This study by Ackerson et al concludes that Domestic violence is
associated with higher odds of smoking and chewing tobacco in India.
The authors have taken into account a range of individual and household
level demographic and socioeconomic covariates.
Odds ratios obtained for the risk have been adjusted for location of
residence, age, sex, religion, caste, marital status, education,
employment, living standard, pregnanc...
This study by Ackerson et al concludes that Domestic violence is
associated with higher odds of smoking and chewing tobacco in India.
The authors have taken into account a range of individual and household
level demographic and socioeconomic covariates.
Odds ratios obtained for the risk have been adjusted for location of
residence, age, sex, religion, caste, marital status, education,
employment, living standard, pregnancy status and body mass index.
However,one of the major factors world wide, that has consistently
emerged as high risk for domestic abuse is alcohol addiction/abuse. A
number of reports from India , Pakistan and several other countries have
also made this observation. Why this important parameter as not been
taken into consideration in this study is unfathomable.
Tobacco use in all forms have been shown to have a wide range of ill-
efects on health including cancer of various sites cardiovascular diseases
to mention a few. Therefore any loopholes in studies involving tobacco
should be effectively addressed.
One would imagine that public concern about butt litter would largely
rise with the amount of butt litter that occurs. One would also
reasonably imagine that news articles dealing with the "problem" of butt
litter would similarly rise. If we take those two assumptions as being a
given for the moment, and then look at the statistics uncovered by this
research, we see something very interesting.
One would imagine that public concern about butt litter would largely
rise with the amount of butt litter that occurs. One would also
reasonably imagine that news articles dealing with the "problem" of butt
litter would similarly rise. If we take those two assumptions as being a
given for the moment, and then look at the statistics uncovered by this
research, we see something very interesting.
Using Google's time search feature we are able to search for news
stories/articles in discrete time units. During the period of 10 inclusive
years 1982 to 1991, there were 7 stories: i.e. less than one story per
year. But during the inclusive 8 year period of 2002 to 2009, there were
242 stories, roughly 30 per year. That's over a 3,000% increase in public
perception of and attention to the problem, which would indicate that
there may have been as much as a 3,000% actual increase in the amount of
butt litter between these two comparative periods.
Some of that may have been generated by increased paranoia about
smoke and dislike/hatred of smoking and smokers, but it's likely that a
great deal of it represents an actual and very serious increase in the
problem.
So what changed in our society between those two periods that caused
this problem to undergo such an incredible escalation? It could be that
there are now far more smokers per given area than there were in the
1980s... but tobacco control statistics don't seem to bear that out:
generally they claim a decrease in smokers while habitable/used land areas
in cities/towns/beaches/parks etc have generally increased along with
general population growth during those years. It could be that smokers
are now less conscious of butt littering as a problem, but given the
increase in media attention to the issue this is also unlikely to be a
cause.
The one outstandingly obvious and overwhelming cause of this problem
would seem to be the antismoking movement's insistence upon throwing
smokers out into the streets to smoke rather than allow for provision of
comfortably separated and ventilated indoor options and venues for smokers
and their friends.
If cigarette butt pollution is indeed the true concern here, then
such indoor options should clearly be explored. If however, as indicated
in the abstract, the focus on cigarette butt litter is simply because such
a focus is seen as a way to "justify environmental regulation and policies
that raise the price of tobacco and further denormalise its use." -- a
pure social engineering mechanism -- then such solutions will of course be
ignored.
Which path do you think tobacco control will take?
Michael J. McFadden,
Author of "Dissecting Antismokers' Brains"
Conflict of Interest:
Author of "Dissecting Antismokers' Brains"
Active member of (and sometimes officer in) a number of citizens' Free Choice groups. No compensation involved.
The correct spelling of the second author's name is "Gombodorj
Tsetsegdary" (first name and then surname name). This error arose due to
the difficulties in translating from Mongolian Cyrillic script to English
language script.
Attending the RCP annual conference in 1999 in London, I remember a
delegate suggesting during a discussion on tobacco control that providing
cheap tobacco could be one way for China to control its population. Though
the suggestion was generally felt to be in poor taste, I am shell shocked
to read the conclusions of this article !
