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(c) 2014 Jon L Gelman, All Rights Reserved.

Tuesday, November 30, 2010

AIG -The Inside Job




Advertised as 'The movie that took over $20 Trillion dollars to make", Inside Job, is now on the screens of theaters throughout the nation. The movie's premise is that the recent,  systemic,   financial collapse was founded upon AIG's  feared inability to payout on the claims for failed sophisticated financial instruments that AIG insured. The resulting consequences of the AIG bailout  became a vehicle to shelter and fund Wall Street at enormous taxpayer expense.

The lack of criminal accountability for AIG, and the insurance industry's inadequate disclosures, poor ratings and reserves, bad investments and resulting political cover, left the industry destitute and unable to meet its fiduciary obligations to its insureds. Despite all of the bad news, AIG continued to pay bonuses to its executives, scheduled junkets and act as a conduit for payments. The movie questions who is actually regulating the financial/insurance industry, and whether the industry has now become so fused with American politics that Wall Street is insulated no  matter which political party is at the helm.

Workers' Compensation insurance coverage is premised on the legislative intent to provide remedial coverage and summary benefits. When major players in the insurance industry jeopardize that coverage, then the result impacts the ability of the system to function and causes lingering inability to pay. Government regulators have the moral, if not the legal obligation, to protect the system.

Pulmonary Embolism Held to Be A Vascular Disease

The NJ Appellate Division held that a pulmonary embolism was a vascular disease and not compensable under the NJ occupational disease provisions of the Workers' Compensation Act. The Court distinguished the medical event from an occupational exposure. Vascular disease are governed by a more stringent standard (NJSA34:15-72).


In reversing the trial court the Appellate Division, held that 5 elements need to be present to prove an occupational condition:

"From our review of the history and application of Section 31, we extrapolate five common themes of occupational disease claims. First, the employee is exposed to conditions that would be viewed as creating a likely risk of injury. Second, there is continued exposure to the work conditions. Third, there is an inherent hazard of continued exposure to the conditions. Fourth, there is attached to that job a hazard that distinguishes it from the usual run of occupations. Fifth, the claim is made because of long-term exposure, not because of one specific event."


The Court distinguished the episode from an "occupational heart condition" which the NJ Supreme Court ruled was compensable condition in Fiore. That condition was a hybrid compensable condition crafted between the standards of NJSA 34:15-31 and NJSA 34:15-7.

Renner v. ATT Docket No. A-3237-09T3, 2010 WL 4811913 (N.J.Super.A.D. 2010)

Monday, November 29, 2010

NIOSH Pocket Guide to Chemical Hazards Available for Free Download

The NIOSH Pocket Guide to Chemical Hazards (NPG) is intended as a source of general industrial hygiene information on several hundred chemicals/classes for workers, employers, and occupational health professionals. The NPG does not contain an analysis of all pertinent data, rather it presents key information and data in abbreviated or tabular form for chemicals or substance groupings (e.g. cyanides, fluorides, manganese compounds) that are found in the work environment. The information found in the NPG should help users recognize and control occupational chemical hazards.

Instructions for Downloading:
Download the NPG CD-Rom as a ISO image file and create a disc with CD-ROM authoring software.
The NPG ZIP file contains a condensed version of the NPG.
All non-Pocket Guide links were removed so that this set of files acts as a "stand-alone" database. These files can be used with a standard web browser or on some mobile devices.



  • 2010-168c.zip (245 MB) (requires WinZip or other unzipping software)
  • 2010-168c.exe(181 MB) (Self-extracting zip file for Windows)
  • 2010-168c.isoNIOSH publication number 2010-168c 
    (ISO Requires CD-Rom Authoring Software)

Friday, November 26, 2010

Hospitals Are Not For Sick People

The New England Journal of Medicine reports that hospitals remain unsafe. A study comparing the last 10 years reflects that there have been no significant changes in safety rates for patients entering hospitals.  For decades the number has been stable, close to 25% of hospital patients get sicker because of unsafe or unhealthy hospital conditions or activities.

"Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2). Multivariate analyses of harms identified by internal reviewers showed no significant changes in the overall rate of harms per 1000 patient-days (reduction factor, 0.99 per year; 95% CI, 0.94 to 1.04; P=0.61) or the rate of preventable harms. There was a reduction in preventable harms identified by external reviewers that did not reach statistical significance (reduction factor, 0.92; 95% CI, 0.85 to 1.00; P=0.06), with no significant change in the overall rate of harms (reduction factor, 0.98; 95% CI, 0.93 to 1.04; P=0.47)."

Adverse complications of medical care provided to injured workers are compensation under workers' compensation. Employers and insurance carriers should encourage safe and harmless medical care for injured workers.

Temporal Trends in Rates of Patient Harm Resulting from Medical Care, N Engl J Med 2010; 363:2124-2134November 25, 2010

Tuesday, November 23, 2010

The Time for a Hexavalent Chromium Safety Standard Is Now


EPA announced the release of the Toxicological Review of Hexavalent Chromium in the September 30, 2010, Federal Register. This draft assessment is provided for public viewing and comment. Public comments received on the Toxicological Review during the public comment period will be provided to the external peer reviewers for their consideration. Any comments not received within the requested time period will be considered by EPA in their revisions. The deadline for comments is December 29, 2010.
EPA is conducting a peer review of the scientific basis supporting the human health hazard and dose-response assessment of hexavalent chromium that will appear on the Integrated Risk Information System (IRIS) database. 

Background

The draft Toxicological Review of Hexavalent Chromium provides scientific support and rationale for the hazard and dose-response assessment pertaining to chronic exposure to hexavalent chromium via ingestion. 

Chromium is a naturally occurring element in the earth’s crust. The three main forms of chromium found in the environment are chromium (0), chromium (III), and chromium (VI), also known as hexavalent chromium. Chromium is widely used in manufacturing processes, and it can be found in many consumer products such as wood treated with copper dichromate, leather tanned with chromic sulfate, and stainless steel cookware. Chromium is released to the environment from natural and anthropogenic sources, with the largest releases occurring from industrial sources. The general population may be exposed to chromium by inhaling ambient air, and ingesting food and drinking water containing chromium. Dermal exposure to chromium can occur from skin contact with certain consumer products or soils that contain chromium.

History/Chronology

Sep 1998
May 2010
EPA initiated an interagency science consultation to review the draft toxicological review and charge to external peer reviewers.
Sep 2010
EPA released the external review draft for public review and comment and the interagency science consultation review draft with comments. EPA also announced a public listening session to be held on November 18, 2010. [Federal Register Sep 30, 2010]
Nov 2010
EPA extended the public comment period an additional 30-days. [Federal Register Nov 10, 2010]

Next Steps

Following the conclusion of the public review and comment period, public listening session, and external peer review, the draft Toxicological Review will be revised and submitted for a final Agency review and an EPA-led Interagency Science Discussion. As a last step, the final assessment will be posted on the IRIS database.


Downloads

·      Charge to the External Reviewers (PDF)  (2 pp, 18 KB, about PDF)

Additional Information

Comments on the assessment may be submitted and reviewed using the e-Government Regulations.gov Web site. From the site, select “Environmental Protection Agency” and the keyword “EPA-HQ-ORD-2010-0540” (for the docket ID) to comment on this report.

Citation

U.S. EPA. IRIS Toxicological Review of Hexavalent Chromium (External Review Draft). U.S. Environmental Protection Agency, Washington, DC, EPA/635/R-10/004A, 2010.

California Office of Environmental Health Hazard Assessment (OEHHA), which supports a proposed Public Health Goal (PHG) of 0.06 parts per billion (ppb) in drinking water.

Delay
Industry groups, American Chemistry Council (ACC) has requested a delay in implementation. ACC  requested even more studies to determine whether CR6 is indeed safe.
Some have indicated that the chromium industry have withheld data concerning the safety of CR6. Experts have already confirmed that CR6 is very dangerous to humans, “Faced with the threat of stronger regulation, the chromium industry initiated an effort to challenge the scientific evidence supporting a more protective [OSHA workplace] standard [for inhalation]. This effort included the use of “product defense” consultants [Exponent and ChemRisk] to conduct post hoc analyses of a publicly-funded study to challenge results viewed unfavorably by the industry” (Michaels et al, 2006). Recent reports have indicated that US troops have allegedly become sickened from exposure to CR6 in Iraq and Afghanistan from burn pit exposures.

