Thanks you for this excellent explanation of the reality behind
tobacco companies' dabbling in so-called CSR programmes.
Earlier this year INGCAT's member organisations agreed a position
statment on tobacco industry CSR programmes that purport to address health
and welfare issues, entitled "The socially responsible tobacco company -
another misleading descriptor". The thrust of the positio...
Thanks you for this excellent explanation of the reality behind
tobacco companies' dabbling in so-called CSR programmes.
Earlier this year INGCAT's member organisations agreed a position
statment on tobacco industry CSR programmes that purport to address health
and welfare issues, entitled "The socially responsible tobacco company -
another misleading descriptor". The thrust of the position is that:
"NGOs’ responsibility is to protect the interests of their
beneficiaries: partnerships that promote the interests of tobacco
companies as they currently operate are incompatible with that duty.
INGCAT members refuse to support, endorse or co-operate with tobacco
companies’ CSR activities on health or poverty relief, and call on other
health and welfare organisations to join us in this stance."
The position statement does not intend to discourage tobacco
companies from making genuine efforts to act as responsible businesses. It
is an attempt to expose the PR reality behind the programmes many tobacco
companies currently trumpet as CSR activity, and ensure that NGOs do not
become, through association with such programmes, unwitting PR agents for
tobacco companies.
The full position statement can be viewed at
http://www.ingcat.org/PDFs/CSRstatement.doc and I'd encourage
organisations to endorse it.
Best wishes
Doreen McIntyre, Director, INGCAT (International Non Governmental
Coalition Against Tobacco)
Competing interests: INGCAT is entirely funded by its member
organisations, who are international health NGOs.
Pokorny et al show that one must use a multilevel model to accurately
identify contextual influences, such as school characteristics, on the
behaviour of individuals. Neither aggregate models nor individual level
only models will be accurate(1). This is a good point well made.
Unfortunately, Pokorny et al use aggregated school level perceived
prevalence of smoking among peers as their contextual example variabl...
Pokorny et al show that one must use a multilevel model to accurately
identify contextual influences, such as school characteristics, on the
behaviour of individuals. Neither aggregate models nor individual level
only models will be accurate(1). This is a good point well made.
Unfortunately, Pokorny et al use aggregated school level perceived
prevalence of smoking among peers as their contextual example variable.
Using this variable makes the model difficult to interpret. A sentence
from the Discussion (p306) highlights this. Abbreviated, it reads
‘students in schools with higher …perceived tobacco use… were more likely
to be smokers than students in schools with lower …peer tobacco use.’
This statement could only be false if students’ perceptions of smoking
prevalence were totally inaccurate. The observers and the observed have
both been sampled and are reporting on one another. However, it is
tempting for authors and readers to interpret these findings as support
for the notion that peer perception is part of the mechanism for why some
schools have a higher prevalence than others, when it simply restates that
finding.
Aside from this, there is another important reason why the prevalence
of smoking among peers, either at the student level or the school level,
should not be included in a multilevel model seeking to understand inter-
school variation in smoking prevalence. Students’ perception of smoking
prevalence among their friends is a measure of actual school smoking
prevalence. If we are seeking to understand why inter-school variation in
smoking prevalence exists, then controlling for it will attenuate the
phenomenon that we are seeking to explain. The papers published by Moore
et al West et al illustrate this(2;3). In both cases, controlling for the
number of friends smoking vastly diminished the unexplained school
variation in smoking. This does not show that the phenomenon is
explained; it shows the circular reasoning above. West et al appreciated
this, and showed that turning the multilevel equation round to predict the
prevalence of friends smoking showed the same inter-school variation and
ranking of schools as was apparent when predicting individuals’ smoking
habit. Notable individual level risk factors, such as peer smoking and
sibling smoking, should not be included in multilevel models.