We have found a series of slight typographical errors in the text of
our paper(1) from the December 2007 issue. The results in the full sample
should have read that, compared to those living in households where women
reported no domestic violence, the odds of smoking were 1.25 (95%
confidence interval 1.20 to 1.31) times higher for those living in
households where women reported past abuse, and 1.38 (95% confidence
inte...
We have found a series of slight typographical errors in the text of
our paper(1) from the December 2007 issue. The results in the full sample
should have read that, compared to those living in households where women
reported no domestic violence, the odds of smoking were 1.25 (95%
confidence interval 1.20 to 1.31) times higher for those living in
households where women reported past abuse, and 1.38 (95% confidence
interval 1.33 to 1.44) times higher for those living in households where
women reported current abuse. The figure representing these results is
correct as published. These corrections are not substantially different
from the results reported and do not alter the findings of the paper.
1. Ackerson LK, Kawachi I, Barbeau EM, Subramanian SV. Exposure to
domestic violence associated with adult smoking in India: a population
based study. Tob Control 2007;16(6):378-83.
Many of Alpert, Connolly and Biener's population level NRT post-
cessation findings are disturbing and worthy of further and deeper review.
What's most baffling is that any government would invest so much
confidence and so many lives in a product without demanding a shred of
population level evidence as to its worth.
According to this paper, the odds of relapse for a heavily dependent
NRT quitter who had quit le...
Many of Alpert, Connolly and Biener's population level NRT post-
cessation findings are disturbing and worthy of further and deeper review.
What's most baffling is that any government would invest so much
confidence and so many lives in a product without demanding a shred of
population level evidence as to its worth.
According to this paper, the odds of relapse for a heavily dependent
NRT quitter who had quit less than six months were 3.53 times that of a
heavily dependent quitter who quit without NRT or professional help. If
true, that puts a rather hefty dent in NRT's most favored failure
explanation, its selection bias theory.
This finding makes troubling the fact that varenicline
(Chantix/Champix) failed to prevail in long-term point prevalence quitting
over nicotine patch in the only head-to-head clinical trials to date
(Aubin 2008 and Tsukahara 2010).
Alpert and colleagues do not attempt to explain the conflict between
clinical trial and population level NRT findings. But I submit that this
outcome was suggested by the first NRT clinical trial ever, the 1971
nicotine gum study by Ohlin and Westling.
Ohlin and Westling found that counseling and support ("ten visits and
more persuasion") was superior to nicotine gum alone, but that nicotine
gum could defeat placebo gum users. Even then, Ohlin and Westling
documented obvious nicotine gum blinding concerns.
Try to name any other placebo-controlled study area where the
condition sought to be treated (withdrawal) does not exist until
researchers command its onset. Name any other study area where the
placebo group is actually punished within 24 hours by a rising tide of
anxieties.
Have three decades of referring to nicotine as "medicine" and its use
"therapy" undermined natural learning and the quitter's ability to self-
discover the most critical recovery lesson of all, that lapse almost
always equals relapse, that one puff is too many and thousands never
enough?
Nearly all population level quitting method surveys to date have
found NRT less effective long-term than quitting without it. If true, are
taxpayers today paying to reduce the quitter's odds of success? Are we
responsible for undercutting their chances and costing many their lives?
John R. Polito
Nicotine Cessation Educator
Conflict of Interest:
Pro bono director of a cold turkey stop smoking website.
The results of the recent study by Alpert et al. were interpreted
incorrectly with respect to the efficacy of nicotine replacement therapy
(NRT).(1) The study only considered relative relapse rates among people
who had already stopped smoking according to whether they had used NRT or
not. This is clearly an inadequate design to address the issue of efficacy
because it ignores the initial quit rates in the two groups. Only...
The results of the recent study by Alpert et al. were interpreted
incorrectly with respect to the efficacy of nicotine replacement therapy
(NRT).(1) The study only considered relative relapse rates among people
who had already stopped smoking according to whether they had used NRT or
not. This is clearly an inadequate design to address the issue of efficacy
because it ignores the initial quit rates in the two groups. Only if the
results had indicated significantly higher relapse among those using NRT
might they have offered evidence against long-term NRT efficacy,
depending, of course, on the initial difference in quit rates (not
measured) and the difference in relapse rates. However, this was not the
case. There was no evidence of differential relapse. Therefore, the
conclusion that these data provide evidence against the effectiveness of
NRT is wrong.
