I would like to propose some additions to Carter’s excellent review paper on Tobacco document research reporting. That is a major contribution to tobacco document research (TDR) methodology.

While discussing possible lessons from historical research to TDR Carter mentions the interpretation of facts. Occasionally the difficulty with TDR lies in establishing the facts (e.g. if plans were implemented). One method to overcome the problem is to put the TDR information into context. The more detailed the information, the more difficult is the task.

A basic method in historical research (also in journalism) is to check the information with the persons mentioned in the documents. That is rarely seen in TDR. However, some authors make explicit that they have not checked the information with the persons concerned. Obtaining information from (present or former) tobacco industry employees is surely a difficult task but that should not be ignored if more accuracy could be attained.

When it comes to evolution of search strategies it is obvious that it is connected to the availability of the documents. The sorting options and optical character recognition as well as the addition of privileged documents to Legacy archive have made new search strategies possible. A fuzzy option for key words would greatly benefit TRC on countries with ominous characters as they tend to be misspelled.

I do applaud Carter’s recommendation of frame analysis. Several TDR related to tobacco lobbying. It seems that the debate on tobacco centers around two competing frames, individual liberty and public health. I’m sure that there is still a lot to be learned from the way the industry has manipulated the language in smoking and health debate.

Carter SM. Tobacco document research reporting. Tobacco Control 2005;14: 368-376.

Manashe CL, Siegel M. The power of a frame: an analysis of newspaper coverage of tobacco issues -- United States 1985-1995. Journal of Health Communication 1998;4:207-25.

Since my original publication in 1995 reporting high rates of denial of smoking in Japanese women,1 and Prof Yano's alternative assessment of the evidence,2 there has been an ongoing correspondence between the two of us.3-6 In his latest letter6 Yano asks whether my paper1 should have been published because it suffers from "erroneous interpretations based on invalid measurements."

My calculations critically depended on the detection of high urinary cotinine/creatinine ratios (CCR) of >100 ng/mg in 28 women who reported that they were nonsmokers. Yano argues that the CCR measurement may have been unreliable because the dry ice sent with the urine samples had sublimated before it reached the laboratory (a problem I have no record or memory of), and that, if the sample had been exposed to high temperature, the measurement might have been inaccurate. Although other references7,8 argue that cotinine levels in unfrozen samples are reliable for research purposes, Yano cites the results of one study9 which did show some increase in cotinine levels in samples stored at high temperatures. However, even at the highest temperature (60°C) and longest storage time (30 days) tested, the increase was by less than 2-fold. In contrast, in 25 of the 28 women reclassified as current smokers, their CCR was more than 2-fold above the, conservative, 100 ng/mg cut-off used, and in 23 of them the CCR was over 500 ng/mg. I do not consider this doubt about possible exposure of samples to high temperature is relevant. If Yano thought it was, why was it not mentioned in his paper?2 I note that Yano states that the potential problem only applied to the first batch of samples. If so, it would be relevant to compare the results for the two batches. My database does not have details of batch. Does Yano's?

Using 100 ng/ml as indicative of true smoking, I estimated that 28/98 = 29% of true smokers denied smoking. In contrast 8/298 = 2.7% of true nonsmokers could be reclassified as smokers. The former misclassification rate, which can cause

substantial bias to estimates of lung cancer risk in nonsmokers associated with spousal smoking, is much higher than the reverse misclassification rate, which in any case has a much lower biasing effect.10

The calculations in Yano's latest letter6 are off the point as they are based on the assumption that self reported smoking is 100% accurate and that it is CCR which is subject to error. The whole point of the study was to test the accuracy of self report using CCR as the gold standard. Clearly CCR is not 100% accurate, but Yano gives no reason why such inaccuracy should affect the major conclusion of my paper.1

Yano is concerned that my formula depends on the prevalence of smoking. I am not sure why. One is attempting to answer the question "What proportion of true smokers deny smoking?" and clearly the number of true smokers must be the denominator in the calculation.

Yano states that Proctor "finally understood and accepted my point on the misclassification formula," but that was before he had consulted me and realized that Yano's approach was erroneous. Then, as now, my views and Yano's seem irreconcilable, and as it was not possible to prepare a paper satisfactory to all, I was asked by Proctor to prepare a paper under my name. Clearly the situation is not ideal, but at least the data and the differing interpretations are in the literature for scientists to form their own judgement. I retain my view that my interpretation is correct and that the measurements made are valid enough for the conclusions I draw.

Peter N Lee P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.

References

1. Lee PN. "Marriage to a smoker" may not be a valid marker of exposure in studies relating environmental tobacco smoke to risk of lung cancer in Japanese non-smoking women. Int Arch Occup Environ Health 1995;67:287-94.

2. Yano E. Japanese spousal smoking study revisited: how a tobacco industry funded paper reached erroneous conclusions. Tob Control 2005;14:227-35.

