News in brief - June 19, 2006

Big tobacco accused of using alcohol, gambling to attract new smokers - AMA publishes guidebooks for preteens - Colon cancer tests underused - Arterial risk from several factors

Big tobacco accused of using alcohol, gambling to attract new smokers

The growing number of marketing campaigns linking smoking to high-risk activities such as the excessive consumption of alcohol and gambling is an attempt by industry to convince a new generation to light up, according to a report issued by the American Lung Assn. last month in honor of World No Tobacco Day.

The report, "Alcohol-Flavored Cigarettes -- Continuing the Flavored Cigarette Trend," highlighted several campaigns that the lung association felt would be particularly attractive to teens and young adults. For example, last year R.J. Reynolds Tobacco Co. sold limited-edition cigarettes flavored with scotch and gin. These products were linked to a "Camel Casino" campaign that encouraged people to go to the brand Web site and gamble for credits that could be used for promotional products and cigarette coupons.

"The industry's goal is obvious -- to get young people hooked on smoking," said John L. Kirkwood, president and CEO of the lung association. Both the ALA and the American Medical Association reiterated calls for stronger regulation of this industry.

"The AMA is extremely concerned that the tobacco industry is allowed to market alcohol-flavored cigarettes, since these products could easily appeal to youth who are beginning to experiment with alcohol," said AMA President J. Edward Hill, MD.

At press time, R.J. Reynolds officials were not available for comment.

AMA publishes guidebooks for preteens

The American Medical Association has created two books to ease the confusion around the transition to adolescence. The American Medical Association Girl's Guide to Becoming a Teen and The American Medical Association Boy's Guide to Becoming a Teen answer questions about mood swings, physical changes, peer pressure, sexual health and dating.

"These books are tremendous resources for preteens and parents of preteens who are looking for reliable medical information to help their children through puberty," said AMA President J. Edward Hill, MD.

The books were authored by Amy Middleman, MD, an adolescent medicine specialist at Texas Children's Hospital in Houston, and are available at bookstores or online through the AMA Press (www.amapress.com).

Colon cancer tests underused

More than 40% of patients who initially had received a positive result on a fecal occult blood test for colon cancer did not receive appropriate diagnostic follow-up tests such as a colonoscopy or barium enema, according to a study published in the May Diseases of the Colon & Rectum. Researchers analyzed nearly 40,000 Veterans Affairs patient records in arriving at their conclusions.

The study even may underestimate the lack of follow-up in the country at large because the VA's level of preventive care and follow-up traditionally has been higher than at most health care settings, the study's authors said. Overall, 61% of eligible VA patients had been screened for colorectal cancer, a rate significantly higher than the national average. Of the screened population, 313 patients had an abnormal FOBT result. Of this group, only 59%, or 185 patients, received follow-up diagnostic tests. Forty-one percent, or 128 patients, got no follow-up at all in the six months following the initial screening.

The study has implications for how health care systems monitor their own quality, the authors say. "Any health care system that provides cancer screening programs needs to track each step in the screening process," said principal investigator David A. Etzioni, MD, a Robert Wood Johnson Clinical Scholar in the Division of General Surgery at the David Geffen School of Medicine at the University of California, Los Angeles.

Arterial risk from several factors

Cigarette smoking and high cholesterol predict risk for some forms of peripheral artery disease, while diabetes predicts risk for other forms of the disease, researchers reported in the May 30 rapid access issue of the American Heart Assn.'s journal Circulation.

Researchers examined risk factors for PAD progression in large blood vessels and in small blood vessels. PAD, which affects about 8 million people in the United States, is characterized by clogged arteries beyond the heart or brain -- most often in the legs.

Researchers identified several risk factors that influence the evolution of large blood vessel PAD and found smoking to be the most powerful predictor that the disease would worsen.

The only significant predictor of small vessel PAD progression found by the researchers was diabetes. "The most surprising result was the absence of an impact of diabetes in large vessel PAD progression," said lead author Victor Aboyans, MD, PhD, a cardiologist and epidemiologist at the Dupuytren University Hospital in Limoges, France.

The results reinforce new American College of Cardiology/AHA guidelines on the management of PAD, published in Circulation in March, said co-author Michael H. Criqui, MD, MPH, professor of medicine and of family and preventive medicine at the University of California, San Diego, School of Medicine.

"If you have PAD and are taking low-dose aspirin and a statin, you're doing two things that are very helpful," he said.