Wider use of methadone urged. WASHINGTON (AP, Dec. 9, 1998) - The administration's push to expand the use of methadone treatment is getting a boost from a panel of scientists who say the synthetic narcotic helps decrease drug use and criminal activity among heroin addicts. The 12 scientists convened by the National Institutes of Health acknowledge that methadone is not a panacea for substance abuse. But in a report published Wednesday in the Journal of the American Medical Association, the panel finds that heroin addiction is a treatable disease and urges the government to expand the availability of methadone programs. JAMA, Dec. 9, 1998.

Health Claims on Labels   The U.S. Supreme Court earlier this week refused to hear a challenge to the government's practice of barring health claims on labels of dietary supplements unless the Food and Drug Administration (FDA) finds there is "significant scientific agreement'' they are valid. Under a 1990 federal law (Nutrition Labeling and Education Act) that gives the FDA authority over health claims on dietary supplement products such as medicinal herbs and vitamins sold over the counter, the agency issued regulations that imposed "significant scientific agreement" as the standard for deciding whether a particular health claim could be made on a label. A group of manufacturers and retailers of dietary supplements calling itself The Nutritional Health Alliance sued over the FDA regulations (along with a health food store, New Nutrisserie). They contended that the labeling restriction amounts to an unlawful prior restraint of truthful commercial speech.

MAJOR NEW TOBACCO RESEARCH FUNDS (US DHHS press release, Dec. 4, 1998). Vice President Gore has announced major new tobacco research funding initiatives that, in the words of an NCI statement, "will alter the way tobacco control research has been traditionally conducted." This infusion, combined with new research funds from the tobacco settlement, could set the stage for major advances. The funding efforts are based on recommendations from the National Cancer Institute's (NCI) Tobacco Research Implementation Group (TRIG), which recommended "nine unique, overarching research opportunities" that need "immediate implementation."

NCI is working to implement the recommendations quickly. "As the first step in following the plan, we are launching two major research initiatives that will be funded at $142 million over five years," says NCI Director Richard Klausner. These are...

TRANSDISCIPLINARY TOBACCO RESEARCH CENTERS PROGRAM. The program is co-funded by NCI ($50 million) and the National Institute on Drug Abuse (NIDA, $20 million). NIH states that "advances in molecular biology, genetics, and behavioral science now provide unparalleled opportunities to study the tobacco problem in ways that will integrate biological and psychosocial models of tobacco and addiction." The Research Centers program will address questions such as: "Why do children start smoking? How can people be helped to quit smoking? Are there genes that predispose people to tobacco addiction?"

STATE AND COMMUNITY TOBACCO CONTROL INTERVENTION RESEARCH. Funded at $72 million by NCI, the program will evaluate state and community tobacco control interventions with an emphasis on mass media and policy interventions aimed at prevention and cessation.

The other seven research opportunities identified by TRIG: * Basic bio-behavioral research on the multidisciplinary factors that influence tobacco use initiation, progression, and cessation; * How best to tailor tobacco cessation interventions to specific subgroups; * The best dissemination mechanisms for proven prevention and treatment interventions;   * Impact of various tobacco control policies;  * Basic biological research on biomarkers of tobacco exposure and on tobacco-induced cellular events linked with stages of carcinogenesis;  * Genetic and environmental interactions in susceptibility to tobacco-related cancers;
* Expanded surveillance systems to monitor behaviors and tobacco-related interventions.

==> TRIG Plan and general information:  http://rex.nci.nih.gov/massmedia/pressreleases/tobacco.htm.
==> Transdisciplinary Tobacco Use Research Centers information:
http://deainfo.nci.nih.gov/concepts/TobaccoCentersRFA.htm.
==> Research in State and Community Tobacco Control Interventions
information: http://deainfo.nci.nih.gov/concepts/TobaccoComRFA.htm

TOBACCO SETTLEMENT (US DHHS Press release, Dec. 4, 1998). The recent multi-state tobacco settlement, while falling short in important areas, includes provisions that could dramatically increase funding for tobacco related research and interventions. Most important is the National Public Education Fund.

