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| Issue 84 | 20 February 2008 |
Having trouble viewing this newsletter? Try the online version. FROM THE DIRECTOR'S DESK
"[It is] not a 'gay science,' I should say, like some we have heard of; no, a dreary, desolate and, indeed, quite abject and distressing one; what we might call, by way of eminence, the dismal science."1 I have been following the debate between Senior Lecturer Eric Crampton and others in the New Zealand Medical Journal about the research commissioned by the Smokefree Coalition (partnered by ASH) on the effects of taxation on tobacco products in New Zealand. Crampton contends in his article that desired outcomes informed the research. In other words the results were predetermined. This taxation study was publicly tendered and while there were two expressions of interest in doing the work, only one group of researchers finally submitted a proposal. I must admit to being a bit disappointed more interest was not shown. It would perhaps have made a nice piece of work for someone like Senior Lecturer Crampton to supervise as an assignment for a group of his students! Arguing from classic economic theory Crampton takes issue with the emphasis the study placed on addiction and suggests the benefits of smoking are understated. He also suggests benefits accruing to the economy in the form of unclaimed pension entitlements from people who die early are also not calculated. So what of the benefits of smoking? The pleasure derived is the benefit mentioned so let us examine that. I read an interesting article in the Otago Daily Times a while ago about smokers grieving for lost pleasures.2 The 'grief' seemed to be more about the difficulty of getting a nicotine hit than anything to do with smoking being a pleasurable activity. This very matter was the topic of some interesting UK research in 2007. In response to comments made by the UK Secretary of State for Health, Dr John Reid who advanced the 'pleasure' argument (June 2004), the research concluded "...we found no evidence to support the conclusion that smoking is associated with heightened pleasure or with better quality of life. In fact, there is evidence to support the opposite."3 We know from New Zealand statistics that young smokers in particular wish they had never started.4 Once a person is addicted it becomes incredibly difficult to quit. This is where economic theory gets murky. In the marketplace a price increase on an item will generally lead to a drop in consumption (all other things being equal). But with cigarettes this is only partially true. Where a significant increase in price has occurred in New Zealand in the past a reduction in consumption of about .4 to 1 has occurred. This is less than half the consumption drop one could expect from any price increase in a normal market, and it is consistent with international results. This indicates the presence of an addiction factor which overrides typical market forces (i.e., it results in market failure) when it comes to tobacco products. I am sure that Senior Lecturer Crampton would agree that policy makers should be concerned about the consequences of market failure and make some policy intervention when there is a good case for doing so. Does this give us the right to tax cigarettes? Let's look at the facts. Around 5,000 people die in New Zealand each year from smoking, including an estimated 350 who die from passive smoking (second-hand smoke). We do not ignore the burden from road deaths, drowning or suicide, so it makes no sense to ignore deaths caused by smoking. As a matter of philosophy we should provide the signals (market and otherwise) that will encourage a smoker to quit and discourage the smoking curious from starting. Price is a key matter here and, in the New Zealand context, tax is the key determinant of the price of cigarettes. This is a classic issue where policy choices have to be made. In making choices the decision maker has a number of tools. While economics is one, it does not trump all other considerations. The drivers of good public health outcomes carry as much if not more weight in this matter. Have a good fortnight. Mark Peck Director ____________________________________ 1. http://en.wikipedia.org/wiki/Dismal_Science IN THIS ISSUE:
SMOKEFREE COALITION STRATEGIC PLANThe second draft of the Smokefree Coalition's Strategic Plan for 2008 to 2011 is online for your perusal and comment. Heavy emphasis has been placed on 'denormalisation' and greater efforts being made on market reform. (See the Gravitas Report.) Members and stakeholders are also reminded about the meeting to be held on 27 February for a final consultation discussion. This is your last chance to register, so those wishing to attend should let Mark Peck know as soon as possible for catering and venue purposes. Please click here for more information. LOOKING AHEAD INTO 2008In this third instalment in our series of articles on the 2008 plans and priorities of tobacco control organisations, we learn about tobacco control research at the School of Population Health, University of Auckland.
