Child Exposure to environmental tobacco smoke

http://www.bmj.com/cgi/content/short/335/7619/545
BMJ 2007;335:545 (15 September), doi:10.1136/bmj.39311.550197.AE (published 9 September 2007)
Research
Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey
Patricia C Akhtar, research fellow1, Dorothy B Currie, senior statistician1, Candace E Currie, director1, Sally J Haw, principal public health adviser2
1 Child and Adolescent Health Research Unit (CAHRU), University of Edinburgh, Edinburgh EH8 8AQ, 2 NHS Health Scotland, Edinburgh EH12 5EZ
Correspondence to: P C Akhtar patricia.akhtar@ed.ac.uk

Objective To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006.
Design Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation.
Setting Scotland.
Participants 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation).
Outcome measures Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation.
Results The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland—a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation.
Conclusions The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.

Some Gene damage: Permanent

Some gene damage from smoking is permanent: study

Aug. 30, 2007
Courtesy BioMed Central
and World Science staff

A new study may help ex­plain why form­er smok­ers are still more prone to lung can­cer than those who have nev­er smoked. It found that smok­ing causes some per­ma­nent ge­ne­tic da­mage.

Quit­ting still of­fers huge health ben­e­fits, re­search­ers stressed, as the risk to form­er smok­ers is much low­er than for cur­rent smok­ers.

A team led by Wan Lam and Ste­phen Lam from the BC Can­cer Agen­cy in Van­cou­ver, Can­a­da, took sam­ples from the lungs of 24 cur­rent and form­er smok­ers, as well as from peo­ple who have nev­er smoked.

They used the sam­ples to cre­ate li­brar­ies us­ing a tech­nique called se­ri­al anal­y­sis of gene ex­pres­sion, which helps to iden­ti­fy pat­terns of gene ac­ti­vity.

Only about a fifth of the genes in a cell are switched on at any giv­en time, but smok­ing leads to changes in gene ac­ti­vity. The re­search­ers found that some of these changes, though not all, per­sisted even years af­ter quit­ting smok­ing.

The re­vers­i­ble genes were par­tic­u­larly in­volved in “xeno­bi­otic” func­tion­s—ma­nag­ing chem­i­cals not pro­duced in the body—and me­tab­o­lism of ge­net­ic ma­te­ri­al and mu­cus se­cre­tion, sci­en­tists found. The irre­vers­i­ble dam­age was to some DNA re­pair genes, and to the ac­ti­vity of genes that help fight lung can­cer de­vel­op­ment.

“Those genes and func­tions which do not re­vert to nor­mal lev­els up­on smok­ing cessa­t­ion may pro­vide in­sight in­to why form­er smok­ers still main­tain a risk of de­vel­op­ing lung can­cer,” said Raj Cha­ri, first au­thor of the stu­dy. To­bac­co smok­ing ac­counts for 85 per­cent of lung can­cers, and form­er smok­ers ac­count for half of those newly di­ag­nosed with the dis­ease.

The gene find­ings are pub­lished in the Aug. 29 is­sue of the on­line re­search jour­nal BMC Ge­nomics.

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quinta-feira, 26 de julho de 2007 10:53
Para: procor@healthnet.org
Assunto: [ProCOR] NGO Report on Women and Tobacco
[The following is forwarded from Sara Sanchez Del Mazo [sara.sanchez-del-mazo@sll.se] who moderates the International Network of Women Against Tobacco listserv.
INWAT (www.inwat.org) is a global network of tobacco control specialists dedicated to achieve improved health and greater equality among women and girls in the world by eliminating tobacco use and exposure.]
-------------
Please find below the NGO Report on Women and Tobacco produced by the International Alliance of Women.
NGO REPORT on Women and Tobacco
Cook Islands, Belize, Bolivia, Brazil, Estonia, Guinea, Honduras, Hungary, Indonesia, Jordan, Kenya, New Zealand, Republic of Korea, Singapore
Submitted by the International Alliance of Women to the 39th session of the Committee on the Elimination of All Forms of Discrimination Against Women (23 July-10 August 2007, New York)
Tobacco poses a threat to achieving the MDGs. That was the conclusion of a WHO report, The Millennium Development Goals and Tobacco Control (WHO, Geneva, 2002). The study shows an alarming trend that links poverty with tobacco use. Poor families are more likely to have smokers than richer families. They allocate a substantial part of their total expenditures to tobacco, often exceeding what they pay for education or health care. For example, in Indonesia, low income families spend 5-15 percent of their income on tobacco.
* Tobacco is the second major cause of death in the world, killing 4.9 million persons each year. Two-thirds of the poor nations have male smoking rates higher than the 35 percent in the developed world. Male prevalence rates in Estonia (44 percent), Hungary (53 percent), Guinea (58.9 percent), Kenya (66.8 percent), Indonesia (69 percent), Republic of Korea (64.8
percent) and Jordan (48 percent) are examples (country data based on Tobacco Control Country Profile 2003, Atlanta, The American Cancer Society et al, 2003.) Death and disability due to tobacco affects women even if they are not smokers. When the male head of household no longer provides an income, women are forced to enter the labor market or manage farmland. With unequal access to credit, agricultural resources, and financial know-how, rural women suffer dire economic consequences.
* In countries where rates of tobacco use may be declining among men such as in New Zealand, Singapore, Belize, Honduras and Brazil, vigilance is needed as tobacco companies increasingly target women. Marketing tactics have been so successful that in the Cook Islands women smokers (71.1 percent) outnumber men two to one. The results of the Global Youth Tobacco Survey also indicate reasons to be alarmed as many girls in their early teens are taking up smoking. For example, in Jordan (1999), only ten percent of women smoked, but over 15 percent of girls aged 13 to 15 were smokers. These statistics may underestimate how much women really use tobacco as chewing tobacco or tobacco used with betel often go unreported.
* How does tobacco affect food security for women? The WHO reports that globally, 5.3 million hectares of arable land are currently under tobacco cultivation, land that could feed 10 to 20 million people. The economic "benefits" are precarious for women farmers in countries such as Kenya and Indonesia because land that is cleared for tobacco farming and wood-fired curing contributes to serious deforestation. The costs are social as well as economic. Women and girls who work in tobacco production and processing seldom receive a just share of the income. They may experience "green tobacco sickness" from handling tobacco leaves and suffer from respiratory, nerve, skin and kidney damage from pesticides.
* The CEDAW can be called upon to strengthen tobacco control and protect women's rights to health. Economic policies such as tax increases on all tobacco products are effective measures. They increase government revenue while discouraging tobacco use. Women appear to be particularly responsive to these economic measures. Working closely with the WHO Framework Convention on Tobacco Control, the CEDAW committee and government can ensure that the MDG goals are achieved.

