MONEY health

Smoking Can Cost You $1 Million to $2 Million in a Lifetime

smoking cigarette wrapped in money on ashtray
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Your pack-a-day habit isn't just destroying your lungs, but your bank account as well—more than you ever imagined.

According to the American Lung Association, tobacco kills nearly half a million Americans annually and costs the nation $333 billion per year in health-care expenses and lost productivity to boot. But it’s hard for the average person—specifically, the average smoker—to wrap one’s brain around such an enormous figure.

Coming to the rescue, timed to coincide with the CDC’s Tobacco Awareness Week, is a new state-by-state analysis from WalletHub detailing the lifelong financial costs of smoking for an individual. Because the average price of a pack of cigarettes varies widely around the country—$5.25 in Virginia, $8 in Michigan, $12.85 in New York—the lifetime outlay varies greatly from state to state as well. In all cases, though, the data gathered by WalletHub show that smoking is incredibly costly in addition to being potentially deadly.

The total cost per smoker is estimated at $1,097,690 in South Carolina—and it’s the least expensive state in the nation. A Kansas City Star headline noted that the “cost of smoking is cheap in Missouri … relatively,” as the state ranks as the eighth least expensive on WalletHub’s list, with the total cost for a lifetime of smoking running “only” $1,177,230. At the high end of the spectrum, there’s Rhode Island, Massachusetts, New York, and Connecticut, where the habit costs more than $1.9 million per person in a lifetime. Priciest of all is Alaska, which crosses the $2 million mark.

For a little perspective, federal data estimates that the cost of raising a child to age 18 is about $250,000—a big chunk of change, but only a small fraction of expenses reportedly incurred by smokers.

Right about now, the average smoker (or just the average reader with a healthy degree of skepticism) is probably thinking: hogwash. The process of coming up with such wild figures must involve a fair amount of smoke and mirrors, so to speak, right?

Let’s have a look at what WalletHub did, exactly. By far, the largest expense incorporated into the per-person total is the “tobacco cost per smoker,” measured at $786,346 in South Carolina, up to roughly $1.5 million in Alaska. WalletHub came up with that figure by multiplying the average price of a pack of cigarettes in each state by the number of days in 51 years. Fair enough. There are cheaper ways to go about buying cigarettes, like buying smokes by the case, but many people purchase by the pack.

What’s trickier is the way that WalletHub pumped up its tobacco cost estimates by calculating “the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.” In other words, the assumption is that money not spent on cigarettes would have been dutifully and wisely invested over those same 51 years.

Similar assumptions have also been used in the now (mostly) discredited “latte factor,” which is the theory that holds that people can wind up with millions in the bank by cutting back on everyday expenses like a daily latte. Among other reasons, this line of thinking is questionable because people don’t necessarily invest money that they don’t spend on some product or service—they’re more likely to simply spend that money on something else.

WalletHub also includes other costs that many smokers never think about, factoring in added health care expenses (with state-by-state data from the CDC) and an 8% hit on income due to smoking, as determined in a study by the Federal Reserve Bank of Atlanta.

Add up all of these and a few other estimated expenses, and over the course of a half-century, the cost to the pack-a-day smoker runs $1 million to $2 million, according to WalletHub. Are the figures overblown? Well, perhaps a bit. There’s a good argument to be made that the data were construed to come up with totals that are as big and headline-worthy as possible. (After all, they got our attention.)

Nonetheless, even if the figures are on the inflated side, it’s an undeniable reality that the smoking habit costs big bucks over a lifetime. And oh yeah, it can make your lifetime a lot shorter. Let’s not forget that.

TIME Infectious Disease

The Flu Shot Isn’t Working Well This Winter

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Elizabeth Renstrom for TIME

People who got the vaccine aren't as shielded as they sometimes are

People who got a flu shot this winter are only 23% less likely to get the flu than someone who didn’t get the vaccine, the Centers for Disease Control and Prevention (CDC) said in a new report Thursday.

This flu season, H3N2 flu viruses have been the most predominant, but the CDC reports that about 70% of them have genetically changed so that they are not as responsive to the flu vaccine as they were in the past. This is likely why the vaccine appears to be less effective, a measure the CDC calculates by looking at the number of medical visits related to the flu.