Results from the PQNIQ trial (Pre-Quitting with Nicotine Replacement Therapy) are being analysed, with preliminary results to be presented at the Society for Research on Nicotine and Tobacco Annual Meeting in Portland, Oregon, at the end of February. Another pilot study nearing completion is the MINUTE Study, an evaluation of the distribution of personalised letters with NRT exchange cards by mail from general practitioners to people identified as smokers on their practice or PHO databases. Good publicity has ensured fast and full recruitment for the WIRED Study, evaluating pharmokinetics, tobacco withdrawal relief and acceptability of an electronic cigarette. The RASP Feasibility Study is currently recruiting smokers to test whether the changes in various characteristics of their voice when they quit smoking are sufficiently sensitive and reliable to be used for verifying their self-reported claim of not having smoked for at least seven days. CTRU's SONIQ Trial (Nicotine Replacement Therapy Selection Box Trial) is currently recruiting 1400 smokers through the New Zealand Quitline. This will be followed later in the year by the RELIQ trial of reduced nicotine cigarettes as a means of quitting smoking. The New Zealand arm of the International Tobacco Control Study is completing its first round of data collection from a cohort of New Zealand smokers. This study, led by the Wellington School of Medicine and involving researchers from 12 other countries, will provide useful information about the impact of a range of tobacco control policies such as taxation, smokefree laws and cigarette packaging. The STUB IT Trial is a study of the effectiveness of a role modelling and support package delivered via 3G mobile phones to aid smoking cessation, and is currently recruiting participants. Priorities for CTRU are to continue current studies, and further develop links with cessation researchers in Asia with a view to collaborating on trialling cessation interventions among the large numbers of smokers in Asian countries. ATCRC's Keeping Kids Smokefree community intervention (funded by the Health Research Council), designed to reduce uptake of smoking among intermediate school age children by changing parents' attitudes and behaviour, is now in its second year. ATCRC will continue to run informative seminars where results of the various research projects are presented. Judith McCool continues work on her adolescent media survey in which a sample of Auckland year 7 and 8 students are followed up over two years to assess media consumption, exposure to tobacco imagery and social and familial factors' effects on smoking intentions and behaviours. The results of the longitudinal analysis are expected by mid year and will contribute information on how to develop effective media-based interventions to prevent smoking uptake among young people. Judith is also working with Richard Edwards and co at Wellington School of Medicine on a study on second-hand smoke exposure and children. Secondary data analysis and supplementary qualitative data will be used to inform explanatory models on the effects of exposure to second-hand smoke in the home on children's smoking attitudes and behaviours. This is a three-year project funded by the Health Research Council and Ministry of Health. Alistair Woodward is contributing to a Handbook on Tobacco Control, to be published later this year by the International Agency for Research on Cancer, on the effectiveness of smoking restrictions. This work will review smokefree interventions around the world, including the effects on smoking rates, economic impacts, exposure to second-hand smoke, and health outcomes. Clinical Trials Research Unit: https://www.ctru.auckland.ac.nz Keeping Kids Smokefree: WIDER ACCESS TO SUBSIDISED NICOTINE REPLACEMENT THERAPYThe Ministry of Health has expanded access to the subsidised Nicotine Replacement Therapy (NRT) programme. From 1 February, all health practitioners with prescribing rights, including GPs, midwives, dentists, optometrists and nurse practitioners, were automatically included in the Quit Cards (NRT) programme. This means they will be able to distribute Quit Cards to their clients. The move follows the update of the comprehensive New Zealand Smoking Cessation Guidelines, which were published and distributed in August last year. The Guidelines provide evidence-based guidance for health care workers in their contacts with people who smoke tobacco, including information on prescribing NRT. Hard copies of the guidelines are available by calling (04) 496 2277 or emailing moh@wickliffe.co.nz (HP4429). You can also view a copy of the Guidelines at: http://www.moh.govt.nz/moh.nsf/indexmh/nz-smoking-cessation-guidelines?Open. With Quit Cards, smokers can purchase an eight-week supply of nicotine patches or gum for a subsidised cost of between $10 and $20. Later this year it is anticipated the Quit Cards programme will be widened to also include a nicotine lozenge. To order Quit Cards, contact Tracey Pirihi at The Quit Group (email: tracey.pirihi@quit.org.nz). FEAR AND SMOKING IN KAREKARE
