The earth is flat, ABBA couldn’t sing a song, Scotland is going to
win the soccer World Cup sometime soon, and snus has played no part in the
reduction in smoking prevalence among Swedish men – or so Tomar et al.
[1]would have us believe. Of all of these issues not remotely supported by
the evidence, the last one is a little more serious in that it may influence
tobacco control...
The earth is flat, ABBA couldn’t sing a song, Scotland is going to
win the soccer World Cup sometime soon, and snus has played no part in the
reduction in smoking prevalence among Swedish men – or so Tomar et al.
[1]would have us believe. Of all of these issues not remotely supported by
the evidence, the last one is a little more serious in that it may influence
tobacco control policies that will affect the lives (and premature deaths) of
millions of people. We therefore feel the need to respond to the plethora of
inaccuracies contained in Tomar et al’s commentary on our review of
the effects of snus in Sweden.[2]
1. Misrepresentation of our review
Tomar et al’s commentary misrepresents our paper throughout. For example,
it states in the second paragraph that a section of Bates et al’s [3]article
cites only three reports and that our review adds "little additional
evidence". We can only assume that Tomar et al. were missing some of
the 11 journal pages, 8 figures, 2 tables and 66 references of evidence. Our
concern that Tomar and colleagues may have been missing some pages was
strengthened when they accused us of ignoring a recently published critical
review by Critchley et al. [4] on the health effects of smokeless
tobacco. On the contrary, our review not only cited the Critchley article, but
quoted its main conclusion verbatim:
"Chewing betel quid and tobacco is associated with a substantial
risk of oral cancers in India. Most recent studies from the US and Scandanavia
are not statistically significant, but moderate positive associations cannot
be ruled out due to lack of statistical power."[4] (quoted on p351)
Similarly, the accusation that "Foulds et al. pay little attention to
those other plausible determinants of patterns of tobacco use in Sweden"
seems rather strange as we stated plainly that:
"Both within and outside Sweden, smoking is primarily influenced by
factors other than availability of smokeless tobacco (for example, real price
of cigarettes, health education, smoke-free air policies, industry marketing
etc)." (p357)
Tomar et al asked, "Could any health professional seriously advocate
taking up oral tobacco as a means of preventing cigarette smoking? This seems
dangerously close to advocating oral opiod narcotics such as codeine as a
means of avoiding heroin use." However, as neither our nor Bates et al’s
articles mentioned a word about health professionals advising their patients
to use oral tobacco or codeine, (nor do we think that they should for those
purposes) we find this to be yet another example of the "straw man"
style of argument on which Tomar’s commentary was largely based.
2. Selective reporting of findings
Tomar et al accused us of selective reporting of findings. Any reviewer
given a word-limit by a journal has to make selective judgements. This is
problematic if methodologically strong studies, particularly those with
results that conflict with the conclusions of the review, are omitted. We
stand by the selection of both studies and results included in the review. For
example, Tomar et al cite two reports by Lindstrom et al. [5,6]
that we
did not mention. These reports were from a single study based in a single city
(Malmo) in the far south of Sweden. We did not include these reports because
they were located in a small part of Sweden where snus use is markedly less
prevalent than the country as a whole, as acknowledged by Lindstrom et al
(e.g. the daily snus prevalence of 7% in men reported in the study is about
one third of that for the country as a whole). Basing conclusions about snus
use in Sweden on a study based exclusively in Malmo is like basing conclusions
on smoking and smokeless use in the USA on studies in Utah. Given that
Lindstrom et al. [5] concluded that:
"Snuff consumption may explain a part of the increase in smoking
cessation among men as opposed to women in Sweden,"
we were also confident that this is not an example of omitting studies that
don’t agree with the review’s conclusions.
The other cohort study cited by Tomar et al [7] was flawed because
it ignored the effect of the change in wording of the questions on snus in the
Living Conditions surveys after 1980-81. The 1980-81 survey simply asked,
"Do you use snus?" (thus including both daily and occasional users)
whereas the subsequent surveys asked specifically about daily and occasional
use.[8] This study therefore mistakenly compared all snus use in
1980-81 with only daily use in 1988-9.
As a test of who has "selectively reported findings", lets
compare our reporting on the prevalence of smoking in young people, and that
of Tomar et al. We summarized the data as follows:
"Looking only at daily smoking prevalence among 16 year olds in
Sweden, this has remained remarkably stable at around 11% for boys and 16% for
girls for the past 20 years." (p357)
Tomar et al, on the other hand, state that:
"Between 1981 and 2001 daily smoking declined more rapidly for
15-16 year old girls (23% to 16%) than boys (13% to 10%), snus use remained
rare among girls, and the sex difference in smoking prevalence decreased."
The full data for daily smoking prevalence by sex for 1981 to 2001 are
shown in the figure below.[8] We’ll let the readers decide whether
this shows a more rapid decline for girls or a stable pattern (other than
normal fluctuations due to sampling differences and factors affecting both
sexes equally such as price changes). We’d suggest that the 1981 figure for
girls smoking prevalence was an outlier (possibly associated with changes in
the wording of the survey questions and definitions of "daily
smoking" that took place 1981-3), and that choosing to emphasize it is an
example of Tomar et al’s own "selective reporting"
Prevelance of daily smoking in Sweden by
boys and girls ages 15 and 16 with linear regression lines.
From annual surveys by CAN, Swedish Council for Information on Alcohol and other
Drugs
3. Tomar et al’s errors in critical appraisal of health effects of snus
Tomar et al. accuse us of "misinterpreting the findings from the Lewin
et al. study", claiming that we cited only the univariate analyses of
results. On the contrary, in addition to their confusion over whether they
were quoting relative risks or odds ratios, Tomar et al chose to cite the
results of the univariate analyses based on only 9 cases and 10 referents (not
controlling for factors such as alcohol use). We concurred with the authors of
the original article [9] in choosing to emphasize the results based on
a larger number of cases after adjusting for factors such as smoking and
alcohol consumption.
Tomar et al also chastized us for "ignoring" the Institute of
Medicine Report.[10] We did in fact cite that report and its findings
many times, but perhaps we should have gone further and quoted that report’s
conclusion on snus and oral cancer:
" In Sweden, there is a very high rate of Swedish snuff (snus) use.
But, the use of snus in Sweden has generally not been associated with oral
cavity cancer (Idris et al, 1998; Kresty et al, 1996; Lewin et al, 1998;
Nilsson, 1998; Schildt et al, 1998). Snus is not fermented and so has a much
lower level of N-nitrosamines (Nilsson, 1998) and has a lower genotoxic
potential (Jansson et al, 1991), which might be related to the lack of
increased risk." Institute of Medicine, [10] 2000, p428, para
2.
Again, it is apparent that our choice not to draw from that report more
heavily was not because it contradicted our overall conclusions. In
fact the IOM report’s assessment of the snus-cancer relationship is at odds
with that of Tomar et al. Perhaps Tomar et al feel that the IOM report was
also, "uncritical, misinterpreted the findings", or is "illustrative
of the type of simplistic conclusions that might be reached when the nuances
of epidemiologic research are not fully appreciated, findings are not fully
evaluated." Or perhaps it is Tomar et al. who are out on a limb in
their interpretation of the evidence?
