Study Restaurant tobacco bans influence teen smoking
Tue, 06 May 2008 01:01:28 GMTBy STEVE LeBLANC, Associated Press Writer
BOSTON - A Massachusetts study suggests that restaurant smoking bans may play a big role in persuading teens not to become smokers. Youths who lived in towns with strict bans were 40 percent less likely to become regular smokers than those in communities with no bans or weak ones, the researchers reported in the May issue of the Archives of Pediatrics & Adolescent Medicine.
The findings back up the idea that smoking bans discourage tobacco use in teens by sending the message that smoking is frowned upon in the community, as well as simply by reducing their exposure to smokers in public places, said Dr. Michael Siegel, of Boston University School of Public Health, and the study's lead author.
"When kids grow up in an environment where they don't see smoking, they are going to think it's not socially acceptable," he said. "If they perceive a lot of other people are smoking, they think it's the norm."
Siegel and his colleagues tracked 2,791 children between ages 12 and 17 who lived throughout Massachusetts. There were no statewide restrictions when the study began in 2001 but about 100 cities and towns had enacted a hodgepodge of laws restricting smoking in workplaces, bars or restaurants.
The teens were followed for four years to see how many tried smoking and how many eventually became smokers.
Overall, about 9 percent became smokers — defined as smoking more than 100 cigarettes.
In towns without bans or where smoking was restricted to a designated area, that rate was nearly 10 percent. But in places with tough bans prohibiting smoking in restaurants, just under 8 percent of the teens became smokers.
The study found that having a smoker as a parent or a close friend was a factor in predicting whether children experiment with cigarettes. But strong bans had a bigger influence on whether smoking grew into a habit, reducing their chances of becoming smokers by 40 percent.
"There is really no other smoking intervention program that could cut almost in half the rate of smoking," Siegel said.
Age was also a factor. Smoking bans had a greater effect on younger teens than on older teens.
The researchers said it's not clear whether strong bans would have the same effect in other states since local towns adopted their restrictions as part of an aggressive anti-smoking campaign throughout the state.
A statewide workplace smoking ban that included restaurants went into effect in mid-2004. Since then, high school smoking rates in Massachusetts have continued to decline, from about 21 percent of students in 2005 to about 18 percent in 2007.
Many restaurant owners fought the ban, saying it could drive away diners, according to Janine Harrod, director of government affairs for the Massachusetts Restaurant Association, which represents 2,000 restaurant owners.
While some restaurants were hurt initially, the effects have eased over time since the ban applies to everyone, she said.
Bill Phelps, a spokesman for Altria, parent company of cigarette-maker Philip Morris USA, said the study shows that the reasons teens take up smoking are complex.
"There is no single reason why young people engage in risky behaviors like smoking," he said. "We believe that there should be a multifaceted approach to address youth smoking."
At least 23 states, the District of Columbia and Puerto Rico require most public places and workplaces, including restaurants and bars, to be smoke free, according to the National Conference of State Legislatures.
Another nine states ban smoking in workplaces but have various exemptions for restaurants or bars.
"We already have more than enough evidence why we should pass these smoke-free laws, but certainly this study should help push them along," said Danny McGoldick of the Campaign for Tobacco Free Kids.
Caution urged in choosing gene tests
Tue, 06 May 2008 00:48:19 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Everyone's genes spell out a risk for some disease, and a coming anti-discrimination law is about to give genetic testing a boost.
But discrimination is just one hurdle. The bigger quandary: Doctors don't yet know how many of the genetic tests being pushed for dozens of conditions are truly useful — and how many are misleading at best.
"Some of these tests are complete rubbish," warns Dr. Howard McLeod, a personalized medicine specialist at the University of North Carolina. "The big challenge for a consumer is figuring out which data is real or not without having to go to medical school."
President Bush is expected soon to sign into law federal protection against genetic discrimination, a bill barring employers and insurers from using test results against patients.
First to benefit will be people who put off learning if they inherited genes responsible for diseases that run in their families — breast cancer, colon cancer, Huntington's, early-age Alzheimer's — for fear of losing insurance coverage or a job.
