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Research & Evidence

Nearly all adult cigarette smokers start smoking before age 26 years, making smoke-free and tobacco-free policies at colleges and universities important.
Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017
Wang, Teresa W., PhD; Michael A. Tynan; Cynthia Hallett, MPH; Laura Walpert, JD; Maggie Hopkins; Darryl Konter; Brian A. King, PhD
Morbidity and Mortality Weekly Report (MMWR)

2019

Andy S L Tan; Soneji Samir, Moran, Meghan Bridgid; Choi, Kevin. "JUUL Labs' sponsorship and the scientific integrity of vaping research." The Lancet, August 3, 2019.

As of 2018, 98 countries regulate e-cigarettes, including their sale, marketing, packaging, manufacturing, taxation, reporting, and clean air laws.1 Some countries have banned e-cigarettes completely, such as Argentina, Saudi Arabia, and Singapore,1 whereas other countries, such as the UK, consider e-cigarettes as part of a public health harm reduction strategy.2 The USA has regulated e-cigarettes as a tobacco product since 2016. 

Walton, MS, Kimp; Teresa W. Wang, PhD; Gillian L. Schauer, PhD; Sean Hu, MD; Henraya F. McGruder, PhD; Ahmed Jamal, MBBS; Stephen Babb, MPH. "State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers - United States, 2011-2017." Centers for Disease Control and Prevention - Morbidity and Mortality Weekly Report, July 19, 2019.

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011–2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3).

Blake, Kelly D., Amanda L. Klein, Laura Walpert, Len Casey, Cynthia Hallett, Clifford Douglas, Bidisha Sinha, Howard K. Koh. "Smoke-free and tobacco-free colleges and universities in the United States." BMJ Journals, July 2, 2019.

Abstract

Objective To describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state.

Methods Data on postsecondary education institutions from the US Department of Education National Center for Education Statistics Integrated Postsecondary Education Data System 2015, and smoke-free and tobacco-free campus protections from the American Nonsmokers’ Rights Foundation’s Smokefree and Tobacco-Free Colleges and Universities List 2017, were integrated to calculate the number and proportion of: (1) smoke-free and tobacco-free accredited, degree-granting institutions and (2) students and staff protected by campus policies and state laws. Campus protections are given a 100% smoke-free designation if smoking is not allowed on campus anywhere, at any time; 100% tobacco-free designations extend smoke-free protections to include non-combustible products such as smokeless tobacco.

Results 823 accredited, degree-granting institutions (16.7%) representing 1816 individual campuses, sites and schools have either 100% smoke-free or 100% tobacco-free protections. An estimated 14.9 million college students (26.9%) and 8.9 million faculty and staff (25.4%) are protected by campus policies and state laws. Only three states and two territories have 100% smoke-free or 100% tobacco-free protections in over half of their institutions; four states and six territories have no known 100% smoke-free or 100% tobacco-free campus protections.

Conclusions In 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.

Advances in cancer diagnosis and treatment have resulted in declining cancer mortality rates during the past 20 years [1], resulting in high rates of return to work following a cancer diagnosis [2]. Cancer survivors report that work provides a sense of normalcy, necessary financial support, and in some cases, social support [3]. Cancer survivors who work after diagnosis have unique needs to ensure optimal outcomes for both the individual and the employer. A supportive work environment is an important factor for success [4]. Work-related factors significantly associated with a greater likelihood of employment or return to work after cancer diagnosis include perceived employer accommodation, flexible work arrange-ments, and supportive services such as counseling, training, and rehabilitation [4].

Sauer, Ann Goding; Rebecca L. Siegel; Ahmedin Jemal; and Stacey A. Fedewa. "Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity." American Association for Cancer Research, April 2019.

Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.

Warren, MD, PhD, Graham W.; Kathleen B. Cartmell, PhD; Elizabeth Garrett-Mayer, PhD. "Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer." JAMA, April 5, 2019.

The cost of cancer treatment is increasingly associated with unfavorable financial outcomes in cancer care,but whether increased costs reflect increased value is unknown. Principles for value-based care in oncology include patient-centered solutions, optimal care, and cost-containment strategies that do not limit patient access or innovation. Guidelines have been developed to define clinically meaningful outcomes in cancer care, but a recent analysis of drug approvals by the US Food and Drug Administration between 2014 and 2016 showed that many drugs did not meet survival goals.  Whereas drug cost and efficacy have been the primary focus for considering value in cancer care, relatively little consideration has been given to other potentially modifiable factors that could affect cancer treatment costs, including health behaviors such as smoking.

The US 2014 Surgeon General’s report concluded that continued smoking among patients with cancer caused adverse outcomes including increased overall- and cancer-specific mortality, risk for second primary cancer, and associations with increased toxic effects from cancer treatment. Smoking cessation in the general population is known to improve health outcomes and create significant reductions in health expenditures. Whereas many studies found that smoking cessation after a cancer diagnosis can improve survival, to our knowledge, there have been no evaluations of the association between continued smoking among patients with cancer and the costs of cancer treatment. Understanding the financial effects of smoking among patients with cancer is needed to develop value-based approaches that could lead to improved cancer treatment outcomes. The objective of this study was to model the additional attributable first-line cancer treatment failures associated with continued smoking and to estimate the attributable incremental cost associated with the need to treat first-line cancer treatment failures attributed to continued smoking.

