One would imagine that public concern about butt litter would largely
rise with the amount of butt litter that occurs. One would also
reasonably imagine that news articles dealing with the "problem" of butt
litter would similarly rise. If we take those two assumptions as being a
given for the moment, and then look at the statistics uncovered by this
research, we see something very interesting.
One would imagine that public concern about butt litter would largely
rise with the amount of butt litter that occurs. One would also
reasonably imagine that news articles dealing with the "problem" of butt
litter would similarly rise. If we take those two assumptions as being a
given for the moment, and then look at the statistics uncovered by this
research, we see something very interesting.
Using Google's time search feature we are able to search for news
stories/articles in discrete time units. During the period of 10 inclusive
years 1982 to 1991, there were 7 stories: i.e. less than one story per
year. But during the inclusive 8 year period of 2002 to 2009, there were
242 stories, roughly 30 per year. That's over a 3,000% increase in public
perception of and attention to the problem, which would indicate that
there may have been as much as a 3,000% actual increase in the amount of
butt litter between these two comparative periods.
Some of that may have been generated by increased paranoia about
smoke and dislike/hatred of smoking and smokers, but it's likely that a
great deal of it represents an actual and very serious increase in the
problem.
So what changed in our society between those two periods that caused
this problem to undergo such an incredible escalation? It could be that
there are now far more smokers per given area than there were in the
1980s... but tobacco control statistics don't seem to bear that out:
generally they claim a decrease in smokers while habitable/used land areas
in cities/towns/beaches/parks etc have generally increased along with
general population growth during those years. It could be that smokers
are now less conscious of butt littering as a problem, but given the
increase in media attention to the issue this is also unlikely to be a
cause.
The one outstandingly obvious and overwhelming cause of this problem
would seem to be the antismoking movement's insistence upon throwing
smokers out into the streets to smoke rather than allow for provision of
comfortably separated and ventilated indoor options and venues for smokers
and their friends.
If cigarette butt pollution is indeed the true concern here, then
such indoor options should clearly be explored. If however, as indicated
in the abstract, the focus on cigarette butt litter is simply because such
a focus is seen as a way to "justify environmental regulation and policies
that raise the price of tobacco and further denormalise its use." -- a
pure social engineering mechanism -- then such solutions will of course be
ignored.
Which path do you think tobacco control will take?
Michael J. McFadden,
Author of "Dissecting Antismokers' Brains"
Conflict of Interest:
Author of "Dissecting Antismokers' Brains"
Active member of (and sometimes officer in) a number of citizens' Free Choice groups. No compensation involved.
NOT PEER REVIEWED
Glantz & Polansky respectfully suggest that I should (1) "Base my
criticisms on actual data and analysis, rather than raising hypothetical
problems and presenting them as if they had been demonstrated to be real"
and (2) "Criticise the proposal based on the actual behavior of the motion
picture industry, not on whether or not youth see some R-rated films."
NOT PEER REVIEWED
Glantz & Polansky respectfully suggest that I should (1) "Base my
criticisms on actual data and analysis, rather than raising hypothetical
problems and presenting them as if they had been demonstrated to be real"
and (2) "Criticise the proposal based on the actual behavior of the motion
picture industry, not on whether or not youth see some R-rated films."
Suggestion 1 seems to be proposing that no one should ask questions
about others' research but instead, keep silent until they complete their
own studies. I will reflect on that advice next time I receive reviewers'
comments on my research. However, in 17 years of editing, I don't believe
I ever saw an author respond to a reviewer's criticisms by saying these
would be ignored until the reviewer submitted their own research.
In fact, Matthew Farrelly who co-authored our PLoS Med paper[1] has
done such research[2] - cited in our paper -- which demonstrated that
smoking is inextricably intertwined with a range of other youth-enticing
variables in movies [2]. As we wrote, smoking characters never just smoke,
and movies showing smoking have a lot more in them that might appeal to
youth at risk of smoking than just smoking. This is a core issue that has
been ignored in all studies to date, other than Farrelly et al's.
Glantz and Polansky's main finding is that "movies with smoking make
87% of what comparably rated smoke-free films make". Consider why this
might be the case. It is implausible that this could be explained by
market forces whereby word would quickly spread around a nation "do not go
to see movie X .. it contains smoking!" Rather, it is far more likely that
movies where smoking occurs are from less popular genres: another
illustration of how preoccupation with judging a movie by whether or not
it contains smoking can obscure consideration of the totality of a movie's
appeal, both in box-office potential and to youth at risk of smoking.
