No Smoking Anywhere: Tough New Law in Kenya

By Theresa Tamkins

Kenya has enacted a tough new smoking rule, which bans smoking on the street and in parks, markets, bars, private homes, and private cars. That’s right: If you’re not lighting up in one of the country’s designated smoking zones, you’re not smoking at all—unless you want to risk imprisonment (up to three years) or a fine of up to $43,000, according to the BBC.
Being an ex-smoker, I tend to give the nicotine-addicted more sympathy than scorn and rarely complain about secondhand fumes. But even I thought, Hmm, wouldn’t that be nice? Read More

Training Student Leaders Cuts Peers' Smoking Rates

(HealthDay News) -- Training influential students to spread anti-smoking messages in their everyday conversations with peers helps reduce smoking rates, according to a U.K. study.

The study included almost 11,000 students, ages 12 to 13, at 59 schools in western England and Wales. At 30 of the schools, certain students were selected to receive training about the risks of smoking, the economic benefits of not smoking, communication skills, group work, negotiation, conflict resolution, sensitivity to others, personal values, and building confidence and self-esteem. The students at the other 29 schools acted as a control group.

For 10 weeks after their ASSIST (A Stop Smoking in Schools Trial) training, the peer support students talked with other students in their age groups about the benefits of not smoking.

Overall, students in those schools were 25 percent less likely to take up regular smoking than students in the control group schools immediately after ASSIST intervention, 23 percent less likely to start regular smoking after one year, and 15 percent less likely after two years.

Among high-risk students (occasional, experimental or ex-smokers at the start of the study) in schools with ASSIST intervention, the risk of regular smoking was reduced by 21 percent immediately after the program, 25 percent after one year, and 15 percent after two years.

Overall, students in the intervention schools were 22 percent less likely to be smokers than those in the control group schools. Based on their findings, the University of Bristol and Cardiff University researchers calculated that widespread implementation of ASSIST could reduce smoking prevalence by 3 percent among students ages 14 to 15. On a U.K.-wide basis, that translates into 43,000 fewer 14- to 15-year-old students who become regular smokers.

The findings were published in this week's edition of The Lancet.

"Our study has shown that the ASSIST training program was effective in achievement of a sustained reduction in uptake of regular smoking in adolescents for two years after its delivery. Furthermore, it was well received by both students and staff," the authors wrote. "Confidence in the robustness of this finding is enhanced by the very high response rates achieved (over 90 percent), the retention of all schools for the duration of the trial, the diversity of the schools involved, and the concurrence of self-reported smoking data with saliva testing."

More information
The U.S. Centers for Disease Control and Prevention has more about youth and tobacco.

Environmental Toxins, Radiation May Be Tied to Breast Cancer

(HealthDay News) -- In the decades following World War II, both breast cancer rates and the use of synthetic chemicals soared in the United States -- and a new report contends there's a strong connection between the two.

Produced by the Breast Cancer Fund, a non-profit group whose mission is to identify environmental links to breast cancer, The State of the Evidence: 2008 concludes toxic chemicals in the environment, along with increased radiation exposure, are the main culprits in the sharp rise of breast cancer incidence.

The report cautions that "in-utero" [in the womb] and early childhood exposure to carcinogens through plasticizers, estrogen-mimicking substances and other chemicals may increase the risk of breast cancer in adult life.

"As we looked at the research comprehensively, the themes of interactions of timing and mixtures of chemical exposures and also radiation exposure as risks emerged. In bringing this broad focus to environmental causes of breast cancer, we hope to find ways to lower the future incidence of breast cancer not only for adults but, most importantly, for our children and grandchildren," said Dr. Janet Gray, an endocrinology researcher at Vassar College, who edited the report.

However, some public health experts say there's no scientific proof establishing a link between environmental contaminants and breast cancer.

Based on a review of more than 400 breast cancer studies, The State of the Evidence noted that more than 80,000 synthetic chemicals are currently used in the United States, although complete toxicological screening data are available for only 7 percent of them. Many of these substances are known to remain in the environment for many years and accumulate in body fat and breast tissue.

One group of chemicals -- phthalates, which the Breast Cancer Fund report identifies as a breast cancer risk -- was in the news last week when the U.S. Senate passed legislation strengthening the Consumer Product Safety Commission with an amendment requiring all children's toys and child-care products to be free of these hormone system disruptors. A study by Fox Chase Cancer Center in Philadelphia last year found that phthalates accelerated breast development and genetic changes in newborn female lab rats, a condition that might predispose the animals to breast cancer later in life.

