The article of Cummins et al. (1) is based on a survey
which according to the authors considers electronic cigarette a risk
for populations with mental health conditions.
First of all, in our opinion it is not correct to agglomerate and treat
all mental health conditions in the same way. It would be like
considering all physical illness the same way. Fever is like a
cancer? A specific phobia is like schizophrenia?
It 'is...
The article of Cummins et al. (1) is based on a survey
which according to the authors considers electronic cigarette a risk
for populations with mental health conditions.
First of all, in our opinion it is not correct to agglomerate and treat
all mental health conditions in the same way. It would be like
considering all physical illness the same way. Fever is like a
cancer? A specific phobia is like schizophrenia?
It 'is true that there is a high level of smoking prevalence in
individuals with mental health conditions but it varies according to
mental health conditions e.g. schizophrenia, major depression,
bipolar disorder.
In two studies we have shown for the first time that regular use of E-
cigarettes substantially decreased consumption of conventional cigarettes
without causing significant side effects in chronic schizophrenic patients
and in depressed patients who smoke (2,3). Large prospective randomized controlled
are now required to confirm these initial observations (4,5).
If these studies further confirm the potential use of the ecig as a tool
in the fight against smoking, we could see the resources of this
instrument rather than just the limits. Millions of lives could be saved
and the smoking cessation centers, in real life settings, could boast a
range of proposed therapies able to increase their level of clinical
efficacy and improve their level of attractiveness for the smoker who
thinks to improve their health and quality of life.
Although not formally regulated, the e-cigarette may help smokers with
mental health conditions to reduce their cigarette consumption or remain
abstinent and reduce the burden of smoking-related morbidity and
mortality. The ultimate goal is to propose an effective intervention to
reduce the harm of tobacco smoking for this challenging population.
References
1. Cummins SE, Zhu S, Tedeschi GJ, Gamst AC, Myers MG. Use of e-
cigarettes by individuals with mental health conditions. Tob Control
doi:10.1136/tobaccocontrol-2013-051511
2. Caponnetto P, Auditore R, Russo C, Cappello G C, Polosa R: Impact of an
Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic
Smokers: A Prospective 12-Month Pilot Study. Int. J. Environ. Res. Public
Health 2013, 10: 446-461.
3. P Caponnetto, R Polosa, R Auditore, C Russo, D Campagna: Smoking
Cessation with E-Cigarettes in Smokers with a Documented History of
Depression and Recurring Relapses. International Journal of Clinical
Medicine 2(3), Vol.2 No.3, July 2011.
4. Caponnetto P, Polosa R, Auditore R, Minutolo G, Signorelli M, Maglia M,
Alamo A, Palermo F, Aguglia E. Smoking cessation and reduction in
schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized
control trial. Trials. 2014 Mar 22;15:88
5. http://clinicaltrials.gov/ct2/show/NCT02124187
Euromonitor International is a world leader in strategy research for
consumer markets, with over 40 years of experience in developed and
emerging economies. Through a combination of specialist industry knowledge
and in-country research expertise, Euromonitor aims to build a market
consensus view of the size, shape and trends in each industry we cover.
Tobacco is no different, and both duty paid and illicit sales are
rese...
Euromonitor International is a world leader in strategy research for
consumer markets, with over 40 years of experience in developed and
emerging economies. Through a combination of specialist industry knowledge
and in-country research expertise, Euromonitor aims to build a market
consensus view of the size, shape and trends in each industry we cover.
Tobacco is no different, and both duty paid and illicit sales are
researched in the same way as all other consumer products.
As impartial market analysts, our research methodology has been
developed over decades and continues to deliver well-respected and widely
used data and insights. For a full description please visit
http://www.euromonitor.com/research-methodology.
In short our aim is to build an industry consensus view of each
market by accessing all relevant public domain material and enhancing this
through an in-country trade survey. The volume and strength of published
source material behind our global systems will vary depending on the
market or category in question and as a result some data sets are more
"hard sourced" than others. This is a widely accepted challenge of
researching international markets.
