Forum to tackle food policy and public health: 6 May 2014

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sugar-nutritionThe Union of Concerned Scientists is hosting a forum on Science, Democracy, and a Healthy Food Policy on Tuesday, 6 May 2014, at the University of Minnesota in Minneapolis–and will be available via live webcast.

The forum will provide an opportunity for policy makers, health advocates, and the public to learn how to improve food policy through science from effective local efforts across the United States.

Click here to learn more about the forum and to register.

Open access textbook on diabetes public health

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Diabetes Public Health: From Data to Policy is now available open access as a Google eBook. This book provides effective approaches to prevent and manage diabetes through the practice of public health. It focuses on diabetes control in the United States and North America, and it is recommended for public health practitioners and researchers and anyone involved in health policy, administration and management.

1. Narayan KMV, Williams D, Gregg EW, Cowie CC. Diabetes Public Health: From Data to Policy. New York: Oxford University Press, 2011.

Tobacconomics: Report on the tobacco industry’s misleading economic arguments

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The tobacco industry uses pseudo economic arguments to divert attention away from the health consequences of smoking to block new health regulations and ultimately protect its revenues, according to Tobacconomics, a report produced by Action on Smoking and Health.

The report debunks claims that support the three major pro-tobacco arguments developed by the industry and its lobbyists, which are recycled again and again for each new policy intervention: standing up for small businesses and defending workers’ jobs; raising the alarm about counterfeit and smuggled tobacco; and denying the effectiveness of tobacco control policies.

1. Action on Smoking and Health. Tobacconomics: How Big Tobacco Uses Dodgy Data to ‘Throw Sand in the Gears’ of Global Health Policy. London, UK: ASH, 2011.

Tobacco Control: Menthol cigarettes

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The May 2011 supplement issue of Tobacco Control is focused on menthol cigarettes. All eight research papers are available open access.

Below are short summaries and links to each research paper.

1. Lee YO, Glantz SA. Menthol: putting the pieces together. Tobacco Control 2011; 20: ii1-ii7.
Information from tobacco industry documents consistently demonstrates that menthol facilitates and increases smoking and reduces quit smoking rates.

2. Anderson SJ, McCandless PM, Klausner K, et al. Tobacco documents research methodology. Tobacco Control 2011; 20: ii8-ii11.
This paper demonstrates the methodology used in researching tobacco documents.

3. Klausner K. Menthol cigarettes and smoking initiation: a tobacco industry perspective. Tobacco Control 2011; 20: ii12-ii19.
Menthol is a prominent design feature used by cigarette manufacturers to attract and retain new, younger smokers who perceive menthol cigarettes as less harsh and easier to smoke.

4. Anderson SJ. Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tobacco Control 2011; 20: ii20-ii28.
Tobacco marketing emphasizing menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find ‘regular’ cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit.

5. Yerger VB. Menthol’s potential effects on nicotine dependence: a tobacco industry perspective. Tobacco Control 2011; 20: ii29-ii36.
The tobacco industry knows that menthol overrides the harsh taste of tobacco and interacts with nicotine to produce tobacco products that are easier to smoke, thereby making it easier to expose smokers, especially those who are new, to the addictive power of nicotine.

6. Yerger VB, McCandless PM. Menthol sensory qualities and smoking topography: a review of tobacco industry documents. Tobacco Control 2011; 20: ii37-ii43.
If menthol in cigarettes was banned, new/experimental smokers might choose not to smoke rather than experience the harshness of tobacco smoke and the irritating qualities of nicotine. Similarly, established menthol smokers might choose to quit if faced with an unpleasant smoking alternative.

7. Salgado MV, Glantz SA. Direct disease-inducing effects of menthol through the eyes of tobacco companies. Tobacco Control 2011; 20: ii44-ii48.
The tobacco industry conducted little research on the potential disease-inducing effects of menthol and did not pursue studies that suggested adverse effects.

8. Anderson SJ. Menthol cigarettes and smoking cessation behaviour: a review of tobacco industry documents. Tobacco Control 2011; 20: ii49-ii56.
Menthol’s cooling and anesthetic effects that mask the short-term negative effects of smoking such as throat pain, burning and cough and the perception that menthol cigarettes are more socially acceptable provide a false assurance that would otherwise motivate smokers to quit.

Tobacco industry added appetite-suppressant substances to cigarettes, study says

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Following the 1998 “Master Settlement Agreement” between the tobacco industry and 46 U.S. states, U.S. tobacco companies made their internal documents available on the internet. Research into these documents indicates that, in the past, tobacco companies enhanced the effects of smoking on appetite and weight by adding appetite-suppressant agents into cigarettes.

During the 1960s, tobacco giant Phillip Morris put a substance containing tartaric acid into its cigarettes in order to reduce smokers’ appetite. This substance was also added to British American Tobacco cigarettes, although researchers did not find at which date, and if it is still the case. The substance 2-acetylpyridine is also claimed as an appetite-reducing molecule and is one of the tobacco additives disclosed on many past lists of cigarette ingredients.

These are important findings in the fight against tobacco addiction because most smokers want to stop smoking, but the fear of weight gain sometimes outweighs the perception of potential health benefits associated with quitting smoking, particularly in women.

