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The following is a statement by Campaign for Tobacco-Free Kids President Matthew L. Meyers:

The government's report today that adult smoking declines have stalled since 2004 is an urgent warning to elected officials that it is premature to declare victory over tobacco and much more must be done to continue reducing tobacco use, which remains the number one preventable cause of death in the United States.

According to the Centers for Disease Control and Prevention, the adult smoking rate in 2008 was 20.6 percent - essentially unchanged since 2004, when 20.9 percent smoked. In fact, the 2008 survey found a small but disturbing uptick in the percentage of smokers, from 19.8 percent in 2007. While the CDC said this increase was not statistically significant, it is the first increase in the adult smoking rate since 1994.

There is no question that we know how to significantly reduce tobacco use, as demonstrated by sharp reductions in adult smoking over the past several decades and a remarkable 45 percent reduction in high school smoking since 1997 (from a peak of 36.4 percent to 20 percent in 2007). But it is also clear from the recent stall in progress that elected officials at all levels must redouble efforts to implement scientifically proven strategies that prevent kids from smoking, help smokers quit and protect everyone from secondhand smoke. The challenge today is to resist complacency and finally fight tobacco use with the political will and the resources that match the scope of the problem.

Congress and President Obama have taken major strides this year by approving a 62-cent increase in the federal cigarette tax and enacting the new law granting the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products and marketing. The 2008 data released today does not reflect the impact of the federal cigarette tax increase, which took effect on April 1 of this year. There is evidence that the cigarette tax increase has already had a significant impact. Cigarette manufacturers reported a 10 percent decline in cigarette sales in the third quarter of this year, and calls by smokers to smoking cessation quitlines increased dramatically following the tax increase.

However, there is much more that must be done at all levels of government:

• The pending health care reform legislation presents Congress with an immediate opportunity for action. It is vital that health care reform include robust funding for community-based prevention initiatives, including tobacco prevention and cessation, that prevent costly diseases. Congress should also require that private and public insurance plans, including Medicaid, cover tobacco cessation services for all beneficiaries. Today's report revealed that almost half of current smokers tried to quit in the past year but were unable to do so successfully. Providing evidence-based interventions will help them succeed. The House-passed health care reform bill achieves these goals, and the Senate bill should as well. With these actions, health care reform can be the first step toward putting in place a national campaign to prevent children from starting to smoke and help smokers quit.
• States must invigorate their efforts to implement three proven strategies to reduce tobacco use: higher tobacco taxes, smoke-free workplace laws and well-funded tobacco prevention and cessation programs. Most states have woefully underfunded their tobacco prevention programs, and in the past year, many have cut them substantially due to fiscal crises. Rather than take these backward steps, states should hike tobacco taxes to help fill budget gaps and use some of the revenue to fund tobacco prevention and cessation programs.
  

Why have smoking declines stalled in recent years? The CDC and other experts have cited several factors, including deep discounts used by tobacco companies to offset tax increases, significant increases in overall tobacco marketing since the 1998 state tobacco settlement and cuts to state tobacco prevention and cessation programs.

It's really very simple. When we increase tobacco prices and fund tobacco prevention and cessation programs, smoking rates go down. When prices stay flat and programs are cut, rates go up. Between 1997 and 2004, the average real (inflation-adjusted) retail price of a pack of cigarettes increased by 63 percent, while adult smoking declined by 15.3 percent. Between 2004 and 2008, the real price of cigarettes increased by just 2 percent, while adult smoking declined by just 1.4 percent (source of price data: The Tax Burden on Tobacco, 2008). Likewise, studies have shown a dose-response relationship between spending on tobacco prevention and cessation programs and both youth and adult smoking declines.

Tobacco use causes more than 400,000 preventable deaths each year and costs the nation nearly $200 billion in health expenditures and lost productivity. The cost of tobacco use in health, lives and dollars is too steep to allow backsliding. We know what works to reduce tobacco use among both youths and adults. What's needed is the political will to implement these solutions as aggressively as the tobacco industry promotes its deadly products.

