Prevention Matters

A new study showing that eating a diet filled with fruits, vegetables, and low-fat dairy foods is associated with a reduced risk of colorectal cancer was named the “Best Prevention Idea of the Week,” while the recent Synar report revealing the national weighted average rate of tobacco sales to minors increased, from 9.9 percent in FFY 2008, to 10.9 percent in FFY 2009 was named the “Worst Prevention Idea of the Week."

BEST

Healthy Diet May Cut Colorectal Cancer Risk

Eating a diet rich in fruits and vegetables, low-fat dairy foods, and fish may reduce your risk of colorectal cancer, according to a new study. Although previous studies have produced conflicting findings about the effectiveness of such a diet, the new research found a benefit.


''We found that eating a largely plant-based diet with higher intakes of fruits, vegetables, whole grains, nuts, seeds, vegetable oils, and low-fat dairy in women and fish in men was associated with a reduced risk of colorectal cancer," says Paige Miller, PhD, a researcher at Pennsylvania State University.

Eating in this healthful way reduced the risk of colon cancer by 65% in women and by 62% in men, she says. ''Why fish was a part of the protective dietary pattern only in men and low-fat diary only in women is not known at this time," Miller tells WebMD.

WORST

Reverse in Trend – Tobacco Sales to Minors No Longer Declining


Although illegal sales of tobacco have decreased over the past 13 years, 2009 sees the first slight upward tick in sales to minors. The Substance Abuse and Mental Health Services Administration recently announced that all the states and the District of Columbia have continued to meet their goals of curtailing sales of tobacco to underage youth (those under 18). However, in federal fiscal year 2009, for the first time ever, the data show a slight increase in the average national rate of tobacco sales to underage youth of about one percent. States goals, set under the Synar Amendment program – a federal and state partnership, are aimed at ending illegal tobacco sales to minors. The increase in the rate may be due to States reducing the number of enforcement inspections they conduct in the face of State budget cuts.

The Centers for Medicare and Medicaid Services (CMS) has proposed a new measure, which is still preliminary, that would expand coverage for evidence-based tobacco cessation counseling for all Medicare recipients. Current Medicare language limits reimbursement for tobacco cessation counseling to patients who have a tobacco-related disease.

The CMS has set a period of time for Public Comments on the proposed determination, after which they will issue a final decision. This period ends June 27, 2010. Partnership for Prevention urges you to offer your own public comment in support of tobacco cessation counseling for Medicare beneficiaries. It’s easy to do – just click on this link, then click on the orange “Comment” button at the top. Type in the box whatever you see fit to communicate about this matter.

As an example, here’s what I wrote in my message to the CMS this morning:

I am writing to express my strong support for the Centers for Medicare and Medicaid Services proposed decision to extend tobacco cessation counseling to all Medicare beneficiaries. It is Partnership for Prevention's position that this policy will help many tobacco users break free from a deadly behavior, people who otherwise would have been unable to do so. Undoubtedly, many lives will be extended and much money saved if this decision is enacted.

Not only is tobacco cessation counseling a Grade A rated recommendation by the U.S. Preventive Services Task Force, it is also received the highest ranking by Partnership for Prevention's National Commission on Prevention Priorities. In that review, physician tobacco cessation counseling was one of only three clinical preventive services to receive the highest score for cost and prevention effectiveness.

I urge the CMS to move forward with this critical public health measure when the public comment period has concluded. The entire Medicare community deserves to benefit from this service, not only those who have been diagnosed with a tobacco related illness. After all, that's what prevention is all about.

It is important that the CMS hears from constituents who support disease prevention, health promotion, and tobacco cessation. If enacted, this measure represents a lifesaving advance in our capacity to guarantee that all tobacco users have access to evidence-based tobacco cessation counseling. A significant public health benefit will be realized.

David Zauche
Senior Program Officer
Partnership for Prevention

Partnership for Prevention is proud that the Indiana state Tobacco Prevention and Control agency took the lead to convene a summit of leaders from around the state representing business, insurers, health systems, policymakers and community educators. The summit participants agreed on a goal of reducing the adult prevalence rate to 8 percent by 2015. To make that possible, many strategies were identified to reduce Indiana’s high smoking rate (currently 23%) through increased access and utilization of tobacco cessation services.

The summit lives on in a new media campaign to promote cessation to tobacco users and their employers.

Diane Canova
Vice President, Policy & Programs
Partnership for Prevention

Why do people fighting against schizophrenia die so much earlier than the population at large? The answer may surprise you. And it’s related to tobacco cessation.

