WHY "LIGHTS" ARE JUST AS DEADLY

“Tar” is the substance delivered by cigarettes that causes cancer and respiratory diseases. Nicotine is the addictive drug people smoke for. Cigarettes marketed as "light", "mild" or "ultra light" are reported to deliver lower quantities of tar and nicotine than regular cigarettes. However, this is only the case when they are smoked in a standard manner by a machine. However humans do not smoke cigarettes in a standard manner like machines. If you have smoked, you will probably recall that some of your cigarettes are smoked intensively almost right down to the butt, while others largely burn out themselves, with only a few quick puffs being taken. You can therefore have complete control of how much smoke you inhale from each cigarette. Cigarette manufacturers reduce the machine-smoked yields of cigarettes by putting tiny holes in the filter (vents) which allow air to be mixed with smoke when a person (or machine) draws a puff. This gives it a lower “tar score” on the machine test. However, smokers who switch to these "light" cigarettes tend to smoke them in a manner which increases the amount of smoke they inhale, such that it is well above the machine-smoked yields printed on the packs. Smokers do this because they are smoking for nicotine, and will puff more frequently, more deeply or simply block the vents with their lips or fingers (subconsciously) in order to obtain their usual dose of nicotine (and therefore tar).

A study has shown that Camel Lights actually contain more nicotine per cigarette (10.3mg) than Camel Full Flavor (9.5 mg). Thus the numbers printed on the packs bear very little relation either to the total quantity contained in the cigarette or absorbed by the smoker.

The majority of smokers of "light" cigarettes believe them to be less harmful than regular brands. Unfortunately the evidence suggests that "light" cigarettes are just as harmful as regular cigarettes, and that for many smokers, switching to "lights" merely delays the day when the person quits completely. Of course, the tobacco industry has known all of this for more than thirty years. An internal memo within the Philip Morris tobacco company in 1976 indicated that their own research on Marlboro Lights already showed that smokers of light cigarettes do not inhale less harmful smoke. It stated, "Marlboro Lights cigarettes were not smoked like regular Marlboros. There were differences in the size and frequency of puffs, with larger volumes taken on Marlboro Lights......In effect, the Marlboro 85 smokers in this study did not achieve any reduction in the smoke intake by smoking a cigarette normally considered lower in delivery".

The main message for smokers is that if you are interested in doing something to reduce or avoid the health risks of smoking, then switching to so called "light" cigarettes will not necessarily help achieve that aim. The single best thing a smoker can do for their health is to stop smoking.

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Good Bye to Mr. Cigarette

Hey Everyone! It's Carrie here. I know...long time no blog. As you can read, we've had a bit of a switcheroo with Freedom from Smoking. Dr. and Mrs. Kleinman's practice is flooded with victims escaping the storm of smoke. So as chance would have it, a blessing comes in the disguise of a slight inconvenience. We're lucky to have Dr. Foulds join the group of Healthline experts. I would say he's hit the ground running at a pace that just may leave this blog smokin'. Tee, hee, hee...

But seriously, folks, lungs are no laughing matter and neither are lip wrinkles caused from puckering up to Mr. Cigarette. Mrs. Kleinman had to quit on helping me quit. So the original idea of setting Valentine's Day as my quit date was pushed back -- for tomorrow night! Mrs. Kleinman suggested that I join a quit smoking group, so I'm attending my first class tomorrow at the Tobacco Education Center at UCSF. For the next 4 Tuesdays I will be attending their group program. I think this will make for some interesting story telling, to say the least. I can't wait to see who will be in the class. This is like the first day of school.

Anyway, I'll be filling you in on what it's like to quit with a group program and what I've learned. Hopefully there will be some extroverts in the class who will be willing to share their smoking stories and their pain of quitting, as well.

Alas, tonight is my last with Mr. Cigarette. I will be breaking his heart. I'll cry as he insists on staying in my life, but I'll just have to throw him out like yesterday's trash. Stay tuned, mes amis, for more on ways to make it through the grieving process.

Other posts by Carrie:

24 Hours Smoke Free

"Cold Turkey" is for the Birds

Read the Fine Print

As the Smoke Clears

The Enchantments of Smoking

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Tobacco Industry Found Guilty of Racketeering

On August 17th, 2006, U.S. District Judge Gladys Kessler made her final ruling in the case of the United States v Philip Morris & other major tobacco companies. After 6 years of litigation, nine months of trial, and thousands of pages of evidence, Judge Kessler found the defendants (the major tobacco companies) guilty on numerous counts of fraud and racketeering. Importantly, she also found that these illegal and fraudulent actions are continuing and are likely to continue in the future. Although this legal case may not be directly relevant to helping individual smokers to quit (and, as always, is being appealed), I think the case, and Judge Kessler’s conclusions should be of interest to anyone who has smoked or has a family member who smokes. Judge Kessler carefully explained her Opinion in this case in a 1,700-page document that really helps us understand the true nature of the tobacco industry. I believe this case and the ruling didn’t get as much publicity as it deserved, perhaps because the case and the final ruling were so detailed that few (including myself) would be able to follow it all. So I’m going to try to summarize the main points, structured around 7 areas in which the tobacco industry were found to have defrauded the American public:

• The Hazards of Smoking: Judge Kessler found that the industry had known for 50 years that cigarette smoking caused diseases, but repeatedly denied the adverse health effects. “They mounted a coordinated, well financed, sophisticated public relations campaign to attack and distort the scientific evidence demonstrating the relationship between smoking and disease.”
• Addiction: Judge Kessler concluded that the tobacco industry had known for 40 years that nicotine in tobacco causes cigarettes to be addictive but also withheld information about their research from the American public. “For approximately 40 years, Defendants publicly, vehemently, and repeatedly denied the addictiveness of smoking and nicotine’s central role in smoking.”
• Nicotine Levels: Judge Kessler concluded that tobacco manufacturers control nicotine levels in cigarettes to ensure that smokers become and stay addicted. “The words of Defendants themselves establish that the goal of their extensive efforts…to control the levels of nicotine delivery was to ensure that smokers obtain sufficient nicotine to create and sustain addiction.”
• Light Cigarettes: The tobacco companies misled consumers into believing that so-called low tar and light cigarettes are healthier than other cigarettes and an acceptable alternative to quitting.
• Marketing to Youth: Judge Kessler concluded that tobacco companies create sophisticated marketing campaigns to get young people to start and continue smoking, so as to replace those who die or quit. “The evidence is clear and convincing- and beyond any reasonable doubt – that Defendants have marketed to young people 21 and under while consistently, publicly, and falsely, denying they do so.”
• Secondhand Smoke: Judge Kessler concluded that the tobacco industry has long known that secondhand smoke is hazardous to non-smokers and were aware that this information could harm their profits. They therefore sought to undermine and suppress research and trivialize it in the mind of the public. Judge Kessler pointed out that this effort to minimize the effects of secondhand smoke continues to this day.
• Suppression of Information: Judge Kessler concluded that for over 50 years the tobacco industry tried to protect itself from litigation by concealing research, destroying documents, and trying to shield documents from the public by pretending that they were “privileged” and protected by law.

To some of you this may not be totally surprising. What is new about this is that rather than it being something we may suspect, it is something that has been proven in a court of law. Not only are public health advocates claiming that the tobacco industry has committed these illegal acts, but a senior judge, having reviewed all the evidence, has come to the conclusion that the tobacco industry is guilty on 7 counts of fraud and racketeering. And what are the consequences for the industry for causing the premature deaths of tens of millions of Americans? This judgment concluded that they would not face any financial penalties, but should stop doing it in the future! Maybe you, like me, don’t think the punishment fits the crime in this case. Maybe you think it doesn’t really matter. But if you or a member of your family picked up a Camel or a Marlboro over the past 50 years there’s a good chance that your health or the health of a loved one was harmed more than it should have been by fraudulent activities by the tobacco companies. I think it is outrageous that they are still getting away with it. What do you think?

More information on this case is available at: Tobacco Law Center

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Do women find it harder to quit smoking?

This past week I attended the annual meeting of the Society for Research on Nicotine and Tobacco, so I thought I’d share with you some of the new findings presented at the meeting. There was a lot of new research addressing the differences between men and women in stopping smoking. First of all, its worth noting that not all studies find a difference in quit rates between men and women, and some of the men who quit cigarette smoking actually switch to another tobacco product (e.g. cigars or snuff) and so they aren’t really quitting tobacco at all. However, it is fairly common for studies to find a lower cigarette quit rate in women than men and this has led researchers to try to figure out the reason why. One study reported by Dr Megan Piper from the University of Wisconsin found that women experience larger increases in craving for a cigarette and withdrawal symptoms (e.g. irritability) than men on the very first day of their attempt to quit. Dr Sharon Allen from the University of Minnesota compared the success rates of women planning to quit smoking in different phases of their menstrual cycle. She found that women were more likely to succeed in quitting smoking (23%) if they planned their quit date to coincide with the luteal phase of their menstrual cycle (i.e. the 2 weeks from ovulation until menstruation). Women were less likely to quit if they planned their quit day to occur in their follicular phase (from menstruation to ovulation), when only 9% succeeded in quitting. This result was somewhat surprising given that previous research had suggested that cigarette cravings may be strongest during the late luteal (premenstrual) phase. Two studies by researchers at Yale University found that women have 20% more brain nicotine receptors than men, and that women have increased sensitivity to nicotine effects.

So some of these new studies are providing potential explanations for why women seem to find it slightly harder to quit than men. In my experience, women do particularly well when they use the nicotine inhaler as an aid to smoking cessation, and many say that they really appreciate that the inhaler replaces the behavioral part of smoking (without delivering the 4000 toxic chemicals in cigarette smoking). When patients attend our tobacco clinic they typically attend a 6-week group and use a combination of medications (e.g. the patch, plus bupropion plus the nicotine inhaler) under medical supervision. With that treatment we find that women have the same high quit rates as men. The new research showing that women trying to quit without any medication experience stronger early cravings and mood disturbance underlines the importance for women to make use of effective FDA-approved medications (nicotine replacement, Zyban or Chantix) if they smoke at least 10 cigarettes per day. The research on quitting smoking in different phases of the menstrual cycle is interesting but the results don’t seem to be consistent enough to lead to clear recommendations. Someone planning a quit attempt should always consider and prepare for the challenges they can anticipate. For some women their menstrual cycle may be an important consideration. I’d be interested to hear from readers’ own experiences of what has helped them quit and whether any of these research findings ring true in your experience.