Sung, Hyuna; Rebecca L Siegel, Philip S Rosenberg, Ahmedin Jemal. "Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry." Lancet Public Health, February 4, 2019.

Background: Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden. Previous studies reported an increase in early onset colorectal cancer, which could partly reflect the obesity epidemic. We examined age-specific contemporary incidence trends in the USA for 30 common cancers, including 12 obesity-related cancers.

Interpretation: The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA. Further studies are needed to elucidate exposures responsible for these emerging trends, including excess bodyweight and other risk factors.

Berry KM, Fetterman JL, Benjamin EJ, et al. "Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths." JAMA Netw Open, February 1, 2019.

This large, nationally representative study of US youths supports the view that e-cigarettes represent a catalyst for cigarette initiation among youths. The association was especially pronounced in low-risk youths, raising concerns that e-cigarettes may renormalize smoking behaviors and erode decades of progress in reducing smoking among youths. Although the individual-level risk of cigarette initiation was comparable for prior e-cigarette users and prior other tobacco product users, the proportion of new cigarette use attributable to prior e-cigarette use appears larger than the proportion attributable to prior use of all other products combined. These findings strengthen the rationale for aggressive regulation of youth access to and marketing of e-cigarettes to achieve future decreases in the prevalence of cigarette use among youths.

Schnoll R, Leone F, Veluz‐Wilkins A,et al. . "A randomized controlled trial of 24 weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence." Psycho‐Oncology, January 24, 2019.

Continuing to smoke after a cancer diagnosis undermines prognosis. Yet few trials have tested Food and Drug Administration (FDA)‐approved tobacco use medications in this population. Extended use varenicline may represent an effective treatment for cancer patients who smoke given barriers to cessation including a prolonged time line for relapse.

"Cancer Facts & Figures 2019." American Cancer Society, January 8, 2019.

Estimated numbers of new cancer cases for 2019, excluding basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimates are not available for Puerto Rico.

Note: State estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding.

Siegel, Rebecca L., MPH; Kimbertly D. Miller, MPH; Ahmedin Jemal, DVM, PhD. "Cancer Statistics, 2019." Wiley Online Library, January 8, 2019.

Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. In this article, we provide the estimated numbers of new cancer cases and deaths in 2019 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most  current population-based data for cancer incidence through 2015 and for mortality through 2016. We also estimate the total number of deaths averted because of the continuous decline in cancer death rates since the early 1990s and analyze cancer mortality rates by county-level poverty.

2018

U.S. Surgeon General Jerome Adams. "Surgeon General’s Advisory on E-cigarette Use Among Youth." December 18, 2018.

I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use. The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is a cause for great concern. We must take action now to protect the health of our nation’s young people.

Patrick, Megan E., PhD; Richard Miech, PhD; Lloyd Johnston, PhD; Patrick M. O’Malley, PhD; Jerald G. Bachman, PhD. "Adolescent Vaping and Nicotine Use in 2017–2018 — U.S. National Estimates." New England Journal of Medicine, December 17, 2018.

 A rapid increase in the prevalence of vaping among adolescents has aroused public health concern. Adolescents who “vape” use a device such as an electronic cigarette to inhale a heated aerosol, which typically contains nicotine. In 2017, vaping was the most common use of any tobacco-like product among adolescents.1 This is a rapid rise from a near-zero prevalence of vaping in 2011.2 We assessed whether the prevalence of nicotine vaping increased among adolescents from 2017 to 2018.

Pankaj Parag Sharma, Mark Benden, Ranjana K. Mehta, Adam Pickens & Gang Han . "A quantitative evaluation of electric sit-stand desk usage: 3-month in-situ workplace study." IISE Transactions on Occupational Ergonomics and Human Factors, September 13, 2018.

Sit-stand desk interventions are deployed to reduce sedentary time and improve ergonomic adjustability in modern workplaces, with ultimate goals of improving health and productivity. Sit-stand desks, however, require workers to take an active role in changing the desk position, and usage compliance of the sit-stand function has been a challenge. This study used computer software to objectively record continuous data on electric sit-stand desk usage during computer use, to understand current desk usage behaviors in a large office environment involving ∼300 workers for 3 months. We found that workers completed roughly one desk position change per work day, and one-fourth of the workers always had the desk in a seated position (during computer use). The methods used here demonstrate a novel approach to record sit-stand desk usage continuously during active computer use.

Kuiper NM, Loomis BR, Falvey KT, Gammon DG, King BA, Wang TW, et al. "Trends in Unit Sales of Flavored and Menthol Electronic Cigarettes in the United States, 2012–2016." Centers for Disease Control and Prevention, Preventing Chronic Disease, August 23, 2018.

CDC and RTI International analyzed retail scanner data to assess national and state-specific trends in sales of flavored and menthol e-cigarettes.  Findings from this analysis include:

  • During 2012-2016, flavored e-cigarette sales as a percentage of all e-cigarette sales rose national from about 2% to nearly 20% in all but four states
  • Menthol e-cigarette sales remained stable nationally at 35-40%
  • Over half of total e-cigarette sales in 2016 were flavored or menthol products, and sales varied by product type
  • Continued monitoring of the variety of flavored tobacco products available in the United States, including combustible, noncombustible, and electronic tobacco products, is critical for informing comprehensive tobacco prevention and control strategies

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