Pipe lovers ride a trend with hot new flavors

Bowling Green is ideal for spring and summer strolls. Hell’s Kitchen is a dark and dingy domain for gritty New Yorkers. And Liberty Island is the place to honor the city’s cultural diversity.
The best thing about these local landmarks: You can now put them in your pipe and smoke ’em!
A group of traditional tobacconists has turned this town into tobacco flavors with a series of pipe blends based on New York icons.
“The tastes are supposed to give smokers something that’s uniquely New York,” says Lou Carbone, president of the New York Pipe Club. “We wanted to avoid cliches about how the Big Apple should taste.”

Now in its fifth decade, the Pipe Club is one of the city’s venerable smoking organizations. But it recently turned a new leaf with its New York State of Mind series, blended by one-time New Yorker Russ Oullette.
So what does New York taste like when it’s turned into tobacco? Put on your smoking jacket and take a tour from your easy chair:
* The Bowling Green blend packs a faint feeling of the fresh outdoors (though, of course, it is illegal to smoke in any park). This is a Virginia blend — meaning that it’s a light and mild smoke — with a savory and citrusy sensation. Perfect for the warmer weather.

The future for smokers

To mark the 70th anniversary of the publication of George Orwell's 1984, Mayor Olivia Nutter today signed an executive order banning cigarette smoking within the city limits. The ban extends to e-cigs, but not marijuana.
The mayor exempted new postal zone 19019 - carved out of Eastwick and Paschall - as a "refuge" where smokers will be forced to live. It is adjacent to the carcinogenic oil refineries.
Nutter said "19019 will be known as Tobacco Town," objected to opponents' use of the term "ghetto" and said ordering smokers to wear a bright yellow "S" on their clothing was nothing more than a "health warning for nonsmokers to stay away."
Asked why she didn't simply ban cigarettes, the mayor said that would be an "infringement of civil liberties, and besides, we use cigarette-tax money to run the schools and to fund food stamps for smokers."
Food stamps have been provided since 2016, when all American cigarette smokers were fired under the "We Will Make You Healthy or Kill You Act."
Ten years earlier, Westgate Resorts, the largest private employer in central Florida, fired employees who smoked. "When I found out it was legal to discriminate against smokers, I put the policy in place," Westgate president and CEO David Siegel said.
Other employers followed suit, saying that firing smokers would reduce their health-care costs.
Using the same rationale, employers then began to fire fat employees, resulting in a wave of American unemployment and more visas for skinny foreigners.
The mass firings followed earlier actions banning smoking in workplaces, restaurants, bars, college dorms and public housing. The housing ban was attacked as discrimination against the poor, but it survived court challenges.
Next came smoking bans in condominiums, with smoker/owners being grandfathered, but prohibiting sale to smokers. Under the Big Brother Act, potential purchasers were required to take a urine test to detect nicotine. That led to the scandal of a black market in clean urine, organized by Lance Armstrong.
Smoking was considered so pernicious that after banning smoking in cars carrying children, child-custody laws were rewritten to award custody to the nonsmoking parent. When both parents were smokers, children were turned over to the Department of Human Services.
In Philadelphia, the original author of anti-smoking legislation was Michael Nutter (the current mayor's father), who banned smoking in workplaces and bars under the heading of the "Clean Indoor Air Worker-Protection Law."
His last "smoking" gun was an executive order in 2014 banning smoking in all city parks, including the 9,200-acre Fairmount Park.
At the time, he gave three reasons: 1) To protect the environment from cigarette butts; 2) to protect people from secondhand smoke; 3) to help people quit.
Critics said that littering was already against the law and that ashtrays - like trash cans for other litter - could relieve the butt problem; that the vast expanse of the park system protects people from secondhand smoke, and that quit-smoking programs (which the city offers) were better options. But they were easily brushed aside by the majority.
"It remains legal to discriminate against smokers," Mayor Olivia said. "And Philly will."

