Decrease in Smoking Prevalence---Minnesota, 1999--2010

Following the landmark 1998 settlement of the lawsuit, State of Minnesota versus Philip Morris, Inc., et al., Minnesota implemented a series of tobacco control efforts to limit the harm caused by tobacco use. Using statewide surveillance data from the Minnesota Adult Tobacco Survey (MATS) and cigarette pack sales data, this report examines the effects of these tobacco-related public health efforts. Compared with a 15% decline in national cigarette smoking prevalence since 1999, adult cigarette smoking prevalence in Minnesota decreased from 22.1% in 1999 to 16.1% in 2010, a 27.1% decrease. During the same period, per capita cigarette sales in Minnesota decreased 40%. In addition, in 2010 compared with 1999, a higher percentage of adults reported that smoking was restricted in their homes (87.2% versus 64.5%) and adults were less likely to report exposure to secondhand smoke (45.5% versus 67.2%).

Cigarette Package Warning Labels and Interest in Quitting Smoking: The Global Adult Tobacco Survey 2008--2010

This report examines smoking prevalence and the effects of cigarette package warning labels on interest in quitting among adults who smoke manufactured cigarettes using data from the Global Adult Tobacco Surveys (GATS) conducted from 2008 to 2010 in 14 countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Vietnam. The report finds that adult usage of manufactured cigarettes varied widely and that warnings on cigarette packages prompt smokers to think of quitting. Among men, smoking prevalence ranged from 9.6% (India) to 59.3% (Russian Federation). Among women, prevalence was highest in Poland (22.9%) and less than 2% in Bangladesh, China, Egypt, India, Thailand, and Vietnam. According to the report, the vast majority of men that use manufactured cigarettes noticed package warning labels—more than 90 percent of men in all countries except India (78.4 percent) and Mexico (83.5 percent). Among women, more than 90 percent in seven of the 14 countries reported noticing package warnings, and at least 75 percent in 12 of 14 countries reported noticing a package warning. Among those who noticed package warnings, data suggest that there was substantial interest in quitting because of the warnings. Prominent, pictorial warnings are most effective in communicating the harms of smoking and use of such warnings is strongly encouraged by CDC and the World Health Organization (WHO). At the time the surveys were conducted, five of the 14 countries participating in the survey had adopted pictorial warnings already. Since that time, four additional countries have passed legislation requiring pictorial warnings.

World No Tobacco Day

Cigars

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco (as opposed to a cigarette, which is defined as a roll of tobacco wrapped in paper or in a substance that does not contain tobacco).1,2The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.1,2,3TypeDescriptionMarket Share (2009)**Percentage of U.S. market for cigar products4Cigar that typically contains at least one-half ounce of aged, fermented tobacco (i.e., as much as a pack of cigarettes) and usually takes 1–2 hours to smoke.A short (3–4 inches) and narrow cigar that typically contains about 3 grams of tobacco and usually does not include a filter.A small cigar that typically is about the same size as a cigarette and usually includes a filter.
In 2009, cigars generated more than $8 billion in retail sales in the United States.4
Cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.1,2

Regular cigar smoking is associated with an increased risk for cancers of the lung, esophagus, larynx (voice box), and/or oral cavity (lip, tongue, mouth, throat).1,2,3Cigar smoking is linked to gum disease and tooth loss.3Heavy cigar smokers and those who inhale deeply may be at increased risk of developing coronary heart disease.1,2,3Heavy cigar smoking increases the risk for lung diseases such as emphysema and chronic bronchitis.1,2,3

Percentage of U.S. adults who were current cigar users in 2009:5

5.4% of all adults in the United States
9.1% of adult males in the United States1.9% of adult females in the United States7.7% of African American adults7.2% of American Indian/Alaska Native adults1.5% of Asian American adults4.9% of Hispanic adults5.3% of white adults

Percentage of U.S. high school students who were current cigar users in 2009:6

10.9% of all students in grades 9–12  6.7% of female students in grades 9–1215.0% of male students in grades 9–2

Percentage of U.S. middle school students who were current cigar users in 2009:6

3.9% of all U.S. students in grades 6–8 3.2% of female students in grades 6–84.6% of male students in grades 6–8In 2009, an estimated 13.3 million people (or 5.3% of people 12 years of age or older) in the United States were current cigar users.5NOTES:
- Adults are defined as persons 18 years of age or older.
- Current cigar use is defined as smoking cigars on 1 or more of the 30 days preceding the survey.