The Fund's purposes "will be to support (1) the study of and programs to reduce youth tobacco product usage and youth substance abuse in the states; and (2) the study of and educational programs to prevent
diseases associated with the use of tobacco products in the states," according to the settlement. Among the Fund's multiple responsibilities:
* Commission studies, fund research, and publish reports on factors that influence youth smoking and substance abuse.  * Track and monitor youth smoking and substance abuse with a focus on
the reasons for increased or failure to decrease tobacco and substance use rates. * Develop, disseminate, and test the effectiveness of counter advertising campaigns.  * Carry out a nationwide, sustained advertising and education program to counter youth tobacco use and educate consumers about the cause and prevention of diseases associated with tobacco use.

The Fund will be established by the National Association of Attorneys General, and will be funded by annual $25 million contributions from the tobacco industry.

Some questions remain: Will the money come through? Will it be allocated according to the needs of public health? Advocates encourage concerned individuals to get involved at the state level to ensure settlement funds are available and well spent. Even if funds are well spent, many — both in the advocacy community and in the general public; feel that the settlement is insufficient. A new Center for Tobacco Free Kids survey found that the majority of Americans "believe it is important for the new Congress to pass comprehensive legislation to implement additional tobacco control measures not included in the settlement."

TAKE ACTION
==> Read the settlement legislation: http://www.naag.org/issues/tobacco/index.php?smod=399  
==> Contact your state's Attorney General to request that settlement funds be spent on tobacco and other public health programs:  http://www.naag.org.
==> Join the Campaign for Tobacco Free Kids national action network:  http://www.tobaccofreekids.com/.  


AGENCY FOR HEALTH CARE POLICY & RESEARCH
The banner headline on the Agency for Health Care Policy and Research's (AHCPR) website reads, "Attention Researchers: Grant Money Available!" The website continues, "AHCPRs Fiscal Year 1999 budget of
$171.055 million will allow the Agency to double the amount it awarded last year for investigator-initiated grants and to pursue critical national priorities, including research on quality and outcomes."

Currently, there are scant data on such issues as behavioral and social intervention cost, cost effectiveness, and patient satisfaction. Lack of data is a barrier to integrating interventions into the mainstream of health care. The time is ripe for initiating more collaborative projects between health and behavior researchers and health services researchers, and for using AHCPR grants to train more health and behavior researchers in health services research.

AHCPR has particular interest in proposals that advance the following priorities: outcomes for the elderly and chronically ill; clinical preventive services; centers for education and research's therapeutics; improving the quality of children’s health; pharmaceutical outcomes research; evidence-based practice; primary care research; shared decision-making; consumer decision-making; costs, quality, and outcomes; quality measurement and improvement. Proposals that place extra focus on vulnerable populations, and that promote partnerships with potential users of the findings will be favored.
==> AHCPR website: http://www.ahcpr.gov

BEHAVIORAL RESEARCH IN DIABETES The NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) currently receives a relatively small number of grant applications related to behavioral science in diabetes, according to Sanford Garfield, PhD, Senior Advisor for Biometry and Behavioral Research in NIDDK's Division of Diabetes Endocrinology and Metabolism.  Garfield emphasizes that "type 2 diabetes is a disease that requires behavioral intervention," and urges behavioral scientists and trainees to submit high quality applications.

What sort of proposals does NIDDK want? Garfield describes NIDDK's diabetes/ behavior research priorities as "fairly broad," including psychosocial aspects of diabetes, the psychological implications of diabetes and their effects on control of diabetes or on physical outcomes, translational research, screening, diagnosis, and self-awareness of diabetes. He notes that NIDDK is working on an outline of priorities in preparation for a Fall 1999 conference on diabetes and behavior. The Health and Behavior Alliance has also  given Garfield a copy of its list of "extraordinary research opportunities" in diabetes, which it recently sent to the congressionally-mandated Diabetes Research Working Group.

