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Biomedical subjects

K E Warner

Publications and source records attributed to K E Warner.

At least 19 recordsLinked to original sources
PubMed2004

Tobacco harm reduction: what do the experts think?

OBJECTIVE: To assess experts' opinions about the future of, and potential to improve individual and public health through "tobacco harm reduction" (THR), the use of novel nicotine containing products purporting to reduce the health risks from cigarette smoking. DESIGN: Semi-structured telephone interviews on nine topic areas, with qualitative content analysis of coded transcripts. PARTICIPANTS: 29 professionals with expertise related to tobacco and interest in THR, including prominent tobacco control advocates (7), pharmaceutical (3) and tobacco industry scientists/officials (5), non-industry scientists (12), and Congressional staff (2). RESULTS: Respondents agreed that harm reduction is at minimum theoretically plausible, that characteristics of "good" and "bad" THR products can be identified, that government regulation is essential but not likely in the foreseeable future, and that additional scientific data are very much needed. However, there was no consensus on specifics, such as preferred regulatory strategies or examples of ideal THR products. Disagreement was seen not only across but also within respondent categories. Mistrust of key stakeholders-for example, tobacco control advocates distrust of tobacco industry scientists and vice versa-was pervasive, and cited frequently as a barrier to regulation and collaboration. CONCLUSIONS: Continued dialogue and debate are essential as we enter a new and uncertain era of products purporting to reduce tobacco produced harm. Experts have concluded that effective government regulation is crucial to minimising the risks associated with THR and maximising potential benefits.

Attitude of Health Personnel↗
PubMed2003

The US tobacco control community's view of the future of tobacco harm reduction.

OBJECTIVE: Tobacco harm reduction (THR) has garnered recent attention due to the introduction of novel nicotine delivery products ostensibly intended to reduce risk for inveterate cigarette smokers. This study evaluates the grassroots tobacco control community's knowledge, opinions, and beliefs about THR. DESIGN: A web/mail survey conducted in October and November 2002, with a telephone survey of a sample of non-respondents. SUBJECTS: The 2833 US based registrants for the 2001 National Conference on Tobacco or Health. MAIN OUTCOME MEASURES: Respondents' awareness of THR, perception of its importance, support for regulation, and perception of which THR products should be recommended to inveterate cigarette smokers. RESULTS: 70% of respondents were aware of THR but respondents had low recognition of specific products at the forefront of the debate, such as Swedish snuff. Half believe THR will reduce smoking cessation and cause nicotine experimentation by children; 63% anticipate unintended adverse side effects. More expect THR to have a negative than a positive impact on health. Large majorities support government regulation of THR and conventional tobacco products, but fewer than 30% expect legislation regulating either. Most would recommend nicotine patches (76%) and gum (70%) to inveterate smokers, but no other product was supported by a majority. Scientists are more supportive of THR than activists, while respondents focusing on national/international issues are more supportive than those concentrating on local/state issues. CONCLUSIONS: Many members of the US tobacco control community are unaware of the THR "movement", while others possess only rudimentary familiarity with it. If and as THR achieves an increasingly prominent role on the tobacco-or-health scene, this community will have to become educated about THR, and be prepared to advocate for regulatory policies that will maximise the potential for positive outcomes. The potential for negative outcomes remains significant.

Adult↗
PubMed2000

Investing in youth tobacco control: a review of smoking prevention and control strategies.

OBJECTIVE: To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES: Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS: Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS: Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating "youth centred" tobacco prevention and control activities.

Adolescent↗
PubMed2000

Smoking prevalence in 2010: why the healthy people goal is unattainable.

OBJECTIVES: This study examined the changes in smoking initiation and cessation needed to realize the Healthy People 2010 national adult smoking prevalence objective (13%). METHODS: Using data from the National Health Interview Surveys, we calculated smoking prevalence over time with a dynamic population demographics model, examining the effects of changes in smoking initiation and cessation. RESULTS: The draft objective is unattainable solely through decreases in smoking initiation. It could be achieved through smoking cessation alone only if cessation rates immediately increased by a factor of more than 3.5. Assuming plausible decreases in initiation and increases in cessation, the draft objective is virtually unattainable. CONCLUSIONS: The health objectives should challenge the status quo but be achievable. Formal analysis often can assist in establishing reasonable objectives.

Adult↗
PubMed1999

Medical costs of smoking in the United States: estimates, their validity, and their implications.

OBJECTIVE: To compare estimates of the medical costs of smoking in the United States and to consider their relevance to assessing the costs of smoking in developing countries and the net economic burden of smoking. DATA SOURCES: A Medline search through early 1999 using keywords "smoking" and "cost", with review of article reference lists. STUDY SELECTION: Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population. DATA EXTRACTION: Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings. DATA SYNTHESIS: With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. The exception, a recent study, found much larger attributable expenditures. The lower estimates may reflect the limitation of analysis to costs associated with the principal smoking-related diseases. The higher estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range. CONCLUSIONS: The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing the magnitude of their current cost-of-smoking burden and their future burdens, with differences in tobacco use histories and the availability of chronic disease treatment affecting country-specific estimates. The debate over the use of gross or net medical cost estimates is likely to intensify with the proliferation of lawsuits against the tobacco industry to recover expenditures on tobacco-produced disease.

Developing Countries↗
PubMed1999

Litigation and public health policy making: the case of tobacco control.

