Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100

Abstract Background Emerging data suggest variability in susceptibility and outcome to coronavirus disease 2019 (COVID-19) infection. Identifying risk factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations. Methods We analyzed electronic health records of the US Veterans Affairs Healthcare System and assessed the prevalence of COVID-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for COVID-19 who were positive, as well as outcome attributable to COVID-19, and stratified by clinical characteristics including demographics, comorbidities, cancer treatment, and cancer type. All statistical tests are 2-sided. Results Of 22 914 cancer patients tested for COVID-19, 1794 (7.8%) were positive. The prevalence of COVID-19 was similar across age. Higher prevalence was observed in African American (15.0%) compared with White (5.5%; P < .001) and in patients with hematologic malignancy compared with those with solid tumors (10.9% vs 7.8%; P < .001). Conversely, prevalence was lower in current smokers and patients who recently received cancer therapy (<6 months). The COVID-19–attributable mortality was 10.9%. Higher attributable mortality rates were observed in older patients, those with higher Charlson comorbidity score, and in certain cancer types. Recent (<6 months) or past treatment did not influence attributable mortality. Importantly, African American patients had 3.5-fold higher COVID-19–attributable hospitalization; however, they had similar attributable mortality as White patients. Conclusion Preexistence of cancer affects both susceptibility to COVID-19 infection and eventual outcome. The overall COVID-19–attributable mortality in cancer patients is affected by age, comorbidity, and specific cancer types; however, race or recent treatment including immunotherapy do not impact outcome.

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Influence of Warning Statements on Understanding of the Negative Health Consequences of Smoking

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa031 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1805-1815 ◽

Cited By ~ 1

Author(s):

Jessica K Pepper ◽

Anh Nguyen Zarndt ◽

Matthew E Eggers ◽

James M Nonnemaker ◽

David B Portnoy

Keyword(s):

Cigarette Smoking ◽

Treatment Condition ◽

Public Understanding ◽

Health Warnings ◽

Health Consequences ◽

Follow Up Study ◽

New Information ◽

The Us ◽

Us Fda

Abstract Introduction Pursuant to the Tobacco Control Act (TCA), the US Food and Drug Administration (FDA) is developing new cigarette health warnings to convey the negative health consequences of cigarette smoking. Aims and Methods This study assessed which of 15 revised warning statements (10 on topics similar to TCA statements and 5 on other topics) promoted greater understanding of cigarette smoking risks relative to TCA statements. In February 2018, adolescent and adult smokers and adolescents susceptible to smoking (n = 2505) completed an online experiment. Control condition participants viewed TCA statements; treatment condition participants viewed combinations of TCA and revised statements. Analyses compared revised statements to TCA statements on the same health topic or to randomly selected TCA statements if there were no statements on the same topic. Results Relative to TCA statements, 12 of 15 revised statements were more likely to be considered new information, and 12 resulted in more self-reported learning. Three revised statements made participants think more about health risks than TCA statements; the reverse was true for one revised statement. Participants rated most TCA and revised statements as moderately believable and informative. Seven revised statements were found to be less believable and factual, and one revised statement more believable and factual. Treatment condition participants correctly selected more smoking-related health conditions than control condition participants (13.79 versus 12.42 of 25). Conclusions Findings suggest that revised statements can promote greater understanding of cigarette smoking risks. Results informed FDA’s selection of warning text that was paired with images for testing in a follow-up study. Implications The US FDA may adjust the text of the cigarette warning statements provided in the TCA if the revised statements promote greater public understanding of the negative health consequences of cigarette smoking. Most of the revised warning statements tested were more likely to be considered new information and resulted in more self-reported learning compared with paired TCA statements, providing support for using revised statements as part of cigarette health warnings. These results informed the development of pictorial cigarette warnings by FDA that were tested in a follow-up study and included in a proposed rule.