Many people I know feel that the school they attended shaped them as
individuals and it seems reasonable to assume that it influences
individuals’ smoking. It is welcome to have papers exploring this
underdeveloped area. We have recently reviewed this literature and made
suggestions as to which variables should be controlled in a multilevel
model exploring inter-school variation, which variables should be
excluded, and which variables should be used as potential causal variables
in mediation analysis(4). The paper by West et al should be essential
reading for anyone seeking to understand how schools influence students’
health behaviour(3).
Reference List
(1) Pokorny, S.B., Jason L.A., & Schoeny M.E. (2004) Current
smoking among young adolescents: assessing school based contextual norms.
Tobacco Control, 13, 301-307.
(2) Moore, L., Roberts C., & Tudor-Smith C. (2001) School smoking
policies and smoking prevalence among adolescents: multilevel analysis of
cross-sectional data from Wales. Tobacco Control, 10, 117-123.
(3) West, P., Sweeting H., & Leyland A. (2004) School effects on
pupils' health behaviours: evidence in support of the health promoting
school. Research Papers in Education, 19, 261-291.
(4) Aveyard, P., Markham W., & Cheng K.K. (2004) A methodological and
substantive review of the evidence that schools cause pupils to smoke.
Social Science & Medicine, 58, 2253-2265.
We have, as addiction scientists, as a goal, the desire to minimize
addictive behaviors and thereby reduce negative outcomes and consequences.
The AMA has this admirable goal in mind but their stated approach is not
likely to get them there. Reducing nicotine in cigarettes has already been
plainly demonstrated to increase tar and CO levels in smokers. We need to
accept this and move in the correct direction, understanding...
We have, as addiction scientists, as a goal, the desire to minimize
addictive behaviors and thereby reduce negative outcomes and consequences.
The AMA has this admirable goal in mind but their stated approach is not
likely to get them there. Reducing nicotine in cigarettes has already been
plainly demonstrated to increase tar and CO levels in smokers. We need to
accept this and move in the correct direction, understanding that the
reduction of smoking will continue to occur through education but will not
reach zero in the near future. A proper approach toward the health of all
people, smokers and non alike, is to develop directives for the production
of low-tar and CO cigarettes that still deliver sufficient amounts of
nicotine so as not to offset the low-tar/CO benefit. Immediately
producible are cigarettes with 10mg tar and CO yet this has not been
coupled with one that has 1.0-1.3mg of nicotine. This range is what
addicts crave and will achieve even if the delivery system requires they
smoke two or in some manner impede the flow of air into the filter.
Providing such a cigarette as above, will give us an immediate positive
impact on health and buy us time to continue the education process in non-
addicted populations. Each company should be directed to carry such a
product as well as step-down products which further reduce tars, CO and
nicotine gradually allowing a transition point for smokers motivated
toward abstinence. As scientists we practice application of sound thought
and not be swayed by political agendas not even our own. Rational,
practical, progressive solutions triggered by insight and inspiration
have been the hallmark and foundation of science since the use of tools.
Let us not get caught up in the trap of popular opinion as to what works.
The author of this artice says, "These classic children's books were
first published in times when smoking was not widely acknowledged as
harmful and a smoking adult male was one of the sex stereotypes". While
this is true for the books cited, I have been looking for children's
picture books with smokers in the illustrations for several years and am
surprised how many current books as well as how many other older book...
The author of this artice says, "These classic children's books were
first published in times when smoking was not widely acknowledged as
harmful and a smoking adult male was one of the sex stereotypes". While
this is true for the books cited, I have been looking for children's
picture books with smokers in the illustrations for several years and am
surprised how many current books as well as how many other older books
include smokers of cigarettes, cigars and pipes. Sometimes the smokers
are not main characters but just in the background. Smoking is more often
in the illustration than in the text. I am in the process of creating a
bibliography of these books and also writing the illustrators to ask just
exactly why they have smokers in the illustrations. What is the message
the illustrator is trying to give?? If anyone is interested in the
results of this bibliography in progress, please feel free to contact me
at the above e-mail. I would also be interested in adding to my
bibliography any books you know of that I have missed. Hannah Pickworth
I was interested to note the links between the tobacco and gambling
industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is
working with Healthy Buildings International (HBI), the indoor air quality
consultancy firm part-funded by the Philip Morris tobacco company.(2)
Previous research has demonstrated how the tobacco industry has used...