As to their second suggestion, it is indisputable that large
proportions of young people often see adult-rated material. There are many
studies showing this in the violence and sexual content areas, as well as
in the tobacco field. My point is simply this: if the R-rating solution is
designed to prevent youth seeing smoking, it may prevent them seeing it in
cinemas, but it will not prevent them seeing the newly rated R movies
elsewhere with consummate ease, increasingly so as download and i-View
markets rapidly expand. This being the case, it surely cannot be long
until proponents of R-rating realize that they will need to call for
total movie censorship of smoking. If they are comfortable with that, is
it time to be open about it?
References
1. Chapman S, Farrelly M. Four arguments against the adult-rating of
movies with smoking scenes. PLoS Med 2011; e1001078.
doi:10.1371/journal.pmed.1001078 Published Aug 23 2011
2. Farrelly M, Kamyab K, Nonnemaker J, E. C (2011) Movie smoking and
youth initiation: parsing smoking imagery and other adult content. Social
Science Research Network. Social Science Research Network. Available:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1799561.
Chapman speculates that basing our analysis on box office gross
receipts while omitting what he describes as available video revenue data
is problematic. However, Chapman does not actually present an analysis
based on reliable data that demonstrates that including post-theatrical
film receipts would reverse the conclusion drawn in our paper.
We used industry-reported "domestic" (Canada and United States) gross...
Chapman speculates that basing our analysis on box office gross
receipts while omitting what he describes as available video revenue data
is problematic. However, Chapman does not actually present an analysis
based on reliable data that demonstrates that including post-theatrical
film receipts would reverse the conclusion drawn in our paper.
We used industry-reported "domestic" (Canada and United States) gross
theatrical sales totals -- not including domestic or foreign ancillary
revenues, such as DVD sales -- because these same data were used to
determine what motion pictures were included in the sample of top-grossing
films (ranking among the top ten films in gross sales in any week of their
first-run, domestic theatrical release). In addition, evidence suggests
that domestic theatrical gross is positively correlated with both DVD
sales and foreign box office (1,2), so it is very unlikely that adding
estimated domestic video revenue to reported domestic theatrical box
office gross would reverse our results, as Chapman speculates.
Chapman also appears to have misunderstood the paper (3) he cited as
evidence that youth have widespread access to R-rated movies. The paper in
question shows that the median viewership rate for an R-rated movie is
only about 17% for adolescents aged 10-14. Thus, even though R-rated films
are smokier on average than youth-rated (G/PG/PG-13) films, youth-rated
films deliver the majority of exposure to onscreen smoking.
Chapman is "perplexed" about why the R rating would reduce youth
exposure to smoking in movies. Here is why the CDC, WHO and a wide range
of public health organizations have endorsed the R rating for on-screen
smoking:
1. Motion pictures are products mostly made by multinational
corporations to sell to a pre-determined market.
2. Obtaining the desired rating for a film is an integral part of its
marketing plan, made before production begins.
3. To obtain the rating desired for marketing purposes, film content
is calibrated in light of the factors that the MPAA uses in assigning
ratings: violence, sex, illegal drugs, and language.
4. If smoking triggered an R rating, studios would integrate this fact
into production plans and see that smoking was left out of films designed
for general and youth markets.
5. As a result, smoking would not appear in future G, PG, and, most
important, PG-13 movies.
6. Youth receive almost 60% of their exposure to onscreen smoking
from youth rated films.
7. If studios adapt to the R rating for smoking as expected, there
will be a proportionate reduction in the dose of smoking delivered to
youth in films.
8. Because of the dose-response relationship between exposure to
smoking in movies and adolescent (and young adult) smoking, there will be
less adolescent smoking.
Note that this logic has nothing to do with whether or not youth see
R-rated films.
Chapman has repeatedly denigrated the R rating for smoking as a way
to reduce the substantial impact that smoking in movies has on youth
smoking behavior. We respectfully suggest that in the future he:
1. Base his criticisms on actual data and analysis, rather than
raising hypothetical problems and presenting them as if they had been
demonstrated to be real.
2. Criticise the proposal based on the actual behavior of the motion
picture industry, not on whether or not youth see some R-rated films.