The Weird Link Between E-Cigarettes and Mental Health Disorders

A new study finds elevated rates of depression, anxiety and other mental disorders among users of e-cigarettes

A new study has found that people suffering from depression, anxiety and other mental disorders are more than twice as likely to spark up an e-cigarette and three times as likely to “vape” regularly than those without a history of mental issues.
Researchers at the University of California, San Diego drew their findings from an extensive survey of American smoking habits. Among 10,041 respondents, 14.8% of individuals suffering from mental health disorders said they had tried an e-cigarette, compared with 6.6% of individuals who had no self-reported history of mental disorders.
The e-smokers’ elevated rates of mental disorders reflected the elevated rates of mental illness among smokers in general. The authors note that by some estimates, people suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.
Many respondents said they switched to e-cigarettes as a gateway to quitting. The FDA has not yet approved e-cigarettes as a quitting aide.
“People with mental health conditions have largely been forgotten in the war on smoking,” study author Sharon Cummins said in a university press release. “But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon.”

Certain places you can smoke a cigarette

SMOKERS should prepare for the day when they are virtually confined to lighting up in their own backyards. They will not be able to smoke on footpaths, and feeding their habits in public will be restricted to a few designated smoking zones.

Dr Penman said it was becoming increasingly unacceptable that people could be subjected to drifts of smoke from fellow pedestrians when they walked down the street.

"It should get to the stage where there are only certain places you can smoke a cigarette, that is, smoking-permitted parks or small squares," he said. "We are recommending to the government that outdoor smoking needs to move . . . to the assumption that smoking is prohibited from all outdoor areas unless otherwise stated."

NSW legislation already bans smoking from enclosed public areas, workplaces, hospitals and cars carrying passengers under 16. In what anti-smoking campaigners describe as a loophole, lighting up is still allowed in semi-enclosed rooms in pubs and clubs.

Heart Foundation NSW chief executive Tony Thirlwell said 74 of the 152 councils in NSW had introduced smoke-free outdoor areas policies, with 14 of those policies covering alfresco dining areas.

Anne Jones, chief executive of Action on Smoking and Health, known as ASH Australia, said councils had taken responsibility where the NSW government "was doing nothing".

But the smoking battleground has moved from indoors to outdoors, with councils leading the charge. Smoking is banned in many children's playgrounds, sports fields, public pools, beaches, outdoor dining areas and bus shelters.

The latest councils to enact smoke-free policies are City of Sydney, Leichhardt and Waverley. Warringah is expanding its policy to cover bus shelters and the grounds of Brookvale Oval. Newcastle has banned smoking at bus shelters. Mr Thirlwell said the next step should be a state law banning smoking in all outdoor crowded areas, including concerts.

Queensland and Victoria had been more active. "The focus up to now has been protecting people indoors," she said. "Now, it's crowded outdoor areas."

Ms Jones praised tough measures announced last week by the Rudd government to raise the prices of cigarettes by about $2 and mandate plain packaging by 2012. In another federal assault on the tobacco industry, displays of its products in shops will stop by July 1.

Smoking kills 15,000 people a year in Australia. The government's aim is to reduce the smoking rate from 16 per cent to 10 per cent within the decade.

People who give up smoking are prone to developing diabetes

“People who give up smoking are prone to developing diabetes because they gain weight,” TheTimes reported. It said a study has found that quitters are twice as likely as smokers, and 70% more likely than non-smokers, to have type 2 diabetes.

This study found that smokers and recent quitters had a greater risk of diabetes compared to those who had never smoked, but that three years after quitting this risk had reduced. The suggestion that this is because quitters are more likely to gain weight is logical, but it cannot be proven by this cohort study.

The results of this study do not mean that smoking is protective to health. Smokers and former smokers were at greater risk of diabetes than those who had never smoked, and the benefits of giving up far outweigh any temporary increase in risk. Instead, these findings emphasise the importance of an active lifestyle and a healthy balanced diet, and demonstrate the importance of providing quitters with education and support to achieve this.

Where did the story come from?

This research was carried out by Hsin-Chieh Yeh and colleagues from Johns Hopkins University, Baltimore; the Federal University of Rio Grande do Sul, Brazil and the University of North Carolina, Chapel Hill. The study was funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Disease. It was published in the Annals of Internal Medicine.

What kind of research was this?

This cohort study enrolled a large group of middle-aged people who were free of diabetes, and followed them up over nine years to assess whether quitting smoking affected the risk of diabetes.

Where a randomised controlled trial (RCT) would be unethical, a cohort study is the best alternative for examining whether a particular exposure, in this case quitting smoking, increases the risk of a certain disease developing over time. The research needs to ensure that people are free from the disease at the beginning of the study, and take into account other confounding factors that could influence any observed associations.

What did the research involve?

