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Pesticides - the real killer in tobacco products
G-7-
Chronic Subtethal Exposure
The premise here is simple: it may not be tobacco that's killing ail those smokers.
Has anyone else noticed that the Surgeon General's warnings never mention
tobacco - only smoking? In this section I suggest that almost al! smoking-related
death is preventable without depriving people who like to smoke of the pleasure of
doing so simply by eliminating chemical contaminants and poisonous synthetic
materials and requiring manufacturers to use 100% natural tobacco leaf.
Copyright© 1996 by Bill Drake All Rights Reserved
Tsble of Contents
This document was last revised on 12/16/98
^Return To Site Index
tXls It The Tobacco, Or The Pesticides?
• An Unnecessary Three Generations
Chlorinated Hydrocarbons And Cigarette Carcinogenicity
•
« Cigarette Research Methods
° Organophosphorous and Carbamate Cigarette Pesticides
l—a-A Curious Blindness
l ^-a—Pesticides, Cigarettes, and Tumors - Early Evidence
1
The Cigarette Industry Line On Pesticides
Cigarettes And Tobacco - Key Differences
• A Long And Winding Trail Of Research
I x*^esearch On Pesticides And Human Health
he'Smoking Guns of 1996
• Chlorinated hydrocarbon Pesticides In Cigarettes
° Aldrin
° Dieldrin
° Endrin
o DDT
o Toxaphene
° Heptachlor
° Chlordane
• Organophosphorus Pesticides In Cigarettes
0 Paraoxon
0 Disulfoton
° Dimethoate
0 Demeton
o Malathion
o BHC
o Lindane
° Parathion
° Diazinon
° Leptophos
1 of 72
■V1/9S
Is It The Tobacco?
Return To Table Of Contents
A proposition for reasonable people to consider - what if it hasn't been the tobacco in cigarettes that's been
killing cigarette smokers?
This isn't a trick question, or a joke.
What if the combinations of pesticide residue contaminants on the tobacco and reconstituted tobacco
portions of cigarettes and other so-called tobacco products are enough in themselves to explain a large
proportion of cigarette-related disease and death?
Then what if residues from chemicals which are known carcinogens like benzene, hexane, and phosgene,
used in the processing of industrial waste into synthetic smoking materials for cigarette manufacturing, and
for manufacturing into smokeless and pipe "tobaccos", are enough to explain a large portion of the
remaining cigarette-related death and disease?
I’ve been tracking the activities of the cigarette industry for almost twenty years and while my research
resources have been limited, Tve pieced together enough of a picture to convince me that it may very well
not be the tobacco at all that's killing many, or even most smokers.
This document, and the associated documents on this site, are dedicated to raising the question of whether
smoking-related disease and death can be largely prevented without having to try to change the desire to
inhale volatilized plant materials for chemical satisfaction, an activity which appears to be hardwired into
the pleasure centers of the brains of a significant portion of the human race, and just as firmly hardwired
into the aversion centers of the brains of everyone else.
If it isn't the tobacco that’s killing people, then almost all of the millions of deaths to come over the next 2050 years from cigarettes and other so-called tobacco products are preventable by requiring that all tobacco
products be manufactured from natural and uncontaminated tobacco.
It's important to know from the beginning, and to keep in mind as you review what I've assembled here as
evidence, that American cigarettes stopped being 100% real leaf tobacco decades ago, and instead are
manufactured using a combination of materials, including:
Real US-grown tobacco leaf - this kind of component is very uncommon in US cigarettes.
Foreign-grown tobacco leaf - this component makes up most of any actual leaf tobacco used in US
cigarettes, but leaf itself is uncommon.
Reconstituted smoking materials made from ground-up foreign tobacco stems, stalks, and waste and a wide
range of additives, glues, fungicides, etc. Use of this tobacco sheet became veiy common in US
cigarettes beginning in the late 1970's and accelerated in the late 1980's. Because of the industry's secret
status and lack of research into the question, nobody knows which US brands, many using images and
words implying that there's tobacco in the pack, are composed mostly or exclusively of this kind of
reconstituted tobacco. We do know that Winston was the first to do so as early as the 1950s.
Synthetic smoking materials are made from materials like recycled paper mill waste, food processing
waste, and recycled municipal cellulosic waste. This material is extremely common in US cigarettes,
especially the Low T&N brands. Again due to secrecy and lack of regulatory oversight, nobody knows
which brands are partly or exclusively made from these synthetic smoking materials.
The giveaway to both synthetic and reconstituted tobacco is that the leafy material in the cigarette tube has
no natural leaf ribs which, if they are present, can be easily detected with any magnifying glass.
With the limited exception of US-grown tobacco, all of the other three materials used to manufacture
cigarettes are normally and commonly contaminated with residues of pesticides which in themselves are
well-established causal agents for breast, lung, and other cancers, for nervous system degeneration, for fetal
malformation and irreversible genetic damage. In the 1985 Food Security Act the US government put a
limited set of regulations in place to deal with pesticide residues on tobacco, requiring that imported FlueCured and Burley leaf tobacco be certified to have been grown using only pesticides registered under the
US Federal Insecticide, Fungicide and Rodenticide Act. As we'll see this is actually tricky wording,
allowing enormous amounts of tobacco waste and scrap to slip through unregulated, and begging the
question of what smoking even regulated pesticides does to human health.
The unbelievable fact is that very few' of the common pesticide contaminants of tobacco appear to have
ever been tested for their health effects when consumed by smoking. This isn't to say that the pesticides
haven’t been studied for their human health effects - they certainly have. The EPA, the FDA, the USDA,
and others have all done extensive work with the tobacco pesticides. There has been a significant amount of
published research on the human health effects of chronic sub-lethal exposure, and of exposure by
inhalation, to many of the common tobacco product pesticide contaminants. There have also been
oral/dermal toxicity studies which have shown many of the common tobacco contaminants are far more
toxic when ingested orally than when absorbed through the skin, which implies similar toxicity when they
are smoked. However, I've searched in vain for literature references to studies on what happens to these
pesticides when they are volatilized by dry distillation and inhaled in combination.
By the time you finish browsing the evidence assembled here, this odd oversight probably won't seem al!
that strange any more.
In another section of this document I've included a broad range of references, but during 1996 alone, US
medical/scientific teams have reported findings that ought to bring the issue of pesticide contamination of
cigarettes into sharp focus:
At least four of the pesticides commonly contaminating US cigarettes, when ingested together even in trace
amounts, become extremely potent chemical agents capable of causing cancers, birth deformities, and
genetic damage even at trace levels. A study by Dr. John MacLachlan of Tulane University, reported in
Science, June, 1996, which had nothing to do with tobacco or cigarettes in particular, demonstrates
that the extremely small dosages of pesticide residues on US cigarettes, which the industry has been
debunking as negligible for decades, turn out to radically enhance each other's toxic, fetus-damaging, and
cancer-causing properties when consumed together. PLEASE NOTE: AS OF LATE AUGUST 1997 DR.
MACLACHLAN'S STUDY IS COMING UNDER CRITICISM BECAUSE OTHERS HAVE NOT BEEN
ABLE TO REPLICATE HIS RESULTS. http://mvw.scienceinag.org:80/science The combinant
effects of trace pesticides in this study were on the order of 1:1600, so those tiny traces ofEndosulfan,
Dieldrin, Disulfoton etc which in themselves may or may not be harmless, are beyond doubt serious health
risks when consumed together - as they are when smoking pesticide-contaminated cigarettes or inhaling
contaminated second-hand smoke.
The risks of inhaling the raw pesticides are great enough, but those risks are compounded by the presence
of xenobiotic combustion by-products. For example, DDT has been a common contaminant of US
cigarettes since the 1950s, and when DDT is burned it creates among other compounds a chemical named
benzo-a-pyrene. This benzo-a-pyrene has been known for at least 35 years to cause lung cancer as fast as
anything known to the industrial world, and it has shown up in assays of cigarette smokestreams since at
least the early 1950s. For many years scientists have been trying to link benzo-a-pyrene to the lung cancer
they know it causes. In 1996 a team led by Mikhail Denissenko reports in Science, October 1996 that
they have traced this chemical step-by-step from the cigarette smokestream to a human chromosome site
called P53 where the mutations leading to human lung cancer are stimulated by BAP's presence.
On the internet see this report at
littp:/Avtvw.scienceinag.org:80/science/sci’ipts/displav,/fuli/274/5286/430.html
For many years researchers have also been working to demonstrate the link between cigarette smoking and
human breast cancer, and although laboratory' research showed several possible strong connections they
weren't able to prove it. Researchers at National Cancer Institute reported in JAMA on Nov. 12,1996
that in women with a weak gene, called NAT2, that defends against toxins and carcinogens, the risk of
breast cancer from smoking a pack of cigarettes a day increases 400% over women with a normal NAT2.
This research shows that a sizeable proportion of women, about 50% of all white women and nearly 40% of
all Black, Hispanic and Asian women inherit this weak NAT2 gene, increasing their risk of breast cancer
from exposure to toxic and carcinogenic chemicals - such as the raw and combusted pesticide compounds
found in cigarette smoke.
For another angle on this increasingly likely link between environmental pesticides and human cancer, with
strong implications for women smokers, see:
Davis D.L., Bradlow HL., Wolff M., Woodruff T., Hoel D.G., Anton-Culver H. 1993, Medical
hypothesis: Xenoestrogens as preventable causes of breast cancer. Environmental Health
Perspectives vlOl n372 p. 7
MacMahon, B., Pesticide Residues And Breast Cancer? Journal of the National Cancer Institute:
JNCI
April, 1994 v 86 n 8, p.572
Hunter, D. J., Kelsey, K. T., Pesticide Residues and Breast Cancer: The Harvest of a Silent
Spring, Journal of the National Cancer Institute: JNCI
April 1993 v85 n8, p.598
Soto, Ana M., Chung, Kerrie L., Sonnenschein, Carlos, The Pesticides Endosulfan, Toxophene,
and Dieldrin Have Estrogenic Effects on Human Estrogen-Sensitive Cells Environmental
Health Perspectives: EHP
April 1994 v!02 n4 p. 380
Chlorinated Hydrocarbons And Cigarette Carcinogenicity
"Organochlorine pesticides are carcinogenic as a class "
Origins of Human Cancer
H.H. Hiatt, et al., Eds. Cold Spring Harbor, 1977
As reported in this 1977 study, by the late 1970s many scientists, including those working for the cigarette
industry, knew that cigarettes and other so-called tobacco products were contaminated with cancer-causing
pesticides in concentrations sufficient to explain cancer in cigarette smokers. As an example, the following
table from the study displays what was already known about many of the common tobacco pesticides and
the concentrations in which they were known to be carcinogenic under conditions of chronic exposure.
Common Name Manufacturer
Carcinogenicity
Carcinogenic Concentration
4Dieldrin
Shell
2.5 PPM
?
Endosulfan
EMC
-(a)
Endrin
Shell/Velsicol
3.2 PPM
+
BHC
Diamond/Hooker
0.50 PPM
-T
DDT
multiple
10.0 PPM
+
Lindane
Diamond/Hooker
236.0 PPM
+
TDE
?
Allied/Rohm & Haas
+
Aldrin
Shell
3.0 PPM (c)
4Chlordane
Velsicol
25.0 PPM
4Heptachlor
Velsicol
10.0 PPM
Toxaphene
multiple
?
(a)
Endosulfan is listed as non-carcinogenic on the basis of a single study in one species only (mice). Innes
et al, (1969). (site editor's note: This classification has since been reversed and endosulfan is now
recognized as a human carcinogen.)
(b)
"Based on the best available data," National Cancer Institute (1979).
(c)
"Causes tumor development in mice at the lowest doses tested. Indeed, it has been impossible to
establish a safe level for this compound." Hart et al (1976).
The authors of this study point out that
"It must be appreciated that the carcinogenicity data on the OCP's, as for the great majority of other
pesticides, are based on ingestion rather than inhalation as the route of exposure, which is likely to be of
relevance to humans. Also the carcinogenicity of "inert ingredients'1 in pesticide formulations, particularly
benzene, asbestos and petroleum oils, must be recognized."
It remains to compare the levels at which these compounds are considered carcinogenic, and the
concentrations reported on commercial cigarettes by competent, scientific literature. Note that some of the
studies are as much as 25 years old, and do not represent the true situation in 1996, which may ven' well be
much worse for a number of reasons discussed following the data. These studies were all available to the
tobacco industry by the time of the 1977 Origins of Human Cancer study cited above; indeed, many
of these studies were industry-funded.
Pesticide
Dieldrin
Endosulfan
Endosulfan
Endrin
Endrin
BHC
BHC
DDT
DDT
DDT
Lindane
Concentration Found
0.04 PPM
0.28 PPM
23.00 PPM
0.06 PPM
0.72 PPM
1.11 ug/pack
0.51 PPM
278.00 ug
7.20 PPM
6.90 PPM
0.33 PPM
Tobacco Product
cigarettes
cigarettes
cured leaf
cigars
cigarettes
cigarettes
cigarettes
cigars
cigarettes
cigarettes
cigarettes
Reference
Dorough & Bryant 76
Dorough & Bryant 76
Reif 77
Dorough-Bryant 78
Sheets 1976
Kamata 1977
Ceschini 1980*
Kamata 1977
Richter 1977
Dorough & Bryant 77
Richter 1978
Aldrin
Toxaphene
Toxaphene
Toxaphene
*16 U.S. brands
0.01 PPM
2.33 PPM
0.38 PPM
4.30 PPM
cigarettes
cigarettes
cigarettes
cured leaf
Ceschini 1980*
Domanski 1977
Dorough-Bryant 77
U.S.D.A. 1977
Cigarette Research Methods
It's important to keep in mind a couple of points whenever you're examining cigarette
research data.
Off-the-shelf cigarettes are rarely tested for pesticide residues in this country, and when
they are. testing methods and procedures are often quite inadequate.
It is extremely difficult to test for pesticides which may only be present in very small
concentrations — which are nevertheless potent enough to cause serious damage through
repeated, low level exposure through smoking.
Pesticide residue testing, when performed, tests only for the presence of the pesticide
itself, and not for its combustion by-products. Thus when a potent carcinogen such as
Dieldrin is reported in cigarettes at concentration of .51 PPM, we have no way of
knowing how much Dieldrin is present in byproduct form.
Cancer-causing properties are only one of the sources of damage from these compounds.
They are also involved in neurological, genetic, cardiac and pulmonary and other injury
to humans, in ways which have never been documented by testing for health impact
through combustion/inhalation.
There is very sparse data available on the human health impact of pesticides in tobacco
because almost all such testing is done on mice and rats. These animals are extremely
susceptible to pure tobacco smoke itself, it is extremely difficult to separate the effects of
tobacco from the effects of minute traces of pesticide.
Many of the chlorinated hydrocarbon compounds are very difficult to detect, particularly
with electron capture detection, the most common measuring technology. Thus, the
residue levels detected in cigarettes are probably much lower than actually exist.
Most recent available data has been used in illustrating concentrations of pesticides in
commercial cigarettes and tobacco products. In the 1950s and 1960s concentrations were
much higher. For instance, published research by scientists at North Carolina State
University reported DDT and TDE concentrations in cigarettes in the late 1950s and early
1960s as high as 600-800 PPM. Of course DDT has been banned for nearly 20 years in
the US, but it is still being used on tobacco crops in third world countries, along with
other banned chlorinated hydrocarbons like endrin. Since smoking-related diseases such
as lung cancer can take decades to develop and emerge, we are just now seeing the results
of this kind of cigarette pesticide contamination in the period 1950-1975.
Each pesticide that contaminates cigarettes has multiple fates, each of which is relevant in
a different way to the smoker. When the cigarette is smoked, air is sucked through the
coal at the tip of the cigarette, and this glowing coal creates an intense dry heat that
instantly vaporizes the leaf, or smoking materials in the zone just behind the coal. These
vaporized, partly burned and partly boiled-off sugars, proteins, nicotine, flavorings,
additives, and pesticide residues combine in the airstream created by the smoker's suction
to create smoke.
Some pesticides survive the boiling-off process better than others. Some are simply
incinerated, leaving no trace of the original compound and creating nothing harmful as a
result of combustion. Others bum completely, but create daughter compounds that range
from unknown to hazardous in their health effects. Others burn incompletely, so that the
smoker receives a volatilized dose of the original pesticide plus the by-products of
combustion of the pesticide, range from unknown to hazardous in their health effects.
The key point here is that out of the combustion and volatilization of the multiple
pesticide residues which can be shown to be common contaminants of the US cigarette
supply create a wide range of hazards many of which need no further proof of their
severity as an immediate preventable threat to public health. If the pesticide
contamination were removed from the US supply, and if the industrial process
contaminants like benzene and hexane were also removed, then there would be a material
reduction in the level of public health threat posed by cigarettes and other so-called
tobacco products, and the rest of the hidden aspects of tills problem could be brought to
light and worked on by scientists, legislators, and citizens.
A Curious Blindness
Where has the Surgeon General been? In some ways, this chief protector of the public
health has been trying to tell us about the problem all along — it's just that the tobacco
industry' is so powerfully sheltered that the Surgeon General hasn't really had the
information available. Also, let's not underestimate the reach and power of the tobacco
industry. It certainly seems from the available literature that the Surgeon General has
been pretty much duped along with everyone else in the official health establishment on
the subject of pesticides in commercial tobacco. Take for example the following
paragraph from the 1981 Surgeon General's report on "The Changing Cigarette."
Influence of Raw Product Modification on the Pharmacology of Cigarette Smoke.
"The composition of smoke is determined by the physical and chemical properties of leaf
tobacco. Modification of the raw product therefore changes the pharmacology' of cigarette
smoke. The diversity of available tobacco germplasm along with known genetic
techniques permits reduction of hazards in cigarettes through plant breeding and
selection. Cultural and curing practices are constantly changing in response to market
demands and the needs of fanners. Pesticides currently registered for use on tobacco have
been tested as contributors to the carcinogenic activity of cigarette smoke condensates.
When used as directed, these materials caused no significant change in biological
activity'. However, the pesticides used in tobacco farming change from time to time in
response to the occurrence of new plant pests; for example, the recent spread of blue
mold in tobacco-growing regions has led to the use of a new pesticide. It is not known
whether the use of such materials may result in changes in the hazards of cigarette
smoke."
This paragraph gives the reader the unfortunate impression that pesticide residues have
been looked into and found not harmful on cigarettes when properly applied in the field.
However, the two studies cited, by G.B. Gori and T.C. Tso are extremely limited in
scope, and examine only what happens to certain legal pesticides when they are applied
at carefully monitored rates onto experimental tobacco plants which are made into
laboratory' cigarettes and tested by limited methods for a restricted range of effects. These
tests do not show the Surgeon General, or the public, anything about the realities of
enormous amounts of illegal pesticides on cigarettes, or about even the residues of legal
pesticides illegally applied in Third World countries at excessive rates.
The Surgeon General, elsewhere in this same report, admits to a large degree of
powerlessness with respect to monitoring anything that the tobacco companies put in
their products. The issue is additives, which get a great deal of attention throughout the
report, but the observations apply equally well to pesticides.
"We must continue to monitor the changing cigarette to ensure that when new cigarette
products appear they do not bring with them new hazards to health. Throughout this
report the need to know about substances added to cigarettes is stated repeatedly. At
present, there is no mechanism by which government or the scientific community can
require disclosure of these additives, which must obviously be a first step in assessing
their health effects. This needs to be corrected by voluntary action or, if necessary, by
legislation."
Secretary' of Health Education and Welfare Patricia Harris, in a letter to Tip O'Neill,
House Speaker, on 1/12/79
Another closely related concern about lower "tar" and nicotine cigarettes is the use of
flavorings and other chemical additives. In order to enhance consumer acceptability.
flavoring substances are added to cigarettes; it may be that the lower the "tar" yield, the
more flavoring additives are used. It is impossible to make an assessment of the risks of
these additives, as cigarette manufacturers are not required to reveal what additives they
use. No agency of the federal government currently exercises oversight or regulatory
authorin’ in the manufacture of cigarette products. Further, no agency is empowered to
require public or confidential disclosure of the additives actually in use by the cigarette
manufacturers.
Since the Surgeon General hasn't been able to "officially" identify and test for
carcinogenicity in the flavor and processing additives, much less the agricultural
chemicals and pesticides in cigarettes, it is little wonder that so much of the research
coming from government health sources has a confused and frustrated tone.
"It cannot be determined whether the unidentified mutagens in cigarette smoke are an
important cause of lung cancer in humans; however, added exposure to any tumor
initiators probably carries an incremental risk of cancer." (p. 38, Changing Cigarette, US
Surgeon General, 1981.)
"Several carcinogens from cigarette smoke should be studied for synergistic, additive or
antagonistic effects on carcinogenesis because tobacco constituents are inhaled or
swallowed as a mixture, not individually." (p. 101, Changing Cigarette, US Surgeon
General, 1981.)
"Of particular concern is the potential teratogenic (fetus damaging) effect of additives
and their combustion products." (p. 12, Changing Cigarette, US Surgeon General, 1981.)
"In recent years, a number of flavoring additives or cellulose-based tobacco substitutes
may have been included in manufactured cigarettes. The nature and amounts of such
additives as actually used are not known, nor is it known what influence these additives
may have on the chemical composition or subsequent biological activity of cigarette
smoke." (p. 17, Changing Cigarette, US Surgeon General, 1981.)
"More data is needed on cigarette flavor additives and their combustion products.
Flavoring agents and additives should be studied by the tobacco companies for
carcinogenicity and toxicity before their commercial use is permitted, and the results of
such studies should be made available." (p. 26, Changing Cigarette, US Surgeon General,
1981.)
Return To Table Of Contents
Pesticides. Cigarettes, and Tumors: Early Evidence
Return To Table Of Contents
Almost all of the significant U.S. work on carcinogens in tobacco smoke has involved a
handful of researchers. By consensus, Dr. Deitrich Hoffman is the most prominent
American expert on the cancer-causing role of compounds found in cigarette smoke.
Dr.Hoffman's American Health Foundation is the source of almost all of the U.S.
Surgeon General's data on carcinogenic compounds in the smoke of U.S. cigarettes, and
this distinguished scientist, along with a skilled team of researchers, has uncovered much
of what little is known about pesticides in cigarettes, and cancer.
Thafs why it is particularly important, as we begin to look at the evidence accumulated
on the role of pesticides in cigarette-related cancer, that we pay attention to this simple
statement from the American Health Foundation in a personal letter to the author,
5/13/82. "There appear to be few - if any - studies on chronic sublethal exposure of
mammals to the tobacco pesticides ..."
In a 1972 study, Chemical Decomposition & Tumorigenicity of Tobacco Smoke, funded
by both the National Cancer Institute and the American Cancer Society, Dr. Hoffman
along with others found both pesticides and their pyrolytic products carcinogenic. In their
conclusion the researchers stated
"One specific characteristic of tobacco smoke is its tumor-promoting activity. Until now,
only limited information has been available as tothe chemical nature of the tumor
promoters. Although volatile phenols and long chain fatty acids are known tumor
promoters when applied in high concentrations, the majority of the promoters in the "Tar"
remain unknown and need to be identified."
Earlier in the report, in one of the rare literature references to the carcinogenic potential
of pesticides in cigarettes, Dr. Hoffman notes:
"We found that trans-4, 4-dicholorstilbene, a major pyrolysis product of DDT and the
alkylating carbazoles are active as tumor accelerators." "Tumor accelerators are defined
as agents which by themselves are inactive as carcinogens, tumor initiators, or tumor
promoters which, however, accelerate the activity of carcinogens and/or tumor initiators."
This 1979 study marked a major statement of position for Dr. Hoffman on the matter of
"tar" coming from cigarettes.
"The carcinogenicity of the particular matter of tobacco smoke is primarily explained by
three types of tumorigenic agents: tumor initiators, tumor accelerators, and tumor
promoters. The majority of the tumor initiators are polynuclear aromatic hydrocarbons,
and, as recently found, a number of alkylated polynuclear aromatic hydrocarbons. A
significant inhibition of the pyrosynthesis of these carcinogenic polycyclics leads to a
significant reduction of the tumorigenicity of tobacco smoke condensate as does the
experimental quantitative reduction of these hydrocarbons in the "tar."
From this point on, Dr. Hoffman’s research has focused increasingly on the issue of
carcinogenic agents in the innocently-named "tar", as well as in the gasses of cigarette
smoke. In the process, he has increasingly become interested in the role of pesticides as
sources of carcinogenic agents in cigarettes, although this has almost been incidental to
the main focus of these studies. For instance, in a 1978 paper on Hydrazines, Dr.
Hoffman reports one of the first indications that Maleic Hydrazide, a suckering agent
used in enormous quantities in the U.S. and almost universally worldwide, was probably
contributing potent carcinogens to cigarette smoke.
"The apparent reluctance of researchers to study hydrazines as environmental
carcinogens may reflect the difficulty of locating and analyzing them. One obvious place
to look is agricultural crops treated with Maleic Hydrazide. We therefore investigated
tobacco (which is treated extensively with MH-30)."
”Our studies with MH-30 also demonstrated the presence in tobacco of Nnitrosodiethanolamine ... and ethyl carbamate. These two additional carcinogens may
contribute to tobacco carcinogenesis."
"It is apparent from the number and variety of hydrazines shown to be animal
carcinogens that all hydrazines should be suspect pending animal studies. It appears that
most hydrazines are tumorogenic in the lungs and blood vessels of laboratory animals."
Dr. Hoffman’s research led to themid-1980s de-registration of Nitrosodiethanolamine as a
carrier solution for the application of Maleic Hydrazide. In the process of his
investigations into this chemical, called NDELA for short, he discovered that it is not
only smokers who are put at hazard through pesticides and herbicides or tobacco.
"Snuff, which is increasingly used as a smoke substitute by young people and which is a
carcinogen in the oral cavity of its long-term users, was shown to contain between 3.2
and 6.8 PPM of NDELA. Thus, this N-nitrosamine adds to the carcinogenic potential of
the tobacco-specific N-nitrosamines in snuff (which range from 5.5 to 106 PPM,
according to an article in preparation by Dr. Hoffman in May '82)."
Dr. Hoffman's work on pesticides, while the most prominent in the country, only touches
on the health issues involved in pesticide residues on cigarettes, a fact which the skilled
researcher himself admits.
"It is apparent that relatively little is known of the fate of pesticides or herbicides that are
applied to agricultural products, while they are in contact with the latter, and when they
are ingested (or inhaled) by man. Certainly more effort is needed in this area of study that
is important to public health." (D. Hoffman, J. Anal. Tox. 11/78).
While there have been only the few studies by Dr. Hoffman and others into the direct role
of pesticides as sources of chemical carcinogens in cigarette smoke, there is a great deal
of evidence that since the pesticides are indisputably present, often in some quantities,
then they must be a major source of the cancerous results of cigarette smoking.
Shortly after Dr. Hoffman's research began to close the research gap, other researchers
traced certain types of cancer directly to cigarettes, but weren't able to describe the
process in minute detail in humans. ( This has happened for the first time in 1996 with the
work in California tracing benzo-a-pyrene in cigarette smoke to the exact spot on a
human chromosome where lung cancer arises.) Thus the tobacco companies have been
able to buy thr ee decades of profits merely by pointing out insistently, continually, and
deceitfully that no direct connection has been made between cancer and smoking.
hr the December 1982 New England Journal of Medicine, Dr. Emmanuel Farber stated
that "about one third of the cancer in North American and Europe is related to the use of
cigarettes and other tobacco products." Dr. Farber went on to say that:
"the conceptual advances concerning ... initiation and promotion are well-known.
However, their mechanistic bases are-only now unfolding ... The basic validity of these
concepts for cancer development in human beings has been established in a few
instances, and as such is reassuring both for the physician and the scientist. For instance
... a limited exposure for only a few months to a known chemical hazard, such as vinyl
chloride, may lead years later to the appearance of angiosarcoma of the liver."
Vinyl chloride is a major pyrolytic byproduct present in cigarette smoke, and is one of the
organ-specific carcinogens described in the research of Dr. Dietrich Hoffman.
The tobacco industry's shoulder-shrugging explanation of the presence of these known
carcinogens in cigarette smoke has always been that the tobacco plant is one of nature's
wonders, that it produces thousands of different compounds when its leaves are burned,
that it takes up immense amounts of soil minerals, metals and heavy elements, and that,
generally, there's just no accounting for how that damned plant eats up all that stuff that
the scientists are forever finding in the smoke of the leaves. Gee whiz, fellers, can't you
just take our word fur it -- all that stuff in tobacco jes' there natchurlly.
Many pesticides inhaled in cigarettes are able to cross the human placental barrier. Some
of these are potent known carcinogens such as Endrin and Parathion. So what happens
when they enter the body of the unborn child? Dr. Farber tells us:
"The presence of many proliferating cells is probably one basis for the susceptibility of
the fetus and neonate [newborn baby] to many chemical carcinogens and would account
for the peak in cancer incidence in the first decade of life. (Author's note: either that, or
the first decade of life that we're seeing now is a preview of things to come for all ages.)
The human fetus, unlike the rodent fetus, acquires the capability of activation of some
carcinogens early in development and thus may be at greater risk than some laboratory
animals for cancer development with chemicals."
This paper is full of chilling possibilities, once you understand the role of cigarettespesticides in the widespread health problems of people all over the world. For example,
Dr. Farber engages in a discussion of how the human body, specifically the liver, adapts
to the stream of carcinogenic chemicals which enter the body by several pathways:
" The liver is by far the most active and most versatile organ in the metabolism of
procarcinogens and of xenobiotic agents generally. It and other organs have an ability to
detoxify potential carcinogens as well as activate them, and the ultimate fate of a
chemical depends largely on the balance between activation and inactivation -- a balance
that is easily modulated in major ways by drugs and other chemicals, age, nutrition and
hormones, as well as genetics.
For example, the carcinogenicity of several aromatic amines for the liver can be
completely prevented by simultaneous exposure to phenobarbital
or 3methylcholanthrene - agents that induce many liver enzymes. This phenomenon of
resistance of the induced liver to some carcinogens may be of great practical importance
to human beings. Virtually all people in the Western world have levels of several
xenobiotic agents, such as chlorophenothane, dieldrin, aldrin, polychlorinated biphenyls,
and dioxins, in their adipose and other tissues. These agents as a group are effective
enzyme inducers in the liver. In addition, many drugs induce microsomal or other
enzymes in the liver or other tissues. Are these inducers malting tissues more or less
susceptible to the acute toxic or carcinogenic effects of other environmental agents?"
Aromatic amines are produced with abandon by burning pesticides, and there is no
dispute as to their carcinogenicity. Yet, Dr. Farber points out, their cancerous potential
can be completely neutralized by phenobarbital. The phenobarbital causes the liver to
produce enzymes which attack and render the aromatic amines powerless to cause cancer
- sometimes.
Can this in any way explain the association between cigarette smoking and the drinking
of alcohol, an intense barbiturate drug? And might one not conclude, given that-we all
have pesticides in our fat, muscle, brain, organ and nerve tissue, that our liver must be
kept in a constant state of arousal, just to deal with this constant or increasing pesticide
contamination of our bodies? Are alcohol and pills a screaming necessity to millions of
us because of pesticides in the most intimate tissues of our being?
Dr. Farber makes many other interesting points in his article. He points out that
"The absolute activities of the various enzymes and especially their relative balance may
have key roles in determining which organ will be a target for a particular carcinogen. An
interesting example of modulation at this level is the liver-kidney axis with
dimethylnitrosamine. This potent carcinogen normally induces liver cancer when taken
through the gastrointestinal tract. However, if the animal is placed on a low-protein diet,
the hepatic activation and metabolism fall off. This pattern allows more of the carcinogen
to be available for action on the kidney and changes the dominant cancer pattern from the
liver to the kidney."
Dimethylnitrosamine is present in cigarette smoke as a combinant pesticide combustion
byproduct. So what Dr. Farber's research shows that if you prefer cancer of the liver,
keep smoking but don't go on a diet. If you want kidney cancer instead, go on a diet and
you might even up your smoking a little, like most folks do. To be fair, that is not Dr.
Farber's conclusion. Instead, he concluded
" Clearly, the pathologic consequences of exposure to any potentially toxic xenobiotic are
related not only to the pathways available for its metabolism but also to the physiologic
state at the time of exposure. Thus, the presence of a known mutagen or carcinogen in the
environment is by no means synonymous with a mutagenic or carcinogenic response by
the exposed person."
Let's switch focus from the larger issues to the very' smallest, al least in proportion - the
role of DNA breaks in initiating cancer. This is the process by which almost all longestablished pesticides which have been shown to be cancer-causing have been thought to
operate. Dr. Farber writes,
"In view of the essentially irreversible nature of initiation with chemicals and the
apparent focal nature of the iniriaiion process, major emphasis at the molecular level is
given to DNA as the target for initiation. However, the evidence is largely
circumstantial."
Dr. Farber then goes into some detail on the most hopeful route toward a cure for
chemically-caused cancers, DNA repair. In particular there is hope that cellular enzymes
do much more than just serve human cells like little programmed slaves; that they can
spring to life and perform intricate repairs of cell DNA when properly stimulated to do
so.
Then comes the hook, as far as cigarette smokers are concerned.
" Although a majority of chemical carcinogens fall well within the current paradigm in
which initiating effects are related to some form of DNA damage, there are known
carcinogens that appear to be exceptions. A growing list of hypolipidemic agents and
several pesticides, herbicides and other xenobiotics have not been shown to generate
mutagenicity or other DNA damaging effects. Is this merely a reflection of deficiencies in
our technology, or are there new pathways to cancer that do not involve DNA damage of
exogenous origin as essential early steps in the process?"
New pathways for cancer? Caused by a new generation of pesticides and herbicides
which operate in new ways? Many of these new chemicals being used on tobacco in the
Third World, long before they are even registered for use in the United States? So, before
scientists have even begun to successfully cancers caused by the old-style pesticides and
herbicides, and before the commercial tobacco industiy is brought under even the
smallest degree of rational, humanistic control, we are now seeing "new pathways to
cancer" opening up as a result of untested, unexamined, unregulated pesticides and
herbicides used on Third World tobacco and other crops.
There is an enormous irony to chemically induced cancer, and that is, as Dr. Farber points
out at the conclusion of his paper, that:
"Some of the most effective chemotherapeutic agents for cancer are carcinogenic. For
treatment of cancer in patients above 50 or 60 years old, the importance of the risk of
carcinogenicity is clearly minimal, given the long latent period for cancer development.
However, in children and young adults, the development of second cancers years after the
effective treatment of the primary tumor is now becoming a recognizable problem."
So when environmental chemicals, particularly those in cigarettes, give a person cancer,
just about all that the physicians can do at present is to treat that cancer with chemicals
which in themselves are likely to cause another type of cancer, and about all that the
doctors can hope that the person is old enough that he or she will die before the second
cancer comes on.
6-S
The Cigarette Industry Line On Pesticides
Early in the inquiries which led me into this complex subject it became clear that there was a
cigarette industry line in place to deal with inquisitive folks. "There is no problem. Once, in the
1950's, there might have been, but now there is no need for concern."
I talked with scientists who ought to have known better who insisted that a teeny bit of pesticides
in your smoke wasn't going to hurt you. I talked with bureaucrats who clearly knew that tobacco
was drenched with dangerous chemicals but. because of tobacco's unregulated status and potent
political clout to assure that it stayed that way - no comment, pure stonewall. " I guess they're
pretty much self-regulating on that one" a senior USDA official once told me, when I pushed him
publicly to explain what if anything the department was doing to determine the health risks to
smokers of known insecticide residues in US tobacco crops. I spoke with a statewide doctors
group who ridiculed the idea that it might be the pesticides and not the tobacco by saying "What's
a little more poison in the poison?" And I talked with a few people who agreed that, if what I said
was true, there was a terrible thing happening. But anyone connected with the industry had,
unremarkably, the same line - "There is no problem. Please stop being a pest. Case closed."
Actually the cigarene industry line is a little more complex than that - better reasoned, more
compelling. Enough so to have stopped those few inquiries aimed in their direction dead in their
tracks for decades.
It's important to realize that the cigarette industry, the US government, the captive university
research community, much of the scientific and medical establishment, and much of the press
have been thoroughly immersed in a complex line of reasoning which has caused and enabled
them to ignore, deliberately or not, the clear implications of what selling, or allowing the sale, or
facilitating the sale of heavily contaminated products to unsuspecting public for decades has
done- which is to move almost universal public opinion to the point where the attitude when a
smoker dies is - "Too bad, but what did they expect?"
It should come as no surprise to anyone who knows the cigarette industry that they have a very
well reasoned line in place for just about every issue that may arise concerning pesticide residues
in tobacco products. I've seen one variation or another of this line used in those few occasions
when the issue has been raised in a public forum, and include it here along with some
commentary' in tire hope that it will be useful to others making fresh inquiries based on the
information presented at this site.
Summary of the line
"Pesticide residues on cigarettes? Well, of course there are bound to be a few traces of
agrichemicals left on the tobacco. But we've never heard of any research that says these pesticides
are harmful in such tiny amounts."
" In fact, we’ve run tests of our own for years, and we've found that levels of important pesticides
have been consistently going down for years on all US tobacco. We've also run our own tests and
found that almost none of the pesticides get through the smoking process. Also, the US
government itself has established residue levels in foods and just about everything else, and US
grown tobacco is carefully inspected by USDA."
"You know, if our farmers weren't able to use some of these pesticides, under careful government
control, then insects would do millions of dollars in damage to valuable crops, and many small
farmers could be wiped out. "
"And of course, these chemicals are also used on just about every other agricultural commodity,
without any cause for alarm as long as residues are kept to a minimum. Just about everything you
eat has some kind of agricultural chemical in it, so why get excited about a few traces of
chemicals in your cigarette - especially if you smoke a filtered, low nicotine brand?"
The Industry' Argument - Point By Point
There are bound to be a few traces of agrichemicals left on the leaves
With some of these pesticides, chronic exposure by inhalation to a trace is all it takes. Others are
present in far more than trace amounts when you take their known human health impact into
account - for example, traces of dieldrin are cumulative and stored in fatty tissue in a supertoxic
form. So over time, and at the rate of 50,000 exposures a year for pack-a-day smokers, traces of
dieldrin become pools of supertoxic dieldrin waiting to be released by any kind of weight loss like the weight loss associated with AIDS or with cancer, for example. What a great time to have
your body fat releasing a mix of supertoxic, supercarcinogenic, super immunity busting chemicals
which have been stored away by your body in the best way it knew how.
We've never heard of any research that says these tiny traces are bad for you.
That's because so little published research has been done in this field. However, there are very
strong indications that in unpublished research by the chemical companies and the cigarette
industry scientists, done primarily as they went through the EPA registration process, the question
of the health hazards presented by these residues were investigated, hi the published literature
there have been very few scientists working on establishing causal connections between any of
the common pesticide contaminants of cigarettes, and the studies which have been done have
focused ironically on one of the more innocuous tobacco chemicals - maleic hydrazide. Well,
innocuous may not be the right word since, when burned, maleic hydrazide does produce copious
amounts of a known high-impact carcinogen benzo-a-pyrene, but in comparison to the
combustion by-products of some of the other common tobacco pesticide contaminants, MH is not
high on the immediate threat list.
Guthrie, F.E. and Sheets, T.J. Pesticide Residues On Tobacco: A Continuing Problem, (in)
Tobacco, 170 (13): ppl7-21, March 1970. One in a very long string of publications by these
scientists who, working for the tobacco industry, have tracked pesticides for decades. They note
that the magnitude of insecticide residues on tobacco leaf compared to other plants exposed to
equal amounts of chemicals is caused by physiological properties of the tobacco leaf itself;
specifically, it's high surface-to-vohune ratio. They also note what they call the "time-honored
practice of preventative insecticide treatments rather than adherence to economic thresholds" and
that complain that tobacco company technologists won't recognize the problem as a major one.
If the danger to the smoker isn't sufficient to grab the attention of health authorities, you'd think
that an understanding of the relationship between the pesticide residues on cigarettes and
children's brain cancer would do the trick, wouldn't you. A high Centers for Disease Control
official at a 1993 Waste Management conference http://atsdrl.atsdr.cdc.gov:8080/cxld.html
explained the results of exposure to Lindane and certain other common household pesticides which also happen to be common contaminants of cigarettes, with the following observations:
Fortunately, childhood cancer is extremely rare and is often curable according to the definition of
5 year survival. Studies of the link between childhood cancer and potential environmental
exposures have been done under a variety of circumstances, some involving paternal occupational
exposure, some maternal occupational or other exposure, and some direct neonatal household
exposures (Ahlbom 1990, DL Davis et al. 1990b, O'Leary et al. 1991).
Preliminary studies by the Missouri State Health Department showed that children exposed to
certain home and garden pesticides had a rate of brain cancer that was up to 6 times higher than
that of children without those exposures (JR Davis et al. 1993). This is an exceptionally strong
association, which is seldom seen in environmental epidemiology.
Another Missouri State Health Department survey (JR Davis et al. 1992) found that a wide
variety of pesticides were being used in households, and people were often unaware that they
were using pesticides. For example, many consumers did not know that pet shampoo and flea
collars contain active, toxic, pesticide ingredients, despite warning labels that advise that children
should not be in contact with them. Surprisingly, 80% of pregnant women polled in this study
also reported using some sort of pesticide while pregnant.
In a case control study comparing reported exposures in children who had brain cancer and other
cancers and using friends without disease as controls, these same authors reported several
troubling results associated with residential uses of pesticides and home and garden insecticides.
They divided children's lives into 3 time periods: the time of pregnancy, birth to 6 months of age,
and 7 months to diagnosis.
They found some suggestion of an increased risk of brain cancer when exposures took place from
birth to 6 months and from 7 months to diagnosis. If the family used a termite pesticide, the risk
of brain cancer was 2.9 times greater, or almost 3 times greater compared with other cancer
controls. For the specific termite pesticide, chlordane, the risk of brain cancer was 1.5 times
greater, but this included a confidence interval of from 0.5 to 4.9.
This study also showed that several specific residential uses increased the risk of childhood brain
cancer. Fog bombs for flea or roach control conveyed a 2 fold higher risk of childhood brain
cancer, when used during pregnancy. Surprisingly, when brain cancer cases were compared with
other cancer controls, children whose families had used flea bombs had a 6 fold higher rate. Flea
collars for dogs and cats are another widely used household pesticide. The data suggest that, for
exposure to the flea collar and the treated pet combined, from birth to 6 months and from 7
months to diagnosis, the relative risk for childhood brain cancer may also be quite high.