Stanton A. Glantz
Jonathan R. Polansky
REFERENCES
(1) Elberse A and Oberholzer-Gee F (2007) Superstars and underdogs:
An examination of the long-tail phenomenon in video sales. Harvard
Business School Working Paper Series, No. 07-015. Accessed at
http://www.aeaweb.org/annual_mtg_papers/2007/0107_1015_1002.pdf on 18
October 2011.
(2) World Health Organization. Smoke-free movies: From evidence to
action (second edition). Box 2: Tobacco images in films from the United
States have worldwide impact. Geneva, 2011. Accessed at
http://whqlibdoc.who.int/publications/2011/9789241502399_eng.pdf on 19
October 2011.
(3) Sargent JD, Tanski SE, Gibson J. Exposure to movie smoking among
US adolescents aged 10 to 14 years: a population estimate. Pediatrics.
2007 May;119(5):e1167-76.
Glantz and Polansky's paper is titled "Movies with smoking make less
money" but it should have continued "... at the box office" because it
failed to consider the major sources of revenue to film studios other than
from box office receipts (DVD and blu-ray sales, rentals and video-on-
demand or iVOD). They write that data from DVD sales and rentals are not
available. However, Nash Information Services (which they reference...
Glantz and Polansky's paper is titled "Movies with smoking make less
money" but it should have continued "... at the box office" because it
failed to consider the major sources of revenue to film studios other than
from box office receipts (DVD and blu-ray sales, rentals and video-on-
demand or iVOD). They write that data from DVD sales and rentals are not
available. However, Nash Information Services (which they reference)
provide estimates from February 12, 2006 for DVD sales and for box office
receipts from 1992. http://www.the-numbers.com/dvd/charts/annual/2010.php
Nash explain "Precise information on DVD sales is not generally available.
Our DVD sales figures are estimates based on studio figures, publicly
available data, and private research on retail sales carried out by Nash
Information Services. The figures include estimated sales at Wal-Mart and
other retailers that do not publicly release sales information."
As can be seen, box office sales remain the dominant source of
revenue to movie studios in the short term, but over time DVD purchases,
rentals and iVODs combined can erode and sometimes overhaul that lead. It
would be wise to re-calculate Glantz and Polansky's data (at least from
2006 from when DVD sales data is available) to see whether their
conclusions hold. But this would still underestimate total revenue. While
Nash provides rankings of DVD rentals, they do not provide their dollar
value. In 2010, the US iVOD market was worth $385m
http://www.internetretailer.com/2011/02/15/apple-has-65-streaming-demand-
videos-market, a still small but rapidly growing fraction of the total
income for movie studios as testified by the on-going demise of suburban
video rental outlets.
I also remain perplexed as to how the proposed R-rating for smoking
scenes would actually reduce exposures to these scenes in youth. As I have
argued previously, studies in this field include R-rating movies in their
exposure assessments. For example, in Sargent et al's 2007 paper, 40% of
the films on the list provided to children to determine exposure were R-
rated(1). Sargent et al have also shown that between 68-81% of US
adolescents are allowed to watch R-rated movies(2-3). Many more watch
without parental approval via downloads and file-sharing. Furthermore,
88.2% of youth-rated movies in the US now have no tobacco scenes
(http://www.cdc.gov/mmwr/p...).
Putting these together, estimates of the effect of movie smoking
exposure already include the impact of the R-rated solution being proposed
to reduce that exposure. If youth who allegedly start smoking because of
exposure to smoking in movies are already watching lots of R-rated movies,
how would an R-rating significantly reduce such exposure? They would not
see them in cinemas, but with consummate ease at home. Moving nearly all
movies with smoking to R-rating would put the onus on parents to regulate
their children's viewing. Few would disagree with that. But why would
parents regulate their children more because of concern about smoking than
they do now with because of concerns about exposure to strong violence and
explicit sex in R-rated movies?
References
1. Sargent JD, Tanski SE, Gibson J. Exposure to movie smoking among
US adolescents aged 10 to 14 years: a population estimate. Pediatrics.
2007 May;119(5):e1167-76.
2. Sargent JD, Beach ML, Dalton MA, Ernstoff LT, Gibson JJ, Tickle
JJ, et al. Effect of parental R-rated movie restriction on adolescent
smoking initiation: a prospective study. Pediatrics. 2004 Jul;114(1):149-
56.
3. de Leeuw RN, Sargent JD, Stoolmiller M, Scholte RH, Engels RC, Tanski
SE. Association of smoking onset with R-rated movie restrictions and
adolescent sensation seeking. Pediatrics. 2011 Jan;127(1):e96-e105.
