CDC

Snus smokeless tobacco: Less harmful than cigarettes, but not safe.

Source: WebMD

By: Daniel J. DeNoon

If you use snus, do you win or lose?

Snus — alternately pronounced snoose or snooze — is a smokeless, flavored tobacco product very different from snuff. When placed between cheek and gum, it doesn’t make you spit.

Even its critics admit that snus is less harmful than other forms of smokeless tobacco. And it is far less harmful than cigarette smoking.

So is snus a good thing?

It would be a good thing if everyone who smoked cigarettes or dipped snuff switched to snus instead. It would be a good thing if snus were a way station on the road to quitting all forms of tobacco. It would even be a good thing if kids who would have become smokers became snus users instead.

But despite all of that, mounting evidence suggests snus isn’t a good thing — and may be far worse than they appear.

Snus: Less Harmful, But Not Safe

Cigarettes are the world’s most efficient nicotine delivery device. They are also the most deadly. Many of the most dangerous byproducts of cigarettes are created during the burning process.

Smokeless tobacco products obviously don’t burn. But smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and esophageal cancer.

Much of this risk comes from cancer-causing chemicals called nitrosamines and polycyclic aromatic hydrocarbons (PAH). And snuff products actually deliver more cancer-causing nitrosamines than cigarettes do.

But nitrosamine content is far lower in snus than in snuff, says Stephen S. Hecht, PhD, professor of cancer prevention at the University of Minnesota.

“Snus are made with a special process to help control nitrosamine levels,” Hecht tells WebMD.

There’s a catch, of course. Carcinogen levels in snus may be lower — but they are not low.

“Nitrosamine levels in snus are still 100 times greater than levels of nitrosamines in foods like nitrite-preserved meats,” Hecht says. “This is not a harmless product.”

And there’s evidence that these nitrosamines — or something else in snus — are causing cancer. In Sweden and Norway, where snus originated, snus users have a significantly higher risk of pancreatic cancer.

Snus are also linked to mouth sores, dental cavities, heart attack, stroke, and diabetes risk. And they do deliver nicotine — an addictive drug.

Snus: Harm Reduction or Multiplication?

OK, so snus isn’t without harm. But if it’s so much safer than cigarettes, wouldn’t it be good for smokers to switch to snus?

In Scandinavia, there’s some evidence that snus contributed to a decline in smoking. Whether that happens in the U.S. depends on young people, says Michael Eriksen, ScD, director of the Institute of Public Health at Georgia State University and former director of the CDC Office on Smoking and Health.

“If we see that existing smokers are the primary users of snus and go from smoking to snus, that would be a public health success story,” Eriksen tells WebMD. “But if kids start out on snus and then grow into smoking, that is going to be a disaster.”

It’s a huge public health experiment — and the results already are plain to see, says Terry Pechacek, PhD, associate director for science at the CDC’s Office on Smoking and Health.

Pechacek notes that more than a fourth of white, male high school students report having used smokeless tobacco products in the last month. Overall, nearly 7% of all U.S. high school students already use smokeless tobacco.

And they are not using snus instead of cigarettes.

“The overwhelming pattern is to smoke cigarettes along with smokeless tobacco — and two-thirds of this is among young adults,” Pechacek tells WebMD. “Over half of teens using smokeless tobacco are also using cigarettes. … It is of great public health concern.”

This isn’t an accident, says Michael Steinberg, MD, MPH, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

Steinberg notes that in 2006, major U.S. cigarette companies bought the major smokeless tobacco brands. And the two major brands of snus? They’re from leading cigarette makers Altria/Philip Morris (Marlboro Snus) and RJ Reynolds (Camel Snus).

“Snus is being co-marketed with cigarettes,” Steinberg tells WebMD. “The companies are not shy in saying, ‘When you can’t smoke, use snus.’ But when you can smoke, it is clear they want you to smoke cigarettes. They make more money from cigarettes sales than anything else on the planet.”

Steinberg also notes that U.S. snus deliver less nicotine than do cigarettes.

“So if people try to get nicotine from snus, they will not get what they are used to. They will go through nicotine withdrawal and so will not use snus alone,” Steinberg says. “My conclusion is that companies do not want to replace cigarettes with snus.”

Snus: An Aid to Quitting Cigarettes?

Data from Sweden show that snus users don’t always progress to cigarette use, and that it’s possible to use snus to reduce dependence on cigarettes.

One Swedish study, for example, found that there were more ex-smokers using snus that there were ex-snus users using cigarettes.

However, Steinberg notes that this study fails to account for significant anti-smoking efforts taking place in Sweden at the same time, such as indoor health programs and government assistance to smoking cessation programs.

“Other countries, such as Norway, have not seen the same outcomes in terms of health benefits of snus as in Sweden,” he says.

Steinberg points to studies showing that snus isn’t any more helpful than nicotine replacement products such as nicotine gum and nicotine nasal spray.

“The real question is who do you buy your nicotine from?” GSU’s Erickson says. “Do you buy it from a tobacco company that can put anything on the market with no testing … or do you buy it from pharmaceutical companies that have to demonstrate the safety and effectiveness of their products as a drug and demonstrate they actually work?”

It’s right there in a big black box on the home page of the Camel Snus web site: “WARNING: Smokeless tobacco is addictive.”

