By Alan Mozes / HealthDay

Tobacco treaty unratified in U.S.

Pact signed in 2004, but never sent to Senate

More than 13 months ago, the United States signed an international tobacco treaty designed to tighten control of cigarette advertising and consumption worldwide, and President Bush said he wanted the Senate to ratify it.

But the treaty -- already in effect in 70 nations from Britain to India to Mexico -- today remains unratified and little discussed in the United States.

It was May 2004 when then-Health and Human Services Secretary Tommy G. Thompson signed the treaty for the United States and said, "I'm hopeful we can get this treaty to pass on a bipartisan basis -- this year." It then disappeared into the State Department and so far has not reappeared.

"The treaty is still under interagency review," State Department spokesman Edgar Vasquez said, adding that it is unclear when the review will be completed. "No decision has been made."

The treaty, negotiated in Geneva over three years, calls for reducing tobacco consumption through various measures, including substantially increasing the size of safety warnings on packaging, strictly limiting cigarette advertising, and moving toward smoke-free workplaces and public areas. It also works to reduce cigarette smuggling -- a priority for tobacco companies.

The Bush administration has been slow to act on six other treaties that it has signed but not sent to the Senate for ratification, but inaction on the tobacco treaty poses unique problems.

Only a spectator?
Long the world leader in tobacco control, the United States now runs the risk of being a spectator when ratified treaty members meet early next year to establish a permanent operating structure and to set priorities for action. If the United States is not a voting treaty member, public health officials say, American views on issues including cigarette advertising, smuggling and secondhand smoke will inevitably be less persuasive.

The organizational meeting will be convened by the World Health Organization and will begin to implement the principles and directives of the Framework Convention on Tobacco Control. All 168 signatories will be able to attend, but only nations that have ratified the treaty will be able to vote. To qualify as a voting member, the United States would have to ratify the treaty by late October or early November, WHO officials said.

"Those who have not ratified can participate as observers, but they'll have no vote and it's unclear how much of a voice," said Heather Selin, tobacco control adviser for WHO's Americas office in Washington. "This will be an important meeting and will get the treaty machinery to start rolling."

Public health advocates report that even without the United States, the invigorated tobacco-control movement has been surprisingly effective in motivating governments to implement potentially lifesaving initiatives.

The use of tobacco by smoking or chewing is the second-leading cause of preventable death worldwide -- after high blood pressure -- and kills almost 5 million people a year, WHO estimates.

The Bush administration has not publicly voiced concerns about the treaty, but neither has it shown any enthusiasm since it was signed.

Objections by tobacco companies
Some congressional officials say the administration doubts the treaty can win the two-thirds Senate majority needed for ratification, in large part because the two largest U.S. tobacco companies have objected to some of its provisions. Others say the administration is unwilling to displease the tobacco industry, which has long been a generous source of campaign funding.

Seth Moskowitz, a spokesman for R.J. Reynolds Tobacco Co., said his company has not taken a formal position on ratification, but it objects to treaty provisions that, it says, would restrict cigarette advertising and centralize and expand government authority over other aspects of the industry. "Some of the restrictions are things that could prevent us from competing effectively for the business of adult smokers," Moskowitz said.

Dawn Schneider, a spokeswoman for Altria Group, the parent of Philip Morris USA, said her company also has some concerns about the treaty -- especially possible restrictions on the sale of cigarettes in duty-free stores and an advertising ban in nations with constitutions that allow it.

But Schneider said Altria, unlike R.J. Reynolds, favors having the Food and Drug Administration regulate tobacco products and is using its influence in Congress to get a bill passed. "We believe the best and most effective way to implement [the goals of the treaty] is through FDA legislation," Schneider said.

It remains unclear how much support the treaty has in the Senate. Some senators, such as Richard Burr (R-N.C.), have been outspoken opponents. "Tobacco is an important agricultural product in our state, and anything that threatens the viability of tobacco farmers, he's opposed to it," said spokesman Douglas Heye.

But others have begun lobbying the administration to move the treaty forward.

‘Long delay’
"This long delay has been very discouraging to many senators," said Allison Dobson, spokeswoman for Sen. Tom Harkin (D-Iowa), who is drafting a letter to Bush calling for a prompt ratification vote. "Harkin believes the votes are there to ratify, but we're very concerned that the administration will end up siding with big tobacco again and not with public health," Dobson said.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the administration is forfeiting the United States' long-standing leadership on tobacco-control issues and faces the prospect of having other nations make decisions that will have a significant impact on U.S. consumers and companies.

"Unlike some of the environmental treaties, nobody can point to any provision of this treaty that would infringe on American autonomy or otherwise adversely affect other American rights. The question then is 'Why haven't we even sent the treaty up for ratification?' " he asked. "The only answer I can come up with is this: that the administration is listening to our least progressive tobacco companies who oppose the treaty. At one point, the administration considered the treaty worth signing. What happened?"

Govt goes back on tobacco ban

TIMES NEWS NETWORK[ WEDNESDAY, JULY 06, 2005 12:34:43 AM ]

NEW DELHI: After so much song and dance over the need to ban smoking on screen, the government has backtracked on imposing such a fiat and insisted that self-regulation by the industry is the best way to fight tobacco.
 

Study: Tobacco Firms Wooed Female Smokers

May 31, 2005 — Tobacco companies did elaborate research on women to figure out how to hook them on smoking even toying with the idea of chocolate-flavored cigarettes that would curb appetite, according to a new analysis.

Researchers at Harvard University's School of Public Health said they examined more than 7 million documents some dating back to 1969, others as recent as 2000 for new details about the industry's efforts to lure more women smokers.