The CDC report, published in the November 13, 2009, issue of the CDC Journal Morbidity and Mortality Weekly Report, can be found at www.cdc.gov/mmwr.

SOURCE Campaign for Tobacco-Free Kids

The following is a statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids:

A landmark report released today by the Institute of Medicine provides powerful new evidence that elected officials have no excuse for failing to enact comprehensive smoke-free workplace laws. The IOM report concludes smoke-free laws reduce the number of heart attacks and save lives. The report also confirms that there is conclusive scientific evidence that secondhand smoke causes heart disease, including heart attacks, and finds there is compelling evidence that even relatively brief exposure to secondhand smoke can lead to a heart attack.

These powerful conclusions, reached by one of the most prestigious scientific authorities in the United States, send a loud and clear message to elected officials across the U.S. and worldwide: No excuses, no half-measures. It's time to protect everyone's right to breathe clean air by enacting comprehensive smoke-free laws that include all workplaces and public places, including restaurants and bars. There should be no exceptions or loopholes. No one should have to put themselves at risk of a heart attack, lung cancer or the other serious diseases caused by secondhand smoke in order to earn a paycheck or enjoy a night out.

In the United States, 27 states, the District of Columbia and Puerto Rico have enacted smoke-free laws that include restaurants and bars. The new report should spur the remaining 23 states to enact comprehensive laws that include all workplaces, restaurants and bars (and all states to eliminate any exceptions that remain in their laws). This report should also spur countries around the world to enact comprehensive smoke-free laws in compliance with the Framework Convention on Tobacco Control, the international tobacco control treaty ratified by 167 countries.

Even before this IOM report, there was already conclusive evidence that secondhand smoke causes death and disease, while smoke-free laws protect health and save lives. As the U.S. Surgeon General stated in issuing a groundbreaking report on secondhand smoke in June 2006, "The debate is over. The science is clear: Secondhand smoke is not a mere annoyance but a serious health hazard that causes premature death and disease in children and nonsmoking adults."

Secondhand smoke contains more than 4,000 chemicals, including at least 69 carcinogens. The Surgeon General found that secondhand smoke is a proven cause of lung cancer, heart disease, serious respiratory illnesses such as bronchitis, low birth weight and sudden infant death syndrome. The Surgeon General also found that secondhand smoke is responsible for tens of thousands of deaths in the U.S. each year, there is no safe level of exposure and smoke-free laws protect health without harming business.

The IOM's conclusions that smoke-free laws prevent heart attacks and that even short-term exposure to secondhand smoke can lead to a heart attack add significantly to the Surgeon General's report. The IOM report was requested by the Centers for Disease Control and Prevention (CDC) in the wake of a growing number of studies in smoke-free localities, states and countries that found reductions in heart attack rates after smoke-free laws are implemented. After reviewing 11 such studies in the United States, Canada, Scotland and Italy and a multitude of other scientific studies examining the relationship between secondhand smoke and cardiovascular disease, an IOM committee of scientific experts reached the following conclusions:

• "The committee concludes that there is a causal relationship between smoking bans and decreases in acute coronary events."
• "The evidence reviewed by the committee is consistent with a causal relationship between secondhand-smoke exposure and acute coronary events, such as acute MI (myocardial infarction)."
• "The committee concludes that it is biologically plausible for a relatively brief exposure to secondhand smoke to precipitate an acute coronary event." According to the report, experimental studies have found that secondhand smoke exposure causes adverse changes in the cardiovascular system that increase the risk of a heart attack.
  

In the U.S., 27 states, Washington, D.C., and Puerto Rico have passed smoke-free laws that cover restaurants and bars. The states are: Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina (Jan. 2, 2010), Ohio, Oregon, Rhode Island, South Dakota (on hold pending resolution of litigation), Utah, Vermont, Washington, and Wisconsin (July 5, 2010).