Snus users get hooked on nicotine. This means that if users try to quit, they will go through the unpleasant sick feeling known as withdrawal. Many will find it very difficult, if not impossible, to stop using nicotine in one form or another.

“Those who sell nicotine would like to keep people hooked on nicotine forever. That is a question, whether lifetime nicotine addiction is acceptable,” Erikson says. “There are 50 million people in the U.S. who are regular nicotine users. The sooner we can get them from relying on smoked nicotine to not-smoked nicotine the better. The sooner we can get them all off nicotine entirely, the better.”

All of the experts who spoke with WebMD agree: Snus clearly aren’t as deadly as cigarettes, but they pose a significant risk to your health.

“The bottom line is there is no safe form of tobacco use,” Pechacek says.

November, 2010|Oral Cancer News|

Oral Cancer Foundation founder named Survivor Circle Award winner by ASTRO

The American Society for Radiation Oncology (ASTRO) has named Brian Hill of Newport Beach, Calif., as its 2010 Survivor Circle Award winner. Hill will be recognized with a trophy and a $1,000 prize during the Awards Ceremony on Tuesday, November 2, 2010, during ASTRO’s 52nd Annual Meeting in San Diego. He has chosen to donate the funds from the award to benefit The Oral Cancer Foundation, the nonprofit he started a decade ago.

The Survivor Circle Award recognizes a cancer survivor who has given back to the community by devoting his or her time to helping others with cancer. Hill was diagnosed with Stage 4 metastatic tonsil cancer in 1997. When he was going through treatment, he had many questions about side effects and realized there was a lack of information and awareness about head and neck cancer even though the disease has a very high death rate, due to it being caught at a late stage in most cases.
“There was a huge lack of information available, and I was desperate to find someone to talk to who had gone through the same thing I was experiencing,” Hill said. “I knew that if I was feeling this way, there had to be others feeling my frustrations too. I then became a student of the disease. ”

After Hill completed his grueling but successful radiation treatments at M.D. Anderson Cancer Center in Houston, he and his wife Ingrid founded The Oral Cancer Foundation in 1999, which is now a national non-profit charity. Besides its original mission of patient support and information dissemination, it is involved in advocacy issues, sponsorship of research, and increasing public awareness and early discovery of the disease.

“Being chosen by ASTRO in this way is a huge honor. I feel as if this is the second time I am the beneficiary, as I owe my being here today to the doctors and radiation technology, which saved my life.” He said. As the pro bono director of the foundation, Hill spends his time speaking at symposia and universities worldwide. He has also worked as an advocate with congressmen and senators on issues as varied as the tobacco bill, Medicare issues of post-treatment patients, the HPV vaccine, and the issues of early cancer detection.

Hill was inducted as the first non-doctor member of the American Academy of Oral Medicine in recognition of contributions to oral cancer public literacy and awareness programs and the promotion of early diagnosis of oral cancer via free public screenings. He has also received awards from the NIH/NIDCR and the Chicago Dental Society, and is a recipient of NYU’s prestigious Strusser award for public service. He sits on oral cancer work groups from the CDC to numerous professional dental and medical society organizations.

“Congratulations to Brian Hill for winning this prestigious award,” Anthony Zietman, M.D., ASTRO president and a radiation oncologist at Massachusetts General Hospital in Boston, said. “Brian embodies everything that the Survivor Circle Award stands for. He beat the odds with his own cancer and has worked tirelessly to promote awareness for an under-recognized type of cancer. I’m proud to have him as a part of the Annual Meeting.”

The ASTRO Annual Meeting is the premier scientific meeting in radiation oncology and attracts more
than 11,000 attendees of various disciplines, including oncologists, physicists, biologists, nurses and other healthcare professionals from all over the world. The theme of this year’s meeting is “Gathering Evidence, Proving Value” and the program will examine the realities of practicing medicine in 2010.

Provided by American Society for Radiation Oncology

October, 2010|OCF In The News|

Decreases in adolescent tobacco use leveling off

Source: HemOncToday.com

Declines in rates of adolescent tobacco use have stagnated in the past few years, prompting the CDC to call for better prevention efforts, according to a recent report.

