Smoking cessation.

BACKGROUND: Although Australia is a world leader in tobacco control, smoking remains the behavioural risk factor making the largest contribution to death and disease. Smoking rates remain high in Aboriginal and Torres Strait Islander people and in people with mental health problems. Priority groups for cessation include women who are pregnant and people with cardiovascular disease. OBJECTIVE: This article, based on the recently published second edition of Supporting smoking cessation: A guide for health professionals, provides an update on current evidence-based practice to support quitting. A brief, time-efficient intervention approach (Ask, Advise, Help) is proposed. New approaches to the use of pharmacotherapy are covered, as is the controversial role of nicotine-containing e-cigarettes and advice for groups with high smoking prevalence and those with special needs. DISCUSSION: A combination of behavioural support along with pharmacotherapy to treat nicotine dependence maximises the chances of successful long-term cessation. Combination nicotine replacement therapy (patch and short-acting oral form) or varenicline are the most effective forms of pharmacotherapy.

Tobacco industry and public health responses to state and local efforts to end tobacco sales from 1969-2020.

BACKGROUND: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. METHODS: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. RESULTS: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. CONCLUSION: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales.

Twenty-year health and economic impact of reducing cigarette use: Minnesota 1998-2017.

BACKGROUND: Adult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult. METHODS: 1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017. RESULTS: The simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion. CONCLUSIONS: Minnesota's investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

Tobacco control in Nepal during a time of government turmoil (1960-2006).

BACKGROUND: Nepal was a monarchy, then a dictatorship, then a democracy. This paper reviews how tobacco control progressed in Nepal in the context of these changes in government from 1950 through 2006. METHODS: We triangulated tobacco industry documents, newspaper articles and key informant interviews. RESULTS: Until 1983, the tobacco industry was mostly state owned. Transnational tobacco companies entered the Nepalese market through ventures with Surya Tobacco Company Private Limited (with Imperial Tobacco Company and British American Tobacco) in 1983 and Seti Cigarette Factory Limited (with Philip Morris International [PMI]) in 1985. Seminars and conferences on tobacco, celebrations of World No Tobacco Day (WNTD) and efforts by WHO helped promote tobacco control in Nepal beginning in the 1970s. Tobacco advocates in Nepal pushed the government to issue executive orders banning smoking in public places in 1992 and tobacco advertising in electronic media in 1998, and to introduce a tobacco health tax in 1993. The tobacco industry lobbied against these measures and succeeded in keeping the tobacco tax low by challenging it in court. Tobacco advocates sued the government in 2003 and 2005, resulting in a June 2006 Supreme Court decision upholding the smoking and advertising bans and requiring the government to enact a comprehensive tobacco control law. CONCLUSIONS: Political instability, conflict, weak governance and the dictatorship significantly affect tobacco control activities in low-income and middle-income countries. Nepal shows that tobacco control advocates can take advantage of global events, such as WNTD, and use domestic litigation to maintain support from civil societies and to advocate for stronger tobacco control policies.

The Mid-Atlantic Twin Registry of Virginia Commonwealth University.

The Mid-Atlantic Twin Registry (MATR) is a population-based registry of more than 60,000 twins primarily born or living in Virginia, North Carolina and South Carolina. Researchers may utilize the MATR for administration of research services, including study recruitment, data or sample (e.g., DNA) collection, archival dataset creation, as well as data collection through mailed, phone or online surveys. In addition, the MATR houses the MATR Repository, with over 1700 DNA samples primarily from whole blood available for researchers interested in DNA genotyping. For over 40 years MATR twins have participated in research studies with investigators from a range of scientific disciplines and institutions. These studies, which have resulted in numerous publications, explored diverse topics, including substance use, smoking behaviors, developmental psychopathology, bullying, children's health, cardiovascular disease, cancer, the human microbiome, epigenetics of aging, children of twins and sleep homeostasis. Researchers interested in utilizing twins are encouraged to contact the MATR to discuss potential research opportunities.

The disease of Sigmund Freud: oral cancer or cocaine-induced lesion?