Since the flu vaccine is developed based on early predictions of what flu viruses will be most common during a certain season, it’s always possible that the estimates will be off and the vaccine won’t protect against the most common flu viruses circulating. Since the CDC started tracking flu vaccine effectiveness in 2004, the rates have ranged from 10% to 60%.

When the flu vaccine is less effective, people need to be more cautious and stringent about other ways to prevent contagion, like washing hands and treating the flu with medication if it is contracted. “Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected,” Joe Bresee, an official in the CDC’s Influenza Division, in a statement.

The report shows that the vaccine is the effective among kids ages 6 to 17. The CDC said it’s classifying this flu season as moderately severe, and that it is similar to the 2012-2013 season.

TIME Infectious Disease

U.S. Hospitals Get Better at Preventing Infections

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Phil Fisk—Getty Images

Progress in combatting a worldwide problem

Hospitals in the United States have made progress in lowering the rates of infections patients get while they are there, according to a new report.

The Centers for Disease Control and Prevention report released Wednesday showed that hospitals have cut down on infections caused by medical mistakes and bacteria. Between 2008 and 2013, there’s been a 46% decrease in bloodstream infections caused by germs getting into the blood when tubes are inserted into veins incorrectly. During the same period, hospitals cut surgical site infections by 19%, and catheter-associated urinary tract infections by 6%.

“Hospitals have made real progress to reduce some types of healthcare-associated infections—it can be done,” CDC director Dr. Tom Frieden said in a statement. “The key is for every hospital to have rigorous infection control programs to protect patients and healthcare workers, and for health care facilities and others to work together to reduce the many types of infections that haven’t decreased enough.”

The data come from the National Healthcare Safety Network (NHSN), which tracks infections nationwide from over 14,500 health care facilities in all 50 states, Washington, D.C., and Puerto Rico.

TIME flu

Here’s Where to Find Out If You’re Likely to Get the Flu

It’s not enough to know if your state is a flu hot zone. Now you can find out if the street you live on is teeming with flu cases

With this year’s flu season nearing epidemic levels — it’s widespread in 43 states, according to the Centers for Disease Control and Prevention (CDC) — prevention (and preparation) is certainly your best medicine.

Fortunately, there is no shortage of apps and websites that can help. Flu tracking is a popular subject, and ever since Google Flu Trends launched in 2008, it seems everyone wants to know how prevalent flu is — not just in their state and in their city, but in their neighborhood and even their office building. (Facebook can even help you figure out which of your friends might have given you the flu but tracking members’ posts about the illness and its symptoms.)

And while none are perfect, there are a few good ones.

The CDC’s FluView:

It gathers data from clinics, urgent care centers, doctor’s offices and hospitals and reports the number of people coming in with flu-like symptoms — fever, cough, sore throats, muscle aches — and people who test positive for the bug. It offers a good snapshot but it has some shortcomings. Because it logs symptoms in addition to diagnosed cases, there’s a chance that some of the fever and respiratory problems could be something else entirely. It also doesn’t record the countless people who likely just decide to weather out their illness at home with over-the-counter remedies or some chicken soup. There’s also a lag in the reporting, which means FluView can’t provide a real-time look at what the virus is doing at a given time.

The CDC has an epidemiologist studying alternative ways of collecting flu information, including crowdsourcing, to see if the CDC can provide more real time data. “There is potential there,” says Lynnette Brammer, an epidemiologist in the influenza division at CDC. “But with any data set you’ve got to know how to appropriately interpret that data and when you might be over reaching.”

MORE: Why Some Experts Want Mandatory Flu Shots For School Kids

Flu Near You:

This app is more granular, portraying in real time the actual level of flu activity in a given area. It can pinpoint your location down to the street and give you a low-moderate-high reading on flu activity. It’s based on self reports from people who register on the app and voluntarily provide information on their sniffle status on a weekly basis. Blue dots indicate people who are still symptom-free, while yellow dots indicate people who might have some of the symptoms of flu — including fever, coughs, or sore throats — and red dots represent people who meet the CDC criteria for influenza-like illness: fever over 100F and a cough or sore throat that’s not caused by any other known infection.