NOT PEER REVIEWED The allegation by Stepanov et al1 that "regulation of TSNA levels in
cigarette smoke should be strongly considered to reduce the levels of
these potent carcinogens in cigarette smoke" ignores substantial evidence
elsewhere in the literature that suggests that such regulation would do
nothing to reduce cancer risk, and, in fact, might increase it.
NOT PEER REVIEWED The allegation by Stepanov et al1 that "regulation of TSNA levels in
cigarette smoke should be strongly considered to reduce the levels of
these potent carcinogens in cigarette smoke" ignores substantial evidence
elsewhere in the literature that suggests that such regulation would do
nothing to reduce cancer risk, and, in fact, might increase it.
Tobacco-specific N-nitrosamines (TSNA) represent two of a very large
number of carcinogens in cigarette smoke. This being the case, there are
two issues that should have been addressed prior to making the
recommendation that TSNA levels be regulated.
The first is the question as to whether altering the blend of tobacco
or curing techniques might increase the levels of other carcinogens.
Stepanov et al do not consider this possibility.
The second relates to the findings of Pankow et al in their 2007
consideration of "Potentially Reduced Exposure Product" cigarettes.2 In
this analysis, Pankow et al estimated the difference in lung cancer risk
that could be achieved by eliminating 13 carcinogens from cigarette smoke,
including the two major TSNAs. They concluded "there is little reason to
be confident that total removal of the currently measured human lung
carcinogens would reduce the incidence of lung cancer among smokers by any
noticeable amount."
Given all of the above, the most logical conclusion would be that
reducing TSNA concentration of cigarette smoke would be a waste of time
and money. Advising smokers that one brand has a lower TSNA concentration
than another brand to imply a lower risk of cancer would be fraudulent.
Joel L. Nitzkin, MD
References
1. Stepanov I, Knezevich A, Zhang L, Watson C, Hatsukami D, Hecht S.
Carcinogenic tobacco-specific N-nitrosamines in US cigarettes: Three
decades of remarkable neglect by the tobacco industry. Tob. Control 2011
20/May;Published online ahead of print.
2. Pankow J, Watanabe K, Toccalino P, Luo W, Austin D. Calculated Cancer
Risks for Conventional and "Potentially Reduced Exposure Product"
Cigarettes. Cancer Epidemiol Biomarkers Prev 2007;16(3):584-92.
NOT PEER REVIEWED I have read with interest the article titled: Carcinogenic tobacco-
specific N-nitrosamines in US cigarettes: three decades of remarkable
neglect by the tobacco industry.[1] In the article, the authors suggest
that the tobacco industry has not attempted in a meaningful way to reduce
or control carcinogenic tobacco-specific N-nitrosamines (TSNAs) either in
general (as implied by the title of the article...
NOT PEER REVIEWED I have read with interest the article titled: Carcinogenic tobacco-
specific N-nitrosamines in US cigarettes: three decades of remarkable
neglect by the tobacco industry.[1] In the article, the authors suggest
that the tobacco industry has not attempted in a meaningful way to reduce
or control carcinogenic tobacco-specific N-nitrosamines (TSNAs) either in
general (as implied by the title of the article) or with respect to
specific brands (as stated in the abstract conclusion). In fact, nothing
could be further from the truth.
R.J. Reynolds Tobacco Company (RJRT) believes that cigarette smoking
is a leading cause of preventable deaths in the United States. Cigarette
smoking significantly increases the risk of developing lung cancer, heart
disease, chronic bronchitis, emphysema and other serious diseases and
adverse health conditions. Reducing the diseases and deaths associated
with the use of cigarettes serves public health goals and is in the best
interest of consumers, manufacturers and society.
