Have We Killed Half of our Soldiers with Cigarettes?

Two long-term studies yield grim stats, and women are no exception.

We know that smoking kills. But until the results of 50 years’ worth of observations on British male smokers was published by Richard Doll and coworkers in the British Journal of Medicine in 2004, we didn’t know how many.  Cigarettes will kill at least half of those who smoke them past the age of 30—possibly more. In older, specific populations, possibly as many as 2/3.

It took a prospective study of more than 34,000 British doctors, starting in 1951 and ending in 2001, to establish the grim parameters with some degree of precision. As the study authors of the 2004 summary paper put it: “A substantial progressive decrease in the mortality rates among non-smokers over the past half century… has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker v non-smoker death rate ratio due to earlier and more intensive use of cigarettes.” In other words, the great reduction in disease mortality rates achieved in the 20th Century, courtesy of better prevention and treatment, effectively never happened for long-term male smokers. Smoking in Britain and America took off in a major way between the two world wars, and sufficient time has now passed to conclude that “men born in 1900-1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers.”

As for women, it took a few decades longer to nail down the truth, because women did not begin smoking in peak numbers until the 1960s. While men born between 1900 and 1930 took to cigarettes in a big way, women born around 1940 were the first cohort of female smokers to consume a substantial number of cigarettes throughout their adult lives. This 20-year lag is crucial, because it means that solid numbers for female mortality rates require solid figures on mortality rates in the 21st Century. And now we have them, courtesy of the Million Women Study in the UK. The results were recently published in The Lancet by Kirstin Pirie and others. They are just as bad as you might have guessed, putting women on a firm equal footing with their male counterparts when it comes to smoking deaths.

The Million Women Study, a database originally used for the UK’s National Health Service Breast Screening Program, recruited female volunteers between the ages of 50 and 69. The figures were eerily similar to those from the earlier study of male British doctors: “If combined with 2010 UK national death rates, tripled mortality rates among [female] smokers indicate 53% of smokers and 22% of never-smokers dying before age 80 years, and an 11-year lifespan difference…. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater.” In this study, the researchers found little difference between female smokers and nonsmokers when it came to confounding variables like weight, blood pressure, or lipid profile. A four-year head start—beginning to smoke at the age of 15 rather than 19, say—can put women at a measurably greater risk for lung cancer deaths.  And a little goes a long way: “Even those smoking fewer than ten cigarettes per day at baseline had double the overall mortality rate of never-smokers.” Low-tar won’t save them, either. “Low-tar cigarettes are not low-risk cigarettes,” the investigators write, “and the Million Women Study shows that more than half of those who smoke them will eventually be killed by them, unless they stop smoking in time to avoid this.”

There it is again: Half of all smokers are going to die from smoking.  As the authors of the Lancet study wrote: “If women smoke like men, they die like men.”

In summary, those who stop smoking at age 50 gain about six years of life expectancy. Quit at 40, and you get an extra nine years. A non-smoker’s chances of living from 70 to 90 are three times higher than a smoker’s. The researchers found that the doctors who stopped smoking by age 30 managed to avoid almost all of the lifespan penalties associated with smoking—primarily lung cancer, COPD, and heart disease. (Only about 3% of smoking deaths are due to fires, accidents, poisonings, etc.). And even lifelong smokers who do not quit until the age of 60 are still rewarded with an extra three years of life span, on average.

Perhaps the saddest thing about the findings is the ways in which they suggest that British and American military commanders may have been sentencing countless numbers of soldiers to death for decades, through the simple act of giving away cigarettes in K-rations, and selling them cheaply in other circumstances. As the report in the British Medical Journal states, “widespread military conscription of 18 year old men, which began again in 1939 and continued for decades, routinely involved provision of low cost cigarettes to the conscripts. This established in many 18 year olds a persistent habit of smoking substantial numbers of manufactured cigarettes, which could well cause the death of more than half of those who continued.” In a perverse reminder of the Agent Orange scandal in Vietnam, American and British military command may have exposed their soldiers to a much greater threat, for a much longer period, with worse odds for survival.