I was interested to note the links between the tobacco and gambling
industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is
working with Healthy Buildings International (HBI), the indoor air quality
consultancy firm part-funded by the Philip Morris tobacco company.(2)
Previous research has demonstrated how the tobacco industry has used HBI
to prevent smoke-free workplaces.(3)
It is concerning that at a time when casino employees in the UK are
demanding smoke-free workplaces their employers are (knowingly or
unknowingly) working with a firm linked to the tobacco industry. But at
least we now know of this link, as do the Trade Union representatives who
are working with these casino companies. Hopefully the unions can use
this information to neutralise any influence the tobacco industry may have
had.
Yours faithfully,
Paul Pilkington
References
1.Hedging their bets: tobacco and gambling industries work against
smoke-free policies Tob Control 2004; 13: 268-276
2. Correspondance between Neil Goulden, Group Managing Director Gala
Group and Paul Pilkington, 1 March 2004.
3. Drope, J, Biolous, SA and Glantz, SA. Tobacco industry efforts to
present ventilation as an alternative to smoke-free environments in North
America, Tobacco Control 2004; 13, 41-47.
If blood lipid profile improves and weight increases with smoking
cessation (1) smoking might be causally related to both the development of
an abnormal blood lipid profile and the avoidance of weight gain or even
weight loss. How then might smoking have increased the risk of non-fatal
myocardial infarction in this study (2)? By reducing the capacity to
respond to reductive stress with a further increase in the degree of...
If blood lipid profile improves and weight increases with smoking
cessation (1) smoking might be causally related to both the development of
an abnormal blood lipid profile and the avoidance of weight gain or even
weight loss. How then might smoking have increased the risk of non-fatal
myocardial infarction in this study (2)? By reducing the capacity to
respond to reductive stress with a further increase in the degree of blood
lipid shift (3)?
The answer may lie in the next step in respoding to a progressive
increase in the degree of reductive stress. If this is reverting to
glucose as the preferred substrate for anaerobic glycolysis that would
mean reversing the increase in nutrient energy density achieved by the
antecedent lipid shift. In the case of an acute reductive stress
equivalent to 25% of dysoxia that could mean having to increase a cardiac
output of 4.7L/min that had been able to meet the tissues needs to as much
as 16.2 L/min to achieve the same objective. A cardiac output of that
magnitude is far in excess of the cardiovascular capacity of even a
healthy fit athlete.
There is another possibility. Anaerobic glycolysis might be averted
after the capacity for increasing nutrient energy density per unit volume
of flowing blood had plateaued by using amino acids for acetyl coenzyme A
synthesis in providing the substrate needed for oxidative phosphorylation
to proceed at the rate needed to meet the tissues needs for ATP
resynthesis at the time(4). But if NH3 is produced in the process the pH
could rise inhibitng oxidative phosphorylation and stimulating anaerobic
glycolysis and with it the demand of glucose(5). This too could incease
the demand for ATP resynthesis far in excess of the cardiovascular
capacity to meet the tissues energy needs.
Smoking might, therefore, have increased the risk of non-fatal
myocardial infarction in this study by limiting the capacity for
accommodating an acute reductive stress with a blood lipid shift and
increasing the likelihood of acute cardiovascular decompensation. In which
case smoking cessation can be expected to eliminate that risk once the
blood lipid profile had been restored to normality even though weight was
gained. What is more the gain in weight might be a compensatory response
that enhanced the capacity to mount a lipid response to acute reductive
stress. In other words a blood lipid shift revealed in blood lipid
profiles may conceal the real capacity for mounting a fatty acid response
to acute reductive stress.