Prevelência de Fumantes: 19%

Notícias
Fumantes são 19% no país, diz pesquisaData: 03/08/2007
Levantamento da Unifesp mostra que para 65,8% dos entrevistados o cigarro não deveria ser liberado em restaurantes.Maior prevalência de fumantes ocorre nas faixas etárias entre 35 anos e 44 anos (24,4%) e entre 45 anos e 59 anos (24,8%)
O percentual de fumantes no Brasil está em 19,3%, segundo pesquisa conduzida pela Unifesp (Universidade Federal de São Paulo) e a Santa Casa de Misericórdia do Rio de Janeiro. O estudo, de abrangência nacional, aponta que a prevalência é maior nas faixas etárias entre 35 anos e 44 anos (24,4%) e de 45 anos a 59 anos (24,8%).
Foram entrevistadas 3.007 pessoas no ano passado, por meio de sorteio. Dessas, 66% chegaram a fumar em algum momento da vida -sendo que 21,3% só experimentaram e 15,4% já não tinham o hábito de fumar quando a entrevista foi feita. Cerca de 20% fumam até hoje. Nesse universo, 80% são fumantes ativos, ou seja, consomem tabaco por pelo menos 20 dias ao mês.
Um dos recortes da pesquisa aborda os hábitos dos pais dos fumantes. Foi constatado que 27% dos brasileiros têm pelo menos um pai também fumante. A influência é maior Entre os adolescentes: 45,4% declararam ser filhos de um pai fumante. Entre os adultos, o percentual cai para 25,1%.
A escolaridade também foi analisada. A pesquisa conclui que o nível de instrução do chefe do domicílio também exerce influência no hábito de fumar. Os fumantes, cujo chefe de domicílio tem nível superior não chegam a 9,5%, enquanto aqueles que tem chefe que não completou o nível primário chega a 20,5%.
A maioria dos entrevistados são contrários ao consumo de tabaco em ambientes fechados e de convívio coletivo. Para 65,8% dos entrevistados, o cigarro não deveria ser liberado em restaurantes e cafés, por exemplo. Nos shopping, 74,3% das pessoas desaprovam o fumo. Em escolas, 92,4% dos entrevistados também acham que não se deve fumar.
A opinião se inverte no caso dos bares. Nesses locais, a tendência é haver uma permissividade maior. Somente 39,7% dos entrevistados responderam que não deveria ser permitido fumar nos bares -em nenhuma área.O levantamento será divulgado oficialmente durante o XIX Congresso da Abead (Associação Brasileira de Estudos do Álcool e Outras Drogas), que acontece em setembro no Rio de Janeiro.

Fonte: Folha SP

De: Prof. Simon Chapman [mailto:chapman@globalink.org]
Enviada em: quinta-feira, 2 de agosto de 2007 07:12
Para: General Messages
Assunto: The case for plain (generic) tobacco packaging

Becky Freeman and I have produced a comprehensive review of relevant evidence about the plain or generic packaging of tobacco products. It draws from sources including internal tobacco industry documents, tobacco industry trade publications and a recent 2007 Morgan Stanley report which declared plain packaging to be one of three outstanding concerns today (along with tax and hiding retail displays).
The full report in high resolution pdf, replete with many illustrations of how packaging is being used as a key promotional vehicle, is available here:
http://tobacco.health.usyd.edu.au/site/futuretc/pdfs/generic.pdf
Feel free to download and distribute and link on your websites. If you would like to reproduce it in bulk as a lobbying tool in your nation, we would be happy to grant permission but would like to be informed.
Simon Chapman

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

www.medscape.com

To Print: Click your browser's PRINT button.
NOTE: To view the article with Web enhancements, go to:http://www.medscape.com/viewarticle/560150

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.
.
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