In a study published this month in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Historically, the problem has been that many in the medical community have opted not to treat tobacco addiction in this population for fear of worsening their patients’ mental health. However, this study concluded that offering such treatments does not appear to cause deterioration in mental health. It also found that pharmaceutical and behavioral treatments doubled the probability of quitting among these patients, whose smoking rates are two to three times higher than average.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that “schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself.”

Dr Lindsay Banham, who led the review, added “what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with severe mental illness has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population.”

David A. Zauche
Senior Program Officer
Partnership for Prevention

Massachusetts is poised to become the first state in the nation to force retailers to prominently display graphic warnings about the perils of smoking right where cigarettes are sold - at tobacco sales racks and next to cash registers. Images of ominously darkened lungs, damaged brains, and diseased teeth could start appearing before the end of the year in more than 9,000 convenience stores, pharmacies, and gas stations, if a proposal by the state Department of Public Health is approved as expected. Other posters would direct smokers to where they can get help to stamp out their habit.

''If somebody is trying to quit smoking and they go back to the store and they're tempted - oh, just one pack - we hope this will help them make a different choice,'' said Lois Keithly, director of the Massachusetts Tobacco Cessation and Prevention Program.

New York City implemented a similar campaign in December, where Anne Pearson serves as an attorney with the city's Bureau of Tobacco Control. ''There's a large body of evidence showing these graphic images are very effective,'' Pearson said. ''They can communicate information in a way that text just can't, and they can also communicate a message to people regardless of their level of literacy and regardless of the language they speak.''

The campaign is being underwritten by $316,000 in federal stimulus money from the Centers for Disease Control and Prevention, which will allow the state to provide the materials to retailers without charge.

David Zauche
Managing Senior Fellow and Senior Program Officer
Partnership for Prevention

According to a survey administered by the Virginia Foundation for Healthy Youth, one out of three teenagers younger than 18 mistakenly identified a new type of smokeless tobacco product as candy or gum. The survey of about 1,400 Virginia residents, including 728 younger than 18, asked them to identify package images for several types of new, smokeless tobacco products, as well as package images of mints and gums. About 39 percent of the respondents younger than 18 identified Camel Orbs, an oral tobacco product that dissolves in the month and delivers nicotine to the user, as mints or gum. Of the teenagers younger than 18 surveyed who do not currently use tobacco, 27 percent said they would try Camel Orbs based on packaging alone.

Another product identified in the survey was Stonewall, a type of smokeless, pellet tobacco sold by Star Scientific Inc. About 35 percent of the survey respondents 18 or younger perceived Stonewall to be candy, mints or gum. Twenty-three percent said they would try Stonewall because of the packaging.

The survey results suggest that packaging of the products alone may appeal to youth, said Danny Saggese, director of marketing for the Virginia Foundation for Healthy Youth."It poses a significant risk to youth and raises the possibility of them not only using these products, but using them in places where smoking is now prohibited, and potentially becoming nicotine addicts," he said.

In March 2010, the U.S. Food and Drug Administration issued a rule restricting access and marketing of cigarettes and smokeless tobacco products to youth. The rule becomes effective June 22, 2010 and will require smokeless tobacco products to have warning labels that cover one-third of the front and back of the packages. However, many tobacco prevention groups and government officials believe the FDA should ban smokeless tobacco products altogether. In an April 18th New York Times interview, U.S. Senator Jeff Merkley of Oregon called the products “tobacco candy,” noting that “everything about them is designed for kids.”

Brandi Robinson
Program Associate
Partnership for Prevention

U.S. Department of Health and Human Services Secretary Kathleen Sebelius has named preventing and reducing tobacco use as a strategic initiative for HHS. Sebelius noted that it will require “comprehensive, sustained, and accountable tobacco control efforts based on evidence-based interventions” to lower the current smoking rate of twenty percent in the U.S.

Initial actions identified to increase efforts to prevent and reduce tobacco use include:

• Strengthening the implementation of evidence-based tobacco control interventions and policies in States and communities;
• Changing social norms around tobacco use;
• Accelerating research to expand the science base and monitor progress; and
• Leveraging HHS systems and resources to create a society free of tobacco-related disease and death.

Increasing efforts in the area of tobacco control is a big step in the right direction to ensure that Americans live healthier lives.