Ought to make a Mom think twice before lighting up.
We've been running our own tests for years and have found that almost none of these chemicals
get through the smoking process.
In 1980 the Swiss State Tobacco Monopoly conducted tests on the efficacy of filters in trapping
pesticide residues and found that an average of 17% of the pesticides on the tobacco got through
even the best filters in mainstream smoke. Then, of course, you always have to watch the use of
language by this industry. While it is true that many of the pesticide residues are unstable under
heat, and therefore do not "come through" after being burned, what isn't being said is that their
decomposition by-products, such as benzo-a-pyrene, can often be more dangerous than the
precursor pesticide itself. A favorite assertion in the industry literature is that the 800°C burning
coal of the cigarette will take care of most of the little bit of pesticide that may be in the tobacco.
However, there are very well-documented EPA incineration tests on many of the common
tobacco pesticide contaminants, and the EPA believes that it takes a high-pressure, oxygen-fed
incinerator operating at 1500°C for 10-15 seconds to 100% incinerate many of these pesticides.
Besides, tire burning coal argument is just plain silly coming from industry scientists, who know
that the smoke which is inhaled and blown into the environment doesn't come from the burning
coal of the cigarette anyway, but from the much cooler region just behind the burning coal where
the smoking materials - not necessarily tobacco - are being dry-distilled along with the complex
toxic soup of contaminants and additives to produce the final product - mainstream smoke.
Ceschini, P; Chauchaix, R. (Research Div., Tabacofina SA, Geneva, Switzerland (1980) Transfer
of organochlorine pesticide residues into cigarette smoke as a function of tobacco blends and
filter types. Beitrang Tabakforsch 10(2):134-138 (English) (11 references)Determinations were
made of the transfer ofpesticides into the smoke from 4 different tobacco blends. The pesticides
studies were BHC, lindane, aldrin, DDT isomers, DDE isomers, TDE isomers, dieldrin, endrin,
endosulfan, and endosulfan sulfate. The average total pesticide transfer rate was 17% aiui
appeared to be independent of tobacco type - American blend, Maryland, Virginia, or Oriental.
The US government has established residue levels in food and just about every other agricultural
commodity
In fact the US government has established residue levels in everything but tobacco products.
While USDA does regulate what US tobacco growers can put on their crop, it has absolutely no
say about what residues are present on foreign-grown tobacco, including tobacco manufacturing
scrap and waste, other than to assure that there are no residues of pesticides specifically banned
for use on tobacco in the US. It also has no say on what pesticide residues are present in any of
the materials it uses to create reconstituted smoking materials and synthetic smoking materials.
Synthetic smoking materials which are commonly made from paper mill waste have very real
potential for having dioxin contamination, which is common in forest products industry waste.
There is no regulation imposed on what the cigarette industry uses to make its synthetic smoking
materials, and thus no inspection of what is going into the lungs of smokers and their families.
US grown tobacco is carefully inspected by the USDA
Absolutely true, and very misleading. Of course the US crop is inspected and the growers don't
use anything but approved chemicals. What little DDT there is in US-grown tobacco is soil
residual, and in many places in the US it has disappeared along with Endrin and some of the other
early heavy hitters. However, US-grown tobacco is the least common ingredient of American
cigarettes, for one thing because it's too expensive compared with foreign-grown. In addition, the
USDA doesn't look at the final product - cigarettes - but only at the American tobacco coming out
oi the fields and into the US system. Finally, the USDA is not inspecting to enforce health
regulations but to assure that growers don't violate environmental laws.
If farmers didn't use pesticides, millions of dollars would be lost each year, and many farmers
would be wiped out
This kind of talk preserves the image of the small independent tobacco farmer making a living on
a few acres, rugged and all-American in their character and dedication. Unfortunately the image
and the reality of the small tobacco grower are quite different, and in many ways they are more
serf than farmer, more slave than freeman.
The reason that US tobacco fanners use so many chemicals on their crop is that the industry
grading system forces them to try to kill everything - using only approved chemicals of course because at auction time even the slightest blemish or discoloration, much less a bunch of insect
holes, will cost them dearly in the amount of money they get. Of course this is largely a sham
because the way the final product is manufactured and homogenized the presence or absence of
insect damage is hardly an economic factor, but the grading system forces small farmers to use
every chemical weapon possible in order to be able to get a high enough price for their crop to
make a living.
These chemicals are used on just about every agricultural commodity
Naturally you don't smoke a tomato (do you?), and you don't eat cigarettes. Also, foreign
tomatoes are inspected by the US and those contaminated with dangerous pesticides are banned.
But foreign-grown tobacco leaf, stems, stalk and waste are inspected only for the presence of
pesticides banned for use on tobacco in the US, not for the wide range of pesticides not covered
by this narrow classification. The only really close attention the US government pays to foreign
tobacco imports is to count them and make sure taxes are paid.
When you eat a tomato or strawberry' contaminated with Toxaphene or Dieldrin, at least! all
you're exposed to is the parent chemical. Your gut has also evolved over millions of years to
handle a wide range of dangerous compounds that mother nature can deliver up in tasty disguises,
but it's only over the past 50 years that our lungs have had to deal with much more than wood
smoke and coal dust, and even that has only been around the human body for 1000 or so years.
But when you smoke a cigarette contaminated with pesticide compounds, or breathe the smoke
from one, you get not only the parent compounds that made it through but also all the daughter
compounds, which are frequently more dangerous in smaller quantities than the originals. And the
part of your body exposed to these potent chemicals isn't your gut, but your lungs.
It might be useful in this regard to look over the list of the EPA's Top Twenty Hazardous
Substances list for 1996 to see how many of these substances are present in cigarettes (shown in
Bold). This fist is compiled annually to alert government agencies and environmental health
authorities to the 20 most dangerous substances currently causing significant health risks to
humans.
Lead
Arsenic - frequently used in fungicides and snailbait in tropical tobacco production
Mercury, metallic- frequently used in fungicides and snailbait in tropical tobacco production
Vinyl Chloride - a combustion byproduct of several known cigarette pesticide residues including
DDT and Endrin
Benzene - a common solvent leaving residues, used to place flavorants into inert carrier materials
like alpha-cellulose
Polychlorinated Biphenyls
Cadmium - common in snailbait in tropical cigar tobacco production
Benzo(a)pyrene - a combustion byproduct produced when common cigarette pesticide
contaminants are combusted, especially the chlorinated hydrocarbons.
Chloroform - produced as a combustion byproduct of pesticide contaminants of cigarette
materials
Benzo(b)fluoranthene
DDT, p'p' - a known contaminant of tobacco worldwide
Aroclor 1260
Trichloroethylene
Aroclor 1254
Chromium (+6)
Chlordane - a known contaminant of US cigarettes throughout the period 1955-1975. and possibly
later
Dibenz[a,h]anthracene - - a combustion byproduct of several of the cigarette/tobacco pesticides
Hexachlorobutadiene
There may be a few others from this list that are present in cigarette smoke as the result of
preventable contamination and deliberate production decisions, but the fact that ten out of the top
twenty are preventable hazards in cigarettes ought to get somebody's attention, don't you think?
Don't worry, especially if you smoke a filtered, low tar brand.
Your friendly tobacco company would like it very much if you didn't worry at all; however, if you
are a smoker and worry enough to smoke a low-tar, low-nicotine, filtered cigarette you may think
you have an edge on safety. Unfortunately, when it comes to pesticides, that's not the case. Low
T&N cigarettes don't have less harmful components in their smokestream, it's just that the
harmful components which would ordinarily come across as tar have been gasified by burning
them at the higher temperatures produced by either special chemicals, or by the design of the tube,
or both.
Please contribute comments, information, research or suggestions, which will enhance the
effectiveness of this site to bdrake@onramp.net
Cigarettes And Tobacco - Not The Same Thing
There is a critical and poorly understood distinction between the health hazards of smoking
tobacco, and smoking cigarettes manufactured partially or totally out of synthetic materials. The
medical & health community has been conned along with the public into participating in debates
around largely phoney issues concerning the hazards of smoking tobacco when this so-called
tobacco industry knows that many consumers are smoking little or no real, natural
unconraminated tobacco in their cigarette brand, but instead are smoking man-made and synthetic
smoking materials containing a wide range of known carcinogens, fetus-damaging compounds,
neurological toxins, and genetic mutagens that are extremely dangerous independent of any
hazards that may be caused by the tobacco, if any, in that same cigarette.
One of the principal man-made ingredients of today's cigarettes is reconstituted tobacco, which
the industry uses to justify its references to tobacco on the packaging of its product. It is
manufactured in large part from waste, or junk tobacco, following roughly the same path from
one cigarette company to another:
The stems and stalks of tobacco grown and processed in foreign countries is brought in duty-free
to the US. These plant parts were waste in their own country of origin, since the leaf components
were separated to be made into cheap cigarettes for third world markets. These stems and stalks
cost the companies nothing to produce, and so even after the cost of transporting them they are
zero-cost materials to use as the basis for the ground up, pressed and glued compound the industry
calls "sheet tobacco". When many cigarette, pipe tobacco, and snuff brands use words or pictures
to imply that there is tobacco in their product, what they technically mean is that there is a lot of
this pressboard scrap material they themselves refer to as sheet.
The Manufacturing of Sheet
To manufacture reconstituted tobacco sheet, tobacco scrap and waste materials are first ground to
a fine powder. Then using various acids and solvents, residual nicotine and natural tobacco
materials are chemically stripped from the cellulose tobacco material.
At this point in the process, non-tobacco filler is added. This filler material is manufactured from
a variety of cellulosic waste materials like recycled municipal paper waste, forest products
industry waste, and food processing waste. This is one of the reasons for the apparently strange
alliances one sees between tobacco companies and companies in industries like paper
manufacturing and food processing - the cigarette industry uses their wastestreams as a source of
alpha-cellulose.
Artificial flavoring chemicals & a wide variety of task-specific chemical additives are then
incorporated into the slurry, using a range of solvents as carrier solutions. Solvents commonly
used in sheet manufacturing include benzene, cyclohexane, and toluene - which are all known
carcinogens, and which all occur in medically significant concentrations as residues in cigarettes
and in assays of cigarette smokestreams.
This problem is discussed very early by the industry, as in U.S.Patent # 3,920,026 dated
November 18, 1975 and assigned to Liggett & Myers Inc., of Durham, N.C. In this patent the
inventors discuss the use of carcinogenic solvents to inject flavor into inert synthetic smoking
materials, and the inability to remove these carcinogenic residues.
"Undesirable taste characteristics of reconstituted tobacco products are often encountered, which
are related to the green taste of poor tobaccos, or the papery taste of stem materials. Incorporation
of flavorants or flavorant release agents into tobacco has typically been accomplished by
dissolving the flavorant or agent into a suitable solvent. The solution of flavorant material is
thereupon sprayed on the tobacco or injected into the tobacco matrix - in the case of reconstituted
sheet.
The solvent employed depends upon the particular flavorant material employed. Solvents have
included water and various organic materials such as alcohol, acetone, or cyclohexane.
Distribution of additives on the tobacco fibers may often be uneven, and more importantly, full
penetration of the added substances into the cellular structure may not be achieved. Removal of
residual solvent is often a problem, "(emphasis added)
At the beginning of the sheet manufacturing process, Nicotine is removed from whatever natural
materials are used, and that same Nicotine is later re-incorporated in precise dosages using
nicotine-impregnated polysaccharide fibers and a variety of other ingenious bio-engineering
techniques.
A wide range of other materials and chemicals are used in production of this reconstituted sheet
tobacco, including glue, bum rate control agents, flavorants, humectants, filler materials, etc.
This chemical slurry mixture is then rolled out into a thin sheet. Using a variety of chemical and
physical processes, this sheet material is then expanded, or "puffed up". The resulting sheet looks
like panicle board, and it is ready to be fed into giant mills which shave it into the little golden
curls you see if you take many modern cigarette brands apart. It looks like tobacco, and by
stretching the truth the manufacturer can claim that it offers real tobacco taste, pure tobacco
pleasure, and imply in ever}' other way that the cigarette contains tobacco.
That little bit of shading of the truth - calling reconstituted stems and stalks, and even synthetic
materials with nicotine added "tobacco" - may turn out to be a central clue to why so many
cigarette smokers are sick and dead from what they had every reason to believe was their tobacco
smoking habit.
A ver}' significant portion of the stems and stalks used to produce American sheet are of third
world origin, where very large volumes of unregulated pesticides, often concocted in mixtures
on-site by illiterate workers, are routinely used on tobacco crops. Many of these agrichemicals are
specifically designed to translocate from leaves into the stems, stalks, and roots where they are
concentrated. After the relatively pesticide-free tobacco leaves have been removed for sale to
quality markets, the remaining stems and stalks, where the systemic pesticides have translocated,
are sent to the US where they become sheet in the lungs of smokers.
Foreign-grown tobacco stems & stalks are routinely shown in European assays to be heavily
contaminated with soil-applied chemicals and suckering agents, as well as solvent residues.
Stems, stalks, and scrap routinely receive heavy fumigation in storage because by their nature
they are heavily infested. For example both leaf and scrap tobacco in storage around the world is
regularly fumigated with methyl bromide, a highly dangerous wide spectrum insecticide, which is
known to leave high concentrations of residue in high protein plant materials like tobacco.
Synthetic Tobacco Smoking Materials Patents
Synthetic smoking materials have been an industry fascination for many years. These are smoking
materials of something other than tobacco, whether synthetic or natural plant materials. The prime
motivation behind development of synthetic smoking materials is economic, but there is also a
strong element of unregulated science, technocracy gone mad. Here's a small selection of cigarette
industry patents in the area of synthetic smoking materials which suggest why nobody should call
these multinational corporations the "tobacco" industry. If you want to do a complete review of all
of the patents the industry has in this and related areas, on the internet go to
http://natents.cnidr.org/pto/classes/us/131/131.html
Patent # 4,243,056 January 6,1981
Assignee: Philip Morris
Discusses a method of impregnating smoking materials with flavorant agents. A very significant
discussion of rhe difficulties of removing residual solvents used in such impregnation. Such
solvents include acetone, cyclohexane, and benzene- all identified as carcinogens long before the
date of issuance of this patent. Establishes that industry continued using such solvents after their
danger was well known.
Patent # 4,379,464 April 12,1983
Assignee: Philip Morris
Discusses the use of tobacco scrap parts, especially stems and leaf midribs, for production of
smoking materials. Specifically describes the motivation for such development as economic.
U.S. Patent #3,529,602 Sept. 22, YTJQTobacco Substitute Sheet Material
Assignee: Philip Morris Incorporated, NY.
One of the earliest references to the manufacture of tobacco sheet. It's worth a long quote just to
see what the cigarette companies were up to way back when - and of course they've come a long
way since, baby.
"The nature of smoking products is such that the manufacture of a tobacco substitute is an
extremely difficult operation. The subtleties of smoking and ofproducing a product which will
be satisfactory to the smoker, both from a taste and flavor aspect and from the aspect of the
other qualities of tobacco that are desired by smokers, make synthesis of such a product
difficult. Thus while many attempts have been made to prepare tobacco substitutes, including
many attempts which were made during wartime when tobacco was difficult to obtain, none
have resulted in the development of a satisfactory tobacco substitute."
"The biological requirements for the growth of a tobacco plant are very different from the
chemical and physical requirements for the generation of a smoke which is desirable from the
smoker's viewpoint. Thus, there are often constituents in tobacco which result in a less
desirable smoke from a smoker's viewpoint and which tend to adversely affect the character of
smoke from tobacco products."
".4 nicotine-donating ingredient is not essential, but is a preferred ingredient. The nicotine may
be added in any of the known ways of incorporating nicotine in tobacco. For example, it may
be added per se to the tobacco or it may be added in the form of a material which releases
nicotine upon burning of the tobacco substitute. The latter method is illustrated in US Pat.
3,109,436, wherein the addition of a nicotine-ion exchange resin to tobacco is described The
nicotine may also be incorporated into other portions of the tobacco product, such as the
wrapper or filter to accomplish the same result."
Patent 4 4.079,^42 March 21,1978
Assignee: Philip Morris
This patent deals with a new process for manufacture of synthetic smoking materials. Pages 1-5
contain an excellent summary of the existing patent literature devoted to development of synthetic
smoking materials, showing a long-term trend in this direction in the industry. The patent
discusses the wide range of cellulosic materials, primarily industrial and agricultural waste
materials, used in development of synthetic smoking materials.
Patent = 3,943,943 March 16,1976
Assignee: Liggett & Myers
Discusses a method of adding flavor and aroma to reconstituted and synthetic smoking materials.
Good evidence of the industry motivation to use such materials.
Patent # 3,920,026 November 18,1975
Assignee: Liggett & Myers
Discusses methods of masking the undesirable taste and aroma characteristics of poor quality
tobacco, and tobacco waste, allowing these materials to be used in manufacturing cigarette
products. Shows industry trend toward use of trash materials.
Return To Table Of Contents
US Patent No. 4,022,223 May 10,1977
Assignee: unknown
A patent for a new kind of cigarette filter material. "Certain heavy metal salt-amine complexes
deposited on suitable bases are highly effective in absorbing or removing hydrogen cyanide
from the smoke of tobacco or a tobacco substitute." (emphasis added)
Patent # 4,319,585 March 16,1982
Assignee: unknown
Discusses development of synthetic flavoring agents. Makes several very important statements.
"It is well known, as far as the ultimate consumer is concerned, that flavor & aroma are perhaps
the largest factors in his selection of a smokable Tobacco product." "The term "tobacco", as used
throughout this specification, is intended to mean any composition intended for use by smoking or
otherwise, whether composed of tobacco plant parts or substitute materials, or both." In addition,
this patent refers to toxicity studies done on several of the synthetic flavoring components under
discussion- indicating that such studies are carried out by industry.
ts Patent # 3,964,496 June 22,1976
Assignee: R.J. Reynolds Tobacco Company
Includes commentary like
"Puffed rice is employed as a tobacco substitute by itself or with other non-tobacco materials to
form smoking products such as cigarettes, cigars, and pipe smoking products. When so used, it is
presently preferred that the puffed rice simulate tobacco and accordingly appropriate procedures
can be employed to provide the puffed rice in the desired size and shape. The burning rate, flavor,
and other properties of non-tobacco smoking products can be altered by incorporating with the
puffed rice suitable additives such as flavorants, tobacco extracts, nicotine, humectants, ash
improving additives, etc."
A little challenge: look at the contents of any cigarette under magnification, and see how much of
it looks like actual, natural leaf material, and how much looks like granular little strips of brown
flavored glued pressed powder. Can you tell?
Return To Table Of Contents
Please contribute comments, information, research or suggestions, which will enhance the
effectiveness of this site to bdrake@onramn.net
Research On Pesticides And Human Health
In environmental health studies one often finds initial remarks similar to this one in the
report on the Toxic Waste Conference of 1993, held by the US government "For several
diseases, including cancer, tobacco use is the most important known preventable cause."
This statement is almost always followed by a disclaimer which points out that despite
best efforts people seem to continue smoking, so this leading form of death is usually set
aside and the scientists go on to discuss all the environmental hazards that they believe
can be addressed - things like exposure to chemical contaminants, toxic fiimes, and
hazardous materials.
What a terrible irony is would be if it is precisely these things in cigarettes, and not the
tobacco, which is the preventable source of much of the disease and death from smoking,
which these scientists believe is an intractable problem.
Here is a selected list of recent publications detailing the relationship between
agricultural pesticides and human health. You'll find many more citations organized by
topic in the bibliography section of this site. While many mention smoking as a leading
cause of preventable disease and death, and others mention smoking as a source of
exposure to hazardous chemicals, none make the connection between man-made,
deliberately applied, knowingly contaminated non-tobacco and reconstituted smoking
materials and the public health crisis created by smoking cigarettes.
Ahlbom A. (1990). Some notes on brain tumor epidemiology. In: Davis DL, Hoel D,
eds. Trends in cancer mortality in industrial countries. Annals of the New York
Academy of Sciences, 609:179-90. New York: New York Academy of Sciences.
Colburn T, Clement C, eds. (1992). Chemically induced alterations in sexual and
functional development: The wildlife/human connection. Advances in Modem
Environmental Toxicology, Vol. 21, Princeton, N.J.: Princeton Scientific Publishing.
Davis DL, Friedler G, Mattison D, Morris R. (1992a). Male-mediated teratogenesis and
other reproductive effects: Biologic and epidemiologic findings and a plea for clinical
research. Reprod Toxicol 6:289-92.
Davis DL, Hoel D, Fox J, Lopez A. (1990a). International trends in cancer mortality in
France, West Germany, Italy, Japan, England, and Wales, and the United States. In:
Davis DL, Hoel D, eds. Trends in cancer mortality in industrial countries. Armais of the
New York Academy of Sciences 609:5-48. New York: New York Academy of Sciences.
Davis DL, Hoel D, Percy C, Ahlbom A, Schwartz J. (1990b). Is brain cancer mortality
increasing in industrial countries? In: Davis DL, Hoel D, eds. Trends in cancer
mortality in industrial countries. Annals of the New York Academy of Sciences 609: 191
-204. New York: New York Academy of Sciences.
Davis DL, Blair A, Hoel DG. (1992b). Agricultural exposures and cancer trends in
developed countries. Environ Health Perspect 100:39 44.
Davis DL, Bradlow HL, Wolff M, Woodruff T, Hoel DG, Anton-Culver H. 1993.
Medical hypothesis: Xenoestrogens as preventable causes of breast cancer. Environ
Health Perspect 101 :372-7.
Davis JR, Brownson RC, Garcia R. (1992). Family pesticide use in the home, garden,
orchard, and yard. Arch Environ Contain Toxicol 22:260-6.
Davis JR, Brownson RC, Garcia R, Bentz BJ, Turner A. (1993). Family pesticide use
and childhood brain cancer. Arch Environ Contam Toxicol 24:87-92.
Glickman LT, Schofer FS, McKee LJ, Reif JS, Goldschmidt MH. (1989). Epidemiologic
study of insecticide exposures, obesity, and risk of bladder cancer in household dogs. J
Toxicol Environ Health 28(4):407-14.’
Hoel DG, Davis DL, Miller AB, Sondik EJ, Swerdlow AJ. (1992). Trends in cancer
mortality in 15 industrialized countries, 1969-1986. J Natl Cancer Inst 84:313-20.
Krieger NK, WolffMS, Hiatt RA, Rivera M, Vogelman J, Orentreich N. (1994). Breast
cancer and serum organochlorines: A prospective study among white, black, and Asian
women. J Natl Cancer Inst 86:589-99.
Lopez A (1990). Competing causes of death: A review of recent trends in mortality in
industrialized countries with special reference to cancer. Ann NY Acad Sci 609:58-76.
Montgomery LE, Carter-Pokras O. (1993). Health status by social class and/or minority
status: Implications for environmental equity research. Toxicology & Industrial Health
9(5):729-75.
Moses M, et al. (1993). Environmental equity and pesticide exposure. Toxicology &
Industrial Health 9(5):913-60.
National Research Council (NRC). (1991). Environmental epidemiology Volume 1:
Public health and hazardous wastes. Washington, D.C.: National Academy Press.
O'Leary LM, Hicks AM, Peters JM, London S. (1991) Parental occupational exposures
and risk of childhood cancer: a review. Am J Ind Med 20:17-35.
Olsen JH, Brown P, Schulgen G, Jensen OM. (1991). Parental employment at time of
conception and risk of cancer in offspring. Eur J Cancer 27:958-65.
Rios R, Poje GV, Detels R. (1993). Susceptibility to environmental pollutants among
minorities. Toxicology & Industrial Health 9(5):797-820.
Sexton, K., Olden, K, Johnson, B. (1993). Environmental justice: The central role of
research in establishing a credible scientific foundation for informed decision making.
Toxicology & Industrial Health 9(5):685-728.
Silbergeld, E.K. (1994). Evaluating the success of environmental health programs in
protecting the public's health. Tn: Andrews JS Jr. Frumkin H, Johnson BL, Mehlman
MA, Xiniaras C, Bucsela J, eds. Hazardous waste and public health: International
congress on the health effects of hazardous waste-. 1993 May 3-6; Atlanta. Atlanta:
Agency for Toxic Substances and Disease Registry, Public Health Service, U.S.
Department of Health and Human Services, pp 43-8.
Strohmer, H., Boldizsar, A., Plockinger, B., Feldner-Busztin, M., Feichtinger, W., (1993).
Agricultural work and male infertility. Am J Ind Med 24(5):587-92.
Wolff, MS., Paolo, G., Toniolo, P., Lee, Eric W., Rivera, M., Dubin, N., (1993). Blood
levels of organochlorine residues and risk of breast cancer. J Natl Cancer Inst 85(8),
April 21.
Lazarus, Philip, Idris, Ali M., Hoffmann, Dietrich, p53 Mutations in Head and Neck
Squamous Cell Carcinomas from Sudanese Snuff (Toombak) Users Cancer Detection
And Prevention, 1996 v20 n4
The year 1997 is off to a very promising start with research like that of Dr. Joe DePierre
of
Lund,
Sweden
Studies on xenobiotic metabolism and its relationship to the effects of xenobiotics on
living
organisms
http://www.biokemi.su.se/Gallerv/depierre i.html
"It has become increasingly clear that hormonal regulation of xenotiobic-metabolizing
enzymes is a general phenomenon, in addition to the genetic up-regulation of these same
enzymes upon exposure to xenobiotics through the process referred to as induction. Our
interest is focused primarily on the hormonal regulation of different isozymes of
cMochrome P-450 and of glutathione transferase by steroid and peptide hormones. There
are large differences in the levels of certain of these hormones in male and female
animals and at different stages of development (e.g., during ontogenesis, after birth, in
connection with puberty, pregnancy and menopause). Again, this project encompasses
three major goals: a) to elucidate the molecular mechanism underlying the hormonal
regulation of xenobiotic-metabolizing enzymes; b) to understand why such regulation
occurs; and c) to determine the consequences of such hormonal regulation for Ute
organism's response to exposure to xenobiotics."
Return To Table Of Contents
The Smoking Guns of 1996
Two scientific studies were published in 1996 which, when all the dots are finally
connected, will reveal a clear picture of the cause of much if not most of the smokingrelated disease and death. Both studies were published in the journal Science. The first,
published in June by Dr. Robert McLachlan and his colleagues at Tulane University,
published research demonstrating that if you combine extremely low doses of four
pesticides, each in itself well below the tlireshold for hazard to humans, you get far more
than what they expected, which was along the lines of 1+1=2. What they found was that
when any of the pesticides were combined - endosulfan, dieldrin, disulfoton, and
toxaphene - the resulting increase in hazard to humans was more like 1+1=1600. The
ingestion of even very tiny amounts of these pesticides in combination appears to create a
health hazard many magnitudes beyond what would occur if you ingested them one at a
time.
The red flag here is that all four of these pesticides have been extremely common
contaminants of U.S. cigarettes since the 1960's. This means that pack-a-day smokers,
and their families, have been exposed to radically enhanced chemical hazard 50,000
times a year with no opportunity to know about the hazard and make decisions based on
this knowledge.
The second 1996 Smoking Gun study was published in Science in October by Mikhail
Denissenko and Gerd Pfeifer of the Beckman Research Center, City of Hope, Duarte,
California and Annie Pao and Moon-shong Tang of the M.D. Anderson Cancer Center
Science Park in Smithville, Texas. They follow the trail of benzo-a-pyrene from ingestion
as part of the cigarette smokestream, to conversion into a compound called BPDE, to
BPDE's attachment at the exact spot on the P53 gene where mutations arise that prevent
the gene from performing its tumor-suppressing tasks in lung and other smoking related
cancers.
The researchers write " Our study provides a direct link between a defined cigarette
smoke carcinogen and human cancer mutations."
What the researchers didn't deal with was the origin of the benzo-a-pyrene, and whether
any of it was from pesticide residues, or from reconstituted or synthetic smoking
materials, rather than from tobacco? It's important not to become focused just on this
current benzo-a-pyrene finding. This extremely lethal chemical has been identified as a
likely cause of lung cancers in cigarette smokers since at least the early 1960's when
smokestream studies identified its presence. What this research has finally done is to
prove, step by step, how benzo-a-pyrene causes cancer in smokers by tracing its path
directly to the spot on P53 where the lung cancer begins. Any doubt that remains that the
benzo-a-pyrene component of cigarette smoke causes lung cancer is unreasonable - but
there are at least two other pieces of this part of the total cigarette health hazard puzzle
which are still uncertain:
What other smokestream components, already fully identified as carcinogenic and
mutagenic, are combustion by-products of pesticide contaminants, of deliberate additives,
and of reconstituted tobacco and synthetic smoking materials?
How does the smokestream profile of a sample of commercial cigarettes compare with
the smokestream profile of natural, uncontaminated tobacco - specifically which
identified carcinogenic and mutagenic chemicals are present in commercial cigarette
smoke that are not present, or are present in different amounts or proportions, in natural
tobacco smoke.
Once we know the answers to these questions, we will have the answer - is it the tobacco,
or is it something else, something largely preventable?
However, serious public health concerns ought to be raised in light of the known health
hazards of chronic exposure to minute environmental amounts of the tobacco pesticides,
the 40-50 year research record tracking the persistent and increasing presence of
carcinogenic, mutagenic, fetus-damaging chemicals in cigarettes specifically designed to
attack life in some of its most resistent forms and known to cause severe damage in
humans.
This record also raises questions of responsibility - who knew or, by virtue of their
command authority, ought to have known about (1) the deliberate incorporation of
designed and patented chemicals for their predictable behavioral and economic benefits
and effects, and (2) about the deliberate use of agrichemicals known to leave
contamination at levels known to be dangerous when consumed by humans under chronic
sublethal conditions, which constitutes normal tobacco product usage.
The following descriptions attempt to summarize what is known about the effects on
humans of the pesticides which have shown up persistently in the research data tracking
concentrations of pesticide residues in commercial US cigarettes, as well as reports
tracking pesticide residues in Europe and Japan.
Research On Pesticides And Human Health
Return To Table Of Contents
In environmental health studies studies one often finds initial remarks similar to this one
in the report on the Toxic Waste Conference of 1993, held by the US government "For
several diseases, including cancer, tobacco use is the most important known preventable
cause." This statement is almost always followed by a disclaimer which points out that
despite best efforts people seem to continue smoking, so this leading form of death is
usually set aside and the scientists go on to discuss all the environmental hazards that
they believe can be addressed - things like exposure to chemical contaminants, toxic
fumes, and hazardous materials.
What a terrible irony is would be if it is precisely these things in cigarettes, and not the
tobacco, which is the preventable source of much of the disease and death from smoking,
which these scientists believe is an intractable problem.
Here is a selected list of recent publications detailing the relationship between
agricultural pesticides and human health. You'll find many more citations organized by
topic in the bibliography section of this site. While many mention smoking as a leading
cause of preventable disease and death, and others mention smoking as a source of
exposure to hazardous chemicals, none make the connection between man-made,
deliberately applied, knowingly contaminated non-tobacco and reconstituted smoking
materials and the public health crisis created by smoking cigarettes.
Ahlbom A. (1990). Some notes on brain tumor epidemiology. In: Davis DL, Hoel D,
eds. Trends in cancer mortality in industrial countries. Annals of the New York
Academy of Sciences, 609:179-90. New York: New York Academy of Sciences.
Colburn T, Clement C, eds. (1992). Chemically induced alterations in sexual and
functional development: The wildlife/human connection. Advances in Modern
Environmental Toxicology, Vol. 21, Princeton, N.J.: Princeton Scientific Publishing.
Davis DL, Friedler G, Mattison D, Morris R. (1992a). Male-mediated teratogenesis and
other reproductive effects: Biologic and epidemiologic findings and a plea for clinical
research. Reprod Toxicol 6:289-92.
Davis DL, Hoel D, Fox J, Lopez A. (199Oa). International trends in cancer mortality in
France, West Germany, Italy, Japan, England, and Wales, and the United States. In:
Davis DL, Hoel D, eds. Trends in cancer mortality in industrial countries. Annals of the
New York Academy of Sciences 609:5-48. New York: New York Academy of Sciences.
Davis DL, Hoel D, Percy C, Ahlbom A, Schwartz J. (1990b). Is brain cancer mortality
increasing in industrial countries? In: Davis DL, Hoel D, eds. Trends in cancer
mortality in industrial countries. Annals of the New York Academy of Sciences 609: 191
-204. New York: New York Academy of Sciences.
Davis DL, Blair A, Hoel DG. (1992b). Agricultural exposures and cancer trends in
developed countries. Environ Health Perspect 100:39 44.
Davis DL, Bradlow HL, Wolff M, Woodruff T, Hoel DG, Anton-Culver H. 1993.
Medical hypothesis: Xenoestrogens as preventable causes of breast cancer. Environ
Health Perspect 101 :372-7.
Davis JR, Brownson RC, Garcia R. (1992). Family pesticide use in the home, garden,
orchard, andyard. Arch Environ Contam Toxicol 22:260-6.
Davis JR, Brownson RC, Garcia R, Bentz BJ, Turner A. (1993). Family pesticide use
and childhood brain cancer. Arch Environ Contam Toxicol 24:87-92.
Glickman LT, Schofcr FS, McKee LJ, Reif JS, Goldschmidt MH. (1989). Epidemiologic
study of insecticide exposures, obesity, and risk of bladder cancer in household dogs. J
Toxicol Environ Health 28(4):407-14.
Hoel DG, Davis DL, Miller AB, Sondik EJ, Swerdlow AJ. (1992). Trends in cancer
mortality in 15 industrialized countries, 1969-1986. J Natl Cancer Inst 84:313-20.
Krieger NK, WoIffMS, Hiatt RA, Rivera M, Vogelman J, Orentreich N. (1994). Breast
cancer and serum organochlorines: A prospective study among white, black, and Asian
women. J Natl Cancer Inst 86:589-99.
Lopez A (1990). Competing causes of death: A review of recent trends in mortality in
industrialized countries with special reference to cancer. Ann NY Acad Sci 609:58-76.
Montgomery LE, Carter-Pokras O. (1993). Health status by social class and/or minority
status: Implications for environmental equity research. Toxicology & Industrial Health
9(5):729-75.
Moses M, et al. (1993). Environmental equity and pesticide exposure. Toxicology &
Industrial Health 9(5):913-60.
National Research Council (NRC). (1991). Environmental epidemiology' Volume 1:
Public health and hazardous wastes. Washington, D.C.: National Academy Press.
O'Leary LM, Hicks AM, Peters JM, London S. (1991) Parental occupational exposures
and risk of childhood cancer: a review. Am J Ind Med 20:17-35.
Olsen JH, Brown P, Schulgen G, Jensen OM. (1991). Parental employment at time of
conception and risk of cancer in offspring. Eur J Cancer 27:958-65.
Rios R, Poje GV, Detels R. (1993). Susceptibility to environmental pollutants among
minorities. Toxicology & Industrial Health 9(5):797-820.
Sexton, K., Olden, K., Johnson, B. (1993). Environmental justice: The central role of
research in establishing a credible scientific foundation for informed decision making.
Toxicology & Industrial Health 9(5):685-728.
Silbergeld, E.K. (1994). Evaluating the success of environmental health programs in
protecting the public's health. Tn: Andrews JS Jr. Frumkin FI, Johnson BL, Mehlman
MA, Xintaras C, Bucsela J, eds. Hazardous waste and public health: International
congress on the health effects of hazardous waste-, 1993 May 3-6; Atlanta. Atlanta:
Agency for Toxic Substances and Disease Registry, Public Health Service, U.S.
Department of Health and Human Services, pp 43-8.
Strohmer, H., Boldizsar, A., Plockinger, B., Feldner-Busztin, M., Feichtinger, W., (1993).
Agricultural work and male infertility. Am J Ind Med 24(5):587-92.
Wolff, MS., Paolo, G., Toniolo, P., Lee, Eric W, Rivera, M, Dubin, N., (1993). Blood
levels of organochlorine residues and risk of breast cancer. J Natl Cancer Inst 85(8),
April 21.
Lazarus, Philip, Idris, Ali M., Hoffmann, Dietrich, p53 Mutations in Head and Neck
Squamous Cell Carcinomas from Sudanese Snuff (Toombak) Users Cancer Detection
And Prevention, 1996 v20 n4
The year 1997 is off to a very promising start with research like that of Dr. Joe DePierre
of
Lund,
Sweden
Studies on xenobiotic metabolism and its relationship to the effects of xenobiotics on
living
organisms
http://www.biokemi.su.se/Gallerv/depierre j.html
"It has become increasingly clear that hormonal regulation of xenotiobic-metabolizing
enzymes is a general phenomenon, in addition to the genetic up-regulation of these same
enzymes upon exposure to xenobiotics through the process referred to as induction. Our
interest is focused primarily on the hormonal regulation of different isozymes of
cytochrome P-450 and of glutathione transferase by steroid and peptide hormones. There
are large differences in the levels of certain of these hormones in male and female
animals and at different stages of development (e.g., during ontogenesis, after birth, in
connection with puberty, pregnancy and menopause). Again, this project encompasses
three major goals: a) to elucidate the molecular mechanism underlying the hormonal
regulation of xenobiotic-metabolizing enzymes; b) to understand why such regulation
occurs; and c) to determine the consequences of such hormonal regulation for the
organism's response to exposure to xenobiotics."
Return To Table Of Contents
The Smoking Guns of 1996
Two scientific studies were published in 1996 which, when all the dots are finally
connected, will reveal a clear picture of the cause of much if not most of the smokingrelated disease and death. Both studies were published in the journal Science. The first,
published in June by Dr. Robert McLachlan and his colleagues at Tulane University,
published research demonstrating that if you combine extremely low doses of four
pesticides, each in itself well below the threshold for hazard to humans, you get far more
than what they expected, which was along the lines of 1+1=2. What they found was that
when any of the pesticides were combined - endosulfan, dieldrin, disulfoton, and
toxaphene - the resulting increase in hazard to humans was more like 1+1=1600. The
ingestion of even very tiny amounts of these pesticides in combination appears to create a
health hazard many magnitudes beyond what would occur if you ingested them one at a
time.
The red flag here is that all four of these pesticides have been extremely common
contaminants of U.S. cigarettes since the 1960's. This means that pack-a-day smokers,
and their families, have been exposed to radically enhanced chemical hazard 50,000
times a year with no opportunity to know about the hazard and make decisions based on
this knowledge.
The second 1996 Smoking Gun study was published in Science in October by Mikhail
Denissenko and Gerd Pfeifer of the Beckman Research Center, City of Hope, Duarte,
California and Annie Pao and Moon-shong Tang of the M.D. Anderson Cancer Center
Science Park in Smithville, Texas. They follow the trail of benzo-a-pyrene from ingestion
as pan of the cigarette smokestream, to conversion into a compound called BPDE, to
BPDE's attachment at the exact spot on the P53 gene where mutations arise that prevent
the gene from performing its tumor-suppressing tasks in lung and other smoking related
cancers.
The researchers write " Our study provides a direct link between a defined cigarette
smoke carcinogen and human cancer mutations."
What the researchers didn’t deal with was the origin of the benzo-a-pyrene, and whether
any of it was from pesticide residues, or from reconstituted or synthetic smoking
materials, rather than from tobacco? It's important not to become focused just on this
current benzo-a-pyrene finding. This extremely lethal chemical lias been identified as a
likely cause of lung cancers in cigarette smokers since at ’east the early 1960's when
smokestream studies identified its presence. What this research has finally done is to
prove, step by step, how benzo-a-pyrene causes cancer in smokers by tracing its path
directly to the spot on P53 where the lung cancer begins. Any doubt that remains that the
benzo-a-pyrene component of cigarette smoke causes lung cancer is unreasonable - but
there are at least two other pieces of this part of the total cigarette health hazard puzzle
which are still uncertain:
What other smokestream components, already fully identified as carcinogenic and
mutagenic, are combustion by-products of pesticide contaminants, of deliberate additives,
and of reconstituted tobacco and synthetic smoking materials?
How does the smokestream profile of a sample of commercial cigarettes compare with
the smokestream profile of natural, uncontaminated tobacco - specifically which
identified carcinogenic and mutagenic chemicals are present in commercial cigarette
smoke that are not present, or are present in different amounts or proportions, in natural
tobacco smoke.
Once we know the answers to these questions, we will have the answer - is it the tobacco,
or is it something else, something largely preventable?
However, serious public health concerns ought to be raised in light of the known health
hazards of chronic exposure to minute environmental amounts of the tobacco pesticides,
the 40-50 year research record tracking the persistent and increasing presence of
carcinogenic, mutagenic, fetus-damaging chemicals in cigarettes specifically designed to
attack life in some of its most resistent forms and known to cause severe damage in
humans.
This record also raises questions of responsibility - who knew or, by virtue of their
command authority, ought to have known about (1) the deliberate incorporation of
designed and patented chemicals for their predictable behavioral and economic benefits
and effects, and (2) about the deliberate use of agrichemicals known to leave
contamination at levels known to be dangerous when consumed by humans under chronic
sublethal conditions, which constitutes normal tobacco product usage.
The following descriptions attempt to summarize what is known about the effects on
humans of the pesticides which have shown up persistently in the research data tracking
concentrations of pesticide residues in commercial US cigarettes, as well as reports
tracking pesticide residues in Europe and Japan.
Upcosiing Tobacco Trials
http://www.tobacco.neu.cdu/Upcomiughtml
Upcoming Major Tobacco Trials
Last Updated 3/18/98
Note that this is far from a complete listing. If you have trial information to share,
please let us know.
IN TRIAL - Engle, etal. v. R.J. Reynolds Tobacco, et al.
(Dade County, Florida, Eleventh Judicial Circuit)
First class action on behalf of smokers to go to trial. This case is
brought on behalf of Florida residents injured as a result of
smoking cigarettes and plaintiffs are seeking as much as $200
billion. Judge Robert Kaye presided over the flight attendants
secondhand smoke class action settled last Fall. (See opt out
notice web site). The defense Began to present its case in
March and this phase of the trial may be wrapped up in the first
weeks of Spring.
VERDICT FOR DEFENDANTS 3/18/90 - - Iron Workers Local
Union No. 17 Insurance Fund v. Philip Morris Inc., etal., No.
1:97-cv-1422, (N.D. Ohio (Akron)).
