I certainly agree with most of the comments of Dr
Kamal Chaouachi but the need to develop one generic
name for the different types of this form of tobacco
smoking is definite and we tend to prefer the term water-
pipe smoking as it denotes the similarity that links all
these forms and shapes and local names. Certainly
these different names are associated with local
geographical languages and idenified best in the
reps...
I certainly agree with most of the comments of Dr
Kamal Chaouachi but the need to develop one generic
name for the different types of this form of tobacco
smoking is definite and we tend to prefer the term water-
pipe smoking as it denotes the similarity that links all
these forms and shapes and local names. Certainly
these different names are associated with local
geographical languages and idenified best in the
repsective languages. The need to use a common generic name is recognized
to avoid using three to five different names in every paper to make sure
that the study covers these
types. Water-pipe tobacco smoking is a good common
name and reflects the major difference from direct
tobacco smoking which is a lower temperature of
burning as well as cooler smoke temperature. This is
reflected in the composition of the smoke and
characteristics of toxic and carcinogenic componenets
as alluded to in some work from Lebanon by Alan
Shihada cited in the original paper discussed here.
Mostafa K. Moahmed
Professor of Community Medicine
AinShams University Faculty of Medicine
Abbassia , Cairo, Egypt
Principal investigator
Egyptian Smoking Prevention Research institute ESPRI
Tel /fax Office 20-2-368-2774 / 368-6275/ 368-8400
Mobile 20-12-241-7933
email: ecgc@internetegypt.com
We wish to draw your attention to some misconceptions in the
following study:
Rima AFIFI SOWEID. Lebanon: water pipe line to youth. Tobacco Control
2005;14:363-4.
>"In Lebanon, youth and women are the target of a marketing
campaign featuring a new tobacco product for use with the more traditional
water pipe."
The caption for the embedded picture is a an erroneous
interpretation. Sociological semiology showed us in the fifties that if
you want to sell a car (to men, of course), you have to depict it with a
nice looking girl leaning on it. Once again, in the present case, the
message is not directed to "youth and women" but to men in the first
instance.
Then, the word "water pipe", in the title and elsewhere, is not
appropriate. It is used only in a certain orientalist or neo-orientalist
literature,(1) just like the sometimes disparaging "hubble-bubble" (2). If
you enter a café in the Middle East or in Europe and North America
nowadays, and order a "water pipe" or a "hubble-bubble", in most cases you
will not be understood. So, let us use the words people use in the real
human world we are interested in, as scientists serving the public health.
-"(N)arghile" is widely used in the Middle East: from Turkey to Iran
via Lebanon, Syria, etc.
-"Hookah" is quite common in Asia (India, Pakistan, etc.) and the English-
speaking world.
-"Shisha" fits first the North of Africa: countries such as Tunisia,
Libya, Egypt and now Morocco but it is also common in the Arab-Persian
Gulf region and now, thanks to the world hookah craze, in every part of
the globe (3).
>"The water pipe is a traditional form of tobacco smoked in Arab
countries, including Lebanon."
It is not. It has been used for centuries in Asia and Africa and not
only in the Arab countries (4).
> "Recently, trends have shifted between tobacco types, and water
pipe smoking is becoming the preference for young people and women
specifically, ousting the once more popular cigarette."
We are afraid they have not. It is also becoming the preference for
men too. It is not ousting the cigarette; on the contrary. People, in
countries like Lebanon, smoke indistinctly hookahs and cigarettes (5).
Tobaccologists are not that much interested in the dozens of millions of
recreational hookah smokers around the word who have been smoking a hookah
once a week or a month over the past centuries. What is of utmost concern
to them is those dual smokers and those who have switched from cigarette
(or bidi, etc.) smoking to narghile use. The body memory of their past
career and their inhaling patterns are different. This is the real health
concern we have to focus on (6)(7).
> "Ironically, with an eye on an ever "health conscious consumer",
the new product comes in individually wrapped portions (hitherto in large
bales) and the promise that it has not been touched by human hands."
