Markham's Behavioral Health

Smoke-Free Policies Prove Effective

Reuters HealthDay reported on July 1, 2008 on a study in the July 2008 issue of Lancet Oncology that found that smoke free policies work.

It has taken a fight in many places to get smoke free policies in place. There have been many obstacles and barriers. It is always difficult to overcome addiction and to give up the profits that accrue from them. It turns out that the Public Health professionals were right all along.

Here is a snippet from the Reuters article:

Smoke-free policies are extremely effective at reducing smoking rates, exposure to secondhand smoke, and even smoking-related heart disease, new research shows.

The report, by an International Agency for Cancer Research working group, also found smoke-free rules don't affect business in restaurants or bars.

The researchers analyzed available evidence and found:

• Implementation of smoke-free policies substantially decreases secondhand smoke exposure.
• Smoke-free workplaces decrease cigarette consumption in continuing smokers.
• Smoke-free policies decrease respiratory symptoms in workers.
• Smoke-free policies don't decrease business in restaurants or bars.
• Voluntary smoke-free home policies decrease adult and youth smoking and children's exposure to secondhand smoke.
• Smoke-free workplaces decrease adult smoking rates.
• Smoke-free policies decrease tobacco use in youths.
• Smoke-free legislation reduces rates of heart disease.

MedlinePlus: Smoke-Free Policies Prove Effective.

Coronary Heart Disease Deaths And Decreased Smoking Prevalence in Massachusetts, 1993-2003

According to a study published in the August, 2008 issue of the American Journal Of Public Health in the ten years since the implementation of the Massachusetts Tobacco Control Program in 1993, the smoking prevalence rate dropped 29% and the coronary heart disease mortality rates dropped 31 %  with 425 fewer deaths which resulted in 3,365 extra life-years.

As a public health intervention, controlling tobacco use in populations has big health dividends. However, they raise interesting moral issues such as should people be able to engage in life damaging behaviors such as smoking? Should this be an individual choice or should governmental intervention make such choices difficult?

Here is the abstract from the AJPH.

We used the previously validated IMPACT coronary heart disease (CHD) mortality model to estimate the CHD deaths attributable to reductions in smoking prevalence following the introduction of the Massachusetts Tobacco Control Program (MTCP) in 1993. A 29% and 31% decline in smoking prevalence and CHD mortality rates occurred, respectively (from 1993 to 2003). A total of 425 fewer CHD deaths, which generated approximately 3365 extra life-years, were attributable to decreased smoking prevalence. With these results in mind, a comprehensive tobacco control program should be sustained and supported.

Coronary Heart Disease Deaths And Decreased Smoking Prevalence in Massachusetts, 1993-2003 -- Kabir et al. 98 (8): 1468 -- American Journal of Public Health.

Chantix May Raise Suicide Risk but smoking is still the far greater health risk

Reuters HealthDay reported on February 1, 2008 that the FDA has warned that the anti-smoking drug, Chantix, might contribute to suicidal ideas and behavior.

There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.

"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.

Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Pifzer who manufactures and markets Chantix says that part of the agitation and suicidal ideas might be linked to nicotine withdrawal. One thing seems clear, and cigarettes are a huge risk factor for premature death so stopping smoking, even with the use of Chantix, is well worth any minimal risk.

Link: MedlinePlus: Quit-Smoking Drug May Raise Suicide Risk.

Supreme Court to consider shield for drug, cigarette firms

The LA Times reported on January 19, 2008 that the Supreme Court may hear a case in which cigarette companies and drug companies argue that they cannot be sued in state court because the Feds already approved their consumer warnings.

I am reminded in reading this about the joke: "What's the three biggest lies ever told?"

"I'll still love you in the morning. The check is in the mail. I'm from the government and I'm here to help you."

The Supreme Court signaled Friday that it may be ready to shield drug companies and cigarette makers from lawsuits from consumers who say they were not fully warned of the dangers of the product. The justices voted to hear a pair of appeals from industry lawyers that, if upheld, would erect a new barrier to lawsuits. Related -Supreme Court of the United States Related Stories -Ruling limits reach of investor suits -Justices uphold ban on test drugs for the dying -High court to hear TV judge's case -Justices to decide whether murder victims' prior statements are admissible For many years, lawyers for the pharmaceutical industry and cigarette makers have argued that their products should be shielded from suits if they have been approved for use by a federal agency -- such as the Food and Drug Administration -- and a warning label is included. For example, most prescription drugs come with labels that indicate they may be safely used under certain conditions. Consumers are also warned against overdosing or using the drug for other purposes. Industry lawyers say these federally approved warning labels should "preempt" or block lawsuits in state courts from consumers who say they used the drug as prescribed but were badly hurt by it. They say the FDA, and not jurors, should have the role of deciding when drugs can be used safely.