Class of about 100 Ohio unions seeking recovery of fund assets
(as well as treble and punitive damages) related to treating
members suffering from tobacco-caused disease brought under
theories of racketeering, antitrust and conspiracy. The class
was certified on October 20, 1998. After three days of
deliberations, an eleven member jury unanimously voted to find
the industry not liable.
One possible explanation for the pro-industry verdict, which
came as a surprise to most observers, is the compressed time
frame for the trial. Under an accelerated schedule ordered by
the trial judge, in four weeks, the allegations of a first of its kind
class action trial dealing with fraud and civil racketeering
charges had to be proven. Likely, the one week provided to the
plaintiffs to present the critical fraud and conspiracy aspects of
the case to the jury was insufficient. Normally, long trials caused
by industry litigation tactics benefit the industry. Here, an
exceptionally and exceedingly short trial may have benefited the
industry.
While some have characterized this loss as an end to union
fund recovery litigation against Big Tobacco, a similar trial is
scheduled for September in Seattle (Northwest Laborers
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Upcoming Tobacco Trials
http://www.tobacco.ncu.cduAJpconiing.htmI
Employers Health & Security Trust Fund et al. v. Philip Morris,
Inc. et al.).
Plaintiff counsel includes Robert Connerton of Connerton & Ray
who has about two dozen similar proposed class actions
pending around the nation. Other firms representing the plaintiff
include: Schwarzwald & Rock in Cleveland; the Landskroner
Law Firm of Cleveland; Milberg, Weiss, Bershad, Hynes &
Lerach in New York and San Diego; Stritmatter, Kessler,
Whelan & Withey in Seattle; Kargianis, Watkins, Marler in
Seattle; Roger M. Adelman of Washington, D.C.; G. Robert
Blakey of Notre Dame Law School; and Einer R. Elhauge of
Harvard Law School.
2/22/99 IN TRIAL - Joann Williams-Branch v. Philip Morris,
Inc., No. 9705-03957, (Circuit Court for the County of
Multnomah (Portland)).
A wrongful death individual lung cancer case against Philip
Morris. Plaintiff counsel includes: Ray Thomas and James
Coon of Swanson, Thomas, & Coons; Bill Gaylord, Gaylord &
Eyerman; Charles Tauman; and Professor Richard Daynard.
IN TRIAL - Olanda Carter v. R.J. Reynolds Tobacco Co., No.
88570-8-T.D.; Edith Kamey v. Philip Morris Inc., No.
89196-8-T.D.; Denise McDaniel v. Brown & Williamson Tobacco
Corp., 90832-8 T.D.; Ruby Settle v. B.A.T. Industries, No.
89226-8-T.D.(Memphis, Tennessee, 13th Judicial District)
First consolidated tobacco trial will be conducted in 2 phases:
Phase One will deal with industry liability on theories of
negligence, strict liability, conspiracy and breach of warranty
while Phase Two will address causation and damages for each
of the five plaintiffs. The same jury will preside over both
phases.
Reportedly, the trial is moving rather slowly and the judge has
not allowed more than about a dozen pieces of documentary
evidence for each plaintiff. This is in sharp contrast to recent
trials in which the jury was allowed to see hundreds of tobacco
industry "secret" documents. The excluded documents
undermined the assertions made by the defendants in trial.. By
preventing tne jury trom seeing potential evidence ot industry
deceit, the plaintiffs are operating at a distinct disadvantage. The
Plaintiffs' attorneys are lead by Curtis D. Johnson, Jr., of
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Upc mu g 1 bbacco frials
http://www.tobacco.ncu.wIuAJpcorning.html
Memphis,TN and Norwood S. Wilner, of Jacksonville, FL.
VERDICT FOR PLAINTIFF 2/9/99 - Henley v Philip Morris
Inc., et ah Sup Ct of CA, SF Case No. 995172.
2/9/99 - In first verdict against Philip Morris, a California
Jury gives $50 million in punitive and $1.5 million in
compensatory damages to smoker with lung cancer!
The jury found Philip Morris liable for Product defect, failure to
warn (before July 1969), Negligence, Fraud, False Promise,
Express Warranty, and Conspiracy.
This is an individual personal injury action on behalf of a 52 year
old woman dying of lung cancer. Marlboro (mfg. by Philip
Morris) was her primary brand although all major cigarette
companies are defendants under fraud and conspiracy
allegations. Plaintiffs attorney is Madelyn Chaber, Wartnick,
Chaber, Harowitz, Smith & Tigerman, San Francisco, CA..
William Ohlemeyer, Shook, Hardy & Bacon, Kansas City, MO, is
lead defense counsel. See First Amended Complaint
VERDICT FOR DEFENDANTS 2/12/99 - Lacy v. Lorillard
Tobacco Company etal., No. 94-01894 ( Sup. Ct., Norfolk
County, Mass.)
A Kent Micronite filter case in which a smoker of Kent cigarettes
during the mid 1950s was stricken with mesothelioma, a rare
and fatal form of lung cancer caused exclusively by exposure to
"blue" asbestos. This is a wrongful death action in which
punitive damages may be awarded under Massachusetts law.
This deadly material was used as a loosely packed filtering
agent for several years by Lorillard. Plaintiff counsel includes
Charles Patrick of Ness, Motley, Loadholdt, Richardson & Poole
(Charleston, SC)as well as noted Micronite filter expert, Daniel
Childs of Johnson & Childs (Philadelphia, PA). The
Massachusetts firm of Hollingsworth & Vose, which assembled
the filters for Lorillard, is a co-defendant but has reportedly been
indemnified by Lorillard.
The Estate of Mildred Lacy is represented by Charles Patrick of
Ness Motley Richardson Loadholdt & Poole (Charleston, SC)
and by Daniel Childs of Johnson & Childs (Philadelphia, PA).
bask
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World Health Organization: A Global Status Report
http://www.cdc.gov/nccdphp/osh/who/whofirst.htn:
Health
Organization
Tobacco or Health Programme
Tobacco or Health:
A Global Status Report
Country Profiles by Region, 1997
Regional Profiles
Africa
The Americas
Eastern Mediterranean
Europe
Southeast Asia
Western Pacific
Global Alphabetical Country Listing
International Issues.
World Health Organization: Tobacco or Health
littp://>vivyv.yvlio.org/programmes/psa/toh.htni
This information is provided on the Internet as a service by the Office on Smoking and Health of the CDC's National Center for
Chronic Disease Prevention and Health Promotion, in its role as a World Health Organization (WHO) Collaborating Center for
Tobacco or Health. Data and information for the country profiles were assembled by the WHO from a number of existing
reports and publications and shared with WHO Regional Offices and member countries for validation.
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Tobacco Free Initiative Home Page
http://www.who.int/toh>
Tobacco Free Initiative
____________________
According to WHO estimates, there are currently 3.5 million deaths a
Information About TFI
year from tobacco, a figure expected to rise to about 10 million by 2030.
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. 70% of those deaths will occur in developing countries.
The sheer scale of tobacco's impact on global disease burden, and
particularly what is likely to happen without appropriate intervention in
developing countries, is often not fully appreciated. The extremely
negative impact of tobacco on health now and in the future is the
primary reason for giving explicit and strong support to tobacco control
on a world-wide basis.
B Mission and Goals of TFI
B Managing the TFI Initiative
B Upcoming Events
B Contacts
In response to these concerns the Director-General, Dr Gro Harlem
Brundtland, established a Cabinet project, the Tobacco Free Initiative
(TFI), in July 1998 to coordinate an improved global strategic response
to tobacco as an important public health issue. The long-term mission
of global tobacco control, which will take several decades to achieve, is
to reduce smoking prevalence and tobacco consumption in all countries
and among all groups, and thereby reduce the burden of disease
caused by tobacco. In support of this mission, the goals of the Tobacco
Free Initiative are to:
• Galvanize global support for evidence-based tobacco control
policies and actions
• Build new, and strengthen existing partnerships for action
• Heighten awareness of the need to address tobacco at all levels
of society
B Why Focus on Tobacco?
GJ World No-Tobacco Day 1999
WHO Tobacco Info
B Executive Board, 103rd Session
TFI: Towards Stronger Global Action
B Director-General's Comments
Relating
to Tobacco
B Director-General's Speeches
Relating
to Tobacco
B WHO Press Releases & Fact Sheets
Relating to Tobacco
• Accelerate national, regional and global strategy implementation
B WHO Publications, Technical
Reports,
Journal Articles, Resolutions, etc.
on Tobacco
• Commission policy research to support rapid, sustained and
innovative actions
B Full Text of Selected WHO
Documents
on Tobacco
• Mobilize resources to support required actions
In achieving these goals, the Tobacco Free Initiative will build strong
internal and external partnerships "with a purpose" with each WHO
Cluster and Regional and Country Offices, and with a range of
organizations and institutions around the world. The purpose of these
partnerships will reflect the unique and complementary roles of WHO's
partners and of WHO at all levels of the organization. Success will be
measured in terms of actions achieved at local, country and global
levels that lead to better tobacco control.
B World No-Tobacco Day 1998
B World No-Tobacco Day 1997
B World No-Tobacco Day 1996
Tobacco on the Web
B Links to tobacco-related sites
The Tobacco Free Initiative will take a global leadership role in
promoting effective policies and interventions that make a real
difference to tobacco prevalence and associated health outcomes.
Despite the seriousness of the problem, there is evidence to show that
countries which undertake concerted and comprehensive actions to
address tobacco control can bring about significant reductions in
tobacco related harm. These success stories indicate the importance of
considering the best mix of specific interventions required to achieve
1 of2
5/4/99 11:54 AM
|
Tobacco free Initiative Home Page
http://www.who. int/toh
considering the best mix of specific interventions required to achieve
the same goal: increased cessation and lowered initiation. The specific
mix of interventions in a broad policy framework will vary according to
each country's political, social, cultural and economic reality.
----- CeBjdisbi® 1398. All rights 1
reserved.
Updated:Mon May 311:16:10
1999
Critical to the success of these global tobacco control actions, will be
the ability to mobilize human, institutional and financial resources to
support enhanced activity. Current allocations at regional and global
levels are severely inadequate, especially when faced with a $400
billion industry which promotes these harmful tobacco products.
Increased allocations will enable improved international research, policy
development and action to address the massive public health impact of
tobacco.
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5/4/99 11:54 AM
Why Focus on Tobacco?
ublic health impact
The extremely negative impact of tobacco on health now and in the future
is the primary reason for giving explicit and strong support to tobacco
control on a worldwide basis. Figure 1 indicates the current percentage of
deaths attributable to tobacco by region and likely projections by the year
2020. The increased impact of tobacco looms as one of the greatest
public health threats in the 21 st century.
HInfo About TFI
Why Focus on Tobacco?
Mission and Goals of TFI
Managing the TFI Initiative
Upcoming Events
Contacts
World No-Tobacco bay
1999
Figure 1: Percent of all deaths attributable to tobacco
WHO estimates that there are currently 3.5 million deaths a year from
tobacco, a figure expected to rise to about 10 million by 2030. By that
date 70% of those deaths will occur in developing countries. Mortality
data does not reflect the enormous additional toll caused by tobacco that
is felt in terms of morbidity, disability and suffering among children and
adults.
Over a billion smokers
There are currently over a billion smokers in the world. The largest single
number is in Asia. From Figure 2 it is clear that the proportion of women
that smoke is comparatively higher in Europe and North America than in
other parts of the world. However, recent estimates suggest growing
numbers of smokers in developing countries, particularly amongst
women (WHO 1997).
Figure 2: Number of smokers by region 1997 (in millions)
Recent trends indicate that the smoking prevalence rate in adolescent
boys and girls is rising in many countries where previously tobacco
control had been considered successful (Figure 3a & 3b). Thus, while
new markets are being opened by industry actions, old markets have not
been closed - tobacco is a global threat.
Figure 3a: Youth smoking (F) Figure3b:Youth smoking (M)
Tobacco use is bad economics
The economic impact of tobacco has been analysed in many countries in
recent years. Studies in countries as diverse as Thailand, South Africa,
Switzerland, China and Brazil are now available to complement some of
the previous studies done in the United Kingdom, USA and Canada.
Together, these studies show that the alleged economic benefits of
tobacco are illusory. There are, however, large direct, indirect and
WHO Tobacco Info
Executive Board, 103rd
Session TFI: Towards
Stronger Global
Action
Director-General's Comments
Relating to Tobacco
Director-General's Speeches
Relating to Tobacco
WHO Press Releases &
Fact
Sheets Relating to Tobacco
WHO Publications,
Technical
cnnicai
Reports, Journal Articles,
Resolutions, etc, on
Full Text of Selected WHO
Documents on Tobacco
World No-Tobacco Day
1998
World No-Tobacco Day
1997
World No-Tobacco Day
1996
Tobacco on the
jgj
intangible costs associated with tobacco that hamper economic
development rather than promote it.
jWeb
Tobacco harms the environment
1 Links to tobacco-related
I sites.
In many of the tobacco growing countries evidence indicates negative
environmental impacts of tobacco agriculture, particularly when
associated with deforestation required to increase farmland and cure
tobacco plants.
I
1
Effective policies and interventions make a difference
Effective policies and interventions make a real difference to tobacco
|
prevalence and consumption, and associated health outcomes. Most of I
the documented successes have occurred in developed countries where 1
effective approaches have been implemented for several years. In more a
recent years, several developing countries have introduced similar
|
measures (Table 1). Early indications are that they too will be effective.
1
Table 1: Recent policies in selected countries
The Finnish experience is particularly important since it stresses the need 1
to consider success in periods of decades rather than years. Figure 4
|
indicates the combined impact of legislation, increased tax and
comprehensive community-based strategies on tobacco consumption in
adults in Finland. Further, it should be noted that when Finland began
addressing tobacco in the 1960s, it was then not the wealthy country it is
today. This has implications for other countries wishing to consider the
Finnish model as one way to move ahead.
1
1
1
i
Figure 4: Consumption of tobacco per adult in Finland
One major study has analysed the individual and combined effects of a
|
range of policies and interventions on future prevalence (Townsend
1998). The results are summarised in Table 2. Price increases (through
excise taxes on tobacco products) constitute by far the most important
policy tool available. The other interventions have demonstrated
effectiveness when properly enacted and enforced. The UK study
highlights the need for policy makers to use the best mix of policies that
will be supported within a particular country at a particular time.
|
Table 2: Policies to reduce smoking prevalence to 20% by
the year 2000 in the UK
Figure 5 demonstrates the long-term impact (1965 to 1985) of
increasingly graduated health education campaigns combined with
smoke free policies in the USA. It shows that, whereas there were about
50 million smokers in 1985, there would have been 90 million if public
health measures had not been introduced in the 20-year period. This
excess translates into many hundreds of thousands of lives saved.
Figure 5: US Public Health success
These success stories indicate the importance of considering the best
1
mix of specific interventions required to achieve the same goal: increased
cessation and lowered initiation. The elements of the WHO
comprehensive policy supported by Member States are summarised in
Table 3. The specific mix of interventions in a broad policy framework will
vary according to each country’s political, social, cultural and economic
reality. Public support, mediated through the media and the legislative
process, are crucial determinants of success.
Table 3: Elements of a comprehensive national policy
Resources are inadequate relative the size of the problem
Human, institutional and financial resources for all aspects of tobacco
control at country, regional and global levels are severely inadequate.
Faced with a US$400 billion industry, global spending on tobacco control
has not addressed most countries' need for even a modicum of human
and institutional capacity. Tobacco control is often tagged onto other
functions. Financial support for international research, policy
development and action to address the impact of tobacco has been
restricted to a few modest initiatives.
The combination of current and future threats combined with the
availability of successful tools for action led to the development of the
tobacco free initiative by Dr Gro Harlem Brundtland as one of her first two
cabinet projects.
__ _ .
Copyright© 1998.
All rights reserved.
Updated:Mon May 3
11:11:181999
Upcoming Events Through 1999
The next ten to twelve months will be decisive for the Tobacco Free
initiative. A number of important meetings at which tobacco control policy
decisions will emerge are listed below.
•
FCTC technical meeting, Canada, 2-4 December 1998
•
WHO Interregional focal point meeting, Egypt, 14-16 December
1998
•
International Consultation on Environmental Tobacco Smoke and
Child Health, Geneva, 11-14 January 1999
•
WHO/Executive Board, 25 January-3 February 1999
•
EURO, AMRO, AFRO meeting, Gran Canaria, 23-27 February 1999
®
World Bank report on economics of tobacco for release, DC, March
1999
0
International legislators in support of tobacco control, DC, March
1999
«
WHO/World Health Assembly, Geneva, 17-26 May 1999
o
International NGO meeting, Geneva, May 1999
•
World No Tobacco Day, 31 May 1999 (Cessation)
®
International Conference on Youth and Tobacco, Singapore,
September 1999
Info About TFI
B
|
Why Focus on Tobacco?
Mission and Goals of TFI
Managing the TFI Initiative
Upcoming Events
Contacts
I
World No-Tobacco bay 1999
jj
■
B
WHO Tobacco Info
Executive Board, 1O3rd
Session TFI: Towards
Stronger Global
—Action
Director-General's Comments
Relating to Tobacco
Director-General's Speeches
Relating to Tobacco
WHO Press Releases & Fact
Sheets Relating to Tobacco
WHO Publications. Technical
Reports. Journal Articles.
Resolutions, etc, on Tobacco
Full Text of Selected WHO
Documents on Tobacco
World No-Tobacco Day 1998
World No-Tobacco Day 1997
World No-Tobacco Dav 1996
Tobacco on the Web
Links to tobacco-related sites
h Managing the Tobacco-Free Initiative
I Info About TFI
B_
■ The success of TFI, considering its many partners within and outside
■ WHO, requires an effective management structure and demonstrable
■ WHO leadership. Diagram A provides the major elements of the structure
I of the Tobacco Free Initiative. TFI is housed within the Noncommunicable
Why Focus on Tobacco?
of TFI
f Mission andtheGoals
TFI Initiative
Upcoming Events
I Managing
Contacts
B Disease Cluster with whom it shares a common Management Support
■ Unit. In addition, it reports directly to the Office of the Director-General
■ especially on issues related to policy and strategy. The Director-General
|■ has appointed Judith Mackay to Chair TFI's Policy Advisory Committee
World No-Tobacco bay 1999
WHO Tobacco Info
■ and Richard Peto to Chair TFI's Scientific Advisory Committee.
Executive Board. 103rd
Session TFI: Towards
Stronger Global
Action
Diagram A: Tobacco-Free Initiative: major elements
Director-General's Comments
Relating to Tobacco
Director-General's Speeches
Relating to Tobacco
WHO Press Releases & Fact
Sheets Relating to Tobacco
WHO Publications. Technical
Reports. Journal Articles,
Resolutions, etc, on Tobacco
Full Text of Selected WHO
Documents on Tobacco
Building national capacity for tobacco control at country level is a
a
■ function that has long been performed by WHO under the previously
H designated Tobacco or Health Program. This function will be strengthened i.
11 to give emphasis to:
Assessment of country and global needs to expedite tobacco
control
Multi-country support to strengthen capacity building through
collaborating center networks, thereby creating a more
sustainable mechanism for building capacity for tobacco control
®
Performance enhancement in certain weak areas: media
advocacy, legislation and economics
I he information management "virtual unit" works closely with CDC,
IDRC (TRIC) Canada, the World Bank, academic institutions and an
international network of NGOs on the Internet to:
•
support the development of a solid evidence base for TFI
•
ensure that a global surveillance system becomes operational
and is used at country level as a policy tool
World No-Tobacco Day 1998
World No-Tobacco Day 1997
World No-Tobacco Day 1996
Tobacco on the Web
Links to tobacco-related sites.
•
United Nations Foundations:
The largest single amount awarded for international tobacco
control activities from the United Nations Foundation. This WHOled proposal has the support of UNICEF, World Bank, CDC,
Campaign for Tobacco-Free Kids, IDRC and many other NGOs. It
will test new partnerships in the field and explicitly reach out and
involve youth in developing countries.
•
United Nations Radio:
TFI's first media workshop involved tobacco control policy
makers, United Nations Radio and key journalists mainly from
developing countries. It resulted in the development of a proposal
aimed at enhancing journalists' knowledge about tobacco control,
strengthening their ability to work more closely together and
developing new media-based tobacco control products.
e
Framework Convention on Tobacco Control:
The WHO Cabinet has given its support for a fast-track approach
for the Framework Convention on Tobacco Control. Technical
meetings are planned over the next six to twelve months during
which time national framework convention commisions/advisory
councils will be established in a number of developing countries.
•
1999 World No-Tobacco Day-Cessation
The focus of the 1999 World No-Tobacco Day will be on
cessation. A consortium comprising IFPMA, World SelfMedication Industry, World Medical Association, International
Council of Nurses, International Network Against Tobacco and
UICC will support TFI to implement a global campaign to give
greater public emphasis to cessation. If many of the adults who
now smoke were to quit over the next 20 years, they could
prevent about one-third of the expected tobacco deaths in 2020!
■ 1 obacco Free Initiative Contacts
3 Info About TFI
H Geneva:
I
g Douglas Bettcher, Framework Convention on Tobacco Control
I Fax: 41 22 7914828
S Email: bettcherd@who.ch
■ Neil Collishaw, National/Multicountry Capacity,
B World No Tobacco Day 1999
I Fax: 41 22 791 4828
E Email: collishawn@who.ch
|
|
I
1|
Why Focus on Tobacco?
Mission and Goals of TFI
Managing the TFI Initiative
Upcoming Events
Contacts
i
World No-Tobacco Day 1999
| WHO Tobacco Info
Leanne Riley, UN Foundation Youth and Tobacco Project
1
|
I
Executive Board. 103rd
Session TFI: Towards
Stronger Global
Action
I
J
Director-General's Comments
Relating to Tobacco
11 Derek Yach, Project Manager
I Fax: 41 22 791 4828
E Email: yachd@who.ch
1
Director-General's Speeches
1
Relating to Tobacco
3
p Regional Advisers for Tobacco Control:
■
WHO Press Releases & Fact
Sheets Relating to Tobacco
I Fax: 41 22 791 4828
■ Email: rileyl@who.ch
H Chitra Subramaniam, External Liaison
■ Fax: 41 22 791 4828
!■! Email: subramaniamc@who.ch
$ WHO Regional Office for Africa
1
B Mr. L. Sanwogou
9 Regional Adviser on Health Education
B World Health Organization
B Regional Office for Africa
11 Medical School, C Ward
B Parirenyatwa Hospital
j
WHO Publications, Technical
Reports. Journal Articles.
Resolutions, etc, on Tobacco
S
|
Full Text of Selected WHO
Documents on Tobacco
3
I
World No-Tobacco Day 1998
World No-Tobacco Day 1997
I
World No-Tobacco Dav 1996
|
■ Mazoe Street
E P.O. Box BE 773
Belvedere
Harare Zimbabwe
Tel: +263 4 70 69 51 / 70 74 93
Fax: +263 4 70 56 19 / 70 20 44
Email: sanwogoul@whoafr.org
WHO Regional Office for the Americas
Dr. Enrique Madrigal
Regional Adviser on Drug Abuse
525, 23rd Street, N.W.
Washington, D.C. 20037
USA
Tobacco on the Web
Links to tobacco-related sites.
Tel: +1202 974 3331
Fax: +1202 974 3631
Email: madriqen@paho.org
WHO Regional Office for the Eastern Mediterranean
Dr. M. Al Khateeb
Regional Adviser on Health Education
World Health Organization
Regional Office for the Eastern Mediterranean
P.O. Box 1517
Alexandria 21511
Egypt
Tel: +203 48 202 23
Fax: +203 48 38 916
Email: alkhateebm@who.sci.eq
WHO Regional Office for Europe
: Dr. P. Anderson
Action Plan for a Tobacco-free Europe
World Health Oganization
| Regional Office for Europe
8, Scherfigsvej
2100 Copenhagen 0
Denmark
Tel: 45 39 17 12 48
Fax: 45 39 1718 54
Email: pan@who.dk
(Asst: Galina Kaern, Phone: 45 39 17 14 35; Email: qka@who.dk
| WHO Regional Office for South-East Asia
Ms. Martha Osei
Regional Adviser on Health and Behaviour
World Health Organization
Regional Office for South-East Asia
World Health Health
Indraprastha Estate
Mahatma Gandhi Road
New Delhi 110002
India
Tel: +91 11 331 7804
Fax:+91 11 331 8607
Email: martha@who.ernet.in
WHO Regional Office for the Western Pacific
Mr. Stephen Tamplin
Regional Focal Point for Tobacco or Health
World Health Organization
Regional Office for the Western Pacific
P.O. Box 2932
1099 Manila
Philippines
Tel: +632 528 8001
Fax: +632 52 11 036/53 60279
Email: tamplins@who.org.ph
-
Key contacts in partnership organizations:
Samira Asma, CDC: global surveillance; methods support
Fax: 1 770 488 5848
Email: sea5@cdc.gov
I
Enis Baris, IDRC, Canada: global research
Fax: 1 613 567 7748
Email: EBaris@idrc.ca
Bruce Dick, UNICEF: youth and tobacco
Fax: 1 212 824 6465
Email: bdick@unicef.org
Delon Human, World Medical Association: health professionals
■ Fax: 33 4 50 40 59 37
1 Ruben Israel, UICC: Globalink
■ Fax: 41 22 8091810
Email: lsrael@uicc.ch
Prabhat Jha, World Bank: excise tax, economic benefits of control
Fax: 1 202 614 0068
Email: piha@worldbank.org
Sushma Palmer, ACT USA: media and communications
Fax: 1 202 965 5996
Email: Spalmer.ceche.dc@worldnet.att.net
Rosa Rivera, United Nations Radio:media and communications
Fax: 1 212 963 3410
Email: riveraz@un.org
Karen Slama, INGCAT Paris: NGO collaboration
Fax: 33 1 43 29 90 87
Email: kslama@worldnet.fr
Elaine Wolfsen, Global Alliance for Women: women and tobacco
Fax: 1 212 286 9561
Selected Collaborating Centres:
Vera Luiza Costa e Silva, Brazil
Fax: 5521 2217006
Email: costaesilva@ax.ape.orq
Michael Eriksen, USA
Fax: 770 488 5767
Email: mpeo@cdc.gov
Bernadette Roussille, CFES, Comite Francais
Copyright ©1998.
All rights reserved.
Update:Mon May 311:11:18
1999
d’Education pour la Sante
Fax: (33) 01 41 33 33 90
Email: cfes@imaqinet.fr
Richard Peto, UK.
Fax: 44 1865 58817
Bengt Wrammer
WHO Collaborating Centre for an
Action Plan for a Tobacco-free Europe
Department of Public Health Sciences
Norrbacka Building
Karolinska Institute
SE-171 76 Stockholm
Sweden
Fax: 46 500 41 60 60 or 46 8 3346 93
Office: 46 8 5177 00 00
Email: mail@skaraborq-institute. se
Weng Xinzhi, China.
Fax: 86 10-6500 5359
Naohito Yamaguchi, Japan.
Fax: 81 3 3546 0630,
Email: nvamaquc@qan2.ncc.qo.ip
Witold Zatonski. Poland.
Fax: 48 22 643 9234/222429
Email: canepid@ikp.atm.com.pl
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Table of Contents
BMJ I998;316:723
(7 March)
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Mudur, G.
India
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New articles cite this article
Ganapati Mudur,
New Delhi
The Indian health
Collections under which this article appears:
ministry has spent
Public Health:
more than five
Smoking
years trying to get
government agreement over legislation to ban tobacco advertisements and prohibit smoking in
public. Antitobacco activists say that progress has been slow because of the perceived economic
importance of tobacco in India and because of lobbying by the tobacco industry.
The government estimates that about 200 million men and 48 million women in India above the
age of 15 use tobacco, and the industry says that tobacco consumption is growing by 2% each
year. Manufactured cigarettes account for less than a fifth of the tobacco consumed in India.
Traditional, hand rolled cigarettes called bidis, which contain unprocessed tobacco and high
levels of tar and nicotine, make up 60% of smoked tobacco. Processed and roasted tobacco is
also chewed or inhaled as snuff.
Two of India's 25 states-Delhi and Goa-have laws to curb smoking in public that cover
educational institutions, hospitals, hotels, and local transport. But antitobacco campaigners say
that the government lacks the machinery to enforce the legislation and to penalise offenders.
Sanjoy Sengputa, programme officer at the Voluntary Health Association of India, said: "India
needs far more aggressive campaigns to highlight the hazards of tobacco. Smokers in public
often do not encounter objections because passive smoking is not yet a major issue here."
A survey covering 10 cities by the independent National Organisation for Tobacco Eradication
last year found that 14% of children between the ages of 13 and 17 smoked cigarettes. "The top
priority should be to ban advertisements and tobacco sponsorships," said Dr Sharad Vaidya,
chairman of the organisation. "Our survey has revealed that a significant proportion of teenagers
who had decided initially not to take up smoking changed their minds and turned into smokers
after they witnessed sports events sponsored by the tobacco industry," he said.
India is the world's third largest producer of tobacco, after the United States and China. The
industry has said that curbs on tobacco would harm the national economy. Tobacco farms and
industry provide jobs for six million people, and India earned more than $200m (£125m)
last year from tobacco exports. The Indian Council of Medical Research has, however, told the
government that the health costs of tobacco far outweigh any economic benefits to the country.
Send a response to this article
Search Medline for articles by:
Mudur, G.
Alert me when:
New articles cite this article
Collections under which this article appears:
Public Health:
Smoking
Problems in discontinuing tobacco cultivation
1.
2.
3.
4.
5.
6.
7.
8.
Revenue losses Rs. 14,000-16,000 million (US $812-1123 million) in excise and
foreign exchange earnings.
Unemployment for hundreds of thousands of trained rural men and women, posing a
social problem for the Government.
Unemployment for workers working in cigarette factories, established with huge
investment.
Aggravation of pesticide residue problems, since alternative commercial and food
crops requuire heavy use of pesticides.
Decreased security for farmers, since no other crop is as drought-tolerant.
Unemployment for hundreds of thousands of tribal people who collect tendu leaves
from the forest for the bidi industry.
Lack of motivation from the Government and social agencies to persuade traditional
tobacco farmers to cultivate profitable substitute crops.
Altered socio-economic conditions of the tobacco farmers if the present hectarage of
400,000 occupied by tobacco is utilised for the production of non-tobacco crops.
Plans for Altered Tobacco Production
1.
2.
3.
4.
Evolve economically viable, tobacco based cropping systems.
Examine the potential of tobacco as an oil seed crop.
Examine alternative uses of tobacco. Development of viable, integrated technology
for the manufacture of edible proteins from green leaves of tobacco and for extraction
of solanesol, nicotine sulfate, malic and citric acids from tobacco and its wastes.
Identification and development of varieties to suit changing quality specifications in
respect of tar and nicotine contents, with emphasis on export quality tobacco.
Source: Challenges in tobacco control in India - by L.D. Samhvi, ICMR.
Economic aspects
Tobacco contributes to both the negative and positive aspects of the country's economy,
but the losses of the country's economy far outweigh the gains.
The losses occur in the form of costs incurred in providing health care for people with
tobacco-related diseases due to loss of productivity caused by decreased efficiency,
disability and premature death.
=? The use of wood in tobacco curing, resulting in environmental degradation and soil
erosion, also has serious economic implications.
o Cost of treatment of three major tobacco-related diseases, namely cancers, heart
diseases and bronchitis, is that it costs the Government about Rs.24190 million (US
$1422.8 million) annually, which is Rs.6850 million (US $ 402.9 million) more than
the revenue and foreign exchange provided by tobacco to the Government.
Source'. Tobacco Control in India - by Luthra et al, Indian Council ofMedical Research,
New Delhi.
Tobacco Economics in India (1992)
Tobacco production is a major industry in India. The current gross product value of
manufactured tobacco is estimated to be of the order of Rs.36,000 million (US $2117
million). Twelve companies with 20 factories manufacture cigarettes in India. In 1987,
of the 75,420 million cigarettes, 51% of them were filter tipped, were produced in India.
The cigarette industry is capital intensive in the organised sector, providing direct
employment for hundreds of thousands of people,
The bidi industry, which is essentially a cottage industry, provides gainful employment
for more than three million people, mostly in rural areas. Annual production of bidi is
estimated to be over 550,000 million pieces.
The excise revenue earned from tobacco is second only to that from mineral oils,
amounting to Rs.15515 million (US $916 million) in 1986-87. Tobacco products are an
important source of foreign exchange earning in India. During 1986-87, Rs. 1711 million
(US $ 101 million) were earned through the export of unmanufactured tobacco and
manufactured tobacco products like bidis, cigarettes, chewing tobacco, snuff zarda and
scented tobacco. India also imports a limited amount of tobacco and its products. In
1984-85, tobacco products worth Rs.3.8 million (US $22300) were imported.
Source: Tobacco Control in India by K. Luthra, et.aL, Indian Council ofMedical
Research, Delhi.
1.
Area of cultivation - 440.1 (x 103 ha)
2.
Production
3.
People engaged in the cultivation - 12,00,000 people
- 497.1 (xlO3 tonnes)
Source: Challenges in Tobacco Control in India by Sanghul.
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Health problems of Tobacco Pr ocessing workers
Sourcic 95 Medico Friend Circle Bulletin, November 1983 (Indian Scene) by Dhruv
MankaaS
The process of converting raw tobacco into processed zarda or beedi zarda consists of
a number of part-manual, part-mechanical operations of winnowing.
Winnowing and blending causes a lot of fine tobacco dust to fly up into the air of the
closed rooms that pass off as factories. For a newcomer, it is impossible to stand there
even for a half a minute without retching or getting about of coughing and sneezing.
New recruits often feel giddy and vomit while working. The whole process also entails
direct contact of the skin with tobacco. During the blending which is done with the legs,
the heat generated by constant sprinkling of the tobacco zarda with water is a problem
added to the risk of constant skin contact.
The workers would be suffering from the following:
1. Respiratory diseases: Chronic bronchitis, emphysemea, bronchial asthma etc., due to
constant inhalation of tobacco dust.
- Malignancies of the respiratory tract.
- Laryngitis, Laryngeal tubtircle, etc.
- Increased proneness to tuberculosis.
2.
Skin diseases like contact dermatitis and allergic disorders.
Many problems not considered earlier have been encountered.
(a)
The incidence of dyspeptic systems, hyperacidity and even peptic ulcer may be
quite high.
(b)
The commonest complaint that the workers have is low backache and pain
between the shoulder blades. This problem seems ahnost universal amongst the
tobacco workers. To this, one can add the problem of painful stiffjoints.
Chronic dacryocystitis seems to be more common than encountered elsewhere. It
may be because of chronic inflammation as a result of tobacco induced irritation,
blocking of the nasolachrymal duct, or as a result of physical blockage of the duct
by tobacco dust.
\
(c)
Chronic dacrocystitis seems to be more common than encountered elsewhere. Ir
may be because of chronic inflammation as a resrilt of tobacco induced irritation,
blocking the nasolachrymal duct, or as a result'of physical blockage of the
tobacco dust.
The leaf of tenbumi plant which grows in wild is used in making bidis. Collection of
these leaves from forest provides seasonal employment to hundreds of thousands of
tribal people in central India, but is causing great strain on environment.
Replacement of tobacco tanning to other cash crops is a difficult proposition since net
returns per hectare are three times higher for tobacco as compared to other crops.
Export decline already and so it is wise to give incentive to tobacco industry to other
export oriented consumer products
Revenue generated from tax increases on tobacco be potentially profitable enterprises
so as to compensate for the eventual decline and ultimate depletion of this source at
revenue.
Rise in tobacco related diseases will increase the economic burden on scarce
resources of Health Ministry.
CGHS and ESIC cover up cost will raise.
Higher sickness rate and premature death in smokers is not only a loss to productivity
but to the productive workforce as well.
Considerable part of the income in poor smokers household is consumed to buy bidis
or cigarettes etc. and consequently less money spending on food adds to pre-existing
malnutrition problem.
Smoking habits are responsible for large number of fires in industry and agriculture.
Agriculture and Labour Force
Cultivation is most labour intensive. From raising the nursery to marketing, it is one
continuous chain of operations needing labourers all through.
-
-
It is estimated that labour required per acre for all the operations from ploughing to
marketing is 304 man and woman days.
Apart from farmers, the buyers (companies) need large army of women labourers for
grading and reducing.
Most of the workers are migrant labourers and their problems are:
Contract wages are low - Rs.5/- for 12 hours in!978;
Housing is poor;
Mothers do not get time to breast-feed their babies;
There is absolutely no provisions for medical care, nobody cares for the sick persons,
no wages, Govt, hospitals far away not able to reach in sickness.
Non-working children who accompany the parents do not get any schooling facility,
no evening class for working children, 90% of gang labourers are illiterate.
Continued cultivation of tobacco over the last 50 years with minimal crop rotation has
exhausted the soil and crop pests have become endemic. The problem of soil
exhaustion have been compounded by the indiscriminate felling of trees as a fuel for
curing purposes. As a result, problems of salinity in the soil have increased. The
ecological degradation has tended to push up the costs. It is estimated each kilogram
of tobacco required 100-130 kg of wood for processing. This results in deforestation.
Further use of chemical insecticides, weedicides etc, pollute soil and water. In
addition, the nutritional elements available in the soil are consumed for production of
a harmful product.
Work related diseases of-ffrbacco-pr.oce.ssmg
Economic arguments
The widely held perception that tobacco control will lead to loss of revenues is really a
perception!
-
-
-
Social and health costs of tobacco far outweigh the direct economic benefits that may
be possible because of tobacco cultivation.
It is reasonable to assume that consumers who stop smoking will reallocate their
tobacco expenditure to other goods and services in the economy. Therefore, falling
employment in the tobacco industry will be offset by increases in employment in
other industry. However, in the short-term, for countries which rely heavily on
tobacco exports entail employment losses.
The need for a multilateral fitnd to assist those countries which will bear the highest
adjustment cost needs to be established.
It is worth noting that the cunent 1.1 billion smokers in the world are predicted to
raise to 1.64 billion by 2025, so no tobacco farmers or workers will be out of work in
the foreseeable future.
Argument of workers and income is like arguing that World War II should have
continued to prevent job losses in munition factories making bombs.
Nowhere do they cost the value of human life.
Source:
1.
2.
'Selling and buying Deception in the Tobacco Industry' by Prof. Judith Mackay Director, Asian Consultancy on Tobacco Control, Hong Kong.
The Framework Convention on Tobacco Control - Draft - Document of FCTC.
Health problems of Tobacco Processing workers
Source: 95 Medico Friend Circle Bulletin, November 1983 (Indian Scene) by Dhruv
Mankad.
-
The process of converting raw tobacco into processed zarda or beedi zarda consists of
a number of part-manual, part-mechanical operations of winnowing.
Winnowing and blending causes a lot of fine tobacco dust to fly up into the air of the
closed rooms that pass off as factories. For a newcomer, it is impossible to stand there
even for a half a minute without retching or getting about of coughing and sneezing.
New recruits often feel giddy and vomit while working. The whole process also entails
direct contact of the skin with tobacco. During the blending which is done with the legs,
the heat generated by constant sprinkling of the tobacco zarda with water is a problem
added to the risk of constant skin contact.
The workers would be suffering from the following:
1. Respiratory diseases: Chronic bronchitis, emphysemea, bronchial asthma etc., due to
constant inhalation of tobacco dust.
- Malignancies of the respiratory tract.
- Laryngitis, Laryngeal tuburcle, etc.
- Increased proneness to tuberculosis.
2.
Skin diseases like contact dermatitis and allergic disorders.
Many problems not considered earlier have been encountered.
(a) The incidence of dyspeptic systems, hyperacidity and even peptic ulcer may be
quite high.
(b) The commonest complaint that the workers have is low backache and pain
between the shoulder blades. This problem seems almost universal amongst the
tobacco workers. To this, one can add the problem of painful stiffjoints.
Chronic dacryocystitis seems to be more common than encountered elsewhere. It
may be because of chronic inflammation as a result of tobacco induced irritation,
blocking of the nasolachrymal duct, or as a result of physical blockage of the duct
by tobacco dust.
Tobacco situation
Shocking facts - Alarming statistics
India
India has over 20 companies involved in cigarette production and sales, offering
more than 100 brands in the Indian market.
It is estimated that over 142 million men and 37 million women above 15 years of
age are regular tobacco users.
It is estimated that 4 million children below 15 years are regular tobacco users.
Tobacco is reported to cause about 635,000 deaths annually.
As many as 25% of all persons above the age of 40 in urban India who smoke are
estimated to suffer from chronic bronchitis.
sf The number of avoidable cases of chronic heart disease and chronic obstructive
lung disease has been estimated at 12 million per year.
The incidence of oral cancer caused by tobacco chewing in India is one of the
world’s highest - about one-third of all cancer cases, with 90% of patients being
tobacco chewers.
Source '. World No-Tobacco Day WHO Publication, 31 May 1998.
The Tobacco Situation:
The Regional Perspective
India (population 935 million)
India produces about 576,200 metric tons of tobacco, making it the third largest
producer in the world. It is estimated that 0.4 million people are engaged in the
tobacco production in the country. A total of about 100 billion cigarettes and 850
million bidis are manufactured in India. Tobacco is used in a wide variety of
smokeless forms. The last decades have seen a phenomenal growth in the chewing
tobacco industry.
It is estimated that 65% of men use tobacco. In some parts of India, women are heavy'
consumers ofchewing tobacco and bidis (from 15-65%). Annually, about 635,000
deaths are attributed to tobacco. India has one of the world’s highest incidence of oral
cancer, about 33.3% of all cancers, caused by tobacco. About half of all cancers
among men and a fourth of those among women are tobacco-related. The number of
avoidable tobacco-related cancers of the upper alimentary and respiratory tract,
coronary heart disease and chronic obstructive lung disease has been estimated as 0.2
million per year. Many still-births, low-birth infants, and prenatal mortality have
been reported among female tobacco chewers in India.
There is no national programme on tobacco control but health warnings are
mandatory on packs and there is a ban on tobacco promotion and advertising over
state controlled media. Significant initiatives have included a smoking ban in public
places in the National Capital Territory of Delhi, and on domestic and some
international flights.
Community and youth educational programmes by non
governmental organizations have been successful in many states.
Source : World No-Tobacco Day WHO Publication, 31 May 1998.
Tobacco Control Measures
WHO calls for redoubled efforts
A ten-point programme for successful tobacco control
1. Protection for children from becoming addicted to tobacco.
2. Use of fiscal policies to discourage the use of tobacco, such as
tobacco taxes.