==> For information about NIDDK and its grants and activities:
http://www.niddk.nih.gov/fund/divisions/DEA/Council/coundesc.htm.
==> To discuss a research idea: Sanford Garfield, Senior Advisor for Biometry and Behavioral Research, garfields@ep.niddk.nih.gov.
 

Doctors weigh pros, cons of online medicine. DURHAM, N.C. (Reuters, Oct. 20, 1998) - Diagnosing illnesses in cyberspace may be a distant reality, but more physicians should take advantage of the Internet and e-mail to inform and communicate with patients, researchers said Tuesday. "E-mail has become a ubiquitous tool for communicating with business associates, friends and family. So there should be little surprise that Net-savvy patients would like greater digital access to their physicians," said Tom Ferguson, the author of an editorial in a special edition of the Journal of the American Medical Association devoted to the subject. Only 1-2% of U.S. physicians offer patients the option of contacting them online, he said.

NICOTINE ADDICTION SCIENCE: FROM CELLS TO SOCIETY
Vice President Al Gore told a two-day conference on nicotine addiction that, "President Clinton and I see tobacco research not just as a policy priority, but as a moral obligation." Gore listed five areas where he felt tobacco research should be focused: causes of addiction, progression from experimentation to addiction, and successful components of prevention programs, cessation programs, and youth cessation programs.

The conference, "Addicted to Nicotine," was sponsored by the National Institute of Drug Abuse in conjunction with the Robert Wood Johnson Foundation (RWJF). Nancy Kaufman, PhD, Vice President of RWJF, called
it "the first ever assemblage and review of nicotine addiction science from cells to society, or the bench to the trench."

Leading researchers outlined the state of research on topics from genetics to neurology to ethnic and social factors in smoking. Among key questions they identified as still needing answers:
- How do youth cope with negative moods?
- What are the effects of certain psychopathologies on tobacco use?
- What compensating behaviors would arise in response to increasing the price of tobacco products or further restricting youth access to products?
- What beneficial or detrimental effects do tobacco prevention programs and/or drug prevention programs have on youth?
- What are the effects of nicotine on learning ability? How does this vary with age and level of exposure?
- What factors, such as marketing of "light" cigarettes, reinforce tobacco use?
- What is the function of stress in initiating and maintaining nicotine use behavior?
- What are the social, biological, and behavioral bases of gender differences in patterns of use and cessation?
- How can we increase motivation toward cessation? What is the ideal combination of interventions?

Kaufman noted that these and other questions are important because they show the broadening perspective of researchers resulting from sharing information, and they provide a useful "roadmap" for funders of
research.

==> The "Addicted to Nicotine" website has summaries of talks, speaker biographies, and live video of each lecture. http://www.nida.nih.gov/MeetSum/Nicotine/NicotineAgenda.html.
==> Conference papers will be published in a special issue of "Nicotine and Tobacco Research," the new journal of the Society for Research on Nicotine and Tobacco.

Impotence warning on cigarettes worries Thai women. BANGKOK (Reuters, Nov. 5, 1998) - A doctor spearheading Thailand's anti-smoking drive said cigarette packs labeled "smoking causes impotence" that went on sale Thursday had prompted a torrent of queries, mostly from worried women married to smokers. Dr. Prakit Vateesatogkit, secretary of the Action on Smoking and Health Foundation, said his office had been inundated with calls from women seeking suggestions as to how they can get their husbands to quit. "They want their husbands to stop smoking," he said. "If smoking affects their husband's sex life, then maybe they will convince them to stop," he said.

