Cigarette, cigar and pipe smoking, passive smoke exposure, and risk of pancreatic cancer: a population-based study in the San Francisco Bay Area

Gregory J Tranah , Elizabeth A Holly , Furong Wang and Paige M Bracci

BMC Cancer 2011, 11:138doi:10.1186/1471-2407-11-138

Published: 15 April 2011

Abstract (provisional)

Backgound. To examine the influence of cigarette, cigar and pipe smoking, cessation of cigarette smoking and passive smoke exposure on the risk of pancreatic cancer.

Methods Exposure data were collected during in-person interviews in a population-based case-control study of pancreatic cancer (N=532 cases, N=1701 controls) in the San Francisco Bay Area. Odds ratios (ORs) were adjusted for potential confounders.

Results The adjusted odds ratio (OR) of pancreatic cancer among current smokers was 1.9 (95% confidence interval (CI), 1.4-2.7). A significant, positive trend in risk with increasing pack-years of smoking was observed (P-trend <0.0001). Compared with participants who continued to smoke, former smokers had no statistically significant elevation in risk of pancreatic cancer 10 years after smoking cessation, with risk reduced to that of never smokers regardless of prior smoking intensity. Both men and women experienced similar increased risk of pancreatic cancer with increasing smoking duration. Cigar and pipe smoking and exposure to passive smoke were not associated with pancreatic cancer.

Conclusions Cigarette smoking is associated with an increased risk of pancreatic cancer. Smokers who had quit for >= 10 years no longer experienced an increased risk. Future work will help to determine the effect of declining smoking rates on pancreatic cancer incidence.

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The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Testimony of J. Glynn Loope for Proposed NYC Smoking Ban

Testimony of J. Glynn Loope, Executive Director
Cigar Rights of America
October 14, 2010
Before the Joint Meeting of the New York City Council
Committee on Health and Committee on Parks and Recreation

Members of Council and of the Committees, thank you for this opportunity to address the proposed ban on smoking in pedestrian plazas and public parks within New York City. I represent Cigar Rights of America, a national advocacy organization for cigar enthusiasts, with partners in the manufacturing and retail tobacconist sectors, as well.

In a national context, the State of New York and New York City specifically ranks among our largest areas for membership, as our members patron some of great cigar shops in the world, right here in New York City.

We would submit that this proposal is based more upon political hype and public relations zeal, than on scientific evidence and a true concern for the public health. It’s a brand of ‘flavor of the month politics,’ that seeks to divert attention from the actual pressing issues of the day for citizens in New York City.

In a public health context, this proposal will not prevent one case of cancer, one case of asthma, one heart attack, or prevent one person from partaking in perfectly legal tobacco products. It is advocated by a city Health Department that used public funds to produce a pamphlet on how to safely use heroin. This is a clear case of misplaced priorities.

I realize how these types of proposals sound like motherhood and apple pie; that it’s all for the good of the general public; and that it somehow makes a governing body sound as if it is being ‘progressive.’

In fact, you would be making bad public policy, based upon questionable science, without a thorough review of all studies surrounding such issues, which provide a more objective view of tobacco use, and outdoor smoking more specifically.

There are others that have. We highlight the City of Athens, Georgia. As they considered an outdoor smoking ban, they learned that no peer review study existed. They consulted with the University of Georgia-Athens, and its renowned environmental health sciences department.

The head of that department stated regarding exposure to outdoor second hand smoke, “Is this of public health concern? Do these levels pose a risk? We haven’t answered that yet.” Based upon that, the local governing body stated that it would not be tackling the issue without more evidence.

We would also point to the analysis within the journal of Toxicology and Pharmacology, which stated regarding Mainstream and Environmental Tobacco Smoke (ETS): “It should be clear that the seemingly insurmountable difficulties in measuring ETS exposures and doses, unresolved classification bias, and the inability to control for numerous independent confounders explain the inconsistency of weak ETS epidemiologic results and speak against the scientifically credible conclusions about a risk that, if real at all, remains imponderable.” [Report Submitted for the Record.]

Or, the British Medical Journal submitted analysis, which stated, “The association between environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.” [Report submitted for the Record.]