3.
Use of a portion of money raised from tobacco taxes to finance
other tobacco control and health promotion measures.
4.
Health promotion, health education and smoking cessation
programmes.
5.
Protection from involuntary exposure to environmental tobacco
smoke (ETS).
6.
Elimination of socio-economic, behavioural and other incentives
which maintain and promote the use of tobacco.
7.
Elimination of direct and indirect tobacco advertising, promotion
and sponsorship.
8.
Controls on tobacco products; prominent health warnings on
tobacco products I advertisements; limits on and mandatory
reporting of toxic constituents.
9.
Promotion of economic alternatives to tobacco
manufacturing.
10.
Effective management, monitoring and evaluation of tobacco
programmes.
Source: World No-Tobacco Day WHO Publication, 31 May
1998.
growing /
Pakistan
http://www.cdc.gov/nccdphp/osh/who/pakistan.htm
Tobacco or Health: A Global Status Report | Country Profiles by Region | Eastern Mediterranean
Pakistan
Socio-demographic characteristics
Population
Total
•>
1990
1995
121,933,000
140,497,000
Adult(i5+)■"■■"■■■■■■■■■•[ ................ 68,130/100................... !............. 78^75,000........
% Urban
32.0
% Rural
...................... 68.0
2025
284,827,000
1................ 195,582,000
34.7
56.7
65.3.......................
433
Health Status
Life expectancy at birth, 1990-95: 60.6 (males), 62.6 (females)
Infant mortality rate in 1990-95 : 91 per 1,000 live births
Socio-Economic Situation
GNP per capita (USS), 1991: 400, Real GDP per capita (PPPS), 1991: 1,970
Average distribution oflabourforce by sector, 1990 - 92 : Agriculture 47%; Industry 20%; Services 33%
Adult literacy rate (%), 1992 : Total 36; Male 49; Female 22
Tobacco production, trade and industry
Agriculture In 1992, 54,626 hectares were harvested for tobacco (0.2% of arable land), slightly more than in 1985. Small quantities of
tobacco are also grown for personal own use and for sale in local markets.
Production and trade Several types of tobacco are grown, including dark tobaccos for bidis, hookah smoking, snuff, and chewing, with
around 50% of the tobacco grown used for cigarette production, Although there has been some variation, it appears that production of
unmanufactured tobacco is increasing in Pakistan; 108,000 tonnes were produced in 1992 (1.3% of the world total), up from 68,000 tonnes in
1990. An annual average 6f317®0i million cigarettes were produced in die period 1990-92. This increased to 36,644 million in 1994. Export
of cigarettes has been less than 5% of production during the early 1990s, with 500 million cigarettes exported in 1994. Export earning of
cigarettes and tobacco leaves amounted to USS 4.9 million in 1993 (less than 0.1 % of total exports). Legal cigarette imports are negligible.
During the early 1990s, when foreign imports were illegal, a wide selection of foreign brands were reportedly sold openly.
Industry
There were 33 cigarette companies in 1993 (3 of which were major companies, affiliated with tobacco multinationals), operating
35 manufacturing plants. There are many small organizations producing tobacco products on a veiy small scale. In 1990, tobacco revenue
constituted 0.7% of GNP.
Tobacco consumption
During the past 20 years, adult per capita consumption of manufactured cigarettes has fluctuated between 650 and 700 cigarettes per annum;
recorded tobacco consumption per adult has been about 1200g. However, two-thirds of the population live in rural areas where tobacco
consumption is mainly in non-cigarette forms. Therefore, it is likely that more tobacco is used for smoking in'bidis and the hookah as well as
for chewing and snuffing than is smoked as cigarettes.
1 of 2
5/4/99 12:13 )
Pakistan
http://www.cdc.g0v/nccdphp/0shAvh0/pakistan.h
Tar/Nicotine/Filters In 1992, tar content was between 16.3- 66 mg, while nicotine was between 1.2-14.2 mg for cigarettes and bidis sold
in Pakistan In 1994, 99% of the manufactured cigarettes were’filter-tippei’
Prevalence
Studies in Karachi found that tobacco is smoked as cigarettes, in bidis and in the hookah, chewed in a variety of forms and snuffed. Many
people practice mixed habits. According to a 1980 survey among 1600 adults age 20 and over in Karachi, 27.4% of males smoked, as did
4.4% of females, compared to 1972 prevalence of 30.3%(M) and 2.2% (F). In 1980, an additional 33% of men and 44% of women chewed
pan, or pan and tobacco, or smoked and chewed. Among women, pan and tobacco chewing were the main habits.
Tobacco control measures
Control on tobacco products
The warning "Smoking is injurious to health - Ministry of Health" must be printed in English and Urdu
on all tobacco packaging The same warning must appear on all advertisements in the press and on television. There are no stipulations on tar
and nicotine yields of cigarettes. Television advertising of tobacco products is prohibited before 10 p.m. and must not exaggerate the pleasures
of smoking. Taxation has passed through several stages since 1980, originally it was 54% of the retail price, then tax banding was introduced
in 1987 with luxury cigarettes carrying a tax of 73%.Jn 1988, all cigarettes were taxed at 73%. Additionally, a sales tax of 12.5% is levied on
all goods, including cigarettes. Other forms of smoking are not taxed. ” ' '
•,
0S'-/L
Protection for non-smokers Smoking is banned in medical colleges and teaching hospitals.
Health Education The government has instituted a long-runningjnti tobacco campaign via television and film advertisemen&In recent
years it has stepped up its campaigns to increase the public awareness to the lung cancer risks associated with smoking. There are two
anti-smoking groups: the Hamdard Foundation and the Cancer Association, however due to budgets constraints, their activities are limited.
Previous Country | Eastern Mediterranean | Next Country
of2
5/4/99 12:14 PM
http://www-usa6.cricket.org/link_t...PAK_BREACH_LOGO_LAW_04JAN1997.htm.
Pakistan in breach of tobacco law
The Electronic Telegraph carries daily news
and opinion from the UK and around the world.
adqyraph
Pakistan in breach of tobacco law
By Nelson Clare in Brisbane
4 January 1997
PAKISTAN batsmen ignored an Australian government order to remove tobacco sponsor's logos when
they faced the West Indies in a day-night match here yesterday. The players took to the crease wielding
bats with the slogans, even though they are breaching tobacco-advertising laws.
Pakistan team manager Yawar Saeed said the batsmen were awaiting orders from their board before
removing the logos from their bats. "I'm not the policy-maker so I'll have to wait until I get the new
instructions," he said.
The Australian government have given Pakistan until Tuesday to remove the Wills Kings cigarette
company slogan from their bats.
The Australian Cricket Board face a #32,000 fine unless Pakistan remove the advertising but Saeed said
he did not know whether the Pakistan board would comply with the order. "If we knew that we were
violating advertising laws, we would not do it. We don't violate rules of our own country or any other
country," he said.
Source: The Electronic Telegraph
Editorial comments can be sent to The Electronic Telegraph at et@telegraph.co.uk
Contributed by Criclnfo Management
Date-stamped : 25 Feb 1998 - 14:41
| Global Navigation??
1 of 1
5/4/99 12:06 PM
http://xiber.com/dawn/news/970607/kse/tobacco.htir
DAWN - the Internet Edition, Pakistan
DAWN
the
INTERNET
TOBACCO
Rates of 06 June, 1997
| Company
|
Open | |
Close
Change! |
High 1
| Lakson Tobacco
j
40.001 |
40.00 j
j
40.00|
|Pak Tobacco
|
28.25 |
28.251
||Premier Tob.
||Sarhad Cig.*
|
40.00 |
40.001
|
97.40] |
97.401
|| Souvenir Tob.
|
9.75 |
9.751
|
Low
Volume;
40.00]
1... . ’ 1____ d
1___ d'1..... .-J
1.
. d
1
'I 1____ d
1_______ il
1___ d1
,d
1
.:
1______ d
NOTE: All rates in Rupees. Unless indicated otherwise, each share is valued at Rs.10.
* Shares valued at Rs.5, ** Shares valued at Rs.50, *** Shares valued at Rs.l00
ITSE Front Page
| Auto & Allied
I Bonds
Cables & Electric
. Cement
Menu for June 07, 1997
© DAWN Group of Newspapers, 1997
1 of 1
5/4/99 12:08 PM
Annual Revenues from Tobacco Taxes...ted Countries, by percent of total
http://www.cctc.ca/ncth/stats/econ/econ-global-taxes.html
Annual Revenues from Tobacco Taxes,
Selected Countries, by percent of total
Country
Percent
of total
tax revenue
U.S. Dollars
(millions)
I
214
j
Sri Lanka
10.6
China
9.0
8,600
Japan
8.3
24,000
India
5.9
1,700
|
Indonesia
5.5
1,500
1
Ghana
3.8
30
Pakistan
3.8
340
Venezuela
3.7
320
Chile
3.6
350
Australia
2.0
2,500
Turkey
1.9
1,000
United States
1.5
12,700
Lithuania
0.5
5
South Africa
0.1
450
j
|
Source: PrabhatJha, World Bank, (Unpublished data, 1997);
as cited in "The Nicotine Cartel, World Watch, July/August, 1997, pg. 19-27.
(Statistics - Tobacco Economics ]
1 of 1
5/4/99 12:09 PM
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01/17/99 - San Francisco set to Fine Bar Patrons for Smoking
01/14/99 - Long-term Smoking Linked to Pancreatic Cancer
01/10/99 - China Issues Punishment for Embezzlement
01/07/99 - Children's Behavior Affected by Mother's Smoking
01/03/99 - Great Britain Releases Plan to Reduce Smoking
12/31/98 - Minnesota Coalition Campaigns for Tobacco Money
12/27/98 - Tobacco Billboards set to Come Down
12/24/98 - Florida's Anti-Smoking Campaign Raises Awareness
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02/28.99 - Passive Smoke Linked to Breast Cancer Risk
02'24 '99 - Phillip Morris to close Louisville Plant
02/21/99 - Big Tobacco Secretly Pushed for Tort Reform
02/17/99 - Cigarette Toxic Substances Revealed
02/14/99 - Research Looks at Low Tar Labeling
02/11/99 - Carcinogens Stay in Body After Smoker Quits
02/07/99 - Warrant Withdrawn by the Queen
02/03/99 - Phillip Morris and 4-H Team Up
01/30/99 - Traces of Tobacco Found in Fetal Fluids
01/27/99 - Gene Found to Influence who will Smoke
01/24/99- Farmers are Set to Receive Aid from Tobacco Companies
Headlines...
03/22/99: Butts, nicotine products can sicken children, pets
A recent article published in the Cincinnati Enquirer indicates that cigarette butts are not only
unsightly but also toxic to toddlers and pets. The most normal reaction is vomiting, says Dr.
Karen Krummen. manager of the Cincinnati Drug & Poison Information Center. "If a large
enough amount is ingested, initially you'd see stimulation, which includes being irritable and
jerking of limbs. It's possible the heart rate and blood pressure could go up. Seizures are unlikely
with cigarettes, but if somebody had enough, it would be possible." According to Dr. Krummen,
there is a 90% chance that if a child has three butts or more, it may cause symptoms which are at
times severe enough to take the child to a hospital! "Be aware that nicotine is in the cigarette and
cigarette butt, which people don't think about. Those things need to be kept out of reach of
children." Not to mention cats and dogs, whose symptoms can mimic those of small children.
[top of page]
03/19/99 : Women Smoking Menthol Cigarettes Have Greater Nicotine Exposure
Results from a recent study conducted by Ahijevych, a researcher with Ohio State's
Comprehensive Cancer Center, indicate that women who smoke menthol cigarettes may be more
likely to inhale deeper with each drag on their cigarette and potentially take in more nicotine than
do smokers of non-menthol cigarettes. The study also showed that users of menthol cigarettes
tend to smoke their first cigarette of the day sooner than do users of non-menthol cigarettes. The
sooner a person smokes his or her first cigarette of the day, the more nicotine dependent the
person is thought to be. "These results should caution smokers who believe that menthol
cigarettes are in some way healthier or less irritating than non-menthol brands. There is no safe
cigarette," said Karen Ahijevych, associate professor of nursing at Ohio State University.
[topof page]
03/14/99 - Make Violence Linked to Smoking while Pregnant
A study just published said that males bom to women who smoke during pregnancy run a risk of
violent and criminal behavior that lasts well into adulthood. The researchers at Emory University
in Atlanta stated that the finding was consistent with studies conducted earlier that linked
prenatal smoking by women to lawbreaking as well as impulsive behavior and attention deficit
behavior. Although these results are similar the researchers said that their study, which was
based on the arrest histories up to age 34 of 4,169 males born between 1959 and 1961 in
Denmark, is the first to show' that the impact lasted beyond adolescents into adulthood. "Our
results support the hypothesis that the maternal smoking during pregnancy is related to increased
rates of crime in adult offspring," the study said. The reasoning behind the results might be
damage done by smoking to the central nervous system of the fetus, researchers said.
(toBof page]
03/11/99 - "Truth" Campaign in Jeopardy
Florida's groundbreaking pilot program to stop teen smoking is in trouble of getting canceled,
and not because of tobacco lobbyists. Although the tobacco industry' contributed $425,000 into
the Florida political campaigns last fall they say they are not the ones who want to kill the
"Truth" campaign. "We are watching from the sidelines," said John French, lobbyist for Phillip
Morris. "Heck we’re way out beyond the stadium on the other side of the railroad tracks, we’re so
far away from this." The main reason the campaign is in jeopardy is because the Republican
leaders are divided on whether or not the campaign is working. Supporters, who insist it is
working, are hoping the Senate will allocate the $61.5 million recommended by Gov. Bush. The
money for the campaign comes from the state's $13.2 billion settlement with the tobacco industry
reached in 1997.
[top of page]
03/07/99 - FTC Wants Disclaimer on "No Bull' Ads
The Federal Trade Commission, detecting confusion from consumers, is making RJ Reynolds
Tobacco Co. put a disclaimer on their No Bull' advertisements. It seems that many people were
thinking that because they advertise no additives in their cigarettes that the cigarettes were safer
for them. RJR spokeswoman said that the disclaimer would read "No additives in our tobacco
does not mean a safer cigarette." The commission conducted its own research and concluded that
people were indeed confused by the advertisements, said Jodie Bernstein, director of the agency's
Bureau on Consumer Protection. Carole Crosslin, spokeswoman for RJR, commented on the
decision saying "We disagree with the FTC's premise, and our own research demonstrated that
smokers do not interpret the phrases to mean that Winston is safe or safer than other cigarettes."
The order from the FTC will go into effect in May after a comment period, said Bernstein.
[top.ofpage]
03/03/99 - International policy conference on Children and Tobacco Announced
The first-ever International Policy Conference on Children and Tobacco was announced to be
held from March 17 to 19 at the Organization of American States in Washington, DC. This
monumental conference, which is being sponsored by U.S. Sens. Dick Durbin, Ron Wyden, and
Susan Collins, will bring together legislators, parliamentarians, and other political leaders
representing more than 30 countries and 75 percent of the world's population. The main issue of
the conference is going to be to identify key policies that nations throughout the world can
pursue to reduce tobacco use by children. The sponsors of the event include American Cancer
Society, The American Public Health Association, the Campaign for Tobacco-Free Kids and the
Robert Wood Johnson Foundation. As far as international participants World Health
Organization, UNICEF and the Organization of American States will all be in attendance.
[top of pa gel
02/28/99 -Passive Smoke Linked to Breast Cancer Risk
US researchers are reporting that exposure to passive smoke may trigger cell changes that lead to
breast cancer. According to the study, which was published in the American Journal of
Epidemiology, the risk of the cell changes is highest in those exposed to second hand smoke
during childhood, before the breast tissue matures. "Our results show that passive exposure to
cigarette smoke increases risk, and many earlier studies didn't take that into account, which
dilutes their results," said lead author Dr. Timothy Lash. "If you compare a group of women
smokers to a group of nonsmokers and don't exclude women exposed to passive smoke, then the
differential in risk between the two groups is diminished," he said. The main theory behind Dr.
lash's approach is that breast tissue is vulnerable to genetic damage when the cells are dividing,
which occurs at puberty and again during pregnancy.
[top of page]
02/24/99 - Phillip Morris to close Louisville Plant
Phillip Morris announced that it would be closing its Louisville plant by the end of 2000,
elimination 1,400 jobs. "It's all about capacity," said Phillip Morris spokesman Rusty Cheuvront.
"It’s going to allow the company to properly align production with demand." The Louisville plant
has been in operation since 1944, and is the state's last major cigarette manufacturing facility.
Workers at the plant earned and average of $21.50 per hour, and the loss of the 1,400 jobs will
cost the local economy close to $63 million in annual payroll. "To be frank this announcement
mean a loss ofjobs that will really hurt," said Louisville mayor Dave Armstrong. Gov. Paul
Patton said that Phillip Morris had told him two years ago that closing the plant was an option,
but the announcement came as a surprise to him. Joe Phelps, secretary-treasurer of the tobacco
workers union, said the closing will come in phases with workers being laid off in July 1999,
April 2000 and July 2000 and the final round in December 2000.
[top of page]
02/21/99 - Big Tobacco Secretly Pushed for Tort Reform
In 1995 Big Tobacco waged a secret effort through front groups to change civil tort laws to make
Minnesota's upcoming suit against the industry harder to prosecute. The effort, according to once
secret documents, included tobacco executives privately enlisting a diverse group of people and
associations to start an aggressive agenda of changing the state's tort laws. Part of the cigarette
manufacturer's plan was to fund their effort through groups with no obvious ties to the industry.
These efforts, mostly unsuccessful, were part of a multi-million dollar national campaign by the
industry in which the tobacco industry would remain in the background while pushing reform
through other organizations. "One of the things that is notable is that the tobacco industry is not
the out-front industry on tort reform, but they've been a major funder and strategist of the
campaign in Congress and maybe even more so in the state campaigns," said Robert Weissman,
co-director of Essential Action, a corporate accountability group funded by Ralph Nader.
[top of page]
02/17/99 - Cigarette Toxic Substances Revealed
The Minnesota Department of Health reported that a survey of more than 700 brands of
cigarettes, cigars, pipe tobacco and snuff shows that they may contain one or all of the toxic
substances arsenic, ammonia, cadmium, lead, or formaldehyde. This report introduces the first
time that the tobacco industry has admitted publicly that their products contain such substances
commonly identified as poisons or cancer causing agents. The report comes in response to a
deadline this week for a new Minnesota law that requires tobacco firms to report annually, in
order to continue selling their products in the state, to the health commissioner whether their
products contain "detectable levels" of ammonia or ammonia compounds, arsenic, cadmium,
formaldehyde, and lead. "I think we have to step back now and look at what the information is
telling us," said Janet Olstad, assistant director of the Family Health Division. "I think it helps
confirm for the public's mind that the substances are contained in tobacco products."
[topofpage]
02/14/99 - Research Looks at Low Tar Labeling
New research indicates that the tobacco industry mislead people about the tar and nicotine that
can be inhaled from "light" cigarettes. The study found that some cigarettes without filters, sold
as "full flavor," have less than half the nicotine content of brands sold as "ultra light" that were
fitted with filters. In addition, the researchers found that smokers inhibit filters that are the main
device for reducing tar and nicotine inhalation by unconsciously blocking the vent holes. The
study included 92 brands of cigarettes sold in Britain, the United States and Canada and was
conducted by researchers from University College London, St. George's Hospital Medical
School, London, and Penn State University, Pennsylvania. The study indicated that the tobacco
company’s claims that their cigarettes were low tar came from tests that were conducted with
smoking machines, which did not replicate how people smoke.
[top of page]
02/11/99 - Carcinogens Stay in Body After Smoker Quits
Researcher at Minnesota Cancer Center have found that cancer causing substances found only in
tobacco remain in the body at significant levels for up to six weeks after people stop smoking.
Even though the discover}' shows that carcinogens remain after quitting it also shows that they
will eventually disappear, which is good news for ex-smokers. "We have very limited data on
how the human body takes up and disposes of carcinogens," said Stephen Hecht, the study's lead
investigator. "It will give us a better understanding of what is happening and give us new ideas
on how to get rid of it or prevent its action." In the study researchers collected urine samples
from 27 participants before they stopped smoking and at one, three, six, 14, and 18 weeks
afterward. The urine was tested for two substances NNAL, and NNAL-Gluc, which the body
makes from a carcinogen found in tobacco. Six weeks after quitting, the two substances had
dropped to 7.6% of the original levels. Levels continued to drop with additional tests; 5% after
10 weeks; 3% after 14 weeks; and 2% after 18 weeks.
[top of page]
02/07/99 - Warrant Withdrawn by the Queen
After 122 years the Queen of England has announced that she will withdraw her royal warrant
from the manufacturer of Benson and Hedges cigarettes. Anti-smoking activists have welcomed
this gesture from the queen after many years of complaining the she was endorsing a product that
took the life of her father, grandfather and great grandfather. Some say that the Prince of Wales,
who is known to be a huge opponent of smoking, had a lot of influence on his mother to
withdraw her warrant. By removing her warrant Gallaher, maker of Benson and Hedges and Silk
Cut brands in Britain, will have to eliminate the Queen's coat of arms from their packages by the
end of the year. "Most of the royal family do not smoke and changing attitudes to smoking have
affected the demand," said Ana Krysztofiak, secretary to the royal household's tradesmen's
warrants committee.
[topofpagej
02/03/99 - Phillip Morris and 4-H Team Up
Officials from the National 4-H council have announced that Phillip Morris has committed $4.3
million over two years to support a program 4-H is developing to discourage underage smoking.
Spokeswoman Mary Camovale said the 4-H deal is part of the $100 million Phillip Morris
announced it would spend on advertising, education, and community based programs to
discourage kids from smoking. Richard Sauer, president of the National 4-H council said 4-H
officials decided to develop a smoking prevention program after youngsters identified smoking
as a key concern. Sauer also said that Phillip Morris was contacted about supporting the effort as
the suggestion of a council member who works for Kraft Foods. "We have complete
independence. They are not going to tell us how to do it or what to do," said Sauer. As of right
now Phillip Morris is the only corporate backer if the 4-H program. Some anti-smoking activists
were a little skeptical of the arrangement. "We are concerned that by partnering with reputable
organizations like the 4-H, Phillip Morris will gain a degree of legitimacy that will enable it to
continue its way; addicting millions of kids to tobacco as it has done for decades," said William
Novell! of Tobacco Free Kids.
[top of page]
01/30/99 - Traces of Tobacco Found in Fetal Fluids
A British study has found that a nicotine metabolite, cotinine, accumulates in the fluid
surrounding a fetus as early as 7 weeks' gestation in both women who smoke and those who are
exposed to smoke at work or in their homes. The study itself involved 85 women who had
requested abortions between 7 and 17 weeks' gestation. Forty of these women were nonsmokers
with little or no exposure to smoke; nineteen did not smoke but were exposed to smoke at home
or work; and 26 of the women smoked between 5 and 25 cigarettes per day. Researchers reported
that levels of cotinine in the fetal serum and amniotic fluid of non-smokers exposed to passive
smoke reached 30% to 44% of the corresponding levels in active smokers. Among the 40 that
had little to no exposure to smoke only 5 were found have levels of cotinine in their urine or
blood above the detection limit. "Our results further support anti-smoking advice, suggesting that
women should not only stop cigarette consumption before conception, but also avoid
environmental tobacco smoke exposure during pregnancy," wrote the researchers in the Journal
of Obstetrics and Gynecology.
[top of page]
01/27/99 - Gene Found to Influence who will Smoke
New research has found that a certain gene can determine the difference as to whether or not
someone will start smoking and then become addicted. In two articles appearing in American
Psychological Association's journal of Health Psychology, researchers wrote that people carrying
a particular version of the dopamine transporter gene are less likely to begin smoking before age
16 and are more likely to be able to quit smoking if they start. In the study of289 smokers and
233 non-smokers, psychologist Caryn Lerman, Ph.D, of the Georgetown University Medical
Center, found that individuals with an SLC6A3-9 genotype were less likely to be smokers than
individuals without that gene. "We found that individuals who have the SLC6A3-9 gene were
one and a half times more likely to have quit smoking than individuals lacking the gene," said
Dr. Dean Hamer, of the National Cancer Institute.
[top of page]
01/24/99- Farmers are Set to Receive Aid from Tobacco Companies
The Governors from five tobacco growing states announced this week that they finally struck a
deal with the largest U.S. cigarette makers to help farmers struggling with lost income due to the
recent national tobacco settlement. This agreement, although still tentative, would establish a
S5.15 billion trust fund to be divided among tobacco states over 12 years. At first RL Reynolds
held out on the deal saying that they preferred their plan of buying more domestic leaf as the best
way to help the farmers. The other companies however said that they would not agree to any deal
unless all four major companies were on board. The financially strapped Reynolds finally agreed
to the plan when the initial payments were lowered and the time frame was lengthened. "This
took some very hard talking ... We hope it will come very close to compensating," said North
Carolina Governor Jim Hunt. The other states involved in the deal include South Carolina,
Virginia, Georgia, and Kentucky.
[top of page]
Headlines...
01/21/99 - Canada Drafts Anti-Tobacco Plan
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Abstract - Tobacco litigation news, including Liggett and other tobacco-related issues. Cash in
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Provides information about the latest lawsuits and class action suits that are popping up all over
the country.
03/22/99: Butts, nicotine products can sicken children, pets
03/19/99 : Women Smoking Menthol Cigarettes Have Greater Nicotine Exposure
03/14/99 - Make Violence Linked to Smoking While Pregnant
03/11/99 - "Truth" Campaign in Jeopardy
03/07/99 - FTC Wants Disclaimer on *No Bull' Ads
03/03/99 - International policy conference on Children and Tobacco Announced
Stanton Glantz interview
http://www2. pbs.org/wgbh/pages/frontline/smoke/interviews/glant2
home
the paper trail
interviews
rearftegs
Stanton Glantz
tahaecs on
the web
teetihack
Professor of medicine at the University of
California, San Francisco and anti-tobacco
researcher.
Q: TELL ME FIRST OF ALL WHAT THE
IMPORTANCE OF BROWN & WILLIAMSON'S
DOCUMENTS ARE?
Glantz: The Brown & Williamson documents give the
public the first really clear and comprehensive view
inside the tobacco industry during the period in which
the evidence that nicotine was addictive became
available, that smoking caused cancer, heart disease, and
other diseases, and shows us that at least this tobacco
company and its multinational parent, British American
Tobacco, fully understood that nicotine was addictive,
fully understood that smoking caused cancer and other
diseases, and was actively working to try and reduce
those dangers. At the same time that they had a massive
and high quality scientific enterprise underway in secret,
their public posture was that the case wasn't proven, that
there was nothing wrong with smoking, that it was
controversial and the documents show how they
developed a bevy of legal strategies and public relations
strategies to keep this information away from the public,
away from the courts, away from the government, to
keep people smoking.
And other documents have come to light since then. For
instance, Congressman Henry Waxman got hold of a
bunch of documents from Philip Morris which he put
into the public record. I've read those documents, and
they're not nearly as complete and comprehensive as
what we have from Brown &Williamson, but the
important thing is that they are completely consistent
with the kinds of things we see in the Brown
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&Wilhamson documents. And so the industry, for 40 or
50 years has succeeded in building an incredible wall
between itself and the public, and running a completely
separate reality inside and outside, and I think many
millions of people have died as a result. And that, I
think, is going to be much harder for them to continue
getting away with when the public has a chance to look
at these things and understand them. It's going to
generate a tremendous amount of public pressure. It
think it's going to make it much easier for the courts to
deal with them, for the federal government to deal with
them. And the kinds of subterfuges and ridiculous
statements that they've gotten away with for years, are
just going to be much harder to do.
Q; JOURNALISTICALLY HOW WOULD YOU
RATE THIS STORY?
Glantz: I was really looking at it more as a scientist than
a campaigner really. I've obviously been involved in
tobacco control for years because when you know what
I know about the science, you have no choice in the
matter. I mean there's an ethical imperative on you. But
really when these documents arrived on my doorstep,
the tilings that sucked me into them was not their
potential political or legal import, it was the documents
as history, the documents as science. It as just an
unbelievable find. As a professor, it would be like an
archaeologist finding a new tomb in Egypt or something.
And in fact, historically, I hadn't really been that
interested in the issues these documents deal with. My
work had been on passive smoking, and tobacco policy
work, not on nicotine pharmacology and cancer. And I'd
actual .
... . the documents in the New York
Tinies a week or so before I got them. Phil Hilts had run
a story. But, and you know, and I thought it was very
interesting, but I...was very interesting, and I went about
my business. But when the documents first arrived and I
realized what they were, my initial reaction was, well,
these are very interesting, and I'll make them available
and somebody can deal with them. But spending 20
minutes looking at them, you just get sucked into the
story that they tell. I mean it's an amazing, amazing story
of what was going on inside these cigarette companies
during this crucial period. I mean I dropped what I was
doing, or piled this on top of the other things I was
doing, because it was such a compelling story. That's not
exactly answering your question.
Now to answer your question, I think that the thing this
shows to journalists is how they've been duped all these
years, you know. And it outlines the tremendously
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effective public relations campaign that the industry has
used, and how cleverly they've manipulated the press in
terms of keeping the public confused about the actual
dangers of tobacco use. They've had a tremendously
sophisticated public relations campaign underway,
which has not only used public relations firms and all
those standard things, but made use of high level
executives, the...lobby high level executives of media
outlets, which is involved in the sub rosa funding of
scientists, who were so called independent experts, that
the media could then be referred to. It involved hiring
people or underwriting the costs of writing articles
critical of the Surgeon General and other anti-tobacco
forces. And that continues to this day.
Q: IN A SENSE YOU FACED THE SAME
PREDICAMENT AS ACTUALLY SOME OF THE
NETWORKS FACE, WHICH WAS WHETHER
TO PUBLISH THIS MATERIAL. AND WHAT
WENT THROUGH YOUR MIND?
Glantz: Yes. There was never any question about
publishing it with me. I mean that's what you do at
university. And it was very clear to me very shortly after
I started looking at these documents that we were going
to write something about them. I didn't have a clue that
we were going to write as much as we ended up writing.
I thought we'd write a paper and send it to a scientific
journal, which is what you're supposed to do when you
are a professor. And as I got...assembled the research
team and got into it...it was very clear that this was
turning into a very major project, so then we thought we
were going to write a couple of papers, and then we
ended up writing a book and 5 papers, which were
published in JAMA which took a tremendous amount of
guts on their part. And my hope had been that, as it is in
anything we do, whether it's this or the research I do in
my laboratory on how hearts work, was that the quality
of the work we could produce would overcome the fear
of the tobacco industry, and I think when you are
dealing with the academic community, there is a very
strong commitment in that community to the truth, and
that commitment, I think, carried the day in helping to
get these papers published, because of the commitment
to have information out there. I mean, that's one of the
core values of the university. And I...when these
documents arrived...it was very clear to me that sooner
or later the shit was going to hit the fan. The tobacco
companies, the kind of seige warfare that they run
against everybody, it was just a matter of time before
they started doing that against the university and against
me. And I went down and informed the attorney at U.C.
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that these had arrived, and that I intended to use them as
research materials. And I'd been told, I'm not to talk
about exactly what was said, but the university was
obviously very' supportive, and have not wavered, and
it’s been from the highest level down. And the chancellor
of this campus, people in the General Counsel's office,
have just been very strong and very supportive.
And I have to say there were periods when Brown &
Williamson came in and started threatening the library,
and it was obvious, threatening to sue the university, and
I figured this is where the rubber hits the road. And I
remember being called down to a meeting with people
from the General Counsel's office, Chris Patti and
others, and I remember riding down the elevator
thinking, this is the time to walk the plank, this is my
little adventure, it's going to hit a wall. That's not at all
what I was told. What I was told was, this is what the
University of California is for. The university is here to
bring the truth to people, to write about things, to do
scholarly research, and we'll defend you. And they did,
and they did spectacularly well. And I think the lesson
for that is that these guys, the tobacco companies, can
be beaten, they can be stood up to if you are willing to
do it. And the university did a superb job, and I think the
contrast between the behaviour of the University of
California as a public institution, standing up to the
tobacco companies, at a time when our Governor's
campaign for President was being run by Philip Morris,
Craig Fuller, the Vice-President of Philip Morris was
running his govematorial campaign, and he's been
destroying the voter mandate for tobacco education
programs, when our legislature has been dominated by
tobacco interests, when the big networks were caving in
to them, when a lot of other publications—newspapers,
magazines—would rather not do tobacco stories, to not
be bothered, really makes me proud to be affiliated with
this institution. Because not only did they do the right
thing, but they did it for the right reasons. They did it for
the right reasons, they did it because of a commitment to
the public interest and to the truth.
I didn't mean to be ranting and raving along. I mean I
feel quite strongly.
Q: SO LET’S COMPARE WHAT HAPPENED TO
WHAT HAPPENED WITH ABC AND CBS.
Glantz: Well, I think the situations at ABC and CBS
were a bit different. I think at ABC, I mean, they were
similar and they were different. I mean from my point of
view they were both driven by basic greed and
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cowardice. The situation at ABC was they did what 1
thought was a superb piece of journalism. They took a
fairly complicated issue and explained it in very clear
and concise terms to the public. The tobacco industry
did then what they do best. They seized on one little
word, spiking, which when you talk about reconstituted
tobacco, I don't even know what the word spiking
means. When you're talking about a manufactured
product, it is like saying, this mouse is spiked with
plastic. I mean a cigarette is a manufactured product,
you know. There is no such thing as a natural cigarette
that you go buy from the tobacco company. It's a very
carefully engineered product where every' aspect of that
cigarette is controlled to very' high standards, quality
control standards. And so when Philip Morris was
complaining about the word 'spiking11 mean it's crazy.
My initial reaction to the suit against ABC was that it
was purely a public relations device. For one thing,
under Kentucky law, pardon me, or under Virginia Law
they couldn't sue them for 10 billion dollars. There were
very severe limitations on the actual exposure that the
company had. So it was all just hot air. And ABC's
initial response was a very very aggressive and well
mounted defence. I was actually contacted by their
lawyers to see if I would be willing to serve as an
expert, and I just didn't have time. I was buried in the
Brown & Williamson documents, and also working with
O.S.LA. at the time, and also I didn't want to sign a
non-disclosure agreement. I felt that that was something
I just won't do. And, but, it was clear to me from talking
to the people I talked to and what they were allowed to
tell me, that the lawyers and the technical experts they
had brought in were mounting this superb defence. The
other thing that was very true from the material that
Congressman Waxman had put into the public record
was that all the same kinds of things that were going on
in the Brown & Williamson, appeared to be going on
inside Philip Morris. If anything Philip Morris had more
sophisticated work going on than Brown & Williamson
did. And my feeling was that Philip Morris would never
actually let the case go to trial, because I think that for
the kind of materials that one can reasonably expect to
see introduced into the public record at the trial, that
would have been a legal disaster for Philip Morris, it
would have had huge implications in the products
liability' actions that are pending, and it would have
provided a gold mine of material for the Food and Drug
Administration. As the case proceeded, Philip Morris
was actually dropping a lot of its own complaints, and
when ABC management capitulated, basically to grease
a merger, was the way it looks to me, I think they did a
huge public disservice, and they did a huge disservice to
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the journalists working for them, who I think, had put
together an absolute first rate piece of journalism, and a
very important piece ofjournalism.
Q: WHAT ABOUT CBS? WHAT'S YOUR VIEW
ON THAT?
Glantz: The situation at CBS is a bit different, and in
some ways, even worse, because there they weren’t even
sued. Basically it looks to me like there was a big
merger or buy-out going on. Key CBS management
were standing to make big bonuses if that buy-out went
through by a certain date. And they just didn't want to be
bothered. And that's part of what the tobacco companies
do. If you deal with them, you know they are going to
hassle you. And you know they're going to do all kinds
of things just to make your life miserable, and they didn't
want to be bothered. And so they didn't even wait to be
sued. They...here we had the media making up theories
under which they can be sued for suppressing or not
suppressing information. It was just outrageous. But I
think it's very much to the credit of the producers and
the other people at 60 Minutes that that piece did get on
the air, and the subsequent stories that ran recently with
Jeff Wigand, the two part piece, which I thought were
very well done, and that, I think showed, that within
CBS the journalists were able to ultimately force the
corporate interests to let the story run. And that, I think,
a lot of people inside the news division at CBS deserve
a lot of credit for pulling that off.
One other thing about this, I think in the end though, the
bullying tactics of the tobacco industry' against the media
are beginning to backfire, because after ABC caved in,
and after CBS pulled the original story, I started getting
calls from major reporters saying, what can you tell us.
My editors want to do a tobacco story to show that
we're not like ABC. We're not like CBS. I mean here,
you're doing the story. And I think in the short run it was
very chilling In the intermediate term, it has actually
increased the level of interest in tobacco. What the long
run implications are, you know, time will tell.
Hext
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A c cording to WHO estimates, there are currently 3.5
million deaths a year from tobacco, a figure expected to rise
to about 10 million by 2030. 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. 70% of those deaths will occur in developing
countries. The sheer scale of tobacco's impact on global
disease burden, and particularly what is likely to happen
without appropriate intervention in developing countries, is
often not fully appreciated. The extremely negative impact of
tobacco on health now and in the future is the primary reason
for giving explicit and strong support to tobacco control on a
world-wide basis.
I n response to these concerns the Director-General, Dr Gro
Harlem Brundtland, established a Cabinet project, the
Tobacco Free Initiative (TFl), in July 1998 to coordinate an
improved global strategic response to tobacco as an
important public health issue. The long-term mission of global
tobacco control, which will take several decades to achieve, is
to reduce smoking prevalence and tobacco consumption in all
countries and among all groups, and thereby reduce the
burden of disease caused by tobacco. In support of this
mission, the goals of the Tobacco Free Initiative are to:
•
•
Galvanize global support for evidence-based tobacco
control policies and actions
Build new, and strengthen existing partnerships for
action
•
Heighten awareness of the need to address tobacco
at all levels of society
•
Accelerate national, regional and global strategy
implementation
a
Commission policy research to support rapid,
sustained and innovative actions
•
Mobilize resources to support required actions
I n achieving these goals, the Tobacco Free Initiative will
build strong internal and external partnerships "with a
purpose" with each WHO Cluster and Regional and Country
Offices, and with a range of organizations and institutions
around the world. The purpose of these partnerships will
reflect the unique and complementary roles of WHO's
partners and of WHO at all levels of the organization.
Success will be measured in terms of actions achieved at
local, country and global levels that lead to better tobacco
control.
The Tobacco Free Initiative will take a global leadership
role in promoting effective policies and interventions that
make a real difference to tobacco prevalence and associated
health outcomes. Despite the seriousness of the problem,
there is evidence to show that countries which undertake
concerted and comprehensive actions to address tobacco
control can bring about significant reductions in tobacco
reiated harm. These success stories indicate the importance
of considering the best mix of specific interventions required
to achieve the same goal: increased cessation and lowered
initiation. The specific mix of interventions in a broad policy
framework will vary according to each country's political,
social, cultural and economic reality.
C r itical to the success of these global tobacco control
actions, will be the ability to mobilize human, institutional and
financial resources to support enhanced activity. Current
allocations at regional and global levels are severely
inadequate, especially when faced with a $400 billion industry
which promotes these harmful tobacco products. Increased
allocations will enable improved international research, policy
development and action to address the massive public health
impact of tobacco.
For World No-Tobacco Day 1998, WHO has chosen the slogan "Growing up without tobacco".
Although the issue of young people and tobacco was previously addressed by WHO in 1990, the
subject bears repeating. On the occasion of World No-Tobacco Day, WHO calls upon
governments, communities, organizations and schools, families and individuals to focus attention
on the seriousness of the tobacco epidemic, to take strong actions to prevent nicotine addiction in
young people and to protect them from the dangers of environmental tobacco smoke. World No
Tobacco Day is also a day marked by an appeal to those who use tobacco to quit for at least 24
hours, as a first step toward breaking their tobacco addiction.
The material in this special issue of Tobacco Alert is intended to assist in the commemoration of
World No-Tobacco Day 1998. Although specific strategies will need to be adapted to the cultural
and socio-economic conditions of individual countries and communities, it is hoped that the
ideas conveyed in this issue will stimulate further progress towards a tobacco-free world.
Opportunities for Action: World No-Tobacco Day and beyond
We live in a world where tobacco kills three and a half million every year, and the death toll is
increasing steadily. One day of activities will not reverse this epidemic — concerted year-round
efforts are necessary. Even so, World No-Tobacco Day provides an opportunity to spotlight
efforts that are already underway or to launch new tobacco control initiatives. For example, in
countries that are striving to enact tobacco control legislation, health advocates could use the
occasion of this year's World No-Tobacco Day to promote the message that the legislation will
help protect young people from tobacco. For some countries, this could be an opportunity to
announce measures to ensure improved enforcement of existing legislation.
The hazards of tobacco use are vastly underestimated by the public and even by many of those
responsible for promoting and protecting public health. In many countries, this may well be the
greatest obstacle to effective tobacco control. World No-Tobacco Day is an ideal opportunity to
raise awareness of the great harm caused by tobacco. Awareness raising activities can take many
forms, including special World No-Tobacco Day seminars, speeches, debates, television
segments, and quit smoking contests. Wherever possible, activities should be framed in a
newsworthy manner.
This year's slogan lends itself well to active participation by young people. This could range
from artwork contests to advocacy work, in which young people "take on the tobacco industry'"
and demand such measures as tobacco advertising bans. For example, children could engage in
letter writing campaigns to public officials as well as tobacco industry executives, with copies of
the letters sent to major newspapers. Young people could also take inventories of all of the
tobacco advertisements near their schools, or stage a protest at a tobacco company sponsored
sports or cultural event. To increase the visibility of these types of actions, and in turn to raise the
collective awareness, media representatives should always be invited to these events.
With proper planning and imagination, World No-Tobacco Day can be a very useful catalyst for
tobacco control action. However, the real challenge will be to continue to maintain momentum
for improved tobacco control thoughout the year. Some countries may find it useful to coordinate
future actions with the year's specific theme, thereby launching a year-long campaign which
focuses on tobacco and young people. For others, a different strategy may be more appropriate.
The fact remains that much needs to be done to reverse the tobacco epidemic, yet with concerted
and sustained efforts on the parts of many concerned organizations and indviduals, we can
sooner come to a time where every day is World No-Tobacco Day.