One obvious confounding variable in such studies is alcohol. It requires a sensitive statistical analysis to work through correlations between drinking, smoking, and, say, liver disease.  But “the large majority of the excess overall mortality among smokers is actually caused by smoking,” the Lancet researchers maintain with confidence.  The overall point seems clear: These long-term results show that the risks from continual cigarette smoking are even greater than we thought.

The dismal bottom line of the two smoking studies is that we appear to be right on schedule for meeting the UN’s prediction of one billion tobacco deaths in this brave new century.

Pirie, K., Peto, R., Reeves, G., Green, J., & Beral, V. (2012). The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK The Lancet DOI: 10.1016/S0140-6736(12)61720-6

Photo Credit: Ianier67 via Creative Commons.

The Hidden Story of How Big Tobacco Invented Freebasing

Review of The Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition.

Part I

It’s easy to think of cigarettes, and the machinations of the tobacco industry, as “old news.” But in his revealing 737-page book, The Golden Holocaust, based on 70 million pages of documents from the tobacco industry, Stanford professor Robert N. Proctor demonstrates otherwise. He demonstrates how Big Tobacco invented freebasing. He shows how they colluded in misleading the public about “safe” alternatives like filters, “low-tar,” and “ultra-lights.” We discover in Lorillard’s archives an explanation of menthol’s appeal to African Americans: It is all part of a desire by “negroes” to mask a “genetic body odor.” Radioactive isotopes were isolated in cigarette smoke, and evidence of the find was published, as early as 1953. He reveals that the secret ingredient in Kent’s “micronite filter” was asbestos. And he charges that the “corruption of science” lies behind the industry’s drive to continue its deadly trade. “Collaboration with the tobacco industry,” writes Proctor, “is one of the most deadly abuses of scholarly integrity in modern history.”

Half of all cigarette smokers will die from smoking—about a billion people this century, if present trends continue. In the U.S., this translates into roughly two jumbo jets crashing, killing everyone onboard, once daily. Cigarettes kill more people than bullets. The world smokes 6 trillion of them each year. (The Chinese alone account for about 2 trillion). Some people believe that tobacco represents a problem (more or less) solved, at least in the developed West.

All of this represents a continuing triumph for the tobacco industry. The aiders and abettors of tobacco love to portray the tobacco story as “old news.” But as Stanford Professor Robert M. Proctor writes in The Golden Holocaust, his exhaustive history of tobacco science and industry: “Global warming denialists cut their teeth on tobacco tactics, fighting science with science, creating doubt, fostering ignorance.”

Checking in at 737 pages, The Golden Holocaust is nobody’s idea of a light read, and at times its organization seems clear only to the author. But what a treasure trove of buried facts and misleading science Proctor has uncovered, thanks to more than 70 million pages of industry documents now online (http://legacy.library.ucsf.edu) as part of the Master Settlement Agreement of 1998. Once the material was finally digitized and available online, scholars like Proctor could employ full-text optical character recognition for detailed searchability. Ironically, this surreal blizzard of documentation was meant to obscure meaningful facts, not make them readily available, but tobacco executives seem not to have factored in digital technology when they turned over the material.

The single most important technological breakthrough in the history of the modern cigarette was flue-curing, which lowers the pH of tobacco smoke enough to make it inhalable. The reason few people inhale cigars, and very few used to inhale cigarettes, is that without some help, burning tobacco has a pH too high for comfortable inhalation. It makes you cough. But flue-curing lowered pH levels, allowing for a “milder,” less alkaline smoke that even women and children could tolerate.

World War I legitimized cigarettes in a major way. Per capita consumption in the U.S. almost tripled from 1914 to 1919, which Proctor considers “one of the most rapid increases in smoking ever recorded.” After World War II, the Marshall Plan shipped a staggering $1 billion worth of tobacco and other “food-related items.” (The U.S. Senator who blustered the loudest for big postwar tobacco shipments to Europe was A. Willis Robertson of Virginia, the father of televangelist Pat Robertson.)

The military, as we know, has historically been gung-ho on cigarettes. And Proctor claims that “the front shirt pocket that now adorns the dress of virtually every American male, for example, was born from an effort to make a place to park your cigarette pack.” In addition, cigarette makers spent a great deal of time and effort convincing automakers and airline manufacturers to put ashtrays into the cars and planes they sold. Ashtrays were built into seats in movie theaters, barbershops, and lecture halls. There was even an ashtray built into the U.S. military’s anti-Soviet SAGE computer in the 50s.

