Doctors Controlling Tobacco

Here is an exerpt from a recent article at "The Heart.org". It tells of how physicians should be on the front lines of tobacco control, effectively forcing change from within - both from a political and cultural standpoint. It is an interesting read. Click over to The Heart for the entire article.

It's no coincidence that the small South American country of Uruguay had a physician as president when it began implementing some of the strongest tobacco-control policies in the world five years ago. Dr Tabaré Vásquez, an oncologist, became president there in 2005 and proceeded to turn the nation of just 3.5 million people into a leading example of how to try to curtail cigarette consumption.

He achieved this through methods that are widely acknowledged to work by those advocating for global tobacco control: banning smoking in public places; increasing taxation on and subsequently the price of cigarettes; banning advertising, sponsorship, and promotion by tobacco companies; restricting the use of misleading words on cigarette packs; and making smoking-cessation programs and products widely available.

But the tobacco industry fought back, with Phillip Morris bringing an international lawsuit against the government there, "not because Uruguay is an important market but because its policies could spread over the world," explained Dr Walter Reyes Caorsi (Casa de Galicia Hospital, Montevideo, Uruguay) during a session on global perspectives on tobacco control at the recent American Heart Association (AHA) 2011 Scientific Sessions. Although Vásquez is no longer president of Uruguay, his successor, José Mujica, says he plans to continue the strong tobacco-control policies established by his predecessor.

Next in line to face the wrath of this industry—and a widely expected lawsuit—is likely the Australian government, which is hoping to enact, by the end of this month, a law that stipulates that cigarettes can be sold only in plain packaging.

Effectiveness of Stop Smoking Ads

Stop smoking ads can be very useful in an effort to educate the general public about the hazards of tobacco use. I still remember having conversations with my parents about smoking after we saw an advertisement on the television. My dad, who smoked, told me smoking was bad and we shouldn't do it. He reinforced the message given on the advertisement. Eventually, he quit cold turkey while I was in college. He later told me that was one of the best decisions he had ever made.

Recently, I blogged about how there were talks of putting graphic pictures on cigarette packaging. People with stomas, oral cancer, etc. The thought process was that the graphic picture warning on the packaging would be more effective than the standard textual "Surgeon General's" warning.

In Australia, they brought these two ad campaigns together. A recent study from Brennan and others in the Tobacco Control journal, evaluated this synergy of adverstisements in an article entitled "Mass media campaigns desidned to support new pictorial health warnings on cigarette packets: evidence of a compliementary relationship" [2011 Apr 7 - Epub ahead of print].

The authors concluded that there does seem to be a synergy between television smoking cessation advertisements and graphic pictorial health warnings on cigarette packaging. They found a complimentary relationship in raising awareness in a positive way about the terrible health consequences associated with tobacco use. They feel that television or mass media campaigns can improve depth of understanding and  help personalize the "quit for your own health" message.

I think this article also points to the success that can be found within a national advertising smoking cessation strategy. I'm still amazed that we'll spend billions (with a B) of dollars to treat disease, but we won't spend a couple of million for advertising to help spread the message that smoking is bad.

Smoking Prevention in Kids

Stupid Is As Stupid Does

If smokers were honest with themselves, they would readily admit that they don't want their kids to follow them into the cigarette smoking world. I think most people (smokers included) know that smoking is bad for them and those around them. So how can we as a community, help the kids turn away from the culture of smoking?

I remember watching television ads detailing the adverse effects of smoking. Those were great because I was incredibly impressionable and even though my dad smoked, I knew that I didn't want to follow in his footsteps. Except for some very artistic "Truth" commercials, I don't see a lot of public support for anti-smoking campaigns. It seems the stop smoking message is having a difficult time getting published on the American airways.

Interestingly, a study from the Netherlands published in Preventive Medicine, looked at what a public prevention program might look like and gives some insight into the success of such a program. They developed a program that targeted elementary students in 5th and 6th grade. These are ten and eleven year olds who are about to be placed into a junior high school atmosphere where all sorts of peer pressures and experimentations are really at work.

The intervention group received only three anti-smoking lessons in both 5th and 6th grade for a total of six lessons prior to advancing to 7th grade. They discovered the kids in the intervention group had a higher intention not to smoke and, in fact, started to smoke less often than the control group kids who did not receive the lessons. The smoking prevalence increased from 2.5% to 3.6% in the intervention group, whereas, the control group saw a jump from 3.2% to 6.5%.

Understand this is only after receiving 3 lessons in each grade prior to going on to secondary school. Imagine if they had received intensive reinforcement at home or on television. It appears that very little effort can provide large gains in helping children avoid taking that first experimental puff. Interestingly, the study found that girls had the greatest difference in smoking prevalency between the intervention and control group.

What does this mean for us? Well, I think it shows that a well placed conversation with your children over their elementary school days, can provide them with a great foundation for not smoking when they get to junior high or high school. So don't be shy about telling your kids to not smoke. Tell them how bad it is and what the potential consequences are when they're young. It seems they'll remember when their friends are telling them how great it is.

Cigarette Smoke

As if we needed proof that tobacco companies could care less about their customers. First, we learn they controlled the levels of nicotine in cigarettes to keep their customers coming back for more. Lawsuits were everywhere and "big tobacco" became associated with the dark underbelly of big business.

There has been speculation for some time now, that smoking has become predominantly a poor man's habit. Oh sure, there are lots of rich people who smoke, but the lionshare of their customer base are of lower socio-economic means. In fact, this could be directly correlated with the level of education achieved by the worldwide smoking community, which is pretty low.

For a long time now, we've known that the more education a person has, the less likely they are to either smoke in the first place or continue to smoke without attempting a cessation program. The journal Public Health evaluated cigarette emissions from a variety of cigarettes which could be purchased in 10 different countries. They wanted to see if the tobacco producers modified their products based on the overall economic standing of the country and its residents. The study showed what you would expect: the higher a country's income, the better and cleaner engineered the cigarettes were and hence, the poorer and less educated you were, the more toxic the cigarette.

So before you buy that pack of cigarettes from a poor country, you might want to think twice. It very likely has many times more the cancer causing agents than your standard US pack.

It's a shame smoking has become such a curse on the lower socio-economic citizens of this world. The poor and uneducated just don't seem to have a chance. Add to this that smoking is such a vital part of their culture, passed on from parents to children. I'm not a real advocate for government telling business what to do, but in this case of the public health, why wouldn't they step into the fight and require more from the producers or at least help educate the poor? If for no other reason than so they can sleep at night.

To keep this from becoming a political conversation, I'll stop there. For those who dislike tobacco control programs, remember this blog entry and ask yourself who is looking out for the little guy?