New state law aims at keeping tobacco beyond kids’ reach

From the Star Tribune at http://www.startribune.com/lifestyle/health/99514364.html

Tobacco -- whether smoked, chewed or otherwise ingested -- must be behind Minnesota store counters by Sunday.
By JEREMY OLSON, Star Tribune
Last update: July 29, 2010 - 12:17 AM


The next generation of tobacco products -- from battery-powered e-cigarettes to strawberry-scented little cigars -- will be harder for young Minnesotans to buy starting Sunday.

A new state law is requiring convenience stores and other retailers to keep tobacco products behind the counter, rather than in appealing displays within easy reach of young customers. It also broadens the definition of tobacco products -- which can't be sold to minors -- to include items that can be "chewed, smoked, absorbed, dissolved, inhaled, snorted, sniffed or ingested by any other means.''

The law is designed to keep Minnesota abreast of the next generation of tobacco and related products that are priced low and marketed to teens, said Kerri Gordon, a spokeswoman for ClearWay Minnesota, a nonprofit quit-smoking organization.

"It's not your grandfather's cigarettes anymore," Gordon said. "Today's tobacco industry is moving heavily into smokeless and spitless products. We're seeing almost edible tobacco."
Examples include Camel Orbs, which are dissolvable nicotine tablets that come in flavors such as "fresh" and in shapes and containers that resemble Tic-Tacs.

"I think they do target a younger audience" with the alternative products, said Calitta Jones, an 18-year-old from St. Paul whose youth group successfully lobbied for a ban on candy cigarettes there. "Most [older] smokers already have their brand. They already know what they like. They don't try too much new stuff."

The share of high school students who smoke has declined from more than 36 percent in 1997 to less than 20 percent last year, according to federal student survey data. But the share of teens who use smokeless tobacco has held steady, around 9 percent, over the same period.

Minnesota, likewise, shows a decline in teen smoking over the past decade through its own student survey. But the state didn't ask about smokeless tobacco use until 2007. The next state survey update comes later this year.

The new law also puts Minnesota ahead of other states in its regulation of products such as e-cigarettes, which heat up cartridges of nicotine or lobelia for smokers without producing smoke.
ClearWay, funded by a state lawsuit settlement with tobacco companies, has taken more interest in these alternative products, and released a report, "Unfiltered," in February detailing the new marketing of tobacco to youth through video game placement, flashy packaging and other methods.

In a commentary in the May issue of Pediatrics, two U.S. Food and Drug Administration doctors said the flood of new products "seems to be reflected in the evolving patterns of tobacco use by youth." The smokeless products also get around indoor smoking bans.

However, some tobacco opponents view the new products as "gateways" that eventually encourage young people to turn to cigarettes.

A study released Wednesday by the University of California, Riverside, for example, found that smokers needed more suction to inhale e-cigarettes and that they might eventually turn to "compensatory" smoking of other products.

Gordon said the revised Minnesota law limits teen access to tobacco products but doesn't change the most important influence on youth smoking: price.

ClearWay had initially proposed redefining little cigars as cigarettes. That would have increased the tax on those cigars, which might have deterred cost-sensitive teens and young adults from buying them. The proposal was dropped, Gordon said, over concerns from some lawmakers that it represented a new tax on business.

Most convenience stores already place all tobacco products behind their counters to deter underage smokers and theft, said Lance Klatt of the Minnesota Service Station and Convenience Store Association, which supported the legislation.

"The [store operators] out there, they don't like promoting tobacco near the candy area," he said. "We want to protect our youth as well."

Jeremy Olson • 612-673-7744

Mass CPR Training in Mall of America Rotunda

Medtronic Foundation teams up with Take Heart™ Minnesota to Help Save Lives From Sudden Cardiac Arrest

(Bloomington) – Mall of America shoppers can save more than just money at this weekend’s sales; they also can learn how to save lives from Sudden Cardiac Arrest during mass CPR training in the Mall of America Rotunda.

Medtronic Foundation and Take Heart™ Minnesota, a group that is working to build community awareness of Sudden Cardiac Arrest (SCA), today announced they will offer mass CPR trainings every 15 minutes from 10:00am to 4:00pm on Saturday to raise awareness about SCA and empower Minnesotans to use CPR to save lives from this leading cause of death in America.

SCA is the leading cause of death in Minnesota; more than 4,500 cases of SCA were reported in Minnesota in 2008 (an average of 12.5 incidences per day).
Sudden cardiac arrest is a leading cause of death in the United States, killing more Americans than lung cancer, breast cancer and HIV/AIDS combined.

