ASHES, 2(5) – Controlling tobacco use by controlling conventional wisdom


Tobacco use continues to be a looming public health threat despite numerous tobacco control policies and programs. A recent empirically-grounded commentary by Frieden & Blakeman (2005) speculated that one reason that tobacco use persists is that there are a number of widely know myths pertaining to tobacco use that weaken efforts to expand tobacco control. In that commentary the authors review those common myths and empirical literature rebutting those myths. This week ASHES reviews their evidence and conclusions (see Figure).

Rebuttal: Evidence from the Empirical Literature
People have free choice whether or not
to smoke
  • 18 times more is spent on
    advertising than tobacco control
  • Nicotine is associated with
  • Most smokers start as teenagers,
    when decision-making skills are still developing, which lowers one’s
    probability of quitting and raises one’s probability of being a
    heavy smoker
  • Companies intentionally increase
    nicotine content
Everyone knows how bad smoking is
  • Few women know of gender specific
  • Most people don’t know smoking
    relates to heart disease
  • Less than ¼ of Chinese men believe
    smoking causes health problems
  • Among rural smokers, reports of
    positive descriptions of smoking are increasing and of associated
    health risks are decreasing
Just a few cigarettes a day can’t hurt
  • Risk for cardiovascular disease
    increases with only 3-5 cigarettes/day
  • Risk is nonlinear at low doses
    (i.e., increasing rapidly)
  • Pregnant women who smoke less that
    5 cigarettes/day have low birth weight babies
“Light” cigarettes are less harmful
  • There is not industry standard to
    define “light” or “ultralight”
  • Companies note that “light” and
    its kind refer to taste and not content
  • “Light” cigarettes include the
    same amount of tar as regular cigarettes (1:1)
  • People inhale harder when they
    smoke “low-tar” cigarettes
It’s easy to stop smoking: If people
want to quit, they will.
  • Though many people quit on their
    own, most people make multiple quit attempts before they stop
  • Only 50% of surveyed doctors who
    smokes and had a heart attack were able to quit
Cessation medications don’t work
  • Studies show that nicotine
    replacement can facilitate quitting
  • Combination therapies (e.g.,
    replacement + therapy) can be even more effective
Once a smoker, always a smoker
  • More than ½ of Americans who ever
    smoked have quit
Smokers may die earlier, but all they
lose are a couple of bad years at the end of life
  • On average, smokers who die of
    tobacco-related illness lose 14 years of life.
  • Elderly smokers have the health of
    individuals 2-4 years their senior and the mental health of
    individuals 10 years their senior
Environmental tobacco smoke may be a
nuisance, but it isn’t deadly
  • The circulatory system of
    non-smokers is similar to that of smokers only 30 minutes after
    smoke exposure
  • Passive smoking is associated with
    respiratory disease, asthma, and sudden infant death syndrome
Tobacco is good for the economy
  • World Bank data indicate that
    money spent on tobacco would be spent on other good and services
  • Some estimate a net increase of
    jobs in America if tobacco were eliminated from the economy
  • Non-smokers miss less work than
We’ve already solved the tobacco
  • More than 1 in 5 adults in America
  • The decline in smoking rates has
    stagnated in recent years
  • An estimated 1 billion people will
    die this century from tobacco-related illness
The tobacco industry no longer markets
to kids or undermines public health efforts
  • The World Health Organization
    reports that tobacco companies continue to target youths and try to
    undermine public health initiatives
  • Many companies file lawsuits
    against public health campaigns they deem “anti-industry”
  • Industry social responsibility
    programs do not change business strategy
  • Children aged 12-17 are more
    likely to be exposed to tobacco advertising (e.g., through movies,
    music videos, television, etc.)

Figure. Myths and Rebuttals Identified by Frieden & Blakeman (2005). Click image to enlarge.

Frieden and Blakemen (2005) provide a large amount of empirical evidence rebutting the myths presented in Table 1. A primary goal of their review was to illustrate how myths limit the public’s ability to expand tobacco control. Although the authors have used empirical literature to contradict the existing myths, they have not related those myths specifically to tobacco control; and, consequently, cannot say that there is a causal link between the existence of the myths and poor tobacco control. One way to gain information about this link would be to survey regulators, for example, to gain their impressions of the impact of myths on policy-making decisions. Because this was a commentary, and not a meta-analysis, the authors did not present a methodological summary of their literature review. At this time we cannot evaluate the representativeness of the literature presented. Nevertheless, the authors provide compelling empirical evidence for the hollowness of the myths. It is important to note, that variations on these myths are often evident for other objects of addiction. It is possible that these myths represent some type of cultural or group rationalization for doing something risky, unhealthy, or bad. Conventional wisdoms are the collective perspectives of individuals; so, the noted myths might represent a social psychological architecture of the justification of risky behavior.

–Debi LaPlante, Senior Editor, The BASIS.


Frieden, T. R., & Blakeman, D. E. (2005). The dirty dozen: 12 myths that undermine tobacco control. American Journal of Public Health, 95(9), 1500-1505.

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