoking product for kids and teens and in fact many companies already offer non-nicotine versions (which presumably would not come under FDA authority). The online marketing offers more youth-enticing flavors like bubble gum. Yes, bubble gum.

Then there are two other big downsides. People who intended to really quit instead substitute e-cigarettes in all the places they now cannot smoke and therefore never get around to really quitting and then there are the people who have quit for years but just cannot resist trying the new “safe” product out and before you know it they are hooked again on the real thing.

Stay tuned for what the FDA does.