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Estimating the Potential Public Health Impact of Prohibiting Characterizing Flavors in Cigars throughout the US

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183234 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3234

Author(s):

Brian L. Rostron ◽

Catherine G. Corey ◽

Enver Holder-Hayes ◽

Bridget K. Ambrose

Keyword(s):

Public Health ◽

Smoking Prevalence ◽

Prediction Interval ◽

Health Benefits ◽

Health Impact ◽

Attributable Mortality ◽

The Us ◽

Cigar Smoking ◽

Potential Public Health ◽

Over Time

Flavored cigar use is common among cigar smokers, particularly those at younger ages. Several US localities have implemented policies restricting the sale of flavored tobacco products, including cigars. We estimated the population health benefits of removal of flavored cigars throughout the US in terms of reductions in cigar smoking-attributable mortality due to increased cessation and reductions in cigar smoking prevalence due to decreased initiation and continuing use. Monte Carlo simulation was used to estimate possible ranges for these values. We used published estimates of cigar use and attributable mortality in the US, as well as prior study conclusions on the effect of local and national flavor restriction policies. We estimated that removal of flavored cigars would result in approximately 800 (90% prediction interval = 400–1200) fewer cigar smoking-attributable deaths in the US each year and 112,000 fewer cigar smokers (90% prediction interval = 76,000–139,000) in each cohort of 18 year olds. The removal of characterizing flavors in cigars sold in the US is thus projected to have substantial public health benefits over time.

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Prevalence and outcome of Covid-19 infection in cancer patients: a national VA study

10.1101/2020.08.21.20177923 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nathanael R Fillmore ◽

Jennifer La ◽

Raphael E Szalat ◽

David P Tuck ◽

Vinh Nguyen ◽

...

Keyword(s):

Cancer Patients ◽

Hematologic Malignancy ◽

Current Smoker ◽

Attributable Mortality ◽

Veterans Administration ◽

Cancer Type ◽

Morbidity Score ◽

Co Morbidity ◽

The Us ◽

Cancer Types

Background: Emerging data suggest variability in susceptibility and outcome to Covid-19 infection. Identifying the risk-factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations. Methods: We analyzed electronic health records of the US National Veterans Administration healthcare system and assessed the prevalence of Covid-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for Covid-19 and their confirmed positivity, with clinical characteristics, and outcome, and stratified by demographics, comorbidities, cancer treatment and cancer type. Results: Of 22914 cancer patients tested for Covid-19, 1794 (7.8%) were positive. The prevalence of Covid-19 was similar across all ages. Higher prevalence was observed in African-American (AA) (15%) compared to white (5.5%; P<.001), in Hispanic vs non-Hispanic population and in patients with hematologic malignancy compared to those with solid tumors (10.9% vs 7.7%; P<.001). Conversely, prevalence was lower in current smoker patients, patients with other co-morbidities and having recently received cancer therapy (<6 months). The Covid-19 attributable mortality was 10.9%. Highest mortality rates were observed in older patients, those with renal dysfunction, higher Charlson co-morbidity score and with certain cancer types. Recent (<6 months) or past treatment did not influence mortality. Importantly, AA patients had 3.5-fold higher Covid-19 attributable hospitalization, however had similar mortality rate as white patients. Conclusion: Pre-existence of cancer affects both susceptibility to Covid-19 infection and eventual outcome. The overall Covid-19 attributable mortality in cancer patients is affected by age, co-morbidity and specific cancer types, however, race or recent treatment including immunotherapy does not impact outcome.

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Deaths Attributable to Cancer in the US Human Immunodeficiency Virus Population During 2001–2015

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1016 ◽

2020 ◽

Author(s):

Marie-Josèphe Horner ◽

Meredith S Shiels ◽

Ruth M Pfeiffer ◽

Eric A Engels

Keyword(s):

Human Immunodeficiency Virus ◽

Proportional Hazards ◽

Kaposi Sarcoma ◽

Cancer Registries ◽

The United States ◽

Population Based ◽

Cox Proportional Hazards ◽

Attributable Mortality ◽

Immunodeficiency Virus ◽

The Us

Abstract Background Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001–2015. Methods We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality, we could perhaps cut these words to accommodate the word limit. However readers will probably want to know what statistical adjustments were made to the model. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non–AIDS-defining cancers. Results Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non–AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001–2005 to 313.6 per 100 000 person-years during 2011–2015, while the PAF increased from 12.6% to 17.1%; the PAF for non–AIDS-defining cancers increased from 7.2% to 11.8% during 2011–2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non–AIDS-defining cancers. Conclusions Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non–AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality.