To that end, RJRT employees have worked for decades to develop and
produce products that potentially reduce exposure to reported toxicants in
cigarette smoke, including TSNAs. RJRT scientists, engineers and
cigarette product developers have, among other efforts: conducted
extensive research to understand the origin of TSNAs in cigarette
tobacco;[2, 3] identified an alternative heating approach (the use of heat
exchangers instead of direct-fire burners) for flue-curing tobacco that
substantially reduces TSNA formation;[4] made that alternative heating
approach available to farmers and ensured that TSNA reductions of 90%, or
more, were realized for flue-cured tobacco upon using it;[4, 5] evaluated
the biological activity of tobacco that was flue-cured with the
alternative heating approach;[6, 7] reduced mainstream smoke TSNA yields
in the marketplace based on inclusion of tobacco produced with the new
process;[8]conducted research to understand possible TSNA formation during
smoking;[9] and developed new cigarette designs that reduce TSNA yields in
mainstream smoke by primarily heating, rather than burning, tobacco as the
cigarette is smoked.[10]
The practice of flue-curing tobacco changed in the mid-1970s, driven
by farm economics. Barns built before then were indirect-fired. They had
a heat exchanger and flue that directed combustion gases out of the barn,
producing tobacco with relatively low levels of TSNAs. With a shift to
direct-fire heating in the mid- to late-1970s, increased concentrations of
nitrogen oxides were realized within the curing barn, leading to increased
levels of TSNAs in cured leaf. Extensive research led to both an
understanding and a mitigation of that process,[3-8] with a return to the
use of heat exchangers in the early 2000s.
Reducing total TSNAs in flue-cured tobacco by 90%, or more, had a
significant impact on the tobacco blends typically found in U.S.
cigarettes, as flue-cured tobacco in one of the principal types of tobacco
found in U.S. tobacco blends. For example, a 38% decline in total TSNAs
for the Kool Filter King cigarette tobacco blend was observed between 1999
and 2004 as flue-cured tobacco with reduced TSNA levels became available
for manufacturing. Results of Stepanov, et al.,[1] suggest that further
reductions occurred after 2004, as tobacco cured with the alternative
heating approach was fully realized in the marketplace. In fact, their
data suggest that Kool Filter King cigarette tobacco blend total TSNAs
were reduced by 46% from 1999 to 2010. As these TSNA reductions
demonstrate, RJRT scientists have not only attempted in a meaningful way,
but succeeded, in reducing and controlling carcinogenic TSNAs in flue-
cured tobacco.
References:
1. Stepanov I, Knezevich A, Zhang L, et al. Carcinogenic tobacco-specific
N-nitrosamines in US cigarettes: three decades of remarkable neglect by
the tobacco industry. Tob Control 2011;doi: 10.1136/tc.2010.042192
2. Davis DL, Beeson DW, Dunlap SP, et al. The relationship of alkaloids,
genotypes and environmental factors on tobacco specific nitrosamines
(TSNA) in burley tobacco: R.J. Reynolds, 2001.
http://legacy.library.ucsf.edu/tid/iug33a00/pdf.
3. Green JM, Caldwell WS. Chemical and microbial changes during flue
curing of NK-149 tobacco [presentation]. 48th Tobacco Chemists' Research
Conference, Greensboro, NC: R.J. Reynolds, 1994.
http://legacy.library.ucsf.edu/tid/abg45b00/pdf.
4. Nestor TB, Gentry JS, Peele DM, et al. Role of oxides of nitrogen in
tobacco-specific nitrosamine formation in flue-cured tobacco. Beitr?ge zur
Tabakforschung International 2003;20:467-475.
5. Gray N, Boyle P. The case of the disappearing nitrosamines: a
potentially global phenomenon. Tob Control 2004;13:13-16.
6. Hayes JR, Meckley DR, Stavanja MS, et al. Effect of a flue-curing
process that reduces tobacco specific nitrosamines on the tumor promotion
in SENCAR mice by cigarette smoke condensate. Food Chem Toxicol
2007;45:419-430.
7. Kinsler S, Pence DH, Shreve WK, et al. Rat subchronic inhalation study
of smoke from cigarettes containing flue-cured tobacco cured either by
direct-fired or heat-exchanger curing processes. Inhal Toxicol 2003;15:819
-854.
8. R.J. Reynolds Tobacco Company. Reynolds Tobacco will use flue-cured
tobacco low in nitrosamines, Press release: R.J. Reynolds, 1999.
http://legacy.library.ucsf.edu/tid/xrm85a00/pdf.
9. Moldoveanu SC, Borgerding M. Formation of tobacco specific
nitrosamines in mainstream cigarette smoke; Part 1, FTC smoking. Beitr?ge
zur Tabakforschung International 2008;23:19-31.
10. Borgerding MF, Bodnar JA, Chung HL, et al. Chemical and biological
studies of a new cigarette that primarily heats tobacco. Part 1. Chemical
composition of mainstream smoke. Food Chem Toxicol 1998;36:169-182.
Etter et al's recommendation to pull E-cigarettes from the market
until drug-type safety and efficacy studies are completed would make sense
if these products were delivering some otherwise unknown chemical
substance and if they were intended as pharmaceutical smoking cessation
therapy. Neither of these conditions applies.