Internationally, a growing number of countries have enacted strong, nationwide smoke-free laws. These include Bermuda, Bhutan, Colombia, Djibouti, Iceland, Ireland, Lithuania, New Zealand, Norway, Panama, Turkey, the United Kingdom, and Uruguay. Most Canadian provinces/territories and Australian states/territories have also enacted such laws.

The Institute of Medicine is part of the U.S. National Academy of Sciences. The report and related materials can be found at www.iom.edu.

SOURCE Campaign for Tobacco-Free Kids

For the first time, researchers at Fred Hutchinson Cancer Research Center have demonstrated that it is possible to successfully recruit and retain a large number of adolescent smokers from the general population into a smoking intervention study and, through personalized, proactive telephone counseling, significantly impact rates of six-month continuous quitting. These findings, by Arthur V. Peterson Jr., Ph.D., Kathleen A. Kealey and colleagues, are reported in a pair of papers in the Oct. 12 "Advance Access" online edition of the Journal of the National Cancer Institute.

"When this study started, despite decades of research and dozens of intervention trials, there was no proven way to reach teens from the general population and recruit them into smoking cessation programs, and there was no proven way to help these teens quit," said Peterson, a member of the Hutchinson Center's Public Health Sciences Division and lead author of the paper that reported the results of the Hutchinson Study of High School Smoking, the largest randomized trial of teen smoking cessation ever conducted.

The trial, funded by the National Institutes of Health, involved 2,151 teenage smokers from 50 high schools in Washington. Half of the schools were randomly assigned to the experimental intervention; teens in these schools were invited to take part in confidential, personalized telephone counseling designed to help motivate them to quit. The remaining 25 schools served as a comparison group; teen smokers from these schools did not participate in the telephone intervention. The study also included 745 nonsmokers to ensure that contacting students for participation in the trial would not reveal a participant's smoking status.

Study recruitment was robust; in the experimental group 65.3 percent of the smokers were eligible and participated in the telephone intervention. Recruitment took place in their junior year and the counseling intervention took place during their senior year. "The literature says it is very difficult to recruit kids to teen smoking programs. People have tried. The field has encountered great obstacles in recruiting teens to smoking cessation programs. And so we took that as a challenge," Peterson said.

The study found that a proactive strategy of reaching out to teens and offering them the opportunity to receive up to nine personalized, confidential telephone counseling sessions effectively helped many of them to kick the habit. In addition, by proactively identifying and recruiting teen smokers (with parental consent for those under age 18), two-thirds of all identified smokers participated in the telephone counseling and nearly half completed all of their scheduled counseling calls.

At the completion of the study, 21.8 percent of all smokers (daily and less than daily) in the counseling group had achieved continuous quitting for six months, as compared to 17.7 percent of those in the comparison group, a difference of 4 percent.

The intervention also impacted three-month, one-month and seven-day smoking abstinence, with differences between the counseling group and the comparison group of 3.3 percent, 6.8 percent and 7.5 percent, respectively. Notably, the one-month and seven-day quit rates among the smokers who received telephone counseling were roughly three times higher than those reported in nearly 50 previous adolescent smoking-cessation trials of a variety of interventions conducted over the past two decades.

"These results are critically important for supporting and stimulating our nation's search to find successful ways to help reduce smoking by teens and young adults," Peterson said.

An estimated 26.5 percent of high school seniors smoke monthly, and 13.6 percent smoke 10 or more cigarettes daily. Although nearly half of all current adolescent smokers report having tried to quit smoking in the past year, only about 4 percent per year succeed on their own. In addition, young adults ages 18 to 24 have the highest smoking rates in the U.S., ranging between 27 percent and 40 percent, depending on geographic region and socioeconomic status.

The telephone counseling intervention was based on the premise that smokers need to believe it is important to quit, have confidence they can quit and have the knowledge and skills needed to be successful with quitting. Therefore, the intervention integrated two types of counseling: motivational interviewing, which emphasizes building motivation and confidence for quitting, and cognitive behavioral skills training, which gives smokers the tools they need to learn how to quit.

