http://www.breathend.com Upper Missouri District Health Unit en-us Fri, 03 Sep 2010 00:00:00 GMT http://www.breathend.com/syndicate/rssnews.png http://www.breathend.com/news/ http://www.breathend.com/news/detail.asp?newsID=82 The only thing that distinguished the commissioners' action was that it took so long for one of North Dakota's most important, most visited cities to approve a ban. Nothing about the lengthy debate and vote was new or distinguished at all. The arguments pro and con have been heard before. Change the name from "Bismarck" to any other city that has gone through the process, and little difference was evident.
As has been the pattern nearly everywhere smoke bans have been considered, the science-based public health argument won the day over the specious business-privilege argument. Cleaning the air in bars of toxins has become a societal priority. It trumps the squishy notion that bans impact people's right to choose and that businesses should have the right to promote a health risk.
(Bismarck adopted a smoke ban in public and quasi-public places about five years ago. Bars were exempted.)
Following the vote, an opponent of the ban was asked if bar owners would take the issue to the city ballot. He said no and conceded that public sentiment was such that a vote would certainly favor a ban. Pro-ban petitions signed by 3,500 Bismarck citizens support his belief. Moreover, wherever a ban has been on the ballot in North Dakota, it has passed easily. And several Bismarck pubs and taverns have gone smoke-free on their own; their financial sky has not fallen.
Bismarck is a major center of commerce and trade. It's the home of state government and the Legislature. Tens of thousands of people trek to the capital city, not only from North Dakota but from around the nation and world. The city should have been the state's leader in going smoke-free in public places and bars. It's an important public health issue, but it's also about image and enlightened thinking.
Well, better late than never. When the bar smoke ban goes into effect Nov. 1, North Dakota's capital city will be able to breathe a lot easier.
]]> Tue, 31 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=83
Cigarettes are the most dangerous consumer product in the world. It is estimated that cigarettes kill 25,000 Texans, 438,000 Americans and 5.4 million people around the world every year. The epidemiologist Sir Richard Peto estimates that worldwide 100 million people died from tobacco in the 20th century and that if the current smoking rates continue, 1 billion people will die in the 21st century. We estimate that a third of the patients who die at M.D. Anderson Cancer Center die simply because they smoked cigarettes. Tobacco-smoke pollution from other people's cigarettes and cigars causes around 50,000 deaths in the United States every year.

In a tobacco industry document from 1953, a senior researcher for the tobacco industry performed a literature search for his bosses and reported that cigarettes probably cause cancer. They did not inform their customers of this finding. The first Surgeon General's Report on Smoking was published in 1964 ¬ followed by 28 more reports. This includes two that are entirely about the severe health effects of tobacco-smoke pollution.

As cardiology researcher Dr. Stan Glantz puts it, "cigarettes are mini toxic waste dumps" producing at least 4,500 chemicals. About 80 of those chemicals cause cancer and others are just very toxic.

The effects of tobacco-smoke pollution can be divided into acute and chronic effects. Some of the worst effects are acute asthma attacks, especially in children, and abnormal platelet function in the coronary arteries that cause heart attacks. We now know that these acute effects occur with very short-term exposures to cigarette smoke.

The chronic effects are atherosclerotic changes of the coronary arteries leading to coronary artery disease and the carcinogens causing a variety of cancers. These cancers include the No. 1 cancer killer in men and women, lung cancer.

Smoke-free workplaces are purely a health issue. Just like asbestos in schools, lead in paint and gasoline, and salmonella in your food, it is an issue of the health of both patrons and workers. There is no right to smoke. Houstonians and Texans do have a right to breathe clean air, indoor and outdoor. Every worker has a right to be protected from toxic exposures at work, including tobacco smoke.

The most effective, and cheapest, public-health intervention Texas can implement is to make indoor air smoke-free. You not only remove the toxic effects on nonsmokers and increase the likelihood that smokers will quit smoking, but it also sends a strong message to children that smoking is not glamorous and is not a socially acceptable activity.

Cigars were relegated to the smoky back rooms 30 years ago. Cigars were going extinct until the cigar industry, with the help of a former Philip Morris CEO, reinvented itself with an amazing public relations and advertising campaign as the sexy, high-class thing to do. Cigars and cigar bars should not be afforded special rights in any legislation. Employees still work there.

Three years ago on Sept. 1, 2007, Houston became a smoke-free city, joining many others around the state. This ordinance came about through a joint effort by political leaders, minority-health coalitions, state and national societies, health institutions, physicians and concerned citizens. The indoor air in workplaces throughout the city is cleaner and healthier for the citizens of Houston. The city's clean indoor air ordinance has helped foster awareness of the risks associated with smoking and secondhand smoke.