In 2009, the two leading cigar companies in the United States had more than 60% of the market:4

Swisher International (i.e., nearly 50% of the U.S. market share with Swisher Sweets® and Swisher Little® brands)Middleton (i.e., about 13% of the U.S. market share with Black & Mild® brand)

Marketing efforts promote cigars as symbols of a luxuriant and successful lifestyle. The following marketing strategies all contribute to the increased visibility of cigar smoking in society:1,2

Endorsements by celebritiesDevelopment of cigar-friendly magazines (e.g., Cigar Aficionado) Images of highly visible women smoking cigarsProduct placement in movies

In 2001, the Federal Trade Commission mandated that cigar packaging and advertisements must display one of the following five "SURGEON GENERAL WARNING" text-only labels on a rotating basis:7

Fact Sheet: Bidis_Kreteks

Bidis are small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries. They consist of tobacco wrapped in a tendu or temburni leaf (plants native to Asia), and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored.1,2Kreteks—sometimes referred to as clove cigarettes—are imported from Indonesia and typically contain a mixture of tobacco, cloves, and other additives.3,4Bidis and kreteks have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.1,3,5,6Neither bidis nor kreteks are safe alternatives to conventional cigarettes.4,5

Because of the low prevalence of use, a limited amount of research on the long-term health effects of bidis has been conducted in the United States.7 However, research studies from India indicate that bidi smoking is associated with cancer and other health conditions.2

Smoke from a bidi contains 3 to 5 times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction.7Bidi smoking increases the risk for oral cancer, lung cancer, stomach cancer, and esophageal cancer.6,8,9,10Bidi smoking is associated with a more than threefold increased risk for coronary heart disease and acute myocardial infarction (heart attack).6,11Bidi smoking is associated with emphysema10 and a nearly fourfold increased risk for chronic bronchitis.6

Because of the low prevalence of use, a limited amount of research on the long-term health effects of kreteks has been conducted in the United States. However, research studies from Indonesia indicate that kretek smoking is associated with lung problems.

Kretek smoking is associated with an increased risk for acute lung injury (i.e., lung damage that can include a range of characteristics such as decreased oxygen, fluid in the lungs, leakage from capillaries, and inflammation), especially among susceptible individuals with asthma or respiratory infections.4Regular kretek smokers have 13 to 20 times the risk for abnormal lung function (e.g., airflow obstruction or reduced oxygen absorption) compared with nonsmokers.12
1.6% of all middle school students1.2% of female middle school students2.0% of male middle school students
2.4% of all high school students2.1% of female high school students2.7% of male high school students

1.2% of all middle school students0.7% of female middle school students1.6% of male middle school students
2.4% of all high school students1.9% of female high school students2.9% of male high school studentsNOTE:
-Current smokers are defined as persons who reported smoking 1 or more bidis or kreteks in the 30 days preceding the survey.

When Smoking Tastes Good, It's Harder to Quit

Seemingly safe—and yummy—cigarette additives like cocoa can have a dangerous effect when inhaled.You may find yourself missing more than nicotine when you finally snub out your last butt. Cigarettes are designed to manipulate your taste buds too, and research shows that tobacco’s flavors, both natural and added, can hold extra sway for many people struggling to quit.

"The sensory components—the taste of it, the feel of inhaled smoke—these are an important part of why people smoke," says Joseph McClernon, PhD, an assistant research professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center.

And they are also an important part of why people quit. "Taste can potentially help us explain who smokes and who doesn’t," says McClernon.

A little chocolate with your cigarette?
A typical cigarette may include cocoa, honey, vanilla, and licorice. While the taste of a particular brand has a lot to do with its tobacco blend, hundreds of additives may be included to smooth out the tobacco’s rough edges and create a more delicious puff.

This may sound like nothing more than a tricky way of winning your loyalty to a particular brand—or to cigarettes in general. But many of these additives can be dangerous when inhaled. "The additives are found in a lot of products that are eaten and are safe, but when burned they’re different products," explains K. Michael Cummings, PhD, chair of the department of health behavior at Roswell Park Cancer Institute in Buffalo, N.Y.

Cocoa, for example, is a nice treat for a cold winter’s night when mixed in its powdered form with hot milk. But when burned in a cigarette, cocoa produces bromine gas, which both dilates and anesthetizes the lungs, maximizing their absorption of smoke and nicotine.

