CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states—Kentucky, North Carolina, Virginia, South Carolina and Tennessee—fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Deep in the brain may lie the secret of why some smokers quit easily and some find it nearly impossible

When a person tries to quit smoking, the cravings, headaches and lethargy that come from the nicotine withdrawal makes it near impossible for many to be successful. But this lack of success could also be a result of how a smoker's brain is wired, according to a study from Duke University.

The study, published in the journal Neuropsychopharmacology, used magnetic resonance imaging to look at the brain activity of 85 smokers who smoked at least 10 cigarettes a day.

Image from CNN (Click on it to see a larger version)

MRI revealed that "people who had stronger connections between two regions of the brain -- one involved in reward and the other in controlling impulsive behavior-- were more likely to be successful at giving up smoking, at least for 10 weeks," Carina Storrs reports for CNN.

"This is the largest study to date where we've attempted to identify neural markers, or predictors, of later success in quitting smoking," Joseph McClernon, associate professor of psychiatry and behavioral sciences at Duke, who led the current study, told Storrs.

The scans were taken one month before the quit date. Then, on their quit date, participants were given nicotine patches and were asked to check in with the researchers to report any relapses over the following 10 weeks.

The study found that the "key difference" was that those who were able to quit had more activity in the insula, a prune-sized section that lies deep in the brain, than those who did not quit.

Researchers can't explain why,but speculate that the insula "acts like a bridge, connecting the reward region with the behavior control regions," Storrs reports, noting that it has also been linked to other types of drug addictions such as alcoholism.

This study offers hope that doctors might come to identify smokers who have poor connectivity in their insula and offer them treatment to strengthen this connectivity. That could be good news for Kentucky, where almost 30 percent of adults smoke and many are trying to quit. Forty-five percent of Kentuckians reported in the CDC's Behavioral Risk Factor Surveillance System that they had tried to quit in 2012.

Jonathan Foulds, professor of public health sciences and psychiatry at Penn State, was not so hopeful, telling Storrs that not enough is known about specific treatments to tell whether they will increase insula connectivity, and that any such treatments will likely "not be affordable options anyway."

Low-income smokers have a harder time quitting, which helps explain why Kentucky leads the nation in smoking

Lower-income smokers have a harder time quitting than health-conscious middle- and upper-class Americans, Keith Humphreys reports for The Washington Post.

The numbers suggest one reason why Kentuckians lead the nation in smoking. Kentucky ranks 48th among the states and the District of Columbia in median household income in 2011-13, according to the Census Bureau; it ranked 45th in per-capita personal income in 2013, according to the Bureau of Economic Analysis.

The pol'ls margin of error was plus or minus 1 percentage point.

A 2008 Gallup poll of more than 75,000 Americans showed that the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. The higher the income category, the lower the smoking rate, except those making less than $6,000 per year, which was skewed because many in this bracket are students, Rob Goszkowski writes for Gallup.

Once health warnings about cigarettes became widely known, better-off Americans were more likely to quit smoking. "High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families," Humphreys reports. Education may also be a factor; income and education are usually closely related.

Humphreys list three reasons poorer smokers have a hard time quitting:
1. They inhale more deeply on each draw from a cigarette, creating stronger addiction and making it harder to quit.
2. They don't have the same social support from their colleagues and friends as wealthier smokers. For example, a doctor is likely to be encouraged to quit smoking or get social disapproval if he or she is the last of their peers to stop; a person who works at roadside cleanup might "face precisely the reverse social incentives from his smoking coworkers," Humphreys writes.
3. They are likely to have less access to effective smoking-cessation programs and less access to address behavioral health issues, like depression, that make quitting more difficult. Kentucky has addressed those problems recently by having Medicaid cover smoking cessation and behavioral-health care by any licensed provider.

Some suggest that because lower income smokers have a harder time quitting, using higher tobacco taxes as an incentive for them to quit should be re-evaluated. Humphreys writes, "Deeply addicted, low-income smokers may face the choice between spending much-needed income on tobacco or venturing into the black market for untaxed cigarettes, which carries significant risks of its own."

Kentucky's cigarette tax of 60 cents a pack is lower than all but 10 states. New York ranks first at $4.35 per pack, which pushes the price of cigarettes to $10-$15 a pack, according to the Campaign for Tobacco-Free Kids website.

Holiday stress can make former smokers relapse; here are ways to keep that from happening

People often smoke when they are stressed, and despite the famous holiday song that claims "It's The Most Wonderful Time of the Year," the season often brings stress that makes many former smokers relapse.

Smoking doesn't really relieve stress, even though many smokers believe it does, The Cleveland Clinic says on its website. In fact, it actually causes a great deal of stress to the body.