“Smoking continues to be the leading preventable cause of death and disability in the United States; and among adult established smokers in the United States, more than 80% began smoking before age 18 years,” CDC researchers wrote.
To evaluate behaviors and attitudes toward tobacco use during the critical period of adolescence, the researchers used National Youth Tobacco Survey (NYTS) data collected from 2000 to 2009.
The NYTS, which presents school-based survey responses from a cross-sectional, nationally representative sample of middle school and high school students, gleans information on youth tobacco use; smoking cessation; tobacco-related knowledge and attitudes; access to tobacco; media and advertising and secondhand smoke exposure. The study has been conducted every 2 years since 2000.
From the 205 participating schools, 22,679 students responded. They were polled about any use of, current use of and experimentation with certain tobacco products, including cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks. Survey questions also investigated students’ willingness to initiate tobacco use.
Results indicated that 8.2% of middle school students and 23.9% of high school students reported current tobacco use in 2009, the researchers said, with 5.2% of middle school and 17.2% of high school students reporting current cigarette use. The researchers also noted that 21.2% of middle school and 24% of high school students were willing to start smoking cigarettes.
Data from 2009 also suggested that, among middle school students, 3.9% currently used cigars; 2.6%, smokeless tobacco; 2.3%, pipes; 1.6%, bidis; and 1.2%, kreteks. A similar distribution of use of these products was noted among high school students, with 10.9% currently using cigars; 6.7%, smokeless tobacco; 3.9%, pipes; 2.4%, kreteks; and 2.4%, bidis.
From 2000 to 2009, decreases occurred among middle school students for current tobacco use, 15.1% to 8.2%; current cigarette use, 11% to 5.2%; and cigarette smoking experimentation, 29.8% to 15%. Overall rates for susceptibility to smoking, however, did not decline. Analysis also indicated that rates of decreases demonstrated no change during this time.
Among high school students, current tobacco use decreased from 34.5% to 23.9% from 2000 to 2009, according to the researchers, with current cigarette use also declining from 28% to 17.2% and rates of experimentation falling from 39.4% to 30.1%. Again, rates of decline did not change.
Prevalence of susceptibility to smoking remained steady for middle school and high school students throughout the study period.
Between 2006 and 2009, however, the willingness to start using tobacco products and current use of cigarettes, cigars, smokeless tobacco, pipes, bidis and kreteks did not change among middle school or high school students. For middle school students, the researchers only noted declines in two subpopulations, with rates of current cigarette use falling from 6.4% to 4.7% among girls and decreasing from 6.5% to 4.3% among white students.
Similarly, from 2006 to 2009, prevalence among high school students only declined in girls for current tobacco use, decreasing from 21.3% to 18.2%, and current cigarette use, with rates falling from 18.4% to 14.8%. Prevalence for current bidi use also declined among white students (2.6% to 1.7%).
“The findings in this report indicate that, from 2000 to 2009, prevalences of current tobacco and cigarette use and experimentation with smoking cigarettes declined for middle school and high school students, but no overall declines were noted for the 2006-2009 period,” the researchers wrote. “The general lack of significant change during the shorter period indicates that the current rate of decline in tobacco use is relatively slow.”
Researchers noted that prevention programs are effective, but they do not receive adequate financial support. “Comprehensive tobacco control programs should be fully funded and implemented, as recommended by the CDC,” they wrote.
The researchers also said better control of cigarette advertisements and more graphic warnings on cigarette packs may help deter adolescents from smoking by altering the general public’s attitudes toward tobacco use.
“Changes in social norms might help reduce youth susceptibility to try cigarettes and other tobacco products and accelerate the decline in tobacco use among youths,” the researchers wrote.

August, 2010|Oral Cancer News|

A tough one to chew on: smokeless tobacco and teens

Source: Medscape Today
Author: Mary E. Muscari, PhD, CPNP, APRN-BC, CFNS

Introduction

One would think that the mere image of a bulgy cheek spewing brown, foul-smelling goo would be more than enough to turn anyone, especially appearance-conscious teens, off of using smokeless tobacco (ST). But then, these media-savvy adolescents probably have discovered snus, a smoke- and spit-free tobacco. According to a recent article in Reuters,[1] the use of ST is on the rise among US teens, reversing a downward trend in tobacco product use by adolescents. The Reuters article cites comments made by Terry Pechacek, PhD, Associate Director for Science, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), in a report to a US Congressional Panel. Among his comments is the suggestion that ST-using Major League Baseball® (MLB) players may be influencing young men to take up the cancer-causing habit. In his report, Dr. Pechacek noted that “the recent increases in ST use by adolescent boys and young adult men and the increasing dual use of cigarettes and ST products may portend a leveling off or even a reversal in the decline in smoking, the perpetuation of nicotine dependence, and continuing high levels of tobacco-related disease and death in the country.”[2] Given this grim outlook, healthcare professionals need to kick up their fight against teen tobacco use by increasing their focus on smokeless forms of tobacco.

Smokeless Tobacco

ST (also known as spit, plug dip, chaw, rack, spits, grizz, and tasties) comes in 2 forms: chew and snuff. Chewing tobacco is available in loose-leaf, twist, and plug forms, whereas snuff comes in moist, dry, and sachet forms.[2,3]

  1. Snuff: Available in dry or moist forms, snuff isfinely ground or shredded tobacco leaves that are packaged in tins or teabag-like pouches. A pinch of snuff is placed between the lower lip and gum or cheek and gum. Users typically spit out the tobacco juices, but those who swallow the juices become more addicted. Dry forms of snuff can be sniffed into the nose; using snuff is also called dipping.[2,3]
  2. Chew (chaw): A wad of chewing tobacco is placed inside the cheek and held there, sometimes for hours, and users spit out the tobacco juices. Chew is made fromloose tobacco leaves that are sweetened and packaged in pouches.
  3. Plug: Chewing tobacco is pressed into a brick, usually with the help of molasses or another sweet syrup. Users cut off or bite off a piece of the plug and hold it between the cheek and gum, spitting out the tobacco juices.
  4. Twist: Twist is flavored chew, braided and twisted into rope-like strands. It is held between the cheek and gum, and users spit out the tobacco juices.
  5. Snus: The relatively new snus(pronounced “snoos”) is a smokeless, spitless tobacco product that originated in Sweden. Snus comes in a pouch that is placed between the upper lip and gum for about a half-hour before discarding.
  6. Dissolvable tobacco products: Pieces of compressed powdered tobacco, similar to small hard candies, dissolve in the mouth and require no spitting of tobacco juices. Instead, they melt like breath mints. Sometimes called “tobacco lozenges,” these products are sold in shiny plastic cases and are not to be confused with the nicotine lozenges used for smoking cessation. Dissolvable tobacco products include[4]:
    • Orbs: similar to popular tiny breath mints;
    • Sticks: similar to toothpicks; and
    • Strips: similar to mouthwash breath strips.

