Michael Yudell, PhD, MPH, Associate Professor, Drexel University School of Public Health
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.
By Jim Buehler, professor of health management and policy, Drexel University
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.
Janet Golden, professor of history, Rutgers University-Camden
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.
Two years ago, the American Journal of Preventive Medicine published results of a study that estimated how much money excessive alcohol consumption costs the United States each year. The tab came to $223.5 billion—a sobering statistic. While a national estimate can inform federal funding decisions about alcohol research and programing, however, the real legal authority to regulate alcohol consumption—and most health behaviors, for that matter—exists at the state level.
This week, another study in the same journal provided estimates of how much excessive alcohol consumption costs in each state—underscoring the economic imperative for individual states to take action. The tri-state area total: $15 billion.
Drawing from national standards, the study defined “excessive” alcohol consumption as having: 4 (woman) or 5 (man) drinks or more on at least one occasion in the previous 30 days or 1 (woman) or 2 (man) drink(s) per day, on average, or any drinks for someone who is under the age of 21 or pregnant. The researchers pulled from various data sources to estimate the numbers of adverse events (e.g., drunk driving accidents, fetal alcohol syndrome, alcohol-attributable deaths) caused by “excesses” in the amount of alcohol consumed in each state per year and multiplied them by estimates of the financial cost associated with each. The researchers then divided the totals by estimates, based on surveys of retail sales, of the number of alcoholic beverages consumed in each state. This yielded the “cost per drink”—an indication of how much the price of every drink would need to be increased to offset the economic consequences of excessive alcohol consumption.
Stacey Trooskin, Assistant Professor, Drexel University College of Medicine
What do you know about hepatitis C?
Did you know that it is the most common bloodborne infection in the United States? That it is five times more common than HIV, yet has a fraction of the government funding for prevention, care and research? That it is often called a silent killer, because infected people can live without symptoms of the virus for as long as two decades before showing signs of liver disease like cirrhosis or liver cancer? Did you also know that 50% to 75% of people living with hepatitis C don’t even know they are infected? Or that, because hepatitis C often goes undiagnosed until significant liver damage has been done, it now kills more people a year in the United States than HIV?
As a clinician whose work focuses on hepatitis C, I see its impact every day. But how do I get the average Philadelphian to pay attention? With World Hepatitis Day on July 28th quickly approaching, I felt I needed a new strategy. So, I did what everyone else with a computer does when they don’t know the answer – I Googled it. And among the things I found is a different, but increasingly effective way to draw the public’s attention to this difficult issue: a dancing flash mob (for other Australian videos of a dancing liver, click here; he's cute!).
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
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.”
Janet Golden, PhD, Professor of history, Rutgers University-Camden
You wouldn’t know it from the title, “American Spirits: The Rise and Fall of Prohibition,” but this exhibit at the National Constitution Center has a public health theme. Sure, it is chock full of information about the political fight for a national prohibition amendment, the criminal underworld that developed to supply spirits to thirsty Americans, and the changing culture of the 1920s spurred by the rise of the speakeasy that brought women into underground drinking establishments. But, the exhibit also has a lot to say about a core principle of public health: harm reduction.
The “drys”—a popular term for prohibition supporters—pointed to the terrible effects of alcohol abuse on the health of drinkers and, very often, their families, who suffered from abuse, poverty, and neglect when a breadwinner’s wages were spent in a saloon. Their solution was codified in the 18th Amendment to the Constitution in 1919, which prohibited the manufacture, sale, or transportation of intoxicating liquors. The Volstead Act, the enabling legislation for the amendment, went in to effect in 1920.
Prohibition reduced alcohol consumption, which had already begun to decline because of state and local laws forbidding alcohol sales. As a result, death rates from cirrhosis and alcohol psychosis declined, as did arrest rates for drunkenness and hospital admissions related to alcohol abuse.