Now is the time for each Houstonian who still smokes to make a personal commitment to quit smoking. The benefits of quitting start immediately and increase rapidly. Everyone can join Houston physicians and health care workers to raise awareness of the dangers of smoking.

Talk to your friends, family members and co-workers about their smoking. Urge them to quit smoking today.

Then we will all have even more to celebrate on the fourth anniversary of Houston becoming a smoke-free city. Maybe even a smoke-free Texas.

Dunnington is professor of radiology and director of GI radiology at the University of Texas M.D. Anderson Cancer Center.
]]> Tue, 31 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=81
City commissioners on Tuesday banned smoking in all pubs, smoke houses and truck stops with a 4-1 vote.

Commissioner Mike Seminary opposed the new law on the grounds it impacted people's right to choose.

The controversy drew 225 spectators to the Civic Center Exhibit Hall. Two very polarized sides of the audience were each given 30 minutes to testify.

The medical community came out in full force in favor of the smoking ban as did several spokespeople of the Bismarck Tobacco Free Coalition.

Dr. Steven Hamar, a Mid Dakota Clinic physician and surgeon, said some 100 studies have been done about secondhand smoke. "They all show that secondhand smoke causes heart disease, lung cancer, other cancers, heart attacks and respiratory illnesses ... pulmonary diseases and asthma," he said.

He quoted U.S. Surgeon General Richard Carmona's findings from 2006 saying, "Secondhand smoke is not a mere annoyance anymore, but a serious health threat that causes premature death and diseases in children and non-smoking adults. ... There is no risk-free level of secondhand smoke."

K.C. Chatwood of Health PRO presented 3,500 signatures from residents who favor the smoking ban. The group consists of respiratory care students and others from the University of Mary.

Chatwood said college students often socialize in bars and that being in smoky bars encourages them to start smoking. "Many students work in bars to help pay their way through college. They have to agree to the secondhand smoke — whether they want to or not," Chatwood said.

She said the ban "would protect people who work in clubs and bars. It would set a positive example for our generations and generations to come."

Amy Heuer, president of the Bismarck chapter of the Tobacco Free Coalition, said the purpose of the new code is to protect all employees and all patrons of establishments. "It is a health issue," she said. She said bar employees would not come forward in favor of the ban due to fear of reprisal.

One man suggested a non-service area be set up outside to allow smokers a place for cigarettes. He also suggested increasing license fees for bars that want to have smoking areas — $6,000 for a bar that provides a smoking room with no service — and use the extra $2,000 for treatment at the city's two hospitals.

Bar operators argued the ban would push their customers to Mandan.

"I am taken aback by the lack of compassion for the people who do smoke to allow them a place to go to enjoy their social life," said Dwight Wrangham of the North Dakota Coin and Tavern Association. "This is serious business. This will affect the lives of these bar owners, many of whom have bought these bars with the intention of catering to smokers. It's a legal thing. People do it."

Wrangham's studies showed tax numbers sunk heavily in other towns where the bars went smoke-free. He said former smoking bars in Fargo saw sales drop 5 percent and cut charitable gaming funds in West Fargo by as much as 36 percent.

Gary Schumacher, co-owner of The Stadium and The Lodge, presented 1,500 signatures from customers who opposed the smoking ban. He said the signatures were collected since last Wednesday.

"I am very concerned in the short term and the long term," Schumacher said. "It's going to be devastating for us. I think it's going to be devastating for several bar owners." He felt the four commissioners who favored the ban made up their minds long before meeting.

After the hour of testimony, commissioners gave a straw poll before voting.

"I vote no," Seminary said. "I've met with with three people who are involved in this effort and asked if they would be willing to vote for a ban on tobacco products in the city and they said, 'No.' ... I get conflicted. Is this really about a health issue?"

Seminary said insurance underwriters told him they cannot detect if people are exposed to secondhand smoke."I believe this is all about rights versus privileges," he said.

"At the end of the day, it's about health and safety," Commissioner Parrell Grossman said.

Commissioner Josh Askvig agreed, saying the public has the right to be protected from known carcinogens.

"Everyone agrees on one thing — secondhand smoke is dangerous," Commissioner Brenda Smith said. "I am not for government interference. I, too, am not happy we have to make this decision, but it comes down to we have to look at health and work safety."

Mayor John Warford said similar points were made when the first public smoking bans were adopted five years ago. He said that while he is a business owner, he also is a health care provider.