I noticed guys surfing in the 70s when I was ten (I'm giving away my age here). Talk about role models! I just wanted to get out there amongst it. Two years later I got my first surfboard – it was straight into the waves near my home town on the west coast of Victoria. I was hooked. Surfing waves, big, scary or small has been my addiction ever since. And I was going to be introduced to another. At 15, still in Australia and with a brain filled mostly with saltwater, I saw Paul Hogan on TV. The soon to be 'Crocodile Dundee' was peddling Winfield Reds with the now infamous catch phrase, "Anyhow, have a Winfield..." I took one look at Mr Hogan in his tuxedo top, bow tie, work shorts and footy boots and said in no uncertain terms, "Ok! I will!" Surfing and my new smoking career ran a happy parallel until the desire to surf saw me run out of cigarettes. On a remote reef break on the edge of the Australian desert I realised I was down to one last smoke. For the next few days I started to learn all about cold turkey, nicotine addiction and withdrawal symptoms. Upon getting back to civilisation, I headed straight back to the Winfields. In the 80s my surfing and tobacco addictions crossed the Tasman. Getting older and wiser, like many smokers, I tried lots of times to quit. Some attempts lasted a few weeks or more, some only for hours. Deep down I knew I wanted to be smokefree, but after a freezing cold four hour surf in the middle of an Aotearoa winter, a cigarette in the car park felt like bliss. By this time I'd been smoking for 20 years (and spent about $35,000 on my addiction in the process) and it wasn't just my finances that had been hit. I was about to learn that my fitness had taken a hammering too. Smoking and surfing collided on a fateful day at Karekare Beach, just south of Piha on Auckland's west coast. I'd had a few decent waves and picked off a good clean right hander, flicking out safely about 50 metres out from the cliff. Being high tide, the cliff was getting a bit of a pounding from the swell – nothing too unusual in this. A friendly rip at the end off the wave just meant a free ride back out to the next wave. Not this day, however. Paddling back out, hoping to gain the rip, the set of the day started to pour up the coast. Wall after wall of white water smashed me backwards, closer and closer to a serious pounding on the looming cliff face. There was only one way out: paddle like hell, duckdive the wall of water and no matter what, don't stop paddling. I'd make a few metres towards the rip, and then the next wall of white water would pound over me, dragging me backwards to come up even closer to the cliff. After what seemed like forever, things were getting serious. I was nearing exhaustion, the ocean wasn't letting up and I had about five metres to the cliff, I was really struggling not to panic. As the last wave smashed against the cliff just a few feet behind me I managed to scrape to the rip totally done in, but out of danger. I collapsed on the beach gasping for oxygen and my legs shaking like jelly, knowing if I hadn't been sucking 20 cigarettes a day I could easily have gotten myself out of the nasty zone. That was it. Lying on the beach at Karekare rasping for air, I knew I'd smoked my last cigarette. I've been smokefree for about 10 years now, much of that time spent working for ASH. I'm still surfing, and quitting is simply the best thing I've ever done! THE PUBLIC HEALTH BILL – HAVE YOUR SAYThe Public Health Bill is reviewing and updating the Health Act 1956 and is the most significant public health legislative reform for decades. It was introduced to Parliament in November 2007, and had its first reading on 12 December. Parliament has referred the Bill to the Health Select Committee, which has called for public submissions, due 7 March. The Public Health Bill covers a wide scope:
The PHA is calling on its members and the public health community in general to make a submission on this important Bill, and National Executive Officer, Dr Gay Keating, is holding a nationwide series of workshops on the Public Health Bill to explain it and give interested people a forum to discuss it. Please see the PHA website for more information. WORLD HEALTH ORGANIZATION RELEASES FIRST REPORT ON GLOBAL TOBACCO USE AND CONTROL EFFORTS