Self-reporting may not provide an entirely accurate picture either, however. To address such confounding factors, Flu Near Your deletes the first two reports by newcomers, to reduce the possibility that new users are just playing around with the app, but there’s still no way to verify the symptoms that people log in. But so far, Mark Smolinski, director of global health for Skoll Foundation Global Health Threats, which created the app, is confident that the reports are valid, since they track pretty well with the CDC data.

Alexis de Belloy, who pores over the Flu Near You data, says that registration for the app is up 40% compared to last year, and the proportion of them who actively respond to the weekly surveys is also up; the more participants, the stronger and more reliable the signal generated by the users.

The Flu Forecaster:

Jeffrey Shaman, professor of at the Mailman School of Public Health at Columbia University, decided to combine a bit of both the CDC and real-time strategies into his flu forecaster, which he launched last year. You can select your city and receive a chart of when flu is likely to peak where you live. It’s based on the same predictive modeling that weather forecasters use — combining information from past flu seasons and current trends to make educated guesses about the ebb and flow of cases in the future. “There are problems with all data, so I don’t think any data should be used in isolation,” he says. “We should consider them all until we have that gold standard.”

And it’s not just an academic exercise. Smolinski points out that critical public health information can be gleaned from flu tracking and forecasting, such as how effective a particular flu season’s vaccine is. By comparing rates of illness among people who have been vaccinated and those who haven’t, doctors can get a good sense of whether the shot is a good match for circulating flu strains or not. It can also help doctors, hospitals and pharmacies to make informed decisions about stocking flu remedies like Tamiflu so everyone who needs them will have access to them.

In Australia, crowd-based online surveillance is becoming the country’s go-to resource on flu tracking. Their system, FluTracking.net, asks participants about whether they have had a fever or cough every week during the flu season; since the program began in 2006, more than 16,000 people now complete the survey regularly. In Europe, 10 countries participate in Influenzanet, an online flu tracking system that also relies on volunteers to report on their symptoms weekly.

“It’s what’s coming down the pike, and what’s going to be in our future,” says Shaman of the real time information from the public. “We already get pollution levels and the pollen count. Why not have a real time flu forecast?”

TIME Addiction

Alcohol Poisoning Kills 6 Americans a Day

CDC says alcohol poisoning deaths are a greater problem than previously thought

America has a drinking problem, with 2,200 people dying each year from alcohol poisoning. That’s an average of six alcohol-related deaths a day, a new Centers for Disease Control and Prevention (CDC) report says.

Alcohol poisoning happens when people drink an excessive amount of alcohol in a short amount of time, causing high levels of alcohol in the body to interfere with and even shutdown parts of the brain that are critical for controlling vitals like heart rate, body temperature, and breathing. Eventually, that can lead to death.

Over 38 million Americans binge drink an average of four times a month, and consume an average of eight drinks per binge, according to the new CDC Vital Signs report. Interestingly, the report shows that the majority of alcohol poisoning deaths happen in adults between the ages of 35 and 64, and 76% of those who die are men, revealing binge drinking is not a behavior solely observed among young people. The CDC reports that while the most deaths occur among non-Hispanic whites, American Indians and Alaska Natives have the most deaths per million people. The death rates also vary widely state to state. For example, alcohol poisoning deaths in Alaska add up to 46.5 deaths per million residents, and in Alabama it’s 5.3 per million residents.

The CDC says the report shows alcohol poisoning deaths are a greater problem than previously believed, and that the numbers are likely an underestimate since alcohol-related deaths are known to be underreported. Alcoholism was a factor in 30% of the deaths and other drug use was a factor in only 3%.

“Alcohol poisoning deaths are a heartbreaking reminder of the dangers of excessive alcohol use, which is a leading cause of preventable deaths in the U.S.,” CDC principal deputy director Ileana Arias said in a statement.