PURPOSE: Sigmund Freud, the father of modern psychoanalysis, suffered from what was considered to be a malignant tumour spreading from the back of his palate. He underwent numerous surgical interventions and radiation therapy over the course of 16 years. Such a long survival casts a shadow of doubt on the diagnosis of oral cancer that was given to Freud. METHODS: The book "Freud: Living and Dying", in which the personal physician of Freud described in detail his patient's fight with oral cancer, was reviewed. Current and past evidence, as well as epidemiological data, on oral cancer and cocaine-induced midline destructive lesions were also reviewed. RESULTS: Tobacco and cocaine are both responsible for oral lesions and Freud was a dedicated cigar smoker as well as a user and defender of cocaine. Freud's medical records indicate that the main cause of Freud's oral disease was excessive smoking. On the other hand, the diagnosis of oral cancer does not seem to be entirely consistent with the 16-year-long survival of Freud. Freud used cocaine regularly in the 1890s, as reported by his personal physician, and it is possible that he continued taking it beyond that time period without feeling the need to inform his doctor. CONCLUSIONS: It is possible that the lesion that progressively and very slowly eroded the splanchnocranial structures of Freud was not a bona-fide cancerous malignancy, but rather, the necrotizing effect of cocaine use that has been previously reported to be responsible for some massive facial destructive lesions.

The "Canone Inverso": when tobacco was not so bad. A Look Back at the Primordial Debate on the tobacco effects in the Occupational Medicine.

AIM: The article provides an overview on the beginning and evolutions of medical observations on tobacco induced diseases between Eighteenth and Nineteenth century. METHODS: By searching for historical medical literature, first studies on tobacco-induced diseases focused on production risks rather than on adverse effects that the use of tobacco has for the human health. RESULTS: The approach induced first eighteenth-century authors to define this substance as a non-pathogenic and, consequently, not to consider tobacco factories dangerous for health workers. In those years, tobacco was employed in therapy as a stimulant treatment and it was considered harmless and even healthy and preventive of several acute diseases. CONCLUSIONS: Authors will show that studies on pathogenic effects of smoking will only start around late nineteenth century, when the idea of the healthiness of tobacco industry was already supported.

Blowing up money? The earnings penalty of smoking in the 1970s and the 21st century.

We analyze the earnings penalty of smoking among Swedish twins in two social contexts: the 1970s, when smoking was common and widely accepted and when there were relatively few tobacco laws aiming to reduce smoking; and the 2000s, when smoking had become more expensive, stigmatizing and less common, and when tobacco laws and regulations had intensified. The results show that the short-term earnings penalty of smoking was much higher in the 21st century than in the 1970s for men. For women, smokers had on average higher annual earnings compared to nonsmokers in the 1970s, but lower annual earnings in the 2000s. In the long run, there was an earnings gap for men between never-smokers and continuous smokers, whereas there was a pronounced earnings 'bonus' of smoking cessation for women. The results emphasize the importance of social context and the long-term horizon when evaluating the consequences of smoking for earnings.

[History of Brazil's tobacco control policy from 1986 to 2016]. / Trajetória da política de controle do tabaco no Brasil de 1986 a 2016.

This study analyzes Brazil's tobacco control policy from 1986 to 2016, seeking to describe the policy's history and discuss its achievements, limits, and challenges. The study adopted a political economics approach and contributions from public policy analysis. Data were based on a search of the literature, documents, and secondary sources and semi-structured interviews with stakeholders involved in the policy. Factors related to the domestic and international contexts, the political process, and the policy's content influenced the institutional characteristics of tobacco control in the country. The study emphasizes the consolidation of Brazil's social rejection of smoking, government structuring of the policy, action by civil society, and Brazil's prestige in the international scenario. Inter-sector tobacco control measures like price and tax increases on cigarettes, the promotion of smoke-free environments, and the enforcement of health warnings contributed to the important reduction in prevalence of smoking. Implementation of the World Health Organization Framework Convention on Tobacco Control in Brazil, beginning in 2006, contributed to the expansion and consolidation of the national policy. However, tobacco-related economic interests limited the implementation of some strategic measures. The challenges feature the medium- and long-term sustainability of tobacco control and the solution to barriers involving crop diversification on current tobacco-growing areas, the fight against the illegal cigarette trade, and interference in the policy by the tobacco industry.