According to the National Cancer Institute, ST contains at least 28 carcinogens in varying concentrations. The most harmful are the tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco. Tobacco-specific nitrosamines have been detected in some ST products at higher levels than levels of other types of nitrosamines, which are allowed in foods, such as bacon and beer. Other carcinogens include N-nitrosamino acids, volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium-210. Similar to smoked tobacco, ST contains nicotine, which is addictive, and the amount of nicotine absorbed from ST is 3 to 4 times greater than the amount delivered by a cigarette. Nicotine is absorbed more slowly from ST than from cigarettes; however, more nicotine per dose is absorbed from ST than from cigarettes, and the nicotine stays in the bloodstream for a longer time.[5]

Prevalence of Smokeless Tobacco Use in Teens

In 1970, men aged 65 years or older were almost 6 times as likely as those aged 18 to 24 years to use ST regularly, but by 1991, young men were 50% more likely than the oldest men to be regular users.[6] The 2009 Youth Risk Behavior Surveillance Survey[7] (YRBSS), which summarized results from public and private schools with students in at least 1 of grades 9-12 in the 50 US states and the District of Columbia, found that 8.9% of students had used ST (eg, chewing tobacco, snuff, or dip) on at least 1 day during the 30 days before the survey. The YRBSS also found that use was higher among boys (15.0%) than girls (2.2%) and higher among white persons (11.9%) than black (3.3%) and Hispanic persons (5.1%).[7]

ST has long been a staple in the rural United States, and it remains a problem among rural youth. The table demonstrates that in many states with large rural areas, prevalence of ST use among youth was higher than the national average.[8] Compared with urban children, rural children in the US are more likely to be poor, be white, and have less educated parents. Rural children also engage in more smoking, drinking, and drug use than their urban counterparts.[9]

Table. 2009 YRBSS Results on Smokeless Tobacco in US Rural Regionsa

State Prevalence Percentage
National 8.9
Alabama 12.4
Alaska 13.6
Arkansas 12.4
Colorado 10.7
Idaho 9.4
Louisiana 9.6
Kentucky 14.2
Montana 14.6
North Dakota 15.3
Oklahoma 10.5
South Carolina 10.4
South Dakota 14.6
Tennessee 12.2
West Virginia 14.4
Wyoming 16.2

a Used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey.

To describe substance use among Pennsylvania rural youth, Aronson and colleagues[10] identified changes and trends from 2001 through 2005 and compared these trends with use among urban youth. They found that ST use was more prevalent among rural youth than urban youth, although a significant shift toward increased ST use among urban 10th-grade boys occurred in 2005. They also found that:

  1. ST use by rural Pennsylvania youth far exceeded use reported at the national level.
  2. In the 12th grade, approximately 25% of rural boys used ST, compared with no more than 15% of urban boys.
  3. Nearly 12% of rural 12th grade girls used ST in 2005.
  4. Prevalence doubled for rural girls in 6th through 8th grades in both 2003 and 2005.
  5. At nearly every time point and in every grade, lifetime ST use increased for rural girls and boys.

Health Hazards of Smokeless Tobacco

The health hazards of ST vary as widely as the types of products and the manner in which they are used. Variations in health risks are possible for persons using both cigarettes and ST compared with those using ST alone. Potential hazards include[3,11]:

  • Nicotine dependence: The nicotine in ST is absorbed directly into the bloodstream and is addicting. Withdrawal often creates the same symptoms as those seen in heavy smokers who attempt to quit. Some manufacturers of ST products have altered the nicotine content and pH, added flavors, and packaged moist snuff in sachets as starter products that gradually move novice users on to higher levels of nicotine as their tolerance increases;
  • Cancer: ST can contribute to oral cancers, as well as cancer of the esophagus and pancreas;
  • Leukoplakia: ST increases the risk for leukoplakia (precancerous lesions);
  • Heart disease: ST contains nicotine, which can contribute to cardiovascular disease and hypertension; and
  • Dental problems: ST can contribute to gingivitis and dental caries.

The Allure of Smokeless Tobacco

ST has been around for a long time. So why are more teens discovering it now? Increased interest in ST may have several causes[3,12]:

  1. Teens may still view ST as relatively harmless compared with cigarettes.
  2. Adolescent girls may use ST to try to lose weight.
  3. With increasing smoking restrictions, ST gives people a way to get nicotine without having to go out in the cold or having to wait until they are out of the no-smoking zone.
  4. Recent mergers and acquisitions resulted in the production and sales of ST moving from companies that do not manufacture cigarettes to companies that do manufacture them.
  5. New forms and flavors of ST are more appealing to youth. A quick Internet search revealed such flavors as apple, butternut, peach, tequila, black wild cherry, “fresh,” and “mellow.” Some of the new snus containers are downright adorable.
  6. Smokeless products are heavily promoted.
  7. Smokeless products are used by youth role models, including MLB players and rodeo stars.