In the early 50s, research by Ernest Wynder in the U.S. and Angel Roffo in Argentina produced the first strong evidence that tobacco tars caused cancer in mice. Roffo in particular seemed convinced that tobacco caused lung cancer, that it was the tar rather than the nicotine, and that the main culprits were the aromatic hydrocarbons such as benzpyrene. Curiously enough, it was influential members of Germany’s Third Reich in the 40s who first took the possibility of a link seriously. Hans Reiter, a powerful figure in public health in Germany, said in a 1941 speech that smoking had been linked to human lung cancers through “painstaking observations of individual cases.”

In the December 1953 issue of Cancer Research, Wynder, et al. published a paper demonstrating that “tars extracted from tobacco smoke could induce cancers when painted on the skins of mice.” As it turns out, the tobacco industry already knew it. Executives had funded their own research, while keeping a close eye on outside academic studies, and had been doing so since at least the 30s. In fact, French doctors had been referring to cancers des fumeurs, or smokers’ cancers, since the mid-1800s. All of which knocks the first leg out from under the tobacco industry’s classic position: We didn’t know any stuff about cancer hazards until well into the 1950s.

Only weeks after the Wynder paper was published, tobacco execs went into full conspiracy mode during a series of meetings at the Plaza Hotel in New York, “where the denialist campaign was set in motion.” American Tobacco Company President Paul Hahn issued a press release that came to be known as the “Frank Statement” of 1954. Proctor calls it the “magna carta of the American’s industry’s conspiracy to deny any evidence of tobacco harms.” How, Proctor asks, did science get shackled to the odious enterprise of exonerating cigarettes? The secret was not so much in outright suppression of science, though there was plenty of that: In one memorable action known as the “Mouse House Massacre,” R.J. Reynolds abruptly shut down their internal animal research lab and laid off 26 scientists overnight, after the researchers began obtaining unwelcome results about tobacco smoke. But the true genius of the industry “was rather in using even ‘good’ science, narrowly defined, as a distraction, something to hold up to say, in effect: See how responsible we are?”

Entities like the Council for Tobacco Research engaged in decoy research of this kind. As one tobacco company admitted, “Research must go on and on.”

A good deal of the industry’s research in the 50s and 60s was in fact geared toward reverse engineering competitors’ successes. Consider Marlboro. Every cigarette manufacturer want to know: How did they do it? What was the secret to Marlboro’s success?

As it turns out, they did it by increasing nicotine’s kick. And they accomplished that, in essence, by means of freebasing, a process invented by the cigarette industry. Adding ammonia or some other alkaline compound transforms a molecule of nicotine from its bound salt version to its “free” base, which volatilizes much more easily, providing low-pH smoke easily absorbed by body tissue. And there you have the secret: “The freebasing of cocaine hydrochloride into ‘crack’ is based on a similar chemistry: the cocaine alkaloid is far more potent in its free base form than as a salt, so bicarbonate is used to transform cocaine hydrochloride into chemically pure crack cocaine.” Once other cigarette makers figured out the formula, they too began experimenting with the advantages of an “enhanced alkaline environment.”
  
(End of Part I)

Photo Credit: http://theloungeisback.wordpress.com/

The Day After

How’s that no-smoking pledge going?

This post is not meant for most of you. Those of you who never smoked, or smoked and quit successfully—move along, maybe check out my earlier posts about smoking this month.

But for those of you who have decided to take the 35th annual Great American Smokeout seriously—for those of you who decided today, or yesterday, or recently, to quit smoking—I have a few remarks, if you have a moment. I’m fairly trustworthy on this subject. I’m a science writer, I follow the field of addiction science, and I smoked a pack of Camel filters a day for about 25 years. In addition, I quit smoking using the most recently available smoking cessation aids—nicotine patches and anti-craving medication, in this case Zyban, a.k.a. Wellbutrin.