Many tobacco control advocates, believing that legislators and regulators have failed to enact and implement sufficiently stringent tobacco control laws, have supported litigation as a means of achieving public health policy goals. In this article, we examine the relationship between litigation and public health policy formulation in the context of the debate over tobacco control policy. The fundamental questions are how social policy should be made regarding the use of tobacco products, and which institutions should be responsible for controlling tobacco use: the market, the political system (i.e., the legislative and regulatory branches of government), or the courts. On balance we conclude that litigation is a second-best solution. We see a distinct role for litigation as a complement to a broader, comprehensive approach to tobacco control policy making, rather than as an alternative to the traditional political apparatus of formulating and implementing public health policy. Our analysis suggests that, in general, public health goals are more directly achievable through the political process than through litigation, though situations such as those concerning tobacco control blur the bounds between litigation and the politics of public health. Litigation has stimulated a national debate over the role of smoking in society and may well move the policy agenda. But we conclude that a sustained legislative and regulatory presence ought to be the foundation of meaningful policy changes.

Humans↗
PubMed1998

Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States.

From 1965 to 1990, the prevalence of cigarette smoking among US adults (aged > or = 18 years) fell steadily and substantially. Data for the 1990s suggest that the smoking initiation rate is increasing and that the decline in the prevalence of smoking may have stalled, raising the fear that the historical 25-year decline will not continue. The authors used a new dynamic forecasting model to show that although the decline may slow down, the demographics of smoking imply that prevalence will inexorably continue to decline over the next several decades, even without any intensified efforts aimed at tobacco control. The authors estimated and validated the model using historical (1965-1993) data collected by the National Health Interview Surveys on the prevalence of smoking among adults. Their results indicate that the current increase in the smoking initiation rate partially explains the fact that the prevalence of smoking has apparently leveled off, but even if the most grim assumptions about future initiation rates are used, the prevalence of smoking among adults will continue to decline for several more decades. The authors predict that if current initiation and cessation behaviors persist, the prevalence of smoking among adults will automatically decline from its current level of 25% to 15-16% by the second quarter of the next century. Even so, smoking will remain the nation's leading cause of premature death.

Adolescent↗
PubMed1998

Effects of radon mitigation vs smoking cessation in reducing radon-related risk of lung cancer.

OBJECTIVES: The purpose of this paper is to provide smokers with information on the relative benefits of mitigating radon and quitting smoking in reducing radon-related lung cancer risk. METHODS: The standard radon risk model, linked with models characterizing residential radon exposure and patterns of moving to new homes, was used to estimate the risk reduction produced by remediating high-radon homes, quitting smoking, or both. RESULTS: Quitting smoking reduces lung cancer risk from radon more than does reduction of radon exposure itself. CONCLUSIONS: Smokers should understand that, in addition to producing other health benefits, quitting smoking dominates strategies to deal with the problem posed by radon.

Adult↗
PubMed1997

The emerging market for long-term nicotine maintenance.

In increasing numbers, Americans will seek to satisfy nicotine addictions through the use of novel nicotine-delivery products devoid of several of the poisons that make cigarettes so deadly. In the vanguard are tobacco industry devices that heat tobacco derivatives rather than burn tobacco, and pharmaceutical industry nicotine-replacement products, with nicotine gum and the patch now available over the counter. Ostensibly, these 2 industries have diametrically opposed objectives, the tobacco industry striving to sustain nicotine addictions, the pharmaceutical industry to end them. However, a series of technological, economic, political, regulatory, and social developments augurs a strange-bedfellows competition in which these industries will vie for shares of a new multibillion dollar long-term nicotine-maintenance market. Regulatory options range from encouraging competition to banning all nicotine-delivery devices. A more realistic approach discourages use of the most dangerous products, while making less hazardous products readily available to adults.

Adult↗
PubMed1997

Environmental tobacco smoke: health effects and policies to reduce exposure.

The health hazards due to exposure to environmental tobacco smoke (ETS) are increasingly established. ETS contains thousands of chemicals including 43 known carcinogens. Known health effects of ETS exposure are lung cancer in nonsmokers, childhood disorders such as bronchitis, and perhaps, heart disease. Workplace exposure to ETS is widespread and is influenced strongly by the type of smoking policy in the workplace. To decrease ETS exposure, efforts to restrict public smoking have proliferated over the past decade. These restrictions have emanated from government as well as voluntary measures by various private industries. Bans on public smoking are effective in reducing nonsmokers' exposure to ETS. Workplace smoking bans also influence the intensity of smoking among employees and may increase quit smoking rates. In addition to the health benefits from smoke-free workplaces, there are likely cost savings to employers who implement such policies.

Cost-Benefit Analysis↗
PubMed1997

Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence-and implications for coverage.

Smoking cessation has been called the 'gold standard' of healthcare cost effectiveness, producing additional years of life at costs that are well below those estimated for a wide range of healthcare interventions. However, the most effective approaches to smoking cessation are not the most cost effective. As we move from the least resource-intensive interventions (e.g distribution of self-help cessation guides) to those that are most resource-intensive (e.g. medical treatments, including the use of nicotine replacement products), both cost and effectiveness increase, but cost increases more rapidly. Nevertheless, it must be considered that different interventions are effective for different people. Resource-intensive treatments may actually be far more cost effective for many people who may not respond to less-intensive interventions. A considered review of the evidence recommends support of all of the major forms of smoking-cessation intervention; even the most expensive are highly cost effective compared with the majority of medical practices that have been studied. Despite their cost effectiveness, smoking-cessation services are not covered by many healthcare providers. This review concludes that such coverage is warranted, primarily because much less cost-effective secondary and tertiary care is covered, encouraging its utilisation, rather than primary prevention. However, the argument favouring coverage is not as clear-cut as might be assumed. Coverage of smoking cessation amounts to a direct subsidy for smokers who want to quit. It is not health 'insurance' in the theoretical meaning of the term. The distinction is important as healthcare systems contemplate future coverage of a range of behaviour-related preventive interventions.

Animals↗