Comprehensive smoking Bans Secondhand

De: Carlos Alberto Machado [mailto:carlos.a.machado@uol.com.br]
Enviada em: sábado, 21 de julho de 2007 09:56
Assunto: Comprehensive Smoking Bans May Decrease Secondhand Smoke Exposure

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Comprehensive Smoking Bans May Decrease Secondhand Smoke Exposure
Laurie Barclay, MD
Medscape Medical News 2007. © 2007 Medscape
July 20, 2007 — Comprehensive smoking bans may decrease secondhand smoke exposure, according to a report in the July 20 issue of the Morbidity and Mortality Weekly Report. Following the 2003 New York state ban on smoking in indoor workplaces and public places, reports of indoor smoking and saliva cotinine levels decreased in nonsmoking participants in the New York Adult Tobacco Survey (NYATS).
"Secondhand smoke (SHS) causes premature disease and death in nonsmokers, including heart disease and lung cancer," write U. Bauer, PhD, from the New York State Department of Health, and colleagues. "The Surgeon General has concluded that no risk-free level of SHS exposure exists; the only way to fully protect nonsmokers is to completely eliminate smoking in indoor spaces. Studies have determined that levels of airborne particulate matter in restaurants, bars, and other hospitality venues and levels of SHS exposure among nonsmoking hospitality employees decrease substantially and rapidly after implementation of laws that prohibit smoking in indoor workplaces and public places."
The New York State Department of Health analyzed data (from June 26, 2003 – June 30, 2004) on observations of indoor smoking by NYATS, as well as cotinine saliva levels in nonsmoking NYATS respondents. The study period began before and ended after implementation of the 2003 New York state ban on smoking in indoor workplaces, restaurants, bars, and other public places.
After the ban took effect, reports of indoor smoking declined significantly, from 19.8% (during June 26 – July 23, 2003) to 3.1% (during April 1 – June 30, 2004) for restaurant patrons, and from 52.4% to 13.4% for bar patrons during the same period. However, the proportion of respondents reporting exposure to SHS in workplaces did not change significantly from 13.6% before implementation of the no-smoking law.
Liquid chromatography with tandem mass spectrometry was used to measure concentration of cotinine in saliva samples that nonsmoking NYATS participants sent in by mail. Mean salivary cotinine decreased by 47.4%, from 0.078 ng/mL during June 26 to July 23, 2003, before the smoking ban was implemented, to 0.041 ng/mL during April 1 to June 30, 2004. During the same periods, the proportion of respondents with cotinine levels below the limit of detection (LOD) of 0.05 ng/mL increased from 32.5% to 52.4%.
"These findings suggest that comprehensive smoking bans can reduce SHS exposure among nonsmokers," the authors write.
An accompanying editorial note states the study limitations of low average quarterly response rates for both NYATS (22%) and the saliva cotinine study (33%, for a cumulative rate of 7%) and an error involved in estimating cotinine values below the LOD to calculate the geometric means.
"Additional research is needed to confirm the findings of this study," the editorial concludes. "However, the results suggest that comprehensive smoke-free air laws can substantially reduce SHS exposure to nonsmokers, even in jurisdictions with a high prevalence of existing smoking restrictions. Even greater reductions in SHS exposure might be expected in jurisdictions that had fewer smoking restrictions in place before implementing a statewide smoke-free air law."
MMWR Morb Mortal Wkly Rep. 2007;56(28):705–708.

An unhealthy abuse of power

An unhealthy abuse of power

Opinion piece in the Financial Times reveals the role of the US Surgeon-General

On the eve of confirmation hearings for a successor to the surgeon-general, Dr Richard Carmona told a congressional committee this week that Mr Bush’s people tried to “water down” a report he wrote on secondhand smoke. Words such as “gagged”, “muzzled” and “censored” were used to describe what the Bush administration did to its former surgeon-general.

The surgeon-general, who works for the Department of Health and Human Services, publicises health risks. He is often called “America’s family doctor” but the metaphor is misleading. Few family doctors infuriate half their patients, as surgeons-general have tended to do.

The same pattern is repeated again and again: a doctor of some professional distinction, vetted for pro-administration sympathies, gets confirmed and quickly becomes a political “maverick”. The problem is simple: the surgeon-general is both a political post, with a good deal of clout, and a “caring” post, which puts it above criticism. Naturally, the temptation of power without accountability arises.

A broader conception of the job is not the only thing that surgeons-general want. They want to pursue their agenda of “science” without “political interference”. Dr Koop told a reporter recently: “There should be a law that says this person would be apolitical and when he is appointed, he will not be answerable to the president for what he says about health or anything else.”

