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).

Myth	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 addiction 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 risks 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 smokers
We’ve already solved the tobacco problem	More than 1 in 5 adults in America smoke 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.

References

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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