In response, the CDC is calling for more members of the medical community to screen and talk to their patients about alcohol, since numbers show only one in six U.S. adults has reported ever talked about their drinking with a health professional. States with stronger alcohol policies also have less binge drinking, and should partner with community workers including police and health workers for better programs, CDC says.

TIME Addiction

The Best Way to Kick Your Smoking Habit

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The more techy interventions, the better

If you’re really committed to quitting smoking for good, it’s time to get tech-savvy.

A new study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that people who use both phone hotlines and online cessation services to help them quit are much more likely to say they’ve abstained from smoking compared to people who opt for just one or the other.

In general, smoking quitlines are proven to be successful interventions for smokers who want to kick the habit. They offer guidance, support and resources to keep quitters on track. Most quitlines also offer a web version of their services, but until now, it hasn’t been clear that more information really is better.

MORE: Here’s the Best Way to Get Someone to Quit Smoking

The new study suggests that it is. Researchers looked at 7,901 people who reported using either phone-only interventions, internet interventions only, or a combination of both. People who used both methods were significantly more likely to report they hadn’t smoked in 3o days when researchers followed up with them. The researchers speculate that dual usage may improve a quitter’s likelihood of succeeding, possibly because they’re strongly committed to their goal.

“Although telephone and Web-based interventions are effective in tobacco cessation, providing access to multiple types of cessation services might improve the odds of users in achieving long-term cessation,” the researchers write. The hope is that physicians will counsel patients on considering both interventions.

Our ever-connected climate may make this easier, and many public health initiatives are seeing success in sending educational text reminders. The National Institutes of Health (NIH) is paying particular attention to how social media and cell phones can best be used to help break addiction. In October, the NIH pledged $11 million to studying the use of social media to help understand, prevent and treat substance use and addiction.

So if you’re ready to accept the challenge of going cigarette-free in 2015, set yourself up for success and log in.

TIME ebola

Atlanta Lab Workers Potentially Exposed to Ebola, CDC Says

CDC Chief Dr. Thomas Frieden Updates Media On Dallas Ebola Response
Exterior of the Center for Disease Control (CDC) headquarters on Oct. 13, 2014 in Atlanta. Jessica McGowan—Getty Images

Officials say up to a dozen CDC employees might have been exposed

Up to a dozen workers at the CDC’s Atlanta campus may have been exposed to a misplaced sample of the Ebola virus, agency officials said on Wednesday.

An agency spokesperson told the Washington Post that scientists mistakenly transferred the sample to an unsecured laboratory for testing. The technician who handled the sample and upwards of a dozen people in the area were being assessed for exposure risks.

A CDC official said the technician at greatest risk had not developed symptoms and would be monitored for 21 days. The exposure occurred Monday afternoon, and was discovered and rapidly escalated to supervisors by Tuesday.

Read more at the Washington Post.

TIME Infectious Disease

1 Million People Have a Disease You’ve Never Heard Of

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Photo Researchers—Getty Images/Photo Researchers RM

Chikungunya virus has infected over one million people this year, but Big Pharma still isn't stepping up

It’s a tale scientists are tired of telling: a disease that’s been carefully watched and studied for years is suddenly infecting an unprecedented number of people while promising drugs and vaccines sit on shelved, unfunded.

This time it’s not Ebola but a mosquito-borne disease called chikungunya, which causes debilitating joint pain and has infected more than 1 million people just this year. Originating in Africa, the virus has rapidly spread into the Caribbean and Central and South Americas, with a smattering of cases in the United States. Chikungunya is nothing like Ebola, but scientists who study it find themselves in a predicament similar to Ebola researchers: Despite decades of study, there’s still no way to treat or prevent it, due in part to a lack of interest from drug companies.

“[Chikungunya] is another example of an emerging infectious disease that we clearly have a light at the end of the tunnel for in a vaccine, and it’s pharmaceutical interest that really seems to be the road block,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who is trying to get support for a chikungunya vaccine his team developed. “It’s the big dilemma. The frustration. Back when Ebola was not on the front pages, we didn’t have very many enthusiastic pharmaceutical companies.”

