Tobacco Companies Still Targeting Teens

Graphic images of bloody gums, somber black ads, and smokeless Hollywood movies are some of the remedies proposed by government agencies and health groups to help stomp out smoking, especially among teens. New evidence points to the fact that -- despite the $200 billion-plus legal settlement with the states and promises to the contrary -- the tobacco industry is still targeting teens in its advertising and promotions.

According to a recent study conducted by the Centers for Disease Control and Prevention in conjunction with the Robert Wood Johnson Foundation, teenagers continue to be exposed to high levels of tobacco promotion in retail stores despite restrictions imposed on advertising. The report concluded that gas station and convenience stores, where 75 percent of teenagers shop once a week or more, were most likely to have "tobacco-friendly" environments where patrons would be frequently exposed to tobacco advertising and promotions.

"This study shows that tobacco advertising in retail stores is much more visible to our youth than tobacco health warning information," said Rosmarie Henson, head of the CDC’s smoking and health program.

The study, which evaluated marketing trends in retail outlets where tobacco products are sold in 163 communities, also reported that tobacco marketing expenditures increased from $6.7 billion in 1998 to $8.2 billion in 1999. In the stores surveyed, self-service cigarette pack placement was observed in 36.4 percent, and multipack discounts were present in 25.2 percent. More than 68 percent of stores had at least one tobacco-branded functional object such as shopping baskets or counter change mats. In comparison, only 4.1 percent of the stores posted tobacco health warning signs.

"The pervasiveness of tobacco advertising in retail stores is weakening efforts to prevent adolescent smoking," said Jeffrey Koplan, MD, director of the CDC. "Directly or indirectly, this highly visible advertising is encouraging a new generation of children to take up a deadly habit."

In response to recent studies, the U.S. Justice Department has presented the tobacco industry with documents listing remedies that would restrict the marketing and sale of cigarettes, according to a March 11 Wall Street Journal report. These remedies, largely targeting minors’ access to cigarettes, call for a complete ban on cigarette vending machines and the removal of the words "light," "low-tar," or "mild," on cigarette labels. All cigarette advertising would be limited to black-and-white print ads, and 50 percent of these ads would contain "graphic health warnings." In reforms that would affect retailers, the government will try to end trade promotions and giveaways, and seek to end "slotting fees" paid to retailers for favorable placement of tobacco products in stores, the Journal said.

Canada has already taken the idea of graphic or shock advertising to heart. The Canadian Dental Association and other concerned health organizations have lobbied government though the "Tobacco or Kids" campaign to adopt new warning labels on cigarette packages featuring a number of disturbing full-color photographs of the effects of smoking. One of the most shocking images is of a mouth with filthy blackened teeth and the warning "cigarettes cause mouth diseases."

"Major health effects like lung cancer and heart disease are very serious; but, particularly with young people, they may seem a long way off," said Burton Conrod, DDS, immediate past president of the Canadian Dental Association. "These images show the immediate effects of tobacco like ugly yellow stains on teeth, gum disease, and bad breath, which directly contradict the glamorous image of smoking and should make an impact on new smokers."

Some antismoking groups are even honing in on Hollywood, asking the Motion Picture Association of America to place stiffer ratings on movies that portray smoking in a positive light. A study released in 2001 from Dartmouth Medical School found that tobacco use was featured in nearly 85 percent of the top 25 highest-grossing movies each year from 1988 through 1997. The MPAA considers violence, nudity, theme, language, sensuality, drug abuse, and other elements when assigning a film rating, according to its Web site.

In an effort to highlight tobacco-free role models for young people, the CDC, World Health Organization, and International Olympic Committee continued their Tobacco-Free Sports public education campaign at this winter’s Olympic and Paralympic games in Utah. The campaign included television public service announcements and posters featuring U.S. Olympians and Paralympians endorsing a smoke-free lifestyle.

"These new education materials are wonderful resources because we recognize that athletes are among the most admired role models for young people, who emulate the behaviors they witness in their heroes," Koplan said.

Although some of these proposals seem vague and their effectiveness hard to quantify, the reaffirmed commitment by the U.S. government to proceed with its legal battle against the tobacco industry will have a definitive outcome, if slow in coming. The Justice Department’s lawsuit, which alleges fraud, racketeering, and conspiracy by the major tobacco companies to conceal health risks of an addictive and deadly product, will begin in June 2003 before U.S. District Judge Gladys Kessler.

USC Working to Develop Virtual Reality Patients

In the craniofacial dentistry of the future, surgeons in training may experience the feeling of slicing through human tissue and bone before ever laying hands on a patient or cadaver.

Dentists may rely on detailed, multilayered 3-D models to give them precise anatomical information and help them determine the best treatment, while parents of children born with cleft palates or other facial anomalies may be shown precisely how their child will look after corrective surgery.

