The ability to prescribe varenicline, the first drug designed to interact with a key brain receptor involved in nicotine addiction, should galvanize all physicians and health systems to step up efforts to treat our most important health problem. Even a small increase in sustained quit rates will yield health benefits that far exceed any other clinical intervention.

Annals of InternalMedicine 21 November 2006 | Volume 145 Issue 10 | Pages 784-785
http://www.annals.org/cgi/content/full/145/10/784

(ASH) United Lincolnshire Hospital Trust has outlined its latest stance against smoking which will allow health workers to refuse to give treatment if a patient, carer or even a friend, refuses to stop smoking when a healthcare worker is present.

The trust will also support any staff member who leaves a home because passive smoking has made them fear for their personal safety - as long as the patient is not in immediate danger.

The move is part of the trust's new Smoke Free policy, which also bans workers from smoking on trust grounds and in vehicles. The new rules come into force on December 1.

Neil Rafferty of FOREST said the trust's policy was the most extreme it had encountered. He said: This is blackmail. When these patients paid their taxes, and their National Insurance, there was no condition attached. They deserve treatment regardless of their lifestyle.

Sources: ASH Daily News and This is Lincolnshire 24 November 2006
Link to article: http://tinyurl.com/yfhnuz

The Food and Drug Administration may soon have the power to regulate cigarettes if hearings that the Senate Health, Education, Labour and Pensions Committee are starting on Tuesday come out in favour of it. If the bill passes, the FDA would be able to cut down on nicotine levels in cigarettes, force tobacco companies to put bigger and more informative health warnings on cigarette packages and ban words like "light," "mild" and "low-tar" in ads and on packages, which officials say falsely influence smokers to believe some cigarettes have fewer health risks than others.

The bill would also allow the FDA to ban posters advertising cigarettes at stop-and-shops, make cigarette ads in magazines that are geared toward young people less appealing and forbid giving out cigarettes as free samples in packs fewer than 20.

Although the FDA wouldn't be able to completely ban nicotine, it would have the power to reduce it and other harmful cigarette ingredients to any level above zero.

Some, including Republican North Carolina Sen. Richard Burr, strongly oppose the legislation.

Burr said he would use "every legislative tool at my disposal" to stall the bill.

He said on Monday, "Clearly, I can only cause so much havoc for so long. I lose this vote over time, but I sure can eat up the clock."
Sources: ASH daily news (www.ash.org.uk) and AHN, Guardian, 28 February 2007
Article link: (AHN) http://tinyurl.com/2hn54l (G)
http://tinyurl.com/2rmakn

New study from the team of Stop-tabac.ch:
Abstract
To identify the most popular smoking cessation Web sites and to compare their quality, we conducted an Internet survey of 706 U.S. current and former smokers who had already visited such a Web site. Participants cited 133 different sites and rated their quality. Surprisingly, two of the three most frequently visited Web sites were owned by tobacco companies: Philipmorrisusa.com and its information resource Quit Assist (cited by 15.9% of participants) and the R. J. Reynolds site (5.9%). However, these two sites were not perceived as helpful. The other most frequently visited sites were QuitNet.com (10.1% of all participants), the site of the American Lung Association (5.2%), and Webmd.com (4.4%). All the nine most frequently visited sites, which together attracted 56% of all visitors, ranked at or below average for quality or helpfulness, and together, the three sites with the highest quality ratings received only 7% of all visitors. Only one-third of participants received follow-up e-mails. Thirteen of the 18 most popular Web sites were for-profit, and several sites promoted unproven methods. Two sites ranked above average for quality, and both were nonprofit: Smokefree.gov and Anti-smoking.org. Quitsmoking.About.com ranked above average for helpfulness. Direct competition radically distinguishes Web sites from other smoking cessation services. However, competition resulted in the selection of tobacco companies sites and commercial sites rather than sites of the best quality. In general, users were not very satisfied with smoking cessation Web sites, and they had difficulty finding the best Web sites. Resources were scattered over dozens of Web sites of often mediocre quality that duplicated each other.
Etter JF. A list of the most popular smoking cessation Web sites and a comparison of their quality . Nicotine & Tobacco Research, Volume 8, Issue 1 Supplement 1 December 2006, pages S27 - S34
Link:
http://www.informaworld.com/smpp/content~content=a769837366~db=all~order=page