Brandi Robinson
Program Associate
Partnership for Prevention

The use of bar-code verification technology to decrease medication errors in hospitals was named the “Best Prevention Idea of the Week,” while misleading tobacco ads aimed at South Asian women was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Bar-Code Technology Reduces Medication Errors in Hospitals

Use of bar-code verification technology can substantially decrease both transcription errors and medication administration errors in hospitals, according to research published in the May 6 issue of the New England Journal of Medicine. "Taken together, our findings show that the bar-code eMAR technology improves medication safety by reducing administration and transcription errors, providing support for the inclusion of this technology as a 2013 criterion for achieving meaningful use under the American Recovery and Reinvestment Act. Given challenges in implementing this technology, however, further research should focus on identifying factors that will lead to its optimal implementation," the authors write.

WORST

Tobacco firms take aim at Bangladeshi, Asian women

Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths. Advertisements telling smokers they are smarter, more energetic and better lovers than their non-smoking counterparts are a familiar sight across Bangladesh — something unimaginable in most other countries. The promotion is being linked to an alarming rise in tobacco use in the impoverished South Asian country, particularly among women and the young — a trend repeated across many developing countries, anti-tobacco groups say.

An analysis of a large number of medical records of people born in Finland indicates a link between psychiatric illness and prenatal exposure to tobacco smoke. Mikael Ekblad, a doctoral student at Turku University in Finland, reported these findings at the meeting of the Pediatric Academic Societies. Children born to mothers who smoked while pregnant had a 44% increased risk of psychiatric drug use later in life, presumably because of psychiatric disorders.

It has long been known that maternal smoking can affect the placenta, often leading to low birth weight or prematurity, and some previous studies had demonstrated the link between mental illness and tobacco smoke in the womb.

Davide Zauche
Managing Senior Fellow and Senior Program Officer
Partnership for Prevention

The World Health Organization’s World No Tobacco Day 2010 will be celebrated on May 31. This year’s health theme is “Gender and Tobacco”, with an emphasis on marketing to women. Though women comprise only 20% of the world’s one billion smokers, the rise in prevalence, especially among girls, is alarming.

The new WHO report, Women and Health, cites the fact that the tobacco industry has ramped up its marketing efforts to women in countries worldwide.

Details about the event and the 2010 focus on women can be found on the WHO website.

On World No Tobacco Day 2010, and throughout the following year, WHO will encourage governments to pay particular attention to protecting women from the tobacco companies' attempts to lure them into lifetimes of nicotine dependence. By responding to WHO's call, governments can reduce the toll of fatal and crippling heart attacks, strokes, cancers and respiratory diseases that have become increasingly prevalent among women. Tobacco use could kill one billion people during this century. Recognizing the importance of reducing tobacco use among women, and acting upon that recognition, would save many lives.

David Zauche
Managing Senior Fellow & Senior Program Officer
Partnership for Prevention

A new study published in the British Medical Journal states that smoking cessation offers a significant benefit to early-stage lung cancer patients by reducing the progression of the disease.
“The adjusted estimates suggest that the risk for death is halved in patients who stop smoking”, say the researchers, led by Amanda Parsons, research fellow at the UK Center for Tobacco Control Studies at the University of Birmingham, United Kingdom.

“The difference in survival between patients who stopped smoking and those who continued is striking", said H. Jack West, MD, medical oncologist at the Swedish Cancer Institute in Seattle, Washington, and author of the Blowing smoke blog on Medscape Oncology. “This effect is larger than that seen with postoperative chemotherapy”, he added.

This research is both fascinating and promising, but must be considered preliminary. Only a large-scale randomized controlled trial will permit researchers to confidently draw conclusions and make patient care recommendations.

David Zauche
Senior Program Officer
Partnership for Prevention

R.J. Reynolds new product “Camel Orbs” poses health risks to infants and children according to a new study published online April 19, 2010 in the journal Pediatrics. Orbs are dissolvable nicotine products, flavored with cinnamon or mint, that are made to look like candy. Gregory Connolly, lead author of the study and director of the Tobacco Control Research Program at Harvard School of Public Health, said, “"This product is called a 'tobacco' product, but in the eyes of a 4-year-old, the pellets look more like candy than a regular cigarette. Nicotine is a highly addictive drug and to make it look like a piece of candy is recklessly playing with the health of children."

Ingestion of tobacco products by infants and children is a major reason for calls to poison control centers nationwide. In 2007, 6,724 tobacco-related poisoning cases were reported among children five years of age and under. Small children can experience nausea and vomiting from as little as 1 mg of nicotine.