No one knows how many people that encompasses. The National Institutes of Health estimates 30 percent of potential volunteers for gene studies cite discrimination fears in backing out. At the same time, states have adopted a patchwork of protections, and steadily growing use of two of the best-proven tests — for the BRCA1 and BRCA2 gene mutations linked to breast and ovarian cancer — suggests that lingering concern hasn't been a huge deterrent for people with strong family histories of disease.
But until now, most genetic testing has been for conditions linked to single genes gone wrong, typically rare ones.
That's changing.
Most diseases — including diabetes and the No. 1 killer, heart disease — are caused by complex interactions of multiple genes and environmental factors, such as diet, exercise and smoking. With scientists rapidly discovering gene variants for these more common conditions, genetic testing in turn is poised to boom.
Yet laboratories can market tests for those newly discovered DNA glitches before scientists prove how risky they are, or whether knowing you have one will make any difference in your health care.
Nor are lab tests subject to the same scrutiny as medical treatments. So while the pace of discoveries makes for a thrilling time, genetic testing in some ways is science's Wild West — with more than 1,200 different genetic tests available but only a fraction accepted by mainstream medical groups, McLeod notes.
Just last week, government health advisers called for more oversight of genetic testing, citing "significant gaps" in validating the tests' usefulness, especially those sold directly to consumers.
Specialists advise anyone considering a gene test to:
_Consult a doctor or one of the nation's 3,000 genetic counselors, to weigh pros and cons.
_Ask what the results will mean for siblings or children. How big is their risk, and do they want to know?
_Ask how accurate the test is, and if knowing you've got a risky gene allows you to take steps for better health or just worry.
"It's not of value unless you're going to do something to modify your health behavior," cautions Angela Trepanier of Wayne State University, president of the National Society of Genetic Counselors.
Stephanie Cone of Oak Harbor, Wash., illustrates the power of gene testing done right. She and her two sisters considered testing for about a decade as their mother beat back four cancer bouts — ovarian, colorectal and two separate breast cancers.
Years before their gene test, Cone and one sister had their ovaries removed. "The family history was clear," Cone says: A grandmother and great-grandmother had both died of ovarian cancer.
But with each of their mother's diagnoses, the sisters wondered if knowing the precise genetic risk might give them more ammunition, and help their own daughters later. A genetic counselor laid out possible scenarios: How would they feel if one sister escaped the gene risk? Would gene carriers get extra breast checks or choose breast removal?
Finally they took the plunge. All three shared their mother's BRCA1 mutation. That meant the final sister to get a hysterectomy also got extra testing that uncovered early-stage ovarian cancer, so she could undergo chemotherapy. And last December, all three sisters checked into the hospital for simultaneous mastectomies.
"I say to my kids all the time, 'We're not afraid of cancer here,'" says Cone, whose 16-year-old daughter already says she'll be tested once she's old enough.
Conversely, not finding one particular gene for, say, breast cancer or diabetes doesn't mean you're off the hook for standard checkups; other genes could still sicken.
"The worry is that people say, 'Oh, I have a normal risk for these markers so I won't be tested ever,'" says UNC's McLeod.
Dr. David Altshuler of Harvard Medical School offers a scary example: He had a patient with a rare type of diabetes caused by a single gene mutation. One of her sons didn't inherit it — but he was at risk for more common Type 2 diabetes simply because he was overweight.
Yet, "he said, 'Now I'm through with diabetes,' and had some ice cream," Altshuler recalls.
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
Government genetic sites: http://www.genome.gov and http://www.genetests.org
Genetics and Public Policy Center: http://www.DNApolicy.org
Genetic counseling: http://www.nsgc.org
WalMart expands lowprice drug program Target follows
Tue, 06 May 2008 02:02:15 GMTBy PEGGY HARRIS, Associated Press Writer
LITTLE ROCK, Ark. - Wal-Mart Stores Inc., the world's largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women's medications at a discount. It also said it would lower the price of more than 1,000 over-the-counter drugs.
Target Corp. said late Monday it would match the major elements of Wal-Mart's program.