Whereas rodeo stars are more likely to influence rural children, baseball players have a much broader influence, and it is the association between MLB and ST that concerns Dr. Pechacek. Chew is probably as much a symbol of baseball as hot dogs, and its use dates back to the mid-1800s. Players initially used it to keep their mouths moist and gloves soft (by spitting into them). ST use began to decline with the increased use of cigarettes in the 1950s, but players reversed that trend and went back to ST when they learned about the dangers of cigarettes. In 1990, MLB warned players of the dangers of ST and began efforts to help players quit. Since that time, many players have educated young baseball players on the dangers of ST.[13]

Implications for Healthcare Providers

Healthcare providers need to be as aggressive with ST as they are with cigarettes, in both research and practice. Research must focus on the specific types of ST to firmly establish correlations with health problems, particularly in pediatric users, to understand the short- and long-term effects. Research should also guide the development of evidence-based prevention and cessation programs. Practitioners should work together with dental professionals to incorporate possible ST use into assessment, prevention, and intervention.

Primary prevention. Healthy People 2010 objective 27-3 is “Reduce the initiation of tobacco use among children and adolescents.” Objective 27-4.a is “Increase the average age of first use of tobacco products by adolescents (from an average of age 12 to an average of age 14 years) and young adults (from age 15 to age 17 years).”[14]These are average ages of initiation; children younger than 12 years often use tobacco products, especially ST. The first thing practitioners must do is to take this objective to a lower age level, preferably beginning with the early school-age years. Primary care providers need to incorporate ST prevention into anticipatory guidance counseling and to instruct parents to talk with their children about ST products and to role-model positive health behaviors by not using ST — or any form of tobacco.

Secondary prevention. All healthcare providers should ask clients, regardless of age, about the use of ST. This is especially true in inpatient facilities, where clients may be using these products while hospitalized. Of course, healthcare providers should also encourage — and help — clients to quit. Quitting is not easy, even for adolescents, because of nicotine dependence. Withdrawal symptoms (dizziness, depression, frustration, impatience, anger, anxiety, irritability, trouble sleeping, difficulty concentrating, restlessness, headaches, tiredness, and increased appetite) are unpleasant. Users may benefit from cessation support groups, such as Nicotine Anonymous or local groups available through the American Cancer Society or those listed in the phone book. Appropriate nicotine replacement treatments may be beneficial; however, these are not approved by the US Food and Drug Administration (FDA) for ST cessation. Smoking cessation medications (such as Bupropion [Zyban®]) are not FDA-approved for children younger than 18 years.[15,16]

On a broader level, healthcare providers can assist schools and state agencies by providing group education on ST. Several federal agencies are available to provide support, including the CDC’s Smoking and Tobacco Use Media Campaign Resource Center.[17] Finally, healthcare providers can become involved in advocacy by supporting legislation that minimizes ST advertising and exposure to minors. Healthcare providers cannot allow the fight against tobacco to be chewed up and spit in the gutter.

Web Resources

Campaign for Tobacco Free Kids

Smokeless Tobacco Fact Sheets

Spit Tobacco: A Guide for Quitting by the National Institute of Dental and Craniofacial Research

Tips for Teens: The Truth About Tobacco

World Health Organization’s Tobacco Free Initiative

July, 2010|Oral Cancer News|

CDC: Global tobacco marketing is reaching young women

Source: CDC
Author: Staff

As World Recognizes “World No Tobacco Day 2010”

Although women account for only about 20 percent of the world’s 1.3 billion smokers, tobacco use among women is on the rise.  Particularly troubling is new data from three countries —Bangladesh,Thailand, and Uruguay—indicating greater exposure to cigarette marketing among young women (ages 15 to 24) than older women, according to a CDC study.

In Bangladesh, exposure to bidi cigarettes (80.1 percent) and smokeless tobacco (69.9 percent) marketing was widespread among women and did not vary by age.  Bidi cigarettes are hand rolled cigarettes made of tobacco that are primarily used in Bangladesh, India, and Pakistan.

Launched in 2007, the Global Adult Tobacco Survey (GATS) is a nationally representative household survey of persons ages 15 years and older being implemented in 14 countries around the world.  Bangladesh, Thailand and Uruguay are the first three countries for which 2009 data is available.  Before GATS, no one standard global survey for adults has consistently tracked tobacco use and other tobacco control measures.

“Tobacco kills more people each year than HIV, tuberculosis, and malaria combined, and tobacco deaths are increasing steadily,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “The results of these surveys show one of the key reasons for the tobacco epidemic – marketing, including to women and girls. Countries around the world should establish and enforce comprehensive bans on advertising, sponsorship, and promotion of tobacco products,” he said.

Other report highlights:

  • In Bangladesh, 1.5 percent of women are current smokers, compared with 44.7 percent of men, while the prevalence of smokeless tobacco use is similar for men and women (26.4 percent and 27.9 percent, respectively)
  • In Thailand, 3.1 percent of women are current smokers, compared with 45.6 percent of men, while the prevalence of smokeless tobacco use is 6.3 percent for women, compared with 1.3 percent for men.
  • In Uruguay, 19.8 percent of women are current smokers, compared with 30.7 percent of men. Uruguay has almost no smokeless tobacco use.