We are sorry to say that it is not a "new product". Indian
manufacturers, like Afzal, for instance, have been providing with these
individually wrapped portions for a very long time now. Besides, this
marketing concept, adopted and developed further by Western manufacturers,
will be very soon available in the whole world.
Generally speaking, this article is interesting and, despite the
above commented upon misconceptions, we cannot but share the author's
concern regarding the existence of this kind of advertisement. Any
advertisement for any substance should be prohibited as a rule.
Kamal Chaouachi, Paris Universities.
Researcher in Socio-Anthropology and Tobaccology
REFERENCES
(1) CHAOUACHI Kamal. Culture matérielle et orientalisme. L'exemple
d'une recherche socio-anthropologique sur le narguilé, Arabica (Paris III
Sorbonne et EHESS), 2005. [Engl.: Material Culture and Orientalism. The
Example of a Socio-Anthropological Research on Narghile]
(2) CHAOUACHI Kamal. Le narguilé. Anthropologie d'un mode d'usage de
drogues douces [Engl.: An Anthropology of Narghile: its Use and Soft
Drugs], Ed. L'Harmattan, 1997, 262 pages.
(3) CHAOUACHI Kamal. The Recent Development of Hookah Use in the
World : a Serious Epidemic or just a Passing Fad ? The Need for a Socio-
Anthropological and Medical Approach. IFSSH (International Forum for
Social Sciences and Health), World Congress "Health Challenges of the
Third Millenium". Istanbul, 21-26 Aug. 2005. Published by YEDITEPE
University, Dept. of Anthropology, Aug. 2005, tome I, pp. 360-1.
(4) CHAOUACHI Kamal. Le narguilé : analyse socio-anthropologique.
Culture, convivialité, histoire et tabacologie d'un mode d'usage populaire
du tabac. Doctoral Thesis, Université Paris X (France), 420 pages. [Engl.:
"Narghile (hookah): a Socio-Anthropological Analysis. Culture,
Conviviality, History and Tobaccology of a Popular Tobacco Use Mode"].
(5) Baddoura R., Wehbeh-Chidiac C. Prevalence of tobacco use among
the adult Lebanese population. July-Sept. 2001; 7 (4/5): 819-28. St-Joseph
University, Beirut, Lebanon. Published by WHO/EMRO.
(6) CHAOUACHI Kamal. Presentazione del narghilè e del suo uso. Guida
critica della letteratura scientifica sul narghilè (shisha, hookah,
waterpipe). Dalle origini ai giorni nostri : necessità di un approccio
interdisciplinare socio-antropologico, medico e farmacologico.
Tabaccologia 2005; 1: 39-47. [Engl.: A critical review of scientific
literature on narghile (Shisha, Hookah, Waterpipe) from its origins to
date: the need for a comprehensive socio-anthropological, medical and
pharmacological approach].
(7) CHAOUACHI Kamal. Shisha, hookah. Le narguilé au XXIe siècle. Bref
état des connaissances scientifiques. [Eng.: Narghile, Hookah in the 21st
Century: An Overview of the Scientific Knowledge]. Le Courrier des
Addictions 2004 (Oct) ; 6 (4) : 150-2.
Prochaska and Velicer have commented on this trial(1), and, having
been alerted to this comment elsewhere, we feel we need to respond
belatedly. They suggest the study had important flaws but do not name
them. We drew attention to those flaws in the conduct of the study in the
report. The major flaw was that midwives in the control arm were less
enthused about the intervention and complied with the protocol less well,...
Prochaska and Velicer have commented on this trial(1), and, having
been alerted to this comment elsewhere, we feel we need to respond
belatedly. They suggest the study had important flaws but do not name
them. We drew attention to those flaws in the conduct of the study in the
report. The major flaw was that midwives in the control arm were less
enthused about the intervention and complied with the protocol less well,
which overstated the benefit of the intervention, which we addressed in
the report. In retrospect, it might also have been better to have had two
larger arms than three.