Had the authors considered more thoroughly the literature they would
surely have been enlightened by the meta-analysis review of relapse and
long-term NRT effectiveness published in Tobacco Control.(2) It would have
helped them understand the issues and to draw an appropriate conclusion,
rather than a perverse one. That review included 4792 randomized subjects
(not self-selected as in the new study) followed up for several years and
found the same result as Alpert: the relapse rate did not differ between
those using NRT and others. Consequently, because the initial NRT quit
rate was higher, efficacy remained after a mean follow-up time of 4.3
years (Odds ratio =1.99, 95% C.I. = 1.50 to 2.64). In contrast to the new
study, all the subjects in that review received some form of professional
support, although often minimal. Therefore, the same finding with respect
to relapse in the new population-based study tends, if anything, to
broaden rather than diminish the evidence for long-term NRT effectiveness.
(1) Alpert HR, Connolly GN, Biener L. A prospective study challenging
the effectiveness of population-based medical intervention for smoking
cessation. Tob Control 2012 10.1136/tobaccocontrol-2011-050129 Online 12
January
(2) Etter JF, Stapleton JA. Nicotine replacement therapy for long-
term smoking cessation: a meta-analysis. Tob Control 2006;15(4):280-5.
Conflict of Interest:
John Stapleton has conducted trials of nicotine replacement and other treatments for tobacco dependence supported by the Medical Research Council, the Department of Health and Cancer Research UK. He was formally an adviser on issues of study design and methodology to several manufacturers of smoking cessation medications, including NRT, bupropion and varenicline.
Readers of our paper Markers of the Denormalisation of Smoking and
the Tobacco Industry may be perplexed about the way the Abstract is
structured with the traditional Background, Methods, Results and
Conclusion headings. These headings were inserted during the editing
process after we as authors had approved the proofs of the paper. The
paper we approved had an unstructured abstract as was appropriate to a
paper of thi...
Readers of our paper Markers of the Denormalisation of Smoking and
the Tobacco Industry may be perplexed about the way the Abstract is
structured with the traditional Background, Methods, Results and
Conclusion headings. These headings were inserted during the editing
process after we as authors had approved the proofs of the paper. The
paper we approved had an unstructured abstract as was appropriate to a
paper of this sort.
We do not believe the error warrants a formal correction, but wanted
readers to understand how the oddity occurred.
Professor Chitta Choudhury
Director, International Centre for Tropical Oral Health, UK
Nitte University Dept of Oral Biology Genomic Studies | Cen Oral Dis
Prev Control, Mangalore, India.
NOT PEER REVIEWED
I refer to the report "How online sales and promotion of snus
contravenes current European Union legislation, published recently in Tob
Control 21 January 2012.
Like Snus, the online trade of Gutkh...
Professor Chitta Choudhury
Director, International Centre for Tropical Oral Health, UK
Nitte University Dept of Oral Biology Genomic Studies | Cen Oral Dis
Prev Control, Mangalore, India.
NOT PEER REVIEWED
I refer to the report "How online sales and promotion of snus
contravenes current European Union legislation, published recently in Tob
Control 21 January 2012.
Like Snus, the online trade of Gutkha (Indian variety of Smokeless
tobacco- ST) is gaining popularity as well as in several outlets in
the UK. If you visit some of the shops in East and north-west London
or in Birmingham, Manchester, Leeds, and Leister (where SE Asian
immigrants are living) you can easily find many shops displaying
various brands of Gutkha sachets. As a member of the National Institute of
Clinical Excellence, (NICE, UK) stakeholders on Smokeless Tobacco control
for SE Asian Migrants , I joined in a meeting and raised the question of
why we can't stop such trade,likewise Snus. But the fact is that there is
no strong legislative support to ban this trade. There is no doubt that online
trade of ST products (not only Snus, also Guthka) is on rise.