Among the litany of inaccurate criticisms and repetitions of points that we
and others have already made (e.g. the need for proper regulation of tobacco
and medicinal nicotine products,[2,11] the possible
cultural-specificity of Sweden’s experience,[2] etc), Tomar et al
made two potentially substantive points: those relating to the pattern of
cohort effects in Sweden, and their suggested alternative explanation for the
sex-difference in Sweden’s smoking prevalence.
4. Birth-cohort patterns relating smoking and snus use.
Tomar et al suggested that the people who initiated snus use in Sweden are
not the same people who have quit smoking, and present an analysis of birth
cohort effects claiming to demonstrate this. They compared the snus use
prevalence among males in different age groups (16-24, 25-34 etc) in 1988/89
with the prevalence of snus use with a different sample (but born in the same
years) collected in a survey in 1996/97. They then compared this with the
relatively small reduction in cigarette smoking prevalence between 1989 and
2000 among different samples from the same birth cohort (offering no
explanation for the change in survey year, to 2000, for the smoking analysis).
They imply that the relatively large increase in snus use and the relatively
small reduction in prevalence of daily cigarette use within the same age
cohort (if not the same sample) shows that the snus use increase and smoking
cessation are independent phenomena.
There are major problems with this analysis, some of which stem from the
fact that the changes in tobacco use are not based on the same people over
time. It is no big surprise that people tend to take up tobacco use when they
are young and try to stop it when they are older (as they do for just about
every other kind of substance use). It is perfectly plausible that despite
this being the over-riding pattern of snus and cigarette use, a meaningful
proportion of smokers in the older age cohorts take up snus (sometimes
temporarily) as a way of stopping smoking and are more successful in their
quit attempt as a consequence. So long as this number is smaller than the
number ceasing snus use (without having smoked), one wouldn’t necessarily
observe an increase in snus prevalence in these older age groups. This is
particularly likely when a sizable proportion of those taking up snus to
replace smoking do so only on a short-term basis, ending up tobacco free by
the next survey. The cohort analysis presented by Tomar et al. is therefore
irrelevant to the issue of whether men who quit smoking were helped to do so
by snus.
A recently published study [12] followed the same cohort of
3244 (75% of the original 4349) participants in the 1980-81 National Survey of
Living Conditions through the 1988-9 and 1996-7 surveys. A strength of this
data-set is that it follows the same participants over a long time period (16
years), and the weaknesses are that those participating tended to be have
slightly lower smoking prevalence than non-participants, some participants
were lost to follow-up (201 men and 129 women due to death) and snus use was
not reported in the published paper. As shown in the table below, smoking
prevalence fell uniformly across the birth cohorts for men (around –14%
prevalence) but the reduction in smoking in women was greater in the younger
age group (-16% in those aged 18-25 in 1980-1, compared with –3% in those
aged 66-73 in 1980-81), and lower overall in women than men (-9 vs –14).
This study did not report snus use data in this cohort and we do not believe
it is appropriate to guess it based on prevalence in a different sample.
However, it is noteworthy that male snus use (occasional plus regular)
increased in Sweden from 16.6% to 25.4% from 1980-81 to 1996-7. Thus a higher
proportion of male than female smokers have succeeded in quitting smoking in
every age group except for 18-40 (most likely due to the extra boost to
cessation surrounding pregnancy in women), and a much higher proportion of men
than women use snus in every age group. The question of how many men quit
smoking by using snus is best addressed by other surveys (discussed below).
Men (n=1834)
Women (n=1610)
Agein
1980-1
% Smoking
1980-1
% Smoking
1988-9
% Smoking
1996-7
% Smoking
1980-1
% Smoking
1988-9
%
Smoking
1996-7
Change in
Smoking 1980-97 (Men)
Change in
Smoking 1980-97 (Women)
18-25
32
27
18
41
34
25
-14
-16
26-33
36
29
21
41
38
31
-15
-10
34-41
40
32
26
36
33
29
-14
-7
42-49
28
22
15
33
27
23
-13
-10
50-57
30
23
15
23
21
16
-15
-7
58-65
27
17
11
17
13
10
-16
-7
66-73
32
24
18
12
12
9
-14
-3
Total Population
33
26
19
32
28
23
-14
-9
Table 1. Prevalence of daily smoking in Sweden in a cohort recruited in
1980-1 and followed up in 1988-9 and 1996-7, by sex and age in 1980-1.[12]
5. Is the sex difference in smoking prevalence due to fewer women in the
smoke-free workplace?
Tomar et al. proposed a speculative and entirely evidence-free explanation
for the differences in smoking prevalence trends for men and women in Sweden:
Smokefree workplace regulations have prompted more men than women to quit
because a lower proportion of women than men are in full time employment (i.e.men
are more likely to be impacted by smokefree workplace regulations).
One thing that doesn’t seem to fit with that is the data on the older age
groups presented in the table above. Those aged 50+ in 1980-1 in that data
would mostly have retired from the workforce by 1996-7 and so might be less
affected by workplace smoking bans. However, despite that, the sex-difference
in cessation is actually stronger in that age group than any other.
Similarly, at the opposite end of the age spectrum, the sex differences in
smoking among school children (shown above) cannot be explained by policies on
smoke-free environments as boys and girls in Sweden are subject to the same
school environment. Examination of the 2002 Swedish Survey of Living
Conditions smoking data [8] by profession also casts doubt on Tomar et
al’s proposal. For examples, among adult students (presumably both sexes
sharing the same campus environment), 11.6% of men smoke compared with 18.6%
of women (no sign of a "gateway effect" here either). Among lower
level office staff, smoking prevalence in men fell from 32.6% in 1989 to 18.0%
in 2002, whereas the change was only from 29.0% to 26.4% for women. In short,
while smoke-free workplace legislation almost certainly triggers smokers to
try to quit, any (non snus-related) sex difference in the effects is extremely
unlikely to be of sufficient magnitude to account for the relatively large sex
differences in smoking patterns that occur even within occupational groups in
Sweden. More persuasive is the data from surveys on the use of snus as a
smoking cessation aid by Swedish men.
6. Use of snus as a smoking cessation aid.
Tomar et al failed to address the evidence [13-16] that a
substantial minority (around 30%) of Swedish men who had quit smoking, state
that they used snus to help them quit smoking. Rather strangely, Tomar et al
tried to brush this important piece of evidence under the carpet by stating
that "the majority" of men quit smoking without snus. If this
statistic had referred to the proportion of ex-smokers who quit by using some
other method (e.g. doctor’s/dentist’s advice, or use of nicotine
replacement therapy) we suspect that Tomar et al would have more honestly
acknowledged that anything that helps 30% of successful quitters to do so is
having a meaningful and important role in smoking cessation.