O estudo analisa a política brasileira de controle do tabaco entre 1986 e 2016, buscando caracterizar a trajetória da política e discutir os seus avanços, limites e desafios. Adotaram-se a perspectiva da economia política e contribuições do referencial de análise de políticas públicas. Realizou-se análise bibliográfica, documental, de dados secundários e de entrevistas semiestruturadas com atores envolvidos na política. Fatores relacionados ao contexto nacional e internacional, ao processo político e ao conteúdo da política influenciaram a institucionalidade do controle do tabaco no país. Ressaltam-se a consolidação da rejeição social ao tabagismo, a estruturação governamental da política, a atuação da sociedade civil e o prestígio do Brasil no cenário internacional. Medidas intersetoriais de controle do tabaco, como o aumento de preços e impostos de cigarros, a promoção de ambientes livres do fumo e a adoção de advertências sobre os malefícios do tabagismo contribuíram para a expressiva redução da prevalência de fumantes no período. A implementação da Convenção-Quadro para Controle do Tabaco da Organização Mundial da Saúde no Brasil, a partir de 2006, contribuiu para a expansão e consolidação da política nacional. No entanto, interesses econômicos relacionados ao tabaco limitaram a implementação de algumas ações estratégicas. Entre os desafios, destacam-se a sustentabilidade do controle do tabaco a médio e longo prazos e a superação das barreiras relacionadas à diversificação em áreas plantadas de fumo, ao combate ao comércio ilícito de cigarros e à interferência da indústria do fumo na política.

El estudio analiza la política brasileña de control al tabaco entre 1986 y 2016, procurando determinar la trayectoria de la política en este sentido, además de discutir sus avances, límites y desafíos. Se adoptaron la perspectiva de la economía política y contribuciones dentro del marco referencial del análisis a las políticas públicas. Se realizó un análisis bibliográfico, documental, de datos secundarios y de entrevistas semiestructuradas con actores involucrados en la política. Los factores relacionados con el contexto nacional e internacional, proceso político y contenido de la política influenciaron la institucionalidad del control al tabaco en el país. Se resaltan la consolidación del rechazo social al tabaquismo, la estructuración gubernamental de la política, la actuación de la sociedad civil y el prestigio de Brasil en el escenario internacional. Las medidas intersectoriales de control al tabaco, como el aumento de precios e impuestos de cigarrillos, la promoción de ambientes libres de tabaco y la adopción de advertencias sobre los perjuicios del tabaquismo contribuyeron a una expresiva reducción de la prevalencia de fumadores durante el período. La implementación de la Convención-Marco para el Control del Tabaco de la Organización Mundial de la Salud, en Brasil, a partir de 2006, contribuyó a la expansión y consolidación de la política nacional. No obstante, los intereses económicos, relacionados con el tabaco, limitaron la implementación de algunas acciones estratégicas. Entre los desafíos, se destacan la sostenibilidad del control al tabaco a medio y largo plazo y la superación de las barreras relacionadas con la diversificación en áreas plantadas con tabaco, el combate al comercio ilícito de cigarrillos y la interferencia de la industria del tabaco en la política.

Origins of tobacco harm reduction in the UK: the 'Product Modification Programme' (1972-1991).

OBJECTIVE: To better understand the current embrace of long-term nicotine maintenance by British governmental agencies and tobacco harm reduction by several leading British public health organisations, describe the context and deliberations of the UK's first formal tobacco risk reduction programme: 'Product Modification'. METHODS: Analysis of previously secret tobacco industry documents, news archives and Parliamentary debate records. RESULTS: From 1972 to 1991, the British government sought to investigate safer smoking through the 'product modification programme'. The Independent Scientific Committee on Smoking and Health (ISCSH) advised the British government on these efforts and collaborated with the tobacco industry, with which government then negotiated to determine policy. The ISCSH operated from four industry-backed premises, which contributed to the ISCSH's support of safer smoking: (1) reduced toxicity indicates reduced risk; (2) collaboration with the tobacco industry will not undermine tobacco control; (3) nicotine addiction is unavoidable; (4) to curtail cigarette use, solutions must be consumer-approved (ie, profitable). These premises often undermined tobacco control efforts and placed the ISCSH at odds with broader currents in public health. The product modification programme was abandoned in 1991 as the European Community began requiring members to adopt upper tar limits, rendering the ISCSH redundant. POLICY IMPLICATIONS: Endorsements of reduced harm tobacco products share the same four premises that supported the product modification programme. Current tobacco harm reduction premises and policies supported by the British government and leading British public health organisations may reflect the historical influence of the tobacco industry.

Le "canceur des fumeurs" in 19th century: the contribution of the French surgeon Étienne-Frédéric Bouisson (1813-1884).