Motivational interviewing, first described in the early '80s by William R. Miller, Ph.D., as a way to help treat problem drinkers, enhances a person's motivation to change by exploring and resolving one's ambivalence about change. In this study, the technique was used to explore and resolve the participants' ambivalence about smoking and quitting, and to mobilize their inner resources to trigger a decision to quit.

"Motivational interviewing is very caring, nonjudgmental and respectful. It is non-confrontational. A counselor would never say, 'I want you to quit smoking.' Instead the counselor would ask what the behavior means to the participant. What do they like about it? What don't they like about it?" explained Kealey, first author of the companion paper, which describes in detail the design and implementation of the telephone counseling intervention.

In motivational interviewing, the counselor would use reflective statements to repeat the participant's own words back to him or her. For example: "So, it sounds to me like you smoke because it helps you to relax when you're under stress. But on the other hand, you said that you really don't like the way it smells, and that it's really expensive. So what do you make of that?"

"In the end, it is the smoker's own reasons and desire to quit that motivate the quit attempt," said Kealey, project manager for the study.

Cognitive behavioral skills training seeks to help people build skills for quitting and preventing relapse through counseling strategies that emphasize practical tools, such as self-talk strategies, ways to cope with stress and smoking triggers, and collaborating on a plan for quitting. "While motivational interviewing increases a person's motivation to quit, cognitive behavioral skills training gives them the resources and the confidence they need to be successful," Kealey said.

Adolescent smoking cessation studies conducted in the past 20 years have been largely unsuccessful in getting teens to quit. These studies have identified significant challenges. To date, only two other randomized controlled trials - with smaller numbers of teen smokers than the Hutchinson Study and conducted in medical settings - have shown promise in achieving significant teen quit rates.

So what makes the Hutchinson Study so effective? The researchers hypothesize that the reason is threefold:

The intervention was proactive, reaching out and engaging teens - "Past research has shown that, for a multitude of reasons, many teen smokers do not seek out help with quitting. However, our study demonstrates that if we reach out to teens, without pressuring them to quit, many will talk to counselors about their smoking and some of those teens will decide to quit," Peterson said.

The counseling was offered by telephone - "This allowed for private, confidential, one-to-one counseling and allowed the counselors to explore and focus on issues specific to the individual smoker," he said. Telephone counseling also gave teens control over the timing and length of the counseling sessions.

The counselors used motivational interviewing techniques in all communications with the teens - "It seemed quite appropriate for us to test this deferential strategy in youth because teens, in particular, don't want to be told what to do," Peterson said. "Our goal was to put them in the driver's seat."

So even though teens tend not to seek help for quitting smoking, this study indicates that they are more likely to succeed with quitting if they have help. "An important message from this study for teens and young adult smokers - really for all smokers - is that personalized telephone counseling can help one be successful with quitting smoking," Peterson said. Such help is available through the nation's network of quit lines, such as 1-800-QUIT-NOW offered through the Washington State Department of Health.

The National Cancer Institute funded the study, which also involved investigators at Group Health Research Institute in Seattle.

At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of world-renowned scientists and humanitarians work together to prevent, diagnose and treat cancer, HIV/AIDS and other diseases.

A new study from The Joint Commission projects that a majority of U.S. hospitals will have a smoke-free campus by the end of 2009. The study, "The Adoption of Smoke-Free Hospital Campuses in the United States," appears in the latest online issue of Tobacco Control, a British Medical Journal Group publication.

By February 2008, more than 45 percent of U.S. hospitals had adopted a smoke-free campus policy -- up from approximately three percent in 1992 when The Joint Commission first introduced standards requiring accredited hospitals to prohibit smoking within the hospital; an additional 15 percent of hospitals reported actively pursuing the adoption of a smoke-free campus policy. The study reveals that non-teaching and non-profit hospitals were more likely to have smoke-free campus policies, and private, non-profit hospitals were three times as likely as for-profits to have a smoke-free campus policy. There was little relationship, however, between the adoption of smoke-free campus policies and the rate at which hospitals provided smoking cessation counseling to their patients.