While these capabilities are still years away, researchers at the Craniofacial Virtual Reality Laboratory at the University of Southern California School of Dentistry are diligently assembling the technological pieces that will bring them to reality.

The school already has the tools to create 3-D images of a person’s face and mouth and can track the motion of the jaw as never before. The challenge is to bring these individual technologies together to create a virtual craniofacial patient, the 21st-century version of a crash-test dummy.

"What we want to produce here is a realistic and accurate model of a patient," said James Mah, DDS, director of the laboratory and an assistant professor in the department of orthodontics. Mah is working with researchers from the School of Dentistry, Keck School of Medicine, and the School of Engineering.

The field of craniofacial dentistry has remained surprisingly untouched by technological advances, Mah said.

Using the virtual craniofacial patient -- complete with a 3-D head and neck -- surgeons could explore different treatments, predict outcomes and explain procedures to real patients. With the help of a special "head-mounted display," computed tomography and magnetic resonance images could be superimposed on a patient.

"It offers the surgeon X-ray vision to see through the patient, to see exactly where the bones, the vessels and the nerves are," Mah said. "That is a new technology that is very much in development. This is the future direction of this project."

Discontinuing Hormone Replacement Does Not Accelerate Bone Loss

Women who stop hormone replacement therapy lose bone at a rate similar to that of women who never took hormones, and longer-term hormone therapy does not appear to increase bone mineral density beyond the first three years of treatment, according to an article in the March 25 issue of the Archives of Internal Medicine.

Gail A. Greendale, MD, from the University of California at Los Angeles School of Medicine; Mark Espeland, PhD, of Wake Forest School of Medicine, Winston-Salem, N.C.; and colleagues measured the bone density of 495 women who participated in the three-year postmenopausal estrogen/progestin interventions randomized controlled trial and had bone density measured again approximately four years after the trial’s conclusion to evaluate hormone therapy’s association with density.

The researchers evaluated whether women lose density after hormone therapy is discontinued; the rate of bone density loss for women who stopped therapy compared to the rate of loss for women not receiving therapy; and the association between long-term hormone replacement therapy and continued bone mineral density gains.

"Women who stopped therapy after one year during the trial had annual rates of density change of -0.54 percent (hip) and -0.81 percent (spine) during the following two years," wrote the researchers. "Those who underwent therapy for three years during the trial and then discontinued it had annual changes of -1.01 percent (hip) and -1.04 percent (spine)."

"Rates of density loss among women who stopped therapy during or after the trials did not differ significantly from those of women who did not undergo therapy, who lost bone at a rate of approximately 1 percent yearly during the first year of the trial and about half that rate afterward," the authors stated. "Women who continued therapy after the trial did not show additional density gains."

According to background information in the article, a variety of long-term benefits may be associated with postmenopausal hormone replacement therapy, including primary prevention of osteoporosis, primary heart disease, and other chronic diseases. One concern is that long-term use of hormone therapy (especially long-term estrogen use) may increase the risk of breast cancer, although results of studies examining this issue have had mixed outcomes.

"In summary, hormone replacement therapy for approximately seven years did not provide further bone mineral density benefit beyond that accrued at three years. Stopping therapy did not lead to an accelerated rate of density decline. The latter findings argue against accelerated bone loss as an explanation for the lack of hip fracture protection afforded by former hormone therapy use. From a clinical perspective, our results suggest that women who stop hormone therapy may resume bone loss, but that it will not be at a very rapid rate," the authors concluded.

Study Finds More Evidence Against Tongue Piercing

A new study published in the March Journal of Periodontology found that extended wear of barbell-type tongue jewelry could increase the chance of gum recession and tooth chipping.

Researchers from Loma Linda University School of Dentistry and Ohio State University College of Dentistry examined and surveyed 52 young adults with pierced tongues. They found gum recession in 35 percent of subjects with pierced tongues for four or more years, and in 50 percent wearing long-stemmed barbells for two or more years.

"During tongue movement, long-stem barbells are more likely to reach and damage the gums than short barbells," said Dimitris Tatakis, DDS, PhD, professor of periodontology at the Ohio State University College of Dentistry and co-author of the study. "Over time, this damage may cause the gums to recede, which can lead to more serious dental/oral complications."

Additionally, 47 percent of young adults wearing either type of barbell for four or more years had chipped teeth. The prevalence of tooth chipping was significantly greater in those wearing short-stemmed barbells (1/4 inch to 5/8 inch) for four or more years.

Researchers believe tooth chipping is a result of habitual biting of the barbell.

"A short barbell is possibly easier to position between teeth, which could be one reason why we are seeing more chipped teeth in this group," Tatakis said. "Another factor that was not investigated could be the size or material of the screw caps attached to the barbell."

Scholarships Increased for Students Who Work in Underserved Areas

The National Health Service Corps will offer a record $89.4 million in scholarship and loan repayments to dentists and other health professions who serve in rural and inner-city areas that lack adequate access to care.

