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Chapter three
Entangled threads
Dependency and addiction
e now know that a tobacco company commercially developed a tobacco plant
with twice the nicotine content of standard tobacco, that several
million pounds of this high-nicotine tobacco are currently stored
in warehouses, and that this tobacco was put into cigarettes that
have been sold nationwide. We now know that several tobacco companies
add ammonia compounds to cigarettes, and that one company's documents
confirm that the intended purposes of this practice is to manipulate
nicotine's delivery to the smoker. And we now know that some in
the industry have identified target ranges of nicotine delivery
these findings lay to rest any notion that there is no manipulation
and control of nicotine undertaken in the industry.
David Kessler
Commissioner of the Food and Drugs Administration
Testimony before the Congressional Subcommittee on Health and
Environment, 1994.
***
The prevalence of smoking among adults varies from over 40% in the Russian Federation and
just under 40% in Denmark, Greece, Hungary, Latvia and Poland
to around 25% or less in Belgium, Croatia, Finland, San Marino and Sweden. The total prevalence figures mask considerable
differences between the sexes, however. Smoking rates among men
are particularly high, i.e. >50% in Armenia, Estonia, Latvia, Lithuania, Poland, the Republic of Moldova, the Russian Federation, Turkey and most likely Ukraine, and as low as 22% in Sweden, 28% in the United Kingdom
and 29% in Ireland. Highest prevalence rates among women appear
to be in Denmark and Hungary with 37% each and Norway 36%. Several
countries, including Albania, Armenia and Uzbekistan, have a prevalence of about 10% or less among women.
Of the 36 countries for which there is some indication of trend,
prevalence overall appears to be increasing in about 15 (predominantly
in the central and eastern part of the Region), decreasing in
another 14 (predominantly in western Europe), and stable in about
6 or 7 from the same areas.
While prevalence among women is generally lower than among men,
it appears to be increasing in about 15 countries -Armenia, Austria, Bulgaria, Estonia, Georgia, Greece, Hungary, Latvia, Lithuania, Malta, Portugal, Romania, the Russian Federation, Spain and the Former Yugoslavia.
Who Regional Office for Europe, 1997.
***
China, the world's most populous country is also the world's leading
consumer of cigarettes...[T]he growth in estimated per capita
consumption of cigarettes has been particularly rapid, increasing
by 260% from the early 1970s to the early 1990s, with consumption
estimated at around 1,900 cigarettes per adult per year. In China
there are about 300 million smokers, about the same number as
in all developed countries combined.
WHO Fact Sheet N118, 1996.
***
Researchers say the consumption of low-tar brands is behind a
surge in cancers, called adenocarcinomas, which attack the deepest
areas of the lungs.
The disease is spurring "a new lung carcinoma epidemic, chiefly
attributable to the switch to low-tar, filtered cigarettes," concludes
a study led by Dr Fabio Levi of Switzerland's University of Lausanne.
The study is published in the March issue of the journal Cancer.
"To satisfy a craving for nicotine, a smoker of low-yield filtered
cigarettes tends to compensate by increasing the number and depth
of puffs"--causing carcinogens to reach deeply into the smallest,
and most vulnerable lung tissue.
Reuters Health Information Services, March 1997.
Disposition
person who has not started smoking as a teenager is unlikely ever to become a smoker.
Many young people progress steadily from experimentation to regular
use, with addiction taking hold in a few years. Young people are
the tobacco industry's primary source of new customers in the
USA.
As the prevalence of adults in the US has declined, the prevalence
among adolescents has remained unchanged. In 1991, 28% of high-school
seniors had smoked within the previous 30 days, and by 1993 the
figure had increased to 30%. Seven out of 10 young people who
smoke report that they have tried to quit at least once and failed.
Nicotine meets a key criteria for addiction or dependence used
by major medical organisations, and the marketplace for tobacco
products is sustained by this addiction.
UICC, New England Journal of medicine, July 1995.
***
...adults with a depressed mood or major depression are more likely
to smoke and less likely to give up smoking than other adults.
Research shows that adults with a depressed mood or major depression are more
likely to smoke and less likely to give up smoking than other
adults.
Although depression is related to smoking among adolescents or
later in life, it is unclear whether high rates of smoking among
adolescents who are depressed are the result of increased rates
of smoking initiation.
A study assessed the relationship between depression and smoking
initiation among people of Mexican, Puerto Rican and Cuban ancestry
residing in specific geographic areas of the United States. Survey
data were examined to calculate the incidence of smoking by presence
of depressed mood, a history of major depression or both conditions.