For Tobacco, trade surveys are conducted with a representative range
of industry stakeholders in each national market, from government bodies
to tobacco brand owners, retailers and health groups, reflecting our wide
client base as well as varied opinions and agendas. By its very nature,
illicit trade in tobacco is a contentious area that is difficult to
quantify - there is often dissonance between sources. A key element of the
value-add of Euromonitor's work lies in our ability to scrutinise and
reconcile differing views by considering illicit trade against local
knowledge of the market and its wider context of national economic
performance, trends in cigarette taxation, movements in unit prices, duty
paid sales (including trends in illicit and duty paid combined) and
smoking populations, as well as porosity of national borders, law
enforcement efforts, and product availability. The context and drivers
behind our figures are explored in accompanying market analysis reports on
each country we research.
As such we are confident Euromonitor International presents the most
widely accepted and realistic estimate of the illicit market, based on an
integrated view of the wider industry context and the factors that
contribute towards it - no single source or figure is taken as definitive.
That said, our clients accept and acknowledge that researching
challenging markets is part of an iterative process. We are constantly
improving our coverage and understanding of consumer products as we access
a wider range of sources in each annual revisit of our industries. As a
result our data may change from one annual update to the next based on new
sources becoming available, key sources resizing markets or an improved
understanding of how to interpret local source material. We are
transparent in our methods and our sourcing and all clients have access to
our analysts and the assumptions that go in to building our data.
Crucially Euromonitor International is an independent company with no
agenda other than to reflect markets and trends as accurately as possible.
As such we are completely impartial, with no bias or reliance on any
single source. Indeed as analysts we welcome all constructive debate and
regularly engage with industry stakeholders from across the board to
review sources and challenge assumptions with the aim of developing
greater understanding of difficult-to-research areas.
Gottlieb rightly provides us evidence to question Food and Drug
Administration (FDA) policy.(1) Indeed, the 2009 law giving the Agency the
authority to regulate tobacco was useless as FDA's Advisory Committee
issued a report which failed to recommend a ban on menthol cigarettes
despite evidence of its devastating effects, a major setback for public
health.(2) Is FDA only overcautious as Gottlieb suggested? Its
professio...
Gottlieb rightly provides us evidence to question Food and Drug
Administration (FDA) policy.(1) Indeed, the 2009 law giving the Agency the
authority to regulate tobacco was useless as FDA's Advisory Committee
issued a report which failed to recommend a ban on menthol cigarettes
despite evidence of its devastating effects, a major setback for public
health.(2) Is FDA only overcautious as Gottlieb suggested? Its
professionalism, competence and integrity may be questioned too!
First, FDA has even promoted the advantages of menthol in terms of harm
reduction.(3) Recurrence occurs, but this time the author failed to
disclose his link with FDA.(4) These reports are weak post hoc analyses
and, most of all, rely on a grossly flawed controlled group: menthol
smokers should be not be compared to smokers of non menthol cigarettes but
to non smokers because the tobacco industry has a well-documented history
of developing and marketing these brands to recruit racial minorities and
youth who would not have smoked otherwise.
Second, FDA's Center for Tobacco Products recently announced it will
analyse cigarette constituents more accurately and reliably, helping to
ensure that accurate scientific data are collected to help fill current
gaps regarding the chemical and physical properties of tobacco products,
and more generally, improve information regarding the harms associated
with tobacco use. "Quality control and sample testing parameters ... will
be conducted ... to allow for certification of product physical parameters
and constituent levels ..."
(http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/AbouttheCenterforTobaccoProducts/ucm391336.htm)"
Cigarettes kill more than 400,000 US people annually in the US, but quality control
will replace tobacco control!
What could be next? Considering the importance of the global warming
issue, the addition to tobacco of the single "cool" molecule, the organic
compound obtained from peppermint, could be rewarded with an Ecolabel
through a partnership with the Environmental Protection Agency.