David Zauche
Senior Program Officer
Partnership for Prevention

Toronto’s ban on smoking in restaurants that led to a major decline in heart and lung hospital admissions was named the “Best Prevention Idea of the Week,” while the lack of progress in eliminating infections that can harm or kill patients in U.S. hospitals was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

Best

Smoking Ban Cut Hospital Admissions

Toronto's ban on smoking in restaurants led to a major decline in heart and lung hospital admissions, a Canadian medical research study said Tuesday. Smoking in restaurants was banned by the city in 2001. The research published in the Canadian Medical Association Journal said within three years, hospitalizations for heart conditions fell 39 percent and 32 percent for respiratory conditions, the Globe and Mail reported. Using data from two other regions in Ontario that didn't have smoking bans, the rate of admissions for heart attacks jumped by almost 15 percent during the same time period, the report said.

Worst

U.S. Hospitals Get Low Marks on Curbing Infections

U.S. hospitals are making little progress in eliminating infections that can harm or kill patients, according to reports released April 13 by the federal Agency for Healthcare Research and Quality. Researchers found that rates of bloodstream infections after operations (postoperative sepsis) increased by 8 percent, rates of catheter-associated urinary tract infections following surgery increased by 3.6 percent, and rates of certain infections due to medical care increased by 1.6 percent. However, rates of pneumonia that developed after surgery (postoperative pneumonia) fell by 12 percent.

The April 16, 2010 issue of the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report includes data collected by the Adult Tobacco Survey (ATS) during February 2003 – November 2007. Among 33 ATSs conducted in 19 states, current cigarette use by adults ranged from 13.3% (Hawaii in 2006) to 25.4% (West Virginia in 2005), with a median of: 19.2%. Among young adults aged 18-29, current cigarette use ranged from 15.8% (Hawaii in 2006) to 40.4% (West Virginia in 2005), with a median of: 26.7%.

The survey also found that with the exception of smokeless tobacco use and pipe use, the median prevalence of current use of each tobacco product was consistently highest among adults aged 18-24 years and lowest among adults aged ≥65 years. Polytobacco use ¬– current use of multiple tobacco products including cigarettes, cigars, pipe tobacco or smokeless tobacco – was also explored in the survey. The percentage of adults using two tobacco products ranged from 10.6% (South Carolina in 2007) to 18.6% (Oklahoma in 2004) (median 14.5%). The percentage of adults using three tobacco products ranged from 1.6% (South Carolina in 2007) to 4.6% (Ohio in 2006) (median 2.9%). The percentage of adults using all four tobacco products ranged from 0.0% (Iowa in 2004, Oklahoma in 2004, and South Carolina in 2007) to 0.6% (Georgia in 2004) (median 0.3%).

Adults who were employed for wages or self-employed were asked whether their employer had offered any programs to help them stop smoking or any other types of help to employees who wanted to quit smoking. Among 12 ATSs, the percentage of adults (smokers and nonsmokers combined) who reported that their employer offered any cessation programs ranged from 19.7% (New Mexico in 2003) to 28.6% (South Carolina in 2007) (median: 23.4%). The percentage of current smokers who reported employer-offered smoking cessation programs ranged from 13.5% (Idaho in 2005) to 22.5% (Iowa in 2006) (median: 18.4%).

Based on the results of the survey, CDC recommends that states establish, maintain, and fund comprehensive tobacco control programs, at least at CDC-recommended levels, to reduce tobacco-related deaths and diseases. CDC regularly evaluates the recommended state ATS questions with a goal of more closely aligning the questions with short-term, intermediate, and long-term outcome indicators to measure progress toward National Tobacco Control Program goals.

The Adult Tobacco Survey is a random-digit--dialed telephone survey of the civilian, noninstitutionalized U.S. population aged ≥18 years that collects data on tobacco use, smoking cessation, secondhand smoke exposure, risk perception and social influences, health influences, and tobacco-related policy issues in the United States.

Brandi Robinson
Program Associate
Partnership for Prevention

Yesterday, the U.S. Navy announced a change in policy – smoking will be banned aboard all submarines. Obviously, prohibiting smoking in such confined spaces makes sense. The question for me was “Why did it take so long?” One can reason that both smoking and non-smoking sailors would be exposed to unacceptable levels of secondhand smoke. Although prior Surgeons General and tobacco control advocates have presented evidence of the health consequences of second-hand smoke, it wasn’t until a 2009 study by the Naval Submarine Medical Research Laboratory confirmed risk to nonsmoking submariners that a policy change was successful.