There appears  to be no valid reason to delay further the implementation of CR6 safety standards by EPA. 


Monday, November 22, 2010

Iowa Workers' Compensation Commissioner Tells Congress AMA Guides Are Objectionable

The Commissioner of the Iowa Division of Workers' Compensation, Christopher James Godfrey, recently testified before Congress that AMA Guides 6 Ed. were problematic. The Commissioner cited the 2008 Iowa Task Force report that found multiple errors and cultural bais in the AMA Guides.

An additional objection made was that the Guides were in conflict with both Iowa statutory and case law. The Commissioner stated, "With all due respect to Dr. Brigham, the Iowa Workers’ Compensation system will evolve and improve when it is decided by the citizens of Iowa that it will evolve and improve. The system will not evolve at the whim or business opportunity of either one physician, one medical association, or a small consensus of the two."


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Congress Told Workers Compensation is a Deteriorating System

The former chair of the 1972 National Commission on Workers' Compensation told Congress that the present system is deteriorating and a new course of action is warranted. Profession Emeritis John F. Burton, Jr., last Wednesday testified before The Subcommittee on Workforce Protections of the Congressional Committee on Education and Labor.

Professor Burton told Congress that during the last 20 years he has observed the "...deterioration in adequacy and equity of state workers' compensation programs..." He reported that "the decline in workers' compensation cash benefits in the states during the 1990's is explained by ....changes in workers' compensation provisions and practice than  is explained by the drop in workplace injuries and disease during the decade."

Burton proposed that Congress consider new legislation to prohibit costs shifting from workers' compensation to Social Security Disability Insurance (SSDI). He advised the Subcommittee that cost shifting was continuing because 15 states were permitted to continue "reverse offset" provisions, the Social Security Administration (SSA) was paying benefits to workers who were not totally disabled under workers compensation acts, and a larger number injured workers were not qualifying for workers' compensation benefits.


As Professor points out, the aging workforce further complicates the burden placed upon the nation's Medicare system. With the erosion of the doctrine that workers' compensation takes the worker as it finds him or her, medical treatment for pre-existing conditions will be a growing cost for Medicare and a cost-shift from the workers' compensation system. The NY Times reported that, "Nearly one-fourth of Medicare beneficiaries have five or more chronic conditions. They account for two-thirds of the program’s spending."

A "reaffirmation" of "Federal standards" as enunciated in the 1972 National Commission report were recommended by Burton.  Additionally, he called upon Congress to enact legislation requiring employers and/or their insurance carriers reimburse Social Security for permanent disability cash benefits paid by Social Security for disability flowing from a work related event or disability.

Friday, November 19, 2010

US Seeks to Amend Complaint in Reimbursement Action to Define SOL

The Centers for Medicare and Medicaid Services (CMS) has filed a Motion to Amend its complaint in a lawsuit that will define the Statute of Limitations in a Medicare Secondary Payer (MSP) recovery action. The action by CMS followed the Court granting CMS's Motion for Reconsideration in order to clarify the alleged $25 Million continuing accrual claim.

The Motion pleads, "Although the United States contends that it has set forth sufficient facts alleging its cause of action, the amendments set forth with more specificity (1) the Defendants’ payment of and receipt of annual payments made and received through 2013 as a result of the Abernathy Settlement Agreement, (2) their liability under the MSP Statute stemming from the annual payments, (3) additional information concerning the identified Medicare beneficiaries among the Abernathy Plaintiffs, (4) changes to certain allegations based on facts included in Court filings, and (5) the removal of The Cody Law Firm as a defendant."

CMS alleges that the parties knew of the outstanding conditional payments made by CMS and failed to reimburse the payments under the MSP Act.

USA v. Strickler, et al., Civil Action No. 1:09-cv- 02423-KOB (USDCT ND Alabama) Filed 11/16/10

Thursday, November 18, 2010

Dean Emily Spieler Requests Congress to Review The Workers' Compensation Disability Rating System

In recent testimony before the Subcommittee on Workforce Protections Committee on Education and Labor U.S. House of Representatives, Emily A. Spieler, Dean of the Northeastern University Law School, requested further investigation to develop a new rating system for workers compensation claims.


