Goodbye from Freedom From Smoking (at least for now)

Dear Readers,

We have been informed that technical changes will mean that Healthline will soon be unable to support the capabilities required to continue the current format for "Freedom From Smoking" and the other HealthLine Experts blogs. But, we have also been reassured that access to past posts should still be available once the transition to a new format has taken place.

We have also been told that the "Comments" sections under the posts has been disabled, which is a pity, but in truth it has not been working perfectly for some time. I have received many copies of readers’ submitted comments that never made it onto the site. So if you were one of many readers who attempted to post a comment that never appeared, I'm sorry but this is outwith my control.

Each of the Healthline Bloggers has been told that it may take some time to develop Healthline’s new blogging system, and I don’t believe that firm decisions have been made regarding its format. So just in case this is my last post as a Healthline blogger, I’d like to thank all those who have read my posts, made comments, or told me that you have appreciated the posts in one way or another.

I have tried to make it a mixture of commentary on current research and policy on tobacco and health, and straightforward information and advice for the tobacco user or their family…hopefully in a manner that might help them to stop using tobacco and live a longer healthier life.

While all of the Healthline blogs will cease for the time being, I hope that tobacco users will still be able to find useful information contained in the blog posts that currently exist. You should still be able to search for specific topics using the “Search Health Experts” box on the upper right side of the page. Typing keywords such as “smoking” and “youth” should bring up all Health Experts blog posts that mention the keywords.

I also want to wish all existing smokers out there all the best in their attempt to quit. It remains the single best thing a smoker can do for their health. Remember that there are some very useful websites out there aim to help smokers to quit. Some of the best are:

www.becomeanex.org
www.quitnet.org
www.smokefree.gov

Also don’t hesitate to make use of free telephone quitlines which are available in many countries. In the USA the toll-free number to call is: 1-800-QUITNOW (1-800-784-8669).

Best of luck and best of health to you.

Jonathan Foulds, PhD.

Labels: jonathan foulds, smoking cessation, website

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10,753 young children poisoned by cigarettes, 3 by novel smokeless products.

A number of colleagues recently mentioned to me that they had heard that new smokeless tobacco products are very dangerous because they cause a lot of poisonings to children. When I checked the internet, sure enough, there were plenty of news headlines along the lines of, “Tobacco mints tied to poisoning in kids” and “Tobacco candy poisoning kids, study shows.” I thought this looked interesting, particularly as I was unaware of any “tobacco candy”.

On looking into it, I found that the source article was one recently published by Professor Greg Connolly at Harvard University and colleagues. The study examined data on all accidental poisonings resulting from ingestion of tobacco products by children under 6 years old, that were reported to poison control centers around the United States.

The study found that over the years 2006-8 there was a total of 13,705 cases reported for all tobacco products, of which the type of tobacco used was unknown in 1197 cases (8.7%). Of the 13705 cases, 10,573 (77%) were caused by consuming cigarettes. 167 were caused by consuming cigars, and 1768 (12.9%) were caused by consuming (presumably traditional forms of) smokeless tobacco.
The new varieties of snus and other novel tobacco products (Camel Orbs, Sticks and Strips) were not widely available in the United States during the period under study, but the authors mentioned that they had heard of 2 cases of mild poisoning of children aged 2 and 3 who had ingested some snus, and a single case of a 3 year-old who was believed to have ingested Camel Orbs in 2009.

The paper serves a useful purpose in quantifying the number of accidental poisonings of young children (primarily less than 2 years old) by tobacco products. Clearly this points to the need for greater awareness among tobacco users to not leave these products where children can access them. It also points to the potential need for childproof containers for all tobacco products.

The thing that struck me as rather odd about this paper was that it focused so much on the harmfulness of the novel smokeless tobacco products. The paper included a photograph of Camel Orbs alongside a packet of tictacs (candies), and certainly they are similar. One difference is that whereas tictacs are contained in easily opened flip-top containers, the new smokeless tobacco products are contained in containers that are not only childproof but are psychologist-proof and actually extremely difficult to open by anyone who tries. I suspect that one reason kids may be poisoned by these products is that it is so difficult to get the product out, and almost impossible to put it back in, leading consumers to leave the loose product laying around.

But the data contained in the report found at least 10,573 cases of children poisoned by cigarettes, as compared with one poisoned by Orbs. It seemed rather strange, given that data, for all the focus and media coverage to be on Orbs. Why no call for all cigarettes to be packaged in childproof containers, rather than flimsy cardboard boxes?

The core message here should be that tobacco is a poison and should never be left accessible to the hands of children.

Reference:
Connolly et al. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics, April 2010.
http://www.ncbi.nlm.nih.gov/pubmed/20403932

Labels: Camel orbs, children, Gregory Connolly, jonathan foulds, poisoning, snus, tobacco

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CBS 60 Minutes documentary on snus smokeless tobacco (2)

This evening the respected CBS documentary news show “60 Minutes” included a feature on smokeless tobacco, focusing on the recent launch of snus in the United States. The show was relatively balanced in focusing on the main potential risks and benefits of snus.

It started by featuring a young man who enjoys using snus in places where he cannot smoke, while continuing with a pack-a-day smoking addiction. The interviewer gave him the bad news, “You are a dual user!”