New study from the team of Stop-tabac.ch:
Abstract
Objective.
The acceptability and impact of partial smoking bans in psychiatric hospitals are not well documented. We assessed the impact of a partial smoking ban in a psychiatric hospital in Switzerland.
Methods.
Before the intervention, smoking was not allowed in bedrooms and dining rooms, but this ban was not enforced. The intervention consisted of banning smoking everywhere, except in dedicated smoking rooms. Patients and staff were surveyed before (October 2003, 49 patients and 57 staff) and 2 months after the smoking ban (April 2004, 54 patients and 54 staff). Analyses included both patients and staff.
Results.
Compared with baseline, after the intervention twice as many non-smokers reported that they were never exposed to environmental tobacco smoke (ETS) in bedrooms (before = 25.0%, after = 54.5%, p = 0.046), dining rooms (35.5 vs. 65.5%, p = 0.037), corridors (10.4 vs. 30.9%, p = 0.001) and meeting rooms (36.8 vs. 75.0%, p = 0.012). The smoking ban was loosely enforced; although the ban reduced ETS, substantial exposure to ETS remained after it was introduced. Most participants (87%) rejected the idea of a total smoking ban.
Conclusion.
The partial smoking ban was well accepted and was associated with less exposure to ETS. However, even a partial ban proved difficult to enforce in this hospital.

Keywords: Smoking; Nicotine dependence; Smoking cessation; Psychiatry

Manuela Etter and Jean-François Etter. Acceptability and impact of a partial smoking ban in a psychiatric hospital. Preventive Medicine Volume 44, Issue 1 , January 2007, Pages 64-69.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPG-4KY88F0-1&_coverDate=01%2F31%2F2007&_alid=524382130&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6990&_sort=d&view=c&_acct=C000043220&_version=1&_urlVersion=0&_userid=779890&md5=f6efc57e74be5195716398ace88729a2

Int J Clin Pharmacol Ther. 2006 Dec;44(12):614-22.
Diehl A, Nakovics H, Croissant B, Smolka MN, Batra A, Mann K.
Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. alexander.diehl (at) zi-mannheim.de
INTRODUCTION: The high morbidity and mortality caused by smoking highlights the importance of investigating new strategies for smoking cessation or reduction. Galantamine is an acetylcholinesterase inhibitor that increases the effect of acetylcholine (ACh). The nicotinic ACh receptor is activated via positive allosteric modulation (APL).
METHODS: We investigated whether galantamine reduces smoking by performing a 24-week randomized, placebo-controlled, multicentric clinical trial in recently detoxified alcohol-dependent patients. We included all study subjects irrespective of an intention or motivation to abstain from nicotine. Specific treatment for cessation or reduction of smoking was not provided. Smoking behavior was assessed by means of patients' diaries. The nicotine metabolite cotinine was measured to verify the number of smoked cigarettes as documented in the patient's diary.
RESULTS: 114 randomized smokers received galantamine (n = 56) or placebo (n = 58) for 12 weeks. Follow-up examinations were terminated after an additional 12 weeks without treatment. Smoking behavior did not differ between both groups at baseline. After treatment, the intention-to-treat analysis revealed significant differences with a 20% lower cumulative number of smoked cigarettes and a 15% lower number of smoking days in the galantamine group compared to placebo. The average number of smoked cigarettes per smoking day as well as the cotinine values decreased about 10%. Cotinine values showed a positive correlation with the number of documented cigarettes, validating the patients' diaries.
CONCLUSION: Our tentative data indicate that galantamine reduces smoking behavior even without any additional specific intervention. We suggest introducing the term "substitution therapy" into the treatment of smoking. This result could open up a new treatment approach for groups of patients which usually have a low motivation for change.