I had decided, after the usual smoker’s run of unsuccessful independent quitting attempts, that the only real hope I had for success was to throw myself into the hands of my primary care physician. Happily, Dr. Joe is a young example of the last of the breed, a lingering remnant of a tribe that used to be known as family doctors. When I told Dr. Joe of my plans to quit smoking, he was overjoyed. Too overjoyed, it seemed to me. As it turned out, there were grounds for my suspicion. Dr. Joe had recently returned from a smoking cessation seminar at the Mayo Clinic in Rochester, Minnesota, with a grab bag of refinements and alternative approaches for setting up a no-smoking regimen. Furthermore, he made it clear that, if necessary—if I forced him to it through relentless noncompliance—he was fully prepared to order regular blood workups to detect and quantify my nicotine levels.

Of course, I instantly regretted setting a foot into this ring, but once Dr. Joe started flinging prescriptions for patches and pills my way, I realized I was in it up to my wallet (Insurance companies weren’t paying for nicotine cessation products, ever, at that time).

Most smokers know the current drill. A few weeks with nicotine patches or gum or nasal spray, combined with a short course of Zyban or Chantix to further reduce cravings, and then you are expected to fly out of the nest and spread the good news.  Most smokers know that even this controversial armamentarium is not going to completely spare them from a rare and special kind of suffering: addictive craving for nicotine.  It’s a mean, rough ride, as everyone knows.

But if you take a few of the major potholes out of the road, smooth over the really big bumps just a little, fill in the low spots a bit as well, you have a fighting chance—especially if you have tried and failed before (almost nobody pulls it off on the first attempt).

Here are the key features of the program, as my doctor worked it up for me:

--Stronger patches. Mayo Clinic and other institutions had made an important discovery, my doctor said. People weren’t wearing strong enough patches. There was a system of matching up patch strength to amount and duration of smoking, and then a step-down procedure, to less and less powerful patches, and it was all listed on the packages, but because of great nervousness over medical complications by a very few individuals who overdid the patch and then chain-smoked on top of that, the result was that the patches as marketed weren’t strong enough, many doctors felt. The advice was to start strong, with the strongest patch available (and perhaps there was even a patient or two who doubled up, ahem). 

--Longer patches. Start strong—and go long. The whole nicotine replacement plan is supposed to last a month or two. Phooey, said Dr. Joe. No telling in advance how long the process will take. There is no set timetable. How long would I be wearing patches and tapering the dose? As long as it took, Dr. Joe inferred, for me not to need them anymore. He seemed prepared to keep me on patches the rest of my life, if it kept me from picking up a cigarette. In the end, when I took off my final, tiny patch, I had been using them for a little less than six months. The recommended five-star treatment plan in the literature and on the packages calls for only 10 weeks, tops.

--Pharmaceuticals. It is admittedly hard to separate out placebo effects from drug effects, in the case of something as elusive as cigarette urges. But I do believe that Zyban took the edge off the worst of my cigarette cravings. It did not eliminate them, anymore than the patches eliminated them. But the medication effectively dissipated the grip of that moment of panic, when you have risen from your chair and set about finding your coat and car keys for a run to the gas station to buy a pack of cigarettes. Or at least that’s the way it felt to me.

--Exercise. Trite? You bet, and you can be sure that I winced and offered a tired smile when I heard my doctor bore in on the subject. Since I knew him to be a crazed bicyclist, I was prepared to disregard most of what he had to say. But his insistence sent me back to the research literature on exercise and its effect on dopamine, serotonin, acetylcholine, and endorphin levels. So I took him up on that firm suggestion as well, and found that, at the least, it helped with a period of rocky sleep in the beginning.

--Diet. No huge changes, just watching the sweets in an effort to avoid surging blood sugar levels. Fruit helps, since constipation is a common side effect of nicotine cessation—just the opposite of how it works with heroin. I continued to drink coffee, but for a while it didn’t taste as good.

--Relaxation. Quitting smoking makes you tense. You think I’m being funny? Quitting smoking makes you tense all over, mentally and physically. During the first few days you’ll notice that your body is clenched, held rigidly. Your posture is likely to be anything but relaxed; your physical movements can be jerky and awkward. A few minutes a day spent sitting with eyes closed, in a relaxed upright posture, thinking of nothing or concentrating on your breathing or meditating either formally or casually, can bring partial relief from all that tension. And on some days, that can be crucial.