The reason smokers think it relieves stress is because nicotine, the mood-altering drug in tobacco, causes the body to release a chemical called dopamine, which creates an initial sense of calm in the body. It also makes the body crave this sensation again and again. "This is a cruel illusion," says the website, because even though the body feels calm, it is really under a great deal of stress. Blood pressure and heart rate increase, muscles become tense, blood vessels constrict and less oxygen is available to the body when you smoke.

Kentucky has many former smokers; 26.5 percent of adults in the state smoke, down from 29 percent two years ago, according to America's Health Rankings. The NYU Langone Medical Center offers these tips to help those who have quit stay smoke-free:

• Remind yourself of the reasons you quit in the first place. Write down the top three reasons you quit smoking and put them somewhere you can see daily.
• Make an action plan for how you are going to handle your holiday triggers. Have a plan for every trigger.
• If you feel the urge to smoke, don’t give in, and remember the 5Ds: Delay. Drink water. Do something else. Deep breathe. Discuss feelings with a friend or family member.
• Reward yourself for staying tobacco-free.

If you relapse, take the immediate steps to get help. Talk to your health-care provider about nicotine replacement therapy. Quit Now Kentucky also offers one-on-one counseling for tobacco users who are ready to quit using tobacco products, call 1-800-784-8669.

Kentucky 's spending of tobacco settlement on tobacco-prevention programs fall far short of what CDC recommends

Kentucky ranks 39th in the country in funding programs that prevent kids from smoking and help smokers quit, according to a national report from a coalition of public-health organizations.

Kentucky ranks sixth in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report, with 17.9 percent of high schoolers reporting they smoke cigarettes. Nationwide, the rate is 15.7 percent. The report challenges states to get their rates as low as Florida's 7.5 percent.

"If Kentucky reduced its high school smoking rate from 17.9 percent to 7.5 percent, it would prevent 148,150 kids from becoming adult smokers, saving 52,290 lives and $2.6 billion in future health care costs," the Campaign for Tobacco-Free Kids says in a press release.

The campaign says it's not that the state lacks the money to spend on such programs.

"Kentucky will collect $347.3 million in revenue this year from the 1998 tobacco settlement and tobacco taxes but will spend only 0.7 percent of the money on tobacco-prevention programs," says the release. "Kentucky spends $2.5 million per year on tobacco prevention and cessation programs, which is 4.4 percent of the $56.4 million recommended by the Centers for Disease Control and Prevention."

Soon after the settlement, the Kentucky General Assembly decided to spend half the settlement on diversifying and improving the state's agricultural economy, with the rest going to health, early-childhood development and other programs. The legislature later began using the fund for water and sewer projects in rural areas.

Kentucky is not alone in scrimping on such programs. Collectively, states have budgeted just 14.8 percent of the $3.3 billion the CDC recommends. States will collect $25.6 billion this year from the tobacco settlement and tobacco taxes but will spend only 1.9 percent of it ($490.4 million) on tobacco prevention programs, the campaign says.

Meanwhile, kids get plenty of tobacco-company marketing enticing them to smoke. "Tobacco companies spend $271.1 million per year to market their products in Kentucky – 109 times what the state spends on tobacco prevention," says the release.

The campaign says tobacco annually claims 8,900 Kentucky lives and costs the state $1.9 billion in health care bills. "Right now, Kentucky is also putting its children at risk and costing taxpayers money by failing to properly fund tobacco prevention efforts that are proven to save lives and health care dollars," says Matthew Myers, president of the campaign for Tobacco-Free Kids. "We need elected leaders in Kentucky to enact a comprehensive smoke-free law and increase funding for proven tobacco-prevention programs,"

The report is titled "Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 16 Years Later." It was also released by the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Study finds electronic cigarettes help people stop smoking

A study has found that electronic cigarettes help people cut back on their use of tobacco, Christopher Ingraham reports for The Washington Post.

The finding was part of a study published in the International Journal of Environmental Research and Public Health, which tracked 48 smokers who were unwilling to quit smoking.

Participants were divided into three groups: two e-cigarette groups and a control group that switched from tobacco to e-cigarettes two months into the eight-month study. During the testing period all three groups were only allowed e-cigarettes. The difference between the groups occurred in between the testing periods.

"At the end of the 8-month study, 21 percent of all participants had stopped smoking tobacco entirely," Ingraham writes. "An additional 23 percent reported cutting the number of tobacco cigarettes they smoked per day by half." Across all three groups, total tobacco consumption fell by 60 percent, and 44 percent of the smokers had reduced or eliminated their tobacco use at the end of the eight months, Ingraham reports.

"The nicotine e-cig offers many smokers a successful alternative for smoking less – or even quitting altogether," write authors Frank Baeyens and Dinska Van Gucht. "E-cig users get the experience of smoking a cigarette and inhale nicotine vapor, but do not suffer the damaging effects of a tobacco cigarette.”