To intensify efforts to reverse this growing epidemic, the World Health Organization (WHO) has released a new report which provides, for the first time, an analysis of the state of tobacco use and control efforts across the world. The report not only documents this in unprecedented detail but also presents a roadmap that identifies the most powerful way forward. The report shows that not a single country has fully implemented all of the key tobacco control measures to reduce smoking rates and that only 5 percent of the world's population live in countries that fully protect their population with any one of the key measures that reduce smoking rates. The report said the "tobacco epidemic" is growing and could claim 1 billion lives by the end of the century unless governments dramatically step up efforts to curb smoking. There is more coverage from Red Orbit Breaking News here. You can download a full copy of the report here. PACIFIC ISLANDS HEARTBEAT SMOKING CESSATION SERVICE
This training is intended for health professionals (such as nurses and community health workers) to enhance their knowledge and skills in providing brief advice to patients/smokers and supporting them by making appropriate referrals to services that can help them in the quit process if they are not registered. Participants and providers who complete this training may register with the Quit Group as Quit Card providers to access the subsidised Nicotine Replacement Therapy (NRT) for clients who smoke and want to quit. The course has a deliberate emphasis on what is culturally relevant and appropriate for Pacific people. The workshop will be held Kenepuru Hospital, Training Room 2, Raiha Street, Porirua, 17-19 March, starting at 9 am. For more information contact Anthony Leaupepe, Training Facilitator, 04 472 2780 ext 2, or e-mail: anthonyl@nhf.org.nz. THROUGH THE SMOKESkull with Cigarette, 2007
Running the Numbers – An American Self Portrait is a series of art works looking at contemporary American culture through statistics. Each image portrays a specific quantity of something: fifteen million sheets of office paper (five minutes of paper use); 106,000 aluminium cans (thirty seconds of can consumption) and so on. The project visually examines the vast and bizarre measures of American society, in large intricately detailed prints assembled from thousands of smaller photographs. The underlying desire is to emphasise the role of the individual in a society that is increasingly enormous, incomprehensible, and overwhelming. The artist, Chris Jordan, hopes the images representing these quantities might have a different effect up his audience than raw numbers alone. Included above are details from Skull with Cigarette, 2007. Based on a painting by Van Gogh, the work depicts 200,000 packs of cigarettes, equal to the number of Americans who die from cigarette smoking every six months. You can find the collection at http://www.chrisjordan.com/current_set2.php?id=?view=XXX_09NNN/. Skull with Cigarette, 2007 is about a third of the way down the page. Interesting stuff! SMOKEFREE SHORTS
MilestonesLook who has had a birthday recently! Cindy Crampton-Cairns, Becky Freeman (now in Australia) and Andrea Johnson New ZealandCigarette shop displays too tempting, says study
The Massey University study confirms overseas findings on the effects of the "powerwall" of tobacco displays in dairies, some supermarkets and service stations. The Government is seeking submissions on whether to tighten restrictions on retail tobacco displays, including possibly banning them altogether. In the study, led by marketing specialist Professor Janet Hoek, in-depth interviews were conducted with 20 people who had attempted to quit smoking in the preceding six to eight months, including some who had resumed smoking. New Zealand Herald, 7 February 2008 Youthline supports ban on tobacco displays Youth development organisation Youthline is supporting a ban on tobacco displays in response to a legislative review and says any advertising of tobacco products promotes smoking as an acceptable choice. Youthline media release, 15 February 2008 Parents urged to keep smoke away from children The Cancer Society's tobacco adviser is congratulating New Zealanders for increasing their stance on smokefree homes. Belinda Hughes says the fact that nearly 90 percent of the country's homes are smokefree is great news. The number of caregivers allowing smoking in homes has decreased by a third. Cancer Society media release, 1 February 2008 Playground anti smoking trial Smokers will soon be asked to kick their addiction near playgrounds in Christchurch public parks. A $35,000 trial in three Hornby parks will encourage smokers to stub out cigarettes around children's playgrounds with new signs and an advertising campaign. The advocates of the plan, which won Christchurch City Council approval yesterday, hope to extend it to every playground in the city. The Press, 16 February 2008 InternationalOne in three songs mentions substance abuse, smoking About one-third of hit songs – including three-quarters of rap songs – have some form of explicit reference to drug, alcohol or tobacco use, a new study has found. "Overall, 116 of the 279 unique songs (41.6 percent) had a substance use reference of some kind. Ninety-three songs (33.3 percent) contained explicit substance use references," wrote the University of Pittsburgh School of Medicine researchers. Washington Post, 4 February 2008 Those seriously mentally ill die 25 years early, and smoking is a major factor