The European Union moved forward, issuing a directive to ban all
characterizing favors in 28 countries, though the menthol flavor will be
given a four-year derogation to 2020.
Could the FDA be under corporate influence? As a Frenchman, I note that
FDA did not hesitate to ban Mimolette, a French cheese, in May 2013. Some
said it was a retaliation to prevent Europe from banning US GMO food
exports. I am not surprised that 37% of American people agreed with
conspiracist beliefs such as "FDA is deliberately preventing the public
from getting natural cures for cancer and other diseases because of
pressure from drug companies."(5)
1 Gottlieb M. Overcautious FDA has lost its way. Tob Control
2014;23:187-8.
2 Siegel M. A Lost opportunity for public health - The FDA Advisory
Committee Report on menthol. N Engl J Med 2011;364:2177-9.
3 Rostron B. Lung cancer mortality risk for U.S. menthol cigarette
smokers. Nicotine Tob Res 2012;14:1140-4.
4 Rostron B. Menthol cigarette use and stroke risk among US smokers:
A critical reappraisal. JAMA Intern Med 2014. Online Mar 10. doi:
10.1001/jamainternmed.2013.9600.
5 Oliver JE, Wood T. Medical Conspiracy Theories and Health Behaviors
in the United States. JAMA Intern Med 2014. Online Mar 17. doi:
10.1001/jamainternmed.2014.190.
It is important for tobacco control policymakers to know the
advantages and disadvantages of different tax policies. It is quite
another thing to move a tax system to optimize tax policy for tobacco
control since there are multiple obstacles to systems change. In addition,
health advocates often do not invest enough time and effort to
understanding the economics of tax systems and the structural impediments
in existing l...
It is important for tobacco control policymakers to know the
advantages and disadvantages of different tax policies. It is quite
another thing to move a tax system to optimize tax policy for tobacco
control since there are multiple obstacles to systems change. In addition,
health advocates often do not invest enough time and effort to
understanding the economics of tax systems and the structural impediments
in existing laws and policies to improve the tax structure.
Consider for a moment the huge amount the tobacco industry invests in the
economics of tobacco, and how it gives big money to lobby and influence
tax policy. I applaud economists who are willing to study and fight for
strong tobacco control tax policies, but in LMIC they are usually far too
few. It is time for local/national health professionals to realize they
better invest in working with economic leaders if they really wish to
influence tax and health investment policies over the long term. Only then
will there be health in all policies, including tax policies on tobacco
and many other products that are necessary to sustain and promote health.
Cartwright (1) has clearly mis-read our article on PMI's Project Star
report(2). The central premise of our article is not that illicit is
overestimated but that the Project Star report cannot be relied on as a
source of data on illicit until there is significantly greater
transparency over the underlying methodology and data inputs and the
contractual arrangements under which it is conducted. KPMG i...
Cartwright (1) has clearly mis-read our article on PMI's Project Star
report(2). The central premise of our article is not that illicit is
overestimated but that the Project Star report cannot be relied on as a
source of data on illicit until there is significantly greater
transparency over the underlying methodology and data inputs and the
contractual arrangements under which it is conducted. KPMG itself would
appear to acknowledge this stating clearly in a disclaimer in each of its
Project Star reports that the data cannot be relied on:
"KPMG wishes all parties to be aware that KPMG's work for Philip Morris
International was performed to meet specific terms of reference agreed
between PMI and KPMG and that there were particular features determined
for the purposes of the engagement. The Report should not therefore be
regarded as suitable to be used or relied on by any other person for any
other purpose."
This lack of transparency is again underlined by Cartwright's failure
to mention in his letter that KPMG receives ?10million from PMI to produce
Project Star, his largest contract
(http://www.kpmg.com/uk/en/about/aboutkpmg/kpmgfoundation/pages/robin-
cartwright.aspx). He also claims this is a project for the European
Commission and Philip Morris yet the Commission denies this. It is
increasingly difficult to see where the truth lies here.