At the beginning of the 19th century, the alarming rise in tobacco consumption and its consequences in health preoccupied physicians. Several medical authors pointed out the harmful effects of smoking, enumerating related disorders. In 1821, the hygienist Alexandre Parent du Châtelet (1790-1835) and the chemist Félix d'Arcet (1814-1847), studied the effects of tobacco in health and concluded that it was a relatively healthy habit providing also a kind of immunity from contagious diseases. The tobacco controversy opened up and continued for almost 40 years. In 1861, the professor of surgery and politician Étienne-Frédéric Bouisson (1813-1884) in his work entitled: "Tribut à la chirurgie ou mémoires sur divers sujets de cette science" (Tribute to surgery or dissertations on various topics of this science) related for the first time tobacco consumption to oral cancer, applying medical statistics and analyzing meticulously all the available data.

A Revolutionary Attack on Tobacco: Bolshevik Antismoking Campaigns in the 1920s.

Using archival records of the Commissariat of Public Health, journals, and propaganda materials from the antismoking campaign of the Soviet 1920s, this article argues that the revolutionary state pursued an antitobacco policy unique in the world in its attack on tobacco use at a national scale. The commissar of public health, Nikolai Alexandrovich Semashko, attempted to severely curtail tobacco cultivation and production, limit tobacco sales, and create a public opinion against tobacco with a propaganda campaign. Even in failing in its farther-reaching goals, the policy proved one of the most forward in terms of antismoking propaganda and state-sponsored treatment regimens, with the distribution of antismoking posters, pamphlets, articles, plays, and films as well as the creation of special state-sponsored smoking-cessation programs that boasted high success rates.

Tobacco-related carcinogenesis in head and neck cancer.

Head and neck cancer (head and neck squamous cell carcinoma (HNSCC)) is a devastating disease. Patients require intensive treatment that is often disfiguring and debilitating. Those who survive are often left with poor speech articulation, difficulties in chewing and swallowing, and cosmetic disfigurement, as well as loss of taste. Furthermore, given that HNSCC survivors are frequently disabled and unable to return to work, the economic and societal costs associated with HNSCC are massive. HNSCC is one of many cancers that are strongly associated with tobacco use. The risk for HNSCC in smokers is approximately ten times higher than that of never smokers, and 70-80% of new HNSCC diagnoses are associated with tobacco and alcohol use. Tobacco products have been used for centuries; however, it is just within the last 60-70 years that we have developed an understanding of their damaging effects. This relatively recent understanding has created a pathway towards educational and regulatory efforts aimed at reducing tobacco use. Understanding the carcinogenic components of tobacco products and how they lead to HNSCC is critical to regulatory and harm reduction measures. To date, nitrosamines and other carcinogenic agents present in tobacco products have been associated with cancer development. The disruption of DNA structure through DNA adduct formation is felt to be a common mutagenic pathway of many carcinogens. Intense work pertaining to tobacco product constituents, tobacco use, and tobacco regulation has resulted in decreased use in some parts of the world. Still, much work remains as tobacco continues to impart significant harm and contribute to HNSCC development worldwide.

On the Origins of the Electronic Cigarette: British American Tobacco's Project Ariel (1962-1967).

Electronic cigarettes are advertised as the latest technological gadget-the smoking equivalent of smart phones. I challenge this sense of novelty by tracing their history to the 1960s, when researchers at British American Tobacco first recognized that smokers' brains were dependent on nicotine. This discovery enabled British American Tobacco to develop a novel kind of smoking device under the codename "Ariel" between 1962 and 1967. Whereas filters were meant to eliminate specific harmful constituents of tobacco smoke, Project Ariel tried to reduce smoking to its alkaloid essence: nicotine. By heating instead of burning tobacco, the scientists working on Ariel managed to produce an aerosol smoking device that delivered nicotine with very little tar while retaining the look and feel of a cigarette. However, after receiving two patents for Ariel, British American Tobacco ultimately decided to abandon the project to avoid endangering cigarettes, its main product. Today, as e-cigarettes are surging in popularity, it is worth revisiting Ariel because it is not just an episode in the history of aerosol smoking devices but its starting point.

Historical declines and disparities in cigarette coupon saving among adolescents in the United States, 1997-2013.