It then had a segment with the widely respected Swedish nicotine addiction expert, Dr Karl Fagerstrom, who stated that snus is 90-99% less harmful than smoking (while admitting some risks, including of pancreatic cancer).

A tobacco control advocate in Indiana expressed concerns about many tobacco users becoming dual users, and also mentioned the concern that children may become addicted to these products. She was particularly concerned that some of the new dissolvable tobacco products look like candy and appear to be designed with kids in mind.

The counterpoint was an interview with a Swedish TV presenter whose mother died of lung cancer, and who himself had been an addicted smoker. He was only able to quit smoking by switching to snus.

The show did not give much explanation about why Swedish snus contains fewer toxins than traditional American smokeless tobacco, and the claims about nicotine delivery of the new dissolvable products may be inaccurate. But it presented the main issues in an interesting and informative manner.

Overall, I suspect this show may be relatively good publicity for snus. The tobacco companies are not allowed to tell the public that snus is much less harmful than cigarettes (its primary benefit), and this show got that information into the public domain. The companies have also been trying hard to draw a distinction between traditional “spit tobacco” and this new more discrete “spitless” form of smokeless tobacco. Again, the show got that message across fairly clearly, without playing down the main potential problems…dual use, addiction and use by youth.

The full section on smokeless tobacco that was shown this evening can be viewed online at:
http://www.cbsnews.com/video/watch/?id=6362540n&tag=contentMain;cbsCarousel

Note also that 3 additional “extra” segments that were not shown on TV can also be viewed at the CBS 60 minutes site. Two of these include interviews with an Indiana University medical professor, Dr Stephen Jay, on use of smokeless tobacco for smoking cessation. The other addresses the same topic with Dr Karl Fagerstrom.

I’d be interested to read your comments on the show and other excerpts from the CBS website.

Labels: 60 minutes, CBS, harm reduction, jonathan foulds, Karl Fagerstrom, smokeless tobacco, snus

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Going Smokeless on CBS 60 minutes

60 Minutes will broadcast a story on smokeless tobacco this Sunday, April 4th. It is available on your local CBS station at 7 p.m. or earlier, depending on time zone. The story will also be available in its entirety on the internet after the show. The website is www.60Minutes.com

“As cigarette sales plunge, tobacco companies are marketing smokeless products to skirt smoking bans and keep customers. Lesley Stahl investigates the pros and cons, Sunday, April 4, at 7 p.m. ET/PT.”

See full preview at:
http://www.cbsnews.com:80/video/watch/?id=6353825n&tag=contentMain;cbsCarousel

At the time of writing I don’t know what angle this show will take. If you watch it and have an opinion, feel free to comment here.

IF you want to learn more about snus, enter the word as a search term and click on the “search health experts” box on the right.

Labels: 60 minutes, CBS, jonathan foulds, smokeless tobacco, snus

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State Medicaid Expenditures Attributable to Smoking

In the United States there is an ongoing debate relating to the rapidly-increasing costs of healthcare and the apparent inadequacy of current systems of health insurance to provide quality healthcare to the US population.

At the same time as this debate is taking place at a national level, each state is facing its own major challenges in balancing its budget during the current economic recession. In the United States, each state is partially responsible (Federal government covers just over 50% of expenses,) for its own expenditures on Medicaid, the health insurance system designed to cover low-income Americans. As a percentage of state budgets, Medicaid expenditures increased from 8% in 1985 to 21.5% in 2006, surpassing elementary and secondary education as the largest single budget item. In 2007 the total Medicaid expense for each of the 50 states was over $144 billion. A recent study by Dr Brian Armor and colleagues at the US Centers for Disease Control (CDC) calculated the proportion of Medicaid expenditure on smoking-caused disease. They reported that smoking prevalence in the adult Medicaid population is approximately 53% greater than that of the overall US adult population (34.5% vs 22.6% in 2006). Overall, about 11% ($22 billions) of Medicaid expenditure is on smoking-attributable costs (e.g. treating smoking-caused cancer, heart disease and respiratory diseases etc in Medicaid patients).

They found that estimated annual smoking-attributable expenditure per state per year varied from $40 million (Wyoming) to $3.3 billion (New York). In my own home state (New Jersey), despite having the lowest proportion of smoking-attributable Medicaid expenditure (6% of Medicaid expenditure), NJ smoking-attributable Medicaid costs totaled $309 million in 2004.

Im partly bringing this up because it links to the building evidence from Massachusetts that covering all evidence-based smoking cessation treatments is effective in helping smokers to quit (see previous blog post). The one published study on the Masshealth smoking cessation benefit showed it was widely used, highly successful and reduced smoking prevalence by 26%. In addition, the Massachusetts Department of Public Health reported heart-attack hospitalizations were down 38 percent, asthma visits dropped 17 percent, and complications in childbirth declined 17 percent for Medicaid clients in the smoking cessation program. It is clear that once they have worked out the cost benefit from the smoking cessation program, it will have an excellent return on investment, both in terms of improved health and reduced healthcare costs.

Other states, including my own, should be looking to quickly improve health and reduce healthcare costs such as Medicaid, by providing good smoking cessation benefits/treatment like Massachusetts.

Labels: expenditure, jonathan foulds, Massachusetts, Medicaid, smoking cessation

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