Carrie Carpenter, the study's lead author, said companies' research went far beyond a marketing or advertising campaign.

"They did so much research in such a sophisticated way," she said. "Women should know how far the tobacco industry went to exploit them."

The report, published in the June issue of the journal Addiction, says tobacco companies looked for ways to modify their cigarettes to give women the illusion they could puff their way into a better life.

One of the documents, a 1987 internal report from Philip Morris, extolled the virtues of making a longer, slimmer cigarette that offered the false promise of a "healthier" product.

"Most smokers have little notion of their brand's tar and nicotine levels," the report states. "Perception is more important than reality, and in this case the perception is of reduced tobacco consumption."

A Philip Morris spokesman declined to comment on the report, saying the company hasn't had a chance to fully review it.

The Harvard researchers spent more than a year sifting through an online database of internal documents made public following the 1998 settlement between tobacco companies and 46 states.

Carpenter said they found at least 320 documents that focused on women's smoking patterns, including a 1982 report from British-American Tobacco Co. that said women buy cigarettes to help them "cope with neuroticism."

"We can safely conclude that the strength of cigarettes that are purchased by women is related to their degree of neuroticism," the report stated.

Other internal studies showed that companies explored adding appetite suppressants to cigarettes.

In 1980, for instance, R.J. Reynolds Co. proposed creating a cigarette with a "unique flavor that decreases a smoker's appetite, including brandy, chocolate, chocolate mint, cinnamon, spearmint and honey."

However, researchers didn't find any evidence they followed through with that idea. Officials at R.J. Reynolds didn't respond to requests for comment.

Paul Bloom, a marketing professor in the business school at the University of North Carolina at Chapel Hill, noted that cigarettes aren't the only "sin product" marketed specifically to women.

"For a long time, they just marketed beer to men. Then they discovered women would drink it, too," Bloom said. "Now binge drinking on campus is just as big a problem with women as it is with men."

Worldwide smoking rates among women are expected to increase 20 percent by 2025, "driven by the growth of female markets in developing countries," while men's smoking rates are steadily declining, the Harvard report says.

Jack Henningfield, a professor of behavioral biology at the Johns Hopkins University School of Medicine, said he hopes the report serves as a "call to action" for government officials to focus their anti-smoking efforts on women, particularly in developing countries.

"It's a time bomb," said Henningfield, director of the Innovators Combating Substance Abuse Program at Johns Hopkins. "They've got to act now to prevent the time bomb from exploding."

Carpenter said there is no evidence in the trove of documents that suggests tobacco companies have stopped targeting women.

"Without regulation from government agencies, we don't know what they're doing today," she added.

The Harvard research project was funded in part by the National Cancer Institute.

Saturday January 29, 05:20 PM

Anti-Tobacco Advertising Associated With Reduced Smoking

Newswise — Reduced cigarette smoking and more favorable anti-smoking attitudes were found among youth exposed to state-sponsored anti-tobacco advertising, according to a study in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The U.S. population has been exposed to an increasing number and variety of televised anti-tobacco advertisements since the early 1990s, according to background information in the article. However, given recent state budget crises and other political influences, many states have severely cut their anti-tobacco campaigns. Despite early evidence suggesting that state-sponsored anti-tobacco media campaigns may reduce adult smoking, few studies have explored their effect on youth.

Sherry Emery, Ph.D., from the University of Illinois at Chicago, and colleagues examined the association between exposure to state anti-tobacco advertising and youth smoking-related beliefs and behaviors. The researchers used targeted ratings point (TRPs) to assess the ratings of an advertisement among U.S. teen audiences. An ad with 80 TRPs per month is estimated to have been seen an average of one time by 80 percent of this age group. This information was combined with survey data from school-based samples of 51,085 students in the contiguous 48 states.

The researchers found that among survey respondents, 14 percent had an average of zero exposures to state-sponsored advertisements in the last four months, 65 percent of the students had an average exposure greater than zero, but less than one, and 21 percent had an average exposure of one or more state-sponsored anti-tobacco advertisements. Students in states with a TRP measure of one or higher were significantly less likely to report having smoked in the past 30 days (18.6 percent) compared with those in markets with no exposure to anti-tobacco advertisements (26.7 percent). Those with one or more state TRPs were more likely to perceive great harm from smoking one or more packs of cigarettes per day (72.1 percent vs. 65.1 percent). Also, students living in areas with an average exposure of at least one state-sponsored anti-tobacco advertisement were more likely to say that they believed they would definitely not be smoking in five years (64 percent vs. 55.3 percent).

“Our analyses suggest that state-sponsored anti-tobacco media campaigns were associated with more favorable antismoking attitudes and beliefs among youth and reduced youth smoking,” the authors write. “The strong associations between antismoking attitudes and beliefs, as well as reduced smoking, among students with a state TRP measure of at least one suggest that it is important to maintain a minimal mean exposure level of at least one cumulative state-sponsored anti-tobacco ad per four-month period for the general teen viewing audience.”

(Arch Pediatr Adolesc Med. 2005; 159: 639-645. Available pre-embargo to the media at http://www.jama.com.)

Editor’s Note: This study was funded by grants from the State and Community Tobacco Control Initiative of the National Cancer Institute, Bethesda, Md., the National Institute on Drug Abuse, Bethesda, Md., and from the Robert Wood Johnson Foundation, Princeton, N.J.