In addition, they state that this is a population-based trial and
this is partly true- we certainly intended that it should be so- but the
trial fell short of this ideal. We asked midwives to recruit every smoker
into the trial regardless of willingness to stop smoking, but, as is clear
from Figure 1, only a minority of smokers were approached. Nearly all
those who were approached agreed. This was a cluster-randomised trial
because we thought it would be difficult for midwives to switch
counselling styles between the TTM-based approach and their normal
approach. However, we trained midwives to approach participants in all
arms of the study in the same way. That is, we asked midwives not to say
to women in the control arm- you will receive my usual care- while for the
intervention arms, midwives were asked not to describe the specific
intervention a woman was to receive. Rather, midwives were trained to
present the possibility that a woman would potentially receive any of the
interventions, when in reality she could only receive one. To have done
otherwise would have risked biasing the trial. Thus, any differences in
the rate at which midwives approached women to participate in the trial
were nothing to do with the attractiveness of the intervention. They were
to do with the enthusiasm of the midwife as we discussed in the trial
report. This may sound subtle but it is important. If the NHS had chosen
to implement the TTM-based intervention, then as every midwife has to
raise smoking and record it on the maternity record, if her standard
intervention was now the TTM-based one, then all women who admitted to
smoking would receive this intervention. Differences in uptake in the
‘real world’ outside this trial would not occur. Consequently, the eight
times the population impact figure of Prochaska and Velicer is wrong, as
the main driver of it is the uptake rates which would not differ outside a
trial, where recruitment meant lots of extra work for the midwife.
Prochaska and Velicer state that we recommend programmes with no
evidence. Actually, the last sentence of our report was ‘Smoking in
pregnancy is currently a problem for which there is no good currently
available solution.’ We still believe this is true at a population level,
but it also reasonable to suggest that all midwives should discuss
smoking, as this seems like an ethical imperative. It seems reasonable
also for midwives to offer assistance to stop, mainly referral to a
specialist who can give that help, and there is good evidence that this is
effective(2). I am pleased to say that one local service manages to see
around half of all pregnant smokers, of whom a third of these set a quit
date and around a quarter of those sustain validated 4-week abstinence.
This clearly shows the small population impact- around 4% of all pregnant
smokers (see
http://www.uknscc.org/2005_UKNSCC/presentations/carmel_ogorman.html), but
this is better than the population impact of the TTM-based interventions
in our trial (where the comparable figure is 2-3%).
One way to better understand the population impacts of the TTM-based
interventions in pregnancy is to see more trials with similar
interventions. Prochaska, Velicer and colleagues completed such a trial
before ours was completed and it is still not published. Understanding
the efficacy of these interventions would be improved if it were.
Reference List
(1) Lawrence PT, Aveyard P, Evans O, Cheng KK. A cluster randomised
controlled trial of smoking cessation in pregnant women comparing
interventions based on the transtheoretical (stages of change) model to
standard care. Tobacco Control 2003; 12:168-177.
(2) Lumley J, Oliver S, Waters E. Interventions for promoting
smoking cessation during pregnancy (Cochrane Review). In: The Cochrane
Library, Issue 1, 2003.
As Professor Chapman has noted some have questioned the merits of
publishing papers that the tobacco industry funded. In the spirit of
Justice Brandeis who noted that, “Sunlight is the best disinfectant” I
believe that more not fewer tobacco industry consultants opinions should
see the light of day. For example I believe that court room opinions
offered under oath, by tobacco hired historians, physicians and others
sho...
As Professor Chapman has noted some have questioned the merits of
publishing papers that the tobacco industry funded. In the spirit of
Justice Brandeis who noted that, “Sunlight is the best disinfectant” I
believe that more not fewer tobacco industry consultants opinions should
see the light of day. For example I believe that court room opinions
offered under oath, by tobacco hired historians, physicians and others
should be published as often as possible perhaps as a regular TC offering
with pro and con commentary. This would permit real peer review of
opinions that have great importance in the creation of policy. I offer
your readers an example. Dr. Sanford H. Barsky gave this opinion on the
case of Mr. Vandenberg, a seventy-nine year old ex-marine and postal
worker who had a 75 pack-year smoking history.
