New Hampshire

Flavored Cigar Use Common among Young Adult Cigar Smokers.

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Flavored cigar use is common among adults who smoke cigars, and particularly high among young adult cigar smokers, according to the first nationwide survey to assess adult use of these products. Flavored cigar smoking also varies by geographic region, the study found.

Also in the News: CDC Updates Hepatitis C Testing Recommendations

Adults born from 1945 through 1965 should be tested for the hepatitis C virus (HCV), according to updated recommendations from the Centers for Disease Control and Prevention (CDC). The CDC estimates that people born during these years account for three-quarters of all HCV infections and nearly three-quarters of HCV-associated deaths in the United States. As a result, these individuals are at greatest risk for liver cancer and other HCV-related liver diseases.

This update adds a target population for testing, but does not replace previous guidelines.

Dr. Brian King and colleagues from the Centers for Disease Control and Prevention (CDC) reported the findings online August 27 in Nicotine & Tobacco Research.

Using data from the 2009–2010 National Adult Tobacco Survey, which included about 119,000 landline and cell phone users, the researchers estimated that 6.6 percent of adults in the United States smoke cigars. Cigar smoking was especially high (15.5 percent) among 18 to 24 year olds. Approximately 43 percent of adults who smoke cigars use flavored cigars, they found. Among 18- to 24-year-old cigar smokers, 57 percent use flavored cigars.

Flavored cigar use was also more common among certain groups, including women and Hispanic cigar smokers, as well as cigar smokers with less education and lower incomes. The highest rates of flavored cigar use among cigar smokers were in North Dakota (71.6 percent) and New Mexico (69.0 percent), and the lowest rates were in New Hampshire (11.1 percent) and New Jersey (23.7 percent).

In 2009, the U.S. Food and Drug Administration (FDA) prohibited the use of certain flavors in cigarettes—such as vanilla, chocolate, cherry, and others that have a distinguishable taste or aroma—under authority granted by the Family Smoking Prevention and Tobacco Control Act. However, the FDA does not currently regulate cigars, and flavored cigars may still be manufactured and sold.

Flavorings, the study authors said, “mask the natural harshness and taste of tobacco.” Cigars contain many of the same toxic substances as cigarettes and smokeless tobacco and raise the risk of several cancers, heart disease, and chronic obstructive pulmonary disease.

Given the high rate of use among cigar smokers, the authors concluded, “efforts to curb flavored cigar smoking have the potential to reduce the prevalence of overall cigar smoking among U.S. adults.”

Source: NCI

 

Medicaid Expansion Appears to Lower 5-Year Mortality.

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Data hint that bolstering the system benefits even those already enrolled.

One of the provisions of the Affordable Care Act, scheduled to take effect in 2014, will allow states to expand Medicaid to include all adults with incomes near the federal poverty level. Researchers tried to predict health benefits from this measure by examining outcomes in three states that have enacted similar Medicaid expansions already.

Adjusted all-cause mortality in the Medicaid-expansion states (New York, Arizona, and Maine) declined by 6.1% in the 5 years after expansion, which is a significant difference compared with mortality in adjacent states used as controls (Pennsylvania, Nevada, New Mexico, and New Hampshire). The differences were greatest among nonwhites, residents of poor counties, and 35- to 64-year-olds. A smaller (but also significant) mortality difference (2.6%) was observed in adults older than 65, along with a significant decline in cost-related delays in care.

Comment: This “natural experiment” addresses a long-debated statistic in the health policy world, in which Medicaid coverage has been associated with worse rather than better health outcomes among adults. This study shows that when confounders are removed, the association is more likely inverse. Although this study had a variety of statistical caveats to consider, its results are consistent with both mortality benefits of Medicaid already established for infants and children, and preliminary results of a randomized, controlled trial of Medicaid expansion in Oregon.

Source: Journal Watch General Medicine