Discs are monitoring my heart rate and on my neck an ultrasound device is allowing the sonographer to take a look inside my carotid artery, through which blood from my heart is being pumped to my brain.
I am lying on a hospital bed in the vascular physiology department of University College London (UCL).
Out of my right eye I can see an alarmingly detailed screen that is beating in time to the blood coursing through my veins.
It does not need an expert to see that on one section there is a small but unmistakeable fuzzy build-up. 'That,' the sonographer announces, 'is plaque.'
This is not what I had expected. I had come to the hospital to take part in a research experiment to find out if my years of light smoking had resulted in any arterial damage.
At 34, and otherwise reasonably healthy, I hadn't expected any. Instead, what I find is that the small build-up in the carotid is the kind of damage which would be expected in a person ten years older.
It is a sobering discovery - and that, doctors hope, is precisely the point.
Normally, this kind of test would only be done in a hospital on stroke patients or those with chronic circulatory problems.
Now, however, with more health funding going into disease prevention, there is increased interest in earlier screening.
One programme under consideration is offering ultrasound screening to smokers in the hope that seeing actual damage to their arteries might motivate them to quit.
Significantly, it is not just the heavy, packet-a-day nicotine addicts who could be targeted, but those - like me - who characterise themselves as 'light smokers'. There are lots of us: of Britain's estimated 12 million smokers, a third smoke less than ten cigarettes a day. We are, by nature, a delusional bunch. We tell ourselves we're not 'proper' addicts.
And research shows we're less motivated to give up. 'What's the point?' we say. 'It's not like we smoke enough to do any major damage.'
I'm a classic example. After a packet-a-day habit in my early 20s, I have dwindled to less than a packet a week. I don't smoke during the day, and often go two or three days without a cigarette.
Put a glass of wine in my hand, however, and I want a fag - and can happily puff my way through five cigarettes or more on a night out. Like most smokers, I have tried - and failed -to give up several times. Motivation is a problem.
As Lion Shahab, a health psychologist at UCL puts it, smokers are good at perceiving a general risk to health but don't apply it to their own - with light smokers the most deluded of all.
"It's the difference between looking at a virtual reality image of a tiger - you may be amazed but you won't run away - and being told the tiger is real, in which case your emotional response is to run.
"Most smokers are good at seeing the virtual reality tiger but not the real one."
Alas, as Professor Robert West, director of tobacco studies at UCL, points out, smoking is one area of consumption where moderation is not the answer.
While the risk of lung cancer grows with the number of cigarettes smoked - more than 20 cigarettes a day raises the risk 30-fold - in terms of heart disease, recent research suggests most of the risks come from the first few cigarettes each day.
A study of Norwegian smokers published last year found that those who smoked up to five cigarettes a day were three times more likely to die of heart disease than non-smokers.
The statistics don't really frighten me, but seeing the damage for myself might. Which is what brings me to UCL.

Source: The Mail on Sunday.
http://www.mailonsunday.co.uk/pages/live/articles/health/healthmain.html?in_article_id=429024&in_page_id=1774

Some states in America are turning their attention to things that distract motorists.

Vermont lawmakers are considering a measure that would ban eating, drinking, smoking, reading, writing, personal grooming, playing an instrument, interacting with pets or cargo, talking on a cell phone or using any other personal communication device while driving. The punishment: a fine of up to $600.

Similar bills are under consideration in Maryland and Texas, and Connecticut has passed one that generically bans any activity that could interfere with the safe operation of a motor vehicle.

Cell phones attracted people to this issue, said Matt Sundeen, a transportation analyst with the National Conference of State Legislatures. Now that people are more focused on distracted driving issues, they're beginning to talk about the broader range of distractions.

Republican state Rep. Thomas F. Koch, sponsor of the Vermont bill, said the motivation came from his own observations: What finally pushed me was when at a stop sign, someone opposite me was trying to navigate around the corner with a cell phone to the ear in one hand and a cigarette in the other, and she wasn't doing very well.

Distracted drivers were involved in nearly eight out of 10 collisions or near-crashes a study by the National Highway Traffic Safety Administration has found.

Sources: ASH daily news and The Guardian 9 February 2007
Link to article:
http://www.guardian.co.uk/uslatest/story/0,,-6402813,00.html

Between 2004 and 2006, in Europe, the number of new cases of cancer increased by 300,000. It is estimated that in 2006 there were 3.2 million new cases of cancer (up from 2.9 million in 2004) and 1.7 million deaths from cancer in the whole of Europe.