7. This is about Sweden, not the USA.
Tomar et al belatedly suggest that the rhetoric be toned down and that
their differing focus relates to differences between national regulations,
companies and products (presumably referring to differences between the USA
and Sweden). However, these national differences are not directly relevant
here because (for once) these papers were NOT about the U.S. These papers were
published in an international journal and focused very specifically on the
evidence to date in Sweden,[2] and the potential implications for
European policy.[3]
8. Both snus and Swedish tobacco control deserve some of the credit
Finally, we’d like to address another point made by Tomar et al – namely
that Sweden quite rightly deserves credit for its tobacco control efforts. In
addition to inventing nicotine replacement therapy, the Swedes have implemented
a number of positive tobacco control interventions and the reduction in smoking
prevalence among women (which has very little to do with snus use) has been
impressive. Sweden’s tobacco control movement has had a particularly strong
component designed to reduce tobacco use among women, thanks in no small part to
the efforts of Margaretha Haglund, who has also been the President of the
International Network of Women Against Tobacco (INWAT) for many years. However,
it is in that context of strong tobacco control measures, often targeting women,
that the larger reduction in smoking prevalence in Swedish men is all the more
remarkable. To deny that snus has played some part in that success (which is the
issue we were asked to review) is to deny the weight of the evidence.
Acknowledgements
Jonathan Foulds and Michael Burke are primarily funded by New Jersey
Department of Health and Senior Services. Jonathan Foulds, Karl Fagerstrom ,
and Lars Ramstrom have worked as consultants and received honoraria from
pharmaceutical companies involved in production of tobacco dependence
treatment medications. Lars Ramstrom has also received project support from
the Swedish National Institute of Public Health and salary from short term
employment with WHO. None of the authors has accepted any funding from the
tobacco industry.
Jonathan Foulds University of Medicine and Dentistry of New Jersey- School of Public health,
Tobacco Dependence Program, New Brunswick, USA
Lars Ramstrom Institute for Tobacco Studies, Stockholm, Sweden
Michael Burke
University of Medicine and Dentistry of New Jersey- School of Public health,
Tobacco Dependence Program, New Brunswick, USA
Karl Fagerstrom Fagerstrom Consulting and The Smokers Information Center, Helsingborg, Sweden
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I'd like to challenge the suggestion in this paper that mobile phone
use does not reduce smoking, simply because smoking teenagers are more
likely to own mobile phones.
The hypothesis advanced by Ann Charlton and I is that mobile phones
share some of the same charatcteristics that attract young people to
smoking (initiation to adult life, peer bonding, individualistic
expression, brand identification etc). I...
I'd like to challenge the suggestion in this paper that mobile phone
use does not reduce smoking, simply because smoking teenagers are more
likely to own mobile phones.
The hypothesis advanced by Ann Charlton and I is that mobile phones
share some of the same charatcteristics that attract young people to
smoking (initiation to adult life, peer bonding, individualistic
expression, brand identification etc). If this is the case, then they are
competing with smoking, and with other expenditures, for teenagers'
spending money. If this is the case, it wouldn't be entirely surprising
to see more mobile phone use among smokers that can afford both. We
implied that needs may be met by mobiles rather than smoking, but it is
possible that teenagers seek these attractive attributes from both mobiles
and smoking.
Whether mobile phone ownership reduces smoking is another matter...
and it depends on how teenagers that don't have a lot to spend or have
other things to spend their money on decide their priorities. It is quite
possible to reconcile higher use of mobile phones among smoking teenagers
with lower overall teenage smoking as a result of mobile phone use. The
difference would be in those non-smokers that would otherwise have become
smokers had they not chosen to spend their discretionary cash on mobile
phones instead of smoking. Those that would have been uninterested in the
shared attributes of smoking and mobile phones would tend neither to smoke
nor to make much use of mobile phones - hence a lower rate on average
among non-smokers even though. In other words, what matters is the
behaviour of the those wavering between smoking and not smoking, not the
overall averages.
Whether the fall in UK teenage smoking can be attrributed in any part
to the rise of mobile phone use is impossible to determine. It could have
reflected a period of adjustment in the spending patterns of young people
that eventually settled with the mobile phone being a 'must-have'
accessory rather than a choice. Smoking rates among teenagers have
remained lower than the high water mark of 1996, but are creeping up. As
teenagers have more spending money, more would be able to afford both.
PS. it remains a hypothesis and I don't claim it to be established as
true. I just don't think that it is convincingly falsified by this paper.
The abstract's conclusion that persistent use of nicotine gum is
"very rare" casts serious doubt upon the authors' objectivity. How can
they here describe a 6.7% chronic nicotine gum use rate at six months as
reflecting a 'very rare' condition while their March 2003 OTC NRT meta-
analysis - published in this same journal - embraced a 7% six-month
smoking abstinence rate finding as "effective?" [1]
The abstract's conclusion that persistent use of nicotine gum is
"very rare" casts serious doubt upon the authors' objectivity. How can
they here describe a 6.7% chronic nicotine gum use rate at six months as
reflecting a 'very rare' condition while their March 2003 OTC NRT meta-
analysis - published in this same journal - embraced a 7% six-month
smoking abstinence rate finding as "effective?" [1]
I do hope the FDA will lay the authors' March 2003 meta-analysis
beside this study's findings as the shocking news is that almost 100% of
nicotine gum users who were declared to have quit smoking for six months
(7%) appear to have still been hooked on the nicotine gum at six months
(6.7%).
The big news is that one-quarter (24%) of nicotine patch users (1.7%
of the 7%) who were previously reported to have successfully quit at six
months were likely still using the nicotine patch.
If almost 100% of gum and 95% of patch users are still hooked on
nicotine at six months and success is "very rare" then doesn't some rather
serious life threatening NRT marketing deception need to be immediately
addressed and corrected? The authors apparently want us to believe that
those spending hundreds of dollars violating FDA use guidelines were not
chemically dependent.
Yes, I'm clearly using Table 1 "one month gap"findings. But if this
study is to be taken seriously, after the authors discarded all purchase
data reflecting multiple same day scans on the assumption that they were
scanning errors, some of which obviously evidenced purchases of multiple
month supplies, I think we must. It also brings the authors selective
data "estimates" closer to historical study findings.
What I find interesting is that there was zero analysis of any
nicotine purchases except for NRT when every nicotine product sold has UPC
codes and participants were required to scan all purchases. Why would
their NRT scans be anymore reliable than other nicotine product scans?
Wouldn't that have provided data on the number of smokers in each
household, their brands, and whether or not they attempted cessation? In
single smoker households the nicotine use picture should be amazingly
clear.
It would be interesting to see this data analyzed by researchers who
are not acknowledged NRT industry consultants and who do not feel
compelled to disclose within the study that they have a personal financial
stake in the development and marketing of new NRT products. The patterns
of NRT use interlaced with cigarette and other nicotine purchases should
produce some rather fascinating info on just how well "therapy" was
actually going. I just don't know if it would be in the pharmaceutical
industry's financial interests to share such details.
If the real agenda of this study - and reflecting back there seems to
have been an overabundance of marketing objectives - is to get the FDA to
double the OTC NRT use recommendation period from three to six months,
thus substantially enhancing profits, the FDA would be well advised to
attack the pharmaceutical industry's hiding of nicotine’s addictive
properties with the same vigor it would if allowed to regulate tobacco
product warnings and a failure to have any U.S. dependency disclosures.
The authors assert that "the literature has seldom examined
dependence upon NRT." Is there any wonder why? Imagine having to put
nicotine addiction warning labels on all nicotine weaning products. They
are badly needed too. The 2003 Memphis youth NRT use survey finding that
teens who have never taken a single puff off of any cigarette are now
daily NRT users should have set off major alarms at the FDA.[2]
Is one of the objectives of this study to diminish growing concern
that NRT products are the new gateway to a lifetime of nicotine dependency
for tens of thousands of youth? If so, is it just possible that a bit of
"real" dependency science may at some point be in order?
