Random Nature #191

Healthier People:  A few years ago, the U.S. set an unrealistically ambitious goal of reducing the percentage of American adults who smoke to 12 percent by 2010.  According to the CDC, we hit a record low last year.

The agency reported that 43.4 million U.S. adults smoked in 2007, or 19.8 percent, compared with 45.3 million in 2006, or 20.8 percent. The rate essentially was unchanged from 2004 through 2006.

The peak of U.S. adult smokers was 53.5 million in 1983, according to U.S. government figures.

The number of adult men who smoke still exceeds women -- 22 percent of men smoke, compared with 17.4 percent of women. The number of white adult smokers was 21.4 percent, compared with 19.8 percent for blacks and 13.3 percent for Hispanics.

The report also found that the percentage of everyday smokers who have tried to quit smoking has dropped from 47 percent in 1993 to nearly 40 percent in 2007. Older smokers were less likely to quit than those ages 18 to 24.

We hear a lot about tobacco companies targeting blacks and Hispanics.    

Despite the many ads for gum, patches, etc. to help people quit smoking, roughly 80 percent of those who quit do so cold turkey.  The CDC study also included stats on how many people who wanted to quit did so for at least a day.  It confuses things to call that quitting.  Obviously though, the best way to lower smoking rates is to keep people from starting. 

Matthew Myers, the executive director of the Campaign for Tobacco-Free Kids, used the study's results to push again for Food and Drug Administration regulation of the tobacco industry.

Myers also focuses on a significant increase in federal and state-tobacco taxes to reduce the number of adult smokers. There is growing expectation that Congress will pass early next year an expansion of the State Children's Health Insurance program, financed primarily through a 61-cent increase in the federal excise tax on cigarettes.

Oregon has certainly been down that road.  If the feds are going to significantly increase the price of cigarettes, one would hope that they'd also boost the enforcement of smuggling, tax-free sales over the internet, tax avoidance via Indian reservations, etc.  And let's not forget the downside of funding children's health insurance with a revenue stream that's supposed to decline.   

Repeat Business:  We've been hearing for awhile now that cigarettes are getting stronger.  For example...

A report published by the Massachusetts Department of Public Health in 2006 found that levels of nicotine in most cigarettes rose by nearly 10 percent from 1998 to 2004.

Okay, but measurements of nicotine addiction tend to be rather imprecise.        

The researchers examined nicotine dependence levels of about 600 smokers who entered treatment programs in northern California to quit smoking during three periods starting in 1989 and ending in 2006.

Seventy-three percent of those seeking medical help to quit smoking in 2005 to 2006 were deemed highly nicotine dependent using scores from a questionnaire given to assess the severity of nicotine addiction, the researchers said.

That compares to 55 percent of those seeking such help from 1989 to 1990 and 66 percent of those seeking treatment in 1994, Dr. David Sachs of the Palo Alto Center for Pulmonary Disease Prevention in California told a meeting of the American College of Chest Physicians.

That's a self-selected group of folks who are subjectively evaluating their own addiction.  Nonetheless over the last several years, there has been an increase in the amount of nicotine that a cigarette delivers. 

...Harvard researchers were able to ascertain how cigarette manufacturers accomplished the increase—by both intensifying the concentration of nicotine in the tobacco and design modifications that increased the number of puffs per cigarette. The end result, says the researchers, is far more addictive cigarettes.

The brands that showed the greatest increase in the amount of nicotine delivered were Camel, Doral, and Newport.  Marlboros didn't change over that period, but were still higher than average.  Note that cigarette manufacturers have been adding ammonia compounds to cigarettes for decades to boost the amount of nicotine they deliver.  For instance, R.J. Reynolds did so to compete with Marlboros and their higher nicotine content.  And when it comes to the lower end of the market, additives can help cheaper tobaccos deliver the jolt of higher-priced cigarettes.  Raising the pH also helps boost nicotine delivery.

Menthol is often thought of as a flavoring, but smokers of menthol cigarettes seem to find it harder to quit.  It's known that menthol eases the harshness of cigarettes, making it easier for young people to adopt the habit and become addicted.  But why it's harder to quit menthol cigarettes is not well understood.  Speaking of targeting, 75 percent of African Americans but just 25 percent of whites smoke menthols.  

The Art of Persuasion:  Tobacco companies have long been some of the world's most savvy advertisers.  That's why it never made sense to force them to run ads discouraging people from smoking...they have a much better understanding of what is and isn't particularly effective.  

Understandably, there have been a number of studies in recent years to determine what types of anti-smoking and smoking-cessation campaigns offer the best chances of success.  Here are a few examples, starting with this link.

Experts repeatedly warn that advertising that works with adults generally will not work with teens. Youth advertising is more effective when “this subculture is addressed in a language it understands and appreciates.” In advertising, a “one size fits all” approach is widely recognised as unsuitable.  Specifically, when targeting adolescents, officials should consider using spokespeople who are just slightly older than the intended audience.  In addition, the following message themes should be examined seriously, since they seem to have the greatest potential for dissuading youths from smoking: second-hand smoke, smoker as negative role model, refusal skills, and deceptive portrayal of a lethal product.

It also seems important to mount a relatively homogeneous or focused campaign. ... Pretesting advertisements with the target audience should minimize the likelihood of running spots that are poorly understood, viewed as irrelevant, or lacking in credibility. 

And the authors also recommended conducting outcome studies.  That would seem to be obvious, but governments often implement programs without setting up a means to measure results.  As the following notes, ineffective advertising can be counterproductive.

The researchers surveyed students in four middle schools about their exposure to anti-smoking ads and their intentions to smoke. They found that, overall, the more the students were exposed to anti-smoking messages, the more inclined they were to smoke. The exception--where exposure to anti-smoking ads correlated with a reduced intention to smoke--occurred among students who said their friends were influenced by anti-smoking messages.

...

"Anti-smoking ads have the greatest impact on smoking attitudes and behavior when adolescents think that their peers are listening to those messages," Paek said. "And that makes sense because people are more likely to listen to what their close peers say rather than what the media says."

...

Her results suggest that campaigns don't work by convincing individuals to avoid tobacco, but rather by helping change the social norms surrounding smoking. With that in mind, she said, campaigns should be designed for a sustained, multi-year effort.

But when it comes to smoking cessation, the more ads folks see, the better.

Using databases on the consumer behavior and magazine-reading habits of 28,303 current or former smokers and advertising data in 26 consumer magazines, Mathios and three Cornell colleagues explored the impact of advertising of smoking-cessation products on quitting decisions.

They found that although some of the increased quitting behavior involves buying smoking-cessation products, just seeing the ads makes it more likely that smokers will try to quit.

Some of these studies have likely been done before by tobacco companies that didn't want us to hear the results. 

More Powerful Than Hunger:  The following quantifies the obvious.

The study found that 23 percent of households with children had at least one smoker, with the incidence higher--32 percent--in low-income households. In those households with a smoker, 17 percent of children were food insecure, compared to 8.7 percent of those children in nonsmoking households. Severe food insecurity was reported for 3.2 percent of children in smoking households, compared to 0.9 percent of those living in households with no smokers.

Because families with at least one smoker spend an estimated 2 percent to 20 percent of their income on tobacco, it's quite likely that smokers' habits drain the money needed to provide adequate food, according to background information with the study.

Parents feel the food pinch themselves, Weitzman said. "They cut back on feeding themselves before they cut back on the children's food," he said. "And parents tend to feed the youngest children better."  

Raising cigarette taxes will exacerbate this problem.  Smoking makes things like school lunch programs more important.