The only evidence of toxicity noted in the Ette...
Etter et al's recommendation to pull E-cigarettes from the market
until drug-type safety and efficacy studies are completed would make sense
if these products were delivering some otherwise unknown chemical
substance and if they were intended as pharmaceutical smoking cessation
therapy. Neither of these conditions applies.
The only evidence of toxicity noted in the Etter paper was FDA data
showing similar trace levels of the same carcinogens found in
pharmaceutical nicotine replacement therapy products already approved by
FDA and a non-toxic level of diethylene glycol in one cartridge.
There is already extensive documentation as to the safety of these
products and the degree to which they are able to satisfy the urge to
smoke. They are intended to be recreational substitutes for cigarettes
for smokers who are unable or uninterested in quitting, yet wish to avoid
the many other toxic substances in cigarette smoke.
Your paper apparently evaluates e-cigarettes against a zero-risk
standard. A comparison to the risk posed by cigarettes would be more
appropriate.
Please note that our new FDA/Tobacco law grandfathers in and will
give full FDA approval to currently marketed cigarettes. I do not
understand how denying smokers access to less toxic alternatives is
beneficial to their personal health, or the health of the larger
community.
If our goal is protection of the health of the public, the only
course of action that makes sense is allowing E-cigarettes to remain on
the market, preferably with strict regulation of manufacture and
marketing, on the same basis as other smokefree tobacco-based products.
A goal of the World Health Organization's Tobacco Control Framework
is to totally eradicate tobacco use (1). The underlying theory is that
anyone who exerts enough will power can overcome addition to nicotine. The
situation may not be as simple as they would like to believe.
The Tobacco Advisory Group of the Royal College of Physicians found
that the development of nicotine addiction includes changes in brain
st...
A goal of the World Health Organization's Tobacco Control Framework
is to totally eradicate tobacco use (1). The underlying theory is that
anyone who exerts enough will power can overcome addition to nicotine. The
situation may not be as simple as they would like to believe.
The Tobacco Advisory Group of the Royal College of Physicians found
that the development of nicotine addiction includes changes in brain
structure and function that impair the ability to achieve and sustain
abstinence. They note that some of these changes may not be entirely
reversible; consequently some smokers may never be able to quit all
nicotine use (2).
Sweden has one of the lowest rates of smoking and lowest lung cancer
rates in the world; however this is not due to the eradication of tobacco
use. It is most likely due to the high percentage of smokers who switched
to low-nitrosamine Swedish snus (3).
Thus it is troubling that Etter, et al, discuss concerns about
electronic cigarettes (e-cigarettes) that are more appropriate for a
medication. This focus ignores the primary purpose for the invention of
the e-cigarette: To allow smokers to save their health and their lives by
switching to a safer alternative source of nicotine (4).
One of the reasons that more smokers have not switched to the
Nicotine Replacement Therapy (NRT) products is that the dosages are kept
low because of concerns about "abuse potential" (5). These doses are
inadequate replacement for many smokers.
In a national survey, Action on Smoking and Health (ASH) found that
9% of UK smokers had tried e-cigarettes and 3% were still using them. This
amounts to 300,000 people who have achieved smoking abstinence thanks to
these products. In a focus group, those who had not tried e-cigarettes
pictured a device that looks and performs much like a real cigarette.
Those who had tried e-cigarettes put greater importance on an "authentic
smoking experience" and strength of nicotine (6).
So when the Research Agenda suggests "a standard dosing regimen" be
developed for e-cigarettes, we consumers cringe. In all the years that we
were smokers, we self-regulated our nicotine intake. We smoked more often
or inhaled more deeply in times of high stress or when we had the need to
remain alert. We smoked less often when we were relaxed and ready to go to
sleep.
In addition, our overall intake varied widely across individuals.
Most smokers averaged a pack a day; but many got along just fine on 5 or
10 cigarettes a day, and some required several packs per day. These
varying needs are reflected in the range of nicotine strengths and
quantity of liquid used per day by e-cigarette consumers (7). Regulating
the products to the point where dosages are kept low for fear of abuse
potential most likely would make the products just as ineffective an
alternative as pharmaceutical NRTs.
It is unquestionably in the best interests of public health to help
as many smokers as possible make the switch as soon as possible to safer
alternatives. If "continued marketing constitutes an uncontrolled
experiment," so what? Continued smoking guarantees irreversible damage to
the lungs, cardiovascular systems, and DNA of smokers who can't quit
during the years that the researchers are satisfying themselves that e-
cigarettes are "safe."