“Monitoring the global tobacco epidemic is essential to measuring the impact of tobacco control policies and interventions,” said Samira Asma, D.D.S., M.P.H., Chief, Global Tobacco Control Branch, CDC’s Office on Smoking and Health.  “The Global Adult Tobacco Survey is critical to our understanding of tobacco use worldwide.”

To effectively combat the tobacco epidemic, the World Health Organization recommends MPOWER, a technical assistance package that requires monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco smoking, warning about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco.

The World Health Organization (WHO) created World No Tobacco Day in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. The theme for this year’sWorld No Tobacco Day—which takes place on May 31—is “gender and tobacco with an emphasis on marketing to women.”

Funding for GATS is provided by the Bloomberg Initiative to Reduce Tobacco Use and is conducted in partnership with the Campaign for Tobacco Free Kids, CDC Foundation, Johns Hopkins Bloomberg School of Public Health, World Health Organization, and the World Lung Foundation. Other participating countries are Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Turkey, Ukraine and Vietnam.

For an online version of the MMWR report, please visit www.cdc.gov/mmwr.  For information on World No Tobacco Day, visit www.cdc.gov/tobacco, and for additional information and materials, including posters, visit WHO’s Tobacco Free Initiative at http://www.who.int/tobacco/en/.

June, 2010|Oral Cancer News|

U.S. cigarette brands tops in cancer causing chemicals

Source: CNN
Author: Miriam Falco

Smokers of U.S. brand cigarettes may get more bang for their buck in the worst way according to a small study conducted by the Centers for Disease Control and Prevention.

Researchers found U.S. made cigarettes contain more cancer-causing chemicals than some cigarettes brands made elsewhere around the world.

“Not all cigarettes are made alike” says Dr. Jim Pirkle, deputy director for science at the CDC’s National Center for Environmental Health. He says this is the first study to show that “U.S. cigarettes have more of the major carcinogen [TSNAs] than foreign made cigarettes.” TSNAs are “tobacco-specific nitrosamines,” the major cancer-causing substance in tobacco.

126 smokers in five cities – Waterloo, Ontario; Melbourne, Victoria (Australia); London, England, Buffalo, New York, and Minneapolis, Minnesota – were recruited for this study.

They were between the ages of 18 and 55 and smoked at least 10 cigarettes a day for the past year and had been brand loyal for at least three months. The cigarettes smoked by the study recruits represented some of the more popular brands for each country including: Players light and DuMaurier in Canada; Marlboro, Newport Light, Camel Light in the U.S.; Peter Jackson and Peter Stuyvesant in Australia; and Benson & Hedges and Silk Cut Purple in the United Kingdom.

Scientists analyzed more than 2,000 cigarette butts to get the data they are reporting today, says Pirkle.

When researchers compared cigarette brands in the U.S. to those in Canada and Australia, they found three times higher levels of the cancer causing substance in the U.S. smokers’ mouths. The mouth levels are important because they give an indication of what levels if carcinogens are going into the lungs. (Smoking tobacco is a major cause of lung cancer).

“If you want to stop exposure to these things, you have to stop smoking.”

They also found twice as much TSNA in the urine samples of U.S. smokers compared to those in Canada and Australia, an indication that cancer-causing substance has traveled throughout the body.

There is no one group that speaks for the tobacco institute anymore, according to Darryl Jason, a spokesman for the Tobacco Merchants Association (TMA), which is why he couldn’t comment on the study. The TMA was founded in 1915 to “manage information of vital interest to the worldwide tobacco industry according to their website. Jason did point out that cigarettes manufactured in the U.S. contain a different blend of tobacco from cigarettes made elsewhere.

The study acknowledges that there are different types of tobacco depending where the cigarettes are made. But that’s only one factor says Pirkle: “The TSNA levels largely come from the way tobacco is cured.” The heating process, humidity and the type of the ferlizer used to grow the tobacco also contribute to the levels of cancer causing substances, says Pirkle.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

June, 2010|Oral Cancer News|

CDC urges 50-state anti-smoking effort

Source: CNN
Author: Ann Curley

In 2007, the Institute of Medicine, the medical branch of the National Academy of Sciences, released “Ending the Tobacco Problem: A Blueprint for the Nation,” stating a goal of eliminating smoking as a public health problem in the United States. The strategies included strengthening and fully activating tobacco control methods similar to the CDC’s plans, as well as tobacco regulation.

In 2008, the World Health Organization’s MPOWER program outlined additional steps that complemented and reinforced the other agencies’ recommendations.

As an example of the success of these strategies, the CDC cites the state of California, which has one of the oldest comprehensive tobacco control programs. California cut adult smoking rates from 22.7 percent in 1988 to 13.3 percent in 2006. That reduction in smoking accelerated the decline of heart disease deaths and lung cancer incidence in California, compared with the rest of the country.

In 2009, 14 states and the District of Columbia implemented an excise tax on cigarettes. Those state tax hikes followed a 62-cent federal cigarette tax hike instituted by Congress in April 2009.

Twenty-four states and D.C. have comprehensive smoke-free laws. Seven states do not have statewide smoke-free laws of any type: Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia and Wyoming.

While some progress has been made in getting more states to implement tobacco control measures, the report stresses that much more is still needed.