Or, the report of the Congressional Research Service which concluded, at best, that further analysis is needed before any credible policies can be objectively developed, as it cited the two largest U.S. studies on this subject, where within these reports, one found a single case of positive risk that was barely statistically significant, and the other no risk at all.” [Report submitted for the Record.]

And, the view of Dr. Michael Siegel of the Boston University School of Public Health, where he recently stated regarding this very proposal, “The argument does not extend to wide open spaces like Central Park and hundreds of other large parks in New York City where there is plenty of room for nonsmokers to walk away from someone who is smoking.” [Article submitted for the Record.]

But let’s take the health debate out of the equation. What about the question of basic fairness to those which decide to use perfectly legal tobacco products, such as cigars, outdoors? Many of these are residents, taxpayers, voters, or travelers and tourists that contribute to the city economy, just like anyone else. Should they not have the same access and ability to use these public resources, while enjoying legal products, and behaving within the bounds of existing law? Of course they should.

In this vain, we would hope you would consider the position and recent action of California Governor Arnold Schwarzenegger, as he vetoed a virtually identical piece of legislation, in a state not known for being ‘tobacco friendly.’ For a proposal that also would have banned smoking in public parks and upon public beaches, the Governor stated, “There is something inherently uncomfortable about the idea of the state encroaching in such a broad manner on the people…”

The proposed ordinance states that the Department of Parks and Recreation shall have the power to enforce the policy. From a purely public safety context, if Parks and Recreation staff have such ‘police powers’ and as actual New York City police officers patrol in Times Square where smoking would become illegal, I would much rather their minds be on identifying a Faisal Shahzad, than a pedistrian with a cigar. We have also read of ‘self policing’ as a component of this ordinance. Do we really want to start pitting city residents against each other in this fashion? Again, a case of misplaced priorities.

If a policy at all is to be considered, then let’s find some common ground. First, we believe this entire proposal should be defeated, but we also know that governing should be the art of compromise. Smoking should not be allowed around children, so establish non-smoking areas near playgrounds, where those under age frequent. Forcing the “coralling” of smokers into an isolated area only exacerbates such problems, and also forces those that enjoy legal tobacco products onto the city’s already crowded sidewalks.

Your consideration of these sentiments and submitted documents is appreciated. We hope you defeat the proposal, or at least, consider options that take into account the needs and wishes of all – all – New Yorkers, and those that enjoy this great city.

Florida Cigar Summit (2010)

On Friday, February 26, cigar industry leaders from the retail, manufacturing, and trade association ranks joined forces for a unified message to the Florida political community – “Help protect the cigar industry in Florida.”

In a true precedent setting moment, the briefing on the state of the cigar industry took place at the historic J.C. Newman Cigar Company facility in Tampa, Florida. Select members of the Florida legislature were briefed on the implications of tax and regulatory policy on this staple industry of the Florida economy.

With over 100 in attendance, nearly a dozen members of the Florida House and Senate heard from leaders in the national cigar industry.

Moderating the discussion was Eric Newman, President of J.C. Newman Cigar Company, who also serves as this year’s chairman of the Cigar Association of America, and Jeff Borysiewicz, owner of Corona Cigar Company, and board member for the International Premium Cigar & Pipe Retailers Association, and Cigar Rights of America.

Also attending was Mike Prendergast, candidate for the US Congress for Florida’s 11th Congressional District, who vowed to take his anti-tax philosophy to Washington.

Attending members of the Florida legislature were provided a tour of the J.C. Newman Cigar Company, while being briefed on what the Florida cigar industry means for local employment, with over 250 retail establishments and 60 family owned manufacturers, leaf dealers, importers and cigar corporate headquarters operations throughout the state, equating to over 5,500 jobs.

It was further noted that over 70% of the cigars sold in the United States are either made or imported through Florida.

Cigar Rights of America joined the Cigar Association of America and the International Premium Cigar & Pipe Retailers Association in co-hosting the forum. Jeff Borysiewicz noted, “We hope that this event sets a national example of the type of discussion that needs to take place in every state. By educating our political leadership at the local, state and federal level on the implications of tax and regulatory policy on cigar consumers and the entire supply chain, hopefully they will be less inclined to consider harmful legislation and budget measures.”