E-cigarettes don't need to be safe in any absolute sense. They only
need to be safer than continued smoking. If they were more harmful than
smoking, we would know that by now.
(1) World Health Organization. Tobacco Cessation: A Manual for
Nurses, Health Workers, and Other Health Professionals. ISBN 978-92-9022-
384-9
http://www.searo.who.int/LinkFiles/Tobacco_Free_Initiative_manual-hsw.pdf
(Accessed May 2011).
(2) Tobacco Advisory Group of the Royal College of Physicians. Harm
reduction in nicotine addiction: Helping people who can't quit. October
2007. Royal College of Physicians.
http://www.tobaccoprogram.org/pdf/4fc74817-64c5-4105-951e-38239b09c5db.pdf
(Accessed May 2011).
(3) Ferberg (2005). Is Swedish snus associated with smoking
initiation or smoking cessation? Tobacco Control 2005;14:422???424.
http://tobaccocontrol.bmj.com/content/14/6/422.abstract (Accessed May
2011).
(4) Demick B. A high tech approach to getting a nicotine fix. Los
Angeles Times. April 25, 2009.
http://articles.latimes.com/2009/apr/25/world/fg-china-cigarettes25
(Accessed May 2011).
(5) McNeill A, Foulds J, Bates C. Regulateion of nicotine replacement
therapies (NRT): a critique of current practice. Addiction (2001) 965,
1757-1768. http://www.tobaccoprogram.org/pdf/nrtcritique.pdf (Accessed May
2011).
(6) Dockrell M, Indu SD, Lashkari HG, McNeill A. "It sounds like the
replacement I need to help me stop smoking": Use and acceptability of "e-
cigarettes" among UK smokers. 12th annual meeting of the Society for
Research on Nicotine and Tobacco Europe. Bath, UK, 2010.
(7) Consumer Advocates for Smoke-free Alternatives Association.
Survey Results.
https://www.surveymonkey.com/sr.aspx?sm=HrpzL8PN5cP366RWhWvCTjggiZM_2b8yQJHfwE9UXRNhE_3d
(Accessed May 2011).
NOT PEER REVIEWED
I am surprised that AIDS has not been blamed on passive smoking yet,
if you excuse my irony.
Quite frankly this obsession with SHS being the cause of SIDS is
quite depressing as an eager public lap up any chance to demonise smokers.
Looking at the empirical evidence it does not back up the hypothesis.
As remarked here by UK journalist Charlie Booker in a piece entitled
"Fiddling those s...
NOT PEER REVIEWED
I am surprised that AIDS has not been blamed on passive smoking yet,
if you excuse my irony.
Quite frankly this obsession with SHS being the cause of SIDS is
quite depressing as an eager public lap up any chance to demonise smokers.
Looking at the empirical evidence it does not back up the hypothesis.
As remarked here by UK journalist Charlie Booker in a piece entitled
"Fiddling those smoking figures again." (1) "The only snag was that the
years between 1970 and 1988, when cot deaths shot up by 500 per cent,
coincided with the very time when the number of adults who smoked in
Britain was falling most sharply, from 45 to 30 per cent. To anyone but a
fanatical anti-smoking campaigner, this might have suggested that
"environmental tobacco smoke" was unlikely to be the chief cause of cot
deaths."
If look at the figures supplied by the UK's government's Office of
National Statistics and look at Figure 2 graph Mr Booker is entirely
correct. (2)
My smoking statistics are supplied by Action on Smoking and Health
(3) and indeed confirm Booker's claims for a reduction in that time.
Also if you look at data on smoking rates smoking is often a sign of
poverty, twice as many poorer people smoke than affluent people 30% vs 15%
typically. Poverty often means you live in less hygienic housing and
surrounds, rubbish, excrement and hypodermic needles etc. Greater
densities of people to pass on virus and bacteria, closer proximities to
industrial and car pollution. All these are confounders with smoking just
a marker that you are poor. As this paper articulates (4)
This paper written by (5) Neuropathologist Hannah Kinney, MD,
neuroscientist David Paterson, PhD, "and colleagues examined brainstem
tissue from 31 infants who died from SIDS and 10 who had died from other
causes. They documented the most comprehensive set of defects known to
date: deficiencies in the serotonin receptor 5HT1A, an abnormally high
number of neurons that make and release serotonin; a preponderance of
immature serotonergic neurons; and insufficient amounts of the serotonin
transporter protein, which "recycles" serotonin so neurons can reuse it.