In 1998, World No-Tobacco Day falls on a Sunday, a day of rest in many countries. Many
countries may therefore wish to plan media and other activities associated with World No
Tobacco Day on a particular day in the previous week 25-30 May 1998. Alternatively, a full
week of events could be undertaken, finishing with World No-Tobacco Day on Sunday. 31 May
1998.
[Next
Previous
Tobacco kills nearly 10,000 people every day
The facts speak for themselves. Tobacco use worldwide has reached the proportion of a.global
epidemic with little sign of abatement. Each year, tobacco causes about three and a half million
deaths throughout the world. This translates to nearly ten thousand deaths per day. Based on
current trends, this will increase to ten million annual deaths during the 2020s or 2030s, with
seven million of these deaths occurring in developing countries. Based on current patterns of
consumption, it is predicted that over 500 million people currently alive will be killed by
tobacco.
In developed countries, where smoking became widespread during the 1940s and 1950s, the
catastrophic effect of past smoking trends can now be seen. About 20% of all deaths occurring at
present in developed countries are due to tobacco. By 2020, it is predicted that tobacco use will
cause over 12% of all deaths globally. By 2020, it is predicted that tobacco will cause more
deaths worldwide than HTV, tuberculosis, maternal mortality, motor vehicle accidents, suicide
and homicide combined.
— ............ -
HOW TOBACCO AFFECTS YOUNG PEOPLE
[Tobacco affects young people in an extraordinary number of ways. Due to environmental
tobacco smoke (ETS) and maternal smoking, children's health may even be compromised from
before the time they are bom. In many countries, children may grow up in a haze of tobacco
smoke, wreaking further havoc with their health. Household money that is spent on tobacco
reduces the amount available for food, education and medical care. Children may also suffer the
emotional pain and financial insecurity that comes from the loss of a parent or caretaker who
Idies an untimely death due to tobacco.
pn another level are the pervasive pressures for young people to use tobacco. People
jeverywhere seem to be smoking. Attractive advertisements and exciting tobacco promotions are
difficult to resist. Especially when the price is affordable, and it's no problem for minors to buy
tobacco.
Even if the health risks are understood, the message that tobacco kills is not very relevant to
iyoung smokers, who believe themselves to be immortal. By the time they are ready to quit
ismoking, addiction has taken hold. These factors all contribute to the grim statistics. Based on
current trends, about 250 million children alive in the world today will eventually be killed by
tobacco.
WHO believes that even' child has the right to grow up without tobacco. This means without the
rampant pressures to use tobacco, which in many countries emanates from all comers. There is a
need to change the environment to one where non-smoking is considered normal social behviour
jand where the choice not to smoke is the easier choice.
Tobacco is fast becoming a greater cause of death and disability than any
single disease
Research shows that the risks from smoking are substantially higher than previously thought.
With prolonged smoking, smokers have a death rate about three times higher than non-smokers
at all ages starting from young adulthood. On average, smokers who begin smoking in
adolescence and continue to smoke regularly have a 50% chance of dying from tobacco. And
half of these will die in middle age, before age seventy, losing around 22 years of normal life
expectancy. Therefore, a lifelong smoker is as likely to die as a direct result of tobacco use as
from all other potential causes of death combined.
Tobacco is a known or probable cause of about 25 diseases, and the sheer scale of its impact on
global disease burden is still not fully appreciated. For example, it is well know that tobacco is
rhe most important cause of lung cancer. Less known is the fact that tobacco kills more people
through many other diseases, including cancers in other parts of the body, heart disease, stroke,
emphysema and other chronic diseases. Studies in the United Kingdom have shown that smokers
in their 30s and 40s are five times more likely to have a heart attack than non-smokers.
•
A ■ ■ ■■ ■
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TOBACCO USE IS A KNOWN
OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
Respiratory diseases:
•
Lip, oral cavity and pharynx
®
Tuberculosis
•
Oesophagus
*
Pneumonia and influenza
®
Pancreas
*
Bronchitis and emphysema
0
Larynx
®
Asthma
•
Lung, trachea and bronchus
•
Chronic airway obstruction
•
Urinary bladder
«
Kidney and other urinary organs
Cardiovascular diseases:
Paediatric diseases:
•
Low birth weight
o
Respiratory distress syndrome
Rheumatic heart disease
Newborn respiratory conditions
Hypertension
Sudden infant death syndrome
.■
.
•
Ischaemic heart disease
•
Pulmonary heart disease
Lung cancer and other diseases caused
by passive smoking
Fires caused by smoking materials
•
Other heart diseases
•
Cerebrovascular diseases
•
Atherosclerosis
•
Aortic aneurysm
»
Other arterial diseases
■
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According to WHO estimates, there are around 1.1 billion smokers in the world—about one-third
of the global population aged 15 years and over. Of these, 800 million are in developing
countries. Data suggest that, globally, approximately 47% of men and 12% of women smoke. In
developing countries, 48% of men and 7% of women smoke, while in developed countries, 42%
of men smoke as do 24% of women. By the mid 2020s, the transfer of the tobacco epidemic from
rich to poor countries will be well advanced, with only about 15% of the world's smokers living
in rich countries. Health care facilities in poorer countries will be hopelessly inadequate to cope
with this epidemic.
In certain regions, the health consequences of tobacco use are particularly devastating. In the
Former Socialist Economies, around 17% of all deaths in 1995 were due to tobacco use. This
figure is expected to increase so that in 2020, more than 22% of all deaths in this region will be
due to tobacco. In 1995, it was estimated that 41% of all deaths among men aged 35-69 years in
this region were caused by tobacco.
There has occured a shifting of the tobacco epidemic. The apparent success in tobacco control in
some countries has been negated by growth in tobacco use in less developed countries. So,
globally there has been no net progress in reducing tobacco consumption. In absolute figures, the
biggest and sharpest increases in disease burden are expected in India and China, where the use
of tobacco has grown most steeply. In China alone, where there are about 300 million smokers,
new data show there are already about three-quarters of a million deaths a year caused by
tobacco. Based on current trends, of all the children and young people under the age of 20 years
alive today in China, at least 50 million of these will eventually die prematurely because of
tobacco use.
Although life expectancy for both sexes is predicted to rise, in many countries, the gap between
them is growing significantly due to the large number of men who smoke and die of tobaccorelated diseases. However, the number of women and girls who smoke is also rising, and so too
will the number of tobacco-related deaths among women.
HEALTH BENEFITS OF QUITTING SMOKING
•
One year after quitting, the risk of coronary heart disease (CHD) decreases by 50%, and
within 15 years, the relative risk of dying from CHD for an ex-smoker approaches that of
a long-time non-smoker.
»
The relative risk of developing lung cancer, chronic obstructive lung diseases, and stroke
also decreases, but more slowly.
•
Ten to fourteen years after smoking cessation, the risk of mortality from cancer decreases
to nearly that of those who have never
smoked.
•
Quitting smoking benefits health, no matter at what age one quits.
ENVIRONMENTAL TOBACCO SMOKE SERIOUSLY DAMAGES HEALTH OF NONSMOKERS
Environmental tobacco smoke (ETS) contains basically all of the same carcinogens and toxic
agents that are inhaled directly by smokers. Evidence is quickly mounting as to the serious health
consequences of ETS, both for adults and for children. These findings make a strong case for
swift and tough policies to limit smoking in public places.
Exposure to ETS is a cause of disease, including lung cancer and possibly coronary heart disease
in healthy non-smokers. Prolonged exposure to environmental tobacco smoke increases the risks
of lung cancer and heart disease in healthy adults, possibly by as much as 20-30%.
ETS can also result in aggravated asthmatic conditions, impaired blood circulation, bronchitis
and pneumonia. It also is a frequent cause of eye and nasal irritation.
Health consequences of ETS particular to young people:
Children exposed to ETS
®
get more coughs and colds and are more likely to suffer acute upper and lower respiratory
tract infections. One study showed that children exposed to ETS during the first 18
months of life have a 60% increase in the risk of developing lower respirator}' illnesses
such as croup, bronchitis, bronchiolitis and pneumonia.
•
have an increased chance of developing asthma. If they already have asthma, second
hand smoke can bring on asthma attacks and make them worse.
•
are at risk of impaired lung function, and may have breathing problems in the future.
•
have an increased frequency of middle-ear infections, which can lead to reduced hearing.
•
Babies bom to women who smoke dining pregnancy, as well as those infants exposed to
ETS have a significantly greater risk of dying of sudden infant death syndrome (SIDS).
Smokeless tobacco use - A growing addiction
Smokeless tobacco is used in many forms around the world. In the United States and parts of
Europe, it is marketed as chewing tobacco and as oral snuff. In south and south east Asia, it is
most commonly consumed in a 1)6161 quid' or 'pan' consisting of tobacco flakes, mixed with
powdered or chopped areca nut, slaked lime and catechu, wrapped in a betel leaf. This practice
is a part of culture and tradition. Smokeless tobacco use has also been reported in parts of Africa
and the former Soviet Union. In India, the more recent trend of chewing prepacked powdered
lareca nut with tobacco, lime and catechu (termed 'pan masala') has started to replace the habit of
betel quid chewing. In Sudan, "toombak" is used orally, while "nass" is widely used in Central
•Asian republics.
^Although the term "smokeless tobacco" is commonly used for tobacco products used orally, this
jis a term promoted by the tobacco industry that suggests that the product is harmless. To avoid
that innocuous connotation, the term "spit tobacco" is increasingly used in countries such, as the
United States.
In the United States, recent surveys have shown alarming increases in use of spit tobacco among
children and younger adults . This increase is primarily due to the growing popularity of oral
snuff use among teenage and young adolescent males. It is estimated that in one million
adolescent boys in the USA use spit tobacco. Spit tobacco is also used by many athletes,
particularly baseball players, who are often role models for these boys. Other populations with
notable patterns of spit tobacco consumption are south and southeast Asian immigrant
communities in the United States and the United Kingdom. These groups continue to use spit
tobacco products manufactured and imported from the Indian subcontinent.
Use of smokeless tobacco, including snuff and chewing tobacco varieties, has been established
to cause oral cancer (one of the ten leading cancers worldwide), irreversible gingival recession,
other oral pathologies, nicotine addiction and cardiovascular diseases. Smokeless tobacco and
betel quid chewing, particularly with tobacco, is the most common cause of oral cancer in high
incidence regions, and ranks globally as the greatest single risk factor for oral cancer. There
have been cases of six year old children in India with submucous fibrosis, a precancerous
condition . In south and southeast Asia, more than 100,000 new cases of oral cancer are
{diagnosed annually. Some 1,700 and 30,000 cases of oral cancer are diagnosed in the UK and
(the USA respectively, each year. It is believed that as many as 75% of oral cancers diagnosed in
ithe United States are attributed to regular use of smokeless tobacco products and alcohol
combined.
| Next
^ Previous
World No-Tobacco Day, 31 May 1995
Some facts on global tobacco use
Scientific evidence has shown that smoking, the major preventable c
world-wide, has a profound impact on public health. WHO estimates
of the global adult population, or 1.1 billion people, of whom 200 mill
smokers. Data suggest that globally nearly 47% of men and 12% of
developing countries, 48% of men and 7% of women smoke while in
countries, 42% of men smoke as do 24% of women. Typically, there
differences in prevalence rates. For example, in Vietnam, the numbe
above the age of 15 is strikingly high, at 50%, while just 3% of femal
1980s, about 20% of all deaths of men in Shanghai were due to smc
rates were much lower. This number will only increase as we start tc
of increased cigarette consumption, especially in the younger genen
Back to Table of
Contents
Each year, tobacco causes 3.5 million deaths, or about 10 000 deatt
million of these deaths currently occur in developing countries. The c
epidemic is predicted to prematurely claim the lives of some 250 mill
adolescents, a third of whom are in developing countries. China, for
that of the 300 million males now aged 0-29, about 200 million will b(
these 200 million smokers, around 100 million will eventually be kille
diseases and half of these deaths will occur in middle-age and befor
has shown that smoking cessation greatly reduces the risk of tobacc
that most of these 100 million deaths are potentially preventable by i
interventions. By 2020, it is predicted that tobacco will become the le
and disability, killing more than 10 million people annually, 2 million <
alone, thus causing more deaths world-wide than HIV, tuberculosis,
motor vehicle accidents, suicide, and homicide combined.
[Previous]
[Next]
The Advisory Kit 1999 in PDF format
World No-Tobacco Day 1998, 1997, 1996
The Tobacco Free Initiative Home Page
Dr.
WHO TO CONTACT
http://www.who.int/psa/toh/AIert/4-96/E/tal3.htni
WHO TO CONTACT
For further information, please contact:
WHO Headquarters
WHO Regional Office for Europe
Mr Neil E. Collishaw
Programme on Substance Abuse
World Health Organization
1211 Geneva 27
Switzerland
Dr P. Anderson
Regional Adviser for the Action Plan for a
Tobacco-free Europe
World Health Organization
Regional Office for Europe
8, Scherfigsvej
2100 Copenhagen
Denmark
Tel: +41 22 791 3423
Fax: +4122 7914851
WHO Regional Office for Africa
Mr L. Sanwogou
Regional Adviser on Health Education
World Health Organization
Regional Office for Africa
P.O. Box No. 6
Brazzaville
Congo
Tel: +226 30 23 12/30 23 13/30 23 01
Fax: +226 30 21 47
WHO Regional Office for the Americas
Dr Enrique Madrigal
Regional Adviser on Drug Abuse
525,23rd Street, N.W.
Washington, D.C. 20037
USA
Tel: +1 202 861 3200
Fax: +1 202 223 5971
WHO Regional Office
for the Eastern Mediterranean
Dr M. Al Khateeb
Regional Adviser on Health Education
World Health Organization
Regional Office for the Eastern Mediterranean
P.O. Box 1517
Alexandria 21511
Egypt
Tel: +45 39 17 12 48
Fax: +45 39 17 18 54
WHO Regional Office for South-East Asia
Ms Martha Osei
Regional Adviser on Health and Behaviour
World Health Organization
Regional Office for South-East Asia
World Health House
Indraprastha Estate
Mahatma Gandhi Road
New Delhi 110002
India
Tel: +91 11 331 7804
Fax: +91 11 331 8607
WHO Regional Office for the Western
Pacific
Dr Rosemarie Erben
Regional Adviser in Health Promotion
World Health Organization
Regional Office for the Western Pacific
P.O. Box 2932
1099 Manila
Philippines
Tel: +632 522 9800
Fax: +632 521 1036
Tel: +203 48 202 23
Fax: +203 48 38 916
1 of 2
3/30/99 1:06 PM
NEW DIRECTIONS IN INTERNATIONAL INFORMATION EXCHANGE
http://www.whojnt/psa/toh/Alert/4-96/&tal2.htm
NEW DIRECTIONS IN INTERNATIONAL
INFORMATION EXCHANGE
The effective use of timely and accurate information and data is an important component of tobacco control
efforts. Tobacco control workers with access to the Internet now have opportunity to receive and exchange
information in a greatly facilitated manner tlirough use of tire GLOBALINK computer network. Managed by the
International Union Against Cancer (UICC), GLOBALINK uses Internet and the World Wide Web to provide
tobacco-related news bulletins, electronic conferences, databases and directories. GLOBALINK members
around the world range from individuals to international organizations: health educators, news editors, cancer
societies, project officers, and government workers. All parties who are interested in tobacco control and whose
membership application is approved by a membership review committee (and who have access to the Internet),
are offered free membership to GLOBALINK.
For a GLOBALINK membership application, click on http://www.uicc.ch/glob/gtap.html
For further information, contact GLOBALINK at:
International Union Against Cancer
Rue du Conseil-General 3
1205 Geneve
Suisse
Tel: +41 22 809 1850
Fax:+41 22 809 1810
E-mail globalink@uicc.ch
World Wide Web: http://www.uicc.ch/globdemo/mainmenu.html
■: Next j Previous
3/30/99 1:05 PM
" omen and, I obacco: Of Smoke and Mirro:
http://www.inwat.org/smokchtni
Women and Tobacco: Of Smoke and Mirrors
©
Back to Fact Sheets
Home
Source: Heart and Stroke Foundation of Ontario
Produced in cooperation with the Canadian Council on Smoking and Health, January 1991
Heart and Stroke Foundation of Ontario
477 Mount Pleasant Road, 4th Floor
Toronto, Ontario M4S 2L9
Tel: (416) 489-7100
Fax: (416) 481-3439
True Liberation: saying no to tobacco
The ads say you're liberated enough to smoke, but they don't tell you that
really taking control comes from being smoke-free. They don't say that you
can lead a healthier life without tobacco. And they don't portray the
powerless feeling that comes with addiction.
Make no mistake, advertisers have known how to market to women. In the
short history (about 60 years) of women's smoking, cigarette advertisers
have successfully manipulated women's hopes and desires to lure them into
tobacco addiction. Recall these popular slogans:
• You’ve Come a Long Way Baby- Virginia Slims
• Reach fora Lucky Instead of a Sweet- Lucky Strikes
• After a Man's Heart- Chesterfields
Independence, a slim body, romance: what more could a woman want?
Well, let's start with good health and a longer life, instead of tobacco-related
disease, disability and death.
Why Women Smoke
Despite what the ads say, the reasons most women smoke are not
glamorous at all. In reality, women smoke:
• because of the loneliness, stress and poverty that often result from
being a single parent.
• as a way to keep the lid on feelings of anger or frustration about
women's unequal status in society and within the family.
• to try to measure up (down, in fact) to society's unrealistic weight
expectations
• because smoking provides frequent and 'acceptable' breaks from the
stringent demands of child caring and housekeeping
• because of a desire to project what is portrayed as a sophisticated or
desirable image
• because of the social influences of family, friends and co-workers
who smoke
• because women, like men, have believed the tobacco industry's lies
• because smoking is addictive.
3/30/99 12:58 PM
"'omen and Tobacco: Of Smoke and Mirrors
http://www.inwat.org/smoke.htni
The Women Who Smoke
° Overall, about 30% of Canadian women use tobacco (occasional
and regular smokers).
• Unemployed women have high smoking rates: 40%, as compared to
28% of employed women.
• Less educated women are more likely to smoke: about 36% of
women with high school but no post-secondary school education
smoke, compared to only about 19% of women who have attained a
university degree.
• Teenage girls are a real cause for concern: about 24% of all
teenage girls in Canada use tobacco, slightly higher than the rate for
teenage boys.
• By their early 20s, almost 38% of young women are smoking,
slightly more than men of the same age, and more than any other
age group of women.
Some women are at extremely high risk:
o Native women have extraordinarily high smoking rates. In the
Northwest Territories, 65% of the Dene women and almost 80% of
the Inuit women smoke, as compared to 39% of non-native women in
the Northwest Territories.
« Francophone women smoke more than anglophone women (and
men).
• Young women with less than high school education;
multi-disadvantaged women; and women in blue-collar jobs are all
more likely to smoke and less likely to have access to prevention
information and support.
• Women who smoke and are exposed to industrial substances that
interact with tobacco; older women smokers with health problems;
women who smoke and use oral contraceptives; and women who
smoke heavily are at high risk of developing and dying form
tobacco-related diseases.
An equal opportunity to reduce the risks
Here are some of the major positive effects of a tobacco-free lifestyle:
• Women report feeling a strong sense of well-being after taking
control by quitting smoking; it often leads to resolving other difficult
aspects of their lives.
• Cardiovascular benefits of being smoke-free begin within 8 hours of
the last cigarette smoked: the carbon monoxide level drops and the
oxygen level in the blood returns to normal.
• Within 72 hours of not smoking, the bronchial tubes expand and lung
volume increases, enhancing exercise capacity.
• Several days after quitting, nerve endings begin to recover,
revitalizing the senses of smell and taste.
• The increased risk of heart disease caused by cigarette smoking is
reduced by half after 1 year and to that of a never smoker in 10 to 15
years after quitting smoking.
• Quitting smoking also, over time, reduces cancer risks.
In the early 1900s, the first women smokers liked to see themselves as
fashionable, liberated, and more than a little risque. Today we know how
2 of 4
3/30/99 12:57 PM
' robacco Of Smoke and Mirrors
http://www.inwat.org/smoke.htm
deceptive this image really is: we know about the epidemic of disease
caused by tobacco use.
You Probably Smoked Your First Cigarette With Your Best Girlfriends:
Why Not Smoke The Last One With Them Too! Women have always
been good at supporting each other. Women can use these nurturing skills
to help their female friends and relatives stop smoking because...IT’S A
HARD ADDICTION TO BREAK. It's easy to become hooked on nicotine,
even after three or four cigarettes. Nicotine can be as powerfully addictive
as heroin or cocaine. It often takes more than one attempt to quit.
Tobacco doesn't discriminate
Tobacco gives women an equal chance to develop emphysema, chronic
bronchitis, peripheral vascular disease, heart disease, stroke, cancers of
the mouth, larynx, bladder and cervix. Women can also experience special
problems associated with reproduction:
• Women smokers can experience decreased fertility and, if pregnant,
a higher risk of miscarriage.
• Women smokers who use contraceptive pills are 10 to 20 times more
likely to suffer from heart disease and are at greatly increased risk for
stroke than non-smokers.
• Cigarette smoking has recently been associated with cancer of the
cervix, a disease likely to strike younger women.
• Smoking causes reduced estrogen levels in women, thereby
contributing to menstrual disorders, early menopause and
osteoporosis.
• If a pregnant woman smokes, the carbon monoxide and nicotine in
her bloodstream crosses the placenta and enters the bloodstream of
the fetus. This can slow down the development of the fetus, result in
lower birth weights and increase the risk of stillbirths and perinatal
deaths.
Tobacco use is the leading cause of premature death in Canada and in the
world. Every 35 minutes a Canadian woman dies prematurely from
tobacco-related cancers, coronary heart disease, and chronic obstructive
lung diseases; in 1988, approximately 15,000 women in Canada died as a
result of tobacco-related illness and disease. Lung cancer is now overtaking
breast cancer as the leading cancer-killer of women and smoking is related
to 90% of all lung cancer cases.
Second-hand smoke is harmful to all those exposed to it. The risk of lung
and cervical cancer increases for both smokers and non-smokers who
breathe in second-hand smoke. Nicotine and other chemicals unique to
tobacco smoke have been found in samples of breastmilk from non-smoking
mothers exposed to second-hand smoke.
Help women choose to be tobacco-free
We can all help women choose to be tobacco-free.
• First and foremost, we can give women non-judgmental support
• in their efforts to quit smoking.
• We can take a women-centered approach in our prevention and
cessation programs. In women-centered programs, women's health is
seen as important in itself, not because how it contributes to
3 of 4
3/30/99 12:59 PM
^'omen
Of Smoke and Mirrors
http://www. inwatorg/smoke.htm
appearance or child-bearing capabilities. Women deserve to have
healthy bodies they feel good about. In a society that promotes less
than normal weights, many women have the added, though often
unfounded, fear of weight gain when they give up smoking.
• Some innovative programs are specific to women with low education
and low incomes who are at high risk of starting or continuing to
smoke. These programs are helping women develop the self-esteem
and determination necessary to stop smoking.
• Effective smoking prevention and cessation programs have to be
accessible to all women including disabled women and women who
need child care.
• School curricula need to address the very serious problem of low
self-esteem
• in many young girls. Young girls report using tobacco as a way to
control weight, as a stress release or 'calming' mechanism and as a
means to portray a certain image.
• Let's help young girls make the decision to not start to smoke.
Prevention can have a major effect on the number of women
smokers, since most female smokers become addicted to tobacco as
teenagers.
Back to top
3/30/99 1:01 PM
THE next wave of the tobacco epidemic: women
http://www.who.int/psa/toh>’Alert/4-96/E/tall.htm
THE NEXT WAVE OF THE TOBACCO EPIDEMIC:
WOMEN
Tobacco use is one of the greatest burdens to the health and well-being of women and girls around the world.
At present, tobacco is killing more than half a million women per year. However, by the year 2020, it is
estimated that the yearly death toll will double. In several countries, lung cancer has already surpassed breast
cancer as the leading cause of cancer deaths among women. In India, where betel quid chewing is widespread
among women, oral cancer is more common among women than breast cancer. In addition, studies have shown
that women are at special risk from tobacco use. Women who smoke experience all the negative health
consequences that male smokers do, as well as others that are gender specific. For example, women who smoke
are at increased risk of cervical cancer, premature menopause and impaired fertility. When women smoke
during pregnancy, there are also serious risks to the unborn baby. Women who smoke in the home also expose
their children to the dangers of second-hand smoke. However, in many countries, there is still a perception that
smoking is a mainly a male problem.
A
Particularly in developed countries, tobacco use is steadily decreasing among men. However, tobacco
companies have quickly shifted their attention to potential new users, and in less developed countries,
transnational tobacco companies are employing sophisticated marketing tactics to target new potential users,
mainly youth and women. These are the same marketing techniques that have been used to promote smoking
among women in developed countries. Their efforts have been rewarded, and in many developed countries,
there already is a trend toward more smoking among teenage girls than boys. From these examples, it is likely
that the smoking patterns among women and girls in the developing countries will follow the same trends.
There is a need to frame women's tobacco use and exposure as a major health and social problem, and build
consensus around this issue. Women's organizations, as well as other sectors of society could be activated to
address the problem. Also recommended is the formation of women's networks on all levels: local, national and
international, including establishing a national coordinating body focusing on women and smoking. These types
of networks could help in the development and implementation of successful smoking prevention and cessation
programmes directed to women and young girls. The International Network of Women Against Tobacco
(INWAT), comprised of some of the world's leading tobacco control advocates, promotes information exchange
and strategising on issues of women and smoking. With coordinated efforts at all levels, INWAT aims to reduce
tobacco use among women and girls in the developed countries and to prevent tobacco use from becoming
established in developing countries, thereby averting the next wave of the tobacco epidemic.
For further information on INWAT contact:
Margaretha Haglund
National Institute of Public Health
Box 27 848
115 93 Stockholm
Sweden
Tei:+46 878 3 3535
Fax:+46 878 3 3505
; Next i Previous
lofl
3/30/99 1:03 PM
INGCAT Members
http://www.globalink.org/gtm/ingcat/english/about/members.htrr
2- g
Members
A
1
1
H
©
H
Founding members:
International Union Against Cancer
International Union Against Tuberculosis and Lung Disease
World Heart Federation
Full members:
Danish National Association Against Lung Disease
Associate members:
ADHUNIK, Bangladesh
ADRA Cambodia
Africa Tobacco Media Programme
Agir pour le Gabon
Alcohol and Drug Information Centre, Ukraine
A.S.B.L. Hainaut-Sante, Belgium
Association Africaine d'Education pour le Developpement
Association Malienne de Lutte Contre le Tabagisme
Association Togolaise de Lutte Contre 1'Alcoolisme et le Tabagisme
Atmata Kendram, Kerala State, India
Australian Cancer Society
British Medical Association
Bulletin CLAACTA
CATU, Uruguay
CDTMR, Vaucluse, France
Cyprus Non Smokers' League
Czech Committee of EMASH
Esperance, Mali
Heart Foundation of Jamaica
Hungarian Red Cross
Independent Sobriety Association, Russia
India Consumer Protection Program - Consumers International
International Union for Health Promotion and Education"
Israel Cancer Association
Ligue Vie & Sante (France)
MADNR/Aer Pur, Romania
National Council for the Prevention of Alcoholism and Drug Dependency,
Sierre Leone
Non-smokers Association, Calcutta, India
National Center for Tobacco-Free Kids, USA
National Non-smokers Forum, Bangladesh
Nigerian Heartcare Foundation
ONCADA, Curasao, Netherlands Antilles
Pakistan Society for Cancer Prevention
Program on Tobacco Prevention and Control, Cuba
Skaraborgs Institute, Sweden
Societe Syrienne Contre le Tabac
Stivoro (Dutch Foundation on Smoking and Health), Netherlands
Swama Hansa Foundation, Sri Lanka
Victorian Smoking and Health Program, Australia
Voluntary Health Association of India (New Dehli)
Zambia Anti-Smoking Society
Back .IP. the tqp
1 ofl
5/4/99 11:44 AM
BBC News | South Asia | Sri Lanka: Tailor sues Ceylon Tobacco
http://news.bbc.co.Uk/hi/english/w..,outh_asia/newsid_l 22000/122513.stm
c □□s ONLINE NETWORK
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Hobocth
Tuesday, June 30, 1998 Published at 07:36 GMT 08:36 UK________
World: South Asia
Sri Lanka: Tailor sues
Ceylon Tobacco
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Help
A Sri Lankan tailor has become the first smoker on the
island to try to sue a tobacco company for damages.
In this section
Nepalis turn out to vote
The man, Kurukulasuriyage Cecil Perera, is claiming
about forty-thousand dollars from the Ceylon Tobacco
Company, which, he says is responsible for his
addiction and illnesses, including lung cancer.
The BBC Colombo correspondent says the case will be
watched closely in Sri Lanka where a large proportion
of the male population smokes.
The Ceylon Tobacco Company is owned largely by the
international consortium, British-American Tobacco.
It is the biggest private sector tax-payer in Sri Lanka.
From the newsroom of the BBC World Service
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1 of 1
El El
5/4/99 11:25 AM
Bangladesh Tobacco Company
http://www.irrc.org/profile/tis/directry/com_prof7sec2_p2.htir
Bangladesh Tobacco Company Lt
SBWWSRIWWW I
Primary Exchange: Dhaka
Manufacturer: Cigarettes
Bangladesh
P.O. Box 6069, Gulshan
Dhaka 1212
BUSINESS SEGMENT BREAKDOWN
(U.S. $ millions)
Financial figures converted from Bangladeshi Taka using the exchange rate of $0.0235 U.S. on Dec. 31, 1996.
NATURE OF PRESENCE IN THE INDUSTRY
Tobacco-Related Subsidiaries and Affiliates
The company's annual report lists no subsidiaries.
Tobacco Operations
Bangladesh Tobacco Co. Ltd. manufactures, markets and distributes cigarettes in Bangladesh. The
company also cultivates, processes, markets and exports leaf tobacco. The company's major international
brands are State Express 555 and John Player Gold Leaf, while its leading local brands are Star and
Scissors, both of which experienced outstanding sales growth (130% and 145%, respectively) in 1996.
Overall, the company's sales grew by more than 20% in 1996, and profit after taxation increased by 9%
over 1995.
1 ofl
5/4/99 11:19 AM
Virtual Bangladesh : Brief Facts
Wysiwyg://! 13/http://www.virtualbangladesh.conVbd_brief_facts.htm
Virtual Bangladesh : Brief Facts
Official Name
The People's Republic Of Bangladesh
Location
Latitude between 20 degree 34' and 26 degree 39' north. Longitude between 88 degree 00'
and 92 degree 41' east.
Area
1,43,988 sq.km.
Boundary
Bounded by India from the north, east and west and by the Bay of Bengal and Burma from
the south.
Climate
Main seasons : Winter (Nov - Feb), Summer (Mar - Jun), Monsoon (Jul - Oct). Temp : Max
34 degree Celsius, Min 8 degree Celsius.
Rainfall
Lowest 47” and highest 136"
Capital
Dhaka (Present area 414 sq. km. Master plan 777 sq.km.)
Population
Total estimated population 110 million. Density of population per sq.km. Is about 1185
State Language
Bangla. English is also widely spoken and understood
National Days
National Martyrs Day - February 21 Independence Day - March 26 Victory Day - December
16
Principal Rivers
Padma, Meghna, Jamuna, Brahmaputra, Madhumati, Surma and Kushlara
Principal Crops
Jute, rice, tobacco, tea, sugarcane, vegetables, potato, pulses, etc.
Important Fruits
Mango, banana, pineapple, jack-fruit, water-melon, green coconut, guava, licis, etc.
Major Industries
Jute, sugar, paper, textiles, fertilizers, cigeratte, cement, steel, natural gas, oil-refinery,
newsprint, power generation, rayon, matches, fishing and food processing, leather, soap,
carpet, timber, ship-building, telephone, etc.
Sea Ports
Chittagong and Mongla
Airports
Zia international airport, Dhaka, Chittagong, domestic airports at Chittagong, Jessore,
Sylhet, Cox's Bazar, Rajshahi and Saidpur
Electricity
220 Volts A.C. in all cities and towns
Tourist Seasons
October to March
Main Tourist Attractions
Colorful tribal life, longest sea beach, centuries' old archeological sites, home of the Royal
Bengal Tiger, largest tea gardens, interesting riverine life, etc.
Wearing Apparel
Tropical in summer, and light-woolen in winter
Currency
The unit of currency is the Taka. Notes are in denominations of 1,2,5,10,20,50,100 and 500
Taka. Coins are 1,5,10,25,50 and 100 Paisa (100 Paisa = 1 Taka)
©All rights reserved. Zunaid Kazi
Last updated on Thursday, March 26,1998.
1 of!
5/4/99 11:35 AV
http://www.who.int/psa/toh/Alert/july95/bangla.htni
Bangladesh
BANGLADESH
Socio-demographic characteristics
(Population j
1990
|
1995 1[ 2025
Total
'|i08,11'8,000;|120,433,006||l%,128,006|
|Adult 15+ ||62,878,000 ||72,874,000 ||148,951,000|
|% Urban j|15?7
(|18.3
^pO.O
|% Rural ||84.3
|[81.7
||60.0
Health Status
Life expectancy (1990-95): at birth 55.6 (males), 55.6 (females); at age 15 51.0 (males), 50.6
(females)
Infant mortality rate in 1990-95 : 108 per 1,000 live births
a
Socio-Economic Situation
GNP per capita ($ US), 1991 : 220
Real GDP per capita (PPP$*), 1991 : 1,160
* PPPS = Purchasing Power Parity
Average distribution of labour force by sector, 1990 - 92 :
Agriculture : 59%
Industry : 13%
Services : 28%
Adult literacy rate (%):
Total: 37
Male : 49
Female : 23
£
Tobacco production, trade and industry
Agriculture In 1993, 47,192 hectares were harvested for tobacco down from 51,855 in 1985. 0.5 % of
all arable land is used for tobacco growing.
Production and Trade Since 1990, about 75,000 tonnes of unmanufactured tobacco were produced
annually, about 0.7% of the world total. In 1992, Bangladesh produced about 75,000 million
manufactured cigarettes and bidis (about 1.3% of world total), up from about 41,000 in 1985. In 1993,
earnings from tobacco export amounted to SUS 10 million. Import costs of tobacco rose from SUS 1.7
million in 1985 to SUS 20 million in 1993. The increase was mainly due to an increase of over 500% in
tobacco leaf import costs.
Industry In 1993 about 131,000 people were employed full-time in tobacco leaf processing and tobacco
manufacturing, wholesaling and retailing occupations. About 204,500 people are engaged full-time in
farming tobacco.
Tobacco consumption
1 of 3
5/4/99 11:28 AM
Bangladesh
http://www.who.int/psa/toh/Alert/july95/bangla.htn:
According to surveys in 1979 and 1981, over 80% of all smokers smoked bidis,* frequently in addition
to other forms of tobacco consumption. Bidi consumption was especially popular among people living in
rural and poorer areas. Cigarettes and bidis account for about 70% (by weight) of the tobacco produced,
with 20% used for chewing tobacco, and the remainder for cigars, oral snuff, and pipe tobacco. It
appears that consumption of bidis continues to increase, while (due largely to an increase in taxes)
cigarette sales are declining. The import of manufactured tobacco products is banned, although it is
reported that smuggling is substantial.
Consumption of Manufactured Cigarettes and Bidis*
Annual average per adult (15+) [Cigarettes Bidis Total
|
|
|
1970-72 _
1980-82
1990-92
|[~
390 |[T20~][5ir~|
||_____ 310 ||370 ||680
|
210 ||780~|[990~|
*Bidi: A small hand-rolled cigarette of unprocessed tobacco, rolled in a tendu leaf.
BANGLADESH
Per adult consumption of cigarettes and Bidis (age 15 +)
0
Tar/Nicotine/Filters Cigarettes have a tar range of 19-27 mg, with the tar content of bidis being in
excess of 23 mg. In 1990, an estimated 7% of all cigarettes produced were filter-tipped.
Relative cost of cigarettes Average labour time required to purchase a pack of 20 cigarettes is
approximately half a day. Bidis, however, are much less expensive, costing only a fraction of the price of
cigarettes.
Prevalence
It is estimated that about 60% of men and 15% of women in Bangladesh are smokers. Combined
smoking prevalence is about 37%.
Tobacco use among population sub-groups Since 1980, smoking prevalence among males has
decreased from 67% to 60%, but smoking rates for females have increased rapidly, from 1% up to 15%
(among female workers in 1980, the smoking rate was already 20%). Smoking prevalence is especially
high among lower income groups; for example, 80% of the country's rickshaw pullers smoke. In a 1979
survey of medical students, 28% were found to be smokers, with 94% of them smoking only cigarettes.
2 of 3
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Bangladesh
http://www.who.int/psa/toh/Alert/july95/bangla.hhr
The smoking rate among physicians increased from around 39% in 1979, to approximately 45% in 1990.
Mortality from Tobacco Use
The Bangladesh Cancer Society estimates that a significant proportion of all cancers in Bangladesh is
related to tobacco use, and that cancers of the oral cavity, pharynx and larynx account for 30% of all
cancers. Smoking is also considered to be an important risk factor for male ischaemic heart disease
patients in their 40s and 50s in Bangladesh.
Tobacco Control Measures
Control on Tobacco Products Health warnings are required on cigarette packages and in
advertisements. However, effectiveness is limited because the warning is small and general in nature, the
literacy rate is low, and the warning applies only to domestic and legally imported cigarettes, which
account for only a minority of the tobacco consumed in the country.
In 1989 tobacco advertising was banned in most media. Although this ban was respected for some time,
now advertisements are widespread. Currently, there are no bans on sales to children.
Annually, US SI 8.5 million is raised from taxes (on legal cigarettes only), accounting for 8% of total
government tax revenue. Cigarette tax increases are scheduled, however.
Protection for non-smokers Administrative measures to create smoke-free areas have been
implemented in hospitals, public transport, elevators, theatres, cinemas and government premises. Some
other workplaces have taken voluntary measures to ensure smoke-free areas.
Health education World No-Tobacco Day is celebrated annually in Bangladesh. Various governmental
and non-governmental organizations are actively working to create public awareness through mass
media, posters, leaflets, billboards, and seminars. The Consumer Association of Bangladesh is especially
active in organizing anti-smoking campaigns over radio and television. High school teachers have to
address the hazards of tobacco. The Ministry of Education has provided articles about the hazards of
tobacco use for publication in school textbooks. However, in rural Bangladesh, many children do not
attend school, and thus do not receive this information.
3 of 3
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Afghanistan
http://www.cdc.gov/nccdphp/osh/who/afghanis.htn-
Tobacco or Health: A Global Status Report | Country Profiles by Region | Eastern Mediterranean
Afghanistan
Socio-demographic characteristics
Population
Total-
Adult (15+)
% Urban
% Rural
II
I
_JI_
_Jl_
_J|_
1990
15,045,000
8,468,000
18.3
81.7
1995 _____ _l|_
II
_JL_ _ 20,141,000 _IL_
_JL_. 11,935,000 _JL_.
20.0
_JL_
_JI_
80.0
_JI_
_JL_
2025
45,262,000 ______ j
29,730,000
40.0
60.0
Health Status
Life expectancy at birth, 1990-95 : 43.0 (males), 44.0 (females)
Infant mortality rate in 1990-95 : 163 per 1,000 live births
Socio-Economic Situation
Average distribution of labourforce by sector, 1990 - 92 : Agriculture 61%; Industry 14%; Services 25%
Adult literacy rate (%), 1992 : Total 32; Male 48; Female 15
Tobacco production, trade and industry
Agriculture
Although it is likely that tobacco is grown on a small scale for traditional use (such as bidis, hookah, and
chewing), there are no data available to document tobacco being grown or its products being manufactured in Afghanistan.
Production and Trade
Approximately 1,400 million cigarettes were imported into Afghanistan in 1992 (0.2% of world
total), with little change since 1980. However, it is likely that this is greatly underestimated, since other-reports indicate that
in 1988, imports from Pakistan alone amounted to 2,336 million cigarettes. In 1993, it was reported that tobacco imports
totalled USS 11.5 million, up from USS 8.6 million in 1990.
Considerable uncontrolled cross-border traffic has been reported in this region, particularly between Afghanistan, Iran and
Pakistan. Contraband cigarettes, coming from Eastern Europe and the Gulf States, are available in the markets of Pakistan
and it is likely that they also appear in Afghanistan.
Tobacco consumption
Although reliable prevalence data are not available, it is known that traditional methods of using tobacco are practised
extensively. The annual adult per capita consumption of manufactured cigarettes has remained around 150 since the 1970s.
However, due to the reported uncontrolled cross-border traffic, actual consumption may be higher.
Consumption of Manufactured Cigarettes
Annual average per adult (15+)
1 of2
1970-72 |r
1980-82 f
150
160
1990-92 !|
140
~~
5/4/99 11:48 AM
Afghanistan
http://www.cdc.gov/nccdphp/osh/who/afghanis.httr
Tar/Nicotine/Filters In 1990, the tar content ranged from about 16.3 mg. to 66 mg., while the nicotine yields ranged from 1.2 mg. to 14.2 mg.
During the early 1990s, the majority (95%) of cigarettes in Afghanistan were filter-tipped.
Tobacco Control Measures
The advertising of cigarettes has been prohibited in Afghanistan since 1971.
Eastern Mediterranean | Next Country
2 of 2
5/4/99 11:48 AM
Tobacco or Health: A Global Status Report | Country Profiles by Region | Southeast Asia
Bhutan
Socio-demographic characteristics
Population
1990
1995
2025
Total
1,544,000
1,638,000
3,136,000
Adult (15+)
916,000
966,000
2,056,000
% Urban
5.3
6.4
19.0
% Rural
94.7
93.6
81.0
Health Status
Life expectancy at birth, 1990-95 : 49.1 (males), 52.4 (females);
Infant mortality rate in 1990-95 : 124 per 1,000 live births
Socio-Economic Situation
GNP per capita (USS), 1991 : 190, Real GDP per capita (PPP$), 1991 : 620
Average distribution oflabourforce by sector, 1990 - 92 : Agriculture 92%; Industry 3%; Services 5%
Adult literacy rate (%), 1992 : Total 41; Male 55; Female 26
Tobacco production, trade and industry
Agriculture In 1985, 80 hectares were harvested for tobacco, mainly on a non-commercial basis’, accounting for
less than 0.1% of all arable landjn Bhutan.