This is a misrepresentation. For it is not “science” that people obey when health policies are implemented. It is power. The science in the 1964 surgeon-general’s report linking smoking to lung cancer stopped relatively few people from smoking. Smoking rates only began to fall steeply only in the 1980s with the introduction of judicial decrees and legislation. State power enforced the surrender of a certain amount of liberty in exchange for a certain amount of cleanliness, health and longevity. Policies on sex education, abortion and cloning are similarly matters of politics, not science. The surgeon-general is not at the intellectual pinnacle of the medical profession. He is at the political pinnacle of the medical profession. None of the surgeons-general in the past generation has been among the country’s authoritative scientists. Their authority derives only from the administration they represent.
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In a political struggle between the presidency and the surgeon-general, the presidency prevails. What was revealed in testimony last week was not the politicisation of the surgeon-general’s office but its de-politicisation. Dr Carmona’s superiors, by reasserting their control over health policy, made it more accountable. That does not mean they made it more competent. If it is competence you want, you have your vote for that.

Source: The Financial Times, 13 July 2007
Article Link: http://tinyurl.com/2gw26w

Population-based evidence of a strong decline in the prevalence of smokers

"Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003)
Carlos Augusto Monteiroa, Tania Maria Cavalcanteb, Erly Catarina Mouraa, Rafael Moreira Claroa, Célia Landmann SzwarcwaldcIntroduction
The adverse effects of tobacco smoking on health have been known since at least the 1950s.1,2 Even the large multinational cigarette companies, who previously denied the problem and questioned the validity of scientific studies, now explicitly admit that tobacco smoking has adverse consequences. There is scientific evidence that even nonsmokers exposed to tobacco smoke (“passive smokers”) have a greater incidence of cancer, cardiovascular disease and respiratory disease.3 As well as being a risk factor for a variety of diseases, smoking is characterized by chemical dependence, and falls into a model of chronic disease with a long-term natural history and with periods of recurrence and remission.4

The accumulation of knowledge on the risks of tobacco smoking has not been enough to reduce worldwide consumption. In fact, tobacco consumption in developing countries has been increasing at an alarming rate as a result of sophisticated global promotion strategies developed by multinational cigarette companies. Favoured by the liberalization of commerce brought about by globalization, such companies are promoting the rapid transfer of the burden of tobacco consumption from rich to poor countries.5 In 1999, smoking already accounted for four million deaths per year worldwide, and half of these occurred in developing countries. At current trends, the number of deaths attributed to smoking will double by 2020, and seven of every ten tobacco-related deaths will take place in developing countries.6

In light of the adverse effects of smoking and the evidence for increased consumption of tobacco, especially in developing countries, the World Health Assembly has approved several wide-ranging resolutions to contain the global demand for tobacco. These culminated in 1999 with the sanction of the Framework Convention on Tobacco Control, a set of multisectoral actions aimed at reducing the demand for, and consequent health effects of, tobacco in the world./.../

Exposure to Secondhand Smoke Among Students Aged 13-15 Years--Worldwide, 2000-2007, July 4, 2007, 298 (1): 35

JAMA -- Exposure to Secondhand Smoke Among Students Aged 13-15 Years--Worldwide, 2000-2007, July 4, 2007, 298 (1): 35: "Exposure to Secondhand Smoke Among Students Aged 13-15 Years—Worldwide, 2000-2007
JAMA. 2007;298:35-36.
MMWR. 2007;56:497-500

Breathing secondhand smoke (SHS) causes heart disease and lung cancer in adults and increased risks for sudden infant death syndrome, acute respiratory infections, middle-ear disease, worsened asthma, respiratory symptoms, and slowed lung growth in children.1-3 No risk-free level of exposure to SHS exists.1 The Global Youth Tobacco Survey (GYTS), initiated in 1999 by the World Health Organization (WHO), the Canadian Public Health Association, and CDC includes questions related to tobacco use, including exposure to SHS.4* This report examines data collected from 137 jurisdictions (i.e., countries and territories) during 2000-2007, presents estimates of exposure to SHS at home and in places other than the home among students aged 13-15 years who had never smoked, and examines the association between exposure to SHS and susceptibility to initiating smoking. GYTS data indicated that nearly half of never smokers were exposed to SHS at home (46.8%), and a similar percentage were exposed in places other than the home (47.8%). Never smokers exposed to SHS at home were 1.4-2.1 times more likely to be susceptible to initiating smoking than those not exposed. Students exposed to SHS in places other than the home were 1.3-1.8 times more likely to be susceptible to initiating smoking than those not exposed. As part of their comprehensive tobacco-control programs, countries should take measures to create smoke-free environments in all indoor public places and workplaces. "
*Additional information available at http://www.cdc.gov/tobacco/global/surveys.htm.

Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure?

Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure?
Coral E. Gartner, Wayne D. Hall, Simon Chapman, Becky Freeman

Background to the debate: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of “harm reduction” point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a “gateway” to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction./.../