State Tobacco Counteradvertising and Adolescents

In an accompanying editorial, David E. Nelson, M.D., M.P.H., from the Centers for Disease Control and Prevention, Atlanta, writes about state-sponsored anti-tobacco advertising, “Despite tremendous strides in reducing youth tobacco use, and substantial research demonstrating that counteradvertising and other components of comprehensive programs are effective in reducing prevalence, as well as being cost-effective, it is obvious that tobacco prevention activities are not institutionalized and that state program expenditures in this area are viewed by many as discretionary.”

“Given the magnitude of the tobacco problem, and the fact that most regular smokers begin by age 18 years, preventing tobacco use among children and adolescents is one of the most important pediatric successes imaginable,” he writes. “Pediatricians and other health care providers, either individually or collectively through professional or other organizations, need to actively support sustaining state comprehensive tobacco control and prevention activities that include counteradvertising. Failing to do so could mean losing the hard-won gains achieved in tobacco prevention over the past several years, and unfortunately, that would be deadly for many people.”

(Arch Pediatr Adolesc Med. 2005; 159: 685-687. Available pre-embargo to the media at http://www.jama.com.)

A study on passive smoking has found children who are exposed to tobacco smoke every day are three-and-a-half times more likely to develop lung cancer than children who are not exposed.

The study involved more than 300,000 people throughout Europe, and is one of the largest ever undertaken on passive smoking.

Professor Paolo Vineis, from the Imperial College of London, says the study confirms previous research.

"There is a large amount of evidence about the association between environmental tobacco smoke and lung cancer," he said.

"In fact in 2002 there was a working group from the International Agency for Research on Cancer, which established that there is sufficient evidence concerning this association.

"There are more than 50 case control studies and a few prospective studies, so the association is well established."

Professor Vineis says the duration for which children are exposed to smoke is the biggest factor in their risk of developing lung cancer.

"The information we collected about childhood exposure tells us that these people were exposed for a very long time, and that's the main issue," he said.

"They started being exposed in childhood and that's what really counts in terms of cumulative risk of lung cancer."

Professor Vineis says it is not clear if children are more vulnerable to the effects of smoke or if the risk of developing cancer is related just to the length of time children are exposed to smoke.

"However, I must say that there is experimental evidence in animals showing that animals at a young age are in fact more susceptible to carcinogens," he said.

Professor Vineis hopes that the study will make some difference.

"People might be more worried about the presence of environmental tobacco smoke in the environment where they work and live," he said.

"In fact, the knowledge of that long-term exposure is important, probably more than the concentration of smoke is quite important."

The study, which has been published in the British Medical Journal has also found that reformed smokers are more susceptible to the effects of passive smoking.

Smokeless Tobacco Presents Heart Risk
6/27/2005

Some people chew tobacco thinking it is less unhealthy than smoking, but new research shows that snuff and chewing tobacco appear to increase the risk of heart disease, HealthDay News reported June 24.

Male smokeless-tobacco users were 20 percent more likely to die of heart disease than nonusers, according to researchers from the American Cancer Society who examined health surveys of more than 1 million American men, including about 10,000 smokeless-tobacco users.

Previous research had shown that smokeless-tobacco users were less likely than smokers to have cardiovascular problems. Lead researcher Jane Henley said that while more research may be needed, it is possible that smokeless tobacco increases the heart rate and stimulates clotting, which can block blood flow.

Henley said that the study should discourage people from using smokeless tobacco as a bridge between smoking and quitting. "We should be encouraging smokers who want to quit to use nicotine-replacement and other safe therapies," she said.

The study was published in the June 2005 issue of the journal Cancer Causes and Control.

India to require pictures of smoking-related diseases on cigarette packs

NEW DELHI (AFP) - India's health ministry will introduce a law forcing tobacco companies to carry pictures of smoking-related diseases on cigarette packs as a health warning, according to a news report

The law is likely to be introduced in parliament within three months, Health Minister Anbumani Ramadoss was quoted as saying by the Hindu newspaper.

"We are going through the models, pictures and images that the tobacco companies will have to put on their packs. I have no hesitation in adding that we are going to chose some of the most horrific, gory images," he said.

Singapore and Thailand currently carry pictures showing oral cancer and other smoking-related diseases on cigarette packs.

Earlier this month Ramadoss called for a ban on smoking scenes in movies and television.

The ban provoked widespread criticism from India's movie industry, Bollywood, which said it would have to edit thousands of films to comply with the ban. But the minister has refused to back down.

India, which accounts for one-sixth of tobacco illnesses worldwide, signed a a global anti-smoking treaty which took effect in March.

At least 2,200 people die daily from tobacco-related diseases in the country of more than one billion people.

Therapies to help tobacco addicts kick the habit

Therapies to help tobacco addicts kick the habit

Tobacco addiction is the leading preventable cause of death in India, accounting for over 800,000 deaths each year. A tobacco addict can improve his health and lengthen his life more, by quitting tobacco addiction along with other lifestyle changes like diet, exercise or stress management. Given the disastrous health hazards caused due to tobacco, anyone who's ever tried quitting knows it's easier said than done. This is because quitting can produce unpleasant withdrawal symptoms like depression, insomnia, irritability, difficulty concentrating, restlessness, anxiety, decreased heart rate, increased appetite, weight gain, and craving for nicotine.

Studies have shown that taking help of various therapies can help a tobacco addict avoid relapse of the addiction, and results in some of the highest long-term abstinence rates from tobacco. Quitting smoking or chewing of tobacco can be achieved successfully, provided the determination to quit is strong along with the involvement of different therapies.