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How Bad Is Smoking For Health?

Almost 20 years ago when I started my first job in tobacco research, I told my new boss that I’d like to get a sense of whether smoking really was so bad for health. I asked him if he could give me something to read to help me understand the health effects. Professor Michael Russell – one of the world’s top researchers into tobacco addiction – was clearly a bit irritated by my question, and proceeded to dump four U.S. Surgeon General’s Reports and two Royal College of Physicians reports on my desk. Each one had about three hundred pages. He said, “If that’s not enough for you I have more in my office”. Since that time many more volumes have been published demonstrating the many ways in which smoking is harmful to health. I can’t pretend to have read all of them. After a while the sheer weight of the evidence becomes so convincing, one doesn’t need any more. The more important task is to communicate it to the public. The simplest way to put it is that if you smoke and keep smoking there’s a 50-50 chance it will kill you. However, I prefer to compare it to the game of drawing straws. A smoker who continues smoking is forced to take a chance like drawing one of 4 straws. Two are long straws, meaning they won’t lose any years of life due to their smoking (one because they were unfortunately destined to die young of other causes, and the other because they were fortunate to have a genetic makeup and other factors making them less prone to lethal smoking-caused diseases). One is a medium length straw, meaning they will lose 10 years of life due to smoking, and the other is a short straw, meaning they will lose 30 years of life due to smoking. Of course no-one knows what straw they are going to get until its too late. If you had to estimate the average risk (30 years, plus 10 years, divided by 4) it is that a smoker will lose 10 years of life as compared with never smoking (but with a 25% chance of dieing so young they never get to see their grandkids grow up).

Some people say they don’t want to live into their 80s anyway. It is important for smokers to know that those years of life lost due to smoking are healthy years, not sick years. Smokers have fewer years in health (free from disability) but also more years in sickness/disability. For every person who is killed by smoking each year in the US (over 400,000 per year) there are 20 still alive who suffer a serious smoking-caused illness that year (ranging from a chest infection to a non-fatal heart attack).

One other simplified way to think about it is that each cigarette takes about 11 minutes off your life. As it takes about that long to smoke the cigarette, it means that every minute spent smoking shortens your lifespan by approximately that same amount of time.

There is no other single behavior that has such a massive impact on one's health, and this is the reason I chose to focus my career on smoking cessation. Psychologists don’t frequently have the opportunity to save a life. I figure that every person I can help to quit smoking gains about 10 healthy years of life, and that’s not bad for a days work! These massive effects of smoking on health are the main reason most smokers want to quit. In future posts I’ll discuss the ways you can increase your chances of successfully quitting. Talk to you soon.
Jonathan

p.s. If you want more information on smoking and health, I recommend this site: http://www.cdc.gov/tobacco/sgr/sgr_2004/sgranimation/flash/index.html

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Introducing Dr. Jonathan Foulds

Welcome to my first post on the Freedom From Smoking blog. Actually I’m going to refer to it as the Freedom From Smoking “Forum” as I’d like this to be a place where readers can ask questions, get answers, dialogue and share experiences, rather than just read what I have to say. So please feel free to post a reply, comment or just ask a question.

So I should probably tell you a bit about myself. I was born and raised in Scotland. I had a brief spell in the US (Georgia) on a soccer scholarship when I was 16-17, before returning to Scotland, where I trained as a clinical psychologist. I did my PhD on smoking cessation at University of London and lived there for 11 years, before coming to the USA in 2000. I direct a program at the University of Medicine and Dentistry of New Jersey that aims to reduce the harm to health from tobacco by helping smokers quit http://www.tobaccoprogram.org/. We have a specialist tobacco clinic that has treated thousands of patients, and we also do research and train other health professionals how to help their patients to quit smoking.

Over the coming months I’ll be posting on this forum 3-4 times per week and my aim is to keep you up to date on the latest information on smoking and how to quit. Next week I’m going to the Annual Meeting of the Society for Research on Nicotine and Tobacco in Austin, Texas. Now that may sound like the ultimate geekfest, but for geeks like me its also the best place to find out about the latest new research on quitting smoking. So I’ll be posting to the forum from Texas with the latest news. My intention is to give you the most useful information to help you or a loved one to quit smoking, and to respond to your questions as quickly as I can. Talk to you soon.

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Good Bye and Continue to Fight Smoking

It's time to turn the reigns over. My medical practice has become so busy that I am no longer able to dedicate the time that this blog deserves. Dr. Jonathan Foulds will be my successor. Dr. Foulds is an excellent replacement as he has helped many, many people successfully quit smoking. He is up to date on the latest developments and has many years of experience under his belt.

Remember, you can quit and quit for good!

DrK

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