If it is the capacity for mounting a fatty acid rsponse rather than
a shift in blood lipid profile per se that is the primary determinant in
meeting the metabolic demands of an acute reductive stress within
cardiovascular capacity then it may be compromised by the administration
of statins. Not only might the size of the mobile pool of fatty acids be
reduced by statins by the ability to release it in a timely manner in
acute reductive stress might be reduced by an accompanying reduction in
the capacity for steroid hormone synthesis. In which case the risk of non-
fatal acute myocardial infarction might be greatest in smokers taking
statins or even confined to them.
1. Botella-Carretero JI, Escobar-Morreale HF, Martin I, Valero AM,
Alvarez F, Garcia G, Varela C, Cantarero M. Weight gain and cardiovascular
risk factors during smoking cessation with bupropion or nicotine.
Horm Metab Res. 2004 Mar;36(3):178-82.
2. M S Mähönen, P McElduff, A J Dobson, K A Kuulasmaa, and A E Evans
Current smoking and the risk of non-fatal myocardial infarction in the WHO
MONICA Project populations
Tob Control 2004; 13: 244-250
3. Successful evolutionary adaptation to environmental stress?
Richard G Fiddian-Green
Heart Online, 14 Jul 2004 eLetter re: D A Lawlor, G Davey Smith, R
Mitchell, and S Ebrahim
Temperature at birth, coronary heart disease, and insulin resistance:
cross sectional analyses of the British women’s heart and health study
Heart 2004; 90: 381-388
4. Might biochemical fermionic complexities be dictated by antecedent
bosonic simplicities?
Richard G Fiddian-Green (26 August 2004) eLetter re: Rodrigo B.
Cavalcanti
Does perioperative lipid-lowering therapy reduce in-hospital mortality
after major noncardiac surgery?
CMAJ 2004; 171: 328
5. pNH3: a relevant pulmonary variable?
Richard G Fiddian-Green
Chest Online, 11 Aug 2004 eLetter re: pNH3: a relevant pulmonary variable?
Richard G Fiddian-Green
Chest Online, 11 Aug 2004
It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and no...
It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and now, thankfully, it has become a 'Prior Proposal'.
But as the authors say, there is good reason to stop tobacco companies having a free hand to do whatever product engineering they like. They have been given a unique exemption from virtually every law and norm of consumer protection and product safety. It is entirely right to stop them making products much more attractive than they would otherwise be - ie. systematically narrow the terms of the broad exemption they have.
But are there also dangers with the new proposal? If smoking is a behaviour based on seeking satisfaction from nicotine, isn't there a danger that reducing the addictiveness (ie. the pharmacological impact) will mean smokers seeking more nicotine for the same satisfaction? If more nicotine is required, then more toxins would be likely to be absorbed along with it, and so more harm caused.
Is there any evidence that, over time, it has become harder to quit smoking because the products have been engineered to be more 'addictive'? (I realise this might be difficult to gather). Have temporary withdrawal symptoms become more severe over time? These are the real harms associated with the addictiveness itself (as opposed to the co-exposure to toxins), so I think we ought to know what the behavioural changes have been before advocating a regulatory change.
Have all the strategies for subverting regulatory interventions available to smokers who are seeking a nicotine fix been considered...? Breaking off filters, switching to hand-rolled or cigars, compensatory smoking behaviour, bootlegging etc.
I don't know the answers to these questions. But to me, they say "not so fast". An approach to harm reduction that reduces the potency of the drug delivery system must consider the behavioural responses to these modifications, and this seems to me to be even more complex and risky than a more straightforward harm reduction strategy focussed on reducing toxins (which is probably pointless for combustible tobacco anyway).
Finally, is reducing addictiveness always right? If you could find a way to increase the addictiveness of medicinal nicotine or even smokeless tobacco, so that they compete better with cigarettes in nicotine delivery while doing orders of magnitude less harm, you may be able on to something that really would save millions of lives.
McAlister and his co-authors make an extremely valuable contribution
to the ongoing debates of health care costs in the form of their estimate
of the cost efficacy of a telephone quit line. The publication of this
data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to
make broader public health decisions based on these estimates....