Let us look at the various therapies for quitting tobacco addiction available today:

1. Nicotine Replacement Therapy (NRT)

Nicotine replacement therapy is a successful and an approved form of medication that can help quit smoking or chewing of tobacco. Nicotine gum is a popular form of NRT available as an FDA approved tobacco cessation aid. NRT gum (NuLife) —now in India, is available on doctor’s prescription. NRT gum delivers small but sustained levels of nicotine in the blood. Nicotine per se is not harmful. Sustained levels of nicotine are useful in quitting as nicotine levels are maintained in the blood and the craving for tobacco is reduced. Here, nicotine is provided but the uptake of nicotine by the body is not as quick as nicotine uptake observed in cigarettes or other forms of tobacco. Hence it’s easier to give up a NRT gum than it is to give up cigarettes and gutka. It is documented that tobacco cessation rates are increased three to four folds if NRT is used along with counseling and behavioral therapy and a strong determination to stop tobacco usage. NRT is also endorsed by leading medical organizations in the world, like the American Cancer Society.

2. Counseling and Behavioural Therapy

Counseling therapy involves the use of continued motivational techniques and support. Here, the doctor helps the tobacco addict move to the preparation stage to quit tobacco addiction, where plans are made for the initiation of therapies like NRT. The doctor or the counselor also helps him change his routine or behavior to avoid situations that increase the chances of failure. For example, if the morning ritual of a tobacco addict is drinking a cup of tea and smoking a cigarette, then that cup of tea can be had later or avoided during those first few weeks. Other means are finding alternative ways to reduce stress caused by quitting tobacco such as exercise, dancing or hot baths. Combined use of counseling, behavioural and drug therapies can dramatically improve the patient's chance of quitting smoking.

3. Yoga and meditation

Yoga is a form of relaxation and exercise that incorporates stretching, meditation, and knowledge of the body's full potential. Yoga helps relieve tension and stress and helps increase the strength and vitality of

physical and mental health. This helps a tobacco addict deal with the difficulty experienced during quitting tobacco.

Meditation calms nerves and allows one to think more clearly. Using the healing power of yoga along with involvement of other therapies helps quit tobacco addiction through an assertive behavior.

4. Support Therapy

Studies have shown that there is a better chance of being successful in quitting tobacco addiction if help is taken in the form of social support along with drug therapies like NRT. One can get support from family, friends, and co-workers. One way is to ask them not to smoke around a tobacco addict or leave cigarettes out and to stop him from smoking or chewing gutka, incase of a relapse.

5. Hypnosis/ other alternative therapies

Hypnosis is a psychological technique that helps reframe thoughts and reshape the world of a person. Though hypnosis is not known to be of considerable benefit, psychiatrists consider this technique helpful as long as one is ready to take multiple tries and many sessions to succeed and finally quit smoking. One must of course, find a reputable skilled practitioner. Other therapies which work well with hypnosis include drug therapy like NRT, Reiki and acupuncture.

Health Benefits of quitting tobacco

•  
• Within 8 hours, carbon monoxide levels drop in the body and oxygen levels in blood return to normal
• Within 48 hours, the risk of heart attack decreases and sense of smell and taste improve
• Within 72 hours, lung capacity increases and breathing becomes easier
• Within 2 weeks to 3 months, blood circulation improves and lung function improves up to 30 percent
• Within 6 months, coughing, sinus congestion, fatigue and shortness of breath improve
• Within 1 year, the risk of a smoking-related heart attack is cut in half
• Within 10 years, the risk of lung cancer is cut in half
• Within 15 years, the risk of dying from a heart attack is equal to a person who never smoked
• Reduction in complications of pregnancy and improvement in chances of conceiving

Source: British Columbia Cancer Agency Care and Research.

A Holistic approach

A holistic method doesn't rely on one or two techniques; rather, it combines as many as possible and addresses the life of the entire person -body, mind, and spirit. Along with the involvement of different therapies, getting plenty of exercise, eating a vegetarian diet, trying a therapeutic fast and taking vitamins during the period when one is trying to quit tobacco also helps. While choosing potentially effective therapies helps achieve the goal of quitting tobacco addiction, the key is to find the right combination of treatments that will help boost the chance of success.

Dr Mohan Jagde

MS (ENT), MCh, FAIS, MBA, DHA, Fe WHO
Head of Department ENT, JJ Hospital, Head and neck cancer surgeon, JJ Hospital
Professor of ENT at JJ Hospital and Grant Medical College

Salman Khan supports ''No Tobacco'' campaign
May 20, 2005
 

Supporting the "No Tobacco" campaign, actor Salman Khan, has urged the Government to curb sale of tobocco and alcohol. "If these are so bad why does not the Government put an end to it. They have done it with drugs they can do it with these as well", he said while announcing a friendly cricket match between actors and doctors to be played on May 21, observed as "The World No Tobacco Day". "Though it appears stylish and cool to smoke on the screen and glossy magazine it is uncool to do so", the actor said while reiterating that he makes special efforts not to project himself as an actor who smokes on the screen. "I have just smoked in one film "Tere Naam", he said. Speaking on the occasion, Justice Y K Sapru of the Cancer Patients Aid Association, revealed that Salman had always supported the cause of cancer patients. The actor has also offered his bone marrow to treat an ailing patient, he said. On other occasions, the actor has participated in Rose Day programmes in aid of cancer patients. He has also organised donation worth lakhs of rupees from various celebrities in the film world. Among those present at the function were actors Ritesh Deshmukh, Sohail Khan, cricketer Vinod Kambli, and TV star Yash Tonk. Salman, later, distributed voice boxes to cancer patients.

New Cancer Drugs Fight Tumors Many Ways

May 13, 2005 — A new generation of experimental cancer drugs is poised to upstage current hotshots by attacking the multiple methods tumors use to grow and spread, instead of just one.