What:
Local first responders and survivors will provide CPR and AED training and life-saving information to Mall of America visitors; each participant will be trained on a training dummy.

When:
Saturday, July 31, 2010
10:00am – 4:00pm

Where:
Mall of America – Rotunda
60 East Broadway
Bloomington, MN 55425

Who:
Sudden cardiac arrest survivors, rescuers and representatives from Take Heart™ Minnesota will be available for interviews and demonstrations.

About Sudden Cardiac Arrest: Often mistakenly referred to as a heart attack, sudden cardiac arrest (SCA) is a condition in which the heart abruptly stops without warning. Most sudden cardiac arrest episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia (VT) or ventricular fibrillation (VF). These are abnormalities of the heart’s electrical conduction system.

SCA is the leading cause of death in the U.S. More than 250,000 Americans die each year from this condition.

Cardiac arrest is reversible in most victims if it’s treated within minutes, but the only effective treatment is the delivery of an electrical shock, either with an automated external defibrillator (AED), or with a stop watch-sized implantable defibrillator.

About Take Heart America™
Take Heart America™ was founded by a network of visionaries who recognized that a coordinated, comprehensive approach to resuscitation therapies would substantially increase sudden cardiac arrest (SCA) survival rates beyond the benefits achieved with individual therapies alone. The initial results from St. Cloud, Minn. and Anoka County, Minn. have been remarkably successful.

Building community awareness is paramount to the Take Heart America™ strategy for saving lives. Teaching cardiopulmonary resuscitation (CPR) and encouraging those who have been trained to act when necessary can significantly increase an SCA victim’s chance of survival. The strategy to deploy automatic external defibrillators (AEDs) in residential communities and public places along with improving the resuscitation techniques of professional rescuers will also increase the chances for the victim to survive and resume a productive life. Take Heart America™ strategies involve working with hospitals to develop clear procedures for ensuring optimal hospital treatment and post-resuscitation care for each SCA survivor.

Learn more at http://www.takeheartminnesota.org/

Heart-attack study: Bypass ER, save lives

Article from the Star Tribune: http://www.startribune.com/lifestyle/health/98980854.html?page=1&c=y

Dr. Kenneth Baran of United Hospital in St. Paul.

Researchers at United Hospital showed that specially trained paramedics save precious minutes.

By MAURA LERNER and JOSEPHINE MARCOTTY, Star Tribune staff writers

If you're having a heart attack, you may not need an emergency room at all, according to a groundbreaking study at United Hospital in St. Paul.

Researchers found that patients get faster care, and are more likely to survive, if an ambulance crew takes them straight to a specialized hospital "cath lab," where doctors can act quickly to open their blocked arteries.

So far, only a small fraction of hospitals use this system, which relies on specially trained paramedics to diagnose heart attacks without the help of emergency room staff.

But the study, led by Dr. Kenneth Baran, suggests that it can cut the time needed to treat the most dangerous heart attacks from an average of 81 minutes to 36 minutes, and vastly improve the chances of recovery.

"Our times were phenomenal," said Baran, a heart specialist at United. In some cases, "we had patients in with their artery open in 20 minutes."

In fact, the average for those who arrived during daytime hours was just 22 minutes -- "the lowest that's been recorded," Baran said.

His research team also found that the patients who went straight to the catheter lab were less likely to die in the hospital (3.9 percent) than those who came through the emergency room (7.5 percent).

Experts say that the minutes after a heart attack are crucial because muscle starts to die when oxygen is cut off. If the blockage can be cleared within 60 minutes or so, experts say, the heart attack may cause little permanent damage.

That's why hospitals and emergency medical systems across the country are scrambling to improve response times. "I think it's quite inspirational," said Dr. Henry Ting, who heads a similar program at the Mayo Clinic in Rochester. The study "shows what is possible with focus and creativity."

Nationally, experts say, the "gold standard" for hospitals is to treat a heart attack patient within 90 minutes of arrival -- called "door-to-balloon time" because doctors use an inflatable catheter to open the blockages.

Many hospitals have cut that time from 110 minutes to less than 80 in the past two years, said Ting, who serves on two national advisory panels. Mayo, United and other leading hospitals, including a handful in the Twin Cities, have cut that in half, in part by bypassing emergency rooms.

"Thirty to 40 minutes, that's a major achievement," he said.

Dr. Ganesh Raveendran, director of cardiac catheterization at the University of Minnesota, agrees. "This is the way it should be," he said, noting that the university hospital has had similar results with an almost identical program. Most ambulances, he said, don't have the proper equipment.

Baran said he began work on the process seven years ago, when heart attack patients coming from other hospitals would go straight to the catheter lab without stopping in the emergency room.