In reading this study it's almost as if the authors want us to
believe that the brain's dopamine, adrenaline and serotonin neurons are
somehow able to discriminate between nicotine from a cigarette and
nicotine from NRT products. How are such shell games and nonsense any
different from the tobacco industry's nonsense?
This study's intro and discussion read like decades of tobacco
industry spin on the issues of addiction and safer cigarettes while again
totally ignoring all nicotine dependency biochemistry or studies raising
legitimate nicotine health risks.
Nicotine addiction isn't about getting high but about how the mind
and body have redefined "normal." Our bodies rebelled against those
first few puffs but quickly adjusted to inhaling thousands of chemicals.
Amazingly, nicotine crossed the blood-brain barrier and was a chemical key
that snugly fit the acetylcholine locks responsible for fine tuning a host
of brain neurochemical pathways including select dopamine, adrenaline and
serotonin circuits, and through cascading indirectly controlling more than
200 neurochemicals.
The mind's adjustments to being constantly bombarded with nicotine
were gradual yet constant. But eventually the brain ran out of tricks as
it could no longer keep up with the smoker smoking more nicotine in order
to achieve remembered prior performance. It did everything possible to
protect its reward, mood and anxiety circuits from overload and burnout.
It some areas it reduced the number of receptors for nicotine, in others
the number of transporters were diminished, while in some regions of the
brain millions of additional neurons were grown.
Through disbursal and turning down the brain's receptiveness to
nicotine, normal brain chemistry was altered as a new sense of normal
emerged and an addiction was born. It was a sense of normal now
completely dependent upon nicotine's two-hour chemical half-life.
Successful dependency recovery is being willing to allow the brain
the time needed to readjust to again functioning without nicotine, and the
quitter time to adjust to the brain's adjustments. It is impossible for
the brain, body and consciousness to adjust to functioning and living
without nicotine until its arrival stops.
If true, how can NRT claim responsibility for a 7% midyear nicotine
cessation rate? It can't. As shown by superimposing this study upon the
authors' March 2003 finding, within six months zero gum users and only
five in one hundred patch users are nicotine free.
But what about the 5% who transdermal nicotine seemed able to help
escape? I submit that they did not quit nicotine while engaged in using
it but only after pulling off that last patch. There is a substantial
body of non-NRT study evidence strongly suggesting that almost twice as
many patch users (10%) would have succeeded if they had not toyed with
months of nicotine weaning.[3]
An unsupported and uneducated quitter's core motivations and nicotine
cessation desires appear unaffected by cessation method unless that method
deprives them of some of their own natural recovery abilities. NRT
appears to do just that by prolonging the up to 72 hours needed for 100%
of nicotine and 90% of nicotine metabolites to be removed from the body
and the brain to begin sensing the arrival of and adjusting to nicotine-
free blood serum.
One of NRT's biggest fictions is that real world 'on-your-own'
quitting rates are the same as those being generated in OTC NRT studies
trying to cope with admitted blinding failures or even employing nicotine
as a placebo device masking agent.[4] It's why the authors continue to
take stabs at the 2002 Pierce JAMA survey conclusion that NRT is no longer
effective, and ignore London and Minnesota surveys with similar findings.
Nicotine is the natural chemical defense that keeps the roots, leaves
and seeds of the tobacco plant from being eaten by bugs. Drop for drop
it's more deadly that strychnine and three times deadlier than arsenic.
Amazingly, the FDA allowed the pharmaceutical industry to redefine and
market an insecticide as medicine and label its use therapy.
It also stood by while new tortured definitions of quitting,
cessation, and abstinence were created allowing NRT to hide nicotine and
addictiveness concerns while making billions in profits by claiming
meaningless odds ratio victories. It watched as researchers kept straight
faces while pretending that those still using nicotine had accomplished
some great feat that was then compared to those who truly had ended all
nicotine use.
What FDA officials should not sweep under the rug or allow studies
such as this to redefine, ignore or minimize is the growing awareness of
the destructive potential of this amazing pesticide. The authors'
assertion that "prolonged use of NRT is not thought to be harmful" is
simply untrue as it flies in the face of a growing list of study concerns
produced by real experts engaged in real science.
The U.S. National Cancer Institute has raised cancer concerns over
the nicotine-derived nitrosamine NKK on normal lung epithelial cells. The
Paris National Institute of Health recently found evidence that nicotine
causes a major fall in production of PSA-NCAM, a protein with a vital role
in the plasticity of the brain with apparent impairment of learning and
memorization.
A 2001 Stanford study concluded that nicotine tremendously
accelerates tumor growth rates and atherosclerosis through angiogenesis.
And an October 2000 study in Pediatrics that followed 8,000 teenagers has
depression experts rethinking why so many nicotine dependent Americans
suffer from chronic depression and other mental health concerns.
But I want to mention one more risk that harm reduction oriented NRT
experts just can't seem to grasp. I'm talking about an entire life being
chemically dependent upon nicotine's two-hour chemical half-life. I'm
referring to again sensing the full glory of our own reward pathway
releases that flow from accomplishment, a big hug, or even a nice cool
glass of water. About handling our own adrenaline releases, our own
anxieties and anger, determining when it's time to eat, dealing with real
hunger pains for the first time in decades, or even something as simple as
the circumstances under which we'll feel our fingers grow cold.
Not only does the brain adapt to the chemical world of nicotine
normal, the new addict quickly forgets who they really were and the
amazing sense of calmness that existed inside their mind prior to climbing
aboard the nicotine, dopamine/adrenaline/serotonin roller-coaster ride of
endless highs and lows. Natural regulation of mood, flight or flight, and
reward is life itself, something more nicotine cannot return.
Big brother health policy has unforgivably used nicotine cessation as
a practice arena for someday going head-to-head with big tobacco in
supplying the daily nicotine needs of a billion addicts. Smokers trusted
us "science" to help arrest their dependency and it lied to them. It not
only knew that "their" definition of quitting included nicotine, NRT
marketing knowingly played upon it by constantly undermining their natural
inclination to want to give up all nicotine by quitting cold.
The white-coat ceremony vow was to do no harm yet physician science
remains silent while knowing that the dismal 5.3% six-month nicotine patch
quitting rate (derived by subtracting persistent purchasers rate of 1.7%
from the OTC NRT finding of 7%) drops to almost zero percent during a
second or subsequent patch attempt.[5] If true, how can those calling
themselves addiction scientists sleep at night knowing that there is no
lesson to be learned from repeated NRT use but that relapse is 100%
guaranteed as dependency, destruction, decay and disease continue bringing
forth vastly increased odds of early demise.
