More than a half million Costa Ricans or a quarter of the population are addicted to tobacco, many of them will die from their addiction. A half century ago, while the Cold War was at its peak and Americans and Soviets competed for conquering space, television was the technological boom. Until then nobody smoked. Or at least we thought. But, that all changed when we saw the Beatles and Ricky Ricardo smoke on the tube, and including physicians promoting smoking in our living rooms

Fifty years later the world has changed and so has Costa Rica.

Today in many major American cities smoking is banned in public places, including restaurants and even in parks. In some states you cannot smoke in your vehicle.

In Costa Rica there is a lot of talk about the ills of smoking and a feeble effort to reduce smoking. Legislators are currently sitting idle on a law that would greatly limit where one can smoke, but that seems to be going up in smoke as there is little will power to move forward with it.

According to the Instituto sobre Alcoholismo y Farmacodependencia (IAFA), some 580.000 people over the age of 12 are addicted to the cigarette and 75% of them are men, consuming some 2.000.000 cigarettes each year.

As if higher tobacco taxes, steeper health insurance premiums and smoke-free workplaces weren’t enough, tobacco users have one more financial incentive to kick the habit — missed job opportunities.

Starting Feb. 1, Memorial Hospital no longer will hire people who use tobacco products, making the hospital one of a small number of employers nationwide that consider smoking status in job applicants.

Under the new rule, which does not affect current Memorial employees, those offered employment at the hospital will be tested for nicotine during their required drug test, a human resources officer said. Even nicotine gum or the patch would make a potential employee ineligible.

The decision not to hire tobacco users isn’t based on potential savings in health care costs, but rather is an extension of the hospital’s commitment to health, said Brad Pope, vice president of human resources. Like all hospitals in the region, Memorial’s entire hospital campus is tobacco-free.

“I understand the concerns people have, but we are here for the health of our community,” he said. “Like it or not, what’s proven is that tobacco is the most preventable cause of death and disability in the United States. I think the Chattanooga and surrounding communities should expect this from Memorial.”

The practice of refusing employment to tobacco users began to crop up a few years ago and isn’t yet widespread, a tobacco control researcher said. Particularly in the deep South, and in a tobacco state such as Tennessee, it’s a bold move for Memorial, said pulmonologist Dr. Carlos Baleeiro, with Battlefield Pulmonology in Fort Oglethorpe

“It’s very brave of them,” he said. “I’m quite impressed by Memorial.”

A growing number of workplaces now deny employees the right to smoke anywhere on their campus, including outside. Policy prohibiting the hiring of tobacco users may be the future as the country develops a deepening social intolerance of smoking, said Jay Collum, coordinator of tobacco education and control at the Chattanooga-Hamilton County Health Department.

“Especially in a tobacco-growing state in the Southeast, this is a huge change in mindset and positioning, but we’re really behind the curve in our area,” he said.

For others, this step is a slippery slope. Some are concerned about the potential for hiring restrictions based on other unhealthy — but entirely legal — behaviors.

Tobacco-control researcher Dr. Michael Siegel, a professor at the Boston University School of Public Health, said he’s an avid proponent of education on the dangers of tobacco use, but he believes policies about not hiring tobacco users amount to discrimination.

Twenty-six states have laws prohibiting such a policy, according to a report he co-wrote last year in the journal Tobacco Control.

“The same rationale that would support not hiring smokers would also support not hiring people who are obese or people who have young children or people who don’t eat nutritious food or people who don’t exercise,” he said. “What it’s basically saying is the private behavior of people in their own homes is somehow relevant to their qualifications to work in a workplace.”

Dr. Siegel worries that if many large employers refuse to hire smokers, tobacco users — those arguably in the greatest need of health care — will struggle to gain employment and health insurance.

“WON’T BE THE LAST”

For smoker Mike Sullivan, an ICU nurse at Memorial, the new rule doesn’t come as a surprise.

“They’re not the first company to do that, and they won’t be the last,” he said.

Mr. Sullivan has smoked on-and-off for more than 30 years, quitting countless times and always going back to the habit.

Mr. Sullivan, 53, said in less than two years he’ll be eligible for retirement, and he’d hoped to come back and work part time at Memorial after retiring. But now, that would mean he’d have to kick the habit for good.