MORE: TIME Person of the Year: The Ebola Fighters

In late 2013, chikungunya hit the west for the first time, in St. Martin. Now, in Puerto Rico alone, there were 10,201 reported cases from May to August 2014. In prior years, the Centers for Disease Control and Prevention (CDC) would only see an average of about 28 cases of chikungunya in the United States brought by travelers who had visited affected countries, primarily in Asia. But so far in 2014, there’s been over 1,900 recorded cases stateside.

Often, chikungunya is compared to dengue fever, but while chikungunya is not often fatal, up to 80% of people infected will show symptoms, which can be excruciating, says Dr. Pilar Ramon-Pardo, a PAHO/World Health Organization adviser in clinical management. “People cannot move because it’s so painful. There are tears in their eyes,” she says. “Sometimes there’s not an appreciation for chikungunya because it has a low fatality rate, but it’s a real public health problem. The economic impact from disability is high.”

Chikungunya was first identified in 1952 in Tanzania, and the more recent outbreaks started emerging in 2003 in East Africa, then spread into Southeast Asia, the Pacific Islands, and eventually to India, where millions of people were infected in 2006. In 2007, it touched down in Italy, at which point the CDC with the Pan American Health Organization (PAHO) doubled down to ensure countries were equipped to keep an eye on—and diagnose—the disease.

“We are very concerned about chikungunya moving into the Western Hemisphere,” says Dr. Roger Nasci of the CDC. “We have the two different species of mosquitoes in the U.S. capable of spreading the virus.” Massive outbreaks in the United States are unlikely; the temperate U.S. climate isn’t especially mosquito friendly, and widespread use of window screens and bug spray limit most Americans’ risk. Still, the disease takes a toll, and other countries are at risk of even more massive outbreaks.

Researchers at the National Institutes of Health (NIH) recently published results from a successful vaccine trial for chikungunya showing it’s safe but in order to take that vaccine to the masses, it needs to undergo an efficacy trial—and then it needs a distributor. Without a pharmaceutical partner, Fauci says a timeline for a chikungunya vaccine is “impossible to predict,” though the NIH is currently meeting with two undisclosed companies for possible partnerships.

A frequent source of funding for neglected infectious diseases, the Bill & Melinda Gates Foundation, does not have any active grants or investment in chikungunya. Meanwhile, for Fauci, getting backing for chikunhunya is a “here we go again” task of trying to churn up interest in a disease that doesn’t make headlines. “It’s a theme that continues to recur among my colleagues and I,” says Fauci.

Read next: The Unexpected Animal Group Dying from Climate Change

TIME Diet/Nutrition

Why Raw Milk Outbreaks Are On the Rise

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This is one health trend you don't want to try

Raw milk skips the commercial chain of pasteurization and homogenization, and many proponents drink to the promise of a purer, less processed food. But the Centers for Disease Control and Prevention (CDC) has long warned that the consumption of raw milk, which poses serious risks to Americans’ health, is nothing more than a misguided health trend. Now, a new report from the agency shows that the yearly number of outbreaks from raw milk is increasing.

Nearly 1,000 people were sickened from raw milk outbreaks from 2007-2012, the report says, and 73 went to the hospital. The new study shows there were an average of 13 outbreaks per year from disease-causing bacteria that can be present in unpasteurized milk between the years 2007-2012, with 81 total outbreaks in 26 states.

That rate has quadrupled since 1993-2006, the data set used when CDC last studied the subject. That time period saw only three outbreaks per year.

Some advocates have argued raw milk is a solution for people who are lactose intolerant, but the CDC and U.S. Food and Drug Administration (FDA) says this is untrue.

“I think there are a lot of people [who are part of] this back-to-nature movement, wanting to support local farms and eat organically. I think the raw milk movement has emerged as part of that,” says CDC epidemiologist Hannah Gould. But because it’s not pasteurized, raw milk can be dangerous. Bacteria like salmonella, E. coli and Campylobacter can all be found in raw milk, and you’d have to heat it to 161 °F for about 20 seconds to kill it off, says the CDC. One of the CDC’s awareness campaign shows a raw milk horror story from a mother who fed it to her son, than saw him go into kidney failure and be placed on a ventilator.

