Smoking and Obesity

Many people know the risks of smoking, and many people know the risks of being over-weight, but not many studies have looked at the mortality risk of the two factors together. As expected, there was an elevated mortality risk that was higher than the risk of any of the two factors by themselves. The research paper’s design was very good in standards of following the requirements of the information needed in a retrospective cohort. The sample size that was used was large >80,000. Of those, over 64,000 were women. Researchers made sure to remove any people that had a history of prior cancer or myocardial infarction (MI). They used a questionnaire to ascertain the exposed and non-exposed groups. Some of the factors looked at in the questionnaire was height, weight, alcohol use, and smoking habits, among other things.

Body mass index (BMI) and smoking status were both stratified to see how the two factors affect mortality risk. The causality of the two factors were very clear in the results that where concluded. It was found that there was a 3.5 to 5 fold increase in all-cause mortality of smokers that were very obese (BMI > 35). In contrast if you where just very obese and did not smoke your Relative Risk (RR) for all-cause mortality was lower (1.4—2.5). The strongest cause and effects found in this study was that of smoking and very obese women who had a 6-11 fold increase in circulatory disease mortality.

In looking at the data I did not see any mistakes in the correlations that were drawn. The confidence intervals used in the study ranged from .005-.0001 so they are definitely in the realm of scientific creditability. Some of the areas that could prove a problem is the fact that the people in the study filled out the questionnaire themselves, and people could have been dishonest about weight or height, which could have made the calculation on BMI skewed to the left, meaning a lower BMI than what they actually are. I think this because most people say they weigh less then they do. Also, there is a problem with the former smokers if they started to smoke again after the survey. Their mortality information should have been with the smokers instead of the non/former smokers.

In all, I think the information obtained from this study is an important find for policy makers, in where money should go in preventative health care, and to which of the sexes should it be focused on more (female). By using this information correctly policy makers can maximize the amount of lives saved.

works cited--
D. Michal Freedman. (2006). The Mortality Risk of Smoking and Obesity Combined. American Journal of Preventive Medicine, 31(5) 355-362

How to get money for not smoking

When trying to quit smoking, it can help to keep your eyes on the prize — especially if that prize is $750.

A new study shows that smokers who earn financial incentives are three times more likely than others to kick the habit. In an experiment with nearly 900 smokers employed by General Electric, 15% of those given incentives were smoke-free after a year, compared with 5% of those who weren't eligible for cash rewards.

The study rewarded employees for incremental milestones — $100 for completing a smoking-cessation class, another $250 for being smoke-free after six months and $400 more for being smoke-free after a year.

"People are drawn to tangible things," says author Kevin Volpp, a doctor at the Philadelphia VA Medical Center and director of the Center for Health Incentives at the University of Pennsylvania. "It makes it easier for you to do in the short term what you know is in your long-term best interest."

The incentives paid for themselves in about three years, says co-author Robert Galvin, GE's chief medical officer. GE plans to offer a version of the smoking-cessation program next year, although officials haven't yet decided the amount of the incentives.

Tobacco taxes also provide strong incentives to quit, says the American Cancer Society's Tom Glynn, who wasn't involved in the study. Research shows that each 10% increase in the cost of cigarettes reduces the teen smoking rate by 7% and the adult rate by 4%.

He says he understands that some people may question the wisdom of paying people to do something that's in their own best interest. But he notes that we already pay for health problems caused by smoking and obesity, through private insurance premiums and taxes for Medicare.

In the study in today's New England Journal of Medicine, researchers gave everyone information about local smoking-cessation classes and the company's coverage of drugs designed to help them quit. Half were also offered incentives. Each group had about the same number of heavily addicted smokers.

Quitters need all the help they can get, Volpp says, noting that 70% of smokers want to quit but only 3% succeed each year. And the relatively low quit rates in his study — in spite of incentives — underscore how difficult it is to quit, even with help.

Glynn hopes the study will inspire other businesses to help employees quit. "In the long run," he says, "stopping smoking pays off for everyone."

For help with quitting, call 800-QUIT-NOW

Cigarettes' Cost in Dollars and Lives

At least one of every 10 patients arrive at Jeffrey D. Forman's medical office with an oxygen tank.

They lug them like carry-on bags. They wheel them on devices that resemble golf caddies, careful not to tangle the plastic tubing that fills their nostrils with life-giving oxygen.

Once, it was cigarettes they carried. Now, battling lung cancer, emphysema or a wasting disease called chronic pulmonary obstructive disorder, they bear the costs of a lifetime of smoking. They illustrate the price that all Americans pay for tobacco and the reason why Virginia Gov. Timothy M. Kaine (D) has brought his tobacco-producing state closer than ever to a ban on smoking in bars and restaurants.