Despite this, many hospitals and other facilities treating the mentally ill insist on permitting and even facilitating smoking by these patients, and some have even gone to court insisting that the patients have a right to smoke – apparently never realising that they stand a much greater risk of medical malpractice law suits if one of more of their smoking patients dies. Action on Smoking and Health (ASH, US) media release, 6 February 2008 To smoke or not to smoke? A clause in the smoking ban has led tavern owners in Minneapolis-St Paul to put on "theatre nights" and label their customers actors so they can light up inside. In Mark Benjamin's view, every bar's a stage and all the men and women merely smokers. Benjamin, a former Marine, has a soft spot for Veterans of Foreign Wars halls, American Legion clubs and small bars he says have lost business because of the statewide smoking ban imposed in October. Star Tribune (US), 14 February 2008 Sad smokers less likely to quit after heart attack Smokers who have depressive symptoms during hospitalisation for a heart attack will have a harder time stopping smoking, a new study shows. Depression is common among heart-attack patients, Dr Anne N Thorndike of Massachusetts General Hospital and Harvard Medical School in Boston, the study's lead author, told Reuters Health, and the findings show "those issues have to be addressed before you can really make much progress with their smoking." Reuters, 4 February 2008 Teen girl smokers less likely to quit
The greatest rise in the number of quitters was among office workers who face the inconvenience and discomfort of going outside to smoke. But teenage girls appear to be the most resistant giving up, believing cigarettes help cut their appetite and so keep them slim. Government figures show the number of people who gave up between April and September last year increased by more than 25 percent compared with the same period in 2006. Evening Standard (UK), 5 February 2008 Anti smoking ads work on teens A confronting television advertising campaign showing a gangrenous foot requiring amputation has successfully turned teenagers off smoking, a new survey shows. Almost 80 percent of respondents in the NSW Cancer Institute study said the anti-smoking campaign made them less likely to smoke, while some 90 percent agreed that an occasional cigarette could do harm. The Age, 8 February 2008 Smoke bans deter young Bans in pubs and clubs have helped reduce the number of young smokers by 30 percent in the past year. The number of 18-29 year olds smoking dropped from 26.2 percent in 2006, to 18.6 percent in 2007, figures released by Quit Victoria revealed. Smoking was banned in Victoria's 7000 pubs, clubs, gaming rooms and cigar bars on 1 July last year. Overall, the number of Victorians smoking has dropped from 21.3 percent in 1998, to 17.3 percent last year. Herald Sun, 15 February 2008 Taxing cigarettes encourages crime It's the easiest of taxes for any government to hike. Slap a dollar or so on a carton of cigarettes and who's going to complain? Not non-smokers. Lord knows, we're smug enough as it is. What do we care if those cowering smokers have to cough up more for their cravings? And smokers just seem to pay more and puff on. Toronto Sun, 8 February 2008 The best way to stoke your Valentine's fire: Don't light up
According to recent studies, 60 percent of all men who smoke suffer from erectile dysfunction – leaving scores of dissatisfied partners burning for more passion. In an effort to dramatically improve upon the high number of failed love making attempts, the Healthy Monday Movement, recommends making Monday the official quit, re-quit and re-commit days to stop smoking, thereby improving the sex lives of all men throughout the country. PRNewswire (US), 13 February 2008 Smoking rate has risen since ban on the 10-pack One of the UK's leading cigarette companies has said that its research shows the average amount of cigarettes smoked per day rose from 16 to 17 in the months following the ban on packets of ten. Since 31 May, smokers have been able only to buy packs of 20, in a move aimed at cutting young smokers out of the market and deterring children from picking up