--Determination. Unfortunately, it wasn’t until everyone around me—my wife, children, parents, close friends, work associates—had all, I sensed, basically given up on me, silently condemning me to the category of Lifetime Smoker, that I finally managed to make a successful run at a major life problem. There are better ways to work up your determination. Find and employ them.

With time, an involved partner, nicotine replacement, and the right medication, the deal can be done. There has never been a better time in history to be a smoker who has decided to quit.

Graphics Credit: http://adoholik.com/

Top 50 Smoking Awareness Blogs

Addiction Inbox makes the cut.

Addiction Inbox is pleased to find itself listed among the "Top 50 Smoking Health Awareness Blogs" by the Pharmacy Technician Certification web site.

Here is the description included in the listing:

"An exhaustive, comprehensive, and stimulating catalogue of information pertaining to the science of substance abuse, the Addiction Inbox counts nicotine amongst its list of dangers. Expect to see articles regarding tobacco control alongside psychological studies on the physical, emotional, and mental elements of addiction."

Thanks go to Ashley M. Jones for the listing, and for bringing it to my attention.

The latest numbers on cigarette smoking from the American Heart Association show that 23.5 % of white males are smokers, with female smokers having closed the gap considerably with a smoking rate of 18.8 %.

26.1 % of black men are smokers, compared to 20.1 % of Hispanic males, and 16.8 % of Asian men. For women, blacks smoke at a rate of 18.5 %, followed by Hispanic women at 10.1 %, and non-Hispanic Asians at 4.6 %.

The tragic winners, and thus the losers, of the smoking sweepstakes are Native Americans, who show smoking rates of 35.6 % for men and 29.0 % for women.

Graphics Credit: www.chantixhome.com

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FDA Bans Flavored Cigarettes

An unintentional boost for cigar sales?

When is a cigar more than just a cigar? When its appearance allows it to circumvent the intent of the Food and Drug Administration’s first ruling related to cigarettes, that’s when.

In its first official ruling since Congress passed legislation giving the agency authority to regulate tobacco (see my earlier post), the FDA banned so-called flavored cigarettes. Cigarette makers can no longer add vanilla, clove, chocolate, or any other fruit or candy flavors to their product. Menthol, for now, is exempt from the ban.

FDA commissioner Margaret Hamburg said that 90 percent of adults who smoke began doing so as children. The president of the Campaign for Tobacco-free Kids agreed, calling flavored cigarettes “starter products” for young smokers in a Dow Jones Newswires report by Jennifer Corbett Dooren.

By law, the agency cannot ban regular cigarettes outright. However, as Gardiner Harris reported in the September 23 New York Times, “the legislation left some details vague. For instance, the agency is required to ban flavored cigarettes, but the law did not clearly define what constituted a cigarette."

Huh? As it turns out, a cigarette is in the mind of the beholder. The FDA maintains that the ban applies to all cigarette-type tobacco products, including those that are “labeled as cigars or as some other product.” A spokesperson for the Campaign for Tobacco-Free Kids agreed: “The FDA demonstrated that they’re serious about enforcing the ban on flavored cigarettes, and serious about preventing tobacco companies from circumventing that ban,” according to the New York Times article.

Not so fast, argued Norman Sharp, president of the Cigar Association of America. Sharp told the Times that the ban clearly did not apply to cigars: “We feel this should go a long way to clearing up any confusion in the marketplace.”

Well, not exactly. An exasperated spokesperson for cigarette maker R.J. Reynolds, also quoted in the article, said: “It’s hard to understand. We need clear and timely guidance so all of us can work together so that we can understand what we need to be doing.”

What about the small brown cigarillos sold by an R.J. Reynolds subsidiary?

“They are not cigarettes,” the spokesperson said.


Photo Credit: http://politics.mync.com/tag/cigarette/

addiction drugs smoking nicotine

Obama’s Addiction

President-elect should come clean about cigarettes.

For a candidacy built on transparency and straightforward messaging, the Obama juggernaut is missing a wonderful opportunity to send direct aid and comfort to struggling addicts everywhere. All the president-elect has to do is admit that he is still struggling to quit smoking cigarettes.

It doesn’t take a campaign genius to understand the reasoning during the primaries: Smoking, something now done behind closed doors, or while leaning against a dark wall out back, was not something Obama’s handlers were eager to have taken up as a topic of discussion with respect to their candidate. The U.K. Guardian maintains that certain opinion polls found Obama’s smoking to be a greater hindrance to his election than the color of his skin.