"From a public health perspective, the benefits of stricter anti-smoking policies are well established," says Scott Williams, Psy.D., associate director, Department of Health Services Research, The Joint Commission. "This study represents the first systematic evaluation of hospitals that have or have not adopted these policies." To download a podcast about the study, visit http://www.jointcommission.org/NewsRoom/Podcasts/smokefree_podcast.htm.

The study was conducted to determine the national prevalence of smoke-free hospital campus policies and the relationship between these policies and performance on nationally-standardized measures for smoking cessation counseling in U.S. hospitals. More than 1,900 Joint Commission-accredited hospitals responded to a survey assessing current smoking policies and future plans. Smoking cessation counseling rates were assessed through nationally-standardized measures. To date, little has been known about smoke-free policy prevalence and its impact. To view the study's abstract, visit http://tobaccocontrol.bmj.com/onlinefirst.dtl.

The research was supported through grants from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation and the Flight Attendants Medical Research Institute. It was conducted in partnership with researchers from the Henry Ford Health System's Center for Health Promotion and Disease Prevention.

Cigarette smoking is the leading preventable cause of death in America, accounting for more than 440,000 deaths each year, according to the U.S. Centers for Disease Control and Prevention (CDC). Cigarette smokers have a higher risk of developing fatty buildups in arteries, several types of cancer and chronic obstructive pulmonary disease (COPD).

Source: The Joint Commission

It's common knowledge that smoking raises risks of lung cancer. And yet researchers haven't known whether continued smoking by lung cancer patients would increase the risk of the cancer's spread.

Researchers at West Virginia University - studying the relationship between death rates from lung cancer and how much a person smoked - have found that smoking intensity in fact predicts how the disease will progress.

Patients who smoked two packs a day had a 58 percent higher risk of their lung cancers returning or spreading compared with nonsmoking patients.

Smoking intensity is one of only two factors found to predict lung-cancer mortality, according to the study published in the May issue of the journal Lung Cancer. The other factor is the stage of the cancer when diagnosed. Almost 350 patients with non-small cell lung cancer were studied.

Males older than age 60 were found to be the heaviest smokers at the time of diagnosis. Patients who smoked more than 61 packs a year had the greatest risk of their cancers recurring, and their survival times were shortest. They were 41 percent more likely to die from lung cancer than patients who smoked less.

"This study is important because lung cancer causes more deaths than any other type of cancer," said lead investigator Nancy L. Guo, Ph.D., a researcher with the Mary Babb Randolph Cancer Center.

"Because five-year survival rates of patients with non-small cell lung cancer are only about 15 percent, it's useful to know which patients are most likely to have their tumors come back," she said. "Our study showed that those who smoked more than 61 packs a year are more likely to develop tumor recurrence and should be considered for more aggressive therapy."

Chemotherapy drugs could be offered to prevent recurrence and spread of tumors, the authors said. And the heaviest smokers might also be targeted for measures to help them quit smoking.

Patients older than age 60 smoked, on average, 164 packs a year. Males smoked 189 packs a year compared with females' average of 112.

Patients with stage 3 tumors smoked an average of 198 packs a year.

The study is titled "Impact and interactions between smoking and traditional prognostic factors in lung cancer progression."

SOURCE West Virginia University Health Sciences Center

An important study presented Thursday at a scientific conference in Dublin, Ireland, provides powerful new evidence that U.S. smokers' risk of developing lung cancer has dramatically and progressively increased over the past four decades. In fact, cigarettes smoked today in the United States may double the risk of lung cancer compared to cigarettes smoked 40 years ago. The study also concludes that changes in cigarette design are the likely cause of this increased lung cancer risk and that regulation of tobacco products could significantly reduce lung cancer rates. The study concludes: "These data suggest that up to one half of current lung cancer occurrence may be attributable to changes in cigarette design and correspondingly that current lung cancer rates might be reduced by up to 50% through regulatory control of cigarette design and composition."