Dean Spieler reviewed current difficulties with the current AMA Guides 6th ed. She stated,
"I urge that you ask the National Academies of Science / Institute of Medicine to conduct a review. This review should include recommendations regarding the best way to develop a new system for rating workers’ injuries as measured by the impact of those injuries and diseases on the extent of permanent impairments, limitations in the activities of daily living, work disability and nonwork disability (or noneconomic losses)."


Click here for complete testimony.

Wednesday, November 17, 2010

Congresswoman Woolsey Calls For A GAO Study of Workers Compensation-Cites Insurance Company Cost Shifting

Below are the prepared remarks of U.S. Rep. Lynn Woolsey (D-CA), chairwoman of the Workforce Protections Subcommittee, for a subcommittee hearing on “Developments in State Workers’ Compensation Systems” 11.17.2010
-
Thank you all for attending this hearing on “Developments in State Workers’ Compensation Systems.” Here in Congress, we don’t examine these state compensation programs very often because they are generally under the purview of state legislatures.

However, there have been some disturbing national trends that may compel a comprehensive reexamination of these state programs and their impact on injured workers.

As most of you are aware, workers’ compensation statutes were passed beginning in the early  20th century to establish a no fault system for providing efficient redress for injured workers.

Workers’ compensation was called the ‘grand bargain.’

Workers waived their rights to bring individual suits against their employers and in return receive compensation for work-related injuries regardless of fault.

Every state and the District of Columbia have workers’ compensation programs in place.

Most employers purchase private workers compensation policies, but others self-insure or purchase insurance from a state managed compensation fund.

Beginning in the 1990s, changes in state workers’ compensation laws--brought about by the lobbying efforts of employers and insurance companies---have resulted in stricter eligibility requirements and the reduction in both the amount and duration of benefits—particularly for those workers with permanent partial disabilities.

Unfortunately this ‘grand bargain’ of the 20th century is not so ‘grand’ any more, especially for injured workers.

In addition, there are two other recent developments that merit our attention

The first has to do with the American Medical Association’s (AMA) Guides to Permanent

Impairment.

And the second concerns a cost-shifting trend away from state workers compensation programs, where the employer is responsible for an employee’s injury, to the federal government’s medical and disability programs.

The AMA Guides have been in effect since 1971 and are now in widespread use.

Some states even require workers’ compensation programs to use the latest edition of the Guides.

These Guides were originally designed to be used by physicians in making a scientific assessment of a worker’s level of impairment---or loss of function---due to a work-related injury.

The determination of whether a worker is permanently disabled and entitled to workers compensation is based upon his or her impairment rating, which is then applied to the specific case of a given worker.

For example, a worker who loses a hand may not suffer permanent disability if he or she is a teacher, but that same worker would be permanently disabled if he or she works in construction.

In 2007, the AMA published the 6th edition of the Guides, and witnesses today will describe how this new edition has dramatically reduced impairment ratings for many types of conditions, without apparent medical evidence, and transparency.

The 6th edition has become so controversial that many states, including Iowa, Kentucky and Vermont have decided not to adopt them.

It also appears that the 6th edition was developed in near secrecy, without the transparency and consensus which should necessarily accompany the development of standards that will have widespread use by state governments.

In addition, it appears that the physicians who developed this latest edition may have ties to insurance companies, and are making a profit training doctors on the use of the 6th edition, which is complicated and very difficult to apply.

The National Technology Transfer Advancement Act of 1996 sets forth minimum criteria for the development of voluntary consensus standards: openness; balance of interests; due process protections; and consensus.

The process used for developing the 6th edition appears to significantly deviate from these standards and is a focus of testimony before us today.

Workers who are wholly dependent on this ‘grand bargain’ when they are injured on the job, are the ones paying the price.

The subcommittee invited the AMA to testify today, but unfortunately, it declined.

Another troubling policy issue is that as eligibility for workers’ compensation benefits have become more restrictive, there has been a cost shift to Medicare and Social Security Disability (SSDI), placing an additional burden on the taxpayer.

In addition, costs are being shifted to private health insurance that should be borne by workers’ compensation policies and employers.

