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(2) PREVIOUSLY
SECRET DOCUMENTS REVEAL THE
TRUTH ABOUT
THE TOBACCO INDUSTRY
(3) IMPROVING
THE TREATMENT OF TOBACCO
DEPENDENCE
According to World Health Organisation
estimates, there are
currently 4 million deaths a year from
tobacco - a figure
expected to rise to about 10 million by
the 2020s or early
2030s. By that date, based on current
smoking trends,
tobacco is predicted to be the leading
cause of disease
burden in the world, causing about one
in eight deaths.
(WHO Tobacco Free Initiative website 2000.
http://www.who.int/toh/)
Tobacco and health is the focus of this
week's theme issue of
the BMJ ± from children's exposure to
passive smoking to
disturbing truths about tobacco industry
practices - this issue
marks next week's world conference on
tobacco or health.
(1) CHILDREN AT
SERIOUS RISK FROM SECOND
HAND SMOKE
(Effect of restrictions on smoking
at home, at school and in
public places on teenage smoking:
cross-sectional study)
http://bmj.com/cgi/content/full/321/7257/333
(Children's exposure to passive smoking
in England since the
1980s: cotinine evidence from population
surveys)
http://bmj.com/cgi/content/full/321/7257/343
(Effect of counselling mothers on
their children's exposure to
environmental tobacco smoke: randomised
controlled trial)
http://bmj.com/cgi/content/full/321/7257/337
(Protecting children from passive
smoking)
http://bmj.com/cgi/content/full/321/7257/310
Three papers in this week's BMJ support
a comprehensive
approach to protect children from environmental
tobacco
smoke and prevent them from becoming established
smokers.
Jarvis and colleagues find that exposure
to passive smoking
among 11-15 year old children in England
has almost halved
since the late 1980s, partly due to a
fall in the percentage of
parents who smoke, and also to reduced
smoking in public
places. Similarly, Wakefield and colleagues
report that bans
on smoking at home - as well as bans in
public places and
enforced school smoking bans - may reduce
teenage smoking
in the United States. They suggest that
one explanation for
this may be that exposure to environmental
tobacco smoke
during childhood may make children more
inclined to take up
active smoking in their teenage years
"by reducing the
noxious deterrence of the first cigarette."
Finally, Hovell and colleagues find that
behavioural
counselling for mothers in California
was effective in reducing
young children's exposure to tobacco smoke
at home -
illustrating the potential of techniques
that impact directly on
smoking parents. This view is reiterated
in an accompanying
editorial by Ferrence and Ashley, who
suggest that shifting
public attitudes towards smoking at home
in the presence of
children means that the climate is now
right for behavioural
interventions aimed at parents. It is
clear, however, that no
one strategy will work alone, they say.
In addition to
increasing smoking restrictions in public
places and
workplaces, price increases, reduced availability
of tobacco
products, and mass media interventions,
are also crucial if we
are to protect children's health and prevent
their recruitment
to smoking in adolescence.
Contacts:
Martin Jarvis, ICRF Health Behaviour Unit,
University
College London, UK
Email: martin.jarvis@ucl.ac.uk
Melanie Wakefield, Health Research and
Policy Centres,
University of Illinois, Chicago, USA
Email: melaniew@uic.edu
Melbourne Hovell, Centre for Behavioural
Epidemiology and
Community Health, San Diego State University,
California,
USA
Email: behepi@rohan.sdsu.edu
Roberta Ferrence / Mary Jane Ashley, Ontario
Tobacco
Research Unit, Toronto, Canada
Email: roberta.ferrence@utoronto.ca
(2) PREVIOUSLY
SECRET DOCUMENTS REVEAL THE
TRUTH ABOUT THE TOBACCO INDUSTRY
(Do candy cigarettes encourage young
people to smoke?)
http://bmj.com/cgi/content/full/321/7257/362
("Operation Berkshire": the international
tobacco companies'
conspiracy)
http://bmj.com/cgi/content/full/321/7257/371
(A day in the life of an advertising
man: review of internal
documents from the UK tobacco industry's
principal
advertising agencies)
http://bmj.com/cgi/content/full/321/7257/366
(The truth about big tobacco in its
own words)
http://bmj.com/cgi/content/full/321/7257/313
Previously secret internal tobacco industry
documents - now
publicly available - form the basis for
three studies in this
week's BMJ. They provide a unique insight
into an industry
determined to protect its commercial interests
at the expense
of world-wide public health.
Francey and Chapman reveal that in 1977,
seven of the
world's major tobacco companies formally
conspired to
promote "controversy" over smoking and
disease and to
mount a program of "smoker reassurance"
to counter the
increasing social unacceptability of smoking.
This conspiracy,
say the authors, led to the formation
of the International
Committee on Smoking Issues, later to
become the
International Tobacco Information Centre,
which operated
through "task forces" to undermine tobacco
control measures
throughout the world.