Vote limbo looms for cigarette tax. SACRAMENTO, Nov. 4 (UPI)- It may be too early to declare certain victory for California's 50-cent-a-pack tax on cigarettes until  all absentee votes are counted. 
Proposition 10 held a narrow lead today based on complete  returns from general election precincts, but the victory margin was only 13,214 votes out of more than 7 million reported.
Spokeswoman Shirley Washington of the secretary of state's office says counties have 29 days to report the latest absentee votes, and the total number is undetermined.
Proposition 10 claims 50.1 percent of the present vote to 49.9 percent in opposition, or 3.550 million votes to 3.537 million against.
Election officials projected a statewide turnout of 9.3 million voters, and 25 percent were expected to use absentee ballots with the likelihood that most would be counted Tuesday.
The measure by actor-director Rob Reiner proposes to raise some $700 million a year for smoking prevention and early childhood development programs.
It also would raise California's tax on tobacco products to the third-highest rate in the nation.
California's present cigarette tax is 37 cents per pack, which includes a 25-cent tax approved by voters in 1988
to raise money for public health programs and anti-smoking efforts.
According to the California Secretary of State, Proposition 10 is winning with 3,550,483 (50.1%) votes in favor and 3,537,269 (49.9%) votes opposed with all precincts counted.   http://vote98.ss.ca.gov/Returns/prop/
The initiative is ahead in 14 of California's 58 counties including the greater San Francisco Bay Area and Los Angeles and proximal coastal counties.  http://vote98.ss.ca.gov/Returns/prop/mapR010.htm
At last count the tobacco industry spent $28.69 million  in their campaign to stop Prop 10 as compared to $7.00 million spent by the proponents http://vote98.ss.ca.gov/lcrV98/c/971981.htm.
The full text of the initiative is available at  http://vote98.ss.ca.gov/VoterGuide/Propositions/10.htm

Proposition 10  would raise California's cigarette excise tax by 50 cents per pack and dedicate the proceeds to early childhood development, health care, and smoking prevention.
Medical treatment for diseases caused by tobacco currently costs California taxpayers billions of dollars each year. This is much more than the amount collected each year in cigarette excise taxes. We feel that the price of cigarettes should more closely reflect the cost of smoking to society (approximately $2 per pack).
The only opposition to Proposition 10 comes from the tobacco cartel and its front groups. No one other than
the tobacco cartel has contributed money against Proposition 10. The tobacco cartel is expected to set a record for the most money ever spent against an initiative in the four weeks prior to a vote.
So far, the tobacco cartel has spent more than $28,000,000 trying to defeat Prop 10. Individual members of the tobacco cartel have contributed as follows: Philip Morris $20,239,057; Brown and Williamson $4,809,056;  Lorillard Tobacco $2,635,489; RJ Reynolds $688,024; Tobacco Institute $116,899; US Tobacco $17,872
If Prop 10 wins, the price of cigarettes will more accurately reflect the cost of smoking to society. Children will get a better start in life. If Prop 10 fails, California taxpayers will continue subsidizing health care for people who choose to use tobacco products but can't afford the consequences.  SmokeFree Educational Services, Inc. http://www.smokefree.org

Federal Health Minister and B.C. Health Minister Announce Co-signing of Tobacco Enforcement Agreement (Health Canada, 15 October 1998)- Health Minister Allan Rock and Health Minister Penny Priddy announced  that the federal government and British Columbia have signed a contribution agreement to jointly fund the enforcement of federal and provincial tobacco legislation. Under the terms of the agreement, the federal and provincial governments will each contribute $600,000 in the 1998-99 fiscal year to a collaborative tobacco enforcement program. The objective is to reduce youth access to tobacco by promoting retailer awareness of, and compliance with, federal and provincial tobacco legislation.

Availability key to addiction, study finds. WASHINGTON (Reuters, Oct. 9, 1998) - Access to a drug may be just as important to whether someone becomes a heavy user as other factors, researchers reported Thursday. They said rats that had constant access to cocaine used more than rats given limited access. If the findings translate to humans, it could explain why some people become worse abusers of drugs than others. George Koob and S.H. Ahmed of the Scripps Research Institute in La Jolla, Calif., tested rats in special cages that let them push a lever and dose themselves with cocaine. Rats are avid fans of cocaine. Koob's team found the longer the rats had access to cocaine, the more they used.

August 10, 1998: How are people in your state behaving? The state Behavioral Risk Factor Survey (BRFSS) data are now available online. You can view the statistics for the U.S. or any state on any of the items in the survey.