The study findings were presented at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SRNT-Europe in Dublin. The study was conducted by researchers David Burns and Christy Anderson of the University of California-San Diego School of Medicine. Dr. Burns is a well-known tobacco control scientist who has served as author, editor or senior reviewer of each of the U.S. Surgeon General reports on tobacco since 1975. He has also edited a series of tobacco control monographs for the National Cancer Institute and is a member of the World Health Organization Study Group on Tobacco Product Regulation.

This study provides some of the strongest evidence to date that how cigarettes are designed and manufactured has a large impact on the amount of death and disease that they cause, and conversely, that effective regulation of tobacco products can reduce disease and save many lives. Lung cancer caused by smoking kills more than 125,000 Americans each year. Preventing half these deaths would save 62,500 lives a year. Tobacco use also causes many other forms of cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD) and numerous other serious illnesses that harm virtually every organ in the human body. It is the overall leading cause of preventable death in the United States, killing more than 400,000 Americans and costing the nation $96 billion in health care bills each year.

This study demonstrates why it is critical that Congress quickly enact legislation granting the U.S. Food and Drug Administration (FDA) regulatory authority over tobacco products. Because no government agency has any authority to regulate tobacco products, tobacco companies currently have free reign over how they manufacture tobacco products and what they put in them. They can make changes that make their products more deadly or more addictive without the knowledge of the public or any government agency. Under the pending legislation, for the first time, a science-based regulatory agency, the FDA, would gain authority to regulate the manufacturing, marketing and sale of tobacco products.

Among other things, this legislation would grant the FDA authority to require changes in the design and contents of tobacco products to protect public health, such as the reduction or elimination of harmful chemicals. The bill would also require tobacco companies to disclose the contents of their products, research about their products and changes to their products. They could no longer secretly change their products. The bill would also crack down on tobacco marketing and sales to kids, require bigger and stronger health warnings, strictly regulate health claims about tobacco products and take other steps to protect public health. These regulations would be funded by a user fee paid by tobacco companies.

The House of Representatives approved this legislation on April 2 by a strong, bipartisan vote of 298 to 112. The new study makes it even more urgent that the Senate quickly take up and pass this long-overdue legislation and resist all efforts to weaken it. President Obama has expressed his strong support for the legislation.

For the study, researchers examined lung cancer rates as well as changes in the design and smoke composition of cigarettes in the United States over the past four decades and then compared U.S. and Australian lung cancer rates over time. From this analysis, the researchers reached four major conclusions:

1) The study provides new evidence that among U.S. smokers the risk of developing lung cancer has progressively increased over the past four decades, controlling for amount and duration of smoking.

2) This increase in the risk of lung cancer among smokers coincides with a change in cigarette design over the past five decades. The study suggests that up to one half of current lung cancer occurrence may be attributable to changes in cigarette design.

3) This increase in risk of smoking over time is not evident for squamous cell carcinoma (one type of lung cancer) of the lung and is driven largely by changes in the risk of adenocarcinoma (another type of lung cancer). The increase in adenocarcinoma as a proportion of all lung cancers is much less evident in Australia. This suggests that the difference may be caused by a difference in the cigarettes used in the two countries. One major known difference in cigarettes between the two countries is the lower levels of tobacco specific nitrosamines (a lung specific carcinogen for adenocarcinoma) in Australian cigarettes. The increased risk of adenocarcinoma in the U.S. may be explained by the higher levels of tobacco specific nitrosamines in U.S. cigarettes.

4) These observations strongly support the need for regulation of tobacco, since technology exists to lower nitrosamines in tobacco, and that current lung cancer rates might be reduced by up to 50% through regulatory control of cigarette design and composition.

SOURCE Campaign for Tobacco-Free Kids