These drugs are like a repairman who brings an entire toolbox to a job instead of just a wrench or hammer. They go beyond current favored medicines like Herceptin, Avastin and Iressa, which have impressed scientists for their ability to precisely target cancer cells while leaving healthy cells alone.

At a cancer meeting Friday, doctors reported that one of Pfizer's new multitasking drugs shrank tumors in 40 percent of people with advanced kidney cancer. Current treatments do that in only about 1 out of 10 cases.

Some patients have been on the experimental drug for more than a year far longer than they'd been expected to live.

Kurt Bonham is one. The California accountant was only 49 when he was diagnosed with kidney cancer that had already spread to his lungs.

"I'd been given my death sentence," he said.

Now, 13 large masses in his lungs have been reduced to specks.

"If I can have five more years, I think that they can come up with something fandangled that will either cure the cancer or manage it," he said.

Doctors hope the new generation of cancer drugs will do just that by blocking cancer's multiple pathways, such as cutting off the blood supply to a tumor or jamming the "switchboard" it uses to send messages to grow and spread.

The Pfizer drug, so new that it's just called AG-013736 for now, attacks blood supply and one of the switchboard's main lines. Another Pfizer drug, Sutent, also takes this approach. Eleven studies testing it against various cancers will be presented at the meeting, held by the American Society of Clinical Oncology.

Amgen, AstraZeneca and Eli Lilly have multitasking drugs in early stages of development. So does Novartis Pharmaceuticals, but its drug, called PTK/ZK, disappointed in a study involving people with advanced colon cancer, doctors reported Friday.

Short-term Effects Of Spit Tobacco Suggest Long-term Health Risks

The study of 16 young men who were habitual spit tobacco users measured their responses 30 minutes after dipping snuff. These readings were compared with measurements from another session involving the same participants after they had used a placebo product that was similar in taste, color and texture but did not contain tobacco or nicotine. The study was randomized and double-blinded; neither the researchers nor the subjects were told when they were taking the placebo and when they were using the tobacco product.

After snuff use, heart rate increased by about 15 beats per minute (25 percent), systolic blood pressure went up by 12 mmHg (10 percent), and measurements of adrenalin in the bloodstream increased by more than 50 percent.

"These results suggest a very significant excitatory effect of substances contained in spit tobacco on the part of the nervous system regulating the heart and blood vessels," says Virend Somers, M.D., Ph.D., the Mayo Clinic cardiologist who led the study. "Although we did anticipate some increase in blood pressure, we were surprised at the magnitude of the increase, as well as the very striking increases in heart rate and plasma epinephrine, or adrenalin. We anticipated that since these individuals were young and healthy and were accustomed to using spit tobacco, that any responses that we measured would be blunted. This makes the degree of increases even more noteworthy."

Robert Wolk, M.D., Ph.D., lead author on this study, noted that these results have implications both for long-term users and for individuals with established heart disease.

"The degree of speeding up of heart rate and increase in blood pressure, as well the increase in adrenalin (epinephrine) levels, suggest that if similar changes occur in people with established heart disease, who use spit tobacco, there may be reason to expect adverse consequences," Dr. Wolk says.

"Dipping" is Rising

More than five million adults – and more than 750,000 adolescents – use smokeless tobacco in the United States. Snuff use is increasing, especially in young males who participate in athletics. Its cardiovascular effects are not as clear or well understood as those of cigarettes, partly because fewer studies have been done, and partly because many spit tobacco users are relatively young and the bad effects may not be apparent unless use continues for prolonged periods.

Blunting a Protective Mechanism

By placing electrodes into the sympathetic nerves of the participants, the researchers also obtained a window on the message from the brain to the blood vessels on a moment-by-moment basis.

Normally, when blood pressure is increased by an external substance, the body seeks to protect the cardiovascular system by decreasing heart rate and dilating the blood vessels. It does this by "shutting down" the sympathetic nervous system, so that heart rate is slower, and the widening of blood vessels starts to bring blood pressure down.

The researchers demonstrated this by giving another group of subjects an intravenous medication, phenylephrine, to raise blood pressure about as much as they saw when spit tobacco was used. In response, those subjects' heart rates decreased by more than 10 beats a minute and the activity of the sympathetic nervous system went down to very low levels.

"This is an example of how the body tries to protect itself from the higher blood pressures," Dr. Somers explains. "However, when the blood pressure is raised by spit tobacco, the heart rate actually speeds up dramatically and there is no decrease in the sympathetic nervous system activity. This tells us that the normal protective mechanisms which help dampen down spikes in blood pressure are blunted when using spit tobacco.

"Spit tobacco is a very potent cause of acute increases in blood pressure, heart rate, and adrenalin levels," Dr. Somers concludes. "Since many athletes, who are already under a fair amount of stress in competitive situations, also use spit tobacco, the blood pressure and heart rate increases need to be recognized and understood. And since spit tobacco not only raises blood pressure but also blunts the body's normal defense response to blood pressure increases, long-term dipping would seem likely to increase the risk of cardiovascular disease."

Smoking bad for pets: insurer-(Yahoo News-13/09/2004)

Dogs living with smokers have a higher incidence of serious conditions such as asthma, nasal and sinus cancer and lung cancer than those who have non-smoking owners, a pet insurer in Britain says. Research carried out in the United States also showed that cats living in smoking households were twice as likely to develop certain forms of cancer, including lymphoma, Asda Pet Insurance said. 

"Many people don't realise that passive smoking can have a very harmful impact on pets in the home, with knock-on implications for vet bills," a spokesman said. The effects of passive smoking were greater on young animals because their lungs were smaller, their immune systems were less well-developed and they breathed faster, the insurer quoted veterinarians as saying.