3. Lee PN. Japanese spousal study: a response to Professor Yano's claims [Commentary]. Tob Control 2005;14:233-4.

4. Yano E. Response to P N Lee [Commentary]. Tob Control 2005;14:234-5.

5. Lee PN. Response to E Yano and S Chapman [Letter]. Tob Control 14:430-1.

6. Yano E. Should a paper with erroneous interpretations based on invalid measurements be published? [Letter]. Tob Control 2005;14:431-2.

7. Foulds J, Feyerabend C, Stapleton J, Jarvis MJ, Russell MAH. Stability of nicotine and cotinine in unfrozen plasma. J Smoking-Related Dis 1994;5:41-4.

8. Greeley DA, Valois RF, Bernstein DA. Stability of salivary cotinine sent through the U.S. mail for verification of smoking status. Addict Behav 1992;17:291-6.

9. Hagan RL, Ramos JM, Jr., Jacob PM, III. Increasing urinary cotinine concentrations at elevated temperatures: the role of conjugated metabolites. J Pharm Biomed Anal 1997;16:191-7.

10. Lee PN, Forey BA. Misclassification of smoking habits as a source of bias in the study of environmental tobacco smoke and lung cancer. Stat Med 1996;15:581-605. Editor: This correspondence is now closed

In the latest issue of Tobacco Control, Radu and others report on tobacco use among Swedish schoolchildren (Tobacco Control 2005;14:405- 408). As a Swede, I was surprised to read about some of their findings.

Children who smoke daily or almost daily are defined as “regular smokers”. The percentage of regular smokers is reported to have decreased to 4 per cent among 16-years-old boys and 15 per cent among girls by 2003.

These figures differ significantly from the data found in the original (Swedish) reports from the CAN (Swedish Council for Information on Alcohol and Other Drugs). According to the latest CAN report (2005) the percentage of “regular smokers” in 2003 was 7 per cent among boys and 13 per cent among girls. So, how can the authors reach the figure 4 per cent for boys?

One explanation, which can be hypothesized from Figure 2 in the paper, may be that “regular smokers” who also use oral snuff, have been excluded from the category of “regular smokers”. If this is the case, I find this to be a highly innovative method of presenting data in order to make them support one’s favourite, preconceived conclusions. Smokers who also use oral snuff – are they not smokers?

The “gender gap” in tobacco habits certainly exists – it has been there ever since the early 1970s, when this series of surveys was started and the use of oral snuff was practically non-existent among boys. The main explanation for this gap seems to be the fact that 16-year-old girls are – biologically and socially – more “grown-up” than boys of the same birth cohort. Additional explanations may of course exist – tobacco initiation is a complex development where several social, psychological and other influences are active.

During the last few years there has been a marked decrease of regular smoking among both boys and girls. At the same time, regular use of oral snuff has also decreased among boys.

To reach – from these data – the conclusion that “snus use suppresses smoking among boys”, appears to be a daring exercise. To me, the jump is far to big.

Paul Nordgren National Institute of Public Health, Stockholm, Sweden paul.nordgren@fhi.se

Dear Editor,

When we received the August 2005 issue of Tobacco Control, we found much in it to help inform our work, as usual.

I am writing, however, because we have some concerns about one of the articles published. “The perimetric boycott: a tool for tobacco control advocacy,” is described as a comprehensive analysis of a number of boycotts, including one organized by Infact (now Corporate Accountability International).

A key point overlooked by the authors is that Corporate Accountability International’s Boycotts are one strategy within a broader campaign challenging life-threatening corporate actions. Though we lifted the Kraft Boycott in June 2003 in celebration of the adoption of the WHO Framework Convention on Tobacco Control, our Tobacco Industry Campaign continues to build momentum—-using the most effective strategies at any given time, and helping to make the WHO FCTC one of the most rapidly embraced UN treaties of all time.

As a membership organization, Corporate Accountability International has developed and carried out a number of grassroots consumer campaigns that have altered the cost/benefit ratio for a corporation to engage in irresponsible and dangerous practices. Our Nestlé Boycott is often cited as pivotal to the emerging corporate accountability movement in the 1970s.

Some of the most significant documented costs to Philip Morris/Altria from the Kraft Boycott included: harm to corporate name, reputation and image—among the most valuable assets of any corporation; direct expenses of salaries for management time spent dealing with the Boycott and its impact; lost management time that could have been spent on acquiring new sales and increasing shareholder value; public relations, advertising and corporate giving to maintain goodwill with consumers, the media and political leaders; and loss of employee morale, affecting both recruitment and retention.

While thorough attention to the effectiveness of our strategies as a movement is important for learning lessons as we move ahead, so too is careful attention to detail and context when critiquing strategies that have advanced our collective work.

Sincerely,

Patti Lynn Campaigns Director

Patti Lynn Campaigns Director Corporate Accountability International (formerly Infact) Campaign Headquarters 46 Plympton Street Boston, MA 02118 USA Phone: 617-695-2525 Fax: 617-695-2626 plynn@stopcorporateabuse.org www.stopcorporateabuse.org