KPMG's claim that the Project Star reports are recognised across Europe as
the most "comprehensive" study of its kind is not disputed. No-one else
has the financial backing or the political self-interest, in the case of
PMI, to produce a report of this size. But comprehensive does not equal
accurate, reliable and transparent. It doesn't matter how many cigarette
packs are collected if the empty pack survey is designed to overestimate
illicit as growing evidence suggests industry empty pack surveys are(2).
Our paper clearly acknowledges that the model used in the Project Star
report has merit but while PMI are so closely involved in the report and
supply the majority of data to be used in the model, it cannot be relied
on. Overwhelming evidence shows the extent to which the tobacco industry
is prepared to manipulate science and data in its own interest(3). The
illicit trade in tobacco is no exception(2,4).
Anna B Gilmore1, Silvano Gallus2, Andy Rowell1, Luk Joossens3
1Department for Health and UK Centre for Tobacco and Alcohol Studies
(UKCTAS), University of Bath, Claverton Down Road, Bath, UK
2Department of Epidemiology, IRCCS--Istituto di Ricerche Farmacologiche
Mario Negri,Milan, Italy
3Association of the European Cancer Leagues and Foundation Against Cancer,
Brussels, Belgium
Competing interests: The authors of this letter authored the paper
being criticised by Cartwright and ABG, SG & LJ were part of the
PPACTE study which Cartwright also criticises.
(1) Cartwright RM. KPMG response to 'Towards a greater understanding
of illicit tobacco trade in Europe: a review of the PMI funded 'Project
Star' report'. Tobacco Control Published Online First 5 March 2014
http://tobaccocontrol.bmj.com/content/early/2014/01/16/tobaccocontrol-2013
-051240.full?sid=ffae5533-cd43-46d0-ae48-3f2d6c0d9b00#responses.
(2) Gilmore AB, Rowell A, Gallus S et al. Towards a greater understanding
of the illicit tobacco trade in Europe: a review of the PMI funded
'Project Star'. Tobacco Control Published Online First 11 December 2013
doi:10.1136/tobaccocontrol-2013-051240.
(3) Michaels D. Doubt is our Product. New York: Oxford University Press,
2008.
(4) Rowell A, Evans-Reeves K, Gilmore AB. Tobacco Industry Manipulation of
Data on and Press Coverage of the Illicit Tobacco Trade in the UK. Tobacco
Control (in press).
Conflict of Interest:
The authors of this letter authored the paper being criticised by Cartwright and ABG, SG & LJ were part of the PPACTE study which Cartwright also criticises.
Significant factual inaccuracies relating to KPMG's annual report
into the European trade in illicit tobacco were made in a recent article
published in Tobacco Control by the BMJ. The report, which KPMG's
Strategy Group has been producing since 2005, is recognised by the UK
National Audit Office, OLAF and the OECD (and by other numerous national
customs authorities and government departments) as the most comprehensive...
Significant factual inaccuracies relating to KPMG's annual report
into the European trade in illicit tobacco were made in a recent article
published in Tobacco Control by the BMJ. The report, which KPMG's
Strategy Group has been producing since 2005, is recognised by the UK
National Audit Office, OLAF and the OECD (and by other numerous national
customs authorities and government departments) as the most comprehensive
study of its kind. The report has earned its solid, international
reputation because it is produced by an independent, professional advisory
firm, using a robust and consistently applied methodology.
The central premise of the article was that the KPMG report
overstates the illicit tobacco trade. However, KPMG estimates since 2005
have correlated within a range given by other organisations, including the
UK National Audit Office, Euromonitor, Joossens and the IARC, amongst many
others. For example, in 2007, Joossens estimated total consumption of
illicit tobacco within the EU to be 8.5%, while the KPMG report estimated
consumption at 8.4%.