"When we look at this board, we are the board of health for the city of Bismarck," he said. "Many of the things we do deal with health and safety. ... I am supporting it because I think it is the right thing. It is our obligation as a city commissioner to look at the big picture from a health and safety standpoint."

"I am very pleased the commission decided to put the health of workers forefront in this battle," Heuer said outside the meeting. "I am very excited and look forward to the enactment date. I am looking forward to the next couple of months of helping the bar owners in making this transition."

Bar owners worried about the new law's impact on their livelihood.

"They didn't address our concerns about outside of the bar smoking. They didn't even consider smoke huts. They didn't address anything that our real concern is that Mandan wasn't going to be part of it," Schumacher said.

When asked, City Attorney Charlie Whitman said bar owners could seek an initiated measure to allow smoke huts to be added to the code.
]]> Tue, 24 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=80
Scientists led by Dr. Ronald Crystal at Weill Cornell Medical College documented changes in genetic activity among nonsmokers triggered by exposure to secondhand cigarette smoke. Public-health bans on smoking have been fueled by strong population-based data that links exposure to secondhand cigarette smoke and a higher incidence of lung diseases such as emphysema and even lung cancer, but do not establish a biological cause for the correlation. Now, for the first time, researchers can point to one possible cause: the passive recipient's genes are actually being affected. (See a new recipe for longevity that says no to smoking.)

Crystal's team devised a study in which 121 volunteers - some of whom smoked and some of whom had never smoked - agreed to have samples of their airway cells studied for genetic activity. The subjects also provided urine so the researchers could measure the amount of nicotine and its metabolites, like cotinine, for an objective record of their exposure to cigarette smoke.

Airway cells that line the bronchus, from the trachea all the way to the tiny alveoli deep in the lungs, are the first cells that confront cigarette smoke, whether it is inhaled directly from a cigarette or secondhand from the environment. Crystal's group hypothesized that any deterioration in lung function associated with cancer or chronic obstructive pulmonary disease, including emphysema and bronchitis, in which the lungs lose their ability to take in air, would begin with these cells. (See TIME's guide for good health at every age.)

And indeed, that's what he and his team found. The researchers removed airway cells from the volunteers using a bronchoscope and tested all 25,000 identified human genes in them to determine which ones were active - either turned on or off - in response to cigarettes. They narrowed the search to 372 genes that were active among the smokers but not in the cells of the nonsmokers. Based on the level of nicotine in the urine, the scientists also divided the volunteers into three groups: smokers, who showed the highest level of the tobacco metabolites; nonsmokers, who showed none of these compounds and a low-exposure group who fell in between. Comparing the 372 genes among these three groups, they found that the low-exposure group shared 34% of the same active genes with nonsmokers and 11% of the same gene activity with smokers. The low-exposure group included both nonsmokers who have never lit up as well as those who admitted to smoking only occasionally.

The results suggest that the genetic changes among the low-exposure volunteers, some of whose exposure is exclusively secondhand, mimicked those of smokers and represent the first molecular steps toward later lung disease. The study did not follow the subjects long enough to document what effect the genetic changes may actually have on the lung tissue, but Crystal says those studies are forthcoming.

"What is interesting to me is how sensitive the lung cells are to any cigarette smoke," he says. "It doesn't matter if you are walking into a cocktail party where other people are smoking or if you smoke one cigarette a week. No matter what level of exposure you have, your lung cells know it and they are responding. It's sort of like canaries in the coal mine - they are crying out and saying, 'I'm changing here, I'm changing the genes that I turn on and off in response to this environmental stress.'" (Read about Bavaria's ban on cigarettes at Oktoberfest.)

It's not clear how permanent these genetic changes are, but previous data suggests that, at least in smokers, some of the alterations may be irreversible. Smokers experience a decline in lung function that is accelerated compared with nonsmokers, and even if they kick the habit, they can never achieve the same level of function as those who never lit up. If the genetic results are confirmed, says Crystal, they may help doctors to identify those whose genetic makeup put them at higher risk of developing lung disease when exposed to cigarettes, and potentially steer them toward drugs that can help them suppress the dangerous effects of nicotine on their cells. (Comment on this story.)