Anyway, the results of a database search regarding online sales and
promotion of Snus revealed that online vendors are targeting non-
Swedish EU citizens. Such online trade may also cross more distant borders, reaching Asia, Africa and Gulf countries. Of course, such business is against
the EU regulation. The Snus is banned in the UK and EU countries, but not
the Gutkha. We don't know why Gutkha is not banned in EU. In this context,
I refer one of our discussions published in Tob Control 9 Nov 2010, suggesting that
Snus and quid (eg. Gutkha) consumption is a risk factor not only for the occurrence
of Oral Cancer, but also for development of Metabolic Syndrome
http://tobaccocontrol.bmj.com/content/19/4/297/reply#tobaccocontrol_el_3489
In my opinion, we require a clear-cut and focused directive
of the WHO Framework Convention on Tobacco Control that specifically addresses Snus and Gutkha. If we can not control online trade of Snus, it will be a bad
situation, because the web-based trade crosses the border very quickly, not
only in EU but also other parts of the world. The disturbing fact is that
Sweden is a signatory of the FCTC yet the Swedish Government is getting
revenue from this online Snus trade.
Professor Chitta CHOUDHURY | Nitte University & Int'l Centre of
Tropical Oral Health, UK
Director, Centre for Oral Disease Prevention & Control, NICE
Stakeholder on ST control for SE Asian Migrants in the UK.
In a recently published article in Tobacco Control, Vander Beken and
colleagues [1] concluded that the Belgian cigarette black-market
manifested myriad links with the legitimate business world and, as a
result, effective tobacco control policies will need to address the role
of legitimate businesses in this market. Our letter confirms this
conclusion within a Canadian context.
In a recently published article in Tobacco Control, Vander Beken and
colleagues [1] concluded that the Belgian cigarette black-market
manifested myriad links with the legitimate business world and, as a
result, effective tobacco control policies will need to address the role
of legitimate businesses in this market. Our letter confirms this
conclusion within a Canadian context.
Approximately 10-17% of cigarettes smoked in Canada in 2005-2006 were
illicit, and 95% of all illicit cigarettes (i.e., contraband) in Canada
were manufactured on First Nations reserves in the provinces of Ontario
and Québec [2,3]. Even though two-thirds of contraband cigarette consumers
report buying contraband cigarettes at off-reserve locations [4], little
is known about the distribution network of contraband cigarettes in
Canada.
Previously, we examined the contraband cigarette market at one of
Canada's largest psychiatric hospitals, a 436-bed facility located in
Toronto [5]. Approximately 60% of the cigarette butts sampled from patient
ashtrays appeared to be contraband; and 80% of the cigarette packages
found in a facility-wide garbage audit at the psychiatric hospital were
from illicit brands manufactured on American Indian reservations in
northern New York State. Anecdotal evidence suggested that independent
convenience stores were serving as a prominent distribution source for
native-manufactured contraband cigarettes, and the current letter examined
this possibility.
We assessed the prevalence of legitimate independent convenience
stores willing to sell illicit native-manufactured cigarettes in Toronto,
Ontario. A list of all independent convenience store tobacco retailers in
the study area was obtained from the City of Toronto. Our sample included
all of the 115 independent convenience stores located within a 2 km
distance from the psychiatric hospital: 30 within 1 km, and 85 within the
1-2 km span. Data collection occurred during July and August 2007. A male
research assistant (aged 36 years) entered each of the 115 stores and
asked the clerk, "Do you have any native cigarettes?" A store was coded
as willing to sell illicit native cigarettes, if: (1) the clerk provided
an affirmative answer; (2) the clerk engaged the research assistant in a
selling transaction (e.g., the clerk asked the research assistant, "How
much money do you have?"); or (3) the research assistant saw the clerk
selling illicit native-manufactured cigarettes to another customer.
Legitimate independent convenience stores located closer to the
psychiatric hospital were significantly more likely to be willing to sell
illicit native-manufactured cigarettes. Approximately 57% (17/30) of the
stores within 1 km of the hospital were willing to sell contraband
cigarettes, while roughly 12% (10/85) of the stores located in the 1-2 km
zone showed the same tendency (chi-square = 24.9, p < 0.001).
Similar to the findings of Vander Beken, et al. 2008, our results
suggest that Ontario tobacco-control policies will need to recognize
legitimate businesses—in our case, independent convenience stores—as
important sources in the distribution network of black-market cigarettes.
References:
1. T Vander Beken, J Janssens, K Verpoest, A Balcaen, and F Vander
Laenen. Crossing geographical, legal and moral boundaries: The Belgian
cigarette black market. Tobacco Control 2008; 17:60-65.