John R. Polito
Nicotine Cessation Educator
[1] Hughes JR, Shiffman S. et al, A meta-analysis of the efficacy
of over-the-counter nicotine replacement, Tobacco Control. 2003
March;12(1):21-7. Full text link -
http://tc.bmjjournals.com/cgi/content/full/12/1/21
[2] Klesges, L. et al, Use of Nicotine Replacement Therapy in
Adolescent Smokers and Nonsmokers, Arch Pediatr Adolesc Med. 2003;157:517-
522. Abstract link - http://archpedi.ama-
assn.org/cgi/content/abstract/157/6/517
[3] Polito, JR, Does the Over-the-counter Nicotine Patch Really
Double Your Chances of Quitting? Link to online article -
http://whyquit.com/whyquit/A_OTCPatch.html
[4] Polito, JR, Are nicotine weaning products a bad joke? Link to
online press release -
http://www.emediawire.com/releases/2003/10/prweb84809.htm
[5] Tonnesen P, et al., Recycling with nicotine patches in smoking
cessation. Addiction. 1993 Apr;88(4):533. Link to abstract -
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8485431&dopt=Abstract
. Also note references to unpublished studies such as the Korberly
nicotine patch study presented at the March 1999 Society for Research on
Nicotine and Tobacco conference in New Orleans in which only 1 out of 149
OTC nicotine patch users was still not smoking at the six month mark.
In all of the arguments I see in many articles, both pro and con,
concerning smoking bans, I note arguments tend to concentrate on
"smoker's rights" and "non-smoker's rights", when neither are relevant to
the real issue. That is, whether or not a proprietor has the right to
operate a business as he sees fit, allowing those who seek and enjoy the
business he offers to freely do so or freely decline it. That speaks more
t...
In all of the arguments I see in many articles, both pro and con,
concerning smoking bans, I note arguments tend to concentrate on
"smoker's rights" and "non-smoker's rights", when neither are relevant to
the real issue. That is, whether or not a proprietor has the right to
operate a business as he sees fit, allowing those who seek and enjoy the
business he offers to freely do so or freely decline it. That speaks more
to the essence of freedom than governmental regulation.
In your article you touch on the fact that the consumer would likely
not report internet pruchases for fear of reprisal in taxation issues. The
state does in fact over look the 1 or 2 carton of cigarette purchase
issues when for instance a business man travels to Kentucky and buys a
couple ther and brings them back with him to California.
I have also detected, in the industry of Internet Toabacco sales,
where th...
In your article you touch on the fact that the consumer would likely
not report internet pruchases for fear of reprisal in taxation issues. The
state does in fact over look the 1 or 2 carton of cigarette purchase
issues when for instance a business man travels to Kentucky and buys a
couple ther and brings them back with him to California.
I have also detected, in the industry of Internet Toabacco sales,
where the new proposals for laws have only one true effect. 91% of the
Internet sales are accpomplished by Soveriegn Tribal nations that pay for
the most part no state or federal taxes and also from the international
online sales points which also pay no state or federal taxes.
There is a movement a foot to set the Jenkins act more stringant and
also prohibit the mailing of cigarettes thru the USPS via the S1177. The
issue would eliminate only and I do say "only" the American online
retailers that pay the federal and for the most part state taxes.
The retailer I web master for is a brick and mortar operatin in
florida, pays Florida and Federal taxes on all cigarettes he sells, online
and thru his store. He would be affected by the changes propsed and the
ones that have already been made in effect in New York for example. Yet
the 91 % that are exempt from following those proposed changes will not be
affected. Not in the slightest bit. To assume that changing the laws to
affect only those that actually pay some State taxes and all federal taxes
would have an impact on internet sales is at the very least a sign of
ignorance. Those who are legitimate would stop and the customers would go
to the tribal nations or to foreign entities for the savings.
Tribal Nations avaoid taxes and ship vis the USPS in New York and the
Universal Postal Union Convention ratified by the United States forbids
the Federal and state governments from prohibition of foreign sales. I see
the irony that a few politicians are seeking special interest money and
support and ignoring the truth and only affecting American tax paying
citizens.
I doubt if you as a liberal would even care but I felt the need to
get it off my chest and tell yo just how wrong you really are in your
views and reporting.
Has the end of Malawi’s tobacco-driven economy come?
Author:
Adamson S. Muula MB BS, MPH
Department of Community Health
University of Malawi College of Medicine
Private Bag 360, Blantyre 3
MALAWI
Email: amuula@medcol.mw
Letter to Editor
In his article about Malawi’s economic reliance on the “green gold”
(tobacco), Peter Davies 1 clearly presented the dilemma that an African
country in...
Has the end of Malawi’s tobacco-driven economy come?
Author:
Adamson S. Muula MB BS, MPH
Department of Community Health
University of Malawi College of Medicine
Private Bag 360, Blantyre 3
MALAWI
Email: amuula@medcol.mw
Letter to Editor
In his article about Malawi’s economic reliance on the “green gold”
(tobacco), Peter Davies 1 clearly presented the dilemma that an African
country in Malawi’s position faces. Such difficult position has been a
matter of debate in other publications 2, and it would seem that it will
basically be economic considerations and not strict public health
(although the economy cannot be wholly delineated from public health) on
the part of countries like Malawi that will eventually force them to
reduce tobacco growing. Of course, part of their reduction of tobacco
producing could be related to the anti-smoking lobby.
Malawi’s economic performance has lately been a matter of concern.
Like in many African countries, the causes and the effects of such slump
in economy is poorly documented. We can not therefore say anything much
about rising malnutrition levels, increasing unemployment and by how much,
as a result of the deteriorating state of the economy. However, we can
speak about the role that tobacco has played in the present state of
affairs.
Malawi is the largest producer of burley tobacco in the world.
According to the Tobacco Exporters’ Association of Malawi (TEAM), Malawi’s
burley tobacco production has been dwindling since 2000. TEAM comprises:
the international tobacco buying companies, the Ministry of Agriculture,
Irrigation and Food Security, Agricultural Research and Extension Trust
(ARET), Auction Holdings Limited (AHL), the National Association of Small
Holder Farmers in Malawi (NASFAM), Tobacco Association of Malawi (TAMA)
and Tobacco Control Commission (TCC). In a press release of 20th September
2003, TEAM reported that while Malawi produced 142.3 million kilograms of
burley tobacco in 2000, production was 102 million kilograms in 2003.3
This 28.3% drop in production translated in loss of US$ 43 million. The
grouping is currently campaigning to ensure that in the forthcoming
growing season, more farmers and hectarage is dedicated to burley tobacco.
What could be the reasons Malawian farmers are no longer growing much
tobacco. Economic considerations rank high. According to Team, the
problems that the Malawi tobacco farmer face include: high transport
costs, input and marketing costs, various bank charges, devaluation of the
local currency and low selling prices for the tobacco at the auction
floor. Auction Holdings Limited, which charges commission for use of its
markets also charges commission and the farmers faces the brunt.
In order to motivate farmers to grow more tobacco, the following
measures have been put in place: the commission payable to Auction
Holdings has been reduced from 3.95% to 3.5%,4 taxes on Hessian bags (for
packaging tobacco) have been removed, tobacco awareness campaign
instituted. TEAM has also embarked on an initiative that will ensure that
the tobacco that reaches the markets will be of high quality thus further
attempting to ensure higher monetary returns to the farmers. This will
probably be achieved through: sales of high quality certified tobacco
seeds, maintenance and construction of tobacco curing barns, holding on
and off-farm field days and conducting tobacco grading course for farmers.