The data for this study were obtained from a previous study on atherosclerosis called the Atherosclerosis Risk in Communities (ARIC) study, which recruited middle-aged people from several sites in the US. The ARIC recruits visited a clinic between 1987 and 1989, and then had three follow-up visits scheduled at about three-year intervals from 1990 to 1998. From this point onwards until 2004, they were only contacted by phone. Smoking status and number of cigarettes smoked was assessed at every follow-up. The development of diabetes up to the last clinic visit in 1998 was determined by fasting blood glucose levels, and from 1998 up to 2004 by self-report of a doctor’s diagnosis of diabetes or use of diabetes medications.

For this particular study, the 17-year follow-up information from the ARIC study was used for the 9,398 middle-aged adults who were free from diabetes when ARIC began and in the first three years of follow-up, and who had information on smoking status at each point during follow-up. For all participants, physical examination, various other medical data and information on other lifestyle factors were collected during follow-up, and various analyses carried out.

People were grouped according to how much they smoked at the beginning of the study. This was calculated as pack-years smoked (average number of cigarettes per day multiplied by the years of smoking divided by 20). People who were lifelong non-smokers formed the control group. For each category the incidence of diabetes during follow-up was calculated.

To assess the effect of quitting smoking on diabetes risk, the researchers looked at the effect of a change in smoking status from the start of the study to the first three-year follow-up, and risk of diabetes at the three and nine-year follow-ups. They also looked at the change in smoking status and the effects on various metabolic variables, such as weight, waist and hip circumference, blood pressure and cholesterol. A number of other statistical analyses were then carried out, including an assessment of how various measures at the beginning of the study could affect weight-gain risk, how various other factors affected diabetes risk, and analyses using only self-reported data.

That multiple statistical tests were carried out is a slight drawback to the study. There are also likely to have been some unavoidable inaccuracies in self-reported measures such as duration of smoking, number of cigarettes smoked and time since quitting.

What were the basic results?

The study found that smoking increased the risk of diabetes, and that there was a dose-response relationship, meaning that the more packs smoked the greater the diabetes risk. Quitting smoking was also associated with increased risk compared to never smoking. New quitters at three-year follow up (380 of them) were 1.73 times more likely than those who had never smoked to develop diabetes. However, when the analysis was adjusted for weight change, white blood cell count at the beginning of the study and all other known risk factors for diabetes (including gender, BMI, waist circumference, physical activity, triglyceride level, cholesterol, blood pressure), the incidence was 1.24 times greater in quitters than those who had never smoked, but this was no longer significant.

The highest risk of diabetes for quitters occurred in the first three years, but gradually reduced to zero at 12 years. Former smokers who had smoked more than three years ago did not have a significantly increased risk of diabetes.

How did the researchers interpret the results?

The researchers concluded that cigarette smoking increases the risk of developing type 2 diabetes, but that quitting smoking also increases the risk in the short term. They advise that smokers who have other risk factors for diabetes receive smoking cessation care coupled with strategies for diabetes prevention and early detection.

Conclusion

Smoking is associated with an increased risk of diabetes, and the current study confirms this. However, the effect of quitting smoking on diabetes risk has been unclear until now. This study found that quitting is associated with an increased risk of developing diabetes in the short term, but that this risk decreases over time. When the researchers adjusted their analyses for weight change since quitting this affected the risk.

This was a well conducted study that carried out extensive follow-up on a large number of participants. However, there are some points to consider:

·         As the authors acknowledge, though they adjusted for various established diabetes risk factors, there is still the possibility of residual confounding from unmeasured factors.

·         Several of the self-reported measures, most notably smoking status, frequency of smoking and time since quitting, are likely to involve some degree of inaccuracy.

·         Multiple statistical tests were carried out, and this is a slight drawback to this research, as it increases the risk that the findings are due to chance only. However, this likelihood is reduced by the fact that the study specified its research hypothesis prior to the start of the study.

·         The theory is that, while quitting smoking may reduce inflammation in the body and so reduce diabetes risk, the weight gain that quitters often experience could adversely influence this risk. Although this pattern may be suggested by these results, no firm conclusions can be made. Adjusting for weight change did reduce the strength of the association between quitting and diabetes risk but the risk remained significant indicating that there are other factors involved. In addition, the reasons for the person’s weight gain have not been examined.

The recommendation of the researchers seems sensible. Smokers who quit should receive advice about avoiding weight gain, diabetes prevention and how to spot the early signs of the disease.