Tobacco- May 22nd, 2015

SD Sioux Tribe Goes Smoke-free
Congratulations to the Cheyenne River Sioux Tribe (CRST), the first tribe in South Dakota to go smoke-free. On May 5, the CRST Tribal Council officially approved the reservation’s Smoke-free Air Act, prohibiting smoking and the use of electronic cigarettes in all indoor public places and workplaces, including restaurants and tribal offices. The Act also restricts outdoor smoking to 50 feet from any public building. Protecting tribal members from secondhand smoke is critical, given a smoking rate among CRST tribal members of approximately 51 percent, compared to 19 percent nationally.

The tribe’s landmark Smoke-free Air Act was the result of more than six years of hard work led by the Canli (Lakota for “tobacco”) Coalition of the Cheyenne River Sioux Tribe, a group of healthcare providers, cultural leaders, educators, environmental workers, community elders and youth. The coalition and other tribal leaders worked relentlessly to promote smoke-free air and educate the tribal community about the dangers of commercial tobacco and second-hand smoke. Since 2009, the Tobacco Control Legal Consortium has provided the tribe with legal technical assistance. By this spring, tribal members of all ages supported the Smoke-free Air Act. Thanks to the passion and commitment of the coalition and other tribal leaders, the Smoke-free Air Act is now in effect. 

Reports and Articles

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation
Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.


We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids.


Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program.


Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; number, NCT01526265.)
You can get a summary of the previous article I sent you out of this editorial. Click this link for the summary. -Nudging Smokers

FDA Announcements – FDA.  The FDA Center for Tobacco Products denied a Citizen Petition from R.J. Reynolds Tobacco Company and American Snuff Company, LLC to change a smokeless tobacco warning statement. FDA also issued a draft guidance regarding FDA’s authority to issue a No-Tobacco-Sale Order (NTSO).

Cheyenne River Sioux Tribe Goes Smoke Free (SD) — The Cheyenne River Sioux Tribe (CRST) is the first tribe in South Dakota to go smoke-free. On May 5, 2015, the CRST Tribal Council officially approved the reservation’s Smoke-Free Air Act prohibiting smoking and the use of e-cigarettes in all indoor public places and workplaces.

Crescent City Passes New Laws (CA) – Crescent City Council passed two new ordinances restricting the location of new tobacco and alcohol retailers (or current retailers expanding their business), requiring them to obtain a Conditional Use Permit (CUP). These laws will go into effect on May 20, 2015 and include conditions such as reduced window advertising, state law requirements, and product placement.

CVS Health Reports Record First Quarter Results per Removal of Tobacco Products – PR Newswire.  Net revenues for the company increased by 11.1% to $3.6 billion since March 31, 2015. The Retail Pharmacy Segment was positively impacted by increased sales, an improved front store margin rate largely driven by the removal of tobacco products and favorable purchasing economics.

Why Do Smokers Try to Quit Without Medication or Counseling? A Qualitative Study with Ex-SmokersBMJ. Key Findings: New explanations were produced as to why smokers quit unassisted: 1) prioritization of lay knowledge gained directly and indirectly from personal experience and peers, 2) evaluation of costs and benefits of quitting unassisted, 3) belief that quitting is a personal responsibility, and 4) perception that quitting unassisted is the “right” or “better” choice in terms of self-identify or self-image.

State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥18 Years — United States, 2011–2013
Weekly May 22, 2015 / 64(19);532-536
Kimberly Nguyen, MS1; LaTisha Marshall, MPH1; Sean Hu, DrPH1; Linda Neff, PhD1 (Author affiliations at end of text)

Cigarette smoking and the use of smokeless tobacco both cause substantial morbidity and premature mortality (1,2). The concurrent use of these products might increase dependence and the risk for tobacco-related disease and death (1,2). State-specific estimates of prevalence and relative percent change in current cigarette smoking, smokeless tobacco use, and concurrent cigarette smoking and smokeless tobacco use among U.S. adults during 2011–2013, developed using data from the Behavioral Risk Factor Surveillance System (BRFSS), indicate statistically significant (p<0.05) changes for all three behaviors. From 2011 to 2013, there was a statistically significant decline in current cigarette smoking prevalence overall and in 26 states. During the same period, use of smokeless tobacco significantly increased in four states: Louisiana, Montana, South Carolina, and West Virginia; significant declines were observed in two states: Ohio and Tennessee. In addition, the use of smokeless tobacco among cigarette smokers (concurrent use) significantly increased in five states (Delaware, Idaho, Nevada, New Mexico, and West Virginia). Although annual decreases in overall cigarette smoking among adults in the United States have occurred in recent years (2), there is much variability in prevalence of cigarette smoking, smokeless tobacco, and concurrent use across states. In 2013, the prevalence ranged from 10.3% (Utah) to 27.3% (West Virginia) for cigarette smoking; 1.5% (District of Columbia and Massachusetts) to 9.4% (West Virginia) for smokeless tobacco; and 3.1% (Vermont) to 13.5% (Idaho) for concurrent use. These findings highlight the importance of sustained comprehensive state tobacco-control programs funded at CDC-recommended levels, which can accelerate progress toward reducing tobacco-related disease and deaths by promoting evidence-based population-level interventions. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, restricting tobacco advertising and promotion, controlling access to tobacco products, and promoting cessation assistance for smokers to quit, as well as continuing and implementing mass media campaigns that contain graphic anti-smoking ads, such as the Tips from Former Smokers (TIPS) campaign (3).


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