Malawi’s reliance on tobacco has reached a crossroads. Economic
factors have forced the tobacco growing community to reduce production, at
least of burley tobacco. While this goes on, the public health fraternity
in the country is relatively quiescent, probably for lack of viable
alternative in the prevailing circumstances. The tobacco industry has
produced a strategy on gaining lost glory. Speaking on the only national
television on 22nd September 2003, the principal secretary in the Ministry
of Agriculture in Malawi said he was aware of the adverse health effects
of tobacco and that was not a matter of argument. It was the lack of
alternatives that mattered. He went on to say, if the anti-tobacco lobby
is successful, then he would ensure that “the last cigarette to be smoked
must come from Malawi”. There is need for the public health teams to take
advantages of the current problems.
Conflict of Interest
None
References
1. Davies P. Malawi: addicted to the leaf. Tobacco Control 2003, 12(1): 91
-3
2. Muula AS. The challenges facing third world countries in banning
tobacco. Bulletin of the World Health Association 2001, 79(5): 480
3. Tobacco Exporters’ Association of Malawi. An appeal to all burley
growers: grow more burley tobacco for more money. Malawi News, 20th-26th
September 2003 p16
4. Auction Holding Limited. Reduction in selling commission. Weekend
Nation. Tamvani, 22nd-23rd September 2003 p 31
Bauld et al (2003) report a number of interesting results from the
evaluation of the NHS smoking cessation services. One result in particular
which warrants further investigation is the finding that 4 week success
(quit) rates were higher for smokers treated in groups compared to those
receiving individual support sessions. The authors briefly discuss
possible explanations for this, including the possibility that the form...
Bauld et al (2003) report a number of interesting results from the
evaluation of the NHS smoking cessation services. One result in particular
which warrants further investigation is the finding that 4 week success
(quit) rates were higher for smokers treated in groups compared to those
receiving individual support sessions. The authors briefly discuss
possible explanations for this, including the possibility that the former
treatment is likely to be offered by more experienced specialist staff.
While this may well be true, I believe a far more likely explantion for
the difference in success rates is due to selection bias as this was not a
randomised study. Smokers with mental health ot other severe psycho-social
problems, including drug or alcohol misuse, are usually deemed unsuitable
for smoking cessation group programmes. Published research indicates that
these smokers tend to be highly nicotine dependent and to have greater
difficulty quitting whatever the treatment offered. The difference in
success rates between groups and individual counselling might, therefore,
simply reflect the two different populations being treated.
Lawrence et al. (2003) reported the results of their cluster RCT on
smoking cessation in pregnant women comparing (1) standard care; (2)
Transtheoretical Model (TTM) based manuals; and (3) TTM computer based
tailored communications.1 In spite of serious flaws in this study, there
were very important results that the authors overlooked. They do not seem
to appreciate that this was a population-based trial where the goal...
Lawrence et al. (2003) reported the results of their cluster RCT on
smoking cessation in pregnant women comparing (1) standard care; (2)
Transtheoretical Model (TTM) based manuals; and (3) TTM computer based
tailored communications.1 In spite of serious flaws in this study, there
were very important results that the authors overlooked. They do not seem
to appreciate that this was a population-based trial where the goal is to
reduce the prevalence of smoking in an important population, pregnant
women. Their analyses treat the project as if it was a traditional
clinical trial where the goal is to assess only efficacy.
The most important analysis for a population trial is to assess the
relative impacts of alternative treatment programs.2,3 Impact equals
reach (or recruitment rate) times efficacy. Historically cessation
programs were assessed just on efficacy. If one treatment program had 30%
point prevalence abstinence at long-term follow-up, it was judged to be
50% more efficacious than a program with only 20% abstinence or efficacy.
But if the first treatment reached only 5% of a population of smokers it
would have an impact of only 1.5% (30% x 5%). It could reduce the
prevalence of smoking in a population by only 1.5%. If the second
treatment could recruit 60% of a population it would have 12% impact, or 8
times more impact than the treatment with greater efficacy. From a public
health policy perspective, preference would be given to programs with the
most impact.
What were the relative impacts of three programs compared in Lawrence
et al.? From the data reported, recruitment rates were calculated for
each of the three groups by dividing the number of pregnant smokers
recruited by the number of eligible smokers available in each group
(Figure 1). Efficacy was calculated by the self-report prevalence rates
at 10 days post-natal corrected by the mis-reporting rates for each group
(Tables 6 & 7 in (1)). Self-reported point prevalence measures are
what are used in determining population prevalence rates of smoking and
are the measures used in the United States for the Public Health Service
sponsored Clinical Practice Guidelines for Treating Tobacco.4
The impact of each of the three treatments is
A. Standard Care Impact = (23.3% recruited x 4.7 point prevalence) =
1.1%.
B. TTM Manual Impact = (39.5% recruited x 7.5% point prevalence) = 3%.
C. TTM Computer-tailored Impact = (58.5% recruited x 15.3% point
prevalence) = 9%.
The TTM Computer-tailored system had 8.2 times greater impact on the
prevalence of smoking compared to Standard Care. The evidence reported by
Lawrence et al. indicates that compared to standard care the TTM expert
system intervention recruited and retained more pregnant smokers, produced
less misreporting, helped more smokers quit, and had much greater impact.
Is there any program that has been found to have greater advantages with a
population of pregnant smokers?
The authors recommend policies that have no evidence. They
recommend, for example, that midwives proactively recruit pregnant smokers
to existing smoking cessation programs (an alternative not evaluated in
their study). In a study in the US of a similar procedure, a major health
care system in the U.S. had doctors, nurses, health educators and
telephone counselors all work proactively to get smokers in primary care
to sign up for cessation programs that were only reaching 1% of eligible
smokers.5 This proactive recruitment protocol, one of the most intensive
in the literature, was able to get 15% of smokers in the precontemplation
stage to sign up. But only 3% showed up. With a combined group in the
contemplation and preparation stages, they were able to get 65% to sign
up. But only 15% showed up. It is almost certain that the alternative
policy recommended by Lawrence et al would have much less impact than the
computer-based program that they reported. Based on the evidence that
they report, we would recommend (1) that impact be used as the primary
outcome criteria and (2) that the programs that have evidence of having
the highest relative impacts for pregnant women be adopted.
James O. Prochaska, Ph.D. and Wayne F. Velicer, Ph.D.
Cancer Prevention Research Center, University of Rhode Island
Correspondence to: James O. Prochaska, Ph.D.
Cancer Prevention Research Center, University of Rhode Island
2 Chafee Rhode Island
Kingston, Rhode Island 02881 USA
jop@uri.edu
velicer@uri.edu
References
1. Lawrence, T., Aveyard, P., Evans, O., & Chang, K.K. (2003). A
cluster randomized controlled trial of smoking cessation in pregnant women
comparing interventions based on the Tran theoretical (stages of change)
model to standard care. Tobacco Control.
2. Velicer, W.F., & DiClemente, C. C. (1993). Understanding and
intervening with the total population of smokers. Tobacco Control, 2, 95-
96.
3. Velicer, W.F., & Prochaska, J.O. (1999). An expert system
intervention for smoking cessation. Patient Education and Counseling, 36,
119-129.
4. Fiore, M.C., Bailey, W.C., Cohen, S.J., et al. (2000). Treating
Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD:
Department of Health and Human Services. Public Health Service.
5. Lichtenstein, E., & Hollis, J. (1992). Patient referral to
smoking cessation programs: Who follows through? The Journal of Family
Practice, 34, 739-794.