The results revealed that depressed mood, a history of major depression
or both conditions were associated with smoking initiation during
childhood, adolescence and young adulthood. The odds ratio for
smoking initiation associated with depressed mood, major depression
or both conditions was statistically significant across developmental
stages. The magnitude of the association between major depression
and smoking initiation increased slightly with increased developmental
age.
The study concluded that the results suggest that the relationship
between depressive states and smoking initiation is established
early in life, and that more definitive studies are needed to
confirm these findings.
Addiction, 91/1, 1996.
****
A study by researchers at the University of Kuopio and the National Public Health Institute
completed in 1995 examined the relationship between cigarette
smoking and depressive symptoms. The purpose of the study was
to examine the relationship between cigarette smoking and depressive
symptoms in a large community-based population survey by using
multivariate design.
Each year from 1978-1995 an independent random sample (n=5,000)
of the Finnish population (15-64 years) was selected from the
National Population Register. A questionnaire, dealing with health
behaviour was mailed annually to the sample. The response rate
varied from 68% to 86%.
After adjusting for potential confounding factors (age, marital
status, education, alcohol consumption, coffee-drinking, leisure
time physical activity) in multiple logistic regression, the study
found that male smokers were 55% and female smokers 47% more likely
to have depressive symptoms compared with non-smokers."
The conclusion of the study found that cigarette smoking is related
to depressive symptoms with a strong, significant dose-response
factor.
***
"But, hey! It's all part of growing up!"
In the late 1980s cartoonist Garry Trudeau satirised many aspects of the
tobacco industry's machinations with his character Mr Butts. In
one Doonesbury strip Mr Butts is advising young Tommy, who can't
get the knack of smoking. "Hey, relax Tommy!", says the crafty
Butts. "Every kid goes through the same thing...Here give it another
go! Oops! You lit the wrong end. Hee, hee! What a dork!
But, hey! It's all part of growing up!"
***
Professor Arja Rimpelä of Tampere School of Public Health has studied the issue of social
class and health behaviour among Finnish young people, and presented
some of her finding to the Smokefree Europe conference.
According to Prof. Rimpelä, the origins of social class have two
main aspects: social origin and achieved social class. The latter
is the social position young people attain through educational
and occupational careers.
"We studied the relationship of achieved social class with health
damaging behaviour at the ages of 16 and 18....Clear connections
with risk-taking behaviour were observed. The lower the predicted
social position in adulthood, the higher the probability of health-damaging
behaviour. The connection with smoking was the most prominent
and even linear. Social class by origin was only weakly related
to addictive, health damaging behaviour."
Hooks and triggers
t the top end of the market, consumers pay considerable attention to issues
such as the level of detail and print quality of the cigarette
die and the intricacies of the embossing on the pack design...For
many smokers, particularly young adults, the requirement is for
a less ornate presentation which reflects the way in which these
individuals wish to present themselves to the world and to be
seen by their peer group."
Ian Maitland, Regional Chief Executive, Rothmans of Pall Mall
UK, at the World Tobacco Symposium, Moscow 1996.
***
...Philip Morris purchased 22 exposures of the Marlboro logo in
the movie of the children's comic sci-fi hero.
In the 1980 movie Superman II, Clark Kent's admirer Lois Lane lights up a cigarette,
and then another, and then another--even though in the 50 years
of comic book appearances made by Lois she never once smoked.
For a reported payment of $42,000, Philip Morris purchased 22
exposures of the Marlboro logo in the movie of the children's
comic sci-fi hero.
***
Studies show that tobacco advertising and promotion are especially effective with young
people. The [US federal] Centres for Disease Control found that
86% of underage smokers buy one of the three most heavily advertised
brands: Marlboro, camel or Newport. In 1992 the cigarette industry
spend $5.2bn on advertising. Only the automobile industry spends
more on advertising in the US. One tobacco firm set up an YAS--Young
Adult Smoker--programme targeting retail shops frequented by young
people.
Adapted from the New England Journal of Medicine, July 1995.
***
Teens were asked to describe in their own words (unaided) why teenagers choose
or are attracted to certain brands of cigarettes. Each quarter
of the sample was given one cigarette brand to discuss. The four
brands that were probed included: Marlboro, Camel, Virginia Slims
and Newport.
Across all four brands, the top three reasons given for teen attraction
to a cigarette brand were: advertising 25.9%, friends smoke the
brand 15.5%, to be cool 9.9%.
Teens' unaided responses reflected the different marketing positions
of the cigarette brands. This indicates that their responses did
not refer to generic promotion but that key benefits promoted
by the cigarette brands are reaching and being understood by teens.
For example, they described the benefits of Virginia Slims as
"to be thin" or "feminine", or "glamorous".
These attributes were not associated with Marlboro or Camel cigarettes.