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Adult invasive pneumococcal disease pre- and peri-pneumococcal conjugate vaccine introduction in a tertiary hospital in Singapore

Journal of Medical Microbiology ◽

10.1099/jmm.0.003764-0 ◽

2009 ◽

Vol 58 (1) ◽

pp. 101-104 ◽

Cited By ~ 8

Author(s):

Li-Yang Hsu ◽

See Weng Lui ◽

Jia Ling Lee ◽

Hazwany Md Mahrom Hedzlyn ◽

Debra Han-Lin Kong ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Pneumococcal Disease ◽

Tertiary Hospital ◽

Invasive Disease ◽

Polysaccharide Vaccine ◽

Attributable Mortality ◽

Study Cohort ◽

Pneumococcal Polysaccharide Vaccine ◽

Vaccine Introduction ◽

The Us

Streptococcus pneumoniae isolates causing invasive disease at a large tertiary institute in Singapore from 2000 to 2007 were serotyped, with 84 (43.8 %) and 159 (82.8 %) isolates belonging to serotypes covered by the pneumococcal heptavalent conjugate and polysaccharide vaccines, respectively. All non-meningitis isolates were susceptible to penicillin, and the attributable mortality was 21.4 %. Patients who fulfilled the US Advisory Committee on Immunization Practices criteria for vaccination with the pneumococcal polysaccharide vaccine comprised 74.0 % of the study cohort and had a significantly higher mortality risk.

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Impact of Pictorial Cigarette Warnings Compared With Surgeon General’s Warnings on Understanding of the Negative Health Consequences of Smoking

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa032 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1795-1804

Author(s):

Jessica K Pepper ◽

Anh Nguyen Zarndt ◽

Matthew E Eggers ◽

James M Nonnemaker ◽

David B Portnoy

Keyword(s):

Tobacco Control ◽

Health Beliefs ◽

Smoking Prevention ◽

Health Warnings ◽

Health Consequences ◽

Treatment Conditions ◽

New Information ◽

The Family ◽

The Us ◽

Selection Of

Abstract Introduction The Family Smoking Prevention and Tobacco Control Act requires cigarette packages and advertisements to bear health warnings with “color graphics depicting the negative health consequences of smoking.” Aims and Methods This study assessed whether new US Food and Drug Administration developed pictorial cigarette warnings (PCW) increased understanding of smoking-related risks relative to the current Surgeon General’s (SG) warnings. In March–May 2019, adolescent and adult smokers and nonsmokers participated in an online experiment with three sessions completed over approximately 2 weeks. Participants viewed 1 of 16 PCW (treatment conditions) or an SG warning (control) on mock cigarette packages and advertisements. Measures assessed whether warnings provided new information, induced thinking about risks, changed smoking-related health beliefs, and were accurately recalled, among other outcomes. Results The majority of PCW (≥13 conditions) resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks; they were viewed as more informative, understandable, and attention-drawing compared with the control condition. Most participants believed the warning were factual, although 8 PCW were perceived as less factual than the control. There were changes toward more agreement with health beliefs for 11 PCW between Sessions 1 and 2 and 7 PCW between Sessions 1 and 3. Participants in all treatment conditions were more likely than control condition participants to correctly recall the warning. Across outcomes, PCW related to addiction, death, and quitting did not perform as well as other PCW. Conclusions Many of the PCW tested increased understanding of the risks associated with cigarette smoking relative to current SG warnings. Implications The Tobacco Control Act requires cigarette packages and advertisements to bear PCW depicting the negative health consequences of smoking. This study tested whether any of 16 newly proposed PCW increased understanding of smoking-related risks relative to existing SG warnings. Results suggest that most PCW tested, particularly those related to less widely known health effects, resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks compared with SG warnings. These results, along with other factors, informed the US Food and Drug Administration’s selection of proposed PCW.