Link: Supreme Court to consider shield for drug, cigarette firms - Los Angeles Times.

Smoking in Movies Linked to Kids Lighting Up

Reuters HealthDay reported on January 8, 2008 on a study which appears in the January, 2008 issue of the journal, Pediatrics, which found that smoking in movies rated G, PG, and PG-13 influence kids to smoke.

Young people who start smoking may be influenced to do so by movies they saw in early childhood, new research suggests.

What's more, the study found that almost 80 percent of the exposure to smoking scenes in movies came through films rated "G," "PG" and "PG-13."

"Movies seen at the youngest ages had as much influence over later smoking behavior as the movies that children had seen recently," said study author Linda Titus-Ernstoff, a pediatrics professor at Dartmouth Medical School.

"And I'm increasingly convinced that this association between movie-smoking exposure and smoking initiation is real," she added. "That's to say, causal. It is quite improbable that the association we see is due to some other influence, some other characteristic inherent in children or parental behavior. The relationship is clearly between movie-smoking and smoking initiation."

The findings are published in the January issue of Pediatrics.

Link: MedlinePlus: Smoking in Movies Linked to Kids Lighting Up.

Smoking linked to teen alcohol and drug use

Reuters reported on October 23, 2007, on a report issued by CASA, the Columbia University's National Center on Alcoholism and Substance Abuse,  which got its data from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), that shows that cigarettes are indeed the gateway drug for alcolescent abuse of alcohol and marijuana. Here is a snippet of the Reuter's report:

Teenagers who smoke are five times more likely to drink and 13 times more likely to use marijuana than those who do not smoke, according to a report issued on Tuesday.

The report by Columbia University's National Center on Addiction and Substance Abuse presented further evidence linking youth smoking to other substance abuse and spotlighted research on how nicotine affects the adolescent brain.

"Teenage smoking can signal the fire of alcohol and drug abuse or mental illness, like depression and anxiety," Joseph Califano, who heads the center and is a former U.S. health secretary, said in a telephone interview.

The report analyzed surveys conducted by the U.S. Substance Abuse and Mental Health Services Administration and other data on youth smokers. Most smokers begin smoking before age 18.

Smokers ages 12 to 17 are more likely drink alcohol than nonsmokers -- 59 percent compared to 11 percent, the report found. Those who become regular smokers by age 12 are more than three times more likely to report binge drinking than those who never smoked -- 31 percent compared to 9 percent.

Link: Smoking linked to teen alcohol and drug use(Print Version).

State Hospitals Struggle to Give Up Smoking

There is an article in the November 16, 2007 issue of the Psychiatric News about how state hospitals across the nation are beginning to address the issue of smoking in their facilities.

It is an interesting observation that people with problems with alcohol, drugs, and serious psychiatric disorders smoke at rates 3 and 4 times the rates of people without those problems. For example, in New York State currently, the smoking prevalence rate in the general population is 16% but among alcoholics it is 85-90% and among people with serious mental illness it is about 75%.

In New York State all alcohol and drug treatment facilities and programs which are licensed by the New York State Office of Alcohol and Substance Abuse (OASAS) must be tobacco free by July 28, 2008. The 14 Alcohol Treatment Facility run by OASAS itself are already tobacco free and this requirement is now being extended to the nonprofit facilities licensed by OASAS. The Psychiatric facilities are still behind though even though they are catching up.

"Smoking kills, and it kills seriously mentally ill people early," Mary Diamond, D.O., said at the APA Institute on Psychiatric Services in New Orleans in October.

About 75 percent of seriously mentally ill people are tobacco dependent—over three times the rate among the general population—yet 59 percent of public mental health facilities still permit smoking, she said. Even some states that have banned cigarettes in prisons continue to allow smoking in their mental hospitals.