“I really think it would be a good incentive” finally to quit, he said.

This year for the first time, new recruits for the Chattanooga Fire Department can’t be smokers, a decision the city hopes will bring both savings in insurance costs and improvement in firefighters’ health.

“The main thing is to keep a healthier employee. We get ’em for 25 to 30 years or longer, and we want them to be healthy throughout their life while they’re here, as well as when they retire,” said Chief Randy Parker.

Costs and productivity consideration have led many employers nationwide, including the Chattanooga Times Free Press, to raise health insurance premiums for employees who use tobacco products and experiment with other programs to encourage wellness and help workers quit using tobacco, said Ron Harr, senior vice president of human resources and public affairs for BlueCross BlueShield of Tennessee.

“There is absolutely an increased interest by our customers in anything they can do that makes their employee group healthier and reduces their insurance risk,” he said.

He had not heard of any other employers in the state actually ruling out smokers as job applicants, he said.

The average smoker costs his or her employer $2,500 to $4,000 more each year in health care costs, compared with a nonsmoker, said Cathy Taylor, assistant health commissioner for the Tennessee Department of Health.

Nationally, smoking is responsible for an estimated $96 billion in direct medical costs and $97 billion in lost productivity annually, according to estimates from the U.S. Centers for Disease Control and Prevention.

Some are optimistic that there will be little resistance to heightened restrictions for smokers. When Hutcheson Medical Center’s campus went smoke-free last year, Dr. Baleeiro recalled that some were concerned about a negative backlash, but that never happened.

The same is true with Georgia’s partial smoking ban that passed in 2005, prohibiting smoking in most public places, he said. Tennessee passed a similar ban in 2007.

“They thought restaurants would go out of business; bars would close, and none of that happened,” he said. “I think (Memorial’s new rule) is going to be an interesting experiment to see how that’s going to be taken in the community.”

According to a study, smokers who are continunally confronted with warnings that cigarettes kill actually develop coping mechanisms to justify continuing their habit.

Comparatively, if smokers are shown warnings suggesting the habit could make them unattractive, they are more likely to give up. Teenagers who took up the habit to impress or fit in with their peers were more likely to be influenced by warnings about their appearance, the study found.

“In general, when smokers are faced with death-related anti-smoking messages on cigarette packs, they produce active coping attempts as reflected in their willingness to continue the risky smoking behaviour,” the study said.

“To succeed with anti-smoking messages on cigarette packs one has to take into account that considering their death may make people smoke.”

The study from the United States, Switzerland and Germany, led by Jochim Hansen of New York University and the University of Basel, asked 39 psychology students who said they were smokers, aged between 17 -41.

Participants filled in a questionnaire determining how much their smoking was based on self-esteem, before being shown cigarette packets with different warnings on them. Half of them read warnings such as “Smoking leads to deadly lung cancer”, while the other half had warnings about attractiveness.

After a 15-minute delay the students were asked more questions about their smoking behaviour and if they intended to quit.

The study, published in the Journal of Experimental Social Psychology, found that cigarette packets with death-related warnings were not effective and even caused more positive smoking attitudes.

“On the other hand, warning messages that were unrelated to death effectively reduced smoking attitudes the more recipients based their self-esteem on smoking.

“This finding can be explained by the fact that warnings such as ‘Smoking brings you and the people around you severe damage’ and ‘Smoking makes you unattractive’ may be particularly threatening to people who believe the opposite, namely that smoking allows them to feel valued by others or to boost their positive self-image.”

A Department of Health spokesman said: “Health warnings on tobacco packaging have played an important role in helping smokers understand the risks of tobacco use and where to get help to quit. Research from around the world has shown that different people react to different types of messages to motivate them to attempt to quit.

“In October 2008, the UK was the first nation in the European Union to introduce graphic picture warnings to cigarette packets that showed smokers the grim reality of the effects smoking can have on their health. We are now currently working with the European Commission to develop new pictorial warnings for tobacco packaging, including testing different types of messages with smokers.”

A new vaccine developed by the North American Nabi Biopharmaceuticals may help bring an end to cigarette addiction. About 1.3 billion people are addicted to tobacco worldwide, including five million Chileans.

Tobacco addiction affects approximately 1.3 billion people worldwide, five million of which are Chilean. Photo courtesy of Flickr username b0r0da

The vaccine NicVax, which will be released towards the end of 2010, promotes the production of antibodies that attach themselves to nicotine particles within the body. Once this happens, the particles become too large to pass into the brain, which inhibits the release of dopamine- the neurohormone associated with feeling pleasure.

So far, trials have been carried out on people who smoke an average of 24 cigarettes each day and show a 50 percent success rate. This is twice the success rate found with prescription medications such as Champix.

“Nicotine patches and other medications replace nicotine with other substances,” said Jimmy Stehberg, a neurobiologist at Universidad Andrés Bello. “But this does not reduce the sensation of pleasure one gets from smoking… the (new) vaccine stops the nicotine from entering the brain, which reduces its addictive qualities.”

Chile’s leading tobacco sales company – Chiletabacos, an affiliate of British American Tobacco (BAT) – has a 98 percent market share of cigarette sales in the country. The company reports that sales this year have dropped to 12 billion cigarettes, down from 14 billion in 2008. The company also reports that consumers are now buying cheaper cigarettes such as Pall Malls (US$2 per pack).

While Pall Mall sales have risen by 32 percent in the recent years, sales of more expensive brands such as Belmont and Derby (US$2.60) have fallen by 50 percent since 2006.

Still, the economic downturn has not dampened the spirits of Chiletabacos general manager Benjamin Kemball, who hopes to maintain current production levels.

“We would like to increase our exports to other markets,” said Kemball. “Now we produce 20 billion cigarettes a year, 14 billion of which are sold locally and the rest is sold in the Southern Cone [Argentina, Paraguay and Uruguay].” The company is currently looking into changing its name to British American Tobacco Chile.

In 2005 Chile’s Free Market Defense Court (TDLC) sanctioned Chiletabacos for exploiting its market position and signing exclusivity contracts with distributors in order to control competition. And in 2006 the Supreme Court upheld the finding against Chiletabacos.

The company was hit again two weeks ago with a new case brought by the National Economic Regulator (FNE). The FNE accused the company of not adhering to the 2006 verdict and asked the TDLC to fine the company US$17 million.

On July 14 Philip Morris – the world’s largest tobacco company – sued Chiletabaco demanding US$137.5 million in compensation. Philip Morris represents 4 percent of the Chilean tobacco market and markets locally the tobacco blends Marlboro and L&M (ST, July 26).

Sources: LA TERCERA, EL MERCURIO
By Gida Homad-Hamam

A ban on smoking in bars and pubs has prompted many New Zealanders to stop smoking at home, Ministry of Health research shows.

Next month will mark six years since the passing of smoke-free legislation that bans smoking in indoor work environments such as clubs, casinos, bars and restaurants. It came into force one year later, in December 2004.

A ministry expert on tobacco, Dr Ashley Bloomfield, says one of the positive spin-offs of the law has been that the number of smoke-free homes has dramatically increased. He attributes the trend to a change in attitude – “People started thinking, `I can’t smoke in the pub so I won’t smoke in my home’.”

A report evaluating the law’s effectiveness and impact across various sectors shows exposure to second-hand smoke in the home decreased from 20% in 2003 to 9% in 2006. And the cultural shift, which has seen smoking become less socially acceptable, has seen smoking rates fall year on year.

The research, he says, also shows “the overall economic impact [of the legislation] was not a negative one”.

But Josh White of the Hospitality Association of New Zealand says there is no doubt the law has had a negative impact on licensed premises. “Everyone that’s tried to survive has had to put a smoking area in at their own cost.”

White had two bars in Hamilton at the time of the change and soon closed one of them – partly because of a drop-off in patronage after the legislation.

Because of the layout of the bar, adding smoking facilities was not an option and smoking customers were forced to stand outside the front entrance, which put off other customers from coming in.

“We had a drop of 30-40%. A group of guys standing out the front door can be intimidating. Not that they were like that, but it’s just not a good look.”

He then bought a premises next-door to the remaining bar and turned it into a garden bar, which has been a success. Adapting his businesses to accommodate smokers and the new law cost him about $230,000, he says.

But he says focusing on food has seen him recoup much of that cost.

The hospitality industry has changed fundamentally from one where patrons “come in after work to drink and have a smoke” to one where people drink less and have a bite to eat.

White says bars and pubs have also been hit by the fact supermarkets “give grog away almost for free”.

Ministry of Health research shows there was an initial spike in supermarket liquor sales after the change in smoking laws, and a moderate drop in retail sales for bars and pubs, but this was not sustained.

Bloomfield says the law’s main objective – to reduce workers’ exposure to second-hand smoke – has been achieved.

“We already had a ban on smoking in office spaces so we were extending that to blue collar facilities like bars and restaurants. There was a bit of difference between Maori and non-Maori exposure in the workplace. We got rid of these quite stark inequalities.”

The 2006 figures showed the number of workers exposed to smoke fell to 8% from 20%. Importantly, the numbers of non-smoking young people continues to rise, with half of teens aged 15-19 years now saying they have never even tried a puff of a cigarette compared to 39% in 2006.

Bloomfield said: “The social environment and the social context has changed…

“When this legislation was passed there was 50% public support for extending the smoke-free ban into the bars.

“Support went from under 50% to 82% within two years. Even two-thirds of smokers supported that full ban.

“The interesting thing is how quickly the public appreciate [being] smoke-free.”

By LEIGH VAN DER STOEP, Sunday Star Times
15/11/2009

A study was recently done in Jamaica as part of the Global Youth Survey. In this study, seven in 10 students thought smoking should be banned in public places. We must commend our young people for their foresight and wisdom.

The fact is studies have shown that the person who inhales smoke either exhaled by the smoker or from a burning cigarette is also at risk for the diseases of the smoker.

The study also revealed some interesting findings about cigarette smoking among young people in Jamaica. Cigarette smoking is a growing among young people; 37 per cent of students reported that they had ever smoked cigarette and 22 per cent currently use tobacco products.

Cigarette smoking at an early age may lead to many problems. For example, when young people smoke, they are more likely to become addicted. In fact, 50 per cent of adults who smoke reported that they had become regular users of cigarettes by age 18. All smokers are at increased risk of smoking-related illnesses. Other studies on cigarette smoking have also made interesting findings:

Increased risk of dying

This is even greater among young people who smoke. Young people who smoke are therefore at greater risk from dying prematurely from smoking-related diseases such as lung cancer, heart disease and strokes. The difficulty we sometimes have in communicating illness and death to young people is that they are in the prime of their lives and many of them don’t appreciate the notion of illness and death as possible. Many of them feel invincible and think illness and death only happen to older people. The reality is, of course, that we will all grow old and with risky behaviours such as smoking, young people increase their risk of becoming ill or dying earlier than necessary.

Smoking is linked to other behaviours

Most studies indicate that cigarette smoking is associated with other unhealthy behaviours and habits such as cannabis smoking, being involved in fights, carrying weapons and engaging in high-risk sexual practices such as unprotected sexual intercourse. We are not saying that it is the actual smoking of cigarettes that lead to these behaviours but that the habit places some young people at greater risk of these behaviours than others.

Reasons for smoking

People smoke for several reasons. Here is a list of reasons given by young people.

1. Advertising: The advertisement of cigarettes is recognised as a major factor influencing youth smoking. Six out of every 10 Jamaican youth reported that they saw advertisements on billboards, in newspapers or magazines.

2. Influences: Children learn what they live. Three in 10 students live in houses where others smoke and six in 10 students reported that they are exposed to smoke in public.

3. Availability: Cigarettes and cannabis are too easily available to young people in Jamaica. About 35 per cent of students in the recent survey indicated that they bought cigarettes in a store and 70 per cent who bought cigarettes in a store reported that they were not refused purchase based on their age.

4. Influences in the wider society: The influences in the wider society are major factors impacting young people’s decision to smoke cigarettes. Some of these influences include the lack of a clear policy and the lack of legislation to restrict sale to minors and smoking in public. Interestingly, as stated above, seven in 10 students think smoking should be banned in public spaces in Jamaica.

Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept Of Community Health and Psychiatry, University of the West Indies, 977-1108; email: yourhealth@gleanerjm.com.

What can we do?

There are several things that we can do as a society.

1. Refer people who smoke for help. If you or someone has a smoking problem, then you should consult your health-care provider or an agency such as RISE (formerly Addiction Alert).

2. We need to support the call for a more effective media campaign to decrease smoking, especially among the youth.

3. We should support all efforts to reduce the sexy depictions of cigarettes in media and entertainment.

4. Use every opportunity to discourage family and friends from providing cigarettes to young people.

5. We need to strengthen our school-based anti-smoking programmes.

6. Support the call for young people to have cigarette smoking banned in public. This is a worthy venture our young people are calling for and, as adults, we should listen to their cries.

A Chinese doctor has spoken of his shock to discover that a four-year-old boy is already a heavy smoker.
Dong Dong, of Banqiao village, near Feidong town in eastern China’s Anhui province, has reportedly been smoking since he was just two.

His family, who run a grocery store, say they have been unable to stop him from stealing cigarettes, reports the Jianghuai Morning Post.

Doctor Zhang Gong, from Anhui Provincial Children’s Hospital, said it was shocking to see such a young child embrace such a dangerous habit.

“From the way the boy smokes and his posture, he looks to have had a long history of smoking even though he is so young,” he said.

Dong lives with his grandparents, who run the shop, because his parents are migrant workers in another city. They say he started smoking by mimicking adults.

“When he needs cigarettes, he just takes them from the house or steals a pack from the store. We just can’t seem to stop him,” said Dong’s grandmother.

They say Dong, who reportedly also drinks alcohol, learned to walk and talk later than other children of the same age in the village.

ANAND: Three partners of a tobacco trading firm from Umreth town of the district has been accused of Rs 85 lakh graft. As per a complaint at
Umreth police station on Sunday, the traders, all of one family, have left the country after the fraud.

Police said, that partners of Ashabhai Gopalbhai and Sons, a tobacco trading firm in Umreth, had taken a loan of Rs 85 lakh from Central Bank of India branch of the town against an equally valued stock of tobacco on March 23, 2006.

However, after paying a few instalments, the firm stopped making repayments. Partners Dinesh Amba Patel, Kashi Patel and Sunil Patel allegedly sold off the stock without telling the bank and fled to a foreign country.

As notices sent by the bank went unanswered for a long time, present manager Kalpana Vaidya registered a case of cheating against all three partners at Umreth police station.

source: sandesh

WEDNESDAY, Sept. 9 – Researchers have found that nicotine, the addictive component in cigarettes, “tricks” the brain into creating memory associations between environmental cues and smoking behavior. This could help explain why former smokers miss lighting up when they are in a bar or after a meal.

The findings from researchers at Baylor College of Medicine are in the Sept. 10 issue of the journal Neuron.

“Our brains normally make these associations between things that support our existence and environmental cues so that we conduct behaviors leading to successful lives. The brain sends a reward signal when we act in a way that contributes to our well being,” study co-author Dr. John A. Dani, professor of neuroscience at BCM said in a college news release. “However, nicotine commandeers this subconscious learning process in the brain so we begin to behave as though smoking is a positive action.”

Dani said that environmental events linked with smoking can become cues that prompt the smoking urge. Those cues could include alcohol, a meal with friends or even the drive home from work.

Dani and Dr. Jianrong Tang, instructor of neuroscience at BCM and co-author of the report, recorded the brain activity of mice as they were exposed to nicotine.

The mice were allowed to roam through an apparatus with two compartments. In one compartment, they received nicotine. In the other, they got a saline solution. The researchers recorded how long the mice spent in each compartment and brain activity within the hippocampus, an area of the brain that creates new memories.

“The brain activity change was just amazing,” Dani said. “Compared to injections of saline, nicotine strengthened neuronal connections — sometimes up to 200 percent. This strengthening of connections underlies new memory formation.”

Dani said understanding mechanisms that create memory could have implications in future research and treatments for memory disorders, such as Alzheimer’s disease, and for dopamine signaling disorders, such as Parkinson’s disease.

More information

The National Institutes of Health has more information on nicotine here.