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Ventilation in bars doesn't control health risk for hospitality workers-(Yahoo News-09/09/2004)

The level of cancer-causing particles is much higher in the air of smoke-filled bars and casinos than on truck-choked highways and city streets, according to the first published comparison of indoor air quality before and after smoke-free workplace legislation. The study, conducted in a casino, six bars and a pool hall in Wilmington, Delaware, is published in the September 2004 Journal of Occupational & Environmental Medicine.

"This research clearly shows that it is far worse for your health to be a bartender or casino dealer in a smoking-permitted establishment than it is to be a turnpike toll collector," says James L. Repace, MSc., the study's author. "These workers breathe an average of 90% cleaner air after a smoke-free workplace law." Repace, a health physicist, is visiting assistant clinical professor at Boston's Tufts University School of Medicine and a secondhand smoke consultant based in Bowie, Md. In 2002, Repace received a Robert Wood Johnson Foundation Innovators Combating Substance Abuse award for his ground-breaking work on the effects of secondhand smoke. Funds from the award helped make this study possible.

Repace assessed air quality in the eight hospitality venues on Friday evenings in November 2002 – before Delaware's smoking ban -- and again in January 2003, two months after the ban took effect. Using state-of-the art monitoring equipment, he measured respirable particulate air pollution (RSP) and particulate polycyclic aromatic hydrocarbons (PPAH), pollutants proven to increase risk of respiratory disease, cancer, heart disease and stroke. Repace's findings demonstrate the dramatic effect of Delaware's smoking ban: Except for residual chalk dust in the pool hall – at 17% of pre-ban levels -- air quality levels post-ban in all venues were indistinguishable from those measured out-of-doors.

Prior to the smoking ban, however, Repace found all eight venues to be heavily polluted. Indoor RSP levels averaged 20 times those in the outdoors and were 4.6 times higher than the level permissible under the U.S. Environmental Protection Agency's National Ambient Air Quality Standard (NAAQS). The hospitality workers were exposed to RSP levels 2.6 times higher than those Repace measured on diesel-exhaust polluted streets in Boston and on Interstate-95 in Delaware. Carcinogenic PPAH levels pre-ban were five times higher than outdoor levels in Wilmington, and exceeded those measured at an I-95 tollbooth at the heavily trafficked Baltimore Harbor Tunnel.

"Before the ban, secondhand smoke contributed 90% to 95% of the RSP air pollution in the studied venues, and 85% to 95% of the carcinogenic PPAH," says Repace. "This demonstrates conclusively that ventilation does not control the life-threatening pollutants inherent to a smoking environment. Only a smoke-free workplace law can protect the health of these workers." Few states have taken action to protect hospitality workers; only 14% of states have laws banning smoking in restaurants, bars, casinos and all other workplaces. According to the federal Agency for Toxic Substances and Disease Registry, people exposed to polycyclic aromatic hydrocarbons (PAHs) for prolonged periods can develop cancer. Ten carcinogenic particulate phase PAHs have been identified in tobacco smoke, representing one-sixth of all known tobacco smoke carcinogens.

Repace has conducted research on indoor air pollution from secondhand smoke for 28 years, and has published more than 60 scientific papers on the topic. Among his major accomplishments, in 1979 he initiated the Environmental Protection Agency's policy interest in indoor air pollution. In 1980 he identified secondhand smoke as a major source of indoor air pollution in a groundbreaking paper that received international scientific attention. Five years later, he estimated that 5,000 lung cancer deaths per year in the U.S. were caused by passive smoking, in a seminal study.

Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field. The program addresses problems related to alcohol, tobacco and illicit drugs, through education, advocacy, treatment and policy research and reform at the national, state and local levels. The Innovators program is run by a national program office at The Johns Hopkins University School of Medicine. 

The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol and illicit drugs. To this end, the Foundation supports scientifically valid, peer-reviewed research on the prevention and treatment of illegal and underage substance use, and the effects of substance abuse on the public's health and well-being. 

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Scientific research supports smoking bans-(Yahoo News-18/08/2004)

With the St. Paul City Council’s approval of a smoking ban in bars and restaurants, the council has acknowledged what the U.S. government concluded 18 years ago: Exposure to secondhand tobacco smoke — “involuntary smoking” — is a serious threat to nonsmokers’ health. In 1986, Surgeon General C. Everett Koop issued a report, “The Health Consequences of Involuntary Smoking,” outlining the risks of inhaling secondhand smoke. The report concluded that “involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers.”

It also concluded that smokers’ children have a greater risk of developing respiratory disorders than nonsmokers’ children, and that separation of smokers and nonsmokers in the same air space does not eliminate nonsmokers’ exposure to environmental tobacco smoke. The report also called on smokers and nonsmokers to take responsibility for their health, as well as that of their children and employees: “As employers and employees we must ensure that the act of smoking does not jeopardize the health of others.”

Eighteen years later, a study in the British Medical Journal published in June concluded secondhand smoke is even more dangerous than previously thought. The study, which followed more than 2,000 nonsmokers for 20 years, measured cotinine (a nicotine byproduct of tobacco smoke) levels in subjects’ blood, and found that nonsmokers with cotinine were at an increased risk for heart attacks by up to 60 percent — which might account for up to 80,000 heart attacks in the United States annually. Stanton Glantz, a University of California-San Francisco researcher, said being close to someone smoking several cigarettes a day is about as bad as being a light smoker yourself.