Co-operation between the manufacturers
of tobacco and
candy cigarettes to effectively promote
smoking in children is
described by Klein and St Clair. They
show that some
tobacco companies granted confectioners
permission to use
cigarette pack designs, tolerated trademark
infringement and
suppressed research showing the potentially
harmful effects of
candy cigarettes in promoting smoking
to children.
Hastings & MacFadyen show that UK tobacco
companies
are actively seeking to encourage smoking
- not just extend
brand share as they frequently claim.
They attract and retain
"new entrants" to the market by creating
"aspirational, lifestyle
brand" images to enhance the appeal of
what they recognise
as a "rites of passage" behaviour. Everything
from pack
design to clever sponsorship deals are
used to strengthen
these brands and "engage" youngsters'
"aspirations and
fantasies" say the authors. The naked
commercial imperative
that underpins this activity totally discredits
voluntary
regulation and demonstrates that tightly
policed, statutory
controls are essential.
These documents contain information that
shocks even
hardened anti-tobacco activists, says
Stanton Glantz in an
accompanying editorial. He suggests that
it is time for British
American Tobacco to make its documentation
freely
available on the internet - as American
tobacco companies
agreed to do as part of a settlement of
lawsuits in 1998. "It
will force the truth out of the shadows
and into the public
eye" he concludes.
Contacts:
Simon Chapman, Department of Public Health
& Community
Medicine, University of Sydney, Australia.
Email: simonc@health.usyd.edu.au
Jonathan Klein, Division of Adolescent
Medicine, University
of Rochester School of Medicine, Rochester,
New York,
USA.
Email: jonathan_klein@urmc.rochester.edu
Gerard Hastings, Centre for Tobacco Control
Research,
University of Strathclyde, Glasgow, Scotland
Email: g.hastings@strath.ac.uk
Stanton Glantz, Institute for Health Policy
Studies, University
of California, San Francisco, USA
Email: glantz@medicine.ucsf.edu
(3) IMPROVING
THE TREATMENT OF TOBACCO
DEPENDENCE
(Smoking, smoking cessation, and
lung cancer in the UK
since 1950: combination of national
statistics with two
case-control studies)
http://bmj.com/cgi/content/full/321/7257/323
(Smoking reduction with oral nicotine
inhalers: double-blind,
randomised clinical trial of efficacy
and safety)
http://bmj.com/cgi/content/full/321/7257/329
(Effectiveness of interventions to
help people stop smoking:
findings from the Cochrane Library)
http://bmj.com/cgi/content/full/321/7257/355
(Improving the treatment of tobacco
dependence)
http://bmj.com/cgi/content/full/321/7257/311
Three articles in this week's BMJ demonstrate
the
importance of stopping smoking or discuss
the effective
methods currently available to help people
kick the habit.
The health benefits of stopping smoking
are highlighted in a
paper by Peto and colleagues. They show
that people who
stop smoking ± even at 50 or 60 years
of age ± avoid most of
their risk of developing lung cancer,
and quitting before
middle age avoids more than 90% of the
risk caused by
tobacco.
Speaking at the press conference will be
Professor Sir
Richard Peto, Professor of Medical Statistics
and Professor
Sir Richard Doll, Emeritus Professor of
Medicine - author of
the 1950 landmark study linking smoking
with increased risk
of lung cancer and co-author of this new
study, fifty years on.
Many people who smoke make multiple attempts
to quit, and
will benefit from the availability of
a range of aids to help
them, according to a paper by Lancaster
and colleagues.
They find that advice from health professionals,
individual and
group counselling, nicotine replacement
therapy and certain
antidepressants are among the most effective
interventions
currently available to help people stop
smoking. For smokers
who are either unable or unwilling to
stop abruptly, Bolliger
and colleagues show that using a nicotine
inhaler can reduce
cigarette consumption by over 50% over
a two-year period.
Although the overall success rates were
relatively small, say
the authors, this is a feasible first
step towards improved
health, and may ultimately lead to these
smokers quitting
altogether.
These findings emphasise the simple, yet
powerful messages
that clinicians can and should communicate
to all patients,
suggest Thun and Glynn in an accompanying
editorial.
?Firstly, don?t smoke. Secondly, if you
do smoke, there are
major health benefits to stopping as soon
as possible, no
matter what your age or how long you have
been smoking.
Thirdly, there are a wide array of effective
cessation
treatments now available.?
Contacts:
Sir Richard Peto or Sir Richard Doll, Clinical
Trial Service
Unit and Epidemiological Studies Unit,
Radcliffe Infirmary,
Oxford, UK.
Tim Lancaster / Lindsay Stead Department
of Primary Health
Care, University of Oxford, Institute
of Health Sciences,
Oxford, UK.
Email: lindsay.stead@dphpc.ox.ac.uk
Chris Bolliger, Department of Internal
Medicine, University
Hospital, Basel, Switzerland (currently:
University of
Stellenbosch, Cape Town, South Africa).
Email: ctb@gerga.sun.ac.za
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London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
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Advancement of Science
(http://www.eurekalert.org)