In the meantime, the latest findings should reinforce public-health messages about the dangers of cigarette smoke, even if it is secondhand, says Dr. Norman Edelman, chief medical officer of the American Lung Association. "When you look at the biology, there is no safe level of exposure to tobacco smoke," he says. "This [study] adds an important piece of evidence that inhaling secondhand smoke is deleterious and does things to the airway that are not good."
]]> Fri, 20 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=79 Wrong, according to a new study that finds even low levels of smoke exposure can cause irreparable damage to cells essential to breathing.
The damage occurred among "casual" smokers and even after exposure to secondhand smoke. The initial damage, while not usually severe, can be cumulative and prolonged exposure to tobacco smoke could lead to chronic obstructive pulmonary disease (COPD) and even lung cancer, the researchers reported.
"It has been known for a long time that secondhand smoke or smoking occasionally can be risky for your health," said study author Dr. Ronald Crystal, chief of the division of pulmonary and critical care medicine at NewYork-Presbyterian Hospital/Weill Cornell, in New York City.
Just how much a little exposure might damage airway cells hasn't been clear, however.
"We found that if we could detect nicotine in the urine we could also detect changes in the genes in the cells lining the airways," said Crystal, who is also chair of the department of genetic medicine at Weill Cornell Medical College.
The bottom line: "There is no level of cigarette smoking or exposure to cigarette smoke that does not make the cells in your lungs sick," he said. "If you are an occasional smoker you are still at risk. Don't think that smoking one or two cigarettes a week means you are home free."
As for secondhand smoke, "if you are working in a place where people smoke, either get them to stop or go get another job," Crystal advised. "If you have somebody at home who smokes, send them outside to smoke. Don't be exposed to secondhand smoke."
The report is published in the Aug. 20 issue of American Journal of Respiratory and Critical Care Medicine.
For the study, Crystal's team recruited 121 people who were nonsmokers, active smokers or low-exposure smokers. To determine who belonged in which group, all participants had their urine tested for levels of nicotine.
Crystal's group next scanned each person's entire genome to determine whether genes governing airway cells were turned on or off.
They found that there was no level of nicotine or cotinine, no matter how small, that did not produce genetic abnormalities.
"These cells are like canaries in the mine, they're crying out for help -- this gene is being turned on, this gene is being turned off," Crystal said. "This now gives us clues to what are the earliest events in terms of what makes our cells go wrong and is the start of these lung diseases, like COPD and lung cancer."
Knowing which genes are damaged could provide targets for new drugs that could protect the lungs, Crystal said.
Dr. Norman H. Edelman, chief medical officer at the American Lung Association and a professor of preventive medicine, internal medicine and physiology & biophysics at Stony Brook University in New York, applauded the study. "I like this one because it cleverly uses molecular biology to answer a very important question, one that I get asked very often ... 'Is there a threshold below which inhalation of tobacco smoke is safe?'" he said. The question is usually asked as, " Is it safe to smoke a few cigarettes a week?" or, "Is it safe to hang out with smoking friends a few times a week?" Edelman added.
"Within the limits of their detection methods, the answer is 'no,'" Edelman said. "Whether the changes they see in folks with minor exposure will eventually lead to disease is unclear, but it is getting more and more clear to me that there really is no totally safe level of tobacco exposure."
]]> Fri, 20 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=78
Liquor establishments in the city will become a little less hazy at midnight, a result of a 4-3 vote by the Grand Forks City Council to ban smoking in bars, truck stops and bowling alleys.

Goulet said being a smoker makes many people incorrectly assume she's upset about the ban.

"I'm actually kind of looking forward to it because I'll smoke less probably," she said. "I think it's probably a good thing."

Goulet and a friend, Jennifer Dotson, were spending their Friday night at Rumors, enjoying their last full night of being able to have a smoke while relaxing over drinks and conversation.

Dotson said she's ready for the ban. She is a smoker, but she quickly admitted sitting in a smoky bar for a while is enough to make anyone "stink bad."

"Some nights, you go out, and when you wake up ... you can still smell the smoke," she said.

Having a cigarette during a night on the town will now just be a lot like it is when she's home – Dotson doesn't smoke inside her own house because she doesn't want her 2-year-old daughter to be around it.

"I think it would actually be better at a bar," Dotson said about the ban. "Yeah, I like to smoke and drink, but it's not really going to bother me to go outside."

Goulet said the change could help smokers decide to quit. And she thinks it won't take long before the ban seems like it's always been in place.

"Just like in Minnesota, they're going to get used to it," she said. "I was just amazed how long it took Grand Forks and North Dakota to get there."

East Grand Forks and all other Minnesota cities went smoke-free several years ago as the result of a statewide indoor smoking ban for most public places.

North Dakota passed a ban around the same time, but that did not include bars – a type of business that was exempt in Grand Forks until now.

Mac Pesch, manager of Rumor's, said his establishment plans to put containers outside to keep the littering to a minimum. And the bar might build a smoke hut this fall to give smokers a place to get out of the weather.