Whatever people think about other issues related to smoking bans, secondhand smoke poses serious health risks to nonsmokers, period. Nonsmoking employees of bars and restaurants should not be forced to put their health in jeopardy in their workplaces, and nonsmoking bar patrons should not be expected to deal with other patrons’ poor health choices. The St. Paul City Council made the right choice. Mayor Randy Kelly should follow suit, and the rest of Minnesota should wake up and smell the smoke-free air, too.

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Nicotine patch helps teens cut cigarette use, Stanford and Packard researchers learn-(Yahoo News-15/08/2004)

Nicotine patches may work as well for teens trying to kick the smoking habit as they do for adults, say researchers from the Stanford University School of Medicine and Lucile Packard Children's Hospital. The findings suggest that physicians should consider the popular therapy for teenaged patients who routinely light up but want to quit. The researchers also found that the patches were equally effective in adolescents regardless of whether they were combined with an antidepressant often used to help adults stop smoking. All teens in the study also received behavioral skills training to help them identify and manage trigger situations that usually had them reaching for a cigarette.

"We're encouraged because in our study the initial quit rates for kids treated with nicotine patches and skills training were similar to those seen in adults," said Joel Killen, PhD, professor (research) of medicine at the Stanford Prevention Research Center and lead author of the study. "Just as importantly, most of the kids in the study were able to substantially reduce their tobacco usage, which has not been seen in previous studies."

The study, published in the August issue of the Journal of Consulting and Clinical Psychology, is the first randomly controlled trial of medication to help young smokers quit and is the first to compare success rates of the patch with and without antidepressant medication in this age group. Despite a national effort to shield kids from the lure of tobacco, one in five U.S. high school seniors smokes daily. Reasons for lighting up for the first time can run the gamut from mimicking family members to deliberate risk taking to weight control. The desire to stop can be equally complex.

"Kids tend to think they can quit whenever they want, that they're bulletproof," said Killen. But a rising awareness of the unpleasant aspects of smoking, coupled with tight pocketbooks and rising cigarette costs, is spurring more teens to reduce or stop smoking. A lot of teens realize that it's a nasty habit," said study co-author and adolescent medicine specialist Seth Ammerman, MD. "Some have noticed that they have poor stamina or have seen relatives die from smoking-related causes. Others have friends who are encouraging them to stop." Ammerman is the medical director of Lucile Packard Children's Hospital's Teen Health Van, which provides care for homeless youth. Quitting can be much more difficult than a teen had expected, however. And those who turn to their doctors for help may not always be getting the support they need. "Most pediatricians who work with kids are not used to treating a drug addiction," said Ammerman. "We're used to giving a kid medicine and then they do well and move on, but treating tobacco addiction takes repeated time and effort."

In the study, the authors tested the effect of the nicotine patch on 211 teens between the ages of 15 and 18 who smoked at least 10 cigarettes a day and had been smoking for the previous six months. The volunteers had all made at least one failed attempt to stop smoking and scored highly on a questionnaire that rates nicotine dependence. Teens were recruited from nine continuation high schools in the San Francisco area. Participants were divided into two groups, one treated with the nicotine patch plus the antidepressant bupropion, and one with the nicotine patch plus placebo. Bupropion, which is also approved as a smoking-cessation aid in adults, is thought to help reduce the depressive symptoms and cravings that can accompany nicotine withdrawal. All of the teens attended weekly group counseling sessions to cope with smoking urges.

Every participant was required to stop smoking two weeks after the first counseling session. All patients received the nicotine patch in tapering strengths for eight weeks. Starting levels were tailored to the daily number of cigarettes a teen had been smoking. Those randomized to receive bupropion began one week before quitting, and continued treatment for nine weeks. Medication and smoking status was confirmed through blood, urine and breath tests. After 10 weeks of treatment, 23 percent of the teens using both the patch and the antidepressant had stopped smoking completely and 28 percent of teens using the patch plus placebo had kicked the habit - a statistically insignificant difference. Maintaining abstinence was even more difficult for teens than it is for adults, however: only 8 percent of teens on both medications and 7 percent of teens on the patch plus placebo were still abstinent after 26 weeks.

Although it was tough to turn down cigarettes for good, most of the kids in both treatment groups were able to reduce and maintain their cigarette intake to just a few cigarettes per day, indicating that the treatment had at least some benefit for nearly all the participants. "Physicians used to believe that they didn't have the appropriate skills to help teens stop smoking," said Killen. "Nicotine-replacement therapies may be a valuable tool for these doctors. This finding gives us a platform to build on, whereas before doctors threw up their hands when faced with teen smokers."

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Does Zarda plus supari equal gutkha? If so, anti-tobacco crusader wants state to ban products-(Times of India-20/05/2004)

In August 2002 the Bombay high court had banned the sale of gutkha. But if anti tobacco crusader and WHO award winner Vincent Nazareth, convener of Crusade Against Tobacco, is to be believed, the lethal product is still available in the market. All the buyer has to do is to purchase two products, zarda and supari, mix them together and presto, he gets gutkha. 

Nazareth wrote to the FDA and state government asking them to test mixes of zarda and supari and ban products if the results revealed anything hazardous. He has now sent a legal notice to Uttam Khobragade, FDA Commisioner, contending that these products could contain magnesium carbonate which can lead to life threatening diseases like cancer and tumours.

FDA Minister Anil Deshmukh has rejected the demand to ban these products. "The basic issue is the presence of magnesium carbonate. We found very few samples of zarda and supari separately and together with this chemical.". the government has initiated action against manufacturers whose samples do not measure up to the standards.