It still is not clear why substance abusers and psychiatric patients smoke at such high rates although there is some evidence that nicotine affects the biochemical balance in the brain. It seems a shame that substance abusers get into recovery, and psychiatric patients compensate and improve, and then cigarettes wind up killing them. Dr. Bob and Bill W. the founders of AA both died from smoking. 

Link: State Hospitals Struggle to Give Up Smoking -- Levin 42 (22): 4 -- Psychiatr News.

Men who smoke risk erectile dysfunction

Hey guys, before you reach for the Viagra and Cialis maybe you ought to quit smoking. According to an article done by Reuters on September 26, 2007, on a study published in the October, 2007 American Journal of Epidemiology, men who smoke risk erectile dysfunction which means they can be impotent which means they can't get it up which means they can't get wood when they want to.

Otherwise healthy men who smoke risk developing erectile dysfunction -- and the more cigarettes they smoke, the greater the risk of erectile dysfunction, according to a new study.

Erectile dysfunction is the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. In a study of 4,763 Chinese men aged 35 to 74 years who were free of blood vessel disease and who reported that they had been sexually active within the last 6 months, the researchers found a significant statistical link between the number of cigarettes smoked and the likelihood of erectile dysfunction.

Link: MedlinePlus: Men who smoke risk erectile dysfunction: study.

New York State Office of Alcoholism and Substance Abuse initiates landmark policy banning tobacco products in its licensed facilities making it first in the nation

The New York State Office Of Alcoholism and Substance Abuse (OASAS), has announced in a press release issued on July 24, 2007, that all New York State licensed alcohol and drug treatment programs will be expected to be tobacco free by July 24, 2008. This means that no tobacco products or paraphernalia such as lighters, rolling papers, etc. will be allowed on agency properties or vehicles. Tobacco products will be considered and treated as contraband just as alcohol and street drugs are in OASAS treatment and prevention facilities. This is the first such policy in the United States and is labled as a "landmark initiative".

For the first time in professional substance abuse history a major regulatory and funding body has taken a sane and rational approach. Nicotine is the most addicting and deadly drug in America. 30,000 Americans die every year from street drugs, 100,000 from alcohol, and 430,000 from tobacco. What is America's drug problem.

Dr. Bob, and Bill W. the founders of Alcoholic Anonymous both died from tobacco.

Here is a brief snippet from the OASAS press release:

OASAS, which certifies and funds more than 1,400 prevention and treatment programs, today issued a proposed regulation that would take effect July 24, 2008, following final approval. It would require that all providers prohibit tobacco within facilities, on all grounds under their control and in program vehicles.

To read the whole press release, click on the link below.

Link: OASAS launches Tobacco Freedom Initiative.

Conscientious objectors persecuted, prosecuted, executed

On September 16, 1939, August Dickmann was the first Conscientious Objector to be executed by the Germans in World War II. Following the execution of the 29 year old Dickmann, the Nazis executed another 270 Conscientious Objector Jehovah Witnesses.

A brief artice on the Peace History web site says:

August Dickmann, a German and a Jehovah's Witness, became the first conscientious objector (CO) to be executed by the Nazis during World War II. The execution by firing squad took place in Sachsenhausen concentration camp before all prisoners, including 400 Jehovah's Witness inmates. Threatened by Commandant Hermann Baranowsky with the same fate, none of the remaining 400 Witnesses renounced their CO position. Later, the Nazis commonly executed Witnesses by guillotine or hanging, not wanting to spend bullets on COs. German military courts sentenced and executed 270 Jehovah's Witnesses, the largest number of COs executed from any victim group during World War II.

Conscientious Objectors continue to be prosecuted and persecuted in most countries at war even the United States. During the Iraq war there have been soldiers who have refused to fight and kill such as Ehren Watada who is scheduled for court martial on October 9, 2007.

How is it that we live in a society and a time in history where people who refuse to attack, injure, and kill others are themselves killed for that refusal? What are we teaching our children?

What passes for history in most schools is a history of generals and war, conquerors and the conquered, winners and loosers, dominators and the dominated. It is time to teach a new history of peace and justice. Conscientious objectors are the saints among us who have lived based on values that our current sinful world rejects. Where the world sees domination and vengeance, conscientious objectors see partnership, peace, and love.

Link: This Week In Peace History.