The recent release of candid black and white photos from Obama’s college years, showing him casually smoking, has brought the issue back to the forefront. “It is a sign of our anxious, needy condition,” opined the Guardian, “that Americans are willing to overlook the president-elect's filthy habit.”

While Nancy Reagan banned smoking in the White House years ago, the cigar-smoking Clinton seems to have gotten a pass, cigars in the popular culture being to cigarettes as the occasional brandy is to a six-pack. While the New York Times debates whether graphic warning labels only increase people’s desire to smoke, nobody seems to be asking whether a president who sneaks out to the Rose Garden to field-strip a Marlboro will serve as a role model or an enabler for fellow smokers.

In a separate article in the Guardian, Alexander Chancellor writes that “Obama appears to have tried really hard to stop, and says he had cut his smoking down to the occasional fag bummed from a member of his staff; but he still hasn’t give up completely, despite being a fitness fanatic who spends more than an hour a day in the gym.” As every addicted smoker who ever tried to quit has discovered, nobody ever sneaks by for long on two or three bummed cigarettes a day. “You either smoke none or you smoke 20,” writes Queenan. “There is no middle ground.”

More to the point, President-Elect Obama is missing out on an opportunity to speak out on a major public health issue. By coming clean about his struggle to overcome his nicotine addiction, Obama would give renewed hope and courage to struggling smokers and ex-smokers everywhere. If Obama, the icon of cool, the Unruffled One, cannot make good on a promise to his wife to quit smoking, then quitting smoking must be one hell of an undertaking.

As Chancellor writes: “The most striking thing about it all is that a man as calm, controlled and disciplined as the next president should have so far failed in his efforts to set himself free. At least I can take comfort from the fact that I am in the most distinguished company. But I also intend to join him in his New Year resolution to stop smoking, mainly in my case because it’s just too expensive.”


Photograph: Lisa Jack/Bloomberg News/Time

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Quitting When You're High

Active smokers underestimate rigors of withdrawal.

An alcoholic wraps his car around a tree in a drunken haze. He has "hit bottom" and vows never to drink again.

A meth tweaker gets so high he becomes unruly and disoriented and is arrested. In jail, cranked to the gills on speed, she pledges to go sober, starting right now.

A cigarette smoker stumbles to bed after a typical two-pack day, coughing, throat burning, reeking of tobacco, and swears that upon waking, his remaining cigarettes will go out with the trash and his life as a human ashtray is over.

Each of these addicts has started off on exactly the wrong foot, and will very likely fail quickly in their quitting attempts, according to recent research on smoking cessation from the University of Pittsburgh and Carnegie Mellon University. It is easy to say you're going to quit while you're high, sailing along on a comfortable level of nicotine in the bloodstream. Once that available nicotine is flushed out, you are going to have some serious second thoughts about the whole enterprise of abstinence. The smoker is likely to wake up the next morning, fumbling for a smokeable butt, muttering to himself: "What in the world was I thinking of last night? No way am I quitting today."

In a study to be published in the September issue of Psychological Science, researchers showed that cigarettes smokers who are not actively craving a cigarette when they vow to quit will likely not succeed, because they inevitably underestimate the rigors of the upcoming withdrawal, and the fierce intensity of their future desire to smoke.

According to lead investigator and professor of psychology Michael Sayette, "this lack of insight while not craving may lead them to make decisions--such as choosing to attend a party where there will be lots of smoking--that they may come to regret."

In the study, titled "Exploring the Cold-to-Hot Empathy Gap in Smokers," the researchers write: "In contrast to smokers in a hot (craving) state, those in a cold (noncraving) state underpredicted the value of smoking during a future session when they would be craving.... Failing to anticipate the motivational strength of cigarette craving, nonsmokers may not appreciate how easy it is to become addicted and how difficult it is to quit once addicted."

George Loewenstein, professor of economics and psychology at Carnegie Mellon and a co-author of the study, said that the research implications for non-smokers were crucial: "If smokers can't appreciate the intensity of their need to smoke when they aren't currently craving, what's the likelihood that people who have never smoked can do so?"