Wal-Mart's move marks the third phase of a company program that began in 2006 to provide a 30-day supply of generic prescription drugs for $4. The Bentonville-based company said the program has saved customers more than $1 billion.
With the expansion, the company began filling prescriptions Monday for up to 350 generic medications at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer, said Wal-Mart Senior Vice President John Agwunobi.
In addition, the company will add several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone deficiency.
For instance, alendronate, the generic version of osteoporosis medication Fosamax, will be added to the list. Company pharmacies will fill 30-day prescriptions of alendronate for $9 and a 90-day supply for $24 at a comparison of $54 and $102, respectively, that women previously paid for the same amounts, the company said.
Tamoxifen, used to treat breast cancer, will be offered for $9 for a 30-day supply, as well as combination estrogen/methyltestosterone tablets, prescribed for menopause and hormone deficiency.
Wal-Mart also will lower the prices of more than 1,000 over-the-counter medications to $4 or less in its pharmacies, company officials said. The company has sold over-the-counter medicines in the past at discounted prices, but revised and expanded its offerings specifically to include commonly used drugs that usually sell for $7 or more, said company spokesman Deisha Galberth.
The over-the-counter medication price rollbacks represent about one-third of the retailer's over-the-counter medicines. They include Wal-Mart's Equate versions of popular drugs, including Zantac, Pepcid and Claritin, and Wal-Mart's Spring Valley prenatal vitamins.
Since 2006, Wal-Mart's $4 generic drug program has expanded to every state, except North Dakota, where Wal-Mart has no in-store pharmacies. And many company competitors have followed the retailer's lead.
Target said it will expand its assortment of $4 prescriptions, offer 90-day supplies for $10, and sell over-the-counter medications for $4 or less. The company said more details about which drugs will be included will be released soon.
While stressing that the expansion was designed to help customers at a time of exorbitant health-care costs and difficult economic times, Wal-Mart's Agwunobi said the program has worked in everyone's favor.
"This is the time for us now to begin building capacity," he said. "It offers employers potential savings. It offers the customers significant savings. It also offers us the ability to add capacity to our pharmacies without adding people."
Agwunobi expects the 90-day discount will increase the company's market share of mail-order and online prescriptions as customers realize the value of the company offer.
Wal-Mart Chief Operating Officer Bill Simon said the results in each phase of the program have been strong and prescription volume has increased, "exceeding our expectations." He said the company would not, however, offer free generic drugs at its in-store clinics as some competitors have.
"We're in business to make money," Simon said. "Free is a price that is not a long-term sustainable proposition."
Shares of Wal-Mart fell 53 cents to $56.97 Monday.
FDA study Insulin pumps linked to injuries deaths in teens
Mon, 05 May 2008 20:56:03 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - Insulin pumps are used by tens of thousands of teenagers worldwide with Type 1 diabetes, but they can be risky and have been linked to injuries and even deaths, a review by federal regulators finds.
Parents should be vigilant in watching their children's use of the pumps, researchers from the Food and Drug Administration wrote. They didn't advise against using the devices. But they called for more study to address safety concerns in teens and even younger children who use the popular pumps.
The federal review of use by young people over a decade found 13 deaths and more than 1,500 injuries connected with the pumps. At times, the devices malfunctioned, but other times, teens were careless or took risks, the study authors wrote.
Some teens didn't know how to use the pumps correctly, dropped them or didn't take good care of them. There were two possible suicide attempts by teens who gave themselves too much insulin, according to the analysis.
"The FDA takes pediatric deaths seriously," said the agency's Dr. Judith Cope, lead author of the analysis. "Parental oversight and involvement are important. Certainly teenagers don't always consider the consequences."
The pumps are popular because they allow young people to live more normal lives, giving themselves insulin discreetly in public and getting pizza with friends late at night. And they're a growing segment of diabetes care, with $1.3 billion in annual sales worldwide, said Kelly Close, a San Francisco-based editor of a patient newsletter. She said 100,000 teenagers may be using them.