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Shock and awe or incentive-compatible harm reduction? Graphic health warnings on tobacco packages

Harm Reduction Journal ◽

10.1186/s12954-021-00487-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Ian Irvine ◽

Hai V. Nguyen

Keyword(s):

Health Warnings ◽

Difference In Differences ◽

Incentive Compatible ◽

The Us ◽

Reduced Products ◽

Quasi Experimental ◽

Suitable Treatment ◽

Alternative Type ◽

Alternative Approaches ◽

Statistics Canada

Abstract Background Graphic Health Warnings (GHWs) on cigarette packages were first introduced in Canada in 2001 and will become mandatory in the US as of January 2022. While previous studies have evaluated the impacts of GHWs, the data used in these studies have several shortcomings. The objective of this paper was to investigate the likely impact of such warnings in the US based upon the experience of Canada using hitherto unexplored monthly cigarette sales data, and to explore if alternative approaches involving risk-reduced products might be more successful in reducing smoking. Methods We used quasi-experimental segmented regression and difference-in-differences analyses. Data on monthly sales (i.e., shipments) of cigarettes from Canadian manufacturers to Canadian retailers during 1995–2005 were obtained from Statistics Canada. Results We found that GHWs did not have a significant impact on the sales of cigarettes in Canada. We propose an alternative type of graphical health messaging that actively combines information on how to quit with the legally required messaging. The novelty of the proposal is that it is incentive compatible for the supply side of the market and if adopted in several states, the measure could be tested by using a suitable treatment–control design. Conclusions Our findings imply that we should not expect any notable decline in sales or consumption as a result of implementation of GHWs in the US. The main impact of GHWs will be to add to the anti-smoking culture that has grown steadily over several decades, and this may impact smoking in the longer term.

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Influence of package colour, branding and health warnings on appeal and perceived harm of cannabis products among respondents in Canada and the US

Preventive Medicine ◽

10.1016/j.ypmed.2021.106788 ◽

2021 ◽

Vol 153 ◽

pp. 106788

Author(s):

Samantha Goodman ◽

Vicki L. Rynard ◽

Maryam Iraniparast ◽

David Hammond

Keyword(s):

Health Warnings ◽

The Us ◽

Perceived Harm

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The Eleventh Circuit Holds that Agreements in which Pharmaceutical Companies Pay Generic Companies Not to Compete May be Valid

The Journal of Law Medicine & Ethics ◽

10.1017/s107311050000749x ◽

2004 ◽

Vol 32 (1) ◽

pp. 181-184

Author(s):

Amy Garrigues

Keyword(s):

Pharmaceutical Companies ◽

Court Decisions ◽

Patent Holder ◽

Trial Court ◽

Court Of Appeals ◽

The Us ◽

Antitrust Laws ◽

Per Se ◽

Appeals Court ◽

Two Sides

On September 15, 2003, the US. Court of Appeals for the Eleventh Circuit held that agreements between pharmaceutical and generic companies not to compete are not per se unlawful if these agreements do not expand the existing exclusionary right of a patent. The Valley DrugCo.v.Geneva Pharmaceuticals decision emphasizes that the nature of a patent gives the patent holder exclusive rights, and if an agreement merely confirms that exclusivity, then it is not per se unlawful. With this holding, the appeals court reversed the decision of the trial court, which held that agreements under which competitors are paid to stay out of the market are per se violations of the antitrust laws. An examination of the Valley Drugtrial and appeals court decisions sheds light on the two sides of an emerging legal debate concerning the validity of pay-not-to-compete agreements, and more broadly, on the appropriate balance between the seemingly competing interests of patent and antitrust laws.

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