Personally, I prefer a description that tells something of the truth
about tobacco smoke, "toxic tobacco smoke." Since the Tenth Report on
Carcinogens indicates that tobacco smoke has 250 toxins in it, I don't see
any reason not to refer to it as toxic tobacco smoke. This is better than
dancing around the danger like many health agencies still do when they
refer to the "health" effects of smoking, when they should be tal...
Personally, I prefer a description that tells something of the truth
about tobacco smoke, "toxic tobacco smoke." Since the Tenth Report on
Carcinogens indicates that tobacco smoke has 250 toxins in it, I don't see
any reason not to refer to it as toxic tobacco smoke. This is better than
dancing around the danger like many health agencies still do when they
refer to the "health" effects of smoking, when they should be talking
about disease and death.
Another quite direct acronym would be smoke harboring inhaleable
toxins (SHIT). I know this would be offensive to most. How apropos.
"Business at New York bars and restaurants has
plummeted by as much as 50 percent in the wake of
the smoking ban - and the drop has already sparked
layoffs and left some establishments on the brink of
shutting their doors, a Post survey has found."
--Cig Ban Leaves Lot Of 'Empties', NY Post, 5/12/03
On May 12, 2003, the New York Post ran two
stories on a...
"Business at New York bars and restaurants has
plummeted by as much as 50 percent in the wake of
the smoking ban - and the drop has already sparked
layoffs and left some establishments on the brink of
shutting their doors, a Post survey has found."
--Cig Ban Leaves Lot Of 'Empties', NY Post, 5/12/03
On May 12, 2003, the New York Post ran two
stories on a survey it had done amongst 50
"randomly selected" New York City bars and
restaurants. 1,2.
The media universally accepted the survey at face value
and promulgated it, repeating the survey's findings
without qualification, and leaving the impression that
restaurant business really had fallen off by as much as
50 percent.
The AP distributed its recap of the survey around the
world 3;. The Washington Post's "Media Critic," Howard
Kurtz, quoted the NY Post story on it sans criticism. 4 A
Connecticut newspaper used it to rail against an
incipient state-wide smoking ban. 5 New Zealand's
Hospitality Association--attributing the survey to the
New York Times--used it to argue against smokefree
legislation. 6 And for Rush Limbaugh, of course, the
survey was the very pinnacle of scientific endeavor. 7
However, this survey had glaring faults, in design and
execution.
1. It seems unlikely that this was a "random" survey.
The "random" claim, repeated by the Post as late as
May 24, 2003,8 is on its face, a sham--at least 3 of
those reported on were noted ban opponents. The law
of averages argues against these 3 randomly turning
up in a survey of 50 of the 13,000 bars and restaurants
in New York City. 8 The obvious question is, how many
other survey subjects were known opponents?
2. The survey design mimics a notorious industry PR
tactic, the "30% Myth."
The Post survey follows in the footsteps of a
tried-and-true Philip Morris diversionary tactic that has
been used so often it was exposed by Consumer
Reports back in 1994. 10 Such surveys are usually
deployed 1) during legislative battles or 2) shortly after
a smoking ban has gone into effect.
3. The actual survey data was not provided in the Post's
story.
Here are the facts behind the survey:
1. At least two prominent 1995 smoking ban opponents
were featured in the NY Post's "random survey:" Joan
Borkowski 11 and Buzzy O'Keefe. 12 Desi O'Brien,
proprietor of Langan's, had previously voiced his
opposition to the 2003 ban in at least two newspaper
articles 13,14 --one of which was from the NY Post
itself. No restaurateur's former activism was
mentioned. In addition, one surveyed bar was named
"Smoke." Citing such a plethora of opponents in a short
article on a 50-restaurant survey doesn't sound
random.
2. One of these opponents was something more than
that. Joan Borkowski, owner of Billy's Tavern, was given
a whole article, "1870 Bar May Get $nuffed Out." But the
Post neglected to inform its readers that 8 years before,
Borkowski was the leader of a Philip Morris-funded
front group (New Yorkers Unite!) fighting the 1995
smoking ban. At that time, Borkowski was involved in
the release of 2 opinion surveys. One survey were
commissioned by the Philip Morris-funded National
Smokers Alliance, the other by the Philip Morris-funded
United Restaurant Hotel Tavern Association. Borkowski
released the surveys in association with the National
Smokers Alliance. 11
Both surveys found that after the 1995 ban, restaurant
business went down.
3. As is usual in these circumstances, the dire
estimates and predictions were later proven wrong by
real studies based on tax data. 15 This was
predictable, because the year before, Consumer
Reports had already exposed the "30% Myth" in a 1994
article on such Philip Morris-funded surveys. 10 (See
excerpt below.)
4. It should be noted that such survey results are greatly
influenced by previous PR. A tobacco company (or its
PR firm or front group) can prepare the ground by
unleashing an ad campaign trumpeting business
losses. It may also even directly contact
restaurateurs--through personal canvassing or direct
mailings--and present to them its harrowing tales and
prognostications. A few months later, a restaurateur
may well repeat such assertions for surveyors.
5. The PR power of such a survey is expanded even
further when restaurateurs in other locales read
unquestioning news coverage of it, presented as fact.
Thus, one scientifically-questionable survey can sow
powerful seeds for more surveys around the country,
and even the world.
6. From 1989 to 2001, the New York Post's owner,
Rupert Murdoch, sat on the Board of Directors of Philip
Morris. 16 The Post's editorials since 1989 have been
consistently against tobacco control. 17
---
1. Cig Ban Leaves Lot Of 'Empties'
Source: New York Post
Date: 2003-05-12
2. 1870 Bar May Get $nuffed Out
Source: New York Post
Date: 2003-05-12
3. Bars And Restaurants Blame Sharp Drop In
Business On Smoking Ban
Source: AP
Date: 2003-05-12
URL:
http://www.sun-sentinel.com/business/local/ny-bc-ny--s
mokingban-nyc0512may12,0,3930062.story?coll=sfla-
business-headlines
4. Media Notes: How Many Votes Is A Picture Worth?
Source: The Washington Post
Date: 2003-05-13
Author: Howard Kurtz / Washington Post Staff Writer
URL:
http://www.washingtonpost.com/wp-dyn/articles/A4436
7-2003May12.html
6. Bars To Close Under Smoke-free Law
Source: nzoom.com (TVNZ)
Date: 2003-05-18
URL:
http://onenews.nzoom.com/onenews_detail/0,1227,190
979-1-7,00.html
7. 2nd Study Confirms 2nd Hand Smoke Harmless
Source: Rush Limbaugh Site
Date: 2003-05-16
URL:
http://rushlimbaugh.com/home/daily/site_051603/conte
nt/cutting_edge.guest.html
9. Smoke Screens
Source: New York Post
Date: 2003-05-24
Author: STEPHANIE GASKELL and DAREH
GREGORIAN
10. Where There's Smoke
Consumer Reports May 1994
11. The Great 1995 New York Smoke-Out Smoke
Screen
THE NEW YORK OBSERVER
MAY 29. 1995
URL:
http://www.nypost.com/news/regionalnews/76479.htm
12. Ban Draws Fire at Eateries
New York Daily News
April 11, 1995
By MARK MOONEY and CORKY SIEMASZKO Daily
News Staff Writers
13. Our Troops Fight For Freedom While Our Pols
Restrict It
Source: New York Post
Date: 2003-03-31
Author: STEVE DUNLEAVY
URL: http://www.nypost.com/commentary/72314.htm
14. Resentment Smolders As Smoking Ban Takes
Hold
Source: Irish Echo
Date: 2003-04-04
Author: Stephen McKinley
URL:
http://www.irishecho.com/newspaper/story.cfm?id=130
48
15. "Tobacco Industry Political Influence and Tobacco
Policy Making in New York 1983-1999"
Source: Center for Tobacco Control Research and
Education. Tobacco Control Policy Making: United
States.