“My opinion is that he has a fairly well differentiated squamous cell
carcinoma of the lung that's arising within a bronchiectatic focus of the
lung and that's going through the stages time [including] the stage of
metaplasia, dysplasia, in situ carcinoma and invasive carcinoma… I think
the squamous cell cancer is arising within this bronchiectatic focus. I
think the chronic inflammation and irritation of this focus is what's
giving rise to the squamous cell cancer; that it's a peripheral squamous
cell cancer, away from the main airways and that his tobacco smoking is
not causally related to the genesis of this particular tumor.” He noted
that, “no one has mentioned the term, bronchiectasis in the medical
records.” And based his opinion, “primarily on pathology” buttressed by
case reports and Spencer’s Textbook of pathology that had “commonly” note
the association between bronchiectasis and lung cancer. He went on to
state that smoking did not contribute to cause the cancer.
I invite your readers to shed light on this opinion.
I serve as an expert witness in Tobacco litigation
A reader has enquired about the funding source for this study. It was
the the National Cancer Institute of the US National
Institutes of Health.
SC- Editor
I would like to propose some additions to Carter’s excellent review
paper on
Tobacco document research reporting. That is a major contribution to
tobacco document research (TDR) methodology.
While discussing possible lessons from historical research to TDR
Carter
mentions the interpretation of facts. Occasionally the difficulty with
TDR
lies in establishing the facts (e.g. if plans were implemented). One
me...
I would like to propose some additions to Carter’s excellent review
paper on
Tobacco document research reporting. That is a major contribution to
tobacco document research (TDR) methodology.
While discussing possible lessons from historical research to TDR
Carter
mentions the interpretation of facts. Occasionally the difficulty with
TDR
lies in establishing the facts (e.g. if plans were implemented). One
method to
overcome the problem is to put the TDR information into context. The
more detailed the information, the more difficult is the task.
A basic method in historical research (also in journalism) is to
check the
information with the persons mentioned in the documents. That is rarely
seen
in TDR. However, some authors make explicit that they have not checked the
information with the persons concerned. Obtaining information from
(present
or former) tobacco industry employees is surely a difficult task but that
should not be ignored if more accuracy could be attained.
When it comes to evolution of search strategies it is obvious that it
is
connected to the availability of the documents. The sorting options and
optical character recognition as well as the addition of privileged
documents
to Legacy archive have made new search strategies possible. A fuzzy option
for key words would greatly benefit TRC on countries with ominous
characters as they tend to be misspelled.
I do applaud Carter’s recommendation of frame analysis. Several TDR
related
to tobacco lobbying. It seems that the debate on tobacco centers around
two
competing frames, individual liberty and public health. I’m sure that
there is
still a lot to be learned from the way the industry has manipulated the
language in smoking and health debate.
Carter SM. Tobacco document research reporting. Tobacco Control
2005;14:
368-376.
Manashe CL, Siegel M. The power of a frame: an analysis of newspaper
coverage of tobacco issues -- United States 1985-1995. Journal of Health
Communication 1998;4:207-25.
Simon Chapman's pictures on page 367 of the latest Tobacco Control
points out that the 7-11 chain of convenience stores in Thailand was
refusing to cover their cigarette products as required by the Ministry of
Health's requirements on advertising. They are now complying with the
regulation and do not have the open display of cigarette products. This
means that all retail shops in Thailand are no longer displaying any...
Simon Chapman's pictures on page 367 of the latest Tobacco Control
points out that the 7-11 chain of convenience stores in Thailand was
refusing to cover their cigarette products as required by the Ministry of
Health's requirements on advertising. They are now complying with the
regulation and do not have the open display of cigarette products. This
means that all retail shops in Thailand are no longer displaying any
tobacco packs or cartons at point of sale. This is an important
achievement in Thailand and comes at the same time that the tax on tobacco
has also just been raised by 4% to 79% of the base price. Price
increases, new picture warning labels, and a ban on point of sale
advertising is a combination that should accelerate the already declining
trend in smoking.
Since my original publication in 1995 reporting high rates of denial
of smoking in Japanese women,1 and Prof Yano's alternative assessment of
the evidence,2 there has been an ongoing correspondence between the two of
us.3-6 In his latest letter6 Yano asks whether my paper1 should have been
published because it suffers from "erroneous interpretations based on
invalid measurements."
Since my original publication in 1995 reporting high rates of denial
of smoking in Japanese women,1 and Prof Yano's alternative assessment of
the evidence,2 there has been an ongoing correspondence between the two of
us.3-6 In his latest letter6 Yano asks whether my paper1 should have been
published because it suffers from "erroneous interpretations based on
invalid measurements."
My calculations critically depended on the detection of high urinary
cotinine/creatinine ratios (CCR) of >100 ng/mg in 28 women who reported
that they were nonsmokers. Yano argues that the CCR measurement may have
been unreliable because the dry ice sent with the urine samples had
sublimated before it reached the laboratory (a problem I have no record or
memory of), and that, if the sample had been exposed to high temperature,
the measurement might have been inaccurate. Although other references7,8
argue that cotinine levels in unfrozen samples are reliable for research
purposes, Yano cites the results of one study9 which did show some
increase in cotinine levels in samples stored at high temperatures.
However, even at the highest temperature (60°C) and longest storage time
(30 days) tested, the increase was by less than 2-fold. In contrast, in
25 of the 28 women reclassified as current smokers, their CCR was more
than 2-fold above the, conservative, 100 ng/mg cut-off used, and in 23 of
them the CCR was over 500 ng/mg. I do not consider this doubt about
possible exposure of samples to high temperature is relevant. If Yano
thought it was, why was it not mentioned in his paper?2 I note that Yano
states that the potential problem only applied to the first batch of
samples. If so, it would be relevant to compare the results for the two
batches. My database does not have details of batch. Does Yano's?
Using 100 ng/ml as indicative of true smoking, I estimated that 28/98
= 29% of true smokers denied smoking. In contrast 8/298 = 2.7% of true
nonsmokers could be reclassified as smokers. The former misclassification
rate, which can cause
substantial bias to estimates of lung cancer risk in nonsmokers
associated with spousal smoking, is much higher than the reverse
misclassification rate, which in any case has a much lower biasing
effect.10
The calculations in Yano's latest letter6 are off the point as they
are based on the assumption that self reported smoking is 100% accurate
and that it is CCR which is subject to error. The whole point of the
study was to test the accuracy of self report using CCR as the gold
standard. Clearly CCR is not 100% accurate, but Yano gives no reason why
such inaccuracy should affect the major conclusion of my paper.1
Yano is concerned that my formula depends on the prevalence of
smoking. I am not sure why. One is attempting to answer the question
"What proportion of true smokers deny smoking?" and clearly the number of
true smokers must be the denominator in the calculation.
Yano states that Proctor "finally understood and accepted my point on
the misclassification formula," but that was before he had consulted me
and realized that Yano's approach was erroneous. Then, as now, my views
and Yano's seem irreconcilable, and as it was not possible to prepare a
paper satisfactory to all, I was asked by Proctor to prepare a paper under
my name. Clearly the situation is not ideal, but at least the data and
the differing interpretations are in the literature for scientists to form
their own judgement. I retain my view that my interpretation is correct
and that the measurements made are valid enough for the conclusions I
draw.
Peter N Lee
P.N. Lee Statistics and Computing Ltd.,
17 Cedar Road,
Sutton, Surrey, SM2 5DA, UK.
References
1. Lee PN. "Marriage to a smoker" may not be a valid marker of
exposure in studies relating environmental tobacco smoke to risk of lung
cancer in Japanese non-smoking women. Int Arch Occup Environ Health
1995;67:287-94.
2. Yano E. Japanese spousal smoking study revisited: how a tobacco
industry funded paper reached erroneous conclusions. Tob Control
2005;14:227-35.
3. Lee PN. Japanese spousal study: a response to Professor Yano's
claims [Commentary]. Tob Control 2005;14:233-4.
4. Yano E. Response to P N Lee [Commentary]. Tob Control
2005;14:234-5.
5. Lee PN. Response to E Yano and S Chapman [Letter]. Tob Control
14:430-1.
6. Yano E. Should a paper with erroneous interpretations based on
invalid measurements be published? [Letter]. Tob Control 2005;14:431-2.
7. Foulds J, Feyerabend C, Stapleton J, Jarvis MJ, Russell MAH.
Stability of nicotine and cotinine in unfrozen plasma. J Smoking-Related
Dis 1994;5:41-4.
8. Greeley DA, Valois RF, Bernstein DA. Stability of salivary
cotinine sent through the U.S. mail for verification of smoking status.
Addict Behav 1992;17:291-6.
9. Hagan RL, Ramos JM, Jr., Jacob PM, III. Increasing urinary
cotinine concentrations at elevated temperatures: the role of conjugated
metabolites. J Pharm Biomed Anal 1997;16:191-7.
10. Lee PN, Forey BA. Misclassification of smoking habits as a
source of bias in the study of environmental tobacco smoke and lung
cancer. Stat Med 1996;15:581-605.
Editor: This correspondence is now closed
Nathan K Cobb raises an important point. This paper has been reviewed
by the Centre for Reviews and Dissemination [1], which provides critical
assessments of the quality of economic evaluations. They raised this issue
along with some other noteworthy points relating to the costs of the
program. Specifically, the costs and the quantities were not reported
separately, which limits the generalisability of the authors' results...
Nathan K Cobb raises an important point. This paper has been reviewed
by the Centre for Reviews and Dissemination [1], which provides critical
assessments of the quality of economic evaluations. They raised this issue
along with some other noteworthy points relating to the costs of the
program. Specifically, the costs and the quantities were not reported
separately, which limits the generalisability of the authors' results.
Also, the date to which the prices related was not reported, hindering any
possible reflation exercises.
The review also reports an error in the cost-effectiveness ratio
calculated by the authors. To calculate this ratio the authors divided the
average cost per client of the counselling service ($60) by the
incremental effect on cessation rates (4.5%). In this incremental
analysis, the authors failed to include the costs incurred by patients in
the self-help group (i.e. those receiving the booklets only), which
amounted to $15 per client. Hence, the incremental cost-effectiveness
ratio of the telephone counselling service would be lower than that
calculated by the authors, and would be around $1,000 ($45 divided by
4.5%)[1]
References
1. Telephone assistance for smoking cessation: one year cost
effectiveness estimations [Abstract 20040366] NHS Economic Evaluation
Database, available http://nhscrd.york.ac.uk/welcome.htm [2005, 5
December]. Abstract of: Telephone assistance for smoking cessation: one
year cost effectiveness estimations, McAlister A, Rabius V, Geiger A,
Glynn T, Huang P, Todd R., Tobacco Control, 2004, 13(1):85-86.
In the latest issue of Tobacco Control, Radu and others report on
tobacco use among Swedish schoolchildren (Tobacco Control 2005;14:405-
408). As a Swede, I was surprised to read about some of their findings.
Children who smoke daily or almost daily are defined as “regular
smokers”. The percentage of regular smokers is reported to have decreased
to 4 per cent among 16-years-old boys and 15 per cent among girls by...
In the latest issue of Tobacco Control, Radu and others report on
tobacco use among Swedish schoolchildren (Tobacco Control 2005;14:405-
408). As a Swede, I was surprised to read about some of their findings.
Children who smoke daily or almost daily are defined as “regular
smokers”. The percentage of regular smokers is reported to have decreased
to 4 per cent among 16-years-old boys and 15 per cent among girls by 2003.
These figures differ significantly from the data found in the
original (Swedish) reports from the CAN (Swedish Council for Information
on Alcohol and Other Drugs). According to the latest CAN report (2005) the
percentage of “regular smokers” in 2003 was 7 per cent among boys and 13
per cent among girls. So, how can the authors reach the figure 4 per cent
for boys?
One explanation, which can be hypothesized from Figure 2 in the
paper, may be that “regular smokers” who also use oral snuff, have been
excluded from the category of “regular smokers”. If this is the case, I
find this to be a highly innovative method of presenting data in order to
make them support one’s favourite, preconceived conclusions. Smokers who
also use oral snuff – are they not smokers?
The “gender gap” in tobacco habits certainly exists – it has been
there ever since the early 1970s, when this series of surveys was started
and the use of oral snuff was practically non-existent among boys. The
main explanation for this gap seems to be the fact that 16-year-old girls
are – biologically and socially – more “grown-up” than boys of the same
birth cohort. Additional explanations may of course exist – tobacco
initiation is a complex development where several social, psychological
and other influences are active.
During the last few years there has been a marked decrease of regular
smoking among both boys and girls. At the same time, regular use of oral
snuff has also decreased among boys.
To reach – from these data – the conclusion that “snus use suppresses
smoking among boys”, appears to be a daring exercise. To me, the jump is
far to big.
Paul Nordgren
National Institute of Public Health,
Stockholm, Sweden
paul.nordgren@fhi.se
I certainly agree with most of the comments of Dr Kamal Chaouachi but the need to develop one generic name for the different types of this form of tobacco smoking is definite and we tend to prefer the term water- pipe smoking as it denotes the similarity that links all these forms and shapes and local names. Certainly these different names are associated with local geographical languages and idenified best in the reps...
Dear Editor,
We wish to draw your attention to some misconceptions in the following study:
Rima AFIFI SOWEID. Lebanon: water pipe line to youth. Tobacco Control 2005;14:363-4.
>"In Lebanon, youth and women are the target of a marketing campaign featuring a new tobacco product for use with the more traditional water pipe."
The caption for the embedded picture is a an erroneous int...
Prochaska and Velicer have commented on this trial(1), and, having been alerted to this comment elsewhere, we feel we need to respond belatedly. They suggest the study had important flaws but do not name them. We drew attention to those flaws in the conduct of the study in the report. The major flaw was that midwives in the control arm were less enthused about the intervention and complied with the protocol less well,...
As Professor Chapman has noted some have questioned the merits of publishing papers that the tobacco industry funded. In the spirit of Justice Brandeis who noted that, “Sunlight is the best disinfectant” I believe that more not fewer tobacco industry consultants opinions should see the light of day. For example I believe that court room opinions offered under oath, by tobacco hired historians, physicians and others sho...
A reader has enquired about the funding source for this study. It was the the National Cancer Institute of the US National Institutes of Health. SC- Editor
I would like to propose some additions to Carter’s excellent review paper on Tobacco document research reporting. That is a major contribution to tobacco document research (TDR) methodology.
While discussing possible lessons from historical research to TDR Carter mentions the interpretation of facts. Occasionally the difficulty with TDR lies in establishing the facts (e.g. if plans were implemented). One me...
Simon Chapman's pictures on page 367 of the latest Tobacco Control points out that the 7-11 chain of convenience stores in Thailand was refusing to cover their cigarette products as required by the Ministry of Health's requirements on advertising. They are now complying with the regulation and do not have the open display of cigarette products. This means that all retail shops in Thailand are no longer displaying any...
Since my original publication in 1995 reporting high rates of denial of smoking in Japanese women,1 and Prof Yano's alternative assessment of the evidence,2 there has been an ongoing correspondence between the two of us.3-6 In his latest letter6 Yano asks whether my paper1 should have been published because it suffers from "erroneous interpretations based on invalid measurements."
My calculations critically depe...
Nathan K Cobb raises an important point. This paper has been reviewed by the Centre for Reviews and Dissemination [1], which provides critical assessments of the quality of economic evaluations. They raised this issue along with some other noteworthy points relating to the costs of the program. Specifically, the costs and the quantities were not reported separately, which limits the generalisability of the authors' results...
In the latest issue of Tobacco Control, Radu and others report on tobacco use among Swedish schoolchildren (Tobacco Control 2005;14:405- 408). As a Swede, I was surprised to read about some of their findings.
Children who smoke daily or almost daily are defined as “regular smokers”. The percentage of regular smokers is reported to have decreased to 4 per cent among 16-years-old boys and 15 per cent among girls by...
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