The CDC’s Best Practices for Comprehensive Tobacco Control Programs 2007 noted that states could plan and enact tobacco control programs with a small percentage of tobacco excise tax revenues and funds from a 1998 agreement between states’ attorneys general and the four largest tobacco companies.

The report concludes that putting uniform tobacco control policies in place would dramatically reduce the health and economic burden on states.

“The first step is knowledge, knowing what the issues are,” Frieden said. “We need to act.”

April, 2010|Oral Cancer News|

House Committee convenes hearing on smokeless tobacco

Source: Cancer.gov
Author: Staff

The House of Representatives Committee on Energy and Commerce, Subcommittee on Health, held a hearing on April 14: “Smokeless Tobacco: Impact on the Health of Our Nation’s Youth and Use in Major League Baseball.” NCI’s Deputy Director of the Division of Cancer Control and Population Sciences Dr. Deborah Winn testified before the committee, as did Dr. Terry Pechacek, associate director for science in the CDC’s Office on Smoking and Health.

The full panel of witnesses included representatives of Major League Baseball (MLB) and the MLB Players Association (MLBPA); Dr. Greg Connolly, a dentist and Harvard professor who has conducted research on smokeless tobacco for more than 20 years; Gruen Von Behrens, an oral cancer survivor and tobacco prevention advocate; and baseball legend Joe Garagiola, Sr., who continues to work as an MLB announcer and is a vocal advocate for ridding MLB of smokeless tobacco.

Dr. Winn’s testimony recognized smokeless tobacco, which includes snuff and chewing tobacco, as an established cause of oral, pharyngeal, pancreatic, and esophageal cancers, and stressed that there is no safe level of tobacco use. She also addressed questions from members of the committee regarding MLB players using smokeless tobacco on the field, and therefore on television. Media depictions of tobacco use have been shown to contribute to an increase in youth tobacco use, explained Dr. Winn. NCI’s “Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use” provides additional information on this topic.

Dr. Pechacek provided an overview of current trends in smokeless tobacco use, revealing that new CDC survey data indicate that after years of decline, smokeless tobacco use is actually increasing now among males in grades 9 through 12. These latest data will be available this summer, when the CDC releases the 2009 Youth Risk Behavior Surveillance System results. These findings add to existing data, which indicate increases in smokeless tobacco use among white and Hispanic young men (particularly those between age 18 and 25) between 2003 and 2008.

Throughout the hearing, committee members and witnesses discussed Minor League Baseball’s policy prohibiting smokeless tobacco use on the field and in the clubhouse. Committee chairman Rep. Henry Waxman (D-CA) and subcommittee chairman Rep. Frank Pallone (D-NJ) encouraged MLB and the MLBPA to discuss and adopt this policy during their upcoming collective bargaining process.

NCI currently funds six grants addressing smokeless tobacco via its RFA, “Measures and Determinants of Smokeless Tobacco Use, Prevention, and Cessation.” More information about these funding opportunities can be found at http://cancercontrol.cancer.gov/tcrb/research_topic-smokeless.html.

More information on the hearing, including a full list of witnesses, can be found on the committee Web site.

For more information about this and other NCI congressional activity, visit the NCI Office of Government and Congressional Relations Web site.

April, 2010|Oral Cancer News|

Busting the myth of the cervical cancer vaccine

Source: Temple University Press
Editorial by: Gkramer

Adina Nack, author of Damaged Goods? Women Living with Incurable Sexually Transmitted Diseases, draws on her expertise as a sexual health researcher to discuss the impact of human papillomavirus (HPV) on men and the need for gender-neutral STD vaccines.

When I wrote my book, Damaged Goods? I focused on how living with contagious, stigmatizing, medically incurable (though highly treatable) infections transformed women’s lives – medically, socially and psychologically. I had included a discussion of the Gardasil vaccine, which had received FDA-approval and CDC recommendation for ‘routine’ use in girls and women (ages 9 to 26) back in 2006, and I had articulated some of my concerns about the delayed testing and approval process for ‘male’ Gardasil.

A family of viruses, HPV is an ‘equal opportunity infector,’ so why have HPV vaccines not been equally accessible for men as well as women? In a recent interview on Huffington Post, several blog posts of my own, and my new feature article, “Why Men’s Health Is a Feminist Issue” (Ms. Magazine,Winter 2010), I investigate the substantial public health costs that result from HPV vaccines, such as Gardasil, not having been originally developed, tested and approved as gender-neutral vaccines.

The narrow and inaccurate marketing of Gardasil as a female-only, “cervical cancer” vaccine has distracted us from public discourse about this family of sexually transmitted viruses that are not only a U.S. epidemic but also a global pandemic. In the U.S., HPV is estimated to affect 75% of adults and certain strains are known to cause potentially fatal oral, cervical, anal, and penile cancers. Researchers are finding that HPV-related male cancers are: on the rise, often fatal due to lack of accurate testing/screening, and, in the U.S., likely result in more combined deaths in men than in women.

Still, Gardasil— primarily branded and marketed as a cervical cancer vaccine for girls and women—remains fairly inaccessible to boys and men. The CDC recommends “routine” Gardasil vaccination for females ages 9-26 for the prevention of cervical cancer and other HPV diseases. But, last October, after the FDA approved Gardasil solely for the prevention of genital warts in boys/men, the CDC’s Advisory Committee on Immunization Practices (ACIP), which makes recommendations for the routine administration of vaccines, voted for a lesser recommendation of “permissive” use in males that is likely to keep the vaccine less affordable for male patients.