McAlister and his co-authors make an extremely valuable contribution
to the ongoing debates of health care costs in the form of their estimate
of the cost efficacy of a telephone quit line. The publication of this
data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to
make broader public health decisions based on these estimates. The
decision not to include the costs from a controlled clinical trial is
undoubtably correct, as they are not generalizable to larger scale
promotion efforts. Most state funded quit lines in operations use multiple
outreach methods, including television, radio, print and physician
outreach to recruit patients into treatment.
To date there have been no estimates published of recruitment costs
into these large-scale quit lines, despite the proliferation of state
programs. This may be due to the fact that it is difficult to break out
costs for recruitment from overall costs for cessation promotion and the
normalization of quitting. None the less, until we have concrete estimates
of the actual cost to recruit participants into such programs it will be
impossible to actually calculate the true cost efficacy.
I am writing in response to the research paper, “Clearing the
airways: advocacy and regulation for smoke-free airlines” by Holm and
Davis, published in the March supplement of Tobacco Control, 2004. While
Holm and Davis present an apparently comprehensive narrative of the events
that lead to the legislative prohibition of smoking in aircraft cabins,
one is left with the sense from their research of...
I am writing in response to the research paper, “Clearing the
airways: advocacy and regulation for smoke-free airlines” by Holm and
Davis, published in the March supplement of Tobacco Control, 2004. While
Holm and Davis present an apparently comprehensive narrative of the events
that lead to the legislative prohibition of smoking in aircraft cabins,
one is left with the sense from their research of “historical documents,
journal and popular press articles, the world wide web and some tobacco
industry documents” that the successful passage of the legislation was due
to clever political maneuvering and the actions of “health advocates”. I
would like to suggest that the flight attendants themselves, as
individuals and members of unions, played a more central role in the
passage of the legislation than was represented by the paper. In fact, the
flight attendants were the critical element in getting congressional
action.
Prior efforts to pass federal legislation on smoke-free worksites had
not found Congress a friendly environment for such bills. One would
therefore question why health advocates had failed to get federal
legislation for smoke-free worksites but were successful in the airlines
case? What was so different about the airline smoking ban case? Holm and
Davis did not answer this question, nor did they bring any insight into
the relationship between the tobacco industry and unions, key players in
this battle. Rather, the paper simply painted a picture of flight
attendants and the Association of Flight Attendants (AFA) as “scenery”,
presenting personal testimonies of their ailments due to years of exposure
to tobacco smoke. Union involvement in the issue is absent from the
discussion and conclusions of this paper. Yet the presence and
participation of the AFA was critical because with the unquestionable
hazards to flight attendants on board, the issue was successfully reframed
as one of “worker health and safety”, rather than the industry’s approach
of “smokers’ rights” and accommodation.
The AFA has had a long history of concern over air quality in
aircraft cabins. The AFA reasoned that advocating for smoking bans was an
avenue to bring forth flight attendant health and safety concerns, since
they feared that “without the intervention of Congress, the National
Academy of Sciences study [on Cabin Air Quality] will end up on one of the
(FAA’s) burners that is so far back you cannot even tell if it is on.”(1)
The authors of this paper attribute the defeat of the tobacco
industry to (i) the industry’s limited leverage over the CAB and FAA, (ii)
their inability to mobilize on a grassroots level and (iii) the lack of
scientific basis to support their position. Absent from Holm and Davis’
discussion is the key role that the AFA played in thwarting industry
efforts to win allies within organized labor. Industry documents reveal
years of strategizing to woo organized labor and in the airlines case, the
AFA and the Air Line Pilots Association (ALPA). The industry had actually
underestimated the power of the flight attendants as they were duly warned
in 1993 in light of smoking bans in bars and restaurants that “an anti-
smoking position developed by HERE (Hotel Employees and Restaurant
Employees International Union), similar to that adopted by the Association
of Flight Attendants could present a major setback. However, HERE as an
ally in this effort, would be a very powerful voice.”(2)
Holm and Davis conclude that the “single-issue focus” in advocacy
work should be a lesson for future health advocacy work. The ownership of
this success is debatable and, perhaps a more important “lesson” to
reflect upon is how a single-issue focus in this instance has helped to
create an alliance between health advocates and unions, while this has not
always been the case. Perhaps a more valuable lesson is that unions are
key players in tobacco policies in the workplace and that health advocates
must consider how this coalition may be strengthened in future battles
over workplaces such as restaurants and bars.