The pumps are used for those with Type 1 diabetes, which accounts for about 5 to 10 percent of all diabetes cases and used to be called "juvenile diabetes." The more common form is Type 2, which is often linked to obesity and more often affects adults.
Type 1 affects an estimated 12 million to 24 million people worldwide and occurs when the body attacks insulin-producing cells in the pancreas. Insulin regulates blood sugar levels, which when too high, can lead to heart disease, blindness and kidney damage.
Insulin pumps are the size of a cell phone and worn on a belt or pocket. They send insulin into the body through a plastic tube with a small tip that inserts under the skin and is taped in place. They cost about $6,000 and supplies run $250 a month. Most health insurers cover much of the cost.
Users must tell the device how much insulin to give before each meal, based on the estimated carbohydrates in the meal. The devices also deliver a continuous low level of insulin.
In the FDA study, appearing in the May issue of the journal Pediatrics, the reports of adverse events and deaths in adolescents using the pumps occurred from 1996-2005.
The FDA requires manufacturers to report injuries that could be linked to medical devices. The authors analyzed reports from patients 12 to 21 years old. They emphasized that the reports aren't always clear about the cause of death or injury.
The devices provide an alternative to multiple daily injections of insulin by syringe; some come with glucose monitors that reduce the number of times the finger must be pricked to test blood sugar.
While some teenagers want to switch from insulin injections to pump therapy to gain more flexibility in their lives, doctors said device problems such as a blocked tube can lead quickly to dangerous episodes of high blood sugar.
"In a matter of a few hours, all the insulin in the body disappears. Metabolically, the child starts to spiral out of control," said Dr. John Buse, the American Diabetes Association's president for medicine and science. Kids need to be aware of the risk, monitor their blood sugar and be ready to give themselves an insulin injection.
Dr. Christina Luedke of Children's Hospital Boston said she carefully screens teenagers and their families before prescribing a pump. She has refused it for some young patients.
"Without appropriate glucose monitoring, the pumps can increase the risk of getting sick more quickly compared to injections," Luedke said. However, she said, proper use makes life more bearable and can improve glucose control.
Teenagers also have problems keeping their diabetes under control with multiple daily insulin injections, doctors and manufacturers said.
"It is a constant struggle for a patient who is an adolescent to stay in control of any therapy," said Steve Sabicer, a spokesman for Minneapolis-based Medtronic Inc., which makes the top-selling insulin pump. The company stands behind the product's safety and "the many years of clinical evidence that support the benefits of insulin pump therapy," he said.
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On the Net:
Pediatrics: http://www.aap.org
Report device problems: http://www.fda.gov/medwatch
Obese momstobe have longer pregnancies
Mon, 05 May 2008 18:38:36 GMTNEW YORK - Pregnant women who are overweight or obese in the first trimester of pregnancy and those who have a greater change in body weight during pregnancy are more apt to have lengthier pregnancies and more complications, according to results of a new study.
Dr. Fiona C. Denison, of the University of Edinburgh, UK, and colleagues analyzed data from the Swedish Medical Birth Register on women who gave birth between 1998 and 2002.
Out of 143,519 pregnancies, 6.8 percent were delivered "postdate" -- defined as longer than 42 weeks. A normal pregnancy lasts 40 weeks.
Compared with women with normal body mass indexes , more women with higher BMIs during the first trimester, as well as those with greater weight gain during pregnancy, had longer-than-normal pregnancies.
Being overweight or obese during the first trimester was also associated with a lower chance of spontaneous delivery at term and being obese was associated with a higher risk of stillbirth, pregnancy-related diabetes and need for cesarean delivery.
"Maternal obesity poses a significant risk to maternal and fetal health during pregnancy, and our study confirms the findings of others that obesity is associated with significant complications including stillbirth, gestational diabetes, pregnancy-induced hypertension and cesarean section," Denison's team concludes.
"If a healthy lifestyle including physical activity and healthy eating, which are more common in underweight women, were advocated more strongly for the obese obstetric population," they suggest, "then obstetric outcomes might be improved."
SOURCE: British Journal of Obstetrics and Gynecology, May 2008.