According to the study first published in April 2011 in the European Journal of Public Health, the findings may help smokers and the health care community to understand at least partially why cigarette smoking is producing the effect of reducing appetite, and could explain in part why smokers weigh in general less than non-smokers.

“Although little is known in the medical literature about the anti-appetite effect of the above cited substances, we can make the hypothesis that the weight gain following smoking cessation could be a ‘rebound effect’ of discontinuation of the daily consumption of an anti-appetite substance through cigarette smoking, as it is known for the use of other anti-appetite substances,” the study said.

1. Gonseth S, Jacot-Sadowski I, Diethelm PA, et al. The tobacco industry’s past role in weight control related to smoking. European Journal of Public Health, published online 7 April 2011. (open access)

High blood pressure, high cholesterol and diabetes rates in Switzerland

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High blood pressure, high cholesterol and diabetes rates in Switzerland have increased in the last decade, according to data from three national health surveys conducted in 1997-2007.

The prevalence of self-reported hypertension, hypercholesterolemia and diabetes was 22.1 percent, 11.9 percent and 3.3 percent in 1997, respectively; and increased to 24.1 percent, 17.4 percent and 4.8 percent in 2007.

Self-reported treatment rates among people with these three cardiovascular risk factors also increased from 52.1 percent, 18.5 percent and 50 percent in 1997 to 60.4 percent, 38.8 percent and 53.3 percent in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Self-reported control levels increased from 56.4 percent, 52.9 percent and 50 percent in 1997 to 80.6 percent, 75.1 percent and 53.3 percent in 2007. Finally, screening during the last 12 months increased from 84.5 percent, 86.5 percent and 87.4 percent in 1997 to 94 percent, 94.6 percent and 94.1 percent in 2007.

1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health 2011; 11: 114. (open access)

Tobacco industry tactics in the developing world

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Tobacco consumption has fallen over the past 20 years in the United States, Australia, Canada and most European countries; and so tobacco companies are turning their marketing efforts to low- and middle-income countries in Africa, Asia and Latin America to compensate for the loss of markets in high-income countries.

The tobacco industry has employed various strategies and tactics including cigarettes smuggling, recruiting of new and young smokers, denying the health consequences of smoking, manipulating governments to delay tobacco control legislations and the sponsoring of health professionals and academic institutions to act in their favor.

In addition to the negative health consequences, this focus has also fostered an economic dependence on tobacco in countries like Malawi and Brazil, who depend on tobacco exports.

Currently, there are over 1.2 billion tobacco users in the world. Around two-thirds of all smokers live in developing countries. Out of the total burden of tobacco-related diseases globally, 70 percent will occur in developing countries by 2030.

1. Doku D. The tobacco industry tactics—a challenge for tobacco control in low and middle income countries. African Health Sciences 2010; 10(2): 201-203. (open access)

Global epidemic of obesity in children, teens and adults

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Obesity is estimated to contribute more than 2.5 million deaths worldwide every year, making it a major global public health problem. Obesity is a risk factor for heart disease, cancer, diabetes and other chronic non-communicable diseases, and is linked to reduced life expectancy.

A study in the Indian Journal of Medical Research provides insights into the worldwide epidemiology of obesity, its determinants and the role of various preventive and treatment modalities used for the primordial, primary and secondary prevention of overweight and obesity.

Individual and community-based weight control strategies need to be reinforced to reverse alarming trends in the magnitude of overweight and obese children and adults. These approaches include limiting the intake of processed sugars and sodium in prepared foods and manufactured products, portion sizes and time spent watching television and using computers, as well as encouraging eating breakfast on a regular basis. Community level interventions include the creation and maintenance of nearby parks, child-friendly bike and walking paths, and physician encouragement of the importance of healthy diets and regular physical activity to children and parents alike.

1. Raj M, Kumar RK. Obesity in children & adolescents. Indian Journal of Medical Research 2010; 132: 598-607. (open access)

Chance of dying early 20% higher in north than south England

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People living in the north of England are 20 percent more likely to die before age 75 years than those living in the south, according to a study spanning four decades. And this figure changed little between 1965-2008, the study said.

Researchers analyzed deaths and population data for all residents from the five northernmost and four southernmost English regions each year from 1965-2008. Results show that overall rates of premature death have been 14 percent higher in the north over the four decades. This inequality was larger for men (15 percent) than for women (13 percent).

This north-south divide decreased significantly but temporarily for both sexes from the early 1980s to the late 1990s, followed by a steep rise from 2000-2008, despite government initiatives to reduce health inequalities over this period.

Time trends also varied with age—most striking among the 20-34 age group, which saw a sharp rise (22 percent) in northern excess deaths from 1996-2008.

The large north-south divide has persisted despite the fact that overall mortality in England has greatly reduced since 1965—by about 50 percent for men and about 40 percent for women with north and south both experiencing similar reductions.

The north-south health divide in England is well documented and has posed a public health challenge—as well as a political and economic challenge—to successive governments. From 2003-2010, the UK government had performance targets for reducing geographical inequalities in health, but there has been little research of time trends in this divide.

More research is needed into: why policies to reduce such inequalities have failed; how the wider determinants of health may be unbalanced between north and south; and what role selective migration plays, according to the study.

1. Hacking JM, Muller S, Buchan IE. Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. BMJ 2011; 342: d508. (open access)