"We are looking for the best and brightest to work where they can turn people’s lives around and provide health care to people not used to getting it," said Health and Human Services Secretary Tommy G. Thompson. "Many students go into medicine hoping to improve the lives of the poor and the uninsured, but graduate with too much debt to pursue such a calling. The National Health Service Corps makes it possible for hundreds of young doctors and clinicians."

The increased resources -- almost $19 million more than last year -- will support 900 new and continuing loan repayment awards and 400 new and continuing scholarship awards. Awardees must agree to provide health care services for a minimum of two to four years in areas of the country with the greatest shortage of health care professionals.

Administered by the Health Resources and Services Administration, the National Health Service Corps represents a key part of the strategy to expand access to health care services to those most in need -- especially those in rural and inner-city communities. Nearly half of the Corps’ clinicians practice in government-supported community health centers, which provide health care to people regardless of their ability to pay and target services in areas where people face financial and social barriers to accessing high-quality care.

The loan repayment program is open to a long list of health care professionals, among them dentists, physicians, and nurses. The scholarship program is open to students enrolled or accepted for enrollment in accredited dental schools, medical schools, family nurse practitioner programs, certified nurse-midwifery programs, and physician assistant programs.

* More information on the Corps and the award application process can be found at the National Health Service Corps Web site at www.http://bhpr.hrsa.gov/nhsc/. Applications are also available by calling (800) 221-9393.

Genetic Disease Information Center Launched

The National Human Genome Research Institute and the National Institutes of Health’s Office of Rare Diseases have launched a new information center that delivers free and immediate access to information specialists who can provide accurate, reliable information about genetic and rare diseases to patients and their families.

There are more than 6,000 genetic and rare diseases afflicting more than 25 million Americans, but many of these illnesses affect relatively few individuals. As a result, information about these rare disorders may be limited or difficult to find. The new service, called the Genetic and Rare Diseases Information Center, will help relieve this problem by providing reliable information about individual disorders.

Opened in February 2002, the center provides experienced information specialists to personally answer questions from patients and family members on the phone, as well as by e-mail, fax, and regular mail.

"I am delighted we can provide a resource that should be of great benefit to individuals with genetic and rare diseases, and their families," said Francis Collins, MD, PhD, director of the research institute. "Valid and accessible information about these conditions is hard to find, and having an information center staffed by professionals will fill a critically important need. The National Human Genome Research Institute is delighted to be partnering with the Office of Rare Diseases to establish this center."

"Now people can talk to someone -- personally -- and get information right away," said Henrietta Hyatt-Knorr, the office’s acting director. "There will be a quick turn around. If you just received a diagnosis for yourself, your spouse, or your child, now you won’t have to wait to find useful information."

The Genetic Alliance, an international coalition of more than 300 lay advocacy organizations and health professionals, staffs the center with information specialists. The center provides callers with authoritative information about specific illnesses from existing public domain sources, including reliable Web sites, brochures, articles, and even chapters from books. Experts at the information center ensure that the information sent out is current and accurate. The center, however, does not provide genetic counseling and does not offer diagnostic testing, referrals, medical treatment, or advice.

Contact information for the center is as follows:

* Telephone, answered Monday through Friday, noon to 6 p.m., Eastern time: voice (888) 205-2311; TTY (888) 205-3223

* E-mail: gardinfo@nih.gov

* Fax: (202) 966-5689

* Mail: Genetic and Rare Disease Information Center, P.O. Box 8126, Gaithersburg, MD 20898-8126.

Honors

Sigmund Abelson, DDS, of Los Angeles; Ronald Redmond, DDS, of San Clemente, Calif.; and Betty Vodzak, DDS, of Lafayette, Calif., received the 2002 Medallion of Distinction Award from the University of the Pacific School of Dentistry during the 103rd annual Alumni Association meeting in March. The medallion is the highest honor bestowed by the organization and recognizes individuals who have made outstanding contributions to the School of Dentistry, research, dental education, or the community.

Upcoming Meetings

2002

May 2-4 British and Irish Dental Associations Annual Conference, Belfast, Northern Ireland, (+44) (0)020-7563-4590, events@bda-dentistry.org.uk

May 7-12 American Academy of Cosmetic Dentistry Annual Session, Honolulu, (800) 543-9220, www.aacdhawaii.com

May 16-19 Organization for Safety and Asepsis Procedures Symposium, Nashville, (800) 298-OSAP, www.osap.org

Sept. 26-28 American Society for Dental Aesthetics, 26th International Conference on Aesthetic Dentistry, Las Vegas, (813) 264-2772, www.asdatoday.com.

Sept. 27-29 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Oct. 11-13 National Association of Filipino Dentists in America Annual Meeting, San Francisco, (818) 988-3910.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.