Exposure to chemicals that mimic estrogens in the body, called xenoestrogens, is thought to be the reason more girls are entering puberty at younger ages, according to Jeanne Rizzo, executive director of the Breast Cancer Fund.

In addition to phthalates, the new report lists other endocrine-disrupting compounds that the study authors say have been shown to affect the risk for breast cancer in humans, or the risk of mammary cancer in animals. Those compounds, according to the report, include:

• Pesticides such as DDT, dieldrin, aldrin and heptachlor; triazine herbicides
• Bisphenol, a chemical used to make plastics, epoxy resins and dental sealants
• Polyaromatic hydrocarbons (byproducts of combustion)
• Tobacco smoke
• Dioxins
• Alkyphenols (industrial chemicals used in cleaning products)
• Metals including copper, cobalt, nickel and lead
• Parabens (anti-microbials used in personal care products)
• Food additives such as compounds given to cattle and sheep to enhance growth

The report also cites environmental factors that may exert cancer-causing effects without hormone disruption. Those factors include exposure to the petrochemical solvent benzene; organic solvents used in the computer, furniture and textile industries; polyvinyl chloride (PVC) used in a variety of appliances, food packages and medical products; 1,3-butadiene, a byproduct of petroleum refining and vehicle exhaust; ethylene oxide, used in medicine and some cosmetics; and aromatic amines, byproducts of manufacturing plastics and dyes. Both ionizing and non-ionizing radiation are also listed as suspected cancer-causing agents, the report stated.

"The conclusions of the surveyed research show us we need to look earlier and earlier at the impact of chemical exposure in utero and early life and how toxins, radiation, genetic predisposition, diet, exercise and all those things interact together to increase breast cancer risk. The results of this study compel us to look at the need for broad public health policy reform and more federally funded research," Rizzo said.

In response to the report, Tiffany Harrington, public affairs director with the American Chemistry Council, said the chemical industry is seeking to better understand the complex relationship between modern chemistry and human health.

"The chemistry industry has contributed to endocrine research by supporting applied scientific studies focused on developing the datasets needed to evaluate the reliability of endocrine screening methods," she said.

Meanwhile, environmental medicine expert Dr. Jonathan Borak, an associate clinical professor of medicine at Yale University's School of Medicine, said a host of studies have found no clear link between specific toxins and breast cancer.

"So far, I have not seen any compelling evidence of a link between any environmental contaminants and breast cancer," he said.

More information
For more on breast cancer, visit the American Cancer Society.

Diabetics Face Doubled Risk of Heart Attack

(HealthDay News) -- Diabetics are more than twice as likely to suffer a heart attack, stroke and death from cardiovascular disease, putting them at the same risk level as non-diabetics who had previously suffered a heart attack, Danish researchers report.

The findings, appearing in April 1 issue of Circulation, led one study author to suggest all diabetics talk to their doctors about possibly starting treatments to control cholesterol levels and blood-pressure levels.

"We've talked about 'the lower, the better' for cholesterol and blood pressure to reduce the risk of heart attack," lead author Dr. Tina Ken Schramm, a research fellow at the Gentofte Hospital in Hellerup, Denmark, said in a prepared statement. "Now I think we should be saying the sooner, the better for primary prevention of cardiovascular diseases in diabetics."

The study analyzes patient and national registries for people aged 30 and older living in Denmark in 1997. Researchers found 71,801 people with diabetes and 79,575 who had a previous heart attack, then identified deaths and causes of death over five years.

"The increased risk was observed in people at all ages with either type 1 or type 2 diabetes who were receiving insulin or other drugs to reduce levels of sugar in the blood," Schramm said. "When people with diabetes do have heart attacks, they are twice as likely to die as non-diabetics."

The relative risk, or hazard ratio, of dying from cardiovascular disease was found to be 2.45 times greater for female diabetics compared with 2.62 times greater for women with a prior heart attack. The relative risk of dying from cardiovascular causes was 2.42 times higher in male diabetics; for men who had a prior heart attack the hazard ratio was 2.44.