Exposure to cigarette coupons is associated with smoking initiation and likelihood of cigarette purchase among adolescents. Some adolescents who are exposed to cigarette coupons take a step further by choosing to save or collect these coupons, a further risk factor for cigarette smoking. This study examines historical trends and disparities in cigarette coupon saving among adolescents in the United States from 1997 to 2013. National samples of 10th and 12th grade students (n=129,111) were obtained from Monitoring the Future surveys in 1997-2013. Prevalence of lifetime and current cigarette coupon saving was estimated in each year in the overall adolescent population, and in race/ethnicity, parent education level, sex, and urban/rural subgroups. Prevalence of lifetime and current cigarette coupon saving was then estimated in each year based on smoking status. Prevalence of cigarette coupon saving has decreased dramatically among adolescents; only 1.2% reported currently saving coupons in 2013. However, disparities in cigarette coupon saving remain with prevalence higher among rural, White, and low parental education level students. Adolescent smokers continue to save coupons at high rates; 21.2% had ever saved coupons and 6.9% currently saved coupons as of 2013. Despite overall declines in adolescent cigarette coupon saving, existing sociodemographic disparities and the considerably high prevalence of coupon saving among adolescent smokers suggest that cigarette coupons remain a threat to smoking prevention among youth. Additional research is needed to further elucidate longitudinal associations between cigarette coupon saving and smoking initiation and maintenance among adolescents.

Philip Morris research on precursors to the modern e-cigarette since 1990.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) is increasing rapidly. Chinese pharmacist Hon Lik is frequently cited as inventing the modern e-cigarette in 2003. However, tobacco companies have developed electronic nicotine delivery systems since at least 1963. METHODS: We searched the University of California San Francisco Truth (formerly Legacy) Tobacco Industry Documents beginning with the terms 'electric cigarette' and 'electronic cigarettes', 'e-cigarette', 'smokeless cigarettes', 'nicotine aerosol', 'tobacco aerosol', and 'vaping' and then expanded the search using snowball sampling. We focused our analysis on Philip Morris (PM) documents discussing technology that aerosolised a nicotine solution because these devices resembled modern e-cigarettes. Over 1000 documents were reviewed; 40 were included in the final analysis. RESULTS: PM started developing a nicotine aerosol device in 1990 to address the health concerns and decreased social acceptability of smoking that were leading smokers to switch to nicotine replacement therapy. PM had developed a capillary aerosol generator that embodied basic e-cigarette technology in 1994, but in the mid-to-late 1990s focused on applying its aerosol technology to pharmaceutical applications because of uncertainty of how such products might affect potential Food and Drug Administration regulation of tobacco products. In 2001, PM resumed its work on a nicotine aerosol device, and in 2013, NuMark (a division of Altria, PM's parent company) released the MarkTen, a nicotine aerosol device. CONCLUSIONS: Rather than a disruptive technology, PM developed e-cigarette technology to complement, not compete with, conventional cigarettes and evade tobacco control regulations.

[The national anti-opium-smoking campaigns across the country in the Republican Period].

Anti-opium-smoking had been the key policy of successive central and local governments from the late Qing Dynasty to the Republican Period. Since the establishment of the Nanjing Provisional Government in January 1912, the Anti-opium-smoking campaign had culminated across the country. Under the support of the government, the "National Anti-Opium Association of China" and "Association of Chinese People Rejecting Opium" were established which made an important contribution to China's anti-opium-smoking campaign.Yunnan, Shaanxi, Heilongjiang, Zhejiang, Shanghai and other local governments also combined with local specific circumstances to make anti-opium-smaking policy for punishing severely the opium cultivation, trade and opium smoking, thus, the overrun of opium began to be brought under an overall control.

History and the future: Looking back to look forward?

History is often dismissed as of little utility in the analysis of policy. This paper provides a justification for its use as evidence. It surveys the rise of the use of history, including public history and history and policy. It looks at two issues which draw on the author's own work: the relationship between regulation and culture for smoking and alcohol; and the response to electronic cigarettes in the light of smoking and public health history. It analyses what history can contribute. Responses are time dependent and change is an essential parameter in understanding policy. Historical research can challenge stereotypes, for example that prohibition was abandoned because it 'failed'. It also forms the bedrock of historical interpretation, which is mutable and often misunderstood outside the profession. History provides policy analysis rather than policy prescription and is a challenging approach, not just a convenient support for established positions. The paper concludes that history is far from moribund as a policy science.