Ingraham lists many of the pros and cons of e-cigs and concludes, "From a public health standpoint, if we're interested in promoting smoking cessation it would seem sensible to encourage studies like this one, which point to new avenues for reducing the harms of smoking and helping people quit altogether."

In some wealthy areas, smoking rates have declined, while smoking rates in working class and rural areas have remained stable. Use of electronic cigarettes among rural teens has also risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

Lexington is considering whether to add electronic cigarettes to its anti-smoking ordinance

The Lexington-Fayette Urban County Council will discuss whether to expand its smoking ban to include electronic cigarettes, possibly as early as Oct. 7 at the General Government Committee meeting, Beth Musgrave reports for the Lexington Herald-Leader.

Berea, Bardstown, Danville, Glasgow, Manchester and Richmond have banned included e-cigarettes in smoking bans; on Oct. 6 Versailles may do likewise. (The city is replacing a Woodford County Board of Health regulation that was ruled unconstitutional.)

Amy Barkley, chairwoman of the Smoke-Free Kentucky Coalition, told Musgrave that cities and states updating their anti-smoking ordinances to include e-cigarettes is "part of a trend," and "Lexington has always been the leader in smoke-free policy in this state."

But e-cigarettes have changed the terms of smoking-ban debates. Tony Florence, co-owner of 723 Vapor Store in Lexington, which sells e-cigarettes, told Musgrave, "It's ludicrous to try to ban something that is trying to help people kick a horrible habit," Florence said. "The way that I look at it, if you are anti e-cigarette then you are really pro-lung cancer."

Gorton, who is a registered nurse, told Musgrave that she supported an amendment to the smoking ordinance because the Fayette County Board of Health recommended it. Gorton also noted that the state now bans all tobacco products, including e-cigarettes, on most state properties and that Rupp Arena and the attached Lexington Convention Center do likewise.

Supporters of e-cigarette ordinances say the devices are not effective in helping people stop smoking and "not much is known about the effects of electronic cigarettes," Musgrave reports. Barkley also told Musgrave that because e-cigarettes look like real cigarettes it "undermines the enforceability of smoking ordinances."

The Food and Drug Administration does not regulate e-cigarettes. Smoke-free advocates, including Barkley say that "until the FDA regulates e-cigarettes, it's best to include them in smoking bans," Musgrave writes.

But Florence told Musgrave that "the federal government hasn't acted on e-cigarettes for a reason: The research is not conclusive."

Carroll County schools will make campuses tobacco-free in 2015, even including outdoor sporting events

The schools in Carroll County, once one of Kentucky's tobacco strongholds, have begun preparing students, parents, teachers and football fans for smoke-free school campuses starting July 1, 2015.

"This ban will apply on district property at all times, in all places and to all people, including at sporting events and inside vehicles," schools spokesman Carl Roberts writes for The News-Democrat in Carrollton. "The ban also will apply to electronic cigarettes. . . . The district is making every effort to inform students, staff and community members of the transition."

That includes signs, social media, print publications, district memos, and announcements at sporting events, Roberts writes. "At sporting events throughout this school year, cards will be distributed to spectators that provide information about the tobacco-free policy. The cards also will include information on smoking/tobacco cessation classes."

Only 35 of the state's 173 school districts are tobacco-free, but some others are planning to impose bans next year, and more may after this year's school-board elections are out of the way.

Carrollton, which once had several tobacco warehouses, was visited in 1998 by then-President Bill Clinton to explain what his administration wanted to about smoking and help tobacco farmers.

Study shows tailored advocacy for local smoking bans in rural Kentucky gets results

Local smoking bans are only possible if the community is ready for this change, Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, writes in a report of a five-year study she conducted in rural Kentucky.

Readiness for change can be developed in rural communities that participate in smoke-free policy initiatives tailored to their community, Hahn writes in The Journal of Rural Health. The study evaluated six stages of readiness to determine if a community was ready to support smoke-free policy, and then tailored interventions based on how ready the community was.

The study was conducted in 37 rural Kentucky counties that were randomly selected from those without smoking ordinances or regulations. Nineteen of the communities received policy-intervention strategies, tailored to their readiness, from a trained community adviser. The remaining 18 were used for comparison. Data were collected annually and policy outcomes were tracked over five years.

Nearly one-third of the counties that were the target of interventions adopted smoking bans covering restaurants, bars, and all workplaces, while none of the comparison counties did.

Rural, tobacco-growing areas were chosen because they are "disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies," Hahn writes in the study, "A Controlled Community-Based Trial to Promote Smoke-Free Policy in Rural Communities."