Industry There is no tobacco manufacturing industry in Bhutan.
Tobacco consumption
Tobacco is smoked in the form of bidis, or rolled in maize leaves; it is also chewed and used as snuff.
le.
4. WrJc
Mortality from Tobacco Use
Chronic lung disease is reported to be an important cause of morbidity and mortality in Bhutan. However, cases of
lung cancer are rare. Almost all the ischaemic heart disease patients attending hospitals are found to be smokers.
Tobacco Control Measures
There is no known national committee on smoking or health, however in the mid 1990s, discussions began about
government legislation on the sale and consumption of tobacco products. There is also increasing govemmnent
efforts to inform people about the health hazards of tobacco use.
Health education
In Bhutan, smoking is generally not approved of due to religious reasons, an'd is frowned
upon by the elders and religious leaders. Physicians also counsel their patients not to smoke, but there is still a lack
of adequate information to the population on the hazards of smoking "No Smoking Day" is held every year in
Bhutan to coincide with WHO's World No Tobacco Day.
Previous Country | Southeast Asia | Next Country
The Tobacco industry needs to recruit new smokers every year to replace those who die from
tobacco-related diseases. The industry's very survival depends on new teenage customers. Few
people start smoking as adults. Thus, children are the industry's most significant target. The
tobacco industry's own documents (see box) demonstrate this proposition. It is therefore little
wonder that tobacco companies spend billions of dollars in their efforts to entice children into
smoking.
tn 1984, a tobacco company market researcher wrote in a previously secret
{internal report:
"Younger adult smokers have been the critical factor in the growth and
{decline of every major brand and company over the last 50 years. They will ;
continue to be just as important to brands/companies in the future for two
simple reasons: The renewal of the{market_stems ahnosLentirelyfrom-l§year-old smokers' No more than 5 percent .oTsmokers-Start after-age-24—
[And]Thel5fand'lo"yalfy of 18-year-old smokers far outweighs any tendency
to switch with age... Brands/companies which fail to attract their fair share of
younger adult smokers face an uphill battle. They must achieve net switching
:gains every year- to merely hold share... Younger adult smokers are the only
{source of replacement smokers... If younger adults turn away from smoking,
the industry' must decline, just as a population which does not give birth will
eventually dwindle."
Young Adult Smokers: Strategies and Opportunites, R.J. Reynolds Tobacco Company,
29 February 1984.
Children around the world are surrounded by advertisements portraying tobacco use asjiin.
sophisticated, modern and Western. In many countries, cigarette advertisements dominate the
radio stations most popular with teenagers. Tobacco advertising exploits the vulnerabilities of
youth by offering tobacco as the means to a_positive self-image and as the key to acceptance by
their peers. Advertising also sends the message that smoking is an "adult" behaviour, and offers
cigarettes as a badge of independence and maturity. ~
Tobacco advertising conveys the message that smoking is the key to social success and upward
mobility, a powerfill draw for young people. This is despite the fact that in many developed
'“countries, smoking rates are significantly higher among the poor and less educated. Some
tobacco companies have used cartoon images in their advertising, with very successful results.
The "Joe Camel" campaign catapulted Joe's brand of cigarettes from one smoked by less than 1%
of U. £ smokers under age 18 to a one-third share of the youth market within three years. That
same cartoon camel was found to have a high level of recognition among three-year-olds, who
were as familiar with him as with Mickey Mouse.
In the United States, the tobacco industry began aggressively targeting women, with the
introduction of a "women's cigarette" in 1968. Within six years, the number of teenaged girls
smoking had more than doubled. The same patterns are being repeated in a host of other
countries.
Tobacco companies say that tobacco advertising is only used to promote brand switching among
smokers. However, studies suggest that the more cigarette companies advertise, the more people,
especially young people start or continuejo smoke,. Studies show that adolescents smoke themost heavily advertised brand, in a proportion far greater than among adults. Cigarette
advertising also reinforces, environmental stimuli to smoke.
Tobacco advertising and promotion aims at expanding the market for their products, specifically
through the targeting of those populations among which there is greatest potentialfor growth,
including youth.
Cigarette advertisements undermine and deflect smokers' concerns about safety, and serve to
reassure smokers or potential smokers that cigarettes are not harmful. Many people do not take
the risks of smoking seriously partly because advertising portrays smoking as innocent and
benign.
Tobacco companies claim that they should have the freedom to advertise their products.
However, most smokers begin smoking when they are too young to understand the risks, and by
the time they are old enough to make an informed choice, their addiction undermines their
freedom of choice. When unfair and iintrutlxfi.il commercial speech is not restricted, other
important freedoms are placed in jeopardy, including children's freedom from deception,
misrepresentation, and psychological manipulation by advertising.
Product placement is another means of increasing the social acceptability of smoking.
Tobacco companies pay large sums of money to film companies so that their cigarettes will be
used in feature films. For example, a prominent American actor was paid US $ 500,000 to ensure
the placement of one company's cigarettes in his films. Product placement payment can also
influence script writing decisions. Lois Lane in Superman movies was a smoker, but the comic
book Lois Lane never smoked!
Sponsorship
As more countries around the world move to ban tobacco advertising, tobacco companies are
quick to divert their attention to the sponsoring of sports and cultural events. This gives them an
ideal opportunity to reach large audiences of young people. In addition to cleverly circumventing
Tobacco advertising bans, companies attempt to use these events to improve their image.
In many developing countries, rock concerts, with their enormous following of young fans, have
been a magnet for tobacco industry sponsorship. In countries where cigarette advertising is
banned or restricted, sponsoring live or televised concerts enables the companies to get around
local regulations. In Taiwan, one multinational tobacco company sponsored a concert with a
popular teen idol in which the only accepted admission "ticket" was five empty packets of the
company's cigarettes.
Through the promotion of sports events, tobacco companies gain widespread exposure for thenbrands and are able to link tobacco with health and athletic prowess. Young people seeing
cigarette logos linked with health, excitement, speed and triumph are likely to Ipse sight of the
reality of death, disease and addiction. A 1994 advertisment by Formula One race promotors
directed to the tobacco industry claimed that the "...Formula One car is the most powerfill
advertising space in the world."
Free Cigarette Giveaways
With an addictive product, it doesn't take much to hook a new customer. For the tobacco
companies, the expense of giving away free samples is overshadowed by the potential for long
term gains, especially from new young customers. Although some countries have already banned
free cigarette samples, this practice still continues in many countries. At rock concerts and discos
around the world, attractive young women hand out popular brands of international cigarettes. In
some cases, those who accept a lit cigarette on the spot are rewarded with a free gift. A multitude
of other examples where young people have been targeted for free cigarette samples have been
reported around the world, particularly in less developed countries.
When children become walking cigarette advertisements: Cigarette-Branded Merchandise
Another popular means of keeping cigarette brands in the public eye and circumventing
restrictions on advertising using cigarette logos on other products such as.saps_.and T-shirts.
Many of these products are popular with children around the world, and they soon become
walking cigarette advertisements.
Counteradvertising can be a useful addition to a tobacco control campaign
In countries around the world, young people are exposed to highly effective tobacco i
adveilising on a daily basis. Tobacco companies spend billions of dollars each year to ;
promote tobacco products, an amount which dwarfs the resources available to most
tobacco control programmes. Thus, one important requirement for an effective
prevention programme is to seriously limit the ability of the tobacco industry to hook a
new generation of smokers through advertising.
At the same time, a number of countries have produced anti-tobacco advertisements
for distribution via mass media. Many of these ads are targeted at young people, with
the aim of de-glamorizing tobacco. There are often possibilities for free distribution of
these ads in the form of public service announcements. However, they are only usefill ■
if they are seen, and not broadcast only during times when most viewers are asleep, hi
some situations, carefully selected paid counter-advertising campaigns may be worth
the cost. In the USA, Doctors Ought to Care (DOC) pioneered the concept of using
paid counteradvertising to ridicule brand name tobacco advertising and promotion.
Health interests can never hope to match the spending by tobacco interests on paid
'
{media advertising, and probably should not try. However, paid media advertising,
p hen used with precision, can be an effective tool in a comprehensive effort to
(discourage tobacco consumption. One way of funding this would be to use a portion of
increased cigarette taxes for this purpose. Examples of this strategy may be seen in
{several states in the USA as well as in other countries, such as Australia, France, and
!New Zealand.
{Next
Previous
World No-Tobacco Day, 31 May 1999
Message from Dr. Gro Harlem Brundtiand,
Director-General of the World Health Organization for World No-Tobacco Da
Giving up smoking is not easy. We know that nicotine is powerfully addictive, and
who have tried to give up, smoking, only to find themselves drawn back to it a few
challenge for us all, and we have to rise to it because we know that getting more s
to reducing the projected tobacco-related death toll over the next two decades. A i
developing country revealed that two-thirds of smokers mistakenly believe that sm
harm; few are interested in quitting, and fewer still have successfully quit. At prese
successfully give up do so without formal help. But we need to greatly increase ra
Today we know that successful and cost-effective treatments exist. Nicotine repla>
as nicotine gum, patches, nasal spray and inhalers as well as non-nicotine medici
can double people's chances of succeeding. These need to be more widely availa
needs to be reduced to bring them within the reach of smokers everywhere. The c
are real health gains to be made from stopping at any age. Those who give up in t
expectancy similar to people who never smoked. I therefore invite all smokers to t
better health and "leave the pack behind."
[Previous]
Back to Table of Contents
The Advisory Kit 1939 in PDF format
World No-Tobacco Day 1998. 1997, 1996
The Tobacco Free Initiative Home Page
[Next]
Tobacco Control Archives
http://galen.library.ucsf.edu/tobacco,
G ALE N'"
SEARCH MEDLINE
fINO BOOKS & JOURNALS
tobacco control archives
ELECTRONIC JOUR HALS
NET RESOURCES
LIBRARY CLASSES
Tobacco Control Archives
How You Can Help
• Tobacco Control Archives Collections
o Brown & Williamson Collection - select this link to search and view the
documents in the Brown & Williamson Collection.
o Joe Camel Campaign: Mangini v. R. J, Reynolds Tobacco Company
Collection - select this link to view the plantiffs legal analysis of the case and
supporting industry documents
o California Documents from the State of Minnesota Depository - select this
link to search and view the documents.
• Archival Project Documentation Plan
• Additional Tobacco Resources available via GALEN II
o Tobacco/Nicotine/Smoking
o Tobacco/Nicotine/Smoking - Archives
□ Tobacco/Nicotine/Smoking - Legislation & Jurisprudence
o Tobacco/Nicotine/Smoking - Mass Media
o Tobacco/Nicotine/Smoking - Publications
The Cigarette Papers Online, the electronic version of The Cigarette Papers, is now
available through GALEN II. The Cigarette Papers, by Stanton A. Glantz, John Slade, Lisa A.
Bero, Peter Hanauer, and Deborah E. Barnes, is based on the Brown & Williamson
documents. Foreword by C. Everett Koop, former Surgeon General of the United States. The
print version was published by the University of California Press.
Purpose
California has been and remains one of the world centers of tobacco control activity and thus
is a natural laboratory for studying the development and impacts of tobacco control policies.
Many researchers have sought to study these policies, but they have been hampered by the
lack of a central, organized source of information. The Tobacco Control Archives (TCA), a
project sponsored by UCSF Library & Center for Knowledge Management, Department of
Archives & Special Collections, will be a central, organized source of information. Its purpose
is to collect, preserve, and provide access to papers, unpublished documents and electronic
resources relevant to tobacco control issues primarily in California.
Collection Overview
The TCA project places special emphasis on Proposition 99, the California anti-tobacco health
education initiative approved in 1989. Proposition 99 was the successful outcome of the
efforts of health and community groups to help reduce smoking by legislative means. The
archival effort will document the emergence of the non-smokers' rights movement, the
Proposition 99 campaign effort, implementation of the legislation by California country
1 of 2
3/31/99 1:30 PM
Tobaeco Control Archives
http://galen.Iibrary.ucsf.edu/tobacco.
offices, and judicial challenges to the proposition.
The TCA will also collect materials relating to other nonsmoking legislative initiatives and
local ordinances, including California propositions and the campaigns of "Proposition 99
Clones" in other states. In addition, the TCA will collect the following categories of materials:
papers and records of individuals and organizations active in the nonsmoking movement,
political campaigns or involved in scholarly research of health effects of tobacco use; tobacco
control investigating issues in general; and the tobacco industry in specific.
Send your comments or inquires about the Tobacco Control Archives to
tobacco-info@library.ucsf.edu.
Last updated: Tuesday, 30-Mar-1999 15:48:29 PST
The Library & Center for Knowledge Management
University of California San Francisco
© 1998 The Regents of the University of California
2 of 2
3/31/99 1:34 PM
gopher://gopher.igc. apc.org:7003/00/news/ta
A bill under consideration in the West Virginia House
of Representatives would raise the penalty for retailers
who sell tobacco to minors.
First-time offenders will face
a maximum fine of $300 and risk suspension of their right
to sell tobacco, under the new bill.
Source:
"West Virginia," USA TODAY, March 5, 1997, p. A9.
(sdb 3/5/97)
Courtesy of: The Advocacy Institute
Date: 3/5/1997
Distributed by:
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Email: info@jointogether.org
Gopher: gopher.jointogether.org 7003
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Tel. 617/437-1500
Fax. 617/437-9394
lofi
3/31/99 1:
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Advocacy Institute (Tobacco)
Topic(s): Tobacco/Nicotine/Smoking ,Tobacco/Nicotme/Smoknig-Mass Media
Title:
Advocacy Institute (Tobacco)
Creator:
The Advocacy Institute (DOE)
Location (URL):
gopher:/7gopher.igc.apc.org:7003/ll/news/tob
Provider:
Institute for Global Communications/Join Together
Description:
Accessing international newspapers and periodicals, the Advocacy Institute has provided a
newsclipping service for articles concerning all aspects of tobacco use, production,
anti-smoking campaigns, legislation, and medical research. This gopher site includes a look
at the recent month's tobacco news, and a database to search for specific tobacco news
articles. This Advocacy Institute site is part of the public gopher of the Institute for Global
Communications which runs four computer networks known as PeaceNet(TM),
EcoNet(TM), ConflictNet and LaborNet. IGC is the U.S. member of the Association for
Progressive Communications, a 16-country association of computer networks working for
peace, human rights, environmental protection, social justice, and sustainability.
Access Type:
Gopher
MeSH:
Tobacco; Nicotine; Smoking
Publication Date:
ISBN/ISSN:
Frpnnpnev •
Monthly
Submitted By:
rlc
Date Submitted:
06/30/97
Last updated: Wednesday, 08-Apr-1998 16:44:57 PDT
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3/31/99 1:3
WON^LIXE: Smoke in the Eye
'' htfp://galen.library.ucsf.edu/kr/data/8
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FRONTLINE: Smoke in the Eye
Topic(s): Tobacco/Nicotine/Smoking-Mass Media
Title:
FRONTLINE: Smoke in the Eye
Creator:
Written by Dan Zegart for Dog and Pony Studios
Location (URL):
http://www2.pbs.org/wgbh/pages/frontline/smoke/
Provider:
WGBH Educational Foundation, FRONTLINE
Description:
Since 1983, FRONTLINE has served as the Public Broadcasting System's flagship
public-affairs series producing television broadcast documentaries that feature
tough,controversial issues or stories others avoided because they seemed too gray and
complex for the black and white spectrum of conventional broadcast journalism.
FRONTLINE has developed a website or internet "webumentary" to compliment their
television productions. On April 2,1996, FRONTLINE broadcast "Smoke in the Eye," a
documentary which traced the efforts of commercial television news journalists to air
stories concerning the tobacco industry and the ensuing litigation efforts which attempted to
and in some cases succeeded in blocking the broadcast of those news stories. This website
includes a reprise of the major points in the television broadcast by featuring text versions
of interviews in the documentary. The webumentary' entitled "The Cigarette Papers: a
Docu-Drama in Three Acts" compliments "Smoke in the Eye," by guiding us through a
selection of documents from the Brown and Williamson Collections maintained by the
UCSF Library' and CKM, Tobacco Control Archives. This selection of documents
highlights the research efforts by the tobacco industry to understand the hazardous effects of
tobacco and addictive properties of nicotine, as well as the strategies employed to conceal
this information from the public.
Access Type:
Web (http)
MeSH:
Tobacco; Nicotine; Television
Publication Date:
April 2,1996
ISBN/ISSN:
Frequency :
None/Not Applicable
Submitted By:
rlc
3/31/99 1:-
RONTLINE: Smoke in the Eye
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Date Submitted:
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Last updated: Wednesday, 08-Apr-1998 16:30:42 PDT
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ames Gcxtiaje interview
http://www2.pbs. org/wgbh/pages/&ontline/smoke/interviews/goodalei
home
the paper trait
interviews
readings
James Goodale
to-saecst on
iba web
feeifhack
GENERAL COUNSEL FOR THE NEW
YORK TIMES DURING THE PENTAGON
PAPERS CASE.
Q: LET'S TALK ABOUT THE
PENTAGON PAPERS FIRST.
WHAT WAS YOUR INSTINCT WHEN
SUDDENLY YOU’RE FACED WITH THIS
DILEMMA THAT THE NEWSPAPER
ASKS YOU ABOUT?
Goodale: With respect to the Pentagon Papers.
you have to look at the law. That is to say the
law that you can read in the case books. Then
you have to ask about the law that you don't
read about in the case books, the First
Amendment. Because the First Amendment isn't
attached to the Pentagon Papers espionage
statute. You have to look at the statutes and then
ask yourself constitutionally can you
nonetheless print, at least in this country.
Q: WHAT CAUSED TO SORT OF GIV E
SUCH WEIGHT TO THE BIBLE OF
HUMAN RIGHTS OVER THE OTHER
LAW?
Goodale: I was lucky because I had been at the
New York Times for a period of 8 years before
the Pentagon Papers came along and being in
of 8
3/31/99 2:1
James Goodale interview
http://www2.pbs.org/wgbh/pages/frontline/smoke/interviews/goodalel.htm
First Amendment in real life and then I began
to teach myself the constitutional law as
applied to the newsroom. So I was lucky. I
thought about the First Amendment.
Q: YOU WENT TO OUTSIDE COUNSEL
FOR ADVICE.
Goodale: We went, yes.
Q: WHAT HAPPENED?
A
Goodale: Well they put out this statute upon
which I just told you and the statute didn't say
anything about the First Amendment and they
said there's an Espionage Act, it applies to
you, you can't publish. You're going to go to
jail.
Q: AND DIDN'T THAT SCARE YOU?
Goodale: I don't get easily scared. I'm a
former hockey player by the way.
Q: SO YOU WOULD GO BACK TO
YOUR CLIENT AND SAY, THIS IS
WHAT THEY SAY BUT—WHAT DID
YOU SAY THEN?
A
Goodale: Well I said look, here's the statute.
It says in black and white what you can't do.
You can't be a spy. First of all I don't think
that applies to you. We're not spies. We're
providing information to the public and that
process is protected by the First Amendment.
So you have to read the Constitution with the
statute and then make a judgment whether the
statute is constitutional or not or whether it
applies. And I said look, I just don't think this
statute applies, first of all and if it does, I
don't think it's constitutional. It can't be.
Q: AND GIVE ME THE SUMMARY
Goodale: Well what happened was that my
advice was listened to. The advice of this
eminent old law firm, which unfortunately no
longer is with us, was not followed. And by
the way that eminent firm had as it's principle
2 of 8
3/31/99 2:09 PIV
James Goodale interview
http://www2.pbs.org/wgbh/pages/frontline/smoke/interviews/goodalel.htnii
partner the former Attorney General of the
United States. He told me I was wrong. I told
him—I was only 37 and he was 62—1 told him
he was wrong. He said, I resign. I'm not going
to defend this case, I'm not going to have this
firm defend, you didn't follow my advice.
And for a period of time about midnight of
this event, I was the only lawyer to defend
that New York Times. But I got some others
and the next day, we went to court and in 8, 9
days later I was proven right.
Q: AND YOU PUBLISHED THE
PENTAGON PAPERS.
Goodale: We published 2 or 3 times and then
we got stopped. And that 9-day period about
which I've just told you was a period where
we didn't publish.
Q: THE MORAL IS THAT IF A
LAWYER HAS HIS EYE ON THE FIRST
AMENDMENT YOU CAN DO A LOT IN
TERMS OF INFORMING THE PEOPLE.
Goodale: Absolutely. Absolutely.
Q: WHAT HAPPENED AT CBS?
Goodale: Well I think that CBS is very much
like the Pentagon Papers case. They looked at
a law, it's called 'inducing breach of contract.'
You and I have a contract and Mike Wallace
comes along he tries to make you the
employee tell him something about our
relationship and the lawyers at CBS were
worried that that three partied event would
cause something that's known as inducing
breach of contract. And they thought that
applying that law, which does exist but it
doesn't apply to the press in my view, could
be applied to the press. And I think that's
where they made the mistake.
Q: IT DOESN’T APPLY TO THE PRESS.
HOW DO YOU COME TO THAT VIEW.
Goodale: Well you ask yourself does the First
Amendment protect the publication of the
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information that's the subject of our contract.
And you then ask yourself well suppose that
information that's subject to our contract is in
the public interest. If it's in the public interest
then the Constitution of the United States says
effectively that type of information ought to
be published. Now if the information is not in
the public interest, suppose it's a trade secret
about how I make Coca Cola and you're an
employee, well that's a different matter. But if
it's information that informs the public, the
First Amendment protects the publication of
that type of information.
Q: WHAT LEADS A DISTINGUISHED
CBS LAWYER, A DISTINGUISHED
OUTSIDE CONSULTING LAWYER TO
COME TO THE DIAMETRICALLY
OPPOSITE CONCLUSION?
Goodale: Well I think that we have
tremendous corporate conglomeration going
on in the United States of media companies.
They're all combining with each other and
that activity requires the concentration of
really skilled corporate people, it takes all
their time. They really don't have the time to
focus on the First Amendment aspects of what
they're doing. And so there's a tilt in corporate
media American now on the business aspects
and the aspects of the First Amendment are
I'm afraid are not getting the same type of
attention. So I think that's what happened.
Q: HOW DANGEROUS IS THIS?
Goodale: Well I think it's extreme extremely
dangerous because we're in an information
revolution, we need these large corporations
and if they do not take into consideration their
principle mission in my view, which is to
inform the public, we're going to end up with
the public not being informed.
Q: HOW MUCH, IN YOUR LEGAL
EXPERIENCE, HAVE YOU HEARD
ABOUT THIS NOTION OF TORTIOUS
INTERFERENCE?
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Goodale: Well the only time I ever heard it
before was from the famed editor Harry Evans
who was the editor of the Sunday Times
before it was bought by Murdoch and an
absolute kingpin in the media business. And
he told me that in England, this was long ago,
that they had this law and he was prevented
from publishing information about
thalidomide which you remember caused
terrible damage to women and children,
because the English courts recognized that
this relationship between a corporation
distillers and its employees was so sacrosanct
that he couldn't publish information that he
wanted to publish about thalidomide. And I
said to him, this was many years ago, gosh
aren't we lucky. In the United States that will
never happen, but it almost did.
Q: ...IT SORT OF DID.
Goodale: Well it did, but you know CBS
finally did publish the information.
Q: BUT THE PRECEDENT
STANDS THEY BLINKED WHEN
CONFRONTED WITH THIS ARCANE
NOTION.... WHAT DOES THAT DO TO
THE REST OF THE MEDIA...WITH
THAT AS A PRECEDENT?
Goodale: Well I think the blink is a very
serious thing because it sends a signal to
lawyers who are defending those companies,
those entities who don't want information
about those entities published. And that signal
is that, if you find yourself in a situation
where you can claim against the media
inducing breach of contract, the media is
going to take the claim seriously. So I think
that's a bad signal to send to those entities.
Q: WHAT'S TO BE DONE ABOUT THAT
NOW?
Goodale: Well I'm here talking. That's not
going to be enough. I think probably what's
going to have to happen is that someone is
going to bring a test case based on this theory
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and the test case will have to go to the
Supreme Court and the Supreme Court will
have to tell us, as I'm sure they will, we have
a First Amendment in this country and that
kind of claim just doesn't work.
Q: WHEN CBS BLINKED, WAS THAT A
KIND OF REFLEXIVE REACTION ON
THEIR PART OR WAS THERE A REAL
EXTERNAL DANGER FACING THEM?
Goodale: I think it was the former. I think
that the lawyers looked at this particular
situation where they had a contract, they knew
they [had] a contract between the employer
and employee and they were worried in sort
of a conventional terms that when a
corporation gets in the middle of that
relationship, a corporation might have some
legal liability. I think what they forgot about
in making that analysis is that CBS isn't any
old corporation. It's in the business of
broadcasting news in some part and because
they forgot the distinction they fell into this
traditional legal analysis.
Q: HOW PARANOID WOULD A
REPORTER BE IN FEELING THAT
THIS IS A NEW FRONT OPENING
UP....THERE WAS DEFAMATION,
THERE WAS LIABLE, THERE WAS
ESPIONAGE, NOW WE HAVE A NEW
FRONT OPENING THAT'S GOING TO
BE FAR MORE INSIDIOUS FROM OUR
POINT OF VIEW.
Goodale: I think because CBS took so much
time to worry about this new legal threat that
it's created a sense of paranoia in the reporting
groups. But in reality I don't think the threat is
real and that the reporters ought to forget their
paranoia. But let's face it, it's a huge
corporation that was in the news business that
was held up for a long period of time so.
Q: AND BEFORE THEM ABC,
ANOTHER HUGE CORPORATION,
WAS FOUGHT TO A STANDSTILL ON
A STORY.
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Goodale: Well I think some of the fight's
gone out of the old press dog here or tiger. I
like to think that the press should fight like
tigers for their freedoms but in this world of
mega corporations, huge business deals, I
think the dollar is controlling a lot of what's
going on in these huge corporations and some
of the fight's gone.
Q: FROM A LAWYER’S
INTERPRETATION, WHAT EFFECT
WOULD IT HAVE ON THE OVERALL
CLAIM OF TORTIOUS
INTERFERENCE OR INDUCING
BREACH OF CONTRACT, THE FACT
THAT CBS MADE A DEAL WITH MR.
WIGAND? IN EFFECT A CONTRACT
WITH HIM WHICH WAS THAT THEY
WOULD NOT BROADCAST UNTIL HE
WAS SATISFIED THAT HIS
INTERESTS WERE PROTECTED.
WOULD THAT HAVE ADDED TO OR
WOULD IT HAVE HAD ANY EFFECT
ON THE REALITY OF A CLAIM OF
TORTIOUS INTERFERENCE?
Goodale: Well I don't think it'd have any
effect on the claim of tortious interference but
let's face it if there was such an agreement and
CBS went ahead and published, the source
would be very unhappy and perhaps could sue
CBS. So that could have been a problem for
CBS. I am fairly well satisfied that there was
no such agreement that lasted for a long
period of time. But had that been in place, it
could have been a problem for CBS.
Q: IN TERMS OF THEIR
RELATIONSHIP WITH WIGAND.
Goodale: With the source, yeah.
Q: WITH THE SOURCE. BUT THE
HYPOTHESIS IS THAT SOMEHOW
THE EXISTENCE OF THIS
CONTRACTUAL ARRANGEMENT
BETWEEN CBS AND THE SOURCE
GAVE SUBSTANCE TO THE CLAIM OR
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THE ANTICIPATED CLAIM BY THE
TOBACCO COMPANY THAT THIS
ACTUAL INTERFERENCE HAD
HAPPENED.
Goodale: I don't think that legally works. I
think what happened is the Wall Street
Journal did a big story on what happened and
it seemed to have had a lot of documents
leaked to it by CBS to justify what CBS did.
And I think what is effectively being said
here, well here's another justification for CBS
in not moving ahead with the story. But I
think it operates on a different plane than the
technical legal thing that you and I have been
talking about.
frontline | WGBH educational foundation |
www.wgbh.org
New Content Copyright © 1998 PBS and WGBH/FRONTLINE
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Policy Statement
http://www.astho.org/htmVbodyjx>licy_statement.litinl
The Association of State and
Territorial Health Officals
NATIONAL ASSOCIATION OF
COUNTY & CITY HEALTH
OFFICIALS
-o
Executive Summary
Through this joint policy statement, the combined memberships of ASTHO and
NACCHO clearly states their intention to eliminate - to the extent possible - the
devastation wreaked on the Americans by a product that when used as intended leads to
disease, disability and death. This policy statement that there can be no hesitation or
delay in implementing measures necessary to protect the public from substances that kill
nearly half a million Americans each year. Within this framework, ASTHO and
NACCHO jointly support the following actions:
>Prohibit access to tobacco by Minors;
>Support actions that limit advertising and promotion of
products;
tobacco
>Support efforts at the Federal level to increase the regulation of
tobacco products;
>Support actions that remove barriers to smoking cessation;
>Restrict exposure to environmental tobacco smoke (ETS);
>Use the media to advocate for regulatory action and to promote
knowledge of tobacco issues;
>lncrease excise taxes to make the price of tobacco products
more prohibitive;
> Support, as appropriate, state and local governments involved in
legal action related to tobacco control;
> Assess the health and economic impact of tobacco use; and
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Policy Statement
http://www.astho.org/html/bodyjxilicystatement.html
> Advocate for the preservation of local government autonomy in
tobacco control ordinances and regulation.
These policy goals are interdependent, none standing alone as a solution to
this country's single most preventable cause of death. However they are also
inflexible and will be revised and redirected as circumstances require.
ASTHO's and NACCHO’s goal is to assist state and local agencies as they
institutionalize tobacco control programs, including effective prevention
activities, media advocacy, and policies to address the goals outlined in
Healthy People 2000 activities that foster a society and environment
supportive of non-use of tobacco as a social norm. State and local health
agencies do not act alone in this effort, but must take the lead as the primary
agents for protecting and improving the health of the nation. NACCHO, which
represents over 2,800 local health officials, and ASTHO, representing the chief
health officials in each state and territory, are committed to promoting healthy
behaviors and preventing disease and premature death resulting from the use
of tobacco products.
To obtain a hard copy of this policy statement, contact the ASTHO Tobacco
Control Project at (202)371-9090.
Policy Statement on Tobacco Use Prevention and Control
The Problem:
When used as intended, tobacco products are known to cause disease,
disability, and the death of oyer_420,000 Americans each year at a cost of over
$50 billion, according to the Centers for Disease Control and Prevention. The
public-health community must take action to minimize the'consequences of
tobacco use by greatly reducing, if not eliminating, its use. State and local
health agencies must work with state legislatures and policy making bodies,
the federal government, community members, voluntary and civic
organizations, health care institutions, educators, the business community and
the media to overcome this public health crisis of a magnitude unequaled by
any other disease.
Data:
State and local health agencies must collect, analyze, and utilize data and
information to respond effectively to rapidly changing tobacco issues. By using
vital statistics records, Behavioral Risk Factor Surveillance System [BRFSS],
Smoking Attributable Morbidity and Mortality Economic Costs [SAMMEC],
Current Population Survey [CPS], Youth Risk Behavior Survey [YRBS], etc.),
state health agencies, in partnership with local health departments, have the
unique expertise and resources available to assemble and disseminate this
information in an organized and understandable manner that will serve to
protect the health of the public.
Institutionalization
Tobacco use prevention and control programs must be institutionalized within
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Policy Statement
http://www.astho.org/html/body__policy_statementhtinl
state and local health agencies to ensure that activities supported by this
policy statement are completed. Institutionalization occurs as programs
become integral parts of state and local health agencies, with adequate
organizational and financial support to ensure significant program outcomes.
Furthermore, efforts need to be made through public-private partnerships to
ensure the durability of tobacco use prevention and control initiatives within the
states and communities.
Counter Measures:
States and local public health officials should recognize that the promotion
practices of the tobacco industry are often targeted at women, youth, and
communities of color. These practices need to be countered by programs
tailored to the development of advocacy leadership in these communities, and
the promotion of diversity within state and local coalitions and program
personnel.
Strategic Actions:
For these goals to be achieved, specific actions must be strategically designed
to address each aspect of the tobacco issue. In addition, state and local
health agencies must be flexible and adaptable in responding to changing
situations and new research For example, questions regarding exposure to
environmental tobacco smoke (ETS) have increased with the growing body of
scientific knowledge about tobacco and ETS. Policy proposals to protect
children from nicotine addiction are another example of an emerging issue
requiring rapid response by public health and its allies. In both cases, a high
level of media focus on these issues has elevated the public's awareness of
the hazards of tobacco. It remains essential that action at the state and local
level be sufficiently strengthened to address the challenge from a tobacco
industry that employs the best lobbying, advertising, marketing, and legal
expertise that unlimited financial resources can buy.
NACCHO and ASTHO Encourage and Support State and
Local Health Officials to Take the Following Actions:
1)
Prohibit access to tobacco by Minors.
8 Support strict enforcement of statutes banning sale or distribution
of tobacco products to minors. Health agencies should
collaborate implement and report on enforcement of youth access
laws, educate tobacco vendors about laws regarding the sale of
tobacco products to minors, and inform vendors of the dangerous
characteristics of the tobacco products they are selling to
underage youth.
• Ban cigarette vending machines or, at a minimum, restrict youth
access and enact significant penalties for sales to underage
youth.
• Encourage the enactment of state legislation or ordinances that
require licenses to sell tobacco products, exact fines and
revocation of licensure for non-compliance, and allow licensing
fees to fund enforcement efforts.
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Policy Statement
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2) Support actions that limit advertising and promotion of
tobacco products. (ASTHO and NACCHO endorse the Food
and Drug Administration regulation of tobacco product
promotions appealing to children)
• Initiate or support extensive restrictions of tobacco advertising,
on billboards, public transportation vehicles, sports stadiums or
arenas, etc.
• Encourage and assist organizations supported by the tobacco
industry to secure alternative sponsorship of community
activities, especially those activities where the use of tobacco
products is clearly contradictory, such as athletics.
3) Support efforts at the Federal level to increase the
regulation of tobacco products.
° Advocate for regulation of the nicotine levels in cigarettes and
stronger warning labels.
° Support FDA regulation pertaining to the sale and marketing of
tobacco products as drug delivery devices.
• Endorse Occupational Safety and Health Administration (OSHA)
proposal to eliminate ETS in worksites.
• Advocate for greater regulation by the Federal Trade
Commission.
4) Support actions that remove barriers to smoking
cessation.
3 Encourage formal smoking cessation counseling, including the
use of cessation products in combination with personal advice
and assistance from health educators or care providers.
• Advocate for third party reimbursement for cessation programs.
• Train health care providers to council and refer patients to
appropriate cessation programs.
° Collaborate with cessation program providers to assure that
clients of public health clinics have ready access to services.
• Promote and support the development of adolescent-specific
tobacco reduction or cessation programs that provide underage
users adequate opportunities to "quit."
5)
Restrict exposure to environmental tobacco smoke (ETS).
• Promote legislation or regulations that effectively provides for
clean indoor air that is free from ETS.
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• Provide data and expert testimony to promote the passage of
state or local legislation, regulations or policies aimed at
enhancing smoking restrictions in places where non-smokers
would be exposed to ETS.
• First emphasize regulation of public areas where people are
required to assemble, then direct efforts at privately owned
facilities. Areas where children gather should be of special
concern since children are especially vulnerable to ETS and
have little control over their environment.
° Provide technical assistance to agencies and businesses in the
development and implementation of smokefree policies.
• Declare meetings sponsored by public health agencies to be
“tobacco-free" and announce them as such in programs and
promotional brochures.
8 Provide educational campaigns designed to help citizens reduce
their exposure to ETS, especially in places not be covered by
laws and ordinances.
6) Use the media to advocate for regulatory action and
promote knowledge of tobacco issues.
• Develop comprehensive media plans related to legislative or
public policy matters.
® Promote counter-advertising to rebut tobacco industry advertising
directed to youth, minorities or women. Women of child bearing
age are of special concern.
• Provide clear information about available resources, such as
smoking cessation programs or educational materials regarding
tobacco that are easily accessible by the public. For instance, a
toll-free hotline could be established.
7) Increase excise taxes to make tobacco prices more
prohibitive.
8 Advocate higher federal, state and local excise taxes on all
tobacco products. Higher prices have been demonstrated to be
especially effective in limiting the initial use of tobacco by youths
and in reducing consumption by smokers.
8 Utilize revenue generated by increased taxes to institutionalize
tobacco control activities, such as health promotion, smoking
cessation, enforcement of tobacco control laws, and to counteract
tobacco industry efforts to promote the use of its products.
8) Support, as appropriate, state and local governments
involved in legal action related to tobacco control.
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Polfcy Statement
http://www.astho.org/html/body_fK31icy_statement.html
• Provide state or local health data, medical and economic cost
information (SAMMEC), and tobacco related mortality statistics.
• Submit amicus curiae briefs on behalf of state or local
government cases.
® Provide consultation to state attorneys general and local
prosecutors.
9) Assess and report the health and economic impact of
tobacco use.
* Advocate for required notation on death certificates of smoking or
other tobacco use as a contributor to mortality.
8 Conduct in each state the Behavioral Risk Factor Surveillance
Survey, Smoking Attributable Morbidity and Mortality Economic
Costs, Current Population Survey, and Youth Risk Behavioral
Survey to monitor tobacco use on an annual basis in each state.
• Assure that surveillance of minors’ access to tobacco is
maintained and compliance with state laws regarding youth
access is monitored.
® Estimate Medicaid costs related to tobacco-induced illness.
10) Advocate the preservation of iocal government autonomy
in tobacco control ordinances and regulation.
• Support the inclusion of specific anti-preemption language in all
tobacco control legislation.
• Counter legislative tactics that seek to rescind existing local
tobacco control ordinances by adding language to minor or
unrelated bills that includes “super-preemption" of all tobacco
control legislation.
• Be aware that the tobacco industry supports preemptive state
laws because local control is especially effective. To the extent
possible, do not make compromises just to get legislation passed,
if resulting language will weaken a bill and preempt the right of
local government to pass stronger, more comprehensive
regulations.
• Be prepared to counter legislative strategies of the tobacco
industry by withdrawing support from bills that have been
weakened by the addition of preemptive language.
• Support initiatives to replace preemptive language in existing
state legislation with specific non-preemptive language.
Furthermore...
The legislative and regulatory strategies recommended above must be precise
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Policy Statement
http://www.astho.org/html/body_poiicy_statemcnLhtml
and specific in addressing certain issues, however the goals and policies
advocated here are not fixed or permanent. Rather, they must remain flexible
and adaptable so that each State and locality is able to respond to increasing
scientific knowledge or changing contingencies. None of the laws, policies, or
actions stand alone; all are part of nationwide strategies intended to protect
the public from what is by far the single most preventable cause of death and
disease in the United States. State or local health agencies do not act alone in
this effort, although each may function as leaders, conveners, and key
contributors to broad-based coalitions acting in concert to address tobacco use
prevention and control issues.
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Hoi News
http://www.asthoorg/html/bo<ly_hot_news.html
Association Of State and
Terriicml Health Officials
1275 K Street NW
Suite 800
Washington. DC 20005-4006
phone: (202>371-9090
tax: (2027-371-9797
(Note: Many of these articles were originally produced for the ASTHO
Report or Tobacco Free Press)
Tobacco Control Page
j
Project Infotmahon
State Highlights
j
Tobacco Seiiiement
j
Tobacco Free Press
|
Past “Hot News” Articles
• Dr James Howell Discusses Florida’s Mega Tobacco
Prevention And Control Program (March April 1998 ASTHO
Report)
• Texas Survey Says Youth Consider Driver’s Licenses More
Important Than Tobacco (March April 1998 ASTHO Report)
• Recent Conference Shows Managed Care Expanding
Tobacco Control Efforts (March April 1998 ASTHO Report)
Policy Statement
DR. JAMES HOWELL DISCUSSES FLORIDA’S MEGA TOBACCO PREVENTION
AND CONTROL PROGRAM (March April 1998 ASTHO Report)
Interview with James T. Howell, MD, State Health Officer, Florida Department of
Health (March April 1998 ASTHO Report)
Question: Florida settled with the tobacco industry for $11.3 billion dollars.
How much of this money will be set aside for tobacco prevention and control
activities?
Howell: The set-aside that we have right now is $200 million to be used within the
next two years for tobacco prevention and control - the two-year mark beginning
September of 1997. That is $100 million per year to be used specifically to
implement a tobacco prevention and control pilot program. Of the $11.3 billion, the
state legislature will determine on an annual basis during appropriations, how much
of the money will be used to continue tobacco prevention and control programs.
Question: Do I understand vou correctlv that the $200 million must be used bv
September 1999?
Howell: Yes; however, the tobacco settlement in Texas has sparked the state to
look again at the definition of the “Most Favored Nations” clause. In Texas, it is
being interpreted as stating that their settlement funds for tobacco prevention
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couldn't be used in any less than two years. Florida could turn around and decide to
use that same language in our own "Most Favored Nations" clause.
Question: It was reported that Florida Judge Harold Cohen released $57
million of these funds to begin moving forward with tobacco prevention
campaigns. When will you have full use of the pilot program funds?
Howell: The $57 million was released; however, the state legislature only have
given us budget authority to spend $10.3 million to begin implementing activities for
the next 45 days. The total release for the remainder of the fiscal year we hope will
be at least $23 million. However, we are going through a process every 45 days to
increase these funds. Right now, the appropriations process is in full motion for next
year’s funding. Hopefully we will be successful in releasing significantly more
money.
Question: What are the stipulations from the negotiated settlement on how
the money needs to be used?
Howell: In the settlement language, the tobacco prevention pilot program provides
for five funded categories that all programs need to be developed around: 1) Media
& Communications, 2) Enforcement, 3) Education & Training, 4) Community-Youth
Partnerships, and 5) Research & Evaluation.
To start the counter-advertising efforts, Governor Chiles in October brought in about
45 kids from around the state to serve in a focus group to look at all the video
announcements that CDC has collected from throughout the country, and narrowed
them down to 8 favorites. Florida will also be using the input from kids to develop
their own campaign. We recently made a contract with an advertising company to
begin developing those ads.
Another large focus of our department has been to develop community partnerships
and coalitions in each of Florida's 67 counties that we are calling “Tobacco Free
Partnerships." We sent out a proposal to conduct a number of activities on the local
level, and now have in every county a maturing partnership.