As further evidence of this psychological mismatch, the researchers cite earlier work performed by the University of Michigan’s Monitoring the Future longitudinal study of 1993, "which found that although only 15% of respondents who were occasional smokers (less than one cigarette per day) predicted that they might be smoking in 5 years, 43% of them were, in fact, smoking 5 years later."

All things considered, it's better to make the quitting decision when you're hurting, not when you're high.

Graphic Credit: Florida State University

Gates, Bloomberg Target Cigarettes

Billionaires pledge $500 million, but will it do any good?

If money were all it took, tobacco smoking would be on the run after Bill Gates and Michael Bloomberg jointly pledged last month to fight tobacco use worldwide, especially in low- and middle-income countries, through the Bill and Melinda Gates Foundation and Johns Hopkins University.

Mayor Bloomberg, who has been involved in anti-smoking campaigns for years, admitted at a joint news conference that "all the money in the world will never eradicate tobacco. But this partnership underscores how much the tide is turning against this deadly epidemic."

The program, put together by Bloomberg and Dr. Margaret Chan of the World Health Organization (WHO), is an ambitious, multi-faceted effort to be coordinated by the Bloomberg Initiative to Reduce Tobacco Use, the WHO, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, and the Centers for Disease Control and Prevention (CDC).

As Donald G. McNeil described the $500 million program, dubbed Mpower, in the July 24 New York Times: "It will urge governments to sharply raise tobacco taxes, prohibit smoking in publics places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting." The program also intends to bring "health officials, consumer advocates, journalists, tax officers and others from third world countries" to the U.S. for workshops and training.

It will not be the first such effort--far from it. Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils.

In America, the Prohibition years from 1920 to 1933 coincided with a short-lived effort to prohibit cigarettes. Leaving no stone unturned in the battle to eliminate drugs and alcohol from American life, Henry Ford and Thomas Edison joined forces to wage a public campaign against the “little white slavers.” Edison and Ford wanted to stamp out cigarette smoking in the office and the factory. Although that effort would have to wait another 75 years or so, New York City did manage to pass an ordinance prohibiting women from smoking in public. (See Siegel, Ronald K. Intoxication: Life in Pursuit of Artificial Paradise). Fourteen states eventually enacted various laws prohibiting or restricting cigarettes. By 1927, all such laws had been repealed.

Finally, Adolf Hitler himself took on the battle against cigarettes--and lost. In 1942, after letting loose a torrent of misbegotten screed about "the wrath of the Red Man against the White Man," Hitler, in one of the most aggressive anti-smoking campaigns in history, banned smoking in public places and slapped heavy taxes on tobacco. But by the mid-1950s, smoking in Germany exceeded prewar levels.

There is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

Photo Credit: National Health Service

Female Smokers and Menstruation

Better to quit after ovulation, study finds.

Women stand a better chance of successfully quitting smoking if they stop during the later phase of their monthly menstrual cycle, according to new research conducted at the University of Minnesota and published in the May 2008 edition of the journal Addiction.

Sharon Allen and co-workers discovered that women who quit smoking right before they start to ovulate--the so-called follicular stage--relapsed more often than women who quit during the "luteal" stage, defined as the two weeks between ovulation and the start of a new cycle. In the study, 86 percent of women who gave up smoking during the follicular phase relapsed during the first 30 days, compared to 66 per cent of women who quit during the later luteal phase.

"Our findings support an important role for ovarian hormones in nicotine addiction and smoking cessation," the authors wrote.

The ebb and flow of estrogen and progesterone during the menstrual cycle can have a direct effect on mood, as evidenced by the well-documented premenstrual syndrome, or PMS. In addition to mood factors, the researchers suggested that female hormones might play a role in the speed with which nicotine is metabolized.

The study of 200 female smokers was conducted by the Tobacco Use Research Center at the University of Minnesota. Earlier work by the group, published in Nicotine & Tobacco Research, had established a strong suspicion that "withdrawal symptomatology in short-term smoking cessation in women is increased in the late luteal phase when pre-menstrual symptomatology is the highest." The group concluded that "it seems prudent to recommend that women quit during the follicular phase of their cycle."

In short, the work suggests that female smokers would be well advised not to inaugurate a quit attempt in the ten days preceding ovulation.

Photo Credit: MedGadget

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