After five decades of smoking, Pattie Tatem, 67, sits in a wheelchair with an oxygen tank at her feet, a victim of severe chronic obstructive pulmonary disease. The disease takes her breath away and makes her feel as if she's drowning. It wiped out her retirement savings. Now it's slowly killing her.

"It catches up with you, and when it hits you, it hits you hard," said Tatem, whose treatment costs are footed mostly by taxpayers through Medicare.

To recover some of Virginia's health-care costs caused by tobacco, Kaine proposed doubling the state tax on cigarettes to 60 cents a pack. The governor and the General Assembly took aim at tobacco in other ways, too, by moving to ban smoking in restaurants and bars and prohibiting people from lighting up in a vehicle when a child is present.

Last week, Kaine announced a compromise with House Speaker William J. Howell (R-Stafford) on a smoking ban that some anti-smoking advocates criticized as too timid. But in years past, even that would have been dead on arrival in the House. The governor's tobacco tax, in contrast, never made it to the floor of the Republican-controlled House or the Democratic-controlled Senate.

In a state whose fortunes have been interwoven with tobacco since Colonial times, opponents warned against damaging an industry that contributes healthy paychecks and tax revenue to the commonwealth.

"These are jobs in my community you're talking about," said Sen. John C. Watkins (R-Chesterfield), whose district is near Philip Morris USA.

But doctors, health advocates and patients tally the costs differently: More than 9,000 Virginians die every year because of tobacco use, and more than 9,000 Virginia youths get hooked every year. More than 1,000 people die from secondhand smoke.

Laurens Sartoris, president of the Virginia Hospital & Healthcare Association, said Virginians pay financially, too, because they pay for smokers' medical bills.

Consider Medicaid, the government-run health insurance for the poor. The program, whose costs are split by states and the federal government, reimburses doctors, hospitals and other providers at a rate substantially below the cost of medical care.

When a smoker goes into the hospital for cancer treatment -- smokers are statistically more likely to need medical care earlier and longer than nonsmokers -- Medicaid covers 75 cents of every dollar in expenses. Taxpayers and patients with private insurance make up the difference.

"That is a hidden, extraordinary, regressive tax on everybody's insurance premiums," Sartoris said.

That's why anti-smoking advocates had pushed for a bigger tobacco tax: to narrow a $148 million gap in Virginia's Medicaid funds that is expected to grow. Along with the smoking ban, the tax would pay further dividends by inhibiting people from starting to smoke and forcing others to cut down, advocates said.

Research shows that for every 10 percent increase in the price of cigarettes, tobacco use drops 7 percent among youths and 2 percent among adults.

Forman, who grew up in Howard County, sees the human consequences of smoking every day. At least half of his patients are smokers or former smokers.

Forman can easily spot the signs of blocked airways: Patients purse their lips, puffing and hyper-inflating their chests in an effort to empty their damaged lungs. After a few minutes with a CT scan, he finds a spidery white speck that means a cluster of cancer cells has taken root in a person's lung.

Then he must break the news to people such as Don Eason.

"I said, 'What you're telling me is, I'm going to die,' " recalled Eason, who underwent surgery about three years ago to remove his right lung and a chunk of his left.

Like many smokers, Eason, 70, an easygoing man with white hair, a Southern accent and a persistent cough, knows what led to this. He was 15 years old and stocking shelves at the A&P in Franklin, Va., when he first smoked. It was a Pall Mall then, and later Salem menthols.

Eason enlisted in the Air Force, became a traveling salesman, ran a barbershop, married, had children and divorced. But cigarettes were a constant. He smoked a pack, maybe a pack and a half, every day.

"Back then, a cigarette and a radio were your buddies," Eason said, remembering the days on the road peddling farm equipment.

After doctors told Eason that he had a year to live, he put his affairs in order. He did not want to leave debts for his daughters to pay. He gave away belongings. He picked out a coffin.

Tatem, a wisecracking former dental hygienist, also started smoking young. As a teenager in Norfolk, she and some girlfriends pilfered Lucky Strikes from her mother's purse. Soon, she became a pack-a-day smoker. Her favorite ritual centered on a morning cigarette, a freshly brewed pot of coffee and a chocolate cookie.

These days, Tatem must be connected to the oxygen supply at all times, a nuisance when the tubes irritate her nostrils or get tangled underfoot in her living room. Her skin, gray and fragile, rips as easily as wet paper, one of the effects of a medication that helps her breathe. Another makes her bones brittle, causing painful fractures.

Two years ago, Tatem was rushed to the hospital. Doctors put her in the hospice unit.

"They said there wasn't anything they could do for me," Tatem said. She rallied, but she said she knows that her prognosis is grim. And she, too, wishes she had never smoked.

"I feel angry at myself for doing it, because no one made me do it," she said.