When looking at heart attack, stroke or death from cardiovascular disease combined, men with diabetes faced a 2.32 higher risk while the risk rate was 2.48 for men who had at least one heart attack. For female diabetics, the combined relative risk was 2.48 while those with a history of myocardial infarction had a hazard ratio of 2.71.

The study did not look at patients on diet-only treatment for diabetes. The researchers also couldn't differentiate between type 1 and type 2 diabetes patients or adjust for common risk factors, including high blood pressure, high cholesterol, obesity, smoking, physical activity and blood glucose levels.

Type 2 diabetes, the most common form of diabetes, develops when the body doesn't make enough insulin and fails to efficiently use what insulin it does produce. In type 1 diabetes, the pancreas makes little or no insulin, requiring the patient to need daily doses of insulin.

More information
The American Diabetes Association has more about diabetes prevention.

Heart Risk Can Be Predicted Without Lab Tests

(HealthDay News) -- When it comes to predicting a person's cardiovascular disease risk, cheap, simple and noninvasive methods can be as effective as lab tests, a new study finds.

The U.S. researchers noted these non-lab methods could be especially useful where lab testing is inconvenient or unavailable, such as in developing countries.

Worldwide, about 80 percent of cardiovascular deaths occur in developing nations, Dr. Thomas Gaziano, of the division of cardiovascular medicine at Brigham & Women's Hospital in Boston, said in a prepared statement.

The team analyzed data on 6,186 people who were aged 25 to 74 when they were first examined between 1971-75 for the NHANES I study. At the time, these participants did not report any history of cardiovascular disease -- such as heart attack, heart failure, stroke or angina -- or cancer.

Over a 21-year period, people in this group had 1,529 first-time cardiovascular events, including 578 deaths due to cardiovascular disease.

The researchers compared the lab-based method and the non-lab method in calculating a number called the c-statistic to assess cardiovascular risk prediction. The lab method included age, systolic blood pressure, smoking status, total cholesterol, diabetes status, and current treatment for high blood pressure. The non-lab method substituted body mass index (BMI, a ratio of weight to height) for cholesterol.

The lab and non-lab method gave similar c-statistics, but the non-lab method can provide risk factor information non-invasively and much faster -- just five to 10 minutes, the study authors said. They added that a cholesterol test is too costly for many people in developing countries.

The study was published in the March 15 issue of The Lancet.

"Although this method requires further validation and calibration, use of a simple non-laboratory approach, as suggested by WHO [World Health Organization], could have profound effects on the affordability and availability of an adequate screening program in developing countries," the study authors wrote. "Initial screening without blood testing could lead to the quick initiation of treatment without the added cost or inconvenience of laboratory testing, and would also keep any potential loss to follow-up due to the extra step in testing to a minimum."

However, an accompanying editorial in the journal suggested this approach may not be appropriate for people in developing countries.

"Although tools that use non-laboratory-based variables can help to improve affordability of screening programs for non-communicable diseases, they should not compromise the safety of patients. For equitable care of cardiovascular disease and other major non-communicable diseases, universal access to a set of essential interventions, including laboratory assays, may be required, even in settings with limited resources," wrote Dr. Shanthi Mendis, of the WHO in Geneva, and Dr. V. Mohan, of the Madras Diabetes Research Foundation in India.

More information
The U.S. Centers for Disease Control and Prevention has more about heart disease risk factors.

Note to self: Don't forget to pack the other 5 recorders

We count six recording devices in the hands of the woman on the right. Why? Is she covering for five colleagues on a smoke break? Is she presenting them as an offering to Press Corps God Barack Obama?

read more digg story

Vitamin E Supplements May Raise Lung Cancer Risk

(HealthDay News) -- Vitamin supplements won't protect people against lung cancer and taking vitamin E may even heighten the risk, a new study finds.

The survey covered the supplement-taking habits and lung cancer incidence of almost 78,000 adults in the state of Washington over a four-year period.

"Our study of supplemental multivitamins, vitamin C, vitamin E and folate did not show any evidence for a decreased risk of lung cancer," study author Dr. Christopher G. Slatore, a fellow in the division of pulmonary and critical care medicine at the University of Washington, said in a statement. "Indeed, increasing intake of supplemental vitamin E was associated with a slightly increased risk of lung cancer."

As reported in the March issue of the American Journal of Respiratory and Critical Care Medicine, the research focused on men and women aged 50 to 76 taking part in the four-year VITAmins and Lifestyle (VITAL) study. Lung cancer was diagnosed in 521 participants surveyed.