Read the Official CRA Press Release

New York Mayor Proposes Smoking Ban in City Parks

By Theodore J. King, CRA Guest Columnist

New York Mayor Michael Bloomberg is now proposing banning smoking in city parks. There was a poll in New York Newsday about this proposed ban.

The poll asked: Is it a good idea because smoking is a filthy habit, even outdoors, or is it wrong because it's in the open air, or do you know?

September 14th, 17% were in favor of the ban, and 81% were against it. The next day, the percentage in favor of the ban went down from 17% to 15%, and those against it went up to 84%!!

It is good to see there are still people who use common sense, which fact brings me to Gilbert Keith (G.K.) Chesterton (1874-1936), a British writer, philosopher, and Christian apologist who wrote about common sense, including the common sense of smoking cigars.

He was a fabulous and fascinating man who wrote more than 100 books and Father Brown mysteries about a Jesuit priest who is as clever as Sherlock Holmes and Hercule Poirot but a lot more humble. G. K. Chesterton also wrote some 4,000 newspaper articles.

Four thousand articles amount to one a day for 11 years!

G.K. Chesterton was a strong advocate of Christian morality but was by no means a dour puritan, and he often had a cigar in his mouth. As Dale Ahlquist, the president of The American Chesterton Society, noted in his book, Common Sense: 101 Lessons from G. K. Chesterton, Ignatius Press (2006), he called the cigar, “My muse...Some men write with a pencil, others with a typewriter. I write with my cigar.”

And because he wrote all those thousands of articles and books, he smoked a lot of cigars!!

Mr. Ahlquist wrote about G. K. Chesterton: “He explains that there is nothing immoral about smoking a cigar. To regard smoking as immoral shows not merely a lack of clear thinking but a lack of clear standards. Lumping the wrong things together as evils blurs the lines between right and wrong and leads to chaos. It also leads to legal and practi- cal confusion.”

And Chesterton was prescient in 1927 when he said, “The lack of clear standards among those who vaguely think of [smoking] as a vice may yet be the beginning of much peril and oppression.” Today, such “peril and oppression” are the smoking bans and tobacco taxes by which we cigar smokers are persecuted.

Mr. Ahlquist in his book stated that the great G.K. Chesterton “defends smoking and drinking . . .as simple, traditional pleasures that have been enjoyed by normal people for centuries. He points out that what society calls ‘progress' usually serves to punish all the things the common man enjoys. Chesterton added, “There is no normal thing that cannot now be taken from the normal man [like cigars, fast foods, etc., etc.]. Mod- ern ‘emancipation' has really been a new persecution of the Common Man and common sense.”

G.K. Chesterton said that, to which I say: Amen -- and let us in Cigar Rights of America smokers fight this persecution in every legitimate way possible, like lobbying our legislators. For more information on G.K. Chesterton: http://www.chesterton.org/.

Drug Paraphernalia and Cigars: Words that Don't Belong in the Same Ordinance

By J. Glynn Loope, CRA Executive Director

There is more trouble in Washington , DC , but this time it's a few blocks from Capitol Hill. It's in the Washington , DC City Council chambers.

An initial group of five (possibly eight) city council members, including Marion Barry, Tommy Wells, Michael Brown, Yvette Alexander and Harry Thomas, have introduced an amendment to the Drug Paraphernalia Act of 1982, known as the “Single Sale of Cigar Products Prohibition Act of 2009.” The very reading of “cigars” in a “drug paraphernalia” ordinance is deeply disturbing, and the reason such a trend needs to stop – now.

The intent of the proposed ordinance is to prevent the use of cigars as a means to marijuana use. The draft ordinance defines cigar as “an individual cigar, cigar leaf wrapper, flavored or non flavored cigar that is referred to as a blunt, blunt wrap, or any other tobacco product that may be used in the ingesting, inhaling or introduction of marijuana to the human body.”
In this draft, there is no mention of price, size, hand-made, machine-made, or other defining characteristics of cigars. While media reports have said its intent is to ban sales at convenience stores and gas stations, there is no mention of them in the bill either.

Local premium tobacconists such as W. Curtis Draper and Georgetown Tobacco view the language as too vague, with John Anderson of W. Curtis Draper stating, “It's scary because it's open ended.” David Berkebile of Georgetown Tobacco intends to join in the opposition. The measure is not without precedent. Just over the border in Maryland , Prince George 's County Council, where ordinances were advanced to require sales of cigars in packs of five, helped usher in a trend with such public policy. That legislation did exempt stores that specialize in cigar sales.

