ASH Daily News for 16 August 2019


  • Eight Sustainability and Transformation Partnerships say no Integrated Care Systems until 2021


  • US: FDA proposes graphic warnings on cigarette packs, advertisements
  • US: More than a third of children and teens inhale secondhand smoke, CDC report finds

Link of the week

  • ASH Fact Sheet: Smoking and mental health


Eight Sustainability and Transformation Partnerships say no Integrated Care Systems until 2021

Many sustainability and transformation partnerships (STPs) will leave it to the April 2021 deadline to become integrated care systems (ICSs), according to the Health Service Journal’s analysis.

Leaders of two areas – the Cornwall and Isles of Scilly, and Humber, Coast and Vale STPs – have confirmed they intend to make the move well before the final deadline for all of England to be covered by ICSs, which is April 2021. The target was included in January’s NHS Long Term Plan. But HSJ analysis suggests a significant number of the 28 remaining STPs are likely to remain “at the back of the queue”, amid warnings over the “ambitious” timescale for the transition in light of competing financial, performance and workforce pressures facing the NHS.

These include: Norfolk and Waveney; Mid and South Essex; Bath, North East Somerset, Swindon and Wiltshire; Hertfordshire and West Essex; Northamptonshire; Somerset; and Kent and Medway.

The first wave of eight ICSs were announced in 2017, followed by four more in May last year and another three this June. Due to mergers there are currently 14 ICSs. The North East and North Cumbria ICS is the biggest, serving three million people. ICS status requires a health economy to demonstrate strategic leadership at a system level, a single plan covering operational and long-term transformation, and managing financial performance against a system “control total”.

Miriam Deakin, director of policy and strategy at NHS Providers, said individual systems were at different stages of their journey towards becoming ICSs but there were concerns over the proposed deadline of April 2021: “This seems ambitious to us given the cultural shift required and the wider pressures the health and care sector is still grappling with in terms of rising demand, financial pressure and widespread workforce vacancies. Although the current legislative framework certainly does not prevent collaboration, it was also established for different times with the aim of competition, not collaboration in mind – and this adds to the complexity trusts and their partners have to deal with as they seek to develop system working.”

Source: Health Service Journal, 15 August 2019

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US: FDA proposes graphic warnings on cigarette packs, advertisements

The U.S. Food and Drug Administration has proposed that cigarette packs carry graphic new health warnings including pictures and text outlining lesser-known risks of smoking like bladder cancer and diabetes as well as lung cancer.

The FDA said the proposed changes, which also drastically increase the size of the warnings, so that they would occupy the top 50% of the area of the front and back panels of packages, could be the most significant to cigarette labels in more than 35 years. The proposal also applies to cigarette advertisements, and would add 13 new warnings, along with colored pictures that outline the risk of diseases associated with smoking. Research has shown that the current warnings on cigarette packages are “virtually invisible to both smokers and non-smokers”, the FDA said.

The new proposal follows a failed bid by the FDA in 2011 for coloured graphic warnings, which was challenged in court by tobacco companies and ultimately declined in 2012. Following a lawsuit filed by several public health groups, a judge issued an order in March 2019 directing the agency to publish a proposed rule by August and issue a final rule in March 2020.

“We learnt a lot from what happened the last time around, and took the time through the research to get this right,” said Mitch Zeller, the director of the FDA’s Center for Tobacco Products on a call with the media. “If we are sued after we issue a final rule, we strongly believe this will hold up under any legal challenges,” he said. The latest proposal is open to public comment for 60 days through October 15, the FDA said.

Source: Reuters, 15 August 2019

See also
CNN: FDA reveals proposed graphic warnings for cigarette packs and ads
NPR: FDA rolls out new graphic warnings for cigarette packages and tobacco ads

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US: More than a third of children and teens inhale secondhand smoke, CDC report finds

More than a third of US children and teenagers inhale secondhand smoke involuntarily, a new report from the Centers for Disease Control and Prevention (CDC) reveals. Between 2013 and 2016, researchers found that 35.4% of youth between ages three and 17 were exposed to secondhand smoke from cigarettes, cigars and pipes. Since the late 1980s, there has been a massive reduction in secondhand smoke exposure thanks to decreased rates of smoking and smokefree policies. However, the report states that over the last few years, the rate of kids exposed to secondhand smoke has “remained steady.”

For the report, released on 15th August 2019, the team analysed data from the National Health and Nutrition Examination Survey. They tested samples of kids’ and teenagers’ blood to measure levels of serum cotinine, which indicates recent exposure to nicotine in tobacco smoke. Researchers excluded youth who were tobacco users.

They found that boys and girls between ages 3 and 11 were more likely to be exposed to secondhand smoke than were teens between ages 12 and 17. The report’s findings also indicated that black children and teens were exposed to secondhand smoke at higher rates than their peers from other ethnic groups. Almost 62% of black youth were exposed, followed by white youth at 34%, Hispanic youth at 25% and Asian youth at 18%.

There was also a stark contrast when comparing exposure by federal poverty level. About 55% of children and teens from families below the federal poverty level were exposed to secondhand smoke compared to just 16% from families that were 400% above the poverty level. This equates to a comparison of a household-of-four with an annual income of $25,750 (£21,188) compared to a similar-sized household with an annual income of $103,000 (£84,750).

Source: Daily Mail, 15 August 2019

CDC: NCHS Data Brief No. 348, August 2019, Secondhand Smoke Exposure Among Nonsmoking Youth: United States, 2013–2016

See also
US News & World Report: Secondhand Smoke Still a Danger for U.S. Youth

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Link of the week

ASH Fact Sheet: Smoking and mental health

Smoking rates among people with a mental health condition are significantly higher than in the general population and there is a strong association between smoking and mental health conditions.

This week, ASH has published an update to our Smoking and Mental Health fact sheet. This fact sheet examines the links between smoking and mental health, rates of smoking among people with different mental health conditions, and interventions to help these people to stop smoking.

See Fact Sheet