Professor Peter Boyle, Director of the International Agency for Research on Cancer (IARC) in Lyon, France, warned that despite better prevention and treatments, Europe faced a major increase in the cancer burden because of the ageing population.

With an estimated 3.2 million new cases, cancer remains an important public health problem in Europe and the ageing of the European population will cause these numbers to continue to increase, even if age-specific rates of cancer remain constant he said.

He said urgent action was needed now to tackle cancer, particularly in Central and Eastern Europe, through measures such as tobacco control and more widespread cancer screening and improving people's diet and lifestyle.

Lung cancer retains its status as the leading cause of cancer death in Europe in 2006, said Prof Boyle. The overwhelming majority of lung cancer is caused by tobacco smoking, and tobacco control is clearly a number one priority in Europe he said.
Source: ASH Daily News and Medical News Today 9 February 2007
Link to article: http://tinyurl.com/2kv595

Reacting to the ASH statement in which their Coalition calls for a new cigarette standard to cut fires , Chris Ogden, Director of Trade and Industry Affairs at the Tobacco Manufacturers' Association commented:

"We, just like the Coalition, would, of course, like to see a reduction in smoking-related fires. The matter is, however, far from straightforward.

"There is no internationally agreed standard for lower ignition propensity cigarettes. We are not opposed to cigarette design modifications if they can achieve meaningful results in real world situations. Any regulatory policy in this regard must be based on sound science and we are in discussions with Government on the issue.

"Regardless of the science there is no such thing as a 'fire-safe' burning cigarette. To convince smokers that there is, runs the risk of creating a sense of complacency. We would support any public information campaigns that encourage consumers to behave responsibly and to extinguish cigarettes properly, especially after the consumption of alcohol which is a contributing factor in a very high percentage of smoking-related fires.

"It is argued that lower ignition propensity cigarettes as in the USA and Canada should be introduced here but cigarette design in the EU is constrained by the legal requirement for set tar, nicotine and carbon monoxide ceilings which affect product design. This is achieved in part by the type of paper used and the density of tobacco. These ceiling requirements do not apply in the USA or Canada."

Sources: http://www.tobacco.org/news/236062.html
and PR Newswire (uk), 2006-11-13

Most Americans believe smokers and obese people should pay more for health insurance, but they have mixed views on how to help the millions without any health insurance, according to a survey published on Tuesday.

The poll of about 1,500 people found that that about 80 percent believe the U.S. health insurance system, with 46.6 million uninsured, needs fixing.

Sixty percent of those polled favored higher premiums for smokers while 30 percent felt the obese should pay more.

"When it comes to personal responsibility, consumers increasingly support making people pay more for unhealthy behavior," said the report in the journal Health Affairs.

Sources: http://www.tobacco.org/news/236075.html
and The Washington Post, 2006-11-14

Health campaigners breathed a collective sigh of relief today after the European Court of Justice ruled that anyone buying cigarettes over the Internet would still be required to pay tax at the rate set by the country of final destination.

The legal dispute centred on a case originally brought by a group of Dutch wine enthusiasts who argued that they should only have to pay local duties on wine imported for personal consumption if ordered over the Internet.

Deborah Arnott, Director of ASH, said:
"Thankfully the ECJ has taken into account the broader health and economic implications of this case. If the Dutch case had been considered lawful it would have been disastrous for the health of Britons and other Europeans living in countries where tobacco taxes are high."

The European Court of Justice ruled that products, including alcohol and tobacco, which are not bought for private purposes must 'necessarily be regarded as being held for commercial purposes' and therefore subject to import tax.

EU laws from 1992 stipulate that tax should be charged at the rate of the country of purchase, allowing an exemption from excise duty only if they are for private use and carried by that individual.

The European Court of Justice called on the EU executive to 'remedy' current EU laws, if it saw fit to do so.

Source: BBC, Forbes, 23 November 2006
Article link: (BBC) http://tinyurl.com/yza6od (F)
http://tinyurl.com/yh8392
ASH press release: http://www.ash.org.uk/html/press/061123.html