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Death Risk for Smokers’ families-(Mid Day-06/04/04)

People who have never smoked but live with smokers have a 15% greater risk of premature death than those in smoke free households, a study has revealed. It shows exposure to smoke in the home can dramatically increase the chances of developing a fatal illness. The findings published in the British Medical Journal led to new demands for a ban on smoking in public.”the results from this study add to the weight of evidence of harm caused by passive smoking and support steps to reduce exposure to other people’s smoke-in the home and in other settings,” said the report’s author, Dr. Tony Blakely.

The study, conducted at the Wellington School of Medicine and Health Sciences in New Zealand, studied data involving householders aged between 45 and 74 at the time of the 1981 and 1996 censuses. They compared the number of deaths in the three years after each census amongst those who never smoked but lived with at least a smoker and those who had never smoked and had a smoke free home.

The figures showed that those who had been exposed to passive cigarette fumes in their own homes were 15% more likely to die during those three years than those who were not.

Dr. Vivienne Nathanson, of the British Medication Association, said the center should some courage and ban smoking in public places. She added, “Evidence is clear-it’s time for action. If Ireland can do it, why not us?” Deborah Arnott, director of the anti-smoking group, ASH said, “The case for a law to end smoking in the workplace and in enclosed public places is now overwhelming.” The chief medical officer Sir Liam Donaldson has already called for an outright ban. A spokesman for the Department of Health said the issue would be addressed in a white paper on public health. He added, “We recognize the danger of second hand smoke and are trying to encourage smoke-free areas in public places.”

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Children are using tobacco laced dental products-study-(Times of India-20/05/2004)

A recent survey has found out that a substantial percentage of school-going children use dental-care products containing tobacco. The first phase of the Global Youth Tobacco Survey 2004, sponsored by the WHO and Centre for Disease Control, USA, has come up with disturbing facts like these for India. Fourteen states, including Maharashtra, have been covered in the survey so far

Says Prakash Gupta of the Epidemiology Research Unit, Tata Institute of Fundamental Research: "We did a survey of 13- to 15-yearold school-going children and found that a disturbing percentage of these children are using dental-care products which contain tobacco. These (products) include Lal Dantamanjan as well as what is colloquially known as the `tobacco toothpaste' which comes in various brands like IPCO, Ganesh,Dentobac or Tona. Other dental-care products like gudaku (a paste of tobacco and molasses), misri (containing powdered, roasted tobacco) and gul are also used by children today"

According to the study the percentage of children using tobacco-laced dental-care products ranges from 6 per cent in Goa to 60 per cent in Bihar The effect of these products is as habit-forming as any other tobacco product. "There is already a law effective from 1992, which says tobacco cannot be added to any dental-care product;" Gupta says. `All that the concerned ministry has to do now is to enforce this law strictly. These dental-care items should be treated as tobacco products. Their ads should be banned, their packaging should carry statutory warnings."

The next part of the study includes an intervention programme and periodical surveys for monitoring the situation.

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Ban on Gutka but what about ads?-(Times of India-14/05/2004)
Study reveals high recall of gutka ads among kids

The two-year gutka ban in the state has not diminished the demand for the tobacco product. The reason-the ban does not cover its advertising, which has retained the gutka on the minds of youngsters. And now, a study conducted by city-based NGO Salaam Bombay Foundation exposes the stronghold of tobacco advertising on the minds of Mumbai teenagers.

Titled “Cancer of the Mind” the study questioned 3,260 children between the age group 12-17 from 15 municipal schools to assess the recall of tobacco advertising amongst them. The findings were revealing-77% recalled a gutka/pan masala advertisement, 17% remembered a raw tobacco ad and only 4% recalled a cigarette ad.

Again over 70% actually recalled the slogan of the ad like Manikchand gutka. Incidentally boys recalled more brands (33%) than girls (23%). Television had the highest impact on the children in remembering the ads. 81% of the respondents watched them on TV, 9% on radio abd only 6% in newspaper ads.

“Ad industry is only focusing on the cigarette ads but it is gutka which is affecting kids. TV has a huge impact since these ads are shown on cable TV. Other products of a tobacco manufacturing company should not be allowed to carry the same brand and slogan as it reiterates the tobacco imagery,” explains Padmini Somani, director, Salaam Bombay.

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Parents smoking outdoors still subject kids to passive smoking-(Times of India-12/05/2004)

Parents who choose not to smoke inside the home may still be subjecting their children to the effects of passive smoking, with harmful particles riding home, clinging to hair and clothes, a new study suggests.

Nicotine, a major ingredient of secondhand smoke, can be detected in the dust and air inside the homes of smokers who deliberately go outside for a puff, `Nature' magazine reports quoting the study. Children in such homes have up to eight times more nicotine in their bodies than the offspring of non-smokers, researchers found.

The levels of nicotine are still quite low says George Matt from San Diego State University, California, who led the study. But they could build over time, potentially making the children more prone to smoking-related problems, such as asthma and sudden infant death syndrome. Cigarette fumes probably get lodged on the hair and clothes of parents, `Nature' quoted Matt as saying.

Particles could then be brought back inside the house, where they would hang in the air or settle in dust. Family members may then inhale them directly or unwittingly transfer them from hand to mouth. Infants are particularly at risk as they spend most of their time indoors and often put objects into their mouths; says Matt. Contaminated dust can settle on toys, carpets and bedding and may remain there for months, he adds.

"The study shows that parents can reduce the amount of passive smoke inhaled by their children by always smoking outdoors," says Matt. "But they would be mistaken to think that this completely protects their children from exposure."

Matt's team, `Nature' reports, looked at 49 family homes with children less than one year old. Fifteen homes were occupied by