Sunday, April 20, 2014
Inquirer Daily News


POSTED: Tuesday, March 4, 2014, 6:30 AM
Filed Under: Addiction | Ethics | Michael Yudell | Smoking
FILE - In this Wednesday, July 17, 2013 file photo, Marlboro cigarettes are on display in a CVS store in Pittsburgh. The nation's second-largest drugstore chain says it will phase out cigarettes, cigars and chewing tobacco by Oct. 1 as it continues to focus more on health care. The move will cost the Woonsocket, R.I., company about $2 billion in annual revenue. (AP Photo/Gene J. Puskar, File)

Last month's announcement by CVS/Pharmacy that it would “stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide by October 1, 2014” has focused attention on the role that retail outlets play in their sale. If other major retailers were to follow CVS/Pharmacy’s lead, perhaps we could push already declining rates of tobacco use even lower (currently, fewer than 1 in 5 Americans smoke cigarettes).

In the wake of the CVS move, to put pressure on other tobacco-selling retailers, 26 prominent health groups have issued an open letter, calling on drug stores and other retailers to stop selling tobacco products. Recent studies have shown that reasons for the voluntary abandonment of tobacco sales are complex: retailers identified the obvious relationship between tobacco use and disease and death, regulatory pressures, an enhanced image, and already declining tobacco sales among the drivers of change. In their 2011 study published in BMC Public Health, Patricia McDaniel and Ruth Malone, highlight the importance of such changes, writing that “voluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco…”

Let’s hope that ongoing pressure on tobacco-selling retailers can continue to transform social norms around tobacco’s sale and use.

POSTED: Tuesday, February 11, 2014, 6:30 AM
Filed Under: Addiction | Smoking
Robin Patterson of Allentown, N.J., vaping with her new variable voltage e-cigarette at Ecigs International, an e-cigarette store in Roxborough. (DON SAPATKIN / Staff)

It’s been hard to avoid stories in the news about “electronic cigarettes”—battery-powered devices that in many cases look like regular cigarettes but instead deliver a vaporized mix of nicotine, flavor additives, and traces of the chemicals left over from extracting nicotine from tobacco. Much of the attention to e-cigarettes arises from debates about whether their manufacture, marketing, sales, and use should be subject to the same federal, state, and local regulations and restrictions as those that govern other tobacco products.Depending on your attitudes towards smoking, government health regulations, and your source of news, you might believe that e-cigarettes are:

  • A way for smokers to satisfy their appetite for nicotine while avoiding the hazards of tobacco smoke;
  • A socially acceptable alternative to smoking (they emit water vapor, not smoke) that should be permitted in public;
  • An alternative to nicotine patches or gum that can help smokers quit or reduce their dependence on nicotine (by turning them into “vapers”);
  • A way for “big tobacco” to bypass tobacco regulations, offset financial losses resulting from reductions in smoking, and lure a new generation into nicotine addiction;
  • A threat to decades of progress in reducing tobacco use;
  • Something that health advocates should endorse as a safer alternative to smoking—a “harm reduction” program, like those that provide clean needles and syringes to drug users to reduce exposures to HIV and other infections;
  • A product with undocumented benefits and risks;
  • Some combination of the above.

While public health advocates are universally committed to reducing smoking, their reaction to the emergence of e-cigarettes has been mixed. Some have called for an outright ban on e-cigarettes until studies have been conducted to document their risks and benefits—a policy that is unlikely to be enacted. Many view e-cigarettes through the same lens as regular cigarettes, remain deeply distrustful of the tobacco industry given its well-documented legacy of concealing information about the risks of smoking, and advocate strong regulations that would limit advertising and make it difficult for teens to purchase e-cigarettes. This position is embodied in statements like one by Erika Seward of the American Lung Association, who was quoted by ABC News as saying, “With e-cigarettes, we see a new product within the same industry—tobacco—using the same old tactics to glamorize their products. They use candy and fruit flavors to hook kids.” Other health advocates view e cigarettes through the “harm reduction” lens and favor regulation of e-cigarettes as “drug delivery devices.” For smokers who are unable or unwilling to abandon their nicotine addiction, this group argues that, despite unknowns about the consequences of inhaling e-cigarette vapors, using e-cigarettes must be less dangerous than inhaling tobacco smoke. Both positions - a ban and regulation as a drug delivery device - are vehemently opposed by e-cigarette-makers.

The e-cigarette industry strongly denies that it markets its products to young people, arguing that there are plenty of adult smokers to convert to their product. Regardless, a growing number of teens are giving them a try. A recent report from the Centers for Disease Control and Prevention (CDC) notes that the percentage of high school students who have tried e-cigarettes doubled from 4.7% in 2010 to 10% in 2012. CDC estimates that there are nearly 1.8 million middle and high-school students who have used e-cigarettes, including 160,000 who have never used regular cigarettes, raising a “serious concern” because of the “negative impact of nicotine on adolescent brain development, as well as the risk for nicotine addiction.” We know that most adult smokers started as teens, but we don’t know yet if the growing number of teens who are trying e-cigarettes will remain e-cigarette users, quit using any form of nicotine, or be drawn into smoking for the first time.