the habit. It meant the starting price for a packet of cigarettes went up from €3 to as much as €7. The Independent (Ireland), 10 February 2008 Smoking studies use real science In a guest editorial on 26 January, Carson Taylor attacks "anti-smoking zealots" who rely on "junk science" to press for laws protecting the public from second-hand smoke. He doesn't identify these zealots, but I will. They include the Surgeon General, EPA, Center for Disease Control, National Institute of Health, WHO and virtually every other public health organisation on the planet. Herald Online (US), 9 February 2008 High incidence of passive smoking found Serving staff in Swiss bars and restaurants could well be passively smoking the equivalent of up to 38 cigarettes a day, a study has found. The report, released by the Valais Anti-Smoking Centre, is said to be one of the first of its kind to quantify the effects of inhaling second-hand smoke. Swiss Info, 13 February 2008 Heart Attacks Drop After Smoking Ban in Italy
Researchers in Rome compared acute coronary events in the city for five years preceding a public smoking ban with those occurring one year after the ban. They found an 11.2 percent reduction in people 35 to 64 years old and a 7.9 percent reduction in those ages 65 to 74. Consumer Affairs, 13 February 2008 Sheraton Hotels to go smokeless Sheraton Hotels and Resorts and Four Points by Sheraton Hotel brands will ban smoking at more than 300 hotels and resorts throughout the US, Caribbean and Canada. Some 8,000 rooms at the hotels will be cleaned, including treatments for air conditioning, walls, rugs, upholstery and hard surfaces. Smoking will also be banned in public areas in the hotels but there will be a designated outdoor area at each property for guests who smoke. Yahoo, 13 February 2008 QUOTABLE QUOTES"The only justification for allowing the displays in shops is if we think tobacco is a normal consumer product. We would argue it's not a normal consumer product because it kills half the people who use it." Quit Group Executive Director, Helen Glasgow "The Internet is full of sites claiming the moon landing was a hoax, Elvis is still alive and there is a conspiracy, hatched by public health officials around the world, to attack second-hand smoke with "junk science. "As for me, I'm siding with the surgeon general who states that "the scientific evidence is now indisputable: second-hand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and non-smoking adults... There is no risk-free level of second-hand smoke exposure." Alan Nichols, Smoking studies use real science "In England we smoke rolled cigarettes. It's better to smoke rollies than straights because straights have chemicals that keep them burning. So if you have to really smoke, smoke rollies." UK singer Joss Stone makes a serious faux pas in a speech at a recent Heart Foundation fundraiser. |
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On the subject of economics, Thomas Carlyle wrote:
The Clinical Trials Research Unit (CTRU) and the Auckland Tobacco Control Research Centre (ATCRC) within the University of Auckland's School of Population Health have several tobacco control projects coming to an end this year.
We also have a number of current trials of novel interventions continuing and
some new projects starting or planned for 2008.
by ASH NZ Smokefree Health Promotion Team Leader – Grant Hocking
Tobacco use is the leading preventable cause of death in the world and one of the biggest public health threats the world has ever faced. It kills 5.4 million people a year. Unchecked, the death toll could increase to more than 8 million a year by 2030.
Cessation Practitioner Training CPT
Where
possible, links are provided below the stories. Please click these to read the
story in full.
Seeing glossy shop displays of cigarette packets undermines people's attempts to quit smoking, according to research completed for groups seeking to have the
'advertising' banned.
Individuals with serious mental illness die, on the average, at least 25 years earlier than the general population, and the leading cause of their deaths-- heart disease -- is directly related to smoking. 
Teenage girls are ignoring health advice and continuing to smoke despite the law against lighting up in public places, say English doctors. Figures suggest that almost 22,000 Londoners gave up cigarettes just before and after the smoking ban introduced last July. 
While smoking may boost a man's image and attractiveness, it does the exact opposite when he reaches the moment to live up to expectations.
A ban on smoking in public places in Italy has sent the number of heart attacks and other acute coronary events spiralling lower according to a report in
Circulation: Journal of the American Heart Association.