This is particularly worrisome, especially during a time of record deficits.

Chairman Miller and I believe that this cost-shifting trend warrants further study.

Therefore, we will be asking the Government Accountability Office (GAO) to do a study and issue recommendations.

The testimony today will illuminate these problems facing injured workers and taxpayers, and I look forward to hearing from our witnesses.

Tuesday, November 16, 2010

CMS Extends Interim Dollar Reporting Threshold Date

II. Extension of Current Dollar Thresholds for Liability Insurance
(Including Self-Insurance) and Workers’ Compensation

The interim dollar reporting thresholds set forth in Section 11.4 of version 3.1 of the MMSEA 111 Liability Insurance (Including Self-Insurance), No-Fault, and Workers’ Compensation User Guide have all been extended by one calendar year.

Under Section 11.4, “Workers’ Compensation ORM”, the date 12/31/2011 is changed to 12/31/2012.
Under Section 11.4, “Liability Insurance and Workers’ Compensation TPOC Amounts”, the last four bullets are revised to read:
• Claim reports where the last (most recent) TPOC Date is prior to January 1, 2013 with TPOC Amounts totaling $0.00 - $5,000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2013 with a total TPOC amount less than or equal to $5000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2013 through December 31, 2013 with TPOC Amounts totaling $0.00 - $2000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2014 with a total TPOC amount less than or equal to $2000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2014 through December 31, 2014, with TPOC Amounts totaling $0.00 - $600.00 are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2015 with a total TPOC amount less than or equal to $600.00 will be rejected.
• No threshold applies to claims where the last (most recent) TPOC Date is January 1, 2015 and subsequent.

November 09, 2010
Medicare Secondary Payer Mandatory Reporting Provisions in
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(See 42 U.S.C. 1395y(b)(7)&(b)(8))


Lloyds Report Targets Potential Cell Phone Liability

Yet another reason why employers should be concerned with the risks of distracted driving has been reported by Lloyds of London. A recent report considers the electromagnetic fields (EMF) from mobile phones a potential risk to health.

The report reviews the medical causation issues involving a myriad of conditions ranging from brain cancer (acoustic neuromas and gliomas) to central nervous system effects, as well as reproduction and biological development consequences of EMF exposure over the long term. In reviewing historical litigation trends, the Lloyds report compares the legal consequences of asbestos exposure and the development of mesothelioma and analyzes the complicity and enormous liability that resulted from corporate concealment and conspiracy.

With over 4.3 billion mobile phones in use worldwide as of June 2009, this report increases the concern of employers who are already experiencing increased liability because of the use of cell phones while driving. A major initiative is underway by US Department of Transportation to curtail the use of cell phone by employee while driving because of the increase risk of motor vehicle accidents.

As workers’ compensation insurance carriers have already been challenged by significant losses as a result of occupational exposure to asbestos, the Lloyds report may encourage employers to restrict the use of a cell phone, except when used in a safe and protected manner. 


Monday, November 15, 2010

Congress to Hear Experts on New State Workers' Compensation Limitations

A sub-committee of the Committee on Education and Labor, chaired by the Congressman George Miller, will be hearing testimony from national experts concerning the new limitations being imposed on State workers' compensation systems. The systemic problems to be examine include the delivery of medical benefits and the assessment of the nature of disability.

On Wednesday, November 17, the Workforce Protections Subcommittee of the House Education and Labor Committee will examine state workers’ compensations systems. Workers’ compensation traditionally provides financial assistance and job training to workers injured on the job and aid to the surviving family of a worker killed on the job.

Not only are the state systems drawing the attention of the US Congress, but also the federal programs are becoming problematic. The United States Postal Service announced last week that workers' compensation costs are so high that the quasi-governmental agency may have to declare bankruptcy.

With the newly elected Republican majority in Congress, the water ahead may be rough for workers' compensation. The last time the Republican's held the majority in Congress, Newt Gingrich , the former Speaker, was entertaining dramatic changes in the program. Those appear to have been refreshed in recent comments about a year ago.

These systems have undergone numerous changes in the past decade as many states have begun strictly limiting workers’ compensation benefits – changes that may be stressing the Social Security Disability Insurance (SSDI) program. Additionally, the American Medical Association’s (AMA) guide to assessing injured workers has undergone significant changes in its latest edition, which has made consequential changes to injured workers’ evaluation procedure.