POSTED: Friday, February 7, 2014, 6:30 AM
Filed Under: Michael Yudell | Smoking

Kudos to CVS/Pharmacy for joining the fight against smoking.

Earlier this week the retail giant announced that it would “stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide by October 1, 2014.” The decision comes as CVS/Pharmacy moves towards expanding its miniclinics and providing more health care advice from its pharmacists and nurse practitioners. For CVS, selling tobacco and being a health care company cannot go hand in hand.

Though we should applaud the move, we should also not forget, as one appropriately cynical voice on a tobacco control list serve pointed out, that we are cheering such progress 50 years after the 1964 Surgeon General’s report on the ill health effects of smoking.

POSTED: Wednesday, January 22, 2014, 2:34 PM

Pennsylvania is one of 11 states that subsidized 93 percent of recent top-grossing movies featuring characters who smoke, according to researchers at the University of California, San Francisco–and one of seven states that gave  more money to those movies than it spent on tobacco prevention.

According to an ad placed in State Legislatures magazine by SmokeFreeMovies, a project of UCSF professor Stanton Glantz, Pennsylvania subsidized production of 24 movies between 2008 and 2012, of which 16 included smoking. It says the industry got $18 million a year in subsidies from the commonwealth for movies that included smoking, and spent $14 million in 2012 on smoking prevention.

“Seven states are now spending more subsidizing movies that promote smoking to kids than they are spending fighting smoking,” writes Glantz, director of UCSF’s Center for Tobacco Control Research and Education, in a new post on his blog.

Ad running in the magazine of the National Conference of State Legislatures.
POSTED: Thursday, April 18, 2013, 6:30 AM

What interests you: Disease sleuthing? Global bioethics? Protecting the food supply? Protecting yourself when you travel?

A new ranking of the top 30 public health blogs places The Public's Health at No. 14. The complete list is below. Lots of interesting stuff.

And if you want to go beyond reading about public health, join us at 6 p.m. Friday for “Blogging and Beer: Public Health in Philadelphia.” Also with us will be our editor at the Inquirer, public health writer Don Sapatkin, and some of our regular contributors. There is no cover charge for what we hope will be a lively discussion at Rembrandt’s Restaurant in Fairmount, one of several health offerings at the Philadelphia Science Festival that we mentioned last week.

Best Public Health Blogs

POSTED: Thursday, February 21, 2013, 4:00 AM
Filed Under: Addiction | Ethics | Smoking
In this Wednesday, Feb. 14, 2007 file photo, a man smokes in Omaha, Neb. Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong their lives, including surgery, chemotherapy and other measures. But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates. (AP Photo/Nati Harnik, File

Jon Kole is in his fourth and final year of a combined MD and Masters of Medical Ethics program at the University of Pennsylvania.

By Jon Kole

What do Cleveland Clinic, the World Health Organization, and Geisinger Health System in central Pennsylvania have in common? They all reject new job applicants who use cigars, cigarettes or other tobacco products. And here in Philadelphia the University of Pennsylvania Health System recently announced that it too, effective July 1, “will cease hiring tobacco users in our efforts to improve the overall health of our workforce while reducing health care benefit costs.”

POSTED: Friday, January 25, 2013, 6:30 AM
Filed Under: Addiction | Jonathan Purtle | Smoking
Daylin Leach (D., Montgomery) has authored a bill to legalize marijuana in Pennsylvania. (Ed Hille / Staff Photographer, file)

By Jonathan Purtle

Earlier this month, Pennsylvania State Sen. Daylin Leach (D., Montgomery-Delaware) announced plans to introduce a bill that would legalize marijuana —  not just for medical purposes, as New Jersey recently did, but also for recreational use.  The substance would be regulated by the state in a way similar to alcohol and tobacco.  As Leach describes on his website, the bill is founded on the idea that marijuana is no more harmful, and less addictive (this is debatable), than both these substances and that the financial costs of keeping marijuana illegal are enormous. Citing data from the White House Office of National Drug Control Policy, Leach points out that 24,685 marijuana arrests were made in Pennsylvania in 2006 — translating into $325 million in criminal justice costs.

Leach’s proposal follows referendums in Colorado and Washington that recently gave those states the green light for recreational marijuana use.  And while  the Pennsylvania bill will likely go up in smoke — Gov.  Corbett has vowed to veto the bill if it reaches his desk — it seems high time to explore the potential pros and cons of legalizing marijuana from a public health perspective.   