Last month, the makers of Gardasil released a study which showed the vaccine to be effective at preventing anal precancers in men. This new evidence, which supports the case for a male vaccination schedule, was presented on February 24 at a meeting of the CDC’s ACIP. As evidence mounts that HPV vaccines (e.g., Gardasil and Cervarix) may prevent a range of serious HPV-related male cancers—including types of oral cancer, which are on the rise—I will be watching to see if the FDA reevaluates its original narrow approval of ‘male’ Gardasil (only for the prevention of genital), which could shape future CDC/ACIP vaccination recommendations.

As a medical sociologist, I am neither pro- nor anti-vaccine, but I do support:

(1) equal access to vaccines

(2) medical studies of vaccines that reveal full ranges of potential health benefits and costs

(3) and a HPV public health campaign that fully educates about the range of treatable and serious health consequences for boys and girls, men and women.

Even the most successful vaccine is not 100% effective, so it is imperative that we expand the discussion of HPV prevention beyond vaccination. Whether or not you are pro- or anti-Gardasil, we all have much to gain from de-stigmatizing STDs and from making comprehensive HPV education more accessible.

This post was inspired by Nack’s posts on Girlw/Pen.

March, 2010|Oral Cancer News|

What’s in a cigarette? FDA will study the ingredients

Source: Yahoo
Author: MICHAEL FELBERBAUM

RICHMOND, Va. – The Food and Drug Administration is working to lift the smokescreen clouding the ingredients used in cigarettes and other tobacco products.

In June, tobacco companies must tell the FDA their formulas for the first time, just as drugmakers have for decades. Manufacturers also will have to turn over any studies they’ve done on the effects of the ingredients.

It’s an early step for an agency just starting to flex muscles granted by a new law that took effect last June that gives it broad power to regulate tobacco far beyond the warnings now on packs, short of banning it outright.

Companies have long acknowledged using cocoa, coffee, menthol and other additives to make tobacco taste better. The new information will help the FDA determine which ingredients might also make tobacco more harmful or addictive. It will also use the data to develop standards for tobacco products and could ban some ingredients or combinations.

“Tobacco products today are really the only human-consumed product that we don’t know what’s in them,” Lawrence R. Deyton, the director of the Food and Drug Administration’s new Center for Tobacco Products and a physician, told The Associated Press in a recent interview.

While the FDA must keep much of the data confidential under trade-secret laws, it will publish a list of harmful and potentially harmful ingredients by June 2011. Under the law, it must be listed by quantity in each brand.

Some tobacco companies have voluntarily listed product ingredients online in recent years but never with the specificity they must give the FDA, said Matt Myers, president of the Campaign for Tobacco-Free Kids.

For example, Altria Group Inc., based in Richmond and the parent company of the nation’s largest tobacco maker, Philip Morris USA, has posted general ingredients on its Web site since at least 1999.

Cigarette makers say their products include contain tobacco, water, sugar and flavorings, along with chemicals like diammonium phosphate, a chemical used to improve burn rate and taste, and ammonium hydroxide, used to improve the taste.

Scientific studies suggest those chemicals also could make the body more easily absorb nicotine, the active and addictive component of tobacco.

“Until now, the tobacco companies were free to manipulate their product in ways to maximize sales, no matter the impact on the number of people who died or became addicted,” Myers said. “The manner of disclosure previously made it impossible for the government to make any meaningful assessments.”

About 46 million people, or 20.6 percent of U.S. adult smoke cigarettes, according to the Centers for Disease Control and Prevention, down from about 24 percent 10 years ago. It also estimates that about 443,000 people in the U.S. die each year from diseases linked to smoking.

Tax increases, health concerns, smoking bans and social stigma continue to cut into the number of cigarettes sold, which were estimated to be down about 12.6 percent in the third quarter compared with the same period last year.

Cigarettes and their smoke contain more than 4,000 chemicals; among them are more than 60 known carcinogens, according to the American Cancer Society. But scientists say they can’t yet tell all they’ll learn from the new data because so little is known about how the chemicals combine to affect people.

“The reality is that we have known so little over time that it’s difficult to know with much accuracy what getting a good look is going to tell us about what we could do in the future,” said Dr. David Burns of the University of California-San Diego, scientific editor of several surgeon general reports on tobacco.

The real test is whether the FDA acts on the information it receives, said David Sweanor, a Canadian law professor and tobacco expert. Canadian authorities are collecting similar data, but they haven’t taken much action based on it, which is critical, he said. The European Union also has similar submission requirements.

Myers warned that a list of ingredients or an unexplained product label is “just as likely to mislead as it is to inform” if consumers don’t know about the relative effects of ingredients.

Altria has supported what it has called “tough but fair regulation.”

But its chief rivals — No. 2 Reynolds American Inc., parent company of R.J. Reynolds, and No. 3 Lorillard, both based in North Carolina — opposed the law. They said it would lock in Altria’s share of the market because its size gives it more resources to comply with regulations and future limits on marketing under the law. Altria’s brands include Marlboro, which held a 41.9 percent share of the U.S. cigarette market in the third quarter, according to Information Resources Inc.

January, 2010|Oral Cancer News|