The former elicited responses such as: "macho/look tough" and
"get free stuff".
Survey by Campaign for Tobacco-Free Kids, 1997.
***
Joe Camel does Vegas. No, its not an adult movie title. It's the latest advertising
campaign from RJ Reynolds, makers of Camel cigarettes. The slick
ads feature the cartoon camel gambling in Las Vegas, belly dancing
and attending a laser show. The promotion includes free concert
tickets, trips to Las Vegas parties, and Camel cash to buy everything
from watches to CD players. Not to be outgunned, Philip Morris,
the company behind the Marlboro Man, gave away five-day train
rides through western states.
Tobacco-Free Kids press release, December 1996.
***
More than 90% of six-year olds match Joe Camel with a picture of a cigarette,
making him as well known as Micky Mouse. Since the introduction
of Joe Camel, the number of children who smoke Camels has increased
by a factor of 50, representing a $476 million increase in annual
sales for RJR Nabisco.
Adbusters, USA, May 1997.
***
There is no evidence that smoking promotes physical health. Its benefits appear to
be psychological and social and are hard to express in quantitative
terms. Many smokers have written eloquently of the assuagement
of irritation and anxiety, the cementing of friendship and the
promotion of human intercourse by the "azure vapour" of tobacco.
The social value of smoking is widely endorsed.
Smoking and Health, Royal College of Physicians of London, 1962.
Horizons
All health care personnel and clinicians should repeatedly and
consistently deliver smoking cessation programmes to their patients.
n many developing and transitional countries, the tobacco industry is no longer
controlled by government monopolies, but by transnational tobacco
companies (TTCs) overtly committed to market expansion. The TTCs
will point out the economic growth and employment that are consequences
of their investments in the country. However, it is often the
case that although a few new factories will recruit employees,
other less efficient factories will be closed down, or employees
will lose jobs due to increased automation of cigarette production.
Additionally, profits form the production will go back to the
tobacco multinational's home country rather than benefiting the
local economy.
WHO, Tobacco Alert, 1997.
***
All health care personnel and clinicians should repeatedly and consistently deliver
smoking cessation programmes to their patients. Smoking cessation
interventions should be delivered by as many clinicians and types
of clinicians as is feasible given available resources.
Smoking Cessation, Clinical Practice Guide Number 18, US Dept.
Of Health and Human Services, 1996.
***
Customs and excise ministries or departments can assist tobacco control efforts
immensely. They can provide information on smuggling and working
with health bodies on the development of anti-smuggling measures,
such as prominent and non-counterfeit able tax markings. Successes
in this realm will ensure that governments do not lose important
tax revenues to smuggling.
WHO, Tobacco Alert, 1997.
***
The evidence suggests that demand for cigarettes is sensitive
to price in all age groups.
Raising the price of tobacco leads to a reduction in consumption. Estimates of
the effects of price on demand--otherwise known as price elasticity--generally
lie between -0.3 and -0.6. This means that if price rises by 10
per cent, there will be a drop of between 3 per cent and 6 per
cent in consumption below the level which would otherwise be seen...
Most smokers take up the habit before they are 20. This means
that any strategy to reduce smoking must include measures to deter
young people. The evidence suggests that demand for cigarettes
is sensitive to price in all age groups. One US study [Lewit,
Coate and Grossman, Journal of Law and Economics, vol XXIV, 1981]
found that the price elasticity of demand for cigarettes amongst
12-17 year olds was as high as -1.4. Real increases in price can
therefore be expected to reduce teenage smoking.
The Importance of Price in Reducing Tobacco Consumption, Department
of Health, UK, 1994.
***
Tobacco use is increasingly recognised as an environmental issue. In many
regions of the world, trees are being cut down so that they can
be used in the curing of tobacco.
WHO, Tobacco Alert, 1997.
***
For the non-smoker the benefits from smoke-free environments cannot be overemphasised.
For smokers the extension of smoke-free environments means less
opportunity to smoke, and consequently, less risk for negative
health effects.
Gunnar Ahlborg, Director of Örebro Medical Centre
Hospital, Sweden.
***
Every smoker undergoing relapse prevention should receive congratulations,
encouragement, and a statement of concern on the part of the clinician
that the patient remain abstinent.
Smoking Cessation, Clinical Practice Guide Number 18,
US Dept. Of Health and Human Services, 1996.
***
The doctor who smokes will inevitably lessen the effect of any campaign of public
education concerning the consequences of the habit and will find
it harder to help his patients who need to stop smoking.
Smoking and Health, Royal College of Physicians of London, 1962. n
Smoke Free Europe - A Forum for Networks - 14 AUG 1997[Next] [Previous] [Up] [Top] [Contents] [Index]