Earlier this year, Mayor Sheila Dixon of Baltimore , Maryland stated, “cheap cigars are becoming popular and these products are addictive and deadly.” The effort in Maryland was praised by the Campaign for Tobacco Free Kids, stating “Individual cigars are more affordable to price sensitive kids.”

We would like to dramatize how such nebulous policies can lead to unwarranted and unjust actions.

Recently, a customer of Havana Connections, a Richmond , Virginia based premium tobacconist, purchased a $10 cigar, left the shop, and proceeded to drive home. He was enjoying the cigar in the privacy of his car, when he saw the blue lights flashing in the rear view mirror.

When the cigar enthusiast asked what the problem was, the officer said he saw smoke, and wanted to know if he was using marijuana. Obviously, the answer was no, but the officer said “well, I have probable cause. Give me the cigar. I need to test it.”After some protest, he took it; set the cigar down, and the officer proceeded to cut this premium hand made cigar in half, dousing it with a solution to test for the presence of marijuana. Guess what? There was none. The cigar enthusiast proceeded to say, “you owe me $10 for that cigar.” The officer said, no, but you can take it up with our office. He did, and they gave him $40 for his trouble. True story. Two weeks old. Amazing.

In government, especially at the local and state level, one of the foremost contributing reasons to bad public policy is the setting of precedent and others saying “we should do that too.” That's how an outdoor smoking ban makes its way from San Francisco to Boston . That has been the case on matters of indoor and outdoor smoking bans, private property (housing) smoking bans, regulation of advertising and marketing, and the setting of tax policy. Hopefully on September 29, a committee of Washington DC City Council will set aside this proposed ordinance. More so, however, there needs to be a halt to the very introduction of these measures across the country.

Time for a Different Health Care Debate

By: J. Glynn Loope, CRA Executive Director

A recent commentary from Dr. Ranit Mishori in Parade Magazine launched a flurry of email from cigar enthusiast brethren who took issue with Dr. Mishori targeting the health effects of enjoying cigars, specifically. He stated that Hollywood was glorifying cigars in the movies, and hence encouraging adolescent adults to take up cigars. Dr. Mishori goes on to state that enjoying cigars has been linked to every health hazard imaginable, and how cigars are actually worse than other forms of tobacco. Well, here we go again.

As expected, Dr. Mishori provides little detail for his claims, and as we all know, all too often cigars are coupled with every other tobacco product in the public policy arena, when it comes to issues of smoking bans, and often taxation.

Now is the time for the debate to shift with regard to public health, and the enjoyment of a cigar. Frankly, all of us need to do a better job of pointing out the contradictions in the field of statistical analysis, and this is our launch at Cigar Rights of America. We are going to run a series of stories and commentary on where you can find the ‘other side of the story,’ for those moments when each of us are engaged in a debate on public health, and the use of a perfectly legal product.

A recent study published in the British Medial Journal, conducted by Dr. James Enstrom and Dr. Geoffrey Kabat of the State University of New York at Stony Brook evaluated the results of an American Cancer Society study that actually began in 1960, and spanned to 1998. Over 118,000 California resident adults were in the study, with an emphasis on evaluating 35,561 individuals that had a spouse in the study with known smoking habits. There were follow-up periods for those in the study during 1960-65, 1966-72, 1973-85, and 1973-1998.

The analysis by Drs. Enstrom and Kabat had some interesting [to say the least] results. They point to the statistical claims by the American Heart Association, California Environmental Protection Agency, and the US Surgeon General that ‘environmental tobacco smoke’ increases risk to coronary heart disease by 30%. The Enstrom/Kabat study notes, “It is unclear how the reported increased risk of coronary heart disease due to environmental tobacco smoke could be so close to the increased risk due to active smoking (also 30%), since the environmental tobacco smoke is much more dilute than actively inhaled smoke.”

Hmmmmm….interesting with the second, and now ‘third hand’ smoke debate, isn’t it? They further note the flaws in the methodology of these previous reports because the data was not “collected in a standardized way.”