Men and Women Smoke—and Quit—Differently

Studies have shown that after six months on nicotine replacement products, women slide back into the habit at higher rates than men.In 2001, a group of young cigarette smokers was fitted with opaque goggles and nose clips at the University of Pittsburgh School of Medicine. After lighting up, the women in the group collectively rated their cigarettes less "satisfying" than the men did. In another study, women who sampled both standard and low-nicotine cigarettes noted less of a difference in their enjoyment and perceived nicotine intake than male participants did.

These are just a few of the research findings into what has emerged as an apparent gender gap between male and female smokers. This research suggests that men smoke mainly for the nicotine, while women tend to care about the smell and taste, the hand-to-mouth sensation, weight control, and boosting their moods.

Although no one really understands what causes these differences, experts say considering them as you implement your quitting strategy might just give you an edge.

Liz Overcame Her Smoking Addiction With ExerciseShe couldn't go cold turkey, so she made gradual changes  Read moreNicotine replacement doesn’t work as well for women
The sexes have about the same rates of success with prescription smoking-cessation drugs, but studies of nicotine replacement therapy (NRT), such as the patch and nicotine gum, reveal differences. NRT seems to help both men and women get through those tricky first few months without cigarettes, but after six months, women slide back into the habit at higher rates than men.

On the other hand, gender differences in smoking addiction may also account for an interesting exception to the NRT gender gap: the inhaler, the small, plastic cigarette-holder-shaped device that provides a dose of vaporized nicotine when you take a determined drag from it. In a 2001 study of 504 smokers, inhalers proved more effective for women than for men (at least in the short term), while men experienced more success with the other three options: spray, patch, and especially gum.

"Women lose both the sensory cues and the nicotine when they quit smoking," Cora Lee Wetherington, PhD, explained in a 2002 article by the National Institute on Drug Abuse (NIDA), where she is the women and gender research coordinator. "Therefore, replacing those cues—something the inhaler can do, but not the patch or gum—and learning ways to avoid or cope with those cues may help more women succeed in quitting."

How to Quit Smoking Without Gaining (Much) Weight

Don't obsess over the scale while you're trying to quit. Focus first on kicking the habit, then worry about your waistline.Will you gain weight if you quit smoking? Probably. Four out of five quitters gain some weight—4 pounds to 10 pounds each, on average. The good news, however, is that quitters usually do get back to a normal weight, especially when the focus is on stopping smoking first.

Should you put off quitting in order to keep off unhealthy extra pounds? Nope. The science is unequivocal: "There’s no question that any weight gain is preferable to continuing to smoke," says Kenneth A. Perkins, PhD, professor of psychiatry at the University of Pittsburgh. Emily Rubin, RD, of the Digestive Disease Institute at Thomas Jefferson University Hospital in Philadelphia, agrees. "You’d have to gain 100 pounds to have the same health risks that a pack-a-day cigarette habit would give you," she says.

Why do quitters usually gain weight?
Smokers develop a lifestyle that revolves around smoking rather than eating or exercising. But it’s also true that smoking helps you keep your weight down (if at great cost to your heart and other organs, not to mention your appearance and smell). As a smoker, your body gets used to these facts:

Smoking burns calories. Smoking elevates your heart rate and increases your metabolism; when you quit, you burn about 100 fewer calories a day. After quitting, it can take weeks or even months for your metabolism to rebound.Smoking suppresses hunger. Nicotine causes the liver to release glycogen, which raises your blood-sugar level slightly and suppresses appetite. Until your metabolism adjusts, expect to gain about a pound a week.Smoking makes you feel good. Nicotine increases the levels of dopamine (a chemical associated with pleasure) in the brain. High-calorie treats, such as candy and cookies, produce much the same effect, so after quitting, you may be tempted to replace cigarettes with food. Alcohol boosts dopamine levels as well, and studies show that alcohol use tends to increase after quitting. This mechanism may explain why bupropion (Zyban), an antidepressant that works on the brain’s dopamine system, has shown to be helpful for smoking cessation.Smoking gives you something to do with your mouth and hands. Eating does the same—and makes you feel less deprived by your decision to quit.Smoking dulls your taste buds. After you quit, food begins to taste and smell better, so you may find yourself wanting to eat more.Smoking is reliable when other things are not. People use both cigarettes and food as a way to deal with boredom or stress, as a reward, or as a crutch in social situations.