Date: February 1, 2000.
URL: http://repositories.cdlib.org/ctcre/tcpmus/NY2000
16. Philip Morris Website
Date: Downloaded May 24, 2003
URL:
http://www.altria.com/investors/annual_report/board/bo
ard01.asp?flash=true
17. New York Post Editorials
Date: Downloaded June 9, 2003
URL:
http://www.tobacco.org/articles.php?media_id=1003&p
attern=editorial
----------------
Excerpt from:
Where there's smoke
Consumer Reports May 1994
SELF-SERVING SURVEYS
THE 30 PERCENT MYTH
When pro-tobacco forces in California want to scare
communities away from public-smoking bans, they
sometimes use seemingly objective surveys that show
restaurants losing an average of 30 percent of their
revenue after bans go into effect. The figure and the
surveys that produced it are far less scientific than they
have been made to appear.
Restaurants in Beverly Hills, for example, are said to
have lost 30 percent of their business during a
smoking ban that became effective in 1987. The
number has been quoted in The Los Angeles Times
and Time magazine. It comes from a survey by the
Beverly Hills Restaurant Association, a group organized
by a public-affairs consultant named Rudy Cole. The
survey asked restaurants how much business they
thought they lost during the ban; it didn't attempt to
quantify those losses using any sort of objective
measure. "That was not a scientific survey," Cole
admits.
A more rigorous study, this one of taxable sales at
Beverly Hills restaurants, was later conducted by the
accounting firm Laventhol & Horwath. It showed a more
modest average drop: 6.7 percent.
The 30 percent figure surfaced again in the city of
Bellflower, a Los Angeles suburb that banned
restaurant smoking from March 1991 to June 1992.
Shortly after the rule took effect, restaurateurs received
survey questionnaires sponsored by Restaurants for a
Sensible Voluntary Policy. That group was supported by
the Tobacco Institute and had Rudy Cole as its
executive vice president. The survey itself was prepared
by an employee of the Dolphin Group, a public-relations
agency that serves Philip Morris USA.
The Bellflower survey--again based on anecdotal
responses-also reported that restaurants lost an
average of about 30 percent of their customers. But a
study of sales receipts commissioned by the city of
Bellflower showed that restaurant revenues actually
rose by 2.4 percent during the smoking ban. Stanton
Glantz and Lisa Smith, researchers at the University of
California, San Francisco, studied sales data in 13
communities that had banned restaurant
smoking-.-including Bellflower and Beverly Hills. They
found no significant longterm drop anywhere.
Pro-tobacoo forces circulated the Bellflower survey in
California towns considering antismoking rules. One
version said the survey was sponsored by the
California Business and Restaurant Alliance. It didn't
mention that the alliance is run by an executive of the
Dolphin Group, Philip Morris' PR firm. The statistic
gained even wider currency when the Tobacco Institute
cited the Beverly Hills survey in ads run in
restaurant-industry publications, urging restaurateurs
to fight smoking bans.
A star is born
An informal survey of restaurateurs in Bellflower, Calif.,
(top) became a formal report showing the alleged
economic impact of a smoking ban. Both were
sponsored by groups connected to the tobacco
industry. One version of the report (middle)
suggested-incorrectly-that it was commissioned by the
city's mayor, Survey statistics were reported as news in
Bellflower (bottom) and other California towns
considering smoking bans.
Dear Editor
The earth is flat, ABBA couldn’t sing a song, Scotland is going to win the soccer World Cup sometime soon, and snus has played no part in the reduction in smoking prevalence among Swedish men – or so Tomar et al. [1]would have us believe. Of all of these issues not remotely supported by the evidence, the last one is a little more serious in that it may influence tobacco control...
I'd like to challenge the suggestion in this paper that mobile phone use does not reduce smoking, simply because smoking teenagers are more likely to own mobile phones.
The hypothesis advanced by Ann Charlton and I is that mobile phones share some of the same charatcteristics that attract young people to smoking (initiation to adult life, peer bonding, individualistic expression, brand identification etc). I...
The abstract's conclusion that persistent use of nicotine gum is "very rare" casts serious doubt upon the authors' objectivity. How can they here describe a 6.7% chronic nicotine gum use rate at six months as reflecting a 'very rare' condition while their March 2003 OTC NRT meta- analysis - published in this same journal - embraced a 7% six-month smoking abstinence rate finding as "effective?" [1]
I do hope...
In all of the arguments I see in many articles, both pro and con, concerning smoking bans, I note arguments tend to concentrate on "smoker's rights" and "non-smoker's rights", when neither are relevant to the real issue. That is, whether or not a proprietor has the right to operate a business as he sees fit, allowing those who seek and enjoy the business he offers to freely do so or freely decline it. That speaks more t...
In your article you touch on the fact that the consumer would likely not report internet pruchases for fear of reprisal in taxation issues. The state does in fact over look the 1 or 2 carton of cigarette purchase issues when for instance a business man travels to Kentucky and buys a couple ther and brings them back with him to California.
I have also detected, in the industry of Internet Toabacco sales, where th...
Has the end of Malawi’s tobacco-driven economy come?
Author:
Adamson S. Muula MB BS, MPH Department of Community Health University of Malawi College of Medicine Private Bag 360, Blantyre 3 MALAWI Email: amuula@medcol.mw
Letter to Editor
In his article about Malawi’s economic reliance on the “green gold” (tobacco), Peter Davies 1 clearly presented the dilemma that an African country in...
Bauld et al (2003) report a number of interesting results from the evaluation of the NHS smoking cessation services. One result in particular which warrants further investigation is the finding that 4 week success (quit) rates were higher for smokers treated in groups compared to those receiving individual support sessions. The authors briefly discuss possible explanations for this, including the possibility that the form...
Lawrence et al. (2003) reported the results of their cluster RCT on smoking cessation in pregnant women comparing (1) standard care; (2) Transtheoretical Model (TTM) based manuals; and (3) TTM computer based tailored communications.1 In spite of serious flaws in this study, there were very important results that the authors overlooked. They do not seem to appreciate that this was a population-based trial where the goal...
Personally, I prefer a description that tells something of the truth about tobacco smoke, "toxic tobacco smoke." Since the Tenth Report on Carcinogens indicates that tobacco smoke has 250 toxins in it, I don't see any reason not to refer to it as toxic tobacco smoke. This is better than dancing around the danger like many health agencies still do when they refer to the "health" effects of smoking, when they should be tal...
Analysis: The Survey as a PR Tactic
"Business at New York bars and restaurants has plummeted by as much as 50 percent in the wake of the smoking ban - and the drop has already sparked layoffs and left some establishments on the brink of shutting their doors, a Post survey has found."
--Cig Ban Leaves Lot Of 'Empties', NY Post, 5/12/03
On May 12, 2003, the New York Post ran two stories on a...
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