Workforce Protections Subcommittee Hearing
2:00 PM, November 17, 2010
2175 Rayburn H.O.B.
Washington, DC

Additional witnesses TBA.

Witnesses:
Emily SpielerDeanNortheastern University School of LawBoston, MA
John BurtonProfessor Emeritus, School of Management and Labor Relations, Rutgers UniversityProfessor Emeritus, School of Industrial and Labor Relations, Cornell UniversityPrinceton, NJ
Christopher GodfreyIowa Workers Compensation CommissionerDes Moines, IA
Dr. John NimlosOccupational Medicine ConsultantShoreline, WA

Sunday, November 14, 2010

USPS May Declare Bankruptcy Citing High Workers Compensation Costs

A small United States Postal Service truck see...
The Washington Post reported Saturday that the US Postal Service (USPS) may declare bankruptcy and cited high combined benefit costs as a major cause for its financial instability.  The quasi-governmental agency is running into problems it claims because of its requirement to to pre-fund $5.4 billion to a retiree health benefit fund and pay $2.5 billion to the federal workers' compensation fund.

The USPS's troubles mirror that difficulties stangulating the nation's network of state workers' systems caused by the inability to fund soaring medical costs enhanced by complications caused by duplicate administrative costs engulfed by a multiplicity of collateral programs. In contested claims injured workers are shifted to other benefit programs to pay for medical costs. Those secondary programs ultimately seek reimbursement from the primary benefit program, workers' compensation coverage, and literally clog up administrative dockets and create greatly enhanced processing costs and monumental delays.

While the USPS will seek assistance from the Republican majority in
US Congress, it is uncertain what financial aid will be forthcoming, or whether Congress will take a deeper look at the nation's workers' compensation entirely. The last time the Republican's dominated Congress proposals were suggested by the former Speaker, Newt Gingrich, to over haul the national system entirely.

The medical component is now in critical condition. It remains uncertain if it will addressed in the next congressional term, or whether it will be the can that is kicked down the road to be dealt with in the future. The growing trend remains, that Federalization of the medical delivery component is the probable  solution to both the USPS's compensation difficulties as well as the the nation's.

...
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

Friday, November 12, 2010

Great American Smokeout --- November 18, 2010


The Great American Smokeout (GASO), sponsored by the American Cancer Society, is an annual event that encourages smokers to quit for at least 1 day in the hope that this might challenge them to stop permanently (1). This year, GASO will be held on November 18.
Major changes have occurred since the first GASO in 1977. In 1978, approximately 34% of adults smoked; by 2009, nearly 21% smoked (2--4). Federal laws now prohibit smoking on airlines, and 24 states and the District of Columbia have comprehensive smoking bans (3,4). The U.S. government also has added coverage of smoking cessation treatments to health plans. As of October 1, 2010, Medicaid programs are required to cover tobacco-dependence treatments for pregnant women, and in 2011, cessation coverage will be provided to all federal employees, retirees, and their spouses and dependents.
Despite progress, 46.6 million U.S. adults smoke, 40% of nonsmokers are exposed to secondhand smoke, and 443,000 deaths each year are attributed to smoking and secondhand smoke (3--5). Additional information and support for quitting is available online (http://www.smokefree.) or by telephone (800-QUIT-NOW [800-784-8669]; TTY 800-332-8615).

References

  1. American Cancer Society. Great American Smokeout. Available at http://www.cancer.org/healthy/stayawayfromtobacco/greatamericansmokeout. Atlanta, GA: American Cancer Society; 2010. Accessed November 2, 2010.
  2. CDC. Surveillance for selected tobacco-use behaviors---United States, 1900--1994. MMWR 1994;43(No. SS-3).
  3. CDC. Vital signs: current cigarette smoking among adults aged ≥18 years---United States, 2009. MMWR 2010;59:1135--40.
  4. CDC. Vital signs: nonsmokers' exposure to secondhand smoke---United States, 1999--2008. MMWR 2010;59:1141--6.
  5. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses---United States, 2000--2004. MMWR 2008;57:1226--8.