Accompanying the smoking ban will be tobacco cessation education and access to nicotine replacement therapy products. Kudos to the Navy for recognizing that forcing submarine sailors to go “cold turkey” would not be a smart move. Hopefully, the cessation programs will be expanded to adhere to the Public Health Service Guidelines’ comprehensive mix of counseling and medications.

Diane M. Canova
Vice President, Policy & Programs

More U.S. smokers than ever are utilizing telephone quitlines to help them stop smoking. However, budget cuts are now limiting access to this critical service according to a report released today by the North American Quitline Consortium and other public health organizations.

"At a time when demand for quitlines is at a record level, it is more important than ever to support proven tobacco cessation efforts,” said Linda Bailey, president and chief executive officer of the North American Quitline Consortium (NAQC). "The investment of $2.19 per capita for quitlines, as recommended by the Centers for Disease Control and Prevention, is based on sound science and real-world experience. States that made the necessary investments have been able to provide cessation services to the growing number of smokers who want to quit. We commend the states that have committed the necessary funding to quitline services and encourage them to continue this practice."

The number of tobacco users calling quitlines—a telephone helpline where smokers can turn for trusted, reliable help when they want to quit—increased 116% between 2005 and 2009, according to the report. Despite this increase in demand, total funding for all U.S. quitlines decreased for the first time ever in Fiscal Year (FY) 2010. Funding has been cut despite the fact that states will collect $25.1 billion in revenue this year from tobacco taxes and legal settlements with the tobacco industry, and more states have already enacted or are considering tobacco tax increases this year. These increases will motivate more smokers to try to quit and provide additional revenue that states can use to fund quitlines and other tobacco prevention and cessation programs.

David Zauche
Senior Program Officer
Partnership for Prevention

The United States is continuing to make great strides toward the elimination of tobacco smoke in the country’s air. According to the Americans for Nonsmokers’ Rights Foundation, as of April 1, 2010, 32 states, along with Puerto Rico, the Northern Mariana Islands, and the District of Columbia have strong state/commonwealth laws in effect that qualify for at least one of the 100% smokefree list categories (workplaces, restaurants, and/or bars). A total of 38 states and the District of Columbia now have 100% smokefree air laws in effect at the local level. Adding to this growing list, by July 5, 2010, Michigan, Kansas and Wisconsin will all be 100% smokefree. More specifically, 57.2% of the U.S. population now lives in cities or states with smokefree non-hospitality workplaces; 68.1% in areas with smokefree restaurants; and 57.1% in areas with smokefree freestanding bars. Forty-one percent of the population is currently protected in all three categories.

For more smokefree lists, maps and reports visit Americans for Nonsmokers' Rights.

Alex Einhorn
Policy and Program Intern

• Require Internet sellers to pay all federal, state, local or Tribal tobacco taxes and affix tax stamps before delivery to any customer;
• Mandate that the age and identification of purchasers be checked at purchase and at delivery
• Require Internet vendors to comply with state and local laws as if they were located in the same state as their customers;
• Provide federal and state enforcement officials with new tools to block delivery of cigarettes and smokeless tobacco products that evade federal or state laws; and
• Ban the delivery of tobacco products through the U.S. mail. 

Partnership recently awarded grants to several state and local organziations to improve preventive services.

With funding from the Centers for Disease Control and Prevention, one-year grants were awarded to regional, state and local organizations to implement innovative strategies to increase chlamydia screening and follow-up care. The grants are also designed to encourage collaboration among local affiliates of the National Chlamydia Coalition (NCC). Comprised of 40 member organizations, the NCC was established to address the continued high burden of chlamydia infections, especially among women age 24 and younger.

Grants have been awarded to a variety of organizations, including county and state health departments, school-based health centers, a department of juvenile services, and a university, among others. The projects will address one or more barriers to chlamydia screening and will be designed to reach a variety of audiences. Lessons learned from the projects will be shared widely so that models can be replicated in other communities. For a complete list of grantees and project descriptions, click here.

Partnership also awarded six ACTTION State Grants for the implementation of innovative strategies to increase access to tobacco cessation treatments. Funds are to be used primarily for the development of state alliances/summit meetings and the creation of strategic plans. The projects will range from focusing on employer groups and health care systems to the uninsured and the behavioral health/substance abuse populations. For a complete list of grantees and project descriptions, click here.

With funding from the Pfizer Foundation, Partnership hopes to dramatically increase access to and use of proven tobacco cessation treatments through this grant program. The focus of the ACTTION state grants is system and policy change in tobacco cessation, rather than the delivery of programs or direct services.