The Enstrom/Kabat report focused on the 35,561 individuals that had never smoked, but who had a spouse that smoked. Their conclusions were that “exposure to environmental tobacco smoke was not significantly associated with the death rate for coronary heart disease, lung cancer or chronic obstructive pulmonary disease in men or women.”

In their conclusion, Drs. Enstrom and Kabat further note that the findings of their report “suggest that the effects of environmental tobacco smoke, particularly for coronary heart disease, are considerably smaller than generally believed.”

The full text of this study will be placed on the CRA web site. This is the beginning of a small series of pieces that we will be doing on how those that want to take away your ability to enjoy a great cigar are twisting facts, issuing false claims, and using biased analysis to take away some of the fundamental freedoms that we enjoy.

http://www.heartland.org/custom/semod_policybot/pdf/23332.pdf

Here Comes the Federal Government – Again.

By J. Glynn Loope, CRA Executive Director
Here on the advent of SCHIP taking effect and raising the price of your favorite cigar, the appetite in Washington for federal intervention in the tobacco industry continues to grow. Now the issue is not just money, but regulation – unbridled and unchecked regulation by a mammoth bureaucracy. Incidentally, the same bureaucracy that's charged with maintaining food safety and drug approval evidently needs more to do.

Rapid Congressional action is being unleashed with legislation patroned by California Congressman Henry Waxman, in the form of HR 1256, which would grant unprecedented federal authority over all forms of tobacco to the Food and Drug Administration – a thought that has been with Congress for over a decade.

HR 1256 has already passed the House Energy and Commerce Committee, which would also allow FDA to regulate the manufacture, distribution and retailing of all tobacco products. It could literally dictate the minutia of color advertising, and allows the imposition of “user fees” on manufacturers to fund FDA regulation, that would mean an estimated $7.6 billion on the industry, over the next ten years. A component of the Waxman bill that is also quite troubling is the ability for FDA to reach onto the actual farm producing the tobacco, and impose a new slate of mandates on the farming community.

CRA noted that the President has recently announced two new nominees to leadership positions at FDA. Dr. Margaret Hamburg served as New York City 's Health Commissioner in the 1990s, and would serve as FDA Commissioner. For the number two post at FDA, President Obama has selected Health Commissioner for the City of Baltimore, Maryland Dr. Joshua Sharfstein. Both of which were leaders of efforts in their respective cities to ban all forms of smoking, including bans in restaurants and bars.

Alternative LegislationWhile no one knows if compromise is in the air, there is an alternative piece of legislation to address the same issue. US Congressman Steve Buyer, as a Republican of Indiana has joined with Congressman Mike McIntyre, Democrat of North Carolina and introduced HR 1261. This legislation seeks to address tobacco in an alternative method, without government regulation.

As opposed to FDA, the Buyer/McIntyre bill would establish the Tobacco Harm Reduction Center at the US Department of Health and Human Services. Its focus is on education and cessation. The new agency would have a sole focus on tobacco, as opposed to drug approval and food safety. Further, the Buyer/McIntyre legislation would not allow for intrusion on traditional farming practices, and would be paid for from general fund revenues, as opposed to new industry “user fees.” HR 1261 also would require states to adopt laws making it illegal for minors to purchase and possess tobacco products.

Click here to view a comparative description of the legislation.

CRA Announces Formation of State Cigar Clubs

In an effort to build a true national network of cigar enthusiasts, and to provide a new program for members to interact socially, as well as to engage in political support with CRA, we are announcing the formation of Cigar Rights Clubs for the states .

By virtue of your membership in CRA, you will be a member of your respective Cigar Rights Club for your state. This will allow us to communicate with you on specific issues that develop in your local community and state, in addition to having state member socials and special events with the makers of your favorite cigars.

This will be a great new way to invite your friends to join CRA, get together for cigar events at your local cigar shops, to be involved in local and state issues, and to build a great sense of camaraderie among our membership.

Also, we will start a competition among the states for new membership growth, with the winning states getting special events and “goodies” from CRA. One thing about cigar enthusiasts - they love a good time.

We will be creating a Cigar Rights Club section on the CRA web site for updates, as well as a news and events page on what's happening in your state. Through this link, you will be able to see where all of your favorite cigar companies are having special events, and those that are noted on the CRA's website as a Great American Cigar Shop^TM.