"Eventually, the idea emerged that maybe we could get medics to make the call in the field without having to double check with a doctor," Baran said.

In 2007, he and other cardiologists began training 300 paramedics in the east metro area to read the results from ECG machines, which can reveal whether a specific type of heart attack has occurred. It became clear, he said, that paramedics could be just as accurate as doctors at correctly reading the results.

Baran says paramedics were quick to adopt the new program. Now, patients are treated so quickly that some ambulance crews see their patients get better before their eyes.

When patients come in through the emergency room, by contrast, they may encounter delays in testing and evaluation, experts say.

'You have to be careful'

Still, experts warn that some patients might need extra testing, to rule out pulmonary embolism or other conditions. "You have to be careful if it's not straightforward," said Dr. Alice Jacobs, a specialist with the Boston Medical Center and an adviser to the American Heart Association. "But if the diagnosis is clear ... you save probably 15, 30 minutes if you bypass the ED."

At first, some cardiologists who perform the catheter procedures were skeptical, Baran said, worried that they would face more false alarms, and have to act as both emergency room doctor and heart specialist. "It was a balancing act like herding cats," he said. But when the results were so good, they said "this is worth it."

If the idea becomes widely accepted, Baran said, the long-term implications are enormous. It could reducing the need for defibrillators and transplants, he said.

But Ting, of the Mayo Clinic, cautions that speeding up treatment is only half the battle. Only half of those having heart attacks bother to call 911; they wait, on average, two hours before going to the hospital.

"This is one piece of the puzzle," he said. "But we've got a lot of work ahead of us."

The study is in the July issue of Circulation: Cardiovascular Quality and Outcomes.
mlerner@startribune.com • 612-673-7384 jmarcotty@startribune.com • 612-673-7394

Timely, Quality Care with AHA There

We hear all the time that elected leaders value the American Heart Association's efforts to pass heart healthy policies in our state and nation - a result of decades of service from committed volunteers, the solid-science supporting the AHA's policy positions and the critical work the AHA performs in diverse communities every day. Through the Get With The Guidelines® program, the AHA works closely with hospital professionals to improve heart disease and stroke patient care utilizing the most recent scientific guidelines. In fact, over 2.2 million Heart and Stroke patients have benefitted from Get With The Guidelines®!

Legislators need to become aware of this important work so they may fully understand the impact of the association's mission and appreciate the expertise the AHA may bring to important issues associated with delivering timely, quality healthcare.

Follow the link below to contact your legislator about the American Heart Association's efforts to improve care in your community:

Timely, Quality Care in Minnesota

Lawmakers are confronted with making very tough decisions these days and they are looking for solid partners to craft smart solutions. The more leaders learn about the ground-breaking work the AHA is performing to improve patient outcomes, the more they will go to the AHA as a partner in identifying solutions to today's challenges. Sending your message today can make a real difference:

Timely, Quality Care in Minnesota

We encourage you to learn more about the Get With The Guidelines® program of the American Heart Association. As always, we thank you for your active voice as a member of the You're the Cure grassroots network. We can't spell CURE, without "U".

You're Invited! 2010 Statewide Health Improvement Program Conference: Making Strides Toward a Better State of Health

Mission:
To help Minnesotans live longer, better, healthier lives by addressing the epidemic of obesity and the use or exposure to commercial tobacco, the 2010 Making Strides Toward a Better State of Health conference will create a positive environment for tribal and local public health, state and local government stakeholders, and community partners from throughout Minnesota for education, skill building, and learning from each other.

The 2010 Statewide Health Improvement Program (SHIP) Conference

*There is no charge for this conference.
When: Tuesday, August 03, 2010 - Wednesday, August 04, 2010
Where:

Earle Brown Heritage Center

6155 Earle Brown Drive

Brooklyn Park, Minnesota 55430

763-569-6300

REGISTER TODAY!

Registration closes Friday, July 23, 2010.
Registration Questions? Government Training Services, 651-222-7409, Catherine Dubbe, x200, cdubbe@mngts.org

Objectives:
-Attendees will understand and be able to articulate and implement at least three new solutions to the problem of obesity and/or commercial tobacco use in Minnesota and their communities.
-Attendees will hear success stories from their peers and gain an understanding of and knowledge to help replicate practices and strategies
-Attendees will be able to demonstrate at least three new strategies to improve the implementation of their current obesity reduction and/or commercial tobacco cessation efforts.
-Attendees will identify at least three experts and/or colleagues who may be a resource for current and future obesity reduction and/or commercial tobacco cessation efforts.