Research and Evaluation has also been given priority. State universities will be
funded to conduct evaluations of the pilot program during its operation and post
operation. We are building an initial evaluation component to all of the funded
budget categories that I mentioned.
Question: Obviously, having a sudden flow of such a tremendous amount of
money for tobacco prevention and control efforts would cause anybody to
scramble to decide how it could be used the most effectively. Describe your
efforts to develop programs that would most effectively utilize the money to
decrease tobacco use.
Howell: Initially in September, we brought in a number of professionals from other
states such as California, Arizona, Massachusetts, and from the CDC Office on
Smoking and Heath to look at what they recommended and what has worked in their
states. In November, we brought together 120 tobacco prevention and control
advocates from the state and local levels to go through a strategic planning
progress, look at the language of the Settlement, formulate ideas, tell us what kinds
of things are working in their area, and tell us what they would like to see on a
statewide level in the pilot program.
Fortunately, the Governor's Office has been very collaborative with us in seeking
out information from organizations such as the American Cancer Society and
American Lung Association. The Governor's office has sent representatives
traveling around the country to learn about different programs. The Governor also
formed an interagency team and sent them to the CDC for a full day of meetings to
learn about best practice programs and look at what the CDC experts know are
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effective in the states. You would be interested to know that Florida has received
over 100 written proposals from in and out of the state on what needs to be done and we have used that input to our advantage.
We will be bringing in again in the near future a number of states to look at our
budged programs and gather feedback and input. We are continuing statewide
“tobacco team” meetings, and an interdepartmental team of experts including legal,
budget, and many others will be putting together pieces of the program.
Question: What are you doing to gather input concerning the needs of special
populations in the state?
Howell: Florida brought together about 60 people from Florida’s minority community
to brainstorm on what programs are effective for special populations, and to recruit
them to participate in local partnerships and review media that will be sent to them.
Funding was also requested to develop a statewide network of minority tobacco
prevention leaders.
Question: What are some very unique qualities about your program?
Howell: There are three things that are very unique about our program. The first
has been the involvement of youth. The Governor has felt that substantial number of
youth is essential to having impact. Second, every county (67 counties) no matter
what size, will have a tobacco coordinator to build partnerships with local
organizations and youth, with financial accountability lying with the county health
director. We have requested over $9 million going out to these coalitions for
support. Third, our Governor is completely involved in this issue and the decision
making process. He is committed to reducing tobacco use in Florida.
Question: What advice would you have to other State Health Officers who
may be faced with difficult decision on how to best use millions of dollars
from tobacco settlement funds?
We have found that utilizing the expertise of our statewide coalition and building
bridges with the Governor and other state powers have been essential. We
recommend working with the medical association to garner their support. We would
also encourage ASTHO to sponsor a large retreat with state health officers from all
other states and their immediate staff to share ideas and discuss how to most
effectively use large budgets.
f® t®p
page
TEXAS SURVEY SAYS YOUTH CONSIDER DRIVER'S LICENSES MORE
IMPORTANT THAN TOBACCO (March April 1998 ASTHO Report)
The Texas Department of Health (TDH) conducted a statewide survey which
demonstrated that the threat of losing their driver’s license would be a strong
deterrent to prevent youth from smoking. Some 64 percent of the youth who
responded said the threat would be sufficient to keep them from smoking, while
another 23 percent said such a sanction would make them at least cut back.
The survey was part of a public education campaign conducted by TDH in response
to a bill recently passed by the Texas Legislature that will impose a range of
penalties for Texans under 18 who use tobacco. Penalties include a $250 fine,
mandatory attendance at tobacco education classes, required community service,
and suspension of the driver’s license for repeat offenders. The bill also banned
vending machines except in “adult only establishments".
NuStats International conducted the survey in Texas for the purpose of identifying
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http://www.astho.org/html/body_hot_news.html
Hot News
the attitudes of Texas children ages 10 through 17 and their parents about tobacco
and the new state law. Two hundred and thirty-three sets of parents and 466
children were surveyed from Texas's broad diversity of people.
TDH Commissioner Dr. William Archer says, “We surveyed young Texans and their
parents to find out what would have the best chance of making kids think twice
before using tobacco. Overwhelmingly, teens said that losing their driver's license is
the sanction most likely to deter them from using tobacco."
Survey findings include:
Youth said the threat of losing driver's licenses (64 percent) and the $250 fine (48
percent) would be the top two deterrents for youth smoking.
Tobacco education class (45 percent) and community service (44 percent) would be
slightly less effective deterrents.
More than half (58 percent) of Texas youth say family members smoke and about a
third (34 percent) have close friends who smoke.
86 percent of parents and 87 percent of youth approve of Texas' new tobacco
prevention law.
Commissioner Archer said, "Texas is getting tough on tobacco because we care
about our children's future and because tobacco is seizing a death grip on our kids
at increasingly early ages." He said statistics from the Texas Commission on
Alcohol and Drug Abuse show that tobacco use by Texas youth increased 25
percent from 1992 to 1996. An estimated 410,000 Texas secondary school
students, including 50,000 seventh-graders, were using tobacco in 1996. "It's
alarming to know that 17 percent of all seventh-graders are using tobacco
products," Archer said.
For more information, contact Dr. Philip Huang, Chief, Bureau of Chronic Disease
Prevention and Control, at 512-458-7200 or phuang@chronic.tdh.state.tx.us .
RECENT CONFERENCE SHOWS MANAGED CARE EXPANDING TOBACCO
CONTROL EFFORTS (March April 1998 ASTHO Report)
Although the price tag on the human suffering caused by tobacco is not possible to
tabulate, measurable costs of tobacco use are increasingly catching the attention of
leaders within managed care organizations (MCO).
A recent conference, attended by several hundred health professionals,
“Addressing Tobacco in Managed Care: Partnering for Success,” stands as
evidence of the increasing visibility of tobacco use within managed care settings.
The conference, held in early February, emphasized the responsibilities that
managed care organizations have to reduce tobacco-caused health disparities. The
meeting showcased successes of those organizations that have already instituted
programs and partnerships with diverse organizations.
The Keynote speaker, Phil Nudelman, PhD, chairman and president of
Kaiser/Group Health, spoke about the particulars of a program to reduce tobacco
use that have proven successful. He reported that in the state of Washington, where
the program has matured, there have been significant measurable success rates.
Dr. Nudelman repeatedly said, "Removing financial barriers is the key to any
successful smoking cessation program.” He also said that to be successful, other
efforts must include: 1) Counseling creating programs and guidelines for physicians
to speak to their patients about smoking; 2) Education through supporting
4 of 5
3/31/99 11:36 AM
Hot New s
http://www.astho.org/htnil/body_hot_news.html
community health education with state and local health departments, through
advertisements in local magazines and newspapers, and through warnings on
publications with cigarette ads in clinic waiting rooms; 3) Muscle lobbying for
clean-air and vending machine restrictions and other policy change advocacy; 4)
Participation getting involved with local organizations; and 5) Commitment
distributing seed grants for coalitions and other smoking prevention groups.
The HMO Group, American Association of Health Plans (AAHP), and the Prudential
Center for Health Care Research, who co-sponsored the conference, also
spotlighted their efforts to reduce tobacco. Said Daniel Wolfson, President and CEO
of The HMO Group, "There is no more valuable public health goal we can tackle
than improving HMDs’ and managed care’s resources and skills to implement
successful tobacco control programs, and to measure their performance.”
The AAHP recently began a new initiative, Addressing Tobacco in Managed Care
(ATMC), that will distribute to heath plans, consumers, and the academic and
medical communities, information about health plan practices that have worked
more effectively, as well as providing extensive information on tobacco prevention
and cessation efforts. Says Ronald Davis, co-director of ATMC, "As leaders in
managed care organizations, we have a special interest in helping people stop
tobacco use and in helping them avoid initiating tobacco use.”
One well-received feature of the two-day meeting was a panel of HMO staff who
had conducted a variety of tobacco prevention activities. Moderated by Dr. Michael
Eriksen, director of the Office on Smoking and Health at CDC, the presentations
described a variety of strategies utilized by managed care organizations to promote
social and policy change concerning tobacco use.
The Health Plan of Nevada and Sierra Community Healthcare Foundation has been
conducting the "Smoking Stinks” campaign for the past year. It incorporates radio
PSAs, teacher education and activity guide, and a week of activities surrounding the
Great American Smoke Out.
Kaiser Foundation Health Plan of Colorado and Group Health Northwest received
funding to utilize the CDC Tobacco Counter-Advertising Campaign materials.
Focus groups were used to select ads for broadcast, and partnerships were
developed with other community organizations to ensure wide exposure to the
messages. Ads were tagged to identify the local sponsorship.
HealthPartners in Minnesota has produced its own anti-smoking video targeted to
youth entitled “Garbage Face.” They have also developed “quit” calendars to assist
with cessation. HealthPartners also takes an active role in advocacy efforts to
change public policy.
Dr. David Kessler, former FDA Commissioner, was the keynote speaker for the
closing luncheon. When introduced, he received a standing ovation from the
audience. Dr. Kessler, with the skill of a practiced storyteller, related the history of
FDA's decision *o assert jurisdiction over nicotine and tobacco. He credited many
on his staff for their creative and intensive work that resulted in the historic 1996
regulation. In spite of law suits and potential legislation, Dr. Kessler is confident
that much of the regulation will stand and that the health of the American public will
be improved because of this creative and historic decision by his agency.
5 of 5
3/31/99 11:38 AM
-6-
Tobacco Control
|
http://www.astlio.org/litml/body_lobacco_control.html
Association Of State and
Territorial Health Officials
1275 K Street NW
Suite SOO
Washington. DC 20005-4006
phone: (202)-371-9090
fax: (202)-371-9797
Arizona Dept, of Health
1 of 2
3/31/99 11:09 AM
ASH UK - Press Release: 971015
http://www.ash.org.uk/pre
16 Fltzhardlnge Street, London W1H 9PL Tel: 0171 224 0743 Fax: 0171 224 0471
ASH
Press release
15 October 1997
Action on Smoking
and Health
Four changes to the legal system that would bring justice for victims of tobacco
Smokers and their health carers have suffered from an extraordinary toll of illness and premature death, but their
ability to seek damages is hampered by the English legal system. The deep pockets of tobacco companies and
massive costs of litigation mean that only the most overwhelmingly strong lung cancer cases have been brought s
far. At a conference organised jointly by ASH and the British Medical Association featuring two top American
lawyers, delegates heard that new cases could include:
• ‘Addiction as injury" and a failure to warn of the addictive properties of nicotine (like the US
Castano cases and its successors)
• Heart disease - recently a successful case in Brazil
• Passive smoking - recently Airline staff settled in Florida (The Broin case)
• Health Authorities and private medical insurers suing for recovery of expenditure on
smoking-related disease.
• Criminal proceedings against tobacco company executives
• Developing world claims heard in the UK
ASH believes that British citizens have suffered no less than Americans, but that it is much harder for them to see
justice. ASH is calling for four changes to the legal system that would open the way for new fronts in the battle t<
hold tobacco companies legally accountable for their wrong doing. These are each features of the US system:
1.
2.
3.
4.
Expansion of the no-win, no-fee system to all cases where money is at stake
Punitive damages to be awarded to punish wrong-doing by tobacco companies
Plaintiffs not to be liable for defendants costs if they lose
Trials to be heard before juries instead of judges
Clive Bates, Director of ASH, said "Tobacco companies have done enormous damage to the health of British pet
and if they have been negligent or deceitful they should be sued and pay heavily. English law tends to deny justic
victims of the the tobacco industry' - though it may be a long haul to change it, even the longest jouney starts wit!
single step."
; Contact
i Clive Bates, Director
; 0171 224 0743 or 0181 800 1336 (hm)
!
: Amanda Sandford, Communications
■ Director
; 0171 224 0743 or 0181 257 3501 (hm)
i
Registered Charity No 262067
Action on Smoking and Health is a company limited by guarantee. Registered in England No 998971. Registered address as above
1 of 1
ash UK - Press Release: 970819
http://www.ash.org.uk/pt’
16 Fltzhardlnge Street, London W1H SPLTel: 0171 224 0743 Fax: 0171 224 0471
Press release
August 19, 1997
Action on Smoking
and Health
World Conference on Tobacco or Health. Beijing, August 24-28,1997
Landmark conference will lead the international fightback against the tobacco
epidemic
Smokers and their health carers have suffered from an extraordinary toll of illness and premature death, but their
ability to seek damages is hampered by the English legal system. The deep pockets of tobacco companies and
massive costs of litigation mean that only the most overwhelmingly strong lung cancer cases have been brought s
far. At a conference organised jointly by ASH and the British Medical Association featuring two top American
lawyers, delegates heard that new cases could include:
a ‘Addiction as injury’ and a failure to warn of the addictive properties of nicotine (like the US
Castano cases and its successors)
• Heart disease - recently a successful case in Brazil
• Passive smoking - recently Airline staff settled in Florida (The Broin case)
• Health Authorities and private medical insurers suing for recovery of expenditure on
smoking-related disease.
» Criminal proceedings against tobacco company executives
• Developing world claims heard in the UK
There is a new mood in the anti-tobacco world and the gathering in China will herald a major intensification of tl
fight against the health problems of tobacco world-wide. As the tobacco industry is increasingly squeezed in the
industrialised world, the companies are aggressively chasing markets in the developing world and Eastern Europ
"Following the US deal, the mood has changed - everyone is saying that if tobacco is guilty in the States, then it’
guilty everywhere. Every country is looking at where it stands on tobacco and health. At this conference we hop
find the common will to confront tobacco companies where they are really staking their future - in developing
countries and Eastern Europe" said Clive Bates, Director of ASH in London.
"It is good to be attending the conference now that Britain has taken a hard line position on tobacco control. Wh
the home of BAT, Imperial Tobacco, and Gallaher gets tough on tobacco, it sends a very positive signal to Brita<
friends in the Commonwealth and wider international community" said Bates.
ASH calls for international convention on tobacco and health
The restrictions in the US settlement do not extend to the activities of the same US tobacco companies operating
abroad. At the conference ASH representatives will argue for an international convention on tobacco and health
under the auspices of the World Health Organization building on existing initiatives. [1] The convention would
include as a minimum•
•
•
•
1 of 2
Broad objectives related to tobacco consumption;
Tobacco control protocol detailing measures to be implemented by the parties;
Reporting requirements and information exchange;
Financial mechanism to fund institution strengthening, crop substitution, implementation and monitoring it
s« UK-ftess Release-97(Jgl9
http://www.ash.org.uk/press/970819.
developing countries and Eastern Europe.
The tobacco control protocol would include as a minimum:
•
•
•
•
Minimum restrictions on advertising, promotion and sponsorship by tobacco companies;
Minimum health warnings and other information on the pack;
Maximum tar and nicotine content of cigarettes;
Co-operation against smuggling.
ASH Director Clive Bates, said: "It’s now time for action not words. Joint action worldwide is essential if we are to
reduce the horrendous toll of tobacco-induced death and disease which is now as common in many developing
countries as in the West."
continues ..JI
Notes to editors:
[1] The call for an international convention follows a resolution passed by the 49th World Health Assembly of the
WHO which urged member states to implement comprehensive tobacco control strategies. The resolution, which
was passed on 25 May 1996, requested the Director-General of the WHO:
(1) to initiate the development of a framework convention
(2) to include as part of this framework convention a strategy to encourage Member States to move progressively
towards the adoption of comprehensive tobacco control policies and also to deal with aspects of tobacco control that
transcend national boundaries.
Document WHA49.17
Forty-ninth World Health Assembly, 25/5/96
ENDS
"
At the conference press office - tel. 00 8610 6424 8985; fax 00 8610 6426 0978
Our hotel: Xiyuan Hotel - 008610 68313388
Registered Charity No 262067
Action on Smoking and Health is a company limited by guarantee. Registered in England No 998971. Registered address as above
of 2
3/31/99 1:2
ontradictory tobacco industry statements
http://www.ash.org.uk/press/contra
ASH Briefing on the tobacco industry
TOBACCO INDUSTRY STATEMENTS ON SMOKING AND HEALTH:
PUBLIC STATEMENTS VERSUS PRIVATE ADMISSIONS
Public standpoint
In 1954. the tobacco companies in the US issued a joint public statement entitled
"A Frank Statement to Cigarette Smokers". Published in 448 newspapers across the US, the statement said:
"Recent reports on experiments with mice have given wide publicity to a theory that cigarette smoking is in some
way linked with lung cancer in human beings. Although conducted by doctors ofprofessional standing, these
experiments are not regarded as conclusive..."
"We accept an interest in people's health as a basic responsibility, paramount to every other consideration in our
business."
From the mid 1950s onwards, the tobacco industry has sought to play down the scientific evidence on the health
consequences of smoking and adopted a policy of spreading doubt and confusion. A massive PR campaign was
mounted to attack not only the scientific data but also science itself. Thus industry statements suggested that
connections between smoking and disease were not real but "merely statistical". One of many examples comes from
BAT in 1981:
"Despite a never-ending stream of research on the possible health hazards ofsmoking, there is no proof ofa cause
and effect relationship between cigarette smoking and various alleged smoking diseases."
Dr. L Blackman, Director of R&D, BAT 1981
If pressed, tobacco executives would retreat behind the facade of not being able to comment on health issues:
1 of 3
3/31/99
adictory tobacco industry statements
http://www.ash.org.uk/'
"All the tobacco industry can do is adopt its neutral stance."
C. Burell, Rothmans. 1989
Some, however, felt that the public should at least be aware of the "alleged" dangers:
"The tobacco manufacturers do not believe that the alleged dangers to health have been scientifically proven, t
agree that smokers should continue to be made aware ofsuch allegations."
P J Hoult, President RJR Macdonald, Canada, 1987
ASH Briefing on the tobacco industry
Meanwhile, internal industry documents painted a rather different picture:
Internal documents:
"There are biologically active materials present in cigarette tobacco. These are:
a) cancer causing b) cancer promoting c) poisonous d) stimulating, pleasurable andflavorful."
Extract from 1961 memo by Arthur D Little Inc. (research partner with Liggett & Myers)
"..evidence is building up that heavy smoking contributes to lung cancer."
2 of 3
Contradictory tobacco industry statements
http://www.ash. orguk/p
Report by C V Mace, Philip Morris scientist, 1958.
"Smoking is a habit ofaddiction."
" The central fact in this subject is that in sufficient doses, tobacco condensate acts as a carcinogen when paint
on the backs of mice or when injected subcutaneously into rats..."
Sir Charles Ellis, senior scientist, BAT, 1962.
"Moreover nicotine is addictive. We are, then, in the business ofselling nicotine, an addictive drug effective in
release ofstress mechanisms."
Addison Yeaman, vice president and general counsel,
Brown & Williamson, 1963
"..we should adopt the attitude that the causal link between smoking and lung cancer is proven because then at
least we could not be any worse off."
Dr. Sidney Green, chief of research at BAT, 1962
3 of 3
BMA press releases
http://www.bma.org.uk/pressrel/arc
..
i><i
Date: 12 March 1998
Embargo: 11 Mar 1998
BMA RESPONSE TO DAMNING NEW EVIDENCE
OF THE EFFECTS OF PASSIVE SMOKING ON
CHILDREN’S HEALTH
Responding to a series of papers in the Journal Thorax,
which shows that passive smoking is linked to respiratory
illness, sudden infant death syndrome, asthma and middle
ear disease in children, the BMA today renewed its attack
on the tobacco industry for attempting to deny and
downplay the health damage caused by environmental
tobacco smoke.
'
Dr Bill O’Neill, Science Adviser to the BMA says:
"Today’s evidence clearly explains why the tobacco
industry has been engaged in a desperate disinformation
campaign. They do not want to be linked to death and
illness in children. But they cannot escape that link. They
spend millions recruiting new young smokers who will be
the parents of tomorrow’s sick children."
Dr O’Neill also called for urgent action to improve
support for parents who want to quit.
"We have a major problem. We have been losing the
struggle to persuade young people not to start smoking.
More than a third of 15 year old girls smoke and by the
time they start a family they are thoroughly hooked. 32
per cent of pregnant women are smokers and this rises to
49 per cent in women from poorer households.
"The stresses and strains of being a parent can make it
very difficult for parents to cope with the idea of giving up
smoking. But it is important that the public understands
just how damaging the effects of tobacco smoke are on
their children’s health. And as that awareness grows,
parents will want to stop. They need and deserve help and
support to succeed."
ends
Issued by: BMA Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JP
1 of 2
BMa press releases
http://www.bma.org.uk/pressrel/arct
tel: 0171 387 4499
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Tob^C'Cx?
’^TiAT/VS
World No-Tobacco Day, 31 May 1999
WHO TO CONTACT
For further information, please contact:
WHO Headquarters
Dr Derek Yach
Project Manager
Tobacco Free Initiative
World Health Organization
1211 Geneva 27
Switzerland
Tel: +41 22 791 2736
Fax: +41 22 791 4769
E-mail: yachd@who.ch
WHO Regional Office for Africa
Back to Table of Contents
Mr L. Sanwogou
Regional Adviser on Health Education
World Health Organization
Regional Office for Africa
Medical School, C Ward
Parirenyatwa Hospital
Mazoe Street
P.O. Box BE 773
Belvedere
Harare
Zimbabwe
Tel: +263 4 70 69 51/70 74 93
Fax: +263 4 70 56 19/70 20 44
E-mail:sanwoqoul@server. whoafr.org
WHO Regional Office for the Americas
Dr Enrique Madrigal
Regional Adviser on Drug Abuse
525, 23rd Street, N.W.
Washington, D.C. 20037
USA
Tel: +1 202 974 3331
Fax: +1 202 974 3631
E-mail: madriqen@paho.org
WHO Regional Office for the Eastern Mediterranean
Dr M. Al Khateeb
Regional Adviser on Health Education
World Health Organization
Regional Office for the Eastern Mediterranean
P.O. Box 1517
Alexandria 21511
Egypt
Tel: +203 48 202 23
Fax: +203 48 38 916
E-mail: alkhateebm@who.sci.eq
WHO Regional Office for Europe
Dr P. Anderson
Regional Adviser for the Action Plan for a Tobacco-Free Europe
World Health Organization
Regional Office for Europe
8, Scherfigsvej
2100 Copenhagen 0
Denmark
Tel: +45 3917 12 48
Fax: +45 39 17 18 54
E-mail: pan@who.dk
WHO Regional Office for South-East Asia
Ms Martha Osei
Regional Adviser on Health and Behaviour
World Health Organization
Regional Office for South-East Asia
World Health House
Indraprastha Estate
Mahatma Gandhi Road
New Delhi 110002
India
Tel: +91 11 331 7804
Fax: +91 11 331 8607
E-mail: martha@who.emet.in
WHO Regional Office for the Western Pacific
Mr Stephen Tamplin
Regional Focal Point for Tobacco or Health
World Health Organization
Regional Office for the Western Pacific
P.O. Box2932
World No-Tobacco Day, 31 May 1999
Message from Dr. Gro Harlem Brundtland. Director-General for World
No-Tobacco Day 1999
Why focus on smoking cessation for World No-Tobacco Day?
Tips for planning a successful World No-Tobacco Day: 31 May 1999
Some facts on global tobacco use
The health consequences of tobacco use
The benefits of quitting smoking
- Health
- Personal
- Financial
Understanding health addiction
- Tobacco is addictive
- Tobacco Industry aware of addictive quality of cigarettes. "In their own words"
- Light and mild cigarettes
Specific targets of cessation efforts
- Adolescents
- Pregnant Women
[French]
Smoking cessation programmes
- Brief interventions by health professionals
- Personalization
- Mass reach programmes
- Alternative methods
Self-directed smoking cessaton
- How do I pick a strategy that's going to work for me?
Pharmacological aids to smoking cessation
- Nicotine replacement therapy
- Nqn-nico[ine_phaimaro^
Policies for public health
- Creating the environments that will help more people decide to quit,
succeed at quiting, and stay quit for good
Who to contact
Acknowledgements
—
The Advisory Kit 1999 in PDF format
World No-Tobacco Day 1998. 1997, 1996
The Tobacco Free Initiative Home Page
The Putnam Pit: Transcript from Minnesota tobacco trial
http://www.putnampit.com/tobacco.htm
Minnesota v. Tobacco
Despite efforts to remove the transcripts from the Internet, The Putnam Pit is posting
what has been suggested are the verbatim proceedings of the lawsuit
STATE OF MINNESOTA AND BLUE CROSS AND BLUE SHIELD OF MINNESOTA,
PLAINTIFFS,
V.
PHILIP MORRIS, INC., ET. AL.,
DEFENDANTS
We want to know if these are accurate transcripts. Please help us.
As a watchdog press, we are posting these files to determine their authenticity and accuracy, and to
monitor the performance of the state lawyers and judiciary. We need to be certain that all information is
correct. Can you help us? Please advise us of any incorrect information contained here.
email The Putnam Pit.
The Putnam Pit has received electronically the following files, ostensibly the transcripts from the trial:
. February 19. 1998
. February 20, 1998
• February 23, 1998
• February 24, 1998
. February 25, 1998
• February 26, 1998
. February 27. 1998
. March 2,1998
. March 3, 1998
. March 4 J 998.
. March 5, 1998
. March 6, 1998
. March 9, 1998
. March 10, 1998
. March 11. 1998
. March 12,.1998
. March 13. 1998
. March 17, 1998
. March 18, 1998
. March 19, 1998
. March 20, 1998
. March 23, 1998
. March 24, 1998
. March 25,1998.
. March 26, 1998
. March 27, 1998
. March 30, 1998
. March 31, 1998
. April 1, 1998
. April 2,1998
. April 3, 1998
. April 6. 1998
. April 7, 1998
. April 8, 1998
. April 9, 1998
. April 10, 1998
1 of3
3/31/99 1:33 PM
Trial Transcripts from the State o...ta v. Philip Morris, Inc., et. al.
http://galen.library.ucsf.edu/kr/data/391 .htm
GALE N‘”
selected internet resources
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Trial Transcripts from the State of Minnesota v. Philip
Morris, Inc., et. al.
Topic(s): Tobacco/Nicotine/Smoking-Legislation and Jurisprudence
Title:
Trial Transcripts from the State of Minnesota v. Philip Morris, Inc., et. al.
Creator:
The Putnam Pit
Location (URL):
http://www.putnampit.com/tobacco.html
Provider:
,
The Putnam Pit
Description:
Court transcripts from the State of Minnesota and Blue Cross and Blue Shield of
Minnesota, plaintiffs, v. Philp Morris, Inc., et. al., defendants. Transcripts span the dates
February 19, 1998 - to the present. The files are made available by The Putnam Pit, an
alternative newspaper and website serving Putnam County, Tennessee.
Access Type:
Web (http)
MeSH:
Tobacco - legislation and jurisprudence; Nicotine - legislation and jurisprudence
Publication Date:
February 1998
ISBN/ISSN:
ISSN 1091 9171
Frequency :
Daily
Submitted By:
RLC
Date Submitted:
03/18/98
Last updated: Wednesday, 08-Apr-1998 16:27:40 PDT
Search Internet Resources:|
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The Library & Center for Knowledge Management
University of California San Francisco
© 1998 Tire Regents of the University of California
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TonUine: smoke in the eye
http://www2.pbs.0rg/wgbh/pages/fr0ntline/9
text version of this page
New Content Copyright © 1998 PBS Online and WGBH/FRONTL1NE
lofl
3/31/99 1:
gopher://gopher.igc.apc.org: 7003/00/news/to
. ,
An article in the NEW YORK TIMES noted that persons
"•'-tn an overabundance of iron in their blood should stop
smoking to help alleviate their condition. Because cancer
cells cannot multiply without iron and oxygen in the blood
stream, and tobacco leaves are rich in iron,, smokers
acquire high levels of iron in their lung tissues and
increase their risk of lung cancer.
One study indicates
that a high iron level is second only to smoking as a cause
of heart attacks.
Source:
Jane E. Brody, "Personal Health," NEW YORK TIMES,
March 5, 1997, p. C8.
(sdb 3/5/97)
Courtesy of: The Advocacy Institute
Date: 3/5/1997
Distributed by:
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Interviews
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Interviews
horns
the paper trait
interviews
readings
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Media critic and former Dean
of the Graduate School of
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tobacco on
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Walter Cronkite
feedback
Former CBS News anchor and
correspondent
Stanton Glantz
Professor of Medicine at the
University of California, San
Francisco
Janies Goodale
General Counsel for the New
York Times during the
Pentagon Papers case.
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Former President of NBC
News and PBS
Philip Hilts
Reporter/correspondent for The
New York Tinies
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First Amendment k
Christopher Patti
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ASH - What's new
ASH 'Whats New1 aims to give an insight into what is happening in tobacco
policy, legislation and litigation. Here articles describe the situation as
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3/31/9'
Wonuk" - <-alth Project: Tobacco Advertising and Women
http://www.now.org/foundation/healtli/whp/fact4.iitnil
slackly
yACT Sheet for the Women’s Health Project
Tobacco Advertising and Women
In 1994, the tobacco industry spent S4.83 billion on
advertising and promotion. CDC study, 1994
"Within six years of rhe tobacco companies introduction of feminine cigarettes and accompanying
advertisement, the number of girls smoking increased 110%."
Smoking Initiation by Adolescent Girls, 1944 through 1988, An Association with Targeted Advertising,
John P. Pierce. Journal of the American Medical Association, Feb. 23, 1994, p610
Tobacco billboards are disproportionally placed in ethnic neighborhoods.
"As in tobacco advertising, smoking in the movies is associated with youthful vigor, good health, good looks,
and personal professional acceptance."
Anna Russo Hazan, PhD, MPH, Helen Levenns Lipton. PhD, and Stanton A. Glantz, PhD. "Popular Films
Do Not Reflect Current Tobacco Use." American Journal of Public Health. June 1994, Vol. 84, No. 6.
Magazines that accept tobacco ads are 38 percent less likely to run articles on tobacco related health risks.
California Department ofHealth Services, Tobacco Control Section
:
.
;
:
;
"As long as women are led to think that smoking makes them beautiful,
successful, slender and all the other images toured by the tobacco industry.
then lung cancer will be a woman's issue." Ellen Gritz, PhD, director of
the Division of Cancer Control at the Jonsson Comprehensive Cancer
Center
■
NOW Foundation Home Page / Donate to the NOW Foundation / Go to NOW Inc, page
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3/31/99 11:04 AM
Tobacco or Health: A Global Status Report | Country Profiles by Region | Southeast Asia
India
Socio-demographic characteristics
■i
Population
1995
2025
r...............................................
850,638,000
935,744,000
1,392,086,000
Adult (15t)
542,391,000
606,250,000
1,071,802,000
% Urban
25.5
26.8
45.2
% Rural
74.5
73.2
54.8
Total
|
1990
Health Status
Life expectancy at birth, 1990-95 : 60.4 (males), 60.4 (females)
Infant mortality rate in 1990-95 : 82 per 1,000 live births
Socio-Economic Situation
GNP per capita (US$j, 1991 : 330, Real GDP per capita (PPPS), 1991 : 1,150
Average distribution of labourforce by sector, 1990 - 92 : Agriculture 62%; Industry711%; Services 27%
Adult literacy rate (%), 1992 : Total 50; Male 64; Female 35
Tobacco production, trade and industry
Agriculture In 1993,417,700 hectares were harvested for tobacco, down from 436,600 hectares in 1985. About
0.2% of all arable land is used for tobacco growing.
Production and Trade
In 1992, 578,800 tonnes (7.0% of world total unmanufactured tobacco) was produced
in India, making it the world's third largest tobacco-growing country. In 1992, India produced about 767,436 million
manufactured cigarettes and bidis, accounting for 13.5% of the world total. About 2,100 million cigarettes were
exported. Only 30 million manufactured cigarettes were imported. In 1990, India's earnings from tobacco exports
totalled USS 127.7 million, compared with USS 122.2 million in 1985. Import costs of cigarettes rose tenfold in the
same period to US$ 3.0 million.
Industry
In 1993, 3.4 million people were estimated to be engaged full-time in tobacco manufacturing. This
accounts for 11.7% of all manufacturing work. Almost 0.9 million people (full-time equivalent) work .in growing
and curing tobacco.
zxvej-a 3)
Tobacco consumption
Annual consumption of manufactured cigarettes declined between 1984 and 1992 from around 90 billion to about 85
billion. In 1992, 6.1% of world total unmanufactured tobacco and 1.5 % of world total manufactured cigarettes were
consumed in India. Only about-_20% of the total tobacco consumed in India (by weight) is in the form of cigarettes.
BTdis account for about 40% oftobacco consumption (about 675,000 million bidis), with the rest divided among
"chewing tobacco, pan masalaj snuff, hookah, hookli, chutta dhumti, and other tobacco mixtures featuring ingredients
such as areca nut. Chuttas and dhumtis are also smoked in reverse fashion, with the lighted end inside the mouth.
Consumption patterns of tobacco show major differences acrossregions.
Consumption of Manufactured Cigarettes
Annual average per adult (15+)
Cigarettes
Bidis
Total
1970-72
170
840
1,010
1980-82 :
180
1,130
1,310
1990-92
150
1,220
1,370
Tar/Nicotine/Filters In 1990, tar levels of cigarettes ranged from 18.0 - 28.0 mg, and nicotine levels from 0.9 -
1.8 mg. Tai' levels of bidis are much higher at 45-50 mg. In 1990, 51% of the cigarettes sold were filter-tipped,
however, there is little difference in nicotine yields of filter and non-filter cigarettes manufactured in India.
Prevalence
Adequate national data on tobacco prevalence of tobacco is not currently available. However, based on estimated
per capita consumption figures, it appears that bidi smoking has risen substantially during the last three decades^
Cigarette smoking increased up to the 1970s, remained stationary or declined somewliardufing'the 1980s. Other
forms of tobacco use have declined considerably over the years.
Tobacco use among population sub-groups
It is estimated that 65% of all men use some form of
tobacco, (about 35% smoking, 22% smokeless tobacco, 8% both). Prevalence rates for women differed widely, from
15% in Bhavnagar to 67% in Andhra Pradesh. However, overall prevalence of bidi and cigarette smoking among
women is about 3%. The use of smokeless tobacco is similar among women and men. About one-third of women
uSe at least one form of tobacco. Differences in tobacco use also vary among other groups;_Sikhs do not use tobacco
at ^ andj?arsis.use very little, while tobacco use is permissible among Hindus, Moslems and Christians. Smoking
rates tend to be higher in rural areas than urbanareas. Smoking is a status symbol among urban educated youths, but
most appear to be unaware of the hazards of smoking.
Mortality from Tobacco Use
Tobacco is responsible for a significant amount of morbidity and mortality among middle-aged adults. India has one
of the highest rates of oral cancer in the wprldjmd the rates are still increasing. Tobacco-related cancers account for
about half of all cancers among men and one-fourth among women. Oral cancer accounts for one-third of the total
cancer cases, with 90% of the patients being tobacco chewers. Clinical observations in some areas have revealed that
over 60% of heart disease patients under 40 years of age are tobacco users; over half of the patients aged 41-60 are
"aisoAmokers.
Tobacco Control Measures
Control on Tobacco Products
Tobacco advertising has been banned in state-controlled electronic media, but
continues without restriction in newspapers, magazines, on posters, billboards, and in the video cassettes of Indian
films. A proposal for a total han on advertising and sponsorship of all tobacco products is under consideration by the
Indian Government
Health wamings-are required on cigarette packets since the "Cigarette Act" of 1975. The government has appointed
a full-time coordinator of tobacco control activities. However, also in 1975 the government dropped restrictions on
package size and contents for cigarettes, cigars and 22 other products, and initiated a Tobacco Development Board~? S/yR 63
for prompting tobacco by offering direct subsidies and a price support system to farmers.
-7
L
Taxes are levied on tobacco products, at varying rates and with varying degrees of effectiveness. Between 1987_and
1992, excise duty on many Indian cigarettes increased between 64% - 112%. Cigarette taxes represent about 75% of
the retail price._Taxes are much lower on packaged chewing tobacco and are rarely collected on bidis and
unpack’aged tobacco products. Regulatory control and the application of retail taxes on these products is extremely
difficult as there is a large sector which operates outside of official control. For example, the bidi industry is highly
decentralized and many manufacturers are unlicensed. Much of bidi manufacturing is one in cottage industry. Often
whole families, including women and children, are engaged in bidi production.
High taxes on manufactured cigarettes and low taxes on bidis and other tobacco products are encouraging
' 4
substitution of bidis and other products for manufactured cigarettes.
Protection for non-smokers
fn 1990,. through an executive order, the government implemented ajirohibition
on smoking in all health care establishments, government offices, educational institutions, air-conditioned railway
cars, chaircars, buses, and domestic passenger flights.
Health education
There is no organization currently working at the national level for tobacco control. Several
non-govemmental organisations and committed individuals at the local levels are also involved, but to date, no
perceptible attitudinal changes among tobacco consumers have been found.
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PC-SPIRS 3.40
MEDLINE (R) 1998/01-1998/10
MEDLINE (R) 1998/0.1.-1998/10 Usage is subject to the terms and conditions of the
Subscription and License Agreement and the applicable Copyright and
intellectual property protection as dictated by the appropriate laws of your
country and/or by International Convention.
1 of 17
Nutrition and chronic diseases—Indian experience.
Gopinath-N
,
Sitaram Bhatia Institute of Science and Research, New Delhi, Igdia.
Southeast-Asian-J—Trop-Med-Public —Health. 1997; 28 Suppl 2: 113-7
This source is Available in S.J.M.C Library
Call Number: From: 1980+
LA: ENGLISH
AB: Socio-economic changes are taking place all over the world, especially in
developing countries, and these influence all aspects of life an all age
per: >ds. Resultant disparities have brought about alarming and increasing
manifestations of malnutrition and non-communicable disease. Illiteracy, poor
health facilities have damaging effects on children. Raising the literacy of
TIs
AU:
AD:
SO:
girls and adolescents will reduce the leading cause of malnutrition in
children, since these future, better educated mothers will be responsible for
the children's welfare: child care status with mother care. Protein calorie
sufficiency is only present in approximately 607. of the rural population•of
India: the remainder has differing degrees of malnutrition. When they move into
better socio-economic status people are at increased risk from coronary heart
disease and diabetes mellitus, for which several theoretical explanations have
been proposed. There is a difference in the patterns of these diseases in urban
and rural populations, the exact basis for which is not yet clear. For example,
in the 25-64 years age group, coronary heart disease prevalence in Delhi is
97/1,000 while in a rural area it is 27/1,000, while the respective figures for
hypertension are 127/1,000 and 29/1,000. The patterns in both groups have
changed within 3-5 years. The geriatric age group has its own, changing
features, due to increasing longevity of life, and to break up of social
customs and family structure.
TXs Cardio vascular-morbidity in proteinuric south Indian NIDDM patieni
AO: Viswanatnam-V; Snehalath&-C; Mathai-T; Jayaraman-M; Ramachandran-A
AD: Diabetes Research Centre, Chenmai, India.
diabetes.researchSgems.vsn1.net.in
SO: Diabetes-Res-Clin-Pract . 1998 Jan; 39(1): 63-7
this source is not Available in S■J■M■C.Library
LA: ENGLISH
AB^ Proteinuria is a well known risk factor for cardiovascular morbidity. There
has been no report on cardiovascular morbidity in Indian NIDDM patients with
proteinuria. He, ice this study has been undertaken to estimate the prevalence of
cardiovascular diseases (CVD) in South Indian NIDDM with proteinuria. We
studied two groups of NIDDM patients with diabetes for > or = 5 years: group PR
with persistent proteinuria of > 500 mg/day (n = 297) and group NPR with
normoalbuminuna (albuminuria < or = 30 micrograms/mg creatinine)(n = 296), who
reported for review during the study period. They were matched for age,
duration of diabetes and BMI. The prevalence of cardiovascular diseases, namely
myocardial infarction, the presence of ischaemic heart disease and the history
OT coronary bypass surgery were compared in the two groups. The prevalence of
hypertension was higher among the PR than the NPR patients (56.5 vs 24.77.’ chi
P
CVD Were detected in 39.27. (n = 116) of the PR and 13.27.
J
NPR groLlPs- (chi 2 = 54.85, P < 0.001). The risk was thus
three-fold higher in the PR group. Univariate analysis showed that in the
proteinuric group, the prevalence of complications was higher in association
12 “
with hypertension (45.87. vs 30.27., chi 2 = 6.82, P = 0.009). Multiple logistic
regression analysis showed that the factors associated with CVD were
proteinuria (odds ratio 5.03), age (OR 1.08) and BMI (OR 1.07) while sex, age
at onset of diabetes, duration of diabetes, hypertension, smoking, HbAl, serum
creatinine, cholesterol and triglycerides did not show independent
contribution. The study, highlights the high risk conferred by macroproteinuria
in Indian NIDDM patients. This risk is found to be independent of the presence
of associated hypertension.
3 of 17
TI: Prevalence of respiratory symptoms and increased specific IgE levels in
West-African workers exposed to isocyanates.
AU: Deschamps-F; Sow-ML; Prevost-A; Henry-L; Lavaud-F; Bernard-J; Kochman-S
AD: Department of Occupational Diseases, CHU Maison Blanche, Reims, France.
SO: J-Toxicol-Environ-Health. 1998 Jul 10; 54(5): 335-42
____ This source is Available only few issues in S.J.M.C. Library
LA: ENGLISH
AB: Respiratory symptoms and immunological effects from chronic exposure to
isocyanates (toluene diisocyanate) were studied in across survey of workers
from West African factories producing paints and polyurethane foam. A
questionnaire, a pulmonary function test, immunoglobulin E (IgE) levels,
radicallergosorbent test (RAST) and an atmospheric sample to quantify
isocyanate exposures were carried out in the workplace for each worker.
Ninety-six workers, of whom 44 had occupational isocyanate-induced asthma, were
included in the study. Twenty-four viral-infected subjects were excluded from
the immunological study. Specific antibodies to isocyanates were detected in
two of the symptomatic individuals. This low proportion appeared to be a common
feature of this disease. The prevalence of .isocyanate-induced asthma in a West
African working population appears to be significant in the context of chronic
human exposure, as current data are based on excessive acute exposure due to an
accident as seen in India.
4 of 17
TI: Predictors of smoking in a cross section of novice mine workers.