Critically, the article misrepresented the methodology KPMG applies
in estimating the consumption of illicit tobacco. The research considers
a number of factors, including empty pack surveys. It is certainly true
that empty pack surveys do not provide the full picture but they do form
an important factor in the equation as they rely purely on physical
evidence, avoiding the variability of consumer bias in interview based
methods. An additional advantage of empty pack surveys is that they
provide a statistically robust and comparable volume of data as they are
conducted consistently across all European markets. In 2010 approximately
430,000 packs were collected throughout Europe in 1,400 population
centres. Additional analysis identifies if the empty pack survey may have
over or under-reported the level of non-domestic packs with the samples
being re-weighted to correct this.
The KPMG report also factors in consumer surveys (conducted by Ipsos
and Nielsen) which drill into the detail of consumers' travel habits,
overall consumption, gender and age to assess the level of legal non-
domestic purchases. Approximately 10% of the 160,000 survey respondents
both travel and purchase cigarettes abroad. These respondents are asked
about the country of purchase and brands purchased. This data can also be
adjusted where it appears to be under-reporting legal tobacco consumption.
For example, correction of under-reporting increased the allocation of
legally purchased packs from Spain to France and from Poland and the Czech
Republic to Germany.
The article goes on to offer an alternative estimation methodology:
the PPACTE study. However, it is prudent to consider the limitations of
this study; notably, the reliance on consumer studies which both under-
report tobacco consumption overall and, in particular, illicit tobacco
consumption. The PPACTE study also uses a substantially smaller sample
size e.g. the methodology used to calculate the illicit volumes equates to
an average of less than 200 per country.
The consumption of tobacco - illicit or otherwise - is understandably
a concerning issue for many people and organisations. While it may be
superficially appealing to discount a report funded by a tobacco company,
the methodology of the 'Project Star' report is robust and unbiased. This
data set is an important source of knowledge for the tobacco industry and
health campaigners alike. An issue can only be tackled, whether for
commercial or health reasons, if its nature and scale is understood. The
Project Star report is widely regarded, by companies and health and
government organisations, as the leading source of data on illicit tobacco
consumption in the EU.
Conflict of Interest:
Author of the report under examination in the paper published in December 2013, entitled 'Towards a greater understanding of the illicit tobacco trade in Europe: a review of the PMI funded 'Project Star''
The recent article by Cai et al, reported that male gender, young
age, low educational attainment, and tobacco cultivation are predictors of
tobacco use and second-hand smoke (SHS) exposure in rural China [1].
Neighborhood-level income was the only contextual predictor of tobacco use
and SHS exposure identified. Hence, the authors suggested that "future
interventions to reduce smo...
The recent article by Cai et al, reported that male gender, young
age, low educational attainment, and tobacco cultivation are predictors of
tobacco use and second-hand smoke (SHS) exposure in rural China [1].
Neighborhood-level income was the only contextual predictor of tobacco use
and SHS exposure identified. Hence, the authors suggested that "future
interventions to reduce smoking and exposure to SHS in China should focus
more on tobacco farmers, less-educated individuals and on poor rural
communities." (pg. ii19)
Nevertheless, Cai and colleagues also found that the Han majority had
higher prevalence of smoking and SHS exposure when compared to ethnic
minorities (p<0.05). Differences in health outcomes and risk factors
have been reported among the Han population when compared to other Chinese
ethnic minorities [2,3]. Stratified analysis might elucidate unique risk
factors to smoking and SHS exposure between ethnic groups important for
the design of tobacco control strategies.
In addition, Cai et al. showed that townships varied widely in the
proportion of the population who were ethnic minorities (3.1% to 97.1%).
In the study of contextual determinants of health, results and
implications should not ignore such vast differences in ethnic composition
between areas. Important information might be conveyed if results were
stratified by the proportion of ethnic minorities in the area (e.g. high,
medium, low). Ethnic minorities living in areas with a high proportion of
the population of the same ethnic minority may experience better health
[4]. Therefore, it might also be important to compare the risk of smoking
and SHS exposure among individuals living in areas highly populated by
their ethnic group versus those residing in areas where they are the
minority group.
