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Created: 19.04.13
Smoking and Heart Disease and Stroke
What Are Heart Disease and Stoke?
Heart disease and stroke are cardiovascular (heart and blood vessel) diseases.1
Heart disease includes several types of heart conditions. The most common type in the United States is coronary heart disease (also known as coronary artery disease), which is narrowing of the blood vessels that carry blood to the heart.2,3 This can cause:
- Chest pain2
- Heart attack (when blood flow to the heart becomes blocked and a section of the heart muscle is damaged or dies)2,4
- Heart failure (when the heart cannot pump enough blood and oxygen to support other organs)2,5
- Arrhythmia (when the heart beats too fast, too slow, or irregularly)2,6
A stroke, sometimes called a brain attack, can occur when a clot blocks the blood supply to part of the brain. Stroke can also occur when a blood vessel in or around the brain bursts. In either case, parts of the brain become damaged or die.7 Stroke can cause disability (such as paralysis, muscle weakness, trouble speaking, memory loss)8 or death.
Smoking is a leading cause of heart disease. Smoking can:9
- Raise triglycerides (a type of fat in your blood)
- Lower "good" cholesterol (HDL)
- Damage cells that line the blood vessels
- Cause thickening and narrowing of blood vessels
- Cause clots to form, blocking blood flow to the heart
Secondhand smoke also damages blood vessels and can trigger a heart attack.9
Smoking is a leading cause of stroke. Smoking can:10
- Make blood thicker and more likely to clot
- Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels leading to the brain
- Pain in the hands and feet; may be severe
- Damage blood vessels in the brain
How Can Heart Disease and Stroke Be Prevented?
Heart disease and stroke are major causes of death and disability in the United States. Many people are at high risk for these diseases and don't know it. The good news is that many risk factors for heart disease and stroke can be prevented or controlled.
The federal government’s Million Hearts™ initiative works to prevent 1 million heart attacks and strokes by 2017.
Talk with your health care provider about your ABCS: 11
- Appropriate aspirin therapy for those who need it
- Blood pressure control
- Cholesterol management
- Smoking cessation (quitting smoking)
In addition to your ABCS, several lifestyle choices can help protect your heart and brain health. These include the followinging:12,13
- Avoid breathing secondhand smoke
- Eat a healthy diet
- Maintain a healthy weight
- Exercise regularly
- Limit alcohol use
How Are Heart Disease and Stroke Treated?
Coronary Heart Disease
Along with adopting lifestyle behaviors, treatment for coronary heart disease may include:
- Medicines to help:14
- Lower the workload on your heart
- Decrease your chance of having a heart attack or dying suddenly
- Lower your LDL ("bad") cholesterol
- Lower your blood pressure
- Stop blood clots from forming
- A procedure or surgery to restore blood flow to your heart:14
- Angioplasty: A procedure to open a blocked or narrow artery in the heart. A thin tube with a balloon at the tip is guided through a blood vessel to reach the blocked artery. The balloon is filled and opens up the artery, increasing blood flow.
- Coronary artery bypass grafting: Surgery in which the doctor removes arteries or veins from other parts of the body and uses them to bypass (go around) narrowed or blocked heart arteries.
- Cardiac rehabilitation, which is a program to improve the health and well-being of people who have heart disease. It includes:15
- Exercise training
- Education on healthy living
- Counseling on stress reduction
Heart Attack
A heart attack is a medical emergency. If you think you are having a heart attack, call 9-1-1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment right away. Every minute counts!
The five most common symptoms of a heart attack are:16
- Pain or discomfort in the jaw, neck, or back
- Feeling weak, lightheaded, or faint
- Chest pain or discomfort
- Pain or discomfort in arms or shoulder
- Shortness of breath
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's started right away. Treatment for heart attack can include:17
- Oxygen therapy
- Medicines to thin your blood and prevent further clotting, lower your heart's workload, increase blood flow to your heart, lower your blood pressure, and/or lower pain and anxiety
- Angioplasty
- Coronary artery bypass grafting
Treatment doesn’t stop after you leave the hospital. At home, this may include:17
- Daily medicines
- Cardiac rehabilitation
- Lifestyle changes, including quitting smoking and staying away from secondhand smoke, eating a healthy diet, exercising regularly, and maintaining a healthy weight
Stroke
A stroke is a medical emergency. If you think you are having a stroke, call 9-1-1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment right away. Every minute counts!
The five most common signs and symptoms of stroke are:18
- Sudden numbness or weakness of the face, arm, or leg
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble seeing in one or both eyes
- Sudden dizziness, trouble walking, or loss of balance or coordination
- Sudden severe headache with no known cause
Early treatment can reduce stroke damage. Patients who arrive at the emergency room within 3 hours of their first symptoms are healthier 3 months after a stroke than those whose care was delayed.19
Treatment for a stroke depends on whether it is from a blocked blood vessel or from a blood vessel that has burst.8 Treatment for stroke can include:20
- Medicines to:
- Break up blood clots in the arteries of the brain
- Keep blood clots from getting larger and stop new blood clots from forming
- Lower blood pressure, if high blood pressure is causing bleeding in the brain
- Medical procedures to open blocked carotid arteries
- Surgery to remove blood from around the brain and to fix damaged blood vessels (if bleeding occurred) or to remove plaque from the larger arteries to the brain (if blockage occurred)
Treatment doesn’t stop after you leave the hospital. At home, this may include:
- Lifestyle changes, including quitting smoking, avoiding secondhand smoke, eating a healthy diet, exercising regularly, and maintaining a healthy weight20,21
- Daily medicines21
- Rehabilitation to help relearn skills that were lost when part of the brain was damaged21
References
- U.S. Department of Health and Human Services. A Report of the Surgeon General. The Health Consequences of Smoking: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004 [accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Coronary Artery Disease (CAD) [last updated 2009 Dec 7; accessed 2013 Feb 11].
- U.S. National Library of Medicine. Coronary Heart Disease
 [last reviewed 2012 June 22; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Heart Disease: Heart Attack [last updated 2012 Apr 9; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Heart Failure Fact Sheet [last updated 2012 Oct 17; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. What Is Arrhythmia? [last updated 2011 July 1; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Stroke [last updated 2012 July 10; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Stroke: Types of Stroke [last updated 2010 Jan 14; accessed 2013 Feb 11].
- U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 Feb 11].
- National Institute of Neurological Disorders. Brain Basics: Preventing Stroke [last updated 2012 Jan 9; accessed 2013 Feb 11].
- U.S. Department of Health and Human Services. Million Hearts™ [accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Heart Disease: Prevention: What You Can Do [last updated 2009 Nov 16; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Stroke: How to Prevent Stroke [last updated 2010 Jan 14; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Is Heart Disease Treated? [last updated 2011 Sept 26; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. What Is Cardiac Rehabilitation? [last updated 2012 Feb 22; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Heart Disease: Signs and Symptoms [last updated 2012 Apr 9; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Is a Heart Attack Treated? [last updated 2011 Mar 1; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Stroke Signs and Symptoms [last updated 2010 Jan 14; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Stroke: Stroke Facts [last updated 2012 Oct 17; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Is Stroke Treated? [last updated 2011 Feb 1; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. Life After a Stroke[last updated 2011 Feb 1; accessed 2013 Feb 11].
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Created: 19.04.13
Smoking and Diabetes
What Is Diabetes?
Diabetes is a group of diseases in which blood sugar levels are higher than normal. Most of the food a person eats is turned into glucose (a kind of sugar) for the body’s cells to use for energy. The pancreas, an organ near the stomach, makes a chemical called insulin that helps glucose get into the body’s cells. When you have diabetes, your body either doesn't make enough insulin or can't use the insulin very well. Less glucose gets into the cells and instead builds up in the blood.
There are different types of diabetes. Type 2 is the most common kind of diabetes in adults and accounts for about 90–95% of all diagnosed cases. Fewer people have type 1 diabetes, which most often develops in children, adolescents, or young adults.2
How Is Smoking Related to Diabetes?
Smoking increases your chance of having type 2 diabetes.3 No matter what type of diabetes you have, smoking makes your diabetes harder to control.
For example, smoking as well as use of other tobacco products (such as snuff) can interfere with how your insulin works (a situation called "insulin resistance").4 Snuff is finely ground tobacco that can be dry, moist, or in tea bag-like pouches.
If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including:3
- Heart and kidney disease
- Poor blood flow in the legs and feet that can lead to foot infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
- Retinopathy (an eye disease that can cause blindness)
- Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination)
If you are a smoker with diabetes and decide to quit smoking or using any type of tobacco product, the health benefits begin right away. People with diabetes who quit have better control of their blood sugar levels.4 Studies have shown that insulin resistance can start to decrease 8 weeks after quitting.4 And recovery from surgery can happen faster.3
How Can Diabetes Be Prevented?
Don’t smoke. Smoking increases your chance of having type 2 diabetes.3
Weight loss (if overweight or obese) and physical activity can prevent or delay type 2 diabetes in adults who are at high risk for the disease.5
How Is Diabetes Treated?
Diabetes treatment and management can include:6
- A healthy diet and physical activity program
- Weight loss (if overweight or obese)
- Medicines to control blood sugar by helping the body use insulin better
- Insulin taken by injections or by using an insulin pump
- Patient education to address problem-solving and coping skills needed to help manage diabetes and its complications
- Medicines to control cholesterol and blood pressure
References
- Centers for Disease Control and Prevention. Basics About Diabetes [last updated 2012 Sept 6; accessed 2013 Feb 12].
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Overview [last updated 2012 Apr 4; accessed 2013 Feb 12].
- U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 Feb 12].
- U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 Feb 12].
- Centers for Disease Control and Prevention. Diabetes Public Health Resource: Prevent Diabetes [last updated 2012 May 14; accessed 2013 Feb 12].
- Centers for Disease Control and Prevention. Diabetes Public Health Resource: 2011 National Diabetes Fact Sheet [last updated 2011 May 20; accessed 2013 Feb 12].
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Created: 19.04.13
Smoking and COPD
What Is COPD?
Chronic obstructive pulmonary disease (COPD) is a serious lung disease that gradually makes it harder and harder to breathe. COPD includes emphysema and chronic bronchitis.1,2
With COPD, less air flows through the airways—the tubes that carry air in and out of your lungs—because of one or more of the following:3,4
- The airways and tiny air sacs in the lungs lose their ability to stretch and shrink back.
- The walls between many of the air sacs are destroyed.
- The walls of the airways become thick and inflamed (irritated and swollen).
- The airways make more mucus than usual, which can clog them and block air flow.
In the early stages of COPD, there may be no symptoms, or you may only have mild symptoms, such as:5
- A nagging cough (often called "smoker's cough")
- Shortness of breath, especially with physical activity
- Wheezing (a whistling sound when you breathe)
- Tightness in the chest
As the disease gets worse, symptoms may include:5
- Having trouble catching your breath or talking
- Blue or gray lips and/or fingernails (a sign of low oxygen levels in your blood)
- Trouble with mental alertness
- A very fast heartbeat
- Swelling in the feet and ankles
- Weight loss
How severe your symptoms are depends on the extent of lung damage. If you keep smoking, the damage will get worse faster than if you stop smoking.5 Among 15 million U.S. adults with COPD, 39% continue to smoke.6
How Is Smoking Related to COPD?
COPD—the number 3 killer in the nation—is almost always caused by smoking.2 Smoking accounts for as many as 9 out of 10 COPD-related deaths.2
COPD most often occurs in people age 40 and older with a history of smoking (either current or former smokers). However, as many as one out of six people with COPD never smoked.2
Smoking during childhood and teenage years can slow how lungs grow and develop. This can increase the risk of developing COPD in adulthood.7
How Can COPD Be Prevented?
The best way to prevent COPD is to never start smoking, and if you smoke, quit. Talk with your health care provider about programs and products that can help you quit. Also, stay away from secondhand smoke, which is smoke in the air from other people smoking.8
How Is COPD Treated?
Quitting smoking is the most important first step you can take to treat COPD. Avoiding secondhand smoke is also critical. Other lifestyle changes and treatments include one or more of the following:9
- For people with COPD who have trouble eating because of shortness of breath or being tired—a special meal plan with smaller, more frequent meals; resting before eating; and/or taking vitamins and nutritional supplements
- A special activity plan to help strengthen the muscles used for breathing
- Medicines such as:
- A bronchodilator to relax the muscles around the airways. This helps open airways and makes breathing easier. Most bronchodilators are taken with a device called an inhaler.
- An inhaled steroid to reduce swelling in the airways.
- Oxygen therapy, which can help people who have severe COPD and low levels of oxygen in their blood to breathe better
- Surgery for people who have severe symptoms that have not improved with other treatments
- Lung volume reduction surgery (LVRS): Surgery to remove diseased parts of the lung so healthier lung tissue can work better. LVRS is not a cure for COPD.
- A lung transplant: Surgery in which one or two healthy lungs from a donor are put in the patient’s body to replace diseased lungs. A lung transplant is a last resort.
Even though there is no cure for COPD, these lifestyle changes and treatments can help you breathe easier, stay more active, and slow the progress of the disease.9
References
- U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. COPD: Are You at Risk?
 [PDF - 960.81KB] [last updated 2011 Sept; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Does COPD Affect Breathing? [accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. What Is COPD? [last updated 2012 June 8; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. What Are the Signs and Symptoms of COPD? [last updated 2012 June 8; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(46):938–43 [accessed 2013 Feb 11].
- U.S. Department of Health and Human Services. A Report of the Surgeon General. Preventing Tobacco Use Among Youth and Young Adults: We CAN Make the Next Generation Tobacco-Free. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health [accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Can COPD Be Prevented? [last updated 2012 June 8; accessed 2013 Feb 11].
- National Heart, Lung, and Blood Institute. How Is COPD Treated? [last updated 2012 June 8; accessed 2013 Feb 11].
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Created: 19.04.13
Smoking and Buerger's Disease
What Is Buerger's Disease?
Buerger’s disease affects blood vessels in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues).1 In some cases, amputation may be required.2
The most common symptoms of Buerger’s disease are:2
- Pale, red, or bluish hands or feet
- Cold hands or feet
- Pain in the hands and feet; may be severe
- Pain in the legs, ankles, or feet when walking—often located in the arch of the foot
- Skin changes, painful sores, or ulcers on the hands or feet
How Is Smoking Related to Buerger's Disease?
Almost everyone with Buerger’s disease smokes cigarettes. However, Buerger’s disease can occur in people who use other forms of tobacco, like chewing tobacco. People who smoke 1½ packs a day or more are most likely to develop Buerger's disease.3
Researchers are working to understand how tobacco increases the risk for Buerger's disease. One idea is that chemicals in tobacco irritate the lining of the blood vessels and cause them to swell.3
How Can Buerger's Disease Be Prevented?
If you want to prevent getting Buerger’s disease, don’t smoke or use any other tobacco products.1
How Is Buerger's Disease Treated?
There is no cure for Buerger’s disease. The only way to keep Buerger’s disease from getting worse is to stop using all tobacco products. Medicines don’t usually work well to treat the disease. The best they can do is to control the symptoms.2
Surgery may help restore blood flow to some areas.1 It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs.2
References
- National Heart, Lung, and Blood Institute. Types of Vasculitis[last updated 2011 Apr 1; accessed 2013 Feb 11].
- Medline Plus. Thromboangiitis Obliterans [last updated 2013 Jan 24; accessed 2013 Feb 11].
- Mayo Clinic. Buerger’s Disease: Risk Factors [accessed 2013 Feb 11].
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Created: 19.04.13
Secondhand Smoke and Asthma
What Is Asthma?
Asthma is a chronic disease that affects the airways of the lungs. During an asthma attack, airways (tubes that carry air to your lungs) become swollen, making it hard to breathe.1,2 As the walls of the airways swell, they narrow, and less air gets in and out of the lungs. Cells in the airways can make more mucus (a sticky, thick liquid) than usual, which can make breathing even harder.2
Symptoms of an asthma attack include:1
- Coughing
- Shortness of breath or trouble breathing
- Wheezing
- Tightness or pain in the chest
Asthma attacks can be mild, moderate, or serious—and even life threatening.1
How Is Smoking Related to Asthma?
If you have asthma, an asthma attack can occur when something irritates your airways and "triggers" an attack. Your triggers might be different from other people’s triggers.3
Tobacco smoke is one of the most common asthma triggers. Tobacco smoke—including secondhand smoke—is unhealthy for everyone, especially people with asthma.3 Secondhand smoke is a mixture of gases and fine particles that includes:4
- Smoke from a burning cigarette, cigar, or pipe tip
- Smoke that has been exhaled (breathed out) by someone who smokes
Secondhand smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer.5
If you have asthma, it’s important that you avoid exposure to secondhand smoke.3
If you are among the 21% of U.S. adults who have asthma and smoke, quit smoking.6
How Can Asthma Attacks Be Prevented?
If you or a family member has asthma, you can manage it with the help of your health care provider (for example, by taking your medicines exactly as your doctor tells you) and by avoiding triggers. Staying far away from tobacco smoke is one important way to avoid asthma attacks. Some other helpful tips are:
- Do not smoke or allow others to smoke in your home or car. Opening a window does not protect you from smoke.5
- If your state still allows smoking in public areas, look for restaurants and other places that do not allow smoking. "No-smoking sections" in the same restaurant with "smoking sections" do not protect adequately from secondhand smoke6 — even if there is a filter or ventilation system.5
- Make sure your children’s day care centers and schools are tobacco-free. For schools, a tobacco-free campus policy means no tobacco use or advertising on school property is allowed by anyone at any time. This includes off-campus school events.7
- Teach children to stay away from secondhand smoke. Be a good role model by not smoking.7
How Is Asthma Treated?
There is no cure for asthma. However, to help control your asthma and avoid attacks:2
- Take your medicine exactly as your doctor tells you.
- Stay away from things that can trigger an attack.
Everyone with asthma does not take the same medicine. Some medicines can be breathed in, and some can be taken as a pill. There are two kinds of asthma medicines —2
- Quick-relief (can help control symptoms of an asthma attack)
- Long-term control (can help you have fewer and milder attacks, but they don’t help you while you are having an asthma attack)
References
- Centers for Disease Control and Prevention. Asthma’s Impact on the Nation: Data From the CDC National Asthma Control Program [PDF - 531.18KB] [accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Asthma: Basic Information [last updated 2012 Aug 3; accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Asthma: Important Asthma Triggers [last updated 2012 August 20; accessed 2013 Feb 11].
- National Toxicology Program. Report on Carcinogens, Twelfth Edition [PDF - 5.59MB]. Research Triangle Park (NC): U.S. Department of Health and Human Services, National Institute of Environmental Health Sciences, National Toxicology Program, 2011 [accessed 2013 Feb 11].
- U.S. Department of Health and Human Services. A Report of the Surgeon General. The Health Consequences of Involuntary Exposure to Tobacco Smoke. Secondhand Smoke: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2013 Feb 11].
- Centers for Disease Control and Prevention. Asthma Stats: Percentage of People With Asthma Who Smoke [last updated 2013 Jan 31; accessed 2013 Feb 11].
- U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2013 Feb 11].
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Created: 19.04.13
In the Spotlight
Upcoming Webinar & Discussion: Collaborating to Control Asthma in Chicago’s Public Housing Using Community Health Workers
May 16, 2013
Webinar: 2 – 3 p.m. ET
Discussion: 3 – 3:30 p.m. ET
Melissa Gutierrez Kapheim, Epidemiologist, Sinai Urban Health Institute(SUHI)
Andy Teitelman, Vice President, Resident Services, Chicago Housing Authority (CHA)
Katrin Kral, Facilitator, U.S. Environmental Protection Agency
Attend this webinar to learn how SUHI and CHA collaborated on a healthy homes pilot program, Helping Children Breathe and Thrive (HCBT), by utilizing community health workers (CHWs) to improve asthma outcomes in six Chicago public housing developments. Recruited from the housing properties, CHWs help families by addressing environmental asthma triggers in the home, and by providing asthma education and connecting families with health and social services. In a study following the program intervention, HCBT achieved an 80 percent reduction in home asthma triggers among program participants.
Additional Resource
To learn more about the demographic and environmental factors in Chicago public housing that contribute to asthma-related hospitalizations, check out this analysis: “Asthma morbidity in adult Chicago public housing residents.”
Released! Leveraging Affordable Care Act Opportunities to Improve Childhood Asthma Outcomes
The Childhood Asthma Leadership Coalition released follow-up briefs to the 2010 Changing Policy: The Elements for Improving Childhood Asthma Outcomes report. The initial report analyzed the chronic disease and recommended ways to improve childhood asthma management. The new briefs look at health insurance coverage, asthma education and clinical care, using health information technology, trigger reduction and development of evidence-based research.
Access the briefs.
Announcements
Webinar Recording and Slides Available! – Health & Housing: A Look at Effective Interventions for People with Asthma
Did you miss the March 19, 2013, webinar with Dr. Dorr Dearborn and Stuart Greenberg? The slides and recording are now available on the Network! Learn how Cleveland’s HUD-funded Case Healthy Homes & Patients Program provided asthma education and targeted healthy homes remediation to achieve a 58.6 percent decrease in hospitalizations of children with asthma.
Check out the questions and answers from the Q&A session in the Discussion Forum. Still have a question? Post it today! |
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Created: 08.03.13
Secondhand Smoke Linked to Early Heart Disease, Study Finds
March 7, 2013
THURSDAY, March 7 (HealthDay News) — The more you’re exposed to secondhand tobacco smoke, the more likely you are to develop early signs of heart disease, a new study indicates.
 The findings suggest that exposure to secondhand smoke may be more dangerous than previously thought, according to the researchers.
For the study, the investigators looked at nearly 3,100 healthy people, aged 40 to 80, who had never smoked and found that 26 percent of those exposed to varying levels of secondhand smoke — as an adult or child, at work or at home — had signs of coronary artery calcification, compared to 18.5 percent of the general population.
Those who reported higher levels of secondhand smoke exposure had the greatest evidence of calcification, a build-up of calcium in the artery walls.
After taking other heart risk factors into account, the researchers concluded that people exposed to low, moderate or high levels of secondhand smoke were 50, 60 and 90 percent, respectively, more likely to have evidence of calcification than those who had minimal exposure.
The health effects of secondhand smoke on coronary artery calcification remained whether the exposure was during childhood or adulthood, the results showed. The study findings are scheduled for presentation Thursday at the annual meeting of the American College of Cardiology (ACC), in San Francisco.
“This research provides additional evidence that secondhand smoke is harmful and may be even more dangerous than we previously thought,” study author Dr. Harvey Hecht, associate director of cardiac imaging and professor of medicine at Mount Sinai Medical Center in New York City, said in an ACC news release.
“We actually found the risk of secondhand smoke exposure to be an equivalent or stronger risk factor [for coronary artery calcification] than other well-established ones such as high cholesterol, hypertension and diabetes. Passive exposure to smoke seems to independently predict both the likelihood and extent of [calcification],” Hecht added.
The findings provide yet more evidence of the need for enforceable public smoking bans and other measures to protect people from secondhand smoke, he said.
“Tobacco smoke can damage the coronary arteries of nonsmokers through many different ways, which can lead to plaque formation and then to heart attacks, so this lends more [credence] to enforcing smoking bans,” Hecht noted in the news release.
To aid prevention of heart disease, discussion of secondhand smoke exposure should be included as a routine part of medical exams, he suggested.
While the study found an association between exposure to secondhand smoke and calcium build up in coronary arteries, it did not prove a cause-and-effect relationship.
The data and conclusions of research presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
More information
The U.S. Centers for Disease Control and Prevention has more aboutsecondhand smoke.
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Created: 19.12.12
Smoking during pregnancy can triple the baby's chance of developing meningitis, researchers warn. Children exposed to smoke from a parent's cigarettes at home are also twice as likely to have the deadly illness.
Source: PTI
Smoking during pregnancy can triple the baby's chance of developing meningitis, researchers warn. Children exposed to smoke from a parent's cigarettes at home are also twice as likely to have the deadly illness. Researchers believe that passive smoking gradually weakens children's immune system making them more susceptible to the illness, the 'Daily Mail' reported.
Researchers from the University of Nottingham analysed 18 studies which looked at the link between passive smoking and meningitis. Meningitis is caused by an infection of the protective membranes surrounding the brain and spinal cord and if not treated quickly it can cause brain and nerve damage.
Symptoms include severe headache, a rash, vomiting, high temperature and a dislike of bright lights.
They found that children exposed to second hand smoke in the home were more than twice as likely to get the illness. The under-fives were even more vulnerable - they were found to be two and a half times more at risk. And children whose mothers smoked during pregnancy were three times more likely to get meningitis, the study published in journal BMC Public Health found.
"We estimate that an extra 630 cases of childhood invasive meningococcal disease every year are directly attributable to second-hand smoke in the UK alone," lead researcher Dr Rachael Murray said. "While we cannot be sure exactly how tobacco smoke is affecting these children, the findings from this study highlight consistent evidence of the further harms of smoking around children and during pregnancy, and thus parents and family members should be encouraged to not smoke in the home or around children," Murray said.
In recent years a number of studies have shown passive smoking increases a child's risk of meningitis but this is one of the first to show the link between a mother smoking during pregnancy. The findings of this latest study imply this process begins while the baby is still in the womb. Experts think that smoke contains bacteria which gradually weaken children's immune systems.
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Created: 03.12.12
Wednesday, November 21, 2012 - Karachi—By the year 2020, Chronic Obstructive Pulmonary Disease COPD (COPD) is predicted to become the third leading cause of death worldwide.
Dr. Javaid A. Khan, Senior Faculty Member Department of Pulmonary and Critical Care Medicine, AKU, sounded this note of warning while addressing an awareness program arranged at Karachi Press Club in relation to the World COPD Day.
Reiterating the theme of this year “ Dr. Javaid stressed on smokers to quit smoking and save their and others lungs. He further elaborated that “Tobacco smoking and usage of fuels such as wood and coal are major causes of Chronic Obstructive Pulmonary Disease COPD, a disease that poses major health hazards and unfortunately remains largely under diagnosed and under treated in Pakistan”
While speaking at the causes and control of COPD, Dr. Musavir Ansarie, Chest Specialist Health Care Hospital, said that the disease could occur due to second hand smoke also and the discouraged the ill trend of ‘Sheesha’ consumption specially in the youth. He mentioned candidly that, “smoking is not trendy, in fact it’s stupidity”.
The audience were given free Spirometry test, that enables measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. The spirometry test was performed by many participants using a device called a spirometer.
Both the doctors explained that as there is no cure for COPD, all the currently available treatments concentrate on slowing progression of the disease, controlling symptoms, reducing complications and improving patient quality of life. “Stopping smoking is the single most effective intervention to reduce the risk of developing COPD and to stop its progression.” The doctors stressed.
While advising people not to ignore symptoms such as continuous cough, cough with sputum, felling breathless etc. And consult their doctors if such symptoms occur. They informed that there are a number of therapeutic interventions available for COPD, including the following inhalers:
Bronchodilators relax and widen the airways making breathing easier and more comfortable Corticosteroids are a class of treatments available to reduce inflammation in the airways. Combination therapies: Combing the above therapies has shown to be a more effective than administering either alone. Combination therapies reduce exacerbations; improve symptoms and slow decline in health status.
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Created: 16.11.12
Friday, November 16, 2012 From Print Edition
Not just smokers, but anyone chronically exposed to smoke in a poorly ventilated space is at risk of developing Chronic Obstructive Pulmonary Disease (COPD), which will become the third leading cause of death worldwide by 2020 from its current ranking as the fifth leading cause.
Renowned pulmonologist and medical specialist, Dr. Naghman Bashir shared this piece of information during a lecture delivered to medical students and faculty of Shifa College of Medicine (SCM) here to mark World COPD Day on Wednesday. The lecture was organised by the federal chapter of the Pakistan Chest Society, which has scheduled similar sessions in other medical colleges of Rawalpindi and Islamabad as well.
Patients (usually smokers or ex-smokers) suffering from COPD have difficulty in breathing, with cough and sputum; in its extreme form, patients are home bound due to breathing disabilities. It is caused almost exclusively by exposure to smoke. Eighty-five per cent of COPD sufferers are, or have been, smokers; the rest are non-smoking women exposed to kitchen smoke in unventilated kitchens, or traffic policemen or auto mechanics chronically exposed to smoke.
Dr. Bashir traced the history of tobacco, which was brought to Europe from America by Christopher Columbus in 1492. The tobacco epidemic then spread to the rest of the world. He explained the health hazards of smoking, which include heart disease, lung diseases particularly COPD, cancers of lung, mouth, oesophagus, stomach, and reproductive organs, sub-fertility, poor blood circulation, and worsening mental and intellectual health.
He quoted Dr. William Vaughan who wrote about the effects of tobacco in 1617 as: “Tobacco that outlandish weede, it spends the braine; it spoils the seede, it dulls the spirite and dims the sight, it robs the woman of her right.”
Later in his presentation, Dr. Bashir discussed a few myths about tobacco and presented facts breaking these myths. The last part of his talk was exclusively devoted to strategies on how to quit smoking. With the help of sketches, he spelled out steps, which, if properly followed, can help smokers quit. While sharing successful strategies to quit smoking, he advised smokers to set a deadline, which should be within two weeks from the day of their decision to quit. He advised them to announce their decision to all including family, friends, colleagues, and even the shopkeeper from where they buy cigarettes, and to seek support from all as they will feel stressed and may express frustration and anger. During these two weeks, smokers should practice to quit. “Whenever the urge strikes, defer for a few minutes. For example, defer this to after meal, or after responding to a phone call or completing some office or home task,” Dr. Naghman Bashir advised. He also suggested removal from reach, everything that reminds a smoker of smoking. “Do not keep a packet of cigarettes with you. Removal all ashtrays, matchboxes, and lighters from your home, office, car and other place of work,” he suggested to this effect.
Whenever hit by the urge to smoke, it is advisable to get yourself busy in some activity like household chores, calling someone, going out for a walk, or going to a smoke-free area like a mosque, library or cinema. “Get yourself busy away from smoking cues like after meals, or drinking tea or coffee. Stay with your children or parents so as to avoid smoking. And when the D Day arrives, do not take a single puff from then onwards. If you feel withdrawal symptoms, consult a doctor who can prescribe you some medicines, which help in quitting and also help in managing withdrawal symptoms,” he concluded.
The session ended with interesting questions from the attendees.
Click here for the original article
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Created: 30.10.12
Smoke-free laws were followed by fewer hospitalizations for respiratory diseases, among other conditions, according to a new study.
4:22PM EDT October 29. 2012 - Smoking bans quickly and dramatically cut the number of people hospitalized for heart attacks, strokes and respiratory diseases such as asthma and emphysema, an analysis out Monday shows.
Heart attack hospitalizations fell an average of 15% after communities passed laws banning smoking in areas such as restaurants, bars and workplaces, according to the largest analysis of smoke-free legislation to date. The analysis included 45 studies covering 33 laws in American cities and states, as well as countries such as New Zealand and Germany.
Stroke hospitalizations fell 16%, while hospitalizations for respiratory disease fell 24%, according to the study, published Monday in Circulation.
The more comprehensive the law, the greater the impact, says senior author Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.
For example, a 2002 law banning smoking only in restaurants in Olmsted County, Minn., had no effect on heart attacks, according to a study also published Monday in theArchives of Internal Medicine. However, hearts attacks fell by 33% after a 2007 law that expanded the smoking ban to all workplaces, including bars, according to the report, from Minnesota's Mayo Clinic.
That drop is especially impressive, given that people in Minnesota got less healthy in the same time, with higher rates of diabetes and obesity. Rates of high blood pressure and unhealthy cholesterol levels stayed the same.
Glantz says state lawmakers should consider these findings when voting to exempt certain facilities, such as bars or casinos, from smoke-free laws. "The politicians who put those exemptions in are condemning people to be put into the emergency room," Glantz says.
David Sutton, a spokesman for Philip Morris USA, the country's leading cigarette maker, says his company agrees that secondhand smoke is dangerous, but he says smoking bans aren't always necessary, and that businesses such as restaurants can accommodate non-smokers through separate rooms or ventilation.
"Reasonable ways exist to respect the comfort and choices of both non-smoking and smoking adults," Sutton says. "Business owners -- particularly owners of restaurants and bars -- are most familiar with how to accommodate the needs of their patrons and should have the opportunity and flexibility to determine their own smoking policy. The public can then choose whether or not to frequent places where smoking is permitted."
Neither report provides information about why smoking bans reduce heart attacks. But Glantz says smoke-free laws tend to lead people to smoke less or quit altogether.
Fewer people smoked at home, as well. The percentage of smoke-free homes in the state grew from 64.5% in 1999 to 87.2% in 2010, a period in which state and federal taxes also rose significantly, the Mayo study shows.
Smoking bans also protect non-smokers, says cardiologist Raymond Gibbons, past president of the American Heart Association, who was not involved in either study. Cigarette smoke can trigger heart attacks in non-smokers with underlying heart disease, he says.
Secondhand smoke affects a non-smoker's blood vessels in as little as five minutes, causing changes that increase the risk of heart attack, according to the Mayo Clinic study. About 46,000 non-smoking Americans die from secondhand smoke exposure each year, according to the National Cancer Institute.
Smoking bans also reduce health care costs -- for individuals, health plans and government payers, Glantz says. Total savings ranged from $302,000 in all health care costs in Starkville, Miss., to nearly $7 million just in heart attack-related hospitalizations in Germany, according to the Circulation study.
"If politicians are serious about cutting medical costs, they need to look at this," Glantz says. "The best way to keep health care costs down is to not get sick. ... There is nothing else you can do to have these big an effect on hospital admissions."
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Created: 05.09.12
Pregnant mom's smoking sets baby on path to obesity, says study
For babies whose moms smoked during pregnancy, a tendency toward obesity may stem from changes in the brain that make fatty foods more enticing, a new study says. (Jose J. Santos / December 19, 2011)
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For babies whose mothers smoked cigarettes during pregnancy, the result may be a powerful drive to consume fatty foods -- and a heightened risk of becoming obese, says a new study.
The study offers new insights into a connection that has only become evident to researchers in the past decade: that children born to mothers who smoked during pregnancy are more likely to be overweight or obese. In the 1960s and 1970s, close to 40% of U.S. and Canadian women smoked during pregnancy, suggesting that tobacco may be one factor in the dramatic run-up of obesity in North America during the past three decades. (Other prenatal factors that may predispose one toward obesity are poorer maternal nutrition, maternal obesity and closely spaced pregnancies.)
But the latest research, published "Online First" in the Archives of General Psychiatry on Monday, suggests that smoking may influence the development of the fetal brain in ways that will predispose the affected baby to choose fatty foods over foods less dense in fat. It appears to do so by suppressing the size of the amygdala, the almond-shaped structure at the heart of the brain that, among other functions, helps regulate appetite and other reward-seeking behavior.
The study recruited 378 Canadian high school students between 13 and 19 years of age -- 180 of them exposed to cigarette smoke while in utero. All were at a late stage in their pubertal transition, a period during which obesity related to mother's tobacco use systematically crops up. Each adolescent had his or her body-mass index and body-fat composition measured, and brain scans assessed the size and structure of several brain regions thought to play a role in appetite and reward-seeking. The teens were also asked about their use of illicit drugs, alcohol or tobacco, and parents filled out questionnaires relating to a mother's smoking during pregnancy, breastfeeding and the family's socioeconomic status.
Compared to kids whose mothers did not smoke during pregnancy, those exposed to cigarette smoke in utero had smaller amygdalea. Their food diaries indicated their diets were higher in fats, representing 33.1% of the daily caloric intake versus 30.4% for nonexposed children.
The average body weight and BMI of the tobacco-exposed group was slightly higher than that of the group whose mothers had not smoked. But their body compositions reflected substantial differences: The tobacco exposed group had on average 15% more body fat than did the group of kids whose moms did not smoke during pregnancy.
Kids whose moms smoked during pregnancy were also significantly more likely to have experimented with illicit drugs and alcohol than did those whose fetal experience was not bathed in nicotine. Curiously, neither group of children was more likely to use tobacco.
"Diets high in fat are considered highly rewarding," the authors write. And that sense of reward that comes with, say, biting into a doughnut, registers in the same places in the brain -- the amygdala among them -- that are activated by drugs of abuse. Past research has found that having an amygdala that is either small or not highly responsive to addictive pleasures is highly correlated to addictive behavior.
"The results of our study are consistent with the fetal programming hypothesis of obesity," the authors state.
Click here for the original Los Angeles Times Article
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Created: 04.09.12
A woman smokes an electronic cigarette. Photographer: Christopher Furlong/Getty Images
Bloomberg News
Electronic Cigarettes Cause Damage to Lungs, Study Finds
By Makiko Kitamura on September 03, 2012
Electronic cigarettes cause damage to the lungs, according to a study that challenges earlier research suggesting the devices to quit smoking are harmless.
E-cigarettes, electronic tubes that simulate the effect of smoking by producing nicotine vapor, caused an immediate increase in airway resistance, lasting for 10 minutes, making it harder for participants to breathe, researchers from the University of Athens said in a study presented at the European Respiratory Society annual meeting in Vienna today.
The researchers used a lung function test to observe airway resistance in 32 participants who used an e-cigarette for 10 minutes. Among the healthy subjects who had never smoked, airway resistance rose to an average 206 percent from 182 percent; among smokers with normal lung function, the reading rose to an average 220 percent from 176 percent.
“We do not yet know whether unapproved nicotine delivery products, such as e-cigarettes, are safer than normal cigarettes, despite marketing claims that they are less harmful,” Christina Gratziou, one of the study authors, said in a statement. “This research helps us to understand how these products could be potentially harmful.”
More research is needed to understand whether the effect on the lungs is long-lasting, Gratziou said.
Not Alternative
Gratziou’s study supports the European Respiratory Society’s position on e-cigarettes and other emerging nicotine delivery products, Klaus Rabe, the group’s president, told reporters today in Vienna.
“ERS does not classify e-cigarettes as a safe alternative to smoking nor does it consider them an approved tobacco cessation tool,” Rabe reiterated from the society’s statement in February. “ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products.”
The study follows a separate paper presented last month by researchers at the Athens-based Onassis Cardiac Surgery Center at the European Society of Cardiology annual meeting that said e-cigarettes prompted no adverse effects on cardiac function.
Previous studies have found that the electronic devices would have to be smoked daily for four to 12 months to achieve the levels of carcinogenic nitrosamines that are present in a single tobacco cigarette, said the researchers for that paper. Industry-wide e-cigarette sales this year are likely to double from $250 million in 2011, according to UBS AG.
Psychological Effects
Electronic cigarettes, which mimic the look and feel of traditional versions without generating smoke and ash, are one of the few smoking alternatives that provide users with their chemical need for nicotine and reproduce the psychological effect of holding and smoking a cigarette, the Onassis researchers said.
Makers of the battery-powered devices include Lorillard Inc. (LO), a Greensboro, North Carolina-based producer of standard cigarettes, which acquired Blu Ecigs for $135 million in April. The U.S. Food and Drug Administration has yet to impose rules on the testing and production of e-cigarettes.
About 2.5 million people use e-cigarettes in the U.S., according to an estimate by the Tobacco Vapor Electronic Cigarette Association.
To contact the reporter on this story: Makiko Kitamura in London at mkitamura1@bloomberg.net
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Created: 24.07.12
Media campaigns encouraging tobacco users to stop
Tuesday, July 17, 2012
Dyersburg State Gazette
The CDC is using hard-hitting media images under its Tips from Former Smokers Campaign to motivate tobacco users to stop using tobacco products. The campaign tells stories of former smokers like Brandon pictured above who has been battling Buerger's disease since he was 18. The disease causes an inflammation of blood vessels and affects blood flow to the hands and feet often leading to amputation.
Last fall the Food and Drug Administration began requiring tobacco industries to incorporate graphic images on all cigarette packs. The requirement, which was part of the Family Smoking Prevention and Tobacco Control Act signed into law by President Barack Obama in June 2009, forces tobacco industries to have the graphic warning labels on at least 50 percent of the cigarette packaging by September 2012.
It turns out the FDA is not the only federal agency using graphic images, as the Centers for Disease Control launched its Tips from Former Smokers Campaign in March and has reported that calls to its quit-smoking hotline have doubled since the ads aired.
The Tips Campaign shares the truth about smoking and the harmful effects of tobacco use through the stories of real people who are currently suffering the effects of their choices. The CDC says that it is using the campaign at the suggestion of the Institute of Medicine, National Cancer Institute and Surgeon General who all recommended that hard-hitting national media campaigns would raise awareness about the dangers of tobacco use and encourage tobacco dependents to quit.
"Although they may be tough to watch, the ads show people living with real, painful consequences from smoking," said CDC Director Thomas R. Frieden, MD, M.P.H. in a press release statement. "For every one person who dies from tobacco, 20 are disabled or disfigured or have a disease that is unpleasant, painful, expensive. There is sound evidence that supports these ads - and, based on the increase in calls to 1-800-QUIT-NOW, we're on our way to helping more smokers quit."
According to the CDC, cigarette smoking is the leading cause of preventable death in the United States accounting for approximately 443,000 deaths in the U.S. each year. The CDC also estimates that tobacco use costs our nation's economy approximately $200 billion each year ($96 billion in health care costs and an additional $97 billion in lost productivity). Because it is a preventable illness, employers and health insurance providers have begun working together to provide incentives for insurance recipients to quit tobacco use if they are currently addicted.
Locally, the city of Dyersburg began working with its employees on July 1 to assist them in stopping their or their dependent's tobacco use. The city also passed a ban on tobacco use in city facilities, vehicles and equipment. Under the new policies city employees will have between July 1 and Dec. 31 to receive aids that will help them eliminate their dependency on tobacco. On Jan. 1, 2013 city employees will be assessed a $5 surcharge on their health care deductions if they are still using tobacco products.
Tobacco dependents that are interested in receiving help can find more information athttp://www.smokefree.gov or by calling 1-800-QUIT-NOW.
Information for this article was obtained through www.cdc.gov.
© Copyright 2012 Dyersburg State Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. |
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Created: 18.07.12
Secondhand Smoke in Childhood Linked to Lung Disease Years Later
Study found it nearly doubled risk for breathing condition
March 19, 2012 Print
MONDAY, March 19 (HealthDay News) -- Children exposed to secondhand smoke have nearly twice the risk of developing a lung condition called chronic obstructive pulmonary disease when they're adults, a new study has found.
Chronic obstructive pulmonary disease (COPD) is a term used for a number of conditions, including emphysema and chronic bronchitis.
In the study, Norwegian researchers looked at 433 adult COPD patients and 325 adults without the disease to assess risk factors for the condition, which causes breathing difficulties and grows worse over time.
Women exposed to secondhand smoke as children had a 1.9 times greater risk of developing the lung disease than those who weren't exposed, while men exposed to secondhand smoke as children had a 1.5 times to 1.7 times greater risk than those who were not exposed, the investigators found.
Overall, childhood exposure to secondhand smoke was a much stronger risk factor for developing COPD than exposure to secondhand smoke during adulthood, according to the report published online recently in the journal Respirology.
"Our results suggest that the long-term burden of COPD could be reduced if children were not exposed to cigarette smoke," study author Ane Johannessen and colleagues at Haukeland University Hospital, in Bergen, Norway, noted in a journal news release. "Further, they indicate that factors affecting early-life development of lung function has important long-term consequences for adult life."
While the study uncovered an association between secondhand smoke exposure in childhood and COPD in adults, it did not prove a cause-and-effect relationship.
More information
The American Academy of Family Physicians has more about chronic obstructive pulmonary disease.
Copyright © 2012 HealthDay. All rights reserved.
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Created: 12.07.12
Protecting Americans from tobacco’s damage
By Margaret Hamburg
JULY 11, 2012
 Three years ago, President Obama signed the Family Smoking Prevention and Tobacco Control Act into law. Those of us present knew we were witnessing history. With the stroke of a pen and strong bipartisan support from Congress, the Food and Drug Administration was charged with protecting public health from tobacco use – the nation’s single most preventable cause of disease, disability and death. More than 1,200 people die each day in the United States because of cigarette use. That is one person every 71 seconds. Today, I am pleased to report that the law is working.
In passing the Tobacco Control Act, Congress recognized that the linchpin of any successful strategy to reduce adult tobacco use must be to prevent young people from ever starting. More than 80 percent of adult U.S. smokers begin smoking as teens. Each day more than 3,800 young people under age 18 smoke their first cigarette, and more than 1,000 become daily cigarette smokers. Reversing this trend requires aggressive action on two fronts: reducing the attractiveness of tobacco products to children and ending their access to them. That’s exactly what the FDA is doing.
During our first 12 months of regulating tobacco, the FDA pulled candy and certain other flavored cigarettes off the market; issued tough new regulations to halt sales of cigarettes, cigarette tobacco, and smokeless tobacco to young people; banned brand-name sponsorship of sporting events and concerts; and implemented requirements for new warning labels for smokeless tobacco products. The FDA also has begun funding state authorities to assure vigorous enforcement of these new actions to protect our children.
The FDA’s efforts haven’t just focused on young people. We’re working to make sure all Americans, young and old, understand the true dangers of tobacco use. That’s why the FDA is enforcing the prohibition on misleading labeling and advertising claims, and why, for the first time, tobacco companies are required to report the quantities of harmful or potentially harmful chemicals in the products they make.
The FDA also is requiring graphic health warnings on cigarette packages and ads. Although a lawsuit by tobacco companies has halted implementation of the warning requirements, FDA will continue to fight to keep them so the United States, like dozens of other countries around the globe, can use this effective way to communicate the dangers of smoking to consumers.
Turning back the tide of suffering and death caused by tobacco use won’t be easy.
Today, FDA researchers are beginning to unravel the mysteries of tobacco use and addiction, including the possibilities of reducing the dangers and addictiveness of tobacco products. FDA scientists also are exploring the full spectrum of health consequences of tobacco use and how best to communicate those dangers to the public. Working with other federal agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health, we will meet those challenges.
Much has been done since that day three years ago when the Tobacco Control Act was signed into law by the president in the White House Rose Garden. To the FDA, these achievements represent a solid foundation to build on. I have never been more confident that, together, we can make tobacco-related death and disease part of America’s past, and not America’s future.
PHOTO: Cigarette butts in an ashtray in Los Angeles, May 31, 2012. REUTERS/Jonathan Alcorn
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Created: 15.06.12
Secondhand smoke tied to more health effects
NEW YORK | Thu Jun 14, 2012 3:14pm EDT
(Reuters Health) - People regularly exposed to secondhand smoke may have increased risks of dying from various causes, a long-term study from China suggests.
Researchers found that compared with adults who lived and worked in smoke-free environs, those exposed to secondhand smoke were more likely to die of heart disease or lung cancer over 17 years.
And they were also more likely to die of stroke or the lung disease emphysema -- two diseases that have had relatively weaker links to secondhand smoke.
The findings, which appear in the medical journal Chest, cannot definitively prove that secondhand smoke is the culprit. But the researchers were able to account for some other key factors, like a person's age, education, job, and blood pressure and cholesterol levels.
And the links between secondhand smoke and mortality remained, say the researchers, led by Dr. Yao He of Chinese PLA General Hospital in Beijing.
"This is exactly the type of study design you want to see," said Joanna Cohen, director of the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health in Baltimore.
Cohen, who was not involved in the research, pointed out that the study followed people over many years, and it found evidence of a "dose-response" relationship -- meaning people's risks climbed as their secondhand smoke exposure increased.
Those things are considered key in building the case for a cause-and-effect relationship.
A number of studies have found that non-smokers who regularly breathe in other people's tobacco smoke have an increased risk of developing heart disease or certain cancers, including lung tumors.
In the U.S., the most recent Surgeon General's report said there was "suggestive" evidence that secondhand smoke might boost people's risk of stroke and emphysema, also known as chronic obstructive pulmonary disease or COPD.
But the evidence was considered insufficient to say there was a "causal relationship," Cohen noted.
"This type of study," she said, "is important for adding to evidence of a causal relationship."
Cohen also said it was "huge" that the information was coming from China. "It's the country with the most number of smokers," she pointed out. And, she said, it is trailing other nations in anti-smoking education and tobacco control.
The current findings are based on 910 adults who were followed over almost two decades.
At the start, 44 percent said they lived with a smoker, while 53 percent said they inhaled secondhand smoke at work.
Over the following years, 249 study participants died. And the risks of death from heart disease, stroke, lung cancer and emphysema were all two to three times higher among people exposed to secondhand smoke.
Among men, for example, 11 percent of the 271 men exposed to secondhand smoke died of stroke. That compared with 6.5 percent of the 168 men who lived and worked in smoke-free surroundings.
The numbers of people who died of each specific cause were fairly small, which is a limitation.
"When numbers get small," Cohen said, "it makes it more difficult to get a precise estimate" of risks.
But she said the results do support evidence that secondhand smoke may boost the risks of not only heart disease and certain cancers, but stroke and emphysema as well.
SOURCE: bit.ly/LoNalu Chest, online May 24, 2012.
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Created: 13.06.12
Even senior citizens can reduce their risk of premature death by giving up cigarettes, a new study says. (Yuri Cortez / AFP/GettyImages / June 11, 2012)
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- By Karen Kaplan, Los Angeles Times/For the Booster Shots blog
It’s never too late to improve your health by giving up cigarettes, according to a new study that looks at how smoking behavior was linked with mortality in people over age 60.
Lifelong smokers often tell themselves that there’s no point in giving up the habit now, after so much damage has already been done. They may also tell themselves that if smoking were truly bad for them, they would have died already.
But neither of these convenient excuses is true, according tothe study published Monday in Archives of Internal Medicine. Three experts from the German Cancer Research Center in Heidelberg combed through 17 studies from the U.S., China, Australia, Japan, England, Spain and France that followed between 863 and 877,243 people for periods ranging from three to 50 years.
After crunching the numbers, they found that compared with people who have never smoked, smokers over the age of 60 were 83% more likely to die while they were being tracked. By comparision, former smokers over the age of 60 were 34% more likely to die while they were being tracked. So moving from the “current smoker” category to the “former smoker” category would reduce one’s risk of premature death by 28%.
Some of the studies contained enough data to compare people in their 60s, 70s and 80s. In a commentary that accompanied the study, Dr. Tai Hing Lam of the University of Hong Kong calculated that for people in their 60s, quitting was linked with a 21% decrease in the risk of premature death. For those in their 70s, that risk was reduced by 27%, and for those in their 80s, the risk fell by 24%.
In general, the studies showed that the longer a person had been classified as a “former smoker” (as opposed to a “current smoker”), the more their risk of premature death fell. By contrast, “current smokers show highest absolute mortality rates in all studies,” the researchers reported.
“The hazardous effects of smoking persist even in oldest age,” the authors concluded. “Even older people who smoked for a lifetime without negative health consequences should be encouraged and supported to quit smoking.”
Lam was more direct with his advice: “Most smokers grossly underestimate their own risks,” he wrote. The World Health Organization likes to say that one out of every two smokers will die from their habit, a statistic that should be printed on all packages of cigarettes “so that all smokers know that they are betting their lives on the toss of a coin,” Lam wrote. (He also added that among those who picked up the habit at a young age, it’s more like two out of three who will die from smoking.)
Doctors should spend at least a few minutes reminding their patients that smoking will increase their risk of cancer, heart disease, stroke, respiratory problems and other serious diseases, and explain that no matter how old they are, those risks will fall if they give up cigarettes, Lam wrote. Smokers should be referred to quit lines or clinics over and over until the message gets through.
“If you have helped 2 smokers quit,” he concluded, “you have saved (at least) 1 life.”
You can read the study online here and the commentary here.
Return to the Booster Shots blog.
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Created: 07.06.12
Curbing pregnant smokers with price hikes
BIRMINGHAM, Ala. (WIAT)-
Around 23% of women enter pregnancy as smokers, and more than half continue to smoke during pregnancy despite the health risks to the baby, excess healthcare costs at delivery and in the future. Now, a new study shows tobacco control policies can curb this habit in pregnant smokers in addition to preventing a return to smoking within four months, on average, after delivery.
“This is one of the first studies of pregnant women’s smoking in the new era of more restrictive state tobacco control policies,” E. Kathleen Adams, PhD, Department of Health Policy and Management, Emory University was quoted as saying. “We found that a $1.00 increase in cigarette taxes increases the quit rate among pregnant women from 44.1% to 48.9%, a sizeable effect. Moreover, tax policies appear to be effective in keeping these women from relapsing in the first few months postpartum, and the implementation of a full workplace smoke-free policy also increases quits.”
The researchers from Emory University and the Centers for Disease Control and Prevention examined cigarette smoking among 225,445 women with live births from 2000-2005 in 29 states plus New York City. They merged data on smoking status (pre-pregnancy smoking; quitting during pregnancy; and remaining quit 4 months after delivery) with cigarette price data, which includes federal, state, and local cigarette excise taxes, data on state tobacco control spending for the period, and the existence of full or partial bans of worksite or restaurant smoking.
The researchers determined that a $1.00 increase in taxes and prices increases the probability of quitting by the last three months of pregnancy by 4.8 percentage points. The probability of continuing to abstain from smoking four months after delivery is increased by 4.2 percentage points or from 21.3% to 25.5%, with a $1.00 increase in real taxes. A full ban on smoking at private worksites increased the probability of quitting smoking during pregnancy by 4-5 percentage points.
Ultimately, the findings were not conclusive about tobacco policies halting pregnant smokers . "Insignificant results on tobacco control spending may indicate that such spending needs to reach a minimum threshold recommended by the Centers for Disease Control and Prevention," Dr. Adams was quoted as saying. "If additional tobacco tax revenues were used by states to support implementation of smoke-free and other effective policies, then tax policy could have additional effects on prevalence of smoking and in turn, help improve birth outcomes, and reduce healthcare costs at delivery.
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Created: 03.06.12
Smoke gets into everything
Tobacco use is the single most preventable cause of disease, disability, and death around the world. The power to prevent this from occurring is in your hands.
TOBACCO use kills. The World Health Organization (WHO) has estimated the death toll for this year to be almost six million people, up by almost a million people from last year’s death toll; it takes more lives than HIV/AIDS, tuberculosis and malaria combined.
If this trend continues, tobacco use could kill more than eight million people per year by 2030, and up to one billion people in total in the 21st century.
Despite such alarming facts and figures at hand, the trend of smoking continues to rise. Smokers continue to pollute their bodies with a potent cocktail of over 4,000 toxic chemicals, NONE of which are beneficial to their bodies. In fact, hundreds of these chemicals are toxic, and around 70 are known to cause cancer.
Your smoking habits will probably not kill you today or tomorrow, but how long can you dodge the bullets before one of them finds the mark?
Homegrown habits
In Malaysia, the trend of smoking continues to grow, thus adding to both national and global statistics. Although male smokers have attained the highest percentage on the “smoking prevalence” charts, the number of women who smoke, both young and old, is also climbing steadily.
Various efforts by the Health Ministry, NGOs, and private and public sectors, as well as the printing of disturbing images on cigarette boxes, and even, the ban on smoking in air-conditioned and certain public areas, have still failed to address the problem.
Thus, the question remains: who is to be blamed?
Male and female smokers commonly justify their smoking habit with the excuse that it purportedly acts as a stress reliever; they claim to need it to deal with the stress and pressures of modern living. Many people perceive the habit to be relaxing, and an enjoyable activity.
Another reason can be attributed to social and psychological factors. Most smokers start smoking during their adolescent or early adulthood years due to peer pressure. Some may smoke because of the “rebellion” factor. With the many warning signs of the dangers of smoking advertised everywhere, smokers have rebelled against this by ignoring the warnings and increasing their nicotine intake.
Some smokers have even convinced themselves that “if it makes you happy, then it can’t be that bad; after all, we are all going to die one day.”
More harmful to women
Women who smoke face higher risks compared to men. This is because of a woman’s genetic make-up and her body’s intolerance to drugs in general.
A woman’s body cannot handle the same quantity of cigarettes smoked by a man. In addition to all the complications of smoking-related diseases, women who smoke are 12 times more likely to develop lung cancer than non-smokers, and those who smoke more than two packs a day have a 74% greater chance of dying from breast cancer.
Older women who have gone through menopause also face a higher risk of hip fracture as a result of smoking when compared to non-smokers. One in eight hip fractures in women are linked to smoking.
The sad fact is that smoking takes a greater toll on women than it does men.
First-hand knowledge
Whether you are a man or woman, think twice before picking up smoking. You may be willing to put your own life and health at risk, but are you also willing to burden your loved ones with the same risks?
Exposure to second-hand smoke can cause respiratory and cardiovascular diseases, disability, and death. It poses just as much risk as direct smoking.
Adults who inhale second-hand smoke face the risk of developing lung diseases, heart diseases and cancers. There are also effects of second-hand smoke on children, which include various infections, low birth weight, and Sudden Infant Death Syndrome.
Problems such as chronic coughing, wheezing, as well as eye and nose irritation can occur in adults and children alike.
Third-hand smoke is defined as the residue from second-hand smoke. The particles from this residue can penetrate into the deepest part of the lungs and contribute to asthma, other respiratory diseases, and even cancer. It is just as harmful as second-hand smoke.
The disease magnet
Smoking and tobacco use harms nearly every organ in the body, and can lead to serious chronic diseases. Statistically, lung cancer remains the main cause of death from smoking, with heart disease coming in second.
The most common diseases from smoking are respiratory diseases, because when you smoke, it goes through your whole respiratory system; there is no escape from the effects. Common respiratory complications include bronchitis, pneumonia, asthma, lung cancer and emphysema (a type of lung disease which makes it hard for a person to breathe). It also leads to cancer of the throat, bladder, kidneys, cervix, pancreas, and stomach.
A smoker may also suffer cardiovascular diseases such as ischaemic heart disease, where there is a reduced supply of blood to the heart muscle, or suffer a stroke.
Be healthy, quit today
Stopping the habit can reduce mortality by as much as 36%, especially among those with coronary artery disease. There are tremendous benefits if you quit smoking. For starters, you will first be adding more days to every year of your life, and the health benefits of quitting starts immediately.
Within 20 minutes of smoking your last cigarette, your body starts its internal healing process, with your heart rate slowing down. The carbon monoxide levels in your blood will return to normal in 12 hours. Within two weeks to three months, your risk of heart attacks begins to drop and your lung function improves.
All these benefits will continue into the months and years ahead. After 15 years, your risk for coronary heart diseases becomes the same as a non-smoker.
The benefits of quitting smoking are many, and there are a multitude of resources out there to help you in your efforts to break this habit.
Treating the habit
Breaking the habit of smoking may be difficult, but it is possible. Most smokers continue to smoke because of their addiction or dependence on nicotine. The psychological and physical dependence on nicotine is the main cause of failure to quit. Most smokers make five to seven attempts before they finally succeed.
Half the battle in quitting lies in actually knowing that you need to quit. This will help you in dealing with the symptoms of withdrawal that can occur, such as bad moods and the craving to smoke.
There are currently two treatment approaches to help you in your attempt to quit smoking and stay tobacco-free.
The first is pharmacologic therapy, while the second is non-pharmacologic treatments.
Pharmacologic therapy, in simple terms, is the use of drugs to treat a certain condition. This treatment method is used to alleviate the withdrawal symptoms from smoking cessation, and helps a smoker abstain from smoking.
Non-pharmacologic treatments include counselling, health education, hypnosis, and acupuncture.
Hypnosis can, in certain cases, be very successful in convincing a smoker to develop and strengthen the desire not to smoke.
Acupuncture is useful in alleviating smoking jitters, irritability, cravings and restlessness.
If you stop smoking now, after 10 years of abstinence, the risk of developing any smoking-associated diseases drops to a level that is one-third to one-half of the risk for people who continue to smoke.
References:
1. http://www.who.int/tobacco/wntd/2012/announcement/en/index.html
2. http://www.who.int/mediacentre/factsheets/fs339/en/index.html
3.http://www.cdc.gov/chronicdisease/resources/publications/AAG/osh.htm
4. http://thestar.com.my/health/story.asp?file=/2011/6/1/health/8773930&sec=health
5. Kah Lin, Khoo, “Smoking is the biggest killer in heart disease – This is how to prevent it”, Berita Yayasan Jantung Malaysia, Vol 29, 1st Issue, 2011.
For more information please see the original article here.
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Created: 01.06.12
No threshold for the adverse effects of secondhand smoke on blood vessels
We have shown that 30 minutes of exposure to secondhand smoke at levels about like experienced in a bar damage and compromise the functioning of arteries in a way that increases the likelihood of a heart attack.
Recently Paul Frey and others here at UCSF published a paper examining what happened to the ability of arteries to function at lowere levels of secondhand smoke. We exposed healthy people to a range of relatively low concentrations of aged secondhand smoke (SHS), similar to those encountered commonly in the community and found that short-term exposure to real-world levels of aged SHS for 30 min resulted in a concentration-dependent decrease in endothelial function as measured by how well arteries dilated in response to demands for increased blood flow (flow-mediated dilation).
There was no evidence of a threshold for this effect, i.e., it was detected even as the exposures of SHS went down.
This study adds to the evidence that even a little secondhand smoke is dangerous.
The full paper is “The Exposure-Dependent Effects of Aged Secondhand Smoke on Endothelial Function” by Paul F. Frey, Peter Ganz, Priscilla Y. Hsue, Neal L. Benowitz, Stanton A. Glantz, John R. Balmes, and Suzaynn F. Schick. Journal of the American College of Cardiology. Available online 14 May 2012. http://dx.doi.org/10.1016/j.jacc.2012.02.025 available at http://www.sciencedirect.com/science/article/pii/S0735109712009424 |
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Created: 05.04.12
Over the past six years, EPA has actively engaged hundreds of community-based asthma management programs, national experts and champions demonstrating a strong commitment to improving community health by promoting asthma awareness and improved asthma outcomes.
While the National Asthma Forum will not occur this year, 2012 brings a unique opportunity for EPA to continue to lead the national effort in the delivery of quality asthma care by fostering dialogue and promoting action in helping asthma programs create, manage and sustain healthy practices in communities across the nation.
We encourage you to access our strong technical foundation and robust network of leaders and champions by taking advantage of the dynamic, interactive resources available to you, including:
AsthmaCommunityNetwork.org: Become a member of this community-based website created to share knowledge and strategies for improving asthma care. Key features include a robust, searchable resource bank; the Asthma Change Package; discussion forums; archives of interactive blogs, podcasts and webinars; access to mentors; and much more.
Newsletters: Receive a monthly newsletter as an AsthmaCommunityNetwork.org member, highlighting successful programs, cutting-edge research, and the latest tools and resources for community-based asthma programs.
Webinars: Gain real-time access to leading technical experts and award-winning asthma management programs addressing a range of topics including developing tailored, in-home interventions; coordinating with local healthy housing programs; managing asthma in school and childcare settings; and more!
Podcasts and Blogs: Learn from expert programs about steps they took to create successful comprehensive asthma management programs in their communities.
CHEST Conference: Attend the Annual ACCP Community Asthma and COPD Coalitions Symposium at the CHEST Conference to learn the latest in asthma care and effective asthma management strategies from leaders in asthma programming.
We are excited to expand the ways that we convene asthma programs to share and learn from one another. Thank you for your continued commitment to creating healthier communities nationwide.
– EPA Asthma Team |
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Created: 05.04.12
Several US states/territories and many municipalities have enacted 100% smokefree laws for all indoor areas of nursing homes, including common areas and private rooms, in order to protect employees, patients, and visitors from secondhand smoke exposure. Additionally, some nursing homes have adopted their own such policies.
Americans for Nonsmokers Rights has compiled a list.
Here is the list as of April 1, 2012.
These laws and policies have been adopted but are not necessarily yet in effect.
STATES
The following 7 states/territories have enacted laws requiring 100% smokefree indoor areas of nursing homes, including common areas and private rooms:
Michigan Montana New Jersey North Carolina Puerto Rico South Dakota Washington
For the complete list of over 130 municipalities and 61 individual nursing homes please click here.
Credit to the American Nonsmokers’ Rights Foundation.
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Created: 01.03.12
In a recent study, nicotine patches have been found to fail most pregnant smokers. To read more click here, here, or here. |
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Created: 30.01.12
Workplace Social Support is Key to Smart Steps Stop-Smoking Program
You can read more here. |
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Created: 24.01.12
A recent study shows for the first time that emphysema, a chronic lung disease, is caused by a specific immune response induced by tobacco smoke. Read more here... |
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Created: 06.01.12
Johns Hopkins researchers, working with mice, successfully used losartan (Cozaar), a commonly prescribed blood pressure medicine, to prevent almost all of the lung damage caused from 2 months of exposure to cigarette smoke. The treatment specifically targeted lung tissue breakdown, airway wall thickening, inflammation, and lung over-expansion.
For more information and to read the full article click here. |
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Created: 19.12.11
Smokers who quit had improved overall quality of life. Daily Rx has posted an interesting article about quitting smoking and overall quality of life. Read more here.
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Created: 15.12.11
Smoking cessation is the key to better health
 Cigarette smoking is one of the leading causes of death in the United States, and it is also the most preventable. Fifty percent of smokers who do not quit will die from smokingrelated diseases or illnesses. One out of every five deaths in the United States is caused by smoking. It is the cause of 90% of deaths from chronic obstructive pulmonary disorder (COPD), 80% of lung cancer deaths in women, and 90% of lung cancer deaths in men. Smoking is also implicated in the development of many other cancers that target major organs, because it negatively affects the entire body. It also increases the risk of cardiovascular disease such as coronary heart disease, which is the number one cause of death in the United States.
Damage from smoking cannot be reversed, but quitting will keep further damage from occurring. Quitting this habit will also reduce the risk of developing a smoking-related disease or illness. Soon after smoking cessation occurs, the individual should experience an increase in circulation and normalization of blood pressure. Breathing will also become easier, and the individual will experience an increase in smell and taste. Each year an individual remains tobacco-free, the risk of cancer declines as well.
There are many different ways smokers can quit. Some choose to seek professional help from a therapist on an individual or group basis, while others use the help of medications to aid the quitting process. Some smokers decide to gradually reduce the amount of cigarettes they smoke daily until they are tobacco free. Others swear the only way to truly quit is by “cold turkey”-- giving the habit up all at once. However the individual decides to quit, it is important to pick a “quit day” and to be fully prepared with prescriptions or anything else necessary to make quitting cigarettes successful.
Tips to Deal with Nicotine Cravings:
• Drink plenty of fluids, especially water. This will help flush the toxins from your body. Keep coffee, soda, and alcohol to a minimum as they can increase tobacco cravings.
• Eat more fruits and vegetables, but do not diet while quitting as this will decrease the chance for success.
• Relieve stress: read a book; exercise; get a massage; practice yoga; take a bath; etc…
• Get more sleep.
• Distract yourself when you feel cravings: chew a piece of gum; go for a walk; listen to music; watch television; play a game; or call a friend or family member to catch up on life’s events.
• Change your daily habits that would normally trigger a smoking habit.
• Clean your home of anything that smells of smoke.
Weight gain, anxiety, and agitation are all normal side effects experienced during the process of smoking cessation. With time, these should subside. It is not uncommon to have to try several times before being able to quit smoking permanently. It is important to remember not to become discouraged. Perseverance is the key and quitting and improved health is possible.
Michelle McGarry is a second year Respiratory Care Student at Quinsigamond Community College. The Respiratory Care Program Coordinator is Karen Kaletski Dufualt of Sutton.
Smoking Cessation is the Key to Better Health, says a new article. For more information click here. |
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Created: 30.11.11
The Partnership at drugfree.org have posted an article saying that treating smoking like a chronic disease helps smokers quit.
Read more here... |
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Created: 29.11.11
The De Soto Explorer has published an article regarding diabetes among Native Americans. Read more about it here.
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Created: 29.11.11
A PROMISE National Conference "Reclaiming the Health of our Tribal Nations" is May 2-3, 2012 and more information about the conference can be found here
Click here to register for the conference
Conference Purpose
A PROMISE: American Indian/Alaska Native Promising Practices to Reclaim Our Health and Mobilize communities to Integrate tobacco & chronic disease prevention and advance policy, Systems and Environmental change.
Conference Vision
Recognizing Tribal governance and responsibility in health promotion and disease prevention for the wellness of our Tribal Nations.
A PROMISE National Conference will feature:
- Tribal governance and policy development to promote healthier Tribal communities
- Best and promising practices integrating tobacco and chronic disease prevention
- Tribal health networks and partnerships improving health through systems and environmental change
Who should attend?
- Tribal Leaders, Health Committee/Board Members
- Tribal Health Directors, Administrators and Managers
- Area Indian Health Boards, Inter Tribal Councils, Tribal Epi Centers
- Tribal and I.H.S Providers, Clinicians and Other Allied Health
- Urban Indian Health Programs
- Local and State Health Department
- Federal programs, such as CDC, HRSA, IHS
- Tribal Colleges and Universities, Colleges of Public Health
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