AU: Kleinschmidt-I
AD: Epidemiology Research Unit, Johannesburg, South Africa.
immokScss.pwv.gov.za
SD: Cent-Afr-J-Med. 1997 Nov; 43(11): 321-4
____ this source is not Available in S.J.M.C.Library
LA: ENGLISH
AB: OBJECTIVE: To determine demographic predictors of smoking status amongst
novice mine workers. SETTING: Prospective mine workers undergoing fitness
examination at the Medical Bureau for Occupational Diseases. DESIGN: Cross
sectional study. MAIN OUTCOME MEASURES: Current smoking status. RESULTS:
Smoking status is significantly linked to age, race group, nationality and
previous employment status. Education is also a predictor of smoking status,
but the association is weak. Smoking prevalence in subgroups of novice mine
workers varies from less than 107. to nearly 757., CONCLUSION: Assumptions of
very high smoking rates amongst, all mine workers are too simplistic. Smoking
cannot be regarded globally as a major confounder of occupational exposure and
occupational lung disease for all groups of mine workers.
5
of 17
TI: Lifestyle factors and stomach cancer [letter]
AU: Krishnamurthy-S
SO: Int-J-Epidemiol. 1998 Feb; 27(1): 153
____ This source is Available only few issues in S.J.M.C. Library
LA: ENGLISH
6 of 17
TI: Cardiovascular risk factors in non-insulin-dependent diabetics compared to
non diabetic controls: a population-based survey among Asians in Singapore.
AU: Hughes-K; Choo-M; Kuperan-P; Ong-CN; Aw-TC
AD: Department of Community, Occupational and Family Medicine, National
University of Singapore, National University Hospital, Singapore, cofkh@nus.sq
SO: Atherosclerosis. 1998 Jan; 136(1): 25-31
____ this source is not Available in S ._J . M ■ C ■ Librar
LA: ENGLISH
AB: Cardiovascular risk factors were compared between 126 people with
non-insulin-dependent diabetes mellitus (NIDDM) and 530 non-diabetics
(controls), in a random sample of people (Chinese, Malays, and Asian Indians)
aged 40—69 years from the general population of Singapore. Data were adjusted
for age and ethnicity. For both genders, people with NIDDM had higher mean body
mass indices, waist—hip ratios and abdominal diameters. They also had a higher
prevalence of hypertension, higher mean levels of fasting serum triglyceride,
slightly lower mean levels of serum high-density-1ipoprotein cholesterol, and
higher mean levels of plasma plasminogen activator inhibitor—1 and tissue
plasminogen activator (antigen)., These factors are.components of syndrome X
(metabolic syndrome) and increase the risk of atherosclerosis and thrombosis.
In contrast, there were no important differences for cigarette smoking < serum
total and low-density-1ipoprotein cholesterol, serum apolipoproteins Al and B,
plasma factor VIIc and plasma prothrombin fragment 1 + 2. Females with NIDDM,
but not males, had a higher mean serum fibrinogen level than non-diabetics,
which could explain why NIDDM has a greater cardiovascular effect in females
than males. Serum 1ipoprotein(a) concentrations were lower in people with
MIDDM. Mean levels of serum ferritin, a pro-oxidant, were higher in people with
NIDDM than controls, but there were no important differences for plasma
vitamins A, C and E, and serum selenium, which are anti-oxidants.
7
of 17
TI: Tobacco use in rural Indian children.
AU: Kr ishnamurthy—S; Ramaswamy—R; Trivedi-U; Zachariah—V
AD: Department of Community Oncology, S.S.B. Cancer Hospital and Research
Center, Kasturba Medical College and Hospital, Manipal.
SO: Indian-Pediatr . 1997 Oct; 34(10): 923-7
____ This source is Available in S.J.M.C Library
____ Call Number: From:_ 1969+
LA: ENGLISH
8
of 17
TI: Clinical profile of lean NIDDM in south India■
AU: Mohan-V; Vijayaprabha-R; Rema-M; Premalatha-G; Poongothai-S; D’eepa-R;
Bhatia-E; Mackay-IR; Zimmet-P
AD: Madras Diabetes Research Foundation, India.
SO: Diabetes-Res-Clin-Pract. 1997 Nov; 38(2): 101-8
____ this source is not Available in S,J.M.C.Library
LA: ENGLISH
AB: The majority (> 80%) of patients with non insulin dependent diabetes
mellitus (NIDDM) present in Europe and America are obese. In developing
countries like India, most NIDDM (> 60%) are non-obese and many are actually
lean with a body mass index (BMI) of < 18.5< and are referred to as lean
NIDDM'. This paper compares the clinical profile of a cohort of 347 lean NIDDM,
with a group of 6274 NIDDM of ideal body weight (IBM) and 3252 obese NIDDM
attending a diabetes centre at Madras in South India. The lean NIDDM who
constituted 3.5% of all NIDDM patients seen at our centre, had more severe
diabetes and an increased prevalence of retinopathy (both background and
proliferative), nephropathy and neuropathy. Although a larger percentage of the
lean NIDDM patients were treated with insulin, 47% of the males and 53% of the
females were still on oral hypoglycaemic agents even after a mean duration of
diabetes of 9.2 +/- 8.1 years. Studies of GAD antibodies, islet cell antibodies
(ICA) and fasting and stimulated C-peptide estimations done in a small subgroup
of the lean NIDDM showed that they were distinct from IDDM patients. More
studies are needed on metabolic, hormonal and immunological profile of lean
NIDDM seen in developing countries like India.
9 of 17
TI: A baseline study of tobacco use among the staff of Aligarh Muslim
University, Aligarh, India.
AU: Yunus-M; Khan-Z
AD: Dept, of Community Medicine, J N Medical College, Aligarh Muslim
University, India.
SO: J-R-Soc-Health. 1997 Dec; 117(6): 359-65
this source is not Available in S.J■M■C.Library
LA: ENGLISH
AB: A cross-sectional study of 2,439 university employees and research scholars
was carried out using the questionnaire method. The objective was to assess the
prevalence and type of tobacco usage and to collect background data for
planning heal th education programmes. The overall prevalence of tobacco usage
was 51.57. among males and 30.37. among females. There were no female smokers,
the preferred habit of tobacco usage among women being chewing. The prevalence
of smoking among non-teaching staff members was significantly higher. Among
females, the prevalence of tobacco chewers was higher in non-teaching staff
members. Tobacco usage (both smoking and usage of other forms) rose with age.
However, even at 20-30 years of age 25.47. of males were addicted to smoking. A
majority of 60.67. had smoked for more than 10 years. Among the staff members
(both teaching and non-teaching) the reason for smoking was either to relax or
because of addiction, whereas the research scholars smoked to improve their
image or for enjoyment/pleasure. The reasons‘given by users of other forms of
tobacco were boredom, to' pass the time or for no reason at all. Among
non-users, the majority were aware of the harmful effects of smoking. Family
pressure and traditions were also important reasons for not smoking. The study
provides a clear picture of tobacco usage within the University.
10 of 17
TI: Magnesium status and risk of coronary artery disease in rural and urban
populations with variable magnesium consumption.
AU: Singh-RB; Niaz-MA; Mbshiri-M; Zheng-G; Zhu-S
AD: Centre of Nutrition and Heart Research Laboratory Medical Hospital and
Research Centre, Moradabad. India.
SO: Maghes—Res.’1997 Sep; 10(3): 205-13
____ this source is not Available in G■J.M.C.Library
LA: ENGLISH
AB: This survey was conducted to determine the association between amount of
magnesium intake and prevalence of coronary artery disease (CAD) and coronary
risk factors in north India. There were 3575 subjects aged 25-64 years
including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women)
subjects. The survey methods were questionnaires for 7-day food intake record,
physical examination and electrocardiography using World Health Organization
criteria. The overall prevalence of CAD was three-fold greater in urban
compared to rural subjects (9.0 vs 3.3 per cent, p < 0.001). The prevalence of
CAD was significantly higher among subjects consuming lower dietary magnesium.
Lower magnesium status was inversely associated with risk of CAD in both rural
and urban subjects in both sexes. Among subjects with low magnesium status,
there was a higher prevalence of hypertension, hypercholesterolemia and
diabetes mellitus showing a significant increasing trend with decrease in
magnesium status. Multivariate logistic regression analysis after pooling of
data from rural and urban subjects and after adjustment of age showed that
magnesium intake had an inverse association with prevalence of CAD. Serum
magnesium (odds ratio: men 1.14, women 1.05), dietary magnesium (men 1.21,
women 1.12), serum cholesterol (men 1.15, women 1.15), blood pressure (1.26
men, women 1.21), diabetes mellitus (men 1.20, women 1.18) in both sexes and
smoking in men (1.05) were significant risk factors of CAD. Lower consumption
of dietary magnesium and low serum Mg level in north India have a higher
prevalence of CAD and of the coronary risk factors hypertension,
hypercholesterolemia and diabetes mellitus. It is possible that increased
intake of magnesium to about 500 mg/day may be of benefit in the prevention of
CAD.
11 of 17
TI: The epidemiology of gestational trophoblastic disease.
AU: Di-Cintio-E; Parazzini-F; Rosa-C; Chatenoud-L; Benzi-G
AD: Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
SO: Gen—Diagn-Pathol . 1997 Nov; 143(2-3): 103-8
this source is not Available in S■J,M.C.Library
LA: ENGLISH
AB: Considerable progress has been made in the knowledge of the epidemiology of
gestational trophoblastic disease (GTD) in the last few years. There are two
main and widely known points related to this disease: its geographical
distribution and the different frequency in the various classes of age. GTD is
more frequent in South-East Asia, India and Africa, and is rare in European and
North American populations. For example, in the United States, the frequency of
GTD was 108 per 100,000 pregnancies in the 1970's. In Europe, particularly in
Italy, frequencies are lower. In northern Italy, the frequency of hydatidiform
mole, in the period 1979-1982, was equal to 62 per 100,000 pregnancies, but in
Indonesia and in China, the reported rates were 993 and 667 per 100,000
pregnancies respectively. GTD disease is more frequent in the extreme classes
of age (under 20 and over 40 years) and the risk may be more than 100 times
greater over 50 years. Besides these risk factors, the possible role of both
genetic (familiarity, blood groups) and environmental factors (diet, cigarette
smoking, etc.) has been investigated on the onset of GTD. This paper reviews
the epidemiologic knowledge on GTD.
12
of 17
TI: Tobacco sponsorship of Formula One motor racing Lletterj
AU: Vaidya-SG; Vaidya-JS
SO: Lancet. 1998 Feb 7; 3.51(9100): 452
____ This source is Available in S.J.M.C Library
Call Number: From: 1930+
LA: ENGLISH
13 of 17
TI: Prevalence, detection, and management of cardiovascular risk factors in
different ethnic groups in south London.
AUi Cappuccio-FP; Cook—DG; Atkinson—RW; Strazzullo-P
AD: Department of Medicine, Gt George's Hospital Medical School, London, UK.
f.cappuccio@sghms.ac. uk
SO: Heart. 1997 Dec; 78(6): 555-63
____ this source is not Available in S.J.M■C.Library
LA: ENGLISH
AB: OBJECTIVE: To assess the prevalence of cardiovascular risk factors and
their level of detection and management in three ethnic groups. DESIGN:
Population based survey during 1994 to 1996. SETTING: Former Wandsworth Health
Authority in South London. SUBJECTS: 1578 men and women, aged 40 to 59 years;
524 white, 549 of African descent, and 505 of South Asian origin. MAIN OUTCOME
MEASURES: Age adjusted prevalence of hypertension, diabetes, obesity, raised
serum cholesterol, and smoking. RESULTS: Ethnic minorities of both sexes had
raised prevalence rates of hypertension and diabetes compared to white people.
Age and sex standardised prevalence ratios for hypertension were 2.6 (957.
confidence interval 2.1 to 3.2) in people of African descent and 1.8 (1.4 to
2.3) in those of South Asian origin. For diabetes, the ratios were 2.7 (1.8 to
4.0) in people of African descent and 3.8 (2.6 to 5.6) in those of South Asian
origin. Hypertension and diabetes were equally common among Caribbeans and West
Africans and among South Asian Hindus and Muslims. Prevalence of severe obesity
was high overall, but particularly among women of African descent (407. (357. to
457.)). In contrast, raised serum cholesterol and smoking rates were higher
among white people. Of hypertensives, 497. (216 of 442) had adequate blood
pressure control. Overall, 187. (80 of 442) of hypertensives and 337. (62 of 188)
of diabetics were undetected before our survey. Hypertensive subjects of
African descent appeared more likely to have been detected (p = 0.034) but less
likely to be adequately managed (p = 0.085). CONCLUSIONS: Hypertension and
diabetes are raised two- to threefold in South Asians, Caribbeans, and West
Africans in Britain. Detection, management, and control of hypertension has
improved, but there are still differences between ethnic groups. Obesity is
above the Health of the Nation targets in all ethnic groups, particularly in
women of African descent. Preventive and treatment strategies for different
ethnic groups in Britain need to consider both cultural differences and
underlying susceptibility to different vascular diseases.
14 of 17
TI: Prevalence of coronary artery disease and coronary risk factors in rural
and urban populations of north India.
AU: Singh—RB; Sharma-JP; Rastogi-V; Raghuvanshi-RS; Moshiri-M; Verma-SP;
Janus-ED
AD: Centre of Nutrition, Heart Research Laboratory, Medical Hospital and
Research Centre, Moradabad, India■
SO: Eur—Heart—J. 1997 Nov; .18(11): 1728-35
this source is not Available in S.J,M.C■Library
LA: ENGLISH
AB: OBJECTIVE: This study was conducted to determine and compare the prevalence
of coronary artery disease and coronary risk factors in both a rural and an .
urban population of Moradabad in north India. DESIGN AND SETTING: A
cross-sectional survey of two randomly selected villages from the Moradabad
district and 20 randomly selected streets in the city of Moradabad. SUBJECTS
AND METHODS: The 3575 subjects were between 25 and 64 years old; 1769 (894 men
and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived
in the city. The survey methods were questionnaires, physical examination and
electrocardiography. RESULTS: The overall prevalence of coronary artery
disease, based on a clinical diagnosis and an electrocardiogram, was 9.07. in
the urban and 3.37. in the rural population. The prevalences were significantly
(P < 0.001) higher in the men compared with the women in both urban (11.0 vs
6.97.) and rural (3.9 vs 2.6"Z) populations, respectively. The prevalence of
symptomatic coronary artery disease (known coronary disease and Rose
questionnaire-positive angina) was 2.37. in the men (n - 19) and 1.57. in the
women (n =.13) in the rural subjects, and 8.57. in the men (n = 77) and 3.47. in
the women (n = 31) in the urban population. When diagnosed on the basis of
electrocardiographic changes alone, the prevalences were 1.57. (n = 26) in the
rural population and 3.07. (n = 55) in the urban. Coronary risk factors were
two- or three-fold more common among urban subjects compared to the rural
population in both sexes. Central obesity was four times more common in the
urban population compared to the rural in both sexes. Sedentary lifestyle and
alcohol intake were significantly (P < 0.01) higher in the urban population
compared to the rural subjects. There was a significant association between
coronary disease and age, hypercholesterolaemia, hypertension and central
obesity in both sexes. Smoking was a significant risk factor of coronary
disease in men. CONCLUSIONS: Coronary artery disease and coronary risk factors
were two or three times higher among the urban compared with the rural
subjects, which may be due to greater sedentary behaviour and alcohol intake
among urbane. It is possible that some Indian populations can benefit by
reducing serum cholesterol, blood pressure and central obesity and increasing
physical activity.
15 of 17
TI: Relation of fetal growth to adult lung function in south India.
AU: Stein-CE; Kumaran-K; Fall-CH; Shaheen-SO; Gsmond-C; Barker-DJ
AD: MRC Environmental Epidemiology Unit, Southampton General Hospital, UK.
SO: Thorax. 1997 Oct; 52(10): S95-9
this source is not Available? in S.J.M.C.Library
LA: ENGLISH
AB: BACKGROUND: Follow up studies in Britain have shown that low rates of fetal
growth are followed by reduced lung function in adult life, independent of
smoking and social class. It is suggested that fetal adaptations to
undernutrition in utero result in permanent changes in lung structure, which in
turn lead to chronic airflow obstruction. India has high rates of intrauterine
growth retardation, but no study has examined the association between fetal
growth and adult lung function in Indian people. We have related size at birth
to lung function in an urban Indian population aged 33-59 years. METHODS: Two
hundred and eighty six men and women born in one hospital in Mysore City, South
India, during 1934-1953 were traced by a house-to-house survey of the city.
Their mean forced expiratory volume in one second (FEV1) and forced vital
capacity (FVC) were measured using a turbine spirometer. These measurements
were linked to their size at birth, recorded at the time. RESULTS: In both men
and women mean FEV1 fell with decreasing birthweightAdjusted for age and
height, it fell by 0.09 litres with each pound (454 g) decrease in birthweight
in men (957. confidence interval (CI) 0.01 to 0.16) and by 0.06 (957. CI -0.01 to
0.13) in women. Likewise, mean FVC fell by 0.11 litres (957. CI 0.02 to 0.19)
with each pound decrease in birthweight in men, and by 0.08 litres (957. CI
0.002 to 0.16) in women. FEV1 and FVC were lower in men who smoked, but the
associations with size at birth were independent of smoking. Small head
circumference at birth was associated with a low FEV1/FVC ratio in men which
may reflect restriction in airway growth in early gestation. CONCLUSION: This
is further evidence that adult lung function is "programmed" in fetal life.
Smoking may be particularly detrimental to the lung function of populations
already disadvantaged by poor rates of fetal growth.
16 of 17
TI: Vasectomy and prostate cancer: a case—control study in India.
AU: Platz-EA; Yeole-BB; Cho-E; Jussawalla-DJ; Giovannucci-E; Ascherio-A
AD: Department of Epidemiology, Harvard School of Public Health, Boston, MA,
USA.
SO: Int—J—Epidemiol. 1997 Oct; 26(5): 933-8
____ This source is Available only few issues in S.J.M■C. Library
LA: ENGLISH
AB: BACKGROUND: The role of vasectomy in the development of prostate cancer
remains controversial. In particular, there has been concern about detection
bias and confounding in the previously published epidemiological studies
examining this hypothesis. With the goal of minimizing detection bias, we have
evaluated the relation between vasectomy and prostate cancer in a population
without routine prostate cancer screening. METHODS: A case-control study
consisting of 175 prostate cancer cases and 978 controls with cancer diagnoses
other than prostate cancer was conducted at hospitals covered by the Bombay
Cancer Registry in Bombay, India. History of vasectomy, demographic, and
lifestyle factors were obtained by structured interview. Multiple logistic
regression was used to estimate odds ratios (OR) and 957. confidence intervals
(CI). RESULTS: Standardizing by age, -8.77. of cases and 8.37. of controls had had
a vasectomy. The OR for prostate cancer comparing men who had had a vasectomy
to those who did not was 1.48 (957. CI: 0.80-2.72) controlling for age at
diagnosis, smoking status, alcohol drinking, and other demographic and
lifestyle factors. Risk of prostate cancer associated with vasectomy appeared
to be higher among men who underwent vasectomy at least two decades prior to
cancer diagnosis or who were at least 40 years old at vasectomy. CONCLUSIONS:
Although not statistically significant, the results of this hospital-based
case-control study are consistent with the hypothesis of a positive association
between vasectomy and prostate cancer. Because routine prostate cancer
screening is not common in this population, detection bias was unlikely to
account for this association.
17 of 17
TI: Strokes in the elderly: prevalence, risk factors & the strategies for
prevention.
AU: Dalal-PM
AD: Department of Neuroscience, Medical Research Centre Lilavati Hospital,
Mumbai.
SO: Indian-J-Med-Res. 1997 Oct; 106: 325-32
____ This source is Available in S.J.M.C Library
____ Call Number: From: 1943+
LA: ENGLISH
AB: Current demographic trends suggest that the Indian population will survive
through the peak years of occurrence of stroke (age 55-65 yr) and
stroke-survivors in the elderly with varying degree of residual disability,
will be a major medical problem. The available data from community surveys from
different regions of Ijndia for 'hemiplegia' presumed to be of vascular origin
indicate a crude prevalence rate in the range of 200 per 100,000 persons. Thus,
the anticipated costs of rehabilitation of stroke-victims will pose enormous
socio-economic burden on our meagre health-care resources, similar to what is
now faced by industrialised nations in the West. Therefore, prevention of
strokes at any age should be our main strategy in national heal th planning.
Among all risk factors for strokes, hypertension is one of the most important
and treatable factor. Community screening surveys, by well defined WHO
protocol, have shown that nearly 15 per cent of the urban population is
'hypertensive' (160/95 mm Hg or more). Though high blood pressure has the
highest attributable risk for stroke, there are many reasons such as patient's
compliance in taking medicines and poor follow up in clinical practice that may
lead to failure in reducing stroke mortality. In subjects who have transient
ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin in
prevention of stroke is well established. It is also mandatory to prohibit
tobacco use and adjust dietary habits to control body weight,' and associated
conditions like diabetes mellitus etc., should be treated. It is advisable to
initiate community screening surveys on well defined populations for early
detection of hypertension and TIAs. Primary health care centres should be the
base-stations for these surveys because data gathered from urban hospitals will
not truly reflect the crude prevalence rates for the community to design
practical prevention programmes.
PC-SPIRS 3.40
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1 of 5
TI : Serum cholesterol and coronary artery disease in populations with low
cholesterol levels: the Indian paradox.
Alls Singh-RB; Rastogi-V; Nias-MA; Ghosh-S; Sy-RG; Janus-ED
AD: Heart Research Laboratory and Centre of Nutrition, Medical Hospital and
Research Centre, Moradabad, India.
SO: Int-J-Cardiol. 1998 Jun 1; 65(1): 81-90
____ this source is not Available in S■J.M,C.Library
LA: ENGLISH
AB: OBJECTIVE: To examine the relation between serum cholesterol and coronary
artery disease prevalence below the range of cholesterol values generally
observed in developed countries. DESIGN AND SETTING: Cross-sectional survey of
two randomly selected villages from Moradabad district and 20 randomly selected
streets in the city of Moradabad. SUBJECTS AND METHODS: 3575 Indians, aged
25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men,
902 women) subjects. The survey methods were questionnaires, physical
examination and electrocardiography . RESULTS: The overall prevalences of
coronary artery disease were 9.07. in urban and 3.3% in rural subjects and the
prevalences were significantly (P<0.001) higher in men compared to women in
both urban (11.0 vs. 6.97.) and rural subjects (3.9 vs. 2.67.). The average serum
cholesterol concentrations were 4.91 mmol/1 in urban and 4.22 mmol/1 in rural'
subjects without any sex differences. The prevalences of coronary artery
disease were significantly higher among subjects with low and high serum
cholesterol concentration compared to subjects with very low cholesterol and
showed a positive relation with serum cholesterol within the range of serum
cholesterol level studied in both rural and urban in both sexes. Among subjects
with low serum cholesterol, there was a higher prevalence of coronary risk
factors, hypertension, diabetes, obesity and sedentary lifestyle. Serum
cholesterol level showed a significant positive relation with low density
lipoprotein cholesterol and triglycerides in all the four subgroups. Logistic
regression analysis after pooling of data from both rural and urban, with
adjustment of age showed that low serum cholesterol level (odds ratio: men
0.96, women 0.91) had a positive strong relation with coronary artery disease
and there was no evidence of any threshold. Diabetes mellitus (men 0.73, women
0.74) and sedentary lifestyle (men 0.86, women 0.74) were significant risk
factors of coronary disease in both sexes. Hypertension (men 0.82, women 0.64)
and smoking (men 0.81, women 0.52) were weakly associated with coronary disease
in men but not in women. CONCLUSION: Serum cholesterol level was directly
related to prevalence of coronary artery disease even in those with low
cholesterol concentration (<5.18 mmol/1). It is possible that some Indian
populations may benefit by increased physical activity and decline in serum
cholesterol below the range of desired serum cholesterol in developed
countries.
2 of 5
TI: Social class and coronary artery disease in a urban population of North
India in the Indian Lifestyle and Heart Study.
AU: Singh-RB; N.iaz-MA; Thakur-AS; Janus-ED; Moshiri-M
AD: Centre of Nutrition, Medical Hospital and Research Centre, Moradabad-10,
India■
SO: Int-J-Cardiol. 1998 Apr 1; 64(2): 195-203
____ this source is not Available in S■J.M.C.Library
LA: ENGLISH
AB: OBJECTIVE: To determine the association of social class with prevalence of
coronary risk factors and coronary artery disease (CAD). DESIGN AND SETTING:
Total community cross sectional survey of 20 randomly selected streets in the
city of Moradabad. SUBJECTS AND METHODS: 1806 urban (904 men and 902 women)
randomly selected subjects aged 25-64 years. The survey methods were physician
and dietitian administered questionnaire, physical examination and
electrocardiography . All subjects were divided into social classes 1-5 based on
attributes of education, occupation, per capita income, housing condition and
consumer durables and other family assets. RESULTS: Social classes 1, 2 and 3
were mainly high and middle socioeconomic groups and 3 and 4 low income groups.
The prevalence of CAD and coronary risk factors hypercholesterolemia,
hypertension, diabetes mellitus and sedentary lifestyle were significantly
higher among social classes 1, 2 and 3 in both sexes compared to lower social
classes. Mean serum Cholesterol, trig lycer ides, low density lipoprotein:
cholesterol and blood pressure were significantly associated with higher and
middle social classes. Smoking was significantly associated with lower social
classes. Multivariate logistic regression analysis after adjustment of age
revealed that social class was positively associated with CAD (odds ratio: men
0.84, women 0.86), hypercholesterolemia (men 0.87, women 0.85), hypertension
(men 0.91, women 0.89), diabetes mellitus (men 0.71, women 0.68) and sedentary
lifestyle (men 0.68, women 0.66). Smoking was significantly associated with CAD
in men. CONCLUSION: Social class 1, 2 and 3 in an urban population of India
have a higher prevalence of CAD and coronary risk factors
hypercholesterolemia, hypertension, diabetes mellitus and sedentary lifestyle
in both sexes.
3 of 5
TI: Oral submucous fibrosis in India: a new epidemic?
AU: Gupta-PC; Sinor-PN; Bhonsle-RB; Pawar-VS; Mehta-HC
AD: Tata Institute of Fundamental Research, Maharashatra , India.
SO: Natl—Med-J-India. 1998 May-Jun; 11(3): 113-6
____ This source is Available in S.J.M.C Library
____ Call Number: From: 1988+
LA: ENGLISH
AB: BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition
caused by use of the areca nut. The reported prevalence of OSF in Bhavnagar
district during 1967 was. 0.167.. We investigated whether the impression of an
increase in the incidence of the disease was real. METHODS: A house-to-house
survey was conducted in Bhavnagar district, Gujarat state. The use of areca
nut-containing products and tobacco was assessed through an interviewer
administered questionnaire. The oral examination was done by dentists. The
diagnostic criteria for OSF was the presence of palpable fibrous bands.
RESULTS: A total of 11,262 men and 10,590 women aged 15 years and older were
interviewed for their tobacco habits. Among 5018 men who reported the use of
tobacco or areca nut, 164 were diagnosed as suffering from OSF. All but four
cases were diagnosed among 1786 current areca nut users (age-adjusted relative
risk: 60.6). Areca nut was used mostly in mawa, a mixture of tobacco, lime and
areca nut, and 10.97. of mawa users had OSF (age-adjusted relative risk: 75.6).
The disease as well as areca nut use was concentrated (about 857.) in the lower
(< 35 years) age group. CONCLUSIONS: An increase in the prevalence of OSF,
especially in the lower age groups, directly attributable to the use of areca
nut products was observed. This could lead to an increase in the incidence of
oral cancer in the future.
4 of 5
TI: Low birth weight and associated maternal factors in an urban area.
AU: Deshmukh-JS; Motghare-DD; Zodpey-SP; Wadhva-SK
AD: Department of Preventive and Social Medicine, Government Medical College,
Nagpur.
SO: Indian-Pediatr. 1998 Jan; 35(1): 33-6
This source is Available in S.J.M.C Library
Call Number: From: 1969+
LA: ENGLISH
AB: OBJECTIVE: To study the prevalence of low birth weight (LBW) and its
association with maternal factors. DESIGN: Cohort study. SETTING: Urban
community. SUBJECTS: Cohort of 210 pregnant women. RESULTS: The LBW prevalence
was 30.37.. On multivariate analyses the maternal factors significantly
associated with LBW were anemia (OR-4.81),•low socioeconomic status (OR-3.96),
short birth interval (OR—3.84), tobacco exposure (OR-3.14), height (DR-2.78),
maternal age (OR—2.68), body mass index (OR—2.02), and primiparity (OR 1.58).
CONCLUSIONS: Anemia, low socioeconomic status, short stature, short birth
interval. Tobacco exposure, low maternal age, low body mass index, and
primiparity are significantly risk factors for LBW.
5 of 5
TI: Prevalence of respiratory symptoms, bronchial hyperreactivity, and asthma
in a megacity. Results of the European community respiratory health survey in
Mumbai (Bombay).
AU: Chowgule-RV; Shetye-VM; Parmar-JR;. Bhosale~AM; Khandagale-MR;
Phalnitkar-SV; Gupta-PC
AD: Department of Chest Medicine, Bombay Hospital Institute of Medical Sciences
and Tata Institute of Fundamental Research, Mumbai, India.
SO: Am-J-Respir-Crit-Care-Med. 1998 Aug; 158(2): 547-54
____ this source is not Available in S.J.M.C.Library
LA: ENGLISH
AB: To estimate adult asthma prevalence in the world's most rapidly growing
mega-city, we applied epidemiologic surveillance tools, as a cooperating center
of the European Community Respiratory Health Survey, to a randomly selected
sample of Mumbai (Bombay) residents in 1992 through 1995. From a metropolitan
population of over 10 million, we took a one-in-ten random sample from
electoral rolls.in a socially diverse residential district, and examined asthma
symptoms in adults age 20 to 44 yr. In Phase I, we interviewed 2,313 adults
about symptoms, asthma diagnosis, and medications in the previous 12 mo. In
Phase II, family and smoking history, socioeconomic data, housing
characteristics, serum IgE, allergy skin tests, spirometry, and methacholine
challenge tests were obtained in a subset of 207. of those who had completed
Phase I. House dust mite was the most common positive skin test (187.
prevalence) and the only one of the nine applied that, was significantly
associated with asthma symptoms and physician-diagnosed asthma. Asthma
prevalence was 3.57. by physician diagnosis, and 177. using a very broad
definition including those with asymptomatic bronchial hyperreactivity. Asthma
prevalence was strongly associated with positive house dust mite skin test,
family history of asthma, and total IgE.
,PC SPIRS 3,40
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intellectual property protection as dictated by the appropriate laws of your
country and/or by International Convention.
1 of 7
TI: Alcohol as an additional risk factor in laryngopharyngeal cancer in
Mumbai—a case-control study.
AU: Rao-DN; Desai-PB; Ganesh-B
AD: Division of Epidemiology and Biostatistics, Parel, Mumbai, India.
SO: Cancer—Detect-Prev. 1999; 23(1): 37-44
____ this source is not Available in S.J.M,C.Library
LA: ENGLISH
AB: A retrospective case-control study of 1698 male pharyngeal and laryngeal
cancers seen at the Tata Memorial Hospital, Mumbai from 1980 to 1984 was
undertaken to assess the association between the cancers and chewing, smoking.
and alcohol habits. Male controls were chosen from persons who attended the
hospital during the same period and who were diagnosed as free from cancer,
benign tumor, and infectious disease. Statistical analysis was based on
unconditional logistic regression method.^Bidi smoking and alcohol drinking
emerged as significant factors for pharyngeal and laryngeal cancers?)
Illiterates had 50 to 60% excess risk for pharyngeal cancer only. Nonvegetarian
diet did not emerge as significant factor in our study.
2 of 7
TIs Dietary factors in oral leukoplakia and submucous fibrosis in a
population—based case control study in Gujarat, India.
AU: Gupta-PC; Hebert-JR; Bhonsle-RB; Sinor-PN; Mehta-H; Mehta-FS
AD: Epidemiology Research Unit, Tata Institute of Fundamental Research, Bombay,
India.
SO: Oral-Dis. 1998 Sep; 4(3): 200-6
____ this source is not Available in S.J.M.C.Library
LA: ENGLISH
AB: OBJECTIVES: To investigate the relationship of specific nutrients and food
items with oral precancerous lesions among tobacco users. DESIGN: A
population-based case-control study. SETTING: Villages in Palitana taluk of
Bhavnagar district, Gujarat, India. SUBJECTS AND METHODS: An
interviewer-administered food frequency questionnaire, developed and validated
for this population, was used to estimate nutrient intake in blinded,
house-to-house interviews. Among 5018 male tobacco users, 318 were diagnosed as
cases. An equal number of controls matched on age (+/- 5 years), sex, village,
and use of tobacco were selected. MAIN OUTCOME MEASURES: Odds ratios (OR) from
multiple logistic regression analysis controlling for relevant variables (type
of tobacco use and economic status). RESULTS: A protective effect of fibre was
observed for both oral submucous fibrosis (OSF) and leukoplakia, with 107.
reduction in risk per g day-1 (P < 0.05). Ascorbic acid appeared to be
protective against leukoplakia with the halving of risk in the two highest
quartiles of intake (versus the lowest quartile: OR = 0.46 and 0.44,
respectively; P < 0.10). A protective effect of tomato consumption was observed
in leukoplakia and a suggestion of a protective effect of wheat in OSF.
CONCLUSION: In addition to tobacco use, intake of specific nutrients may have a
role in the development of oral precancerous lesions.
3 of 7
TI: Drug abuse in Nepal: a rapid assessment study.
AU: Chatterjee-A ; Uprety-L; Chapagain-M; Kafle-K
AD: University of California at Los Angeles, Fogarty International Training
Program, School of Public Health, Department of Epidemiology. USA.
pH '6'
SO: Bull-Narc. 1996; 43(1-2): .11-33
this source is not Available in S.J,M.C.Library
LA: ENGLISH
AB: A rapid assessment of drug abuse in Nepal was 'conducted at. different sites,
including eight municipalities in the five development regions of the country.
To interview various groups of key informants, such methods as semi-structured
interviews, in-depth interviews and focus group discussions were used. A
snowball sampling strategy for respondents who were drug abusers and a
judgemental sampling strategy for the non-drug-using key informants were
applied. About one fifth of the sample was recruited from the treatment centres
and the rest from the community. Drug abusers in prison were interviewed, and
secondary data from treatment centres and prisons analysed. The study revealed
that the sample of drug abusers had a mean age of 23.3 years and was
overwhelmingly male. Most respondents lived with their families and were either
unemployed or students. About 30 per cent of the sample was married. A large
majority of the sample had a family member or a close relative outside the
immediate family who smoked or drank alcohol and a friend who smoked, drank or
used illicit drugs. Apart from tobacco and alcohol, the major drugs of abuse
were cannabis, codeine-containing cough syrup, nitrazepam tablets,
buprenor-phine injections and heroin (usually smoked, rarely injected). The
commonest sources of drugs were .other drug-using friends, cross-border supplies
from India or medicine shops. The commonest source of drug money was the
family. There has been a clear trend towards the injection of buprenorphine by
abusers who smoke heroin or drink codeine cough syrup. The reasons cited for
switching to injections were the unavailability and rising cost of
non-injectable drugs and the easy availability and relative cheapness of
injectables. About a half of the injecting drug users (IDUs) commonly reported
sharing injecting equipment inadequately cleaned with water. Over a half of
IDUs reported visiting needle-exchange programmes at two of the study .sites
where such programmes were available. Infection by the human immunodeficiency
virus (HIV) appears to be low among IDUs, although systematic surveillance is
absent. Two thirds of the sample had experienced sexual intercourse. The last
sex partners reported by respondents were commercial sex workers, wives or girl
friends. Condom use was low with primary partners and relatively high with sex
workers. Treatment facilities, mostly located in the central urban areas of the
country, are meagre. An overwhelming majority of drug abusers felt the need to
stop abusing drugs. Cost-effective drug treatment and HIV prevention programmes
for IDUs are urgently needed in all areas of the country.
4 of 7
TI: Head and neck cancer: a global perspective on epidemiology and prognosis.
AU: Sankaranarayanan-R; Masuyer-E; Swaminathan-R; Ferlay-J; Whelan-S
AD: Unit of Descriptive Epidemiology International Agency for Research on
Cancer 150, Lyon, France.
SO: Anticancer-Res. 1998 Nov-Dec; 18(6B): 4779-86
____ this source is not Available in S.J.M.C.Library
LA: ENGLISH
AB: Head and neck cancers (ICD-9 categories 140-149 and 161) are common in
several regions of the world where tobacco use and alcohol consumption is high.
The age standardized incidence rate of head and neck cancer (around 1990) in
males exceeds 30/100, 000 in regions of France, Hong Kong, the Indian
sub-continent, Central and Eastern Europe, Spain, Italy, Brazil, and among US
blacks. High rates (> 10/100,000) in females are found in the Indian
sub-continent, Hong Kong and Philippines. The highest incidence rate reported
in males is 63.58 (France, Bas-Rhin) and in females 15.97 (India, Madras). The
variation in incidence of cancers by subsite of head and neck is mostly related
to the relative distribution of major risk factors such as tobacco or betel
quid chewing, cigarette or bidi smoking, and alcohol consumption. Some degree
of misclassification by subsites is a clear possibility in view of the close
proximity of the anatomical subsites. While mouth and tongue cancers are more
common in the Indian sub-continent, nasopharyngeal cancer is more common in
Hong Kong; pharyngeal and/or laryngeal cancers are more common in other
populations. While the overall incidence rates show a declining trend in both
sexes in India. Hong Kong, Brazil and US whites, an increasing trend is
observed in most other populations, particularly in Central and Eastern Europe,
Scandinavia, Canada, Japan and Australia. The overall trends are a reflection
of underlying trends in cancers of major subsites which seem to be related to
the changing prevalence of risk factors. The five year relative survival varies
from 20-907. depending upon the subsite of origin and the clinical extent of
disease. While primary prevention is the potential strategy for long term
disease control, early detection and treatment may have limited potential to
improve mortality in the short term.
5 of 7
TIs Acute respiratory disease survey in Tripura in case of children below five
“years of age.
AU: Deb—SK
AD: Department of Paediatrics, IBM Hospital, Agartala.
SQ: J-Indian-Med-Assoc. 1998 Apr; 96(4): 111-6
____ this source is not Available in S.J,M.C.Library
LA: ENGLISH
AB: This epidemiological study has been carried out in urban and rural areas of
West Tripura district, to determine the incidence, causes, risk factors,
morbidity and mortality associated with acute respiratory infection (ARI) and
impact of simple case management in children under 5 years of age. The annual
attack rate (episode) per child was more in urban area than in rural area.
Monthly incidence of ARI was 237. in urban area, 17.657. in rural area. The
overall incidence of ARI was 20%. The incidence of pneumonia was 16 per 1000
children in urban area and 5 per 1000 in rural area. The incidence of pneumonia
was found to be the highest in infant group; 37. of ARI cases in rural area and
77. in urban area developed pneumonia. Malnourishment in urban area was 547. and
in rural area 657.. Malnourished children have higher likelihood for developing
respiratory infection. The relative risk (RR) of developing pneumonia was 2.3
in malnourished children. Most children (597.) had been immunised with measles
and diphtheria, pertussis and tetanus (DPT) vaccine earlier. The immunisation
had a protective role in pneumonia. The RR was 2.7 in non-immunised group. Air
pollution of the urban area had stronger relation for bronchial asthma than
pneumonia. Breastfeeding had protective role in pneumonia and severe disease.
Bottlefeeding had greater risk of developing pneumonia. Lower socio-economic
status had the greater risk, of ARI episodes. ARI was decreased as the petcapita income increased. An increase in magnitude of ARI was observed with the
decrease of literacy rate. Administration of co-trimoxazole for pneumonia case
by trained health worker using simple case management strategies can reduce
deaths from pneumonia significantly. Health education can change health care
seeking behaviours and attitude of parents and other family members to take
care of the ARI child in the home itself for preventing pneumonia death.
6 of 7
TI: Risk assessment of tobacco, alcohol and diet in cancers of base tongue and
oral tongue—a case control study.
AU: Rao-DN; Desai-PB
AD: Division of Epidemiology and'Biostastistics, Tata Memorial Hospital , Parel ,
Mumbai, India.
SO: Indian—J—Cancer. 1998 Jun; 35(2): 65-72
____ This source is Available in S.J.M.C Library
____ Call Number: From: 1963+
LA: ENGLISH
AB: This is a retrospective case-control study of male tongue cancer patients
seen at Tata memorial Hospital, Bombay, during the years 1980-84. The purpose
of the study was to identify the association of tobacco, alcohol, diet and
literacy status with respect to cancers of two sub sites of tongue namely
anterior portion of the tongue (AT) (ICD 1411-1414) and base of the tongue (BT)
Tobacco Control — Balbach and Glantz 7 (4); 397
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Tob Control 1998:7:397-408 ( Winter)
► Abstract of this Article
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Tobacco control advocates must
demand high-quality media
campaigns: the California experience
► PubMed Citation
Edith D Balbach. Stanton A Glantz
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Abstract
Top
OBJECTIVE—To document efforts on the part of public officials
■ Abstract
in California to soften the media campaign's attack on the tobacco
.’ Introduction
Methods
industry' and to analyse strategies to counter those efforts on the
Early controversies over the—
part of tobacco control advocates.
Legislative attempts to weaken—
METHODS—Data were gathered from interviews with programme
Using contracting procedures to—
participants, direct observation, written materials, and media
Implementing Pringle's policies...
Shutting the public health—
stories. In addition, internal documents were released by the state's
▼ Administration secretly tonedDepartment of Health Services in response to requests made under
Public health advocacy groups...
■v The TEROC purge
the California Public Records Act by Americans for Nonsmokers'
The advertisements are...
Rights. Finally, a draft of the paper was circulated to 11 key
Discussion
players for their comments.
▼ References
RESULTS—In 1988 California voters enacted Proposition 99, an
initiative that raised the tobacco tax by $0.25 and allocated 20% of the revenues to anti-tobacco
education. A media campaign, which was part of the education programme, directly attacked the
tobacco industry, exposing the media campaign to politically based efforts to shut it down or soften it.
Through use of outsider strategies such as advertising, press conferences, and public meetings,
programme advocates were able to counter the efforts to soften the campaign.
CONCLUSION— Anti-tobacco media campaigns that expose industry manipulation are a key
component of an effective tobacco control programme. The effectiveