I was interested to note the links between the tobacco and gambling
industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is
working with Healthy Buildings International (HBI), the indoor air quality
consultancy firm part-funded by the Philip Morris tobacco company.(2)
Previous research has demonstrated how the tobacco industry has used...
I was interested to note the links between the tobacco and gambling
industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is
working with Healthy Buildings International (HBI), the indoor air quality
consultancy firm part-funded by the Philip Morris tobacco company.(2)
Previous research has demonstrated how the tobacco industry has used HBI
to prevent smoke-free workplaces.(3)
It is concerning that at a time when casino employees in the UK are
demanding smoke-free workplaces their employers are (knowingly or
unknowingly) working with a firm linked to the tobacco industry. But at
least we now know of this link, as do the Trade Union representatives who
are working with these casino companies. Hopefully the unions can use
this information to neutralise any influence the tobacco industry may have
had.
Yours faithfully,
Paul Pilkington
References
1.Hedging their bets: tobacco and gambling industries work against
smoke-free policies Tob Control 2004; 13: 268-276
2. Correspondance between Neil Goulden, Group Managing Director Gala
Group and Paul Pilkington, 1 March 2004.
3. Drope, J, Biolous, SA and Glantz, SA. Tobacco industry efforts to
present ventilation as an alternative to smoke-free environments in North
America, Tobacco Control 2004; 13, 41-47.
If blood lipid profile improves and weight increases with smoking
cessation (1) smoking might be causally related to both the development of
an abnormal blood lipid profile and the avoidance of weight gain or even
weight loss. How then might smoking have increased the risk of non-fatal
myocardial infarction in this study (2)? By reducing the capacity to
respond to reductive stress with a further increase in the degree of...
If blood lipid profile improves and weight increases with smoking
cessation (1) smoking might be causally related to both the development of
an abnormal blood lipid profile and the avoidance of weight gain or even
weight loss. How then might smoking have increased the risk of non-fatal
myocardial infarction in this study (2)? By reducing the capacity to
respond to reductive stress with a further increase in the degree of blood
lipid shift (3)?
The answer may lie in the next step in respoding to a progressive
increase in the degree of reductive stress. If this is reverting to
glucose as the preferred substrate for anaerobic glycolysis that would
mean reversing the increase in nutrient energy density achieved by the
antecedent lipid shift. In the case of an acute reductive stress
equivalent to 25% of dysoxia that could mean having to increase a cardiac
output of 4.7L/min that had been able to meet the tissues needs to as much
as 16.2 L/min to achieve the same objective. A cardiac output of that
magnitude is far in excess of the cardiovascular capacity of even a
healthy fit athlete.
There is another possibility. Anaerobic glycolysis might be averted
after the capacity for increasing nutrient energy density per unit volume
of flowing blood had plateaued by using amino acids for acetyl coenzyme A
synthesis in providing the substrate needed for oxidative phosphorylation
to proceed at the rate needed to meet the tissues needs for ATP
resynthesis at the time(4). But if NH3 is produced in the process the pH
could rise inhibitng oxidative phosphorylation and stimulating anaerobic
glycolysis and with it the demand of glucose(5). This too could incease
the demand for ATP resynthesis far in excess of the cardiovascular
capacity to meet the tissues energy needs.
Smoking might, therefore, have increased the risk of non-fatal
myocardial infarction in this study by limiting the capacity for
accommodating an acute reductive stress with a blood lipid shift and
increasing the likelihood of acute cardiovascular decompensation. In which
case smoking cessation can be expected to eliminate that risk once the
blood lipid profile had been restored to normality even though weight was
gained. What is more the gain in weight might be a compensatory response
that enhanced the capacity to mount a lipid response to acute reductive
stress. In other words a blood lipid shift revealed in blood lipid
profiles may conceal the real capacity for mounting a fatty acid response
to acute reductive stress.
If it is the capacity for mounting a fatty acid rsponse rather than
a shift in blood lipid profile per se that is the primary determinant in
meeting the metabolic demands of an acute reductive stress within
cardiovascular capacity then it may be compromised by the administration
of statins. Not only might the size of the mobile pool of fatty acids be
reduced by statins by the ability to release it in a timely manner in
acute reductive stress might be reduced by an accompanying reduction in
the capacity for steroid hormone synthesis. In which case the risk of non-
fatal acute myocardial infarction might be greatest in smokers taking
statins or even confined to them.
1. Botella-Carretero JI, Escobar-Morreale HF, Martin I, Valero AM,
Alvarez F, Garcia G, Varela C, Cantarero M. Weight gain and cardiovascular
risk factors during smoking cessation with bupropion or nicotine.
Horm Metab Res. 2004 Mar;36(3):178-82.
2. M S Mähönen, P McElduff, A J Dobson, K A Kuulasmaa, and A E Evans
Current smoking and the risk of non-fatal myocardial infarction in the WHO
MONICA Project populations
Tob Control 2004; 13: 244-250
3. Successful evolutionary adaptation to environmental stress?
Richard G Fiddian-Green
Heart Online, 14 Jul 2004 eLetter re: D A Lawlor, G Davey Smith, R
Mitchell, and S Ebrahim
Temperature at birth, coronary heart disease, and insulin resistance:
cross sectional analyses of the British women’s heart and health study
Heart 2004; 90: 381-388
4. Might biochemical fermionic complexities be dictated by antecedent
bosonic simplicities?
Richard G Fiddian-Green (26 August 2004) eLetter re: Rodrigo B.
Cavalcanti
Does perioperative lipid-lowering therapy reduce in-hospital mortality
after major noncardiac surgery?
CMAJ 2004; 171: 328
5. pNH3: a relevant pulmonary variable?
Richard G Fiddian-Green
Chest Online, 11 Aug 2004 eLetter re: pNH3: a relevant pulmonary variable?
Richard G Fiddian-Green
Chest Online, 11 Aug 2004
It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and no...
It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and now, thankfully, it has become a 'Prior Proposal'.
But as the authors say, there is good reason to stop tobacco companies having a free hand to do whatever product engineering they like. They have been given a unique exemption from virtually every law and norm of consumer protection and product safety. It is entirely right to stop them making products much more attractive than they would otherwise be - ie. systematically narrow the terms of the broad exemption they have.
But are there also dangers with the new proposal? If smoking is a behaviour based on seeking satisfaction from nicotine, isn't there a danger that reducing the addictiveness (ie. the pharmacological impact) will mean smokers seeking more nicotine for the same satisfaction? If more nicotine is required, then more toxins would be likely to be absorbed along with it, and so more harm caused.
Is there any evidence that, over time, it has become harder to quit smoking because the products have been engineered to be more 'addictive'? (I realise this might be difficult to gather). Have temporary withdrawal symptoms become more severe over time? These are the real harms associated with the addictiveness itself (as opposed to the co-exposure to toxins), so I think we ought to know what the behavioural changes have been before advocating a regulatory change.
Have all the strategies for subverting regulatory interventions available to smokers who are seeking a nicotine fix been considered...? Breaking off filters, switching to hand-rolled or cigars, compensatory smoking behaviour, bootlegging etc.
I don't know the answers to these questions. But to me, they say "not so fast". An approach to harm reduction that reduces the potency of the drug delivery system must consider the behavioural responses to these modifications, and this seems to me to be even more complex and risky than a more straightforward harm reduction strategy focussed on reducing toxins (which is probably pointless for combustible tobacco anyway).
Finally, is reducing addictiveness always right? If you could find a way to increase the addictiveness of medicinal nicotine or even smokeless tobacco, so that they compete better with cigarettes in nicotine delivery while doing orders of magnitude less harm, you may be able on to something that really would save millions of lives.
McAlister and his co-authors make an extremely valuable contribution
to the ongoing debates of health care costs in the form of their estimate
of the cost efficacy of a telephone quit line. The publication of this
data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to
make broader public health decisions based on these estimates....
McAlister and his co-authors make an extremely valuable contribution
to the ongoing debates of health care costs in the form of their estimate
of the cost efficacy of a telephone quit line. The publication of this
data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to
make broader public health decisions based on these estimates. The
decision not to include the costs from a controlled clinical trial is
undoubtably correct, as they are not generalizable to larger scale
promotion efforts. Most state funded quit lines in operations use multiple
outreach methods, including television, radio, print and physician
outreach to recruit patients into treatment.
To date there have been no estimates published of recruitment costs
into these large-scale quit lines, despite the proliferation of state
programs. This may be due to the fact that it is difficult to break out
costs for recruitment from overall costs for cessation promotion and the
normalization of quitting. None the less, until we have concrete estimates
of the actual cost to recruit participants into such programs it will be
impossible to actually calculate the true cost efficacy.
I am writing in response to the research paper, “Clearing the
airways: advocacy and regulation for smoke-free airlines” by Holm and
Davis, published in the March supplement of Tobacco Control, 2004. While
Holm and Davis present an apparently comprehensive narrative of the events
that lead to the legislative prohibition of smoking in aircraft cabins,
one is left with the sense from their research of...
I am writing in response to the research paper, “Clearing the
airways: advocacy and regulation for smoke-free airlines” by Holm and
Davis, published in the March supplement of Tobacco Control, 2004. While
Holm and Davis present an apparently comprehensive narrative of the events
that lead to the legislative prohibition of smoking in aircraft cabins,
one is left with the sense from their research of “historical documents,
journal and popular press articles, the world wide web and some tobacco
industry documents” that the successful passage of the legislation was due
to clever political maneuvering and the actions of “health advocates”. I
would like to suggest that the flight attendants themselves, as
individuals and members of unions, played a more central role in the
passage of the legislation than was represented by the paper. In fact, the
flight attendants were the critical element in getting congressional
action.
Prior efforts to pass federal legislation on smoke-free worksites had
not found Congress a friendly environment for such bills. One would
therefore question why health advocates had failed to get federal
legislation for smoke-free worksites but were successful in the airlines
case? What was so different about the airline smoking ban case? Holm and
Davis did not answer this question, nor did they bring any insight into
the relationship between the tobacco industry and unions, key players in
this battle. Rather, the paper simply painted a picture of flight
attendants and the Association of Flight Attendants (AFA) as “scenery”,
presenting personal testimonies of their ailments due to years of exposure
to tobacco smoke. Union involvement in the issue is absent from the
discussion and conclusions of this paper. Yet the presence and
participation of the AFA was critical because with the unquestionable
hazards to flight attendants on board, the issue was successfully reframed
as one of “worker health and safety”, rather than the industry’s approach
of “smokers’ rights” and accommodation.
The AFA has had a long history of concern over air quality in
aircraft cabins. The AFA reasoned that advocating for smoking bans was an
avenue to bring forth flight attendant health and safety concerns, since
they feared that “without the intervention of Congress, the National
Academy of Sciences study [on Cabin Air Quality] will end up on one of the
(FAA’s) burners that is so far back you cannot even tell if it is on.”(1)
The authors of this paper attribute the defeat of the tobacco
industry to (i) the industry’s limited leverage over the CAB and FAA, (ii)
their inability to mobilize on a grassroots level and (iii) the lack of
scientific basis to support their position. Absent from Holm and Davis’
discussion is the key role that the AFA played in thwarting industry
efforts to win allies within organized labor. Industry documents reveal
years of strategizing to woo organized labor and in the airlines case, the
AFA and the Air Line Pilots Association (ALPA). The industry had actually
underestimated the power of the flight attendants as they were duly warned
in 1993 in light of smoking bans in bars and restaurants that “an anti-
smoking position developed by HERE (Hotel Employees and Restaurant
Employees International Union), similar to that adopted by the Association
of Flight Attendants could present a major setback. However, HERE as an
ally in this effort, would be a very powerful voice.”(2)
Holm and Davis conclude that the “single-issue focus” in advocacy
work should be a lesson for future health advocacy work. The ownership of
this success is debatable and, perhaps a more important “lesson” to
reflect upon is how a single-issue focus in this instance has helped to
create an alliance between health advocates and unions, while this has not
always been the case. Perhaps a more valuable lesson is that unions are
key players in tobacco policies in the workplace and that health advocates
must consider how this coalition may be strengthened in future battles
over workplaces such as restaurants and bars.
Charles Levenstein, Ph.D., M.Sc.
Professor Emeritus of Work Environment Policy; and
Co-Director, Organized Labor and Tobacco Control Network
University of Massachusetts Lowell
Lowell, MA
References
1. Achenbaugh N, Finucane M. FAA Should Create An Office To Address
Crewmember And Passenger Health. R.J. Reynolds. September 19, 1986. Access
Date: October 23, 2002. Bates No.:506294126/4131. URL:
http://legacy.library.ucsf.edu/tid/hje71d00.
2. Ogilvy Adams & Rhinehart, Savarese and Associates. Restaurant
Smoking Ban Strategy. Tobacco Institute. August 23, 1993. Access Date:
July 8, 2003. Bates No.:TI01621153/1159. URL:
http://legacy.library.ucsf.edu/tid/cyr30c00.
I have recently completed a doctoral thesis exploring the
epistemological challenges associated with the inclusion of health
promotion in medical undergraduate education.
Those challenges reflect the dilemmas associated with teaching about
smoking cessation. It is in fact only recently that the UK NHS plan has
suggested a consistent approach for the delivery of smoking cessation
services and previous to that th...
I have recently completed a doctoral thesis exploring the
epistemological challenges associated with the inclusion of health
promotion in medical undergraduate education.
Those challenges reflect the dilemmas associated with teaching about
smoking cessation. It is in fact only recently that the UK NHS plan has
suggested a consistent approach for the delivery of smoking cessation
services and previous to that there had been a lack of consensus about not
only about how to respond to and support the smoker who wants to stop but
also whether or not such a provision should be part of the clinicians’
role.
Intervention is the essence of health promotion activity but its
evidence base has been contested, the theories underpinning and informing
activity are eclectic and few clinicians will have engaged with this
discipline in any depth.
For educationalists the inclusion of health promotion, and
specifically smoking cessation, in curricular content has been fraught
with difficulties and your findings reflect this. However based on my
ethnographic research findings I have constructed a new working definition
of health promotion which should assist both medical educators and medical
teachers in the development of the learning outcomes and objectives as
well as the approaches to assessment. The definition is as follows; Health
promotion is the study of, and the study of the response to, the
modifiable determinants of health. By using this definition, exploring
what is arguably modifiable as well the evidence base for response or
intervention, medical educators can progress in the generic field of
health promotion teaching as well as the specific field of smoking
cessation (1).
I would argue, however, that those medical teachers, who will be
charged with the responsibility to teach medical students the current
approaches to smoking cessation will need to have the opportunities to
familiarise themselves with, and engage with, the debates associated with
health promotion theories, evidence and practice.
At this medical school we intent to look at the needs of our medical
teachers in this regard and hope to be able to have pragmatic approaches
to assessment by 2007 for senior medical students.
Reference List
(1) Wylie A. Health promotion and medical education; An exploration
of the epistemology and the challenge. King's College, London,
2003.Unpublished
In their e-letter of 19 December 2003, Tomar et al promised that
"Many of the specific comments of Foulds et al. will be addressed in a
subsequent response". No response has since been forthcoming.
Given that Tomar et al's contribution managed to avoid peer review
and to appear in the paper edition of Tobacco Control as apparently the
last word on the subject, I think it is beholden upon them to say what
they...
In their e-letter of 19 December 2003, Tomar et al promised that
"Many of the specific comments of Foulds et al. will be addressed in a
subsequent response". No response has since been forthcoming.
Given that Tomar et al's contribution managed to avoid peer review
and to appear in the paper edition of Tobacco Control as apparently the
last word on the subject, I think it is beholden upon them to say what
they accept and don't accept in the criticisms of their article that
followed on e-TC. Obviously, if competing interests could also be declared
that would be a bonus. I have none.
Sir,
I read with interest the paper by Cains et al. (2004) on the effect of “no
smoking” areas in licensed clubs in the metropolitan area of Sydney. They
found only an insufficient effect of “no smoking” zones especially when
this was only a subsection of the whole room without separation.
In spite of this finding this poor protection of the non-smokers is still
much favoured in the hospitality industry around the world. T...
Sir,
I read with interest the paper by Cains et al. (2004) on the effect of “no
smoking” areas in licensed clubs in the metropolitan area of Sydney. They
found only an insufficient effect of “no smoking” zones especially when
this was only a subsection of the whole room without separation.
In spite of this finding this poor protection of the non-smokers is still
much favoured in the hospitality industry around the world. Therefore I
want to support the Australian findings with our preliminary data from
Vienna, Austria.
The Viennese cuisine is well recognised for tasty and fine meals. But the
pleasure of dinners in restaurants is often diminished because of
environmental tobacco smoke (ETS). Neither innkeepers nor guests seem to
be fully aware of this problem. As part of a larger project (Moshammer and
Neuberger, 2004) we did measure nicotine concentration also in some
restaurants and pubs in Vienna in 2002. Only few (and usually vegetarian)
restaurants are truly “non-smoking” in Vienna. We did select 6 restaurants
of different standards (pubs and cheaper restaurants for the working class
people and more expensive restaurants) with no separation of smokers and
non-smokers and collected nicotine on a filter using a calibrated pump
during lunch or dinner (in total 9 measurements). We also found two
restaurants that provide a “no smoking” area but without functional
separation from the smoking area: One café has declared a few tables near
the entrance as “no smoking” (where the ventilation of the whole room
apparently is mostly via this entrance door) and a restaurant (at the
university hospital) partly separates the dining room into two parts by a
shield that does not reach the ceiling.
In the restaurants with no separation we found nicotine levels
ranging from below 0.1 to 193.1 µg/m³, with an arithmetic mean of 37.1 and
a median of 15.7 µg/m³. The two values obtained in the “no smoking” area
of the café were 17.7 and 43.4 while the only value from the “smoking”
area in the same room was only 15.7 µg/m³.
In the restaurant at the hospital we measured concentrations between 6.8
and 39.5 µg/m³ (mean: 21.8, median: 19.8, in total 4 values) and in the
“smoking” area (with 3 measurements) between 16.8 and 28.6 µg/m³ (mean:
23.1, median: 23.9).
Although we can provide only few spot measurements it seems obvious that
under certain conditions the customers in the “no smoking” area could even
be more exposed than where smoking is allowed. In the other case the
separation at least was not very sufficient. Any differences between the
two areas were less pronounced than day-to day variations or between
different restaurants with no separation at all.
References:
Cains T, Cannata S, Poulos R, Ferson MJ, Stewart BW. Designated “no
smoking” areas provide from partial to no protection from environmental
tobacco smoke. Tobacco Control 2004; 13: 17-22
Moshammer H, Neuberger M. Nicotine and surface of particulates as
indicators of exposure to environmental tobacco smoke in public places in
Austria. Int. J. Hyg. Environ. Health 2004; in press.
The findings presented by Roddy et al. [1] paint a dim picture of
tobacco
training in the UK, but rosier than that in U.S. schools of public health
(SPH).
As part of the Association of Schools of Public Health(ASPH)/American
Legacy
Foundation “STEP UP” initiative, we administered an ASPH survey to the 27
faculty members of the San Diego State University Graduate School of
Public
Health (SDSU GSPH) and also to...
The findings presented by Roddy et al. [1] paint a dim picture of
tobacco
training in the UK, but rosier than that in U.S. schools of public health
(SPH).
As part of the Association of Schools of Public Health(ASPH)/American
Legacy
Foundation “STEP UP” initiative, we administered an ASPH survey to the 27
faculty members of the San Diego State University Graduate School of
Public
Health (SDSU GSPH) and also to 13 members of other departments. We also
reviewed the course catalog, and extramural research records.
Of the 76 classes offered by the GSPH, only 10 addressed tobacco in
any
form. Most of the 10 used tobacco only as illustrations of other content,
such
as research methods. None emphasized tobacco as a serious risk factor, or
control methods. Only two courses offered to the university’s 32,000
undergraduate students included tobacco content, one in health education
and one in psychology. Psychology and nursing had two and three graduate
classes, respectively, that mentioned tobacco. It is unlikely non-
responders
provided tobacco education, and department chairs confirmed this
conclusion.
With over 1,069 full-time equivalent faculty at SDSU, only 11 are
conducting
tobacco research. The GSPH has nine tobacco grants. Two full time faculty
teach most of the classes that include tobacco content, reaching about 35
students/year.
Undergraduate and graduate students have little exposure to tobacco
content
and little opportunity for tobacco-related research training. Similar to
Roddy
et al. [1], the ASPH survey of member schools indicated that about half
included some form of tobacco-related content [2], but few had a strong
tobacco control program.
Physicians leaving medical school feel unprepared to provide tobacco-
related
assistance to patients [3,4,5]. Dental schools may be the exception, yet
leave
considerable room for improvement [6]. Lack of tobacco control training
may
be true of schools of law, business, social sciences, biology and liberal
arts
programs. If so, the vast majority of students are not obtaining basic
education about the risks of or means of controlling tobacco.
The NIH spends about 1% of its research funds on tobacco-related
research,
possibly due to under-representation of tobacco control proposals [7] or
to
under-promotion by NIH. A search of NIH websites produced zero current
RFP/RFAs and zero training opportunities specific to tobacco.
Efforts are under way to increase professional education about
tobacco [8,9],
but extramurally supported programs may not be sustainable without
support from intramural sources. In the face of an industry that actively
undermines tobacco control efforts and that funds legislators, academic
administrators, and investigators in schools of medicine, dentistry,
public
health and basic science departments [10], we challenge university faculty
and academic administrators to dramatically increase the emphasis on
tobacco-control. We challenge tobacco control investigators to more
actively
promote research assistantships, and to make better use of available pre-
and post-doctoral fellowships as a means to recruit and support future
investigators. For one of the greatest public health crises, this is a
tragedy of
academic planning and government support.
References
1 Roddy E, Rubin P, Britton J, on behalf of the Tobacco Advisory
Group of the
Royal College of Physicians. A study of smoking and smoking cessation on
the curricula of UK medical schools. Tobacco Control 2004;13:74–77.
2 ASPH Tobacco Studies Survey 2001-2002. Association of Schools of
Public
Health/American Legacy Foundation. Available online: http://www.asph.org/
document.cfm?page=788. Accessed March 1, 2004.
3 Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in
US
undergraduate medical education. Journal of the American Medical
Association 1999;282:825-9.
4 Khurana S, Batra V, Kim V, Patkar A, Leone FT. Attitudes and
beliefs of
physicians-in-training regarding nicotine addiction and treatment. Chest
2002;122:S9.
5 Teaching Smoking Cessation: An Expert Interview With Vikas Batra,
MD, and
Frank T. Leone, MD. Medscape 12/30/2002. Available online: http://
www.medscape.com/viewarticle/446283?mpid=8129. Accessed April 3,
2003.
6 Weaver RG, Whittaker L, Valachovic RW, Broom A. Tobacco control
and
prevention effort in dental education. Journal of Dental Education
2002;66:
426-9.
7 Hughes J, Liguori A. A critical review of past NIH research funding
on
tobacco and nicotine. Nicotine and Tobacco Research 2000;2:117-20.
8 Tobacco Control in the 21st Century. University of Sydney,
Australia.
Available online: http://www.health.usyd.edu.au/tob21c. Accessed April 3,
2003.
9 Curricular innovation grant abstracts. Association of Schools of
Public
Health/American Legacy Foundation. Available online: http://www.asph.org/
document.cfm?page=791. Accessed March 1, 2004.
10 Chapman S, Shatenstein, S. The ethics of the cash register: taking
tobacco
research dollars. Tobacco Control 2001;10:1-2.
Cains et al., studying the extent to which designated "no smoking"
areas provide protection from environmental tobacco smoke (ETS), conclude
that such areas achieve some reduction in the level of exposure of
individuals to ETS. They indicate an average 53% reduction in nicotine
levels and 52% reduction in PM10 levels. These numbers, although not
marginal, are not sufficient to provide an adequate level of protection....
Cains et al., studying the extent to which designated "no smoking"
areas provide protection from environmental tobacco smoke (ETS), conclude
that such areas achieve some reduction in the level of exposure of
individuals to ETS. They indicate an average 53% reduction in nicotine
levels and 52% reduction in PM10 levels. These numbers, although not
marginal, are not sufficient to provide an adequate level of protection.
It should be added that these numbers probably overestimate the
actual exposure reduction obtained by introducing a division of the space
between a "smoking" and a "no smoking" area. To estimate such a reduction,
one would need to compare exposure to ETS in a situation where smoking is
permitted in the entire space versus the exposure level in the "no
smoking" area when the space is split. This difference is the real measure
of improvement (if any) brought by the introduction of separated areas.
Comparing the exposure to ETS between the "smoking" and "no smoking" areas
after such introduction has taken place is not equivalent. Such comparison
takes as its reference the "smoking area" in which the level of smoking
per unit volume may be much higher than in a space in which smoking is
permitted everywhere. It is indeed reasonable to expect that the "smoking"
area be occupied by a higher proportion of smokers, who probably smoke
more (owing to the social validation of smoking that such an area
provides). This situation may even have over time have a self-exacerbating
effect, since some (light) smokers may prefer to go to the "no smoking"
area as even they get growingly incommodated by the high level of ETS in
the "smoking" area.
Dear Editor,
I was interested to note the links between the tobacco and gambling industries outlined by Mandel and Glantz.(1)
I have recently discovered that at least one UK casino company is working with Healthy Buildings International (HBI), the indoor air quality consultancy firm part-funded by the Philip Morris tobacco company.(2) Previous research has demonstrated how the tobacco industry has used...
If blood lipid profile improves and weight increases with smoking cessation (1) smoking might be causally related to both the development of an abnormal blood lipid profile and the avoidance of weight gain or even weight loss. How then might smoking have increased the risk of non-fatal myocardial infarction in this study (2)? By reducing the capacity to respond to reductive stress with a further increase in the degree of...
McAlister and his co-authors make an extremely valuable contribution to the ongoing debates of health care costs in the form of their estimate of the cost efficacy of a telephone quit line. The publication of this data should provide new evidence to convince payors to cover cessation.
However, since recruitment costs were excluded, it is difficult to make broader public health decisions based on these estimates....
Dear Editor,
I am writing in response to the research paper, “Clearing the airways: advocacy and regulation for smoke-free airlines” by Holm and Davis, published in the March supplement of Tobacco Control, 2004. While Holm and Davis present an apparently comprehensive narrative of the events that lead to the legislative prohibition of smoking in aircraft cabins, one is left with the sense from their research of...
I have recently completed a doctoral thesis exploring the epistemological challenges associated with the inclusion of health promotion in medical undergraduate education.
Those challenges reflect the dilemmas associated with teaching about smoking cessation. It is in fact only recently that the UK NHS plan has suggested a consistent approach for the delivery of smoking cessation services and previous to that th...
In their e-letter of 19 December 2003, Tomar et al promised that "Many of the specific comments of Foulds et al. will be addressed in a subsequent response". No response has since been forthcoming.
Given that Tomar et al's contribution managed to avoid peer review and to appear in the paper edition of Tobacco Control as apparently the last word on the subject, I think it is beholden upon them to say what they...
Sir, I read with interest the paper by Cains et al. (2004) on the effect of “no smoking” areas in licensed clubs in the metropolitan area of Sydney. They found only an insufficient effect of “no smoking” zones especially when this was only a subsection of the whole room without separation. In spite of this finding this poor protection of the non-smokers is still much favoured in the hospitality industry around the world. T...
The findings presented by Roddy et al. [1] paint a dim picture of tobacco training in the UK, but rosier than that in U.S. schools of public health (SPH).
As part of the Association of Schools of Public Health(ASPH)/American Legacy Foundation “STEP UP” initiative, we administered an ASPH survey to the 27 faculty members of the San Diego State University Graduate School of Public Health (SDSU GSPH) and also to...
Cains et al., studying the extent to which designated "no smoking" areas provide protection from environmental tobacco smoke (ETS), conclude that such areas achieve some reduction in the level of exposure of individuals to ETS. They indicate an average 53% reduction in nicotine levels and 52% reduction in PM10 levels. These numbers, although not marginal, are not sufficient to provide an adequate level of protection....
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