POSTED: Wednesday, November 28, 2012, 6:30 AM
Filed Under: Kids | Nan Feyler | Smoking

Nan Feyler is chief of staff for the Philadelphia Department of Public Health.

By Nan Feyler

Exposure to secondhand smoke is dangerous, especially to infants and children. Secondhand smoke can impact children’s lung growth and pulmonary functions. It can cause sudden infant death syndrome (SIDS), respiratory illnesses, ear infections and more frequent and severe asthma attacks.

Smoke-free laws have significantly reduced exposure to secondhand smoke. Philadelphia’s Clean Indoor Air Worker Protection Law banned smoking in Philadelphia’s restaurants, bars and workplaces in 2007. Last year, Philadelphia implemented a 100 percent smoke-free policy for all city recreation centers, pools and playgrounds. A handful of other places have followed suit, including Cherry Hill this week.
But what about homes? The home is now becoming the predominant location in the United States where children as well as adults are exposed to secondhand smoke. A recent survey conducted by the Annenberg Public Policy Center (not yet published) found that slightly more than half of Philadelphia households with a smoker and a child under 13 allowed smoking in the home. Another study, of low income children with asthma in Baltimore, found evidence of significant exposure to secondhand smoke in younger children, children with a higher number of household smokers, and homes without complete smoking bans (as well as homes where a caregiver reported symptoms of depression and there were more than moderate levels of daily stress).
Families face practical barriers to enforcing a smoke-free household rule. Tobacco is an addiction, and smokers struggle with limiting or curtailing their habit; when the weather makes smoking outdoors uncomfortable, or if there are no good or safe places to smoke outside, they will do it in the house. A caretaker who smokes may be deterred from going outside where he or she cannot supervise the children, or would need to bundle them up to leave the house together. People report reluctance to engage in conflict with smokers who live in the house or visit. Living in a home owned by a relative who smokes can make a smoke-free rule impossible to enforce.
It may come as no surprise that heads of households who overcome these barriers credit their own motivation and commitment. In one study, participants who were able to establish smoke-free homes said they were motivated foremost by concern for the health of their children. Quitting smoking, contemplating quitting, and smoking less often went along with their decision to prohibit indoor smoking for others. Some changed their habits to increase the amount of smoking they did outdoors, ended a relationship with a smoker, or moved out in order to establish a smoke-free household.
Determining the best strategy to reduce the health risks associated with secondhand smoke at home raises complex issues. What should be the government’s role in reducing smoking in private homes or cars, especially when children’s health is at stake? Increasingly, evidence shows a health threat from smoking in an adjacent housing unit, like an apartment, where toxins from secondhand smoke seep through walls, ductwork, windows, and ventilation systems. Should smoke-free laws be extended to include multiunit private housing? Should smoking in a car be banned when children are present?
Alternatively, what kind of encouragement would help people voluntarily ban smoking on their own? Given the challenges of adopting a smoke-free home, is there value in supporting families who take a gradual, more incremental approach – starting small, say, by not smoking in front of children or establishing a single smoke-free room – as worthwhile steps on the path to going entirely smoke-free? Or does this confuse the message because only a total ban on secondhand smoke will protect children’s health?
For specific suggestions, download the New York City Department of Health pamphlet, "How to Make Your Home Smoke-Free.
Public education is critical. In the U.S. and elsewhere, media campaigns focused on secondhand smoke have successfully reduced exposure to secondhand smoke and promoting quitting among adult smokers. Pediatricians can also play an important role in helping parents understand the risks – to their children’s health – of their own habit.
It’s worth taking a moment to applaud the recent news that smoking among adults in Philadelphia decreased from 27.3 percent in 2008 to 23.5 percent in 2012,a drop that works out to 15 percent – and 40,000 fewer smokers. While the rate of smoking in in the city is still well above the19.3 percent national average, this is real progress and everyone who has successfully quit smoking should be congratulated. (Rates vary significantly from neighborhood to neighborhood, as shown in this interactive map of smoking rates in the city and Pennsylvania suburbs.) As every former smoker knows, quitting is not easy – but success is possible.
If you are a smoker, the single best way to protect your family from secondhand smoke is to quit. For help, call the Pennsylvania Free Quit Line at 1-800-QUIT-NOW, or go to,where there are a range of services to help smokers stop once and for all. In the meantime, enforcing smoke-free policies at home will protect the health of other adults and children living there. And smokers who have instituted smoke-free home rules are significantly more likely to quit or to smoke fewer cigarettes per day. Restricting smoking also sends an important antismoking message to your children.
So, while policymakers grapple with the public health goal of reducing secondhand smoke exposure, there is a clear role for the smokers, too: Keep trying to quit! You can do it. And while you’re thinking about it, do what you can to avoid exposing others – especially children – to your cigarette smoke. For inspiration, check out this video.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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