In addition to the expected association with smoking, family history and other lung cancer risk factors, there was a slight but statistically significant association with vitamin E supplementation and incidence of the disease, the researchers found.

Every increase in vitamin E of 100 milligrams per day was associated with a 7 percent rise in lung cancer risk -- translating into a 28 percent increase in risk over 10 years for someone taking 400 milligrams of vitamin E daily.

"This provides additional evidence that taking vitamin supplements does not help prevent lung cancer," said Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society.

The society does not currently recommend use of any vitamin supplement to prevent malignancy, Jacobs said. However, "our dietary guidelines do recommend eating five or more servings of a variety of vegetables each day," he noted.

A representative of the supplements industry called the study results "not all that surprising."
"Vitamins are essential nutrients that act to maintain health and prevent vitamin deficiency," Pamela Mason, spokeswoman for the London-based Health Supplements Information Service, said in a statement. "They were never intended to be used to prevent chronic disease such as cancer. Indeed, it would be asking a lot of a vitamin pill to expect it to prevent cancer."

Since the primary cause of lung cancer is smoking, the best preventive measure is simply not to smoke, Jacobs said. Nutrients can play an auxiliary role, he noted. Anyone who cannot quit should avoid taking beta-carotene supplements, because studies have linked them to an increased risk of lung cancer, Jacobs said.

On the other hand, "for former smokers, there is some evidence that vegetables high in carotinoids, such as carrots and sweet peas, decrease the risk," he said.

Some vitamins have been linked to a reduced risk of other cancers, added Edward Gorham, an associate professor of family and preventive medicine at the University of California at San Diego.

"We have worked with vitamin D, and we found a protective effect of vitamin D on colon cancer, breast cancer and ovarian cancer, and recently a modest effect on lung cancer," Gorham said.
But that effect came not from supplements but from sunlight, which causes vitamin D to be formed in the human body, he said.

"These results with multivitamins dont surprise me because there is so little vitamin D in multi-supplements, 100 or 200 International Units," Gorham said. "To achieve the effect, it takes 2,000 IU. If youre in the tropics, that amounts to 10 or 15 minutes in the sun. In southern California, it takes 10 or 15 minutes in the summer and longer in the winter because the sun angle is so low."

One study has also associated vitamin D supplements with a decreased risk of colon and breast cancer in women, Gorham said.

More information
There's more on nutrition and cancer prevention at the American Cancer Society.

Genetic Factors for Smoking Boost Chronic Bronchitis Risk

(HealthDay News) -- While smoking is the leading risk factor for chronic bronchitis, genes also play a major role in the development of the disease, say Swedish researchers.

The study, which analyzed data on more than 40,000 twins born in 1958 or earlier, found that inherited genes accounted for 40 percent of the risk for chronic bronchitis and that 14 percent of the genetic risk was also linked to a genetic predisposition to smoke, whether or not a person actually smoked.

The findings are published in the first issue for March of the American Journal of Respiratory and Critical Care Medicine.

"(This) study on the population-based Swedish Twin Registry, showing a genetic effect for the development of chronic bronchitis that does not differ by sex, is the first to our knowledge to quantify heritability of the disease," Jenny Hallberg, of the department of public health sciences at Karolinska Institutet in Stockholm, said in a prepared statement.

Previous research had suggested that women were more likely than men to develop chronic bronchitis, so the findings that prevalence didn't differ by sex pointed to a number of intriguing possibilities, she noted.

"It is possible that women are more prone to report symptoms. Or, more likely, this could be an effect of smoking being more harmful for women due to their smaller lungs from start [exposure to cigarette smoke relative to body size]," Hallberg wrote.

The finding that genetic factors that contribute to chronic bronchitis are largely independent of smoking shouldn't be interpreted to mean that smoking has no effect on the disease, she cautioned.

"Although there was some genetic interplay, it is safe to say that smoking itself, and not the genes that predispose one to smoking, is a larger risk factor in developing chronic bronchitis of environmental exposures -- primarily smoking -- than genetic predisposition. This is true of both men and women," Hallberg wrote.

Chronic bronchitis and emphysema account for most cases of chronic obstructive pulmonary disease (COPD).

More information
The American Academy of Family Physicians has more about chronic bronchitis.