Charles Levenstein, Ph.D., M.Sc.
Professor Emeritus of Work Environment Policy; and
Co-Director, Organized Labor and Tobacco Control Network
University of Massachusetts Lowell
Lowell, MA
References
1. Achenbaugh N, Finucane M. FAA Should Create An Office To Address
Crewmember And Passenger Health. R.J. Reynolds. September 19, 1986. Access
Date: October 23, 2002. Bates No.:506294126/4131. URL:
http://legacy.library.ucsf.edu/tid/hje71d00.
2. Ogilvy Adams & Rhinehart, Savarese and Associates. Restaurant
Smoking Ban Strategy. Tobacco Institute. August 23, 1993. Access Date:
July 8, 2003. Bates No.:TI01621153/1159. URL:
http://legacy.library.ucsf.edu/tid/cyr30c00.
Dear Norbert
Thanks you for this excellent explanation of the reality behind tobacco companies' dabbling in so-called CSR programmes.
Earlier this year INGCAT's member organisations agreed a position statment on tobacco industry CSR programmes that purport to address health and welfare issues, entitled "The socially responsible tobacco company - another misleading descriptor". The thrust of the positio...
Editor Chapman's report gives us great courage that the written word is in the end the most powerful tool for change, truth and enlightenment.
We know too from tobacco industry documents that some of the closest readers of TC are the executives of those companies.
Kudos and congratulations to the editorial team at TC.
Norbert Hirschhorn MD
Pokorny et al show that one must use a multilevel model to accurately identify contextual influences, such as school characteristics, on the behaviour of individuals. Neither aggregate models nor individual level only models will be accurate(1). This is a good point well made.
Unfortunately, Pokorny et al use aggregated school level perceived prevalence of smoking among peers as their contextual example variabl...
We have, as addiction scientists, as a goal, the desire to minimize addictive behaviors and thereby reduce negative outcomes and consequences. The AMA has this admirable goal in mind but their stated approach is not likely to get them there. Reducing nicotine in cigarettes has already been plainly demonstrated to increase tar and CO levels in smokers. We need to accept this and move in the correct direction, understanding...
The author of this artice says, "These classic children's books were first published in times when smoking was not widely acknowledged as harmful and a smoking adult male was one of the sex stereotypes". While this is true for the books cited, I have been looking for children's picture books with smokers in the illustrations for several years and am surprised how many current books as well as how many other older book...
Dear Editor,
I was interested to note the links between the tobacco and gambling industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is working with Healthy Buildings International (HBI), the indoor air quality consultancy firm part-funded by the Philip Morris tobacco company.(2) Previous research has demonstrated how the tobacco industry has used...
If blood lipid profile improves and weight increases with smoking cessation (1) smoking might be causally related to both the development of an abnormal blood lipid profile and the avoidance of weight gain or even weight loss. How then might smoking have increased the risk of non-fatal myocardial infarction in this study (2)? By reducing the capacity to respond to reductive stress with a further increase in the degree of...
McAlister and his co-authors make an extremely valuable contribution to the ongoing debates of health care costs in the form of their estimate of the cost efficacy of a telephone quit line. The publication of this data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to make broader public health decisions based on these estimates....
Dear Editor,
I am writing in response to the research paper, “Clearing the airways: advocacy and regulation for smoke-free airlines” by Holm and Davis, published in the March supplement of Tobacco Control, 2004. While Holm and Davis present an apparently comprehensive narrative of the events that lead to the legislative prohibition of smoking in aircraft cabins, one is left with the sense from their research of...
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