Pesch said the ban could hurt Rumors' gaming or even the overall business. But he also saw this type of change as something that was almost inevitable.
]]> Sat, 14 Aug 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=77 The findings, which add to the growing body of evidence linking secondhand smoke to cardiovascular disease, came from a study by University College London of more then 13,000 people in England and Scotland.

Researchers used a saliva test that can measure the amount of secondhand smoke people have been exposed to and followed the group for an average of 8 years, keeping track of who developed heart disease and who died.

Over the course of the study, 32 out of about 1,500 people who had never smoked but were exposed to high levels of secondhand smoke died of heart disease, compared to 15 out of about 1,000 "never-smokers" with low exposure.

Researcher Dr. Mark Hamer said analyses restricted to never-smokers found that high secondhand smoke exposure was associated with more than a two-fold increased risk of dying from heart disease.
A "high" level of exposure, Hamer explained, would be equivalent to living with a smoker and getting exposed to secondhand smoke pretty much every day.

About 1 in 5 of the people in the study had high exposure levels, according to the saliva test.

People exposed to a lot of secondhand smoke, as well as smokers themselves, were younger and more likely to be male, worse off financially, and less physically active than people with low exposure.
But even when controlling for these potentially confounding factors, the link between secondhand smoke exposure and heart disease remained.

The study is published in the latest issue of the Journal of the American College of Cardiology.

Hamer's team also found evidence, as have other research teams, that secondhand smoke triggers inflammation in the body, a known risk factor for heart disease.
]]> Wed, 23 Jun 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=76
The Napoleon vote is instructive because it puts the lie to the cover lawmakers have used to avoid approving a statewide ban that could be modeled after successful bans in Fargo and West Fargo.

Logan County is not a center of liberalism or government nannyism. But it is clear that voters there understand the risks of tobacco smoke and therefore put legitimate health concerns above phony business rights claims.

We say "successful" bans in Fargo and West Fargo because a new study confirms what ban supporters knew (from fallout in other cities) when they pushed for bans in Fargo and West Fargo: Economic impacts come immediately after the bans go into effect, but do not last. Bars, the study said, have done just fine without tobacco. After a short-lived blip, taxable sales for bars actually went up substantially in Fargo and West Fargo. During the same time, bar sales in Grand Forks, which has no smoke ban, dipped more than 20 percent. A Grand Forks ban goes into effect Aug. 15. Prediction: The sky will not fall on Grand Forks bars.

The study was commissioned by Fargo Cass Public Health and performed by the North Dakota State Data Center. It was released Tuesday.

Like any business sector, the bar business has churn. Some bars do well, some don't. Since the smoking ban movement took hold a few years ago, a tiny handful of bar owners whose establishments failed were quick to blame smoke bans. But other reasons – from bad management to tough competition to retirements to the economic downturn of the past few years – appear to be bigger factors than smoking bans. Good managers adjust to smoke bans, and, as the study shows, even thrive.

Legislators who are blinded by the toxic smoke of the tavern lobby might want to consider Napoleon, Fargo, West Fargo and Grand Forks when a statewide smoke ban comes up in the 2011 session, as it surely will. They should understand that whenever and wherever a smoke ban has been on the ballot, it's passed handily. They should peruse the new study that explodes the myth that bars die when a city adopts a smoking ban.

Fact is people, not bars, die because of smoking. Legislators who don't get that are in effect endorsing sickness and death.



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Forum editorials represent the opinion of Forum management and the newspaper's Editorial Board.
]]> Thu, 17 Jun 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=75
The study, commissioned by Fargo Cass Public Health and performed by the North Dakota State Data Center, found that business activity actually increased during the period examined, 2004 to 2009.

Drinking establishments in Fargo and West Fargo did experience a short-term dip in business activity, but gained over the long term, according to the study.

The results were released by the Smoke-Free Air for Everyone coalition, which advocates for comprehensive smoking bans.

So far, Fargo, West Fargo, Grand Forks and Napoleon have adopted smoke-free ordinances. Devils Lake voters will decide the issue in November and Minot is conducting a smoke-free opinion survey.

North Dakota takes in less than $22 million a year from cigarette taxes, but pays $442 million in direct medical and lost productivity from tobacco use, according to figures from the North Dakota Department of Health.

For more on the story read The Forum Wednesday.
]]> Tue, 15 Jun 2010 00:00:00 GMT http://www.breathend.com/news/detail.asp?newsID=74
This week's vote was 263 in favor of the ban and 94 against, meaning three-fourths of voters approved the idea.

Bar owners were split on the issue. The Downtowner Bar wanted to go smoke-free but Freddie's did not.]]> Sat, 12 Jun 2010 00:00:00 GMT