2. Physicians for a Smoke-Free Canada. Warning signs about cigarette
smuggling: And actions governments can take to address this growing
problem. Ottawa: Physicians for a Smoke-Free Canada; 2006 December.
3. Imperial Tobacco. Collateral damage: Illicit tobacco trade takes
on phenomenal proportions. 2006 [cited 2007 February 5th]; Available
from:
http://www.imperialtobacco.com/onewebca/sites/IMP_5TUJVZ.nsf/vwPagesWebLive/362441A11150B0B6C1257108005E76AC?opendocument&DTC=&SID=
4. GFK Research Dynamics. New Information on Illegal Tobacco Sales:
National Study for the Canadian Tobacco Manufacturers' Council.
Mississauga, ON: Imperial Tobacco; 2007 July.
5. RC Callaghan, J Tavares, and L Taylor. Illicit cigarette markets
in marginalized, low-income populations: an example from psychiatric
patients in Toronto, Ontario. American Journal of Public Health 2008; 98:4
-5.
This study by Ackerson et al concludes that Domestic violence is associated with higher odds of smoking and chewing tobacco in India. The authors have taken into account a range of individual and household level demographic and socioeconomic covariates. Odds ratios obtained for the risk have been adjusted for location of residence, age, sex, religion, caste, marital status, education, employment, living standard, pregnanc...
One would imagine that public concern about butt litter would largely rise with the amount of butt litter that occurs. One would also reasonably imagine that news articles dealing with the "problem" of butt litter would similarly rise. If we take those two assumptions as being a given for the moment, and then look at the statistics uncovered by this research, we see something very interesting.
Using Google's t...
The correct spelling of the second author's name is "Gombodorj Tsetsegdary" (first name and then surname name). This error arose due to the difficulties in translating from Mongolian Cyrillic script to English language script.
Attending the RCP annual conference in 1999 in London, I remember a delegate suggesting during a discussion on tobacco control that providing cheap tobacco could be one way for China to control its population. Though the suggestion was generally felt to be in poor taste, I am shell shocked to read the conclusions of this article !
Conflict of Interest:
None declared
We have found a series of slight typographical errors in the text of our paper(1) from the December 2007 issue. The results in the full sample should have read that, compared to those living in households where women reported no domestic violence, the odds of smoking were 1.25 (95% confidence interval 1.20 to 1.31) times higher for those living in households where women reported past abuse, and 1.38 (95% confidence inte...
Many of Alpert, Connolly and Biener's population level NRT post- cessation findings are disturbing and worthy of further and deeper review. What's most baffling is that any government would invest so much confidence and so many lives in a product without demanding a shred of population level evidence as to its worth.
According to this paper, the odds of relapse for a heavily dependent NRT quitter who had quit le...
The results of the recent study by Alpert et al. were interpreted incorrectly with respect to the efficacy of nicotine replacement therapy (NRT).(1) The study only considered relative relapse rates among people who had already stopped smoking according to whether they had used NRT or not. This is clearly an inadequate design to address the issue of efficacy because it ignores the initial quit rates in the two groups. Only...
Readers of our paper Markers of the Denormalisation of Smoking and the Tobacco Industry may be perplexed about the way the Abstract is structured with the traditional Background, Methods, Results and Conclusion headings. These headings were inserted during the editing process after we as authors had approved the proofs of the paper. The paper we approved had an unstructured abstract as was appropriate to a paper of thi...
Professor Chitta Choudhury Director, International Centre for Tropical Oral Health, UK
Nitte University Dept of Oral Biology Genomic Studies | Cen Oral Dis Prev Control, Mangalore, India.
NOT PEER REVIEWED I refer to the report "How online sales and promotion of snus contravenes current European Union legislation, published recently in Tob Control 21 January 2012. Like Snus, the online trade of Gutkh...
In a recently published article in Tobacco Control, Vander Beken and colleagues [1] concluded that the Belgian cigarette black-market manifested myriad links with the legitimate business world and, as a result, effective tobacco control policies will need to address the role of legitimate businesses in this market. Our letter confirms this conclusion within a Canadian context.
Approximately 10-17% of cigarettes...
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