Cultural differences and ethnic composition of a geographic area
should be considered in the design and implementation of tobacco control
programs and in the allocation of resources. Resources may be better spent
in areas with a high proportion of the Han population; while areas with a
high minority population may be at decreased risk. Interventions should be
culturally appropriate to minimize the expenditure of resources on
ineffective strategies.
Diana M. Sheehan, MPH
References
1. Cai L, Wu X, Goyal A, et al. Multilevel analysis of the
determinants of smoking and second-hand smoke exposure in a tobacco-
cultivating rural area of southwest China. Tob Control
2013;22(suppl2):ii16-20.
2. Ruixing Y, Hui L, Jinzhen W, et al. Association of diet and
lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han
populations. Public Health Nutr 2009;12(4):553-561.
3. Sun H, Zhang Q, Luo X, et al. Changes of adult population health
status in China from 2003 to 2008. PLoS One 2011;6(12):e28411.
4. Inagami S, Borell LN, Wong MD, et al. Residential segregation and
Latino, black and white mortality in New York City. J Urban Health
2006;83(3):406-20.
NOT PEER REVIEWED
To the Editor:
The habit of water pipe smoking is rapidly extending in all occidental
countries. This rise in popularity appears to be correlated with the
advent on store shelves of an array of fruit-flavored tobacco mixtures,
which list ''molasses'' as a primary ingredient. Also there is a
widespread misperception among smokers that the water through which the smoke
bubbles acts as a filter, rendering...
NOT PEER REVIEWED
To the Editor:
The habit of water pipe smoking is rapidly extending in all occidental
countries. This rise in popularity appears to be correlated with the
advent on store shelves of an array of fruit-flavored tobacco mixtures,
which list ''molasses'' as a primary ingredient. Also there is a
widespread misperception among smokers that the water through which the smoke
bubbles acts as a filter, rendering it considerably less harmful than that
of cigarettes [1]. A recent systematic review showed that the main motives
for water pipe tobacco smoking were socializing, relaxation, pleasure and
entertainment. Peer pressure, fashion, and curiosity were additional
motives for university and school students [2]. However, the habit of
smoking tobacco in water pipes is an old practice in the Eastern
Mediterranean countries like Egypt, Jordan, Syria, Lebanon and Iraq [3].
Recently, Jaboc and collaborators (2013) published a crossover study about
biomarkers of toxicant exposure with water pipe compared with cigarettes.
The study included 13 volunteers from San Francisco (USA) who smoked both
cigarettes and water pipes. The results showed that water pipe was
associated with greater exposure to carbon monoxide, polycyclic aromatic
hydrocarbons and benzene compared with cigarette smoking. Finally, the
authors concluded that water pipe smoking is associated with a high risk of
leukemia related to high levels of benzene exposure [4].
If Jaboc and collaborators' (2013) conclusions were right, we would expect
higher prevalence of leukemia in the Eastern Mediterranean region compared
with the Occidental Countries.
Reviewing cancer registries in GLOBOCAN 2008, we can notice that adjusted
standardized mortality rates of leukemia in males are comparable in the
European Region (5.0 per 100.000) to the Eastern Mediterranean Region (4.7
per 100.000). A similar rate is noticed in the Americas Region (5.0 per
100.000) [5].
Deficient registration systems could not be the explanation. Neoplasms
principally attributed to smoking like lung, laryngeal and oro-pharyngeal
cancers have similar prevalence in Egypt like many of the occidental
countries [5].
Water pipe tobacco brands used in the study of Jacob and collaborators
(2013) were Nakhla and Al-Waha. These are the same brands usually consumed
in the Eastern Mediterranean countries, like Egypt. On examining the box
of Nakhla Double Apple brand, widely consumed in Spain, we can find a
clear notice that it contains 0% tar.
During the smoking process cigarette tobacco burns directly, whereas water
pipe tobacco does not burn in a self-sustaining manner and requires an
external heat source such as charcoal. I think that the high level of
polycyclic aromatic hydrocarbon and benzene in the urine samples of water
pipe smokers in the study of Jaboc and collaborators (2013) could be
attributed to the charcoal disks used in many occidental countries. These
quick lighting charcoal disks are impregnated in gasoil rich in polycyclic
aromatic hydrocarbons and benzene. Smoke from these impregnated charcoal
disks is inhaled by water pipe smokers [1]. In Eastern Mediterranean
countries like Egypt, natural charcoal is used and is burned slowly in
special clay or metallic receptacles [1,3]. This could explain the
comparable prevalence of leukemia in Egypt and Occidental Countries.
Examining quick lighting charcoal disk tubes available in Spain, we can
notice that they lack labeling about the hazards of their use for water
pipe smoking. Regulations and control for the use of these impregnated
charcoal disks in the European Countries are urgently needed.
REFERENCES
1. Shihadeh A. Investigation of mainstream smoke aerosol of the argileh
water pipe. Food Chem Toxicol 2003;41(1):143-52.
2. Akl EA, Jawad M, Lam WY, Co CN, Obeid R, Jihad Irani J. Motives,
beliefs and attitudes towards waterpipe tobacco smoking: a systematic
review. Harm Reduct J 2013;10:12.
3. Chaouachi K. The medical consequences of narghile (hookah, shisha) use
in the world. Rev Epidemiol Sante Publique 2007;55(3):165-170.
4. Jacob P 3rd, Abu Raddaha AH, Dempsey D, Havel C, Peng M, Yu L, Benowitz
NL. Comparison of nicotine and carcinogen exposure with water pipe and
cigarette smoking. Cancer Epidemiol Biomarkers Prev 2013;22(5):765-72.
5. International Agency for Research on Cancer. GLOBOCAN 2008. Available
at: http://globocan.iarc.fr/ (Accessed 31 August 2013).
NOT PEER REVIEWED The article by Berman et al "Estimating the cost of a smoking employee" has attempted to quantify the costs associated with employing smokers. As the article indicates several companies are now actively discriminating against smokers so it is important that any costs are fully justified. One area that concerns me about this is a tendency towards oversimplification of a complex situation. In particular the assu...
NOT PEER REVIEWED The article by Berman et al "Estimating the cost of a smoking employee" has attempted to quantify the costs associated with employing smokers. As the article indicates several companies are now actively discriminating against smokers so it is important that any costs are fully justified. One area that concerns me about this is a tendency towards oversimplification of a complex situation. In particular the assumption that the breaks a smoker takes from work are a cost to the employer. Clearly a smoking break is time away from workplace tasks, but the assumption that this is just about time at the desk ignores a growing body of evidence that taking regular breaks from work is beneficial to individual health (1), which might counter some of the negative health risks associated with smoking, and that breaks are also beneficial to workplace productivity. Research has suggested that people taking regular breaks are more creative, more focussed and ultimately more productive (2,3). Prolonged attention to an individual task has, somewhat counter-intuitively, been shown to hinder performance. Taking a break from the task improves overall focus (2). Similarly breaks that have a positive association for the person taking the break are linked to positive performance effects and lower levels of negative emotions (3). All of this suggests that smokers taking breaks might actually increase their performance and benefit employers. Not taking such effects into account is potentially unfair to smokers and also risks breaks being associated by employers with negative effects for all of us.
References:
1) Levene: http://dx.doi.org/10.2337%2Fdb10-1042
2) Ariga: http://dx.doi.org/10.1016/j.cognition.2010.12.007
3) Trougakos: http://dx.doi.org/10.1108/S1479-3555(2009)0000007005
We appreciate Dr. Blum's interest in our study and his comments.
Data used for our study were collected and coded based on the public
health surveillance model, which is more fully described elsewhere (1).
Only a carefully selected set of items from tobacco news stories were
coded over an extended period of time, with editorial cartoons and letters
to the editor not included in the system. The newspapers were
specific...
We appreciate Dr. Blum's interest in our study and his comments.
Data used for our study were collected and coded based on the public
health surveillance model, which is more fully described elsewhere (1).
Only a carefully selected set of items from tobacco news stories were
coded over an extended period of time, with editorial cartoons and letters
to the editor not included in the system. The newspapers were
specifically chosen based on their larger circulation numbers and
geographic representation. As often occurs with surveillance system data,
they can be more useful for generating than testing specific research
hypotheses (2).
We agree it would be valuable to assess the level of news coverage
for tobacco issues in the broader context of media coverage for other
topics; unfortunately, doing so was far beyond the scope this project.
There were, of course, many more tobacco activities or events over
the 7-year period contributing to higher levels of news coverage than we
could possibly highlight in the figures. We agree that prominence
accorded to tobacco news stories by news media gatekeepers, as assessed by
whether they appear on the front page of a newspaper or are mentioned
early in television broadcasts, or if they appear in elite media outlets
such as the New York Times, is important (3).
Additional items were added to the system beginning in 2007 that
allowed for some analyses of prominence from 2007-2010, and these findings
were mentioned in our paper. More research about prominence along the
lines suggested by Dr. Blum is warranted, and such research would,
ideally, confirm or deny his impression that there were only been a
handful of significant tobacco stories in recent years.
We believe the prominence versus quantity argument as it pertains to
news media coverage of tobacco represents a false choice: both are
important and they are interrelated. Tobacco control and prevention
activities or events that result in news stories in elite media are likely
to generate a large quantity of news coverage over time in other media
outlets. Conversely, if a large number of news stories about a specific
tobacco-related topic appear in other media outlets, they will likely gain
the attention of elite media gatekeepers and result in increased coverage
in their news venues.
1. Nelson DE, Evans WD, Pederson LL, et al. A national surveillance
system for tracking tobacco news stories. Am J Prev Med. 2007;32:79-85.
2. Lee LM, Teutsch SM, Thacker SB, St. Louis, ME (eds). Principles
& Practice of Public Health Surveillance (3rd ed). New York: Oxford
University Press; 2010.
3. Gorman L, McLean D. Media and Society into the 21st Century: A
Historical Introduction (2nd ed). Hoboken, NJ: Wiley-Blackwell; 2009.
The article of Cummins et al. (1) is based on a survey which according to the authors considers electronic cigarette a risk for populations with mental health conditions. First of all, in our opinion it is not correct to agglomerate and treat all mental health conditions in the same way. It would be like considering all physical illness the same way. Fever is like a cancer? A specific phobia is like schizophrenia? It 'is...
Euromonitor International is a world leader in strategy research for consumer markets, with over 40 years of experience in developed and emerging economies. Through a combination of specialist industry knowledge and in-country research expertise, Euromonitor aims to build a market consensus view of the size, shape and trends in each industry we cover. Tobacco is no different, and both duty paid and illicit sales are rese...
Gottlieb rightly provides us evidence to question Food and Drug Administration (FDA) policy.(1) Indeed, the 2009 law giving the Agency the authority to regulate tobacco was useless as FDA's Advisory Committee issued a report which failed to recommend a ban on menthol cigarettes despite evidence of its devastating effects, a major setback for public health.(2) Is FDA only overcautious as Gottlieb suggested? Its professio...
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Dear Editor
Cartwright (1) has clearly mis-read our article on PMI's Project Star report(2). The central premise of our article is not that illicit is overestimated but that the Project Star report cannot be relied on as a source of data on illicit until there is significantly greater transparency over the underlying methodology and data inputs and the contractual arrangements under which it is conducted. KPMG i...
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NOT PEER REVIEWED Dear Editor,
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