In 1987, the FDA banned interstate sale or distribution of unpasteurized milk, but states set their own laws when it comes to what can be sold in-state. Currently, 30 states allow the legal sale of raw milk, and since 2004, eight new states have allowed the sale. The new data shows more than 80% of the outbreaks tallied in the new report occurred in states where selling raw milk is allowed.

“As states continue to legalize raw milk, I would expect it’s likely we will see more outbreaks and illnesses associated with it,” says Gould. “When we see something happening like this huge increase in the number of outbreaks caused by raw milk, we try to put out the message that this going on, and provide that information to state legislators trying to make decisions about raw milk as well as alert consumers to the risks.”

Read next: Now Coming to Your Morning Cereal Bowl: Quinoa

TIME ebola

How Effective Is Screening for Ebola at Airports?

New York's JFK Airport Begins Screening Passengers For Ebola Virus
A plane arrives at New York's John F. Kennedy Airport (JFK) airport on October 11, 2014 in New York City. Spencer Platt—Getty Images

Since August, 80,000 passengers have been screened for Ebola at various airports around the world. Here’s what health officials found

As the Ebola outbreak in West Africa escalated over the summer, the World Health Organization recommended airport screening as a way to contain spread of the disease. WHO advised that all people leaving the most severely affected countries—Guinea, Liberia and Sierra Leone—should have their temperatures taken and be asked about any Ebola-related symptoms they might have, including fever, headaches, vomiting and diarrhea.

Since the program began in August, more than 80,000 passengers have been screened as they left these countries, 12,000 of them headed for the U.S. Do the screenings work? In a report published in the MMWR, officials at the U.S. Centers for Disease Control reveal the latest information from the program.

Anyone with a fever or other symptoms—or who reported having a high risk of being exposed to Ebola, such as having contact with Ebola patients—was not allowed to fly. According to the CDC report, none of those who were denied boarding were diagnosed with Ebola. But two patients without symptoms when they left West Africa, Thomas Eric Duncan and Dr. Craig Spencer, eventually developed Ebola after arriving in the U.S.

The MMWR report also details the U.S.’s more stringent airport entry screening for all passengers arriving from the three affected countries. Beginning Oct. 11, all passengers coming to the U.S. from these countries were required to fly into one of five airports: John F. Kennedy International Airport in New York, Newark Liberty International Airport in New Jersey, Washington-Dulles International Airport, Chicago O’Hare International Airport or Hartsfield-Jackson Atlanta International Airport. They are also required to take their temperatures for 21 days, the incubation period for the Ebola virus, and report them to local health officials. The designated airports are equipped with trained public health personnel who meet passengers and provide them with a kit to help them record their temperatures, as well as educate them about who to call if they develop symptoms.

From Oct. 11 to Nov. 10, 1, 993 passengers were screened this way, and 4.3% were referred to the CDC for additional evaluation. Seven people had symptoms and were referred to proper medical personnel, but none developed Ebola. “Using these processes to educate each traveler and then link the traveler to public health authorities for the duration of the incubation period is of critical importance to facilitate rapid detection of illness and implementation of appropriate public health control measures,” the authors write.

But the most effective way to prevent the epidemic from spreading is to control it at its source. In a separate MMWR report, researchers at the CDC say that their first assessment of Ebola infection and control in Sierra Leone reveals many gaps. In a review of six of the 14 districts in Sierra Leone that are affected by Ebola, the CDC Ebola Response Team found that none had a dedicated infection control supervisor to oversee training and implementation of infection control procedures, such as wearing protective equipment and isolating patients. There were also no national, district or facility standards for infection control, and screening of patients for Ebola was inadequate. All districts also lacked sufficient personal protective equipment, the gear that is critical for protecting health care workers treating Ebola patients, and many did not have running water, enough chlorine bleach to sanitize contaminated objects, or incinerators for burning disposable medical waste.

“An increasingly coordinated and comprehensive [infection and prevention control] program with district and health facility level support is urgently needed to prevent Ebola in districts where the prevalence is low and to strengthen the existing…response in areas with high prevalence of Ebola,” the CDC officials write.

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