Male SIDS infants had significantly fewer 5-HT1A receptors than females,
offering a possible explanation why boys succumb to SIDS twice as often as
girls."
To be fair it does go on to say speculatively that "Although more
research is needed, Kinney, Paterson and colleagues believe that factors
such as maternal smoking and alcohol use during early fetal development
may derail development of the brainstem serotonin system."
This paper certainly concludes that smoking is irrelevant. (6)
This paper also explores the much higher death rates among lower
socio-economic groups (7)
In conclusion "Fiddling those smoking figures again" may have struck
again.
7th April 2011 speaker at the "Tobacco dependence should be recognised by the state as a medical condition, not a lifestyle choice." My travel expenses were met by Pfizer.
One would imagine that public concern about butt litter would largely rise with the amount of butt litter that occurs. One would also reasonably imagine that news articles dealing with the "problem" of butt litter would similarly rise. If we take those two assumptions as being a given for the moment, and then look at the statistics uncovered by this research, we see something very interesting.
Using Google's t...
NOT PEER REVIEWED Glantz & Polansky respectfully suggest that I should (1) "Base my criticisms on actual data and analysis, rather than raising hypothetical problems and presenting them as if they had been demonstrated to be real" and (2) "Criticise the proposal based on the actual behavior of the motion picture industry, not on whether or not youth see some R-rated films."
Suggestion 1 seems to be proposing...
But the evidence is that no media campaign based on health warnings is likely to be effective.
So comparing different varieties of campaigns unlikely to be effective doesn't seem very productive.
Comparing varieties of campaigns using themes known to be effective, might be worthwhile.
Ref:
Evaluation of Antismoking Advertising Campaigns Lisa K. Goldman, MPP; Stanton A. Glantz, PhD. J...
Chapman speculates that basing our analysis on box office gross receipts while omitting what he describes as available video revenue data is problematic. However, Chapman does not actually present an analysis based on reliable data that demonstrates that including post-theatrical film receipts would reverse the conclusion drawn in our paper.
We used industry-reported "domestic" (Canada and United States) gross...
Glantz and Polansky's paper is titled "Movies with smoking make less money" but it should have continued "... at the box office" because it failed to consider the major sources of revenue to film studios other than from box office receipts (DVD and blu-ray sales, rentals and video-on- demand or iVOD). They write that data from DVD sales and rentals are not available. However, Nash Information Services (which they reference...
To The Editor:
NOT PEER REVIEWED The allegation by Stepanov et al1 that "regulation of TSNA levels in cigarette smoke should be strongly considered to reduce the levels of these potent carcinogens in cigarette smoke" ignores substantial evidence elsewhere in the literature that suggests that such regulation would do nothing to reduce cancer risk, and, in fact, might increase it.
Tobacco-specific N-nitr...
NOT PEER REVIEWED I have read with interest the article titled: Carcinogenic tobacco- specific N-nitrosamines in US cigarettes: three decades of remarkable neglect by the tobacco industry.[1] In the article, the authors suggest that the tobacco industry has not attempted in a meaningful way to reduce or control carcinogenic tobacco-specific N-nitrosamines (TSNAs) either in general (as implied by the title of the article...
NOT PEER REVIEWED To The Editor:
Etter et al's recommendation to pull E-cigarettes from the market until drug-type safety and efficacy studies are completed would make sense if these products were delivering some otherwise unknown chemical substance and if they were intended as pharmaceutical smoking cessation therapy. Neither of these conditions applies.
The only evidence of toxicity noted in the Ette...
A goal of the World Health Organization's Tobacco Control Framework is to totally eradicate tobacco use (1). The underlying theory is that anyone who exerts enough will power can overcome addition to nicotine. The situation may not be as simple as they would like to believe.
The Tobacco Advisory Group of the Royal College of Physicians found that the development of nicotine addiction includes changes in brain st...
NOT PEER REVIEWED I am surprised that AIDS has not been blamed on passive smoking yet, if you excuse my irony.
Quite frankly this obsession with SHS being the cause of SIDS is quite depressing as an eager public lap up any chance to demonise smokers.
Looking at the empirical evidence it does not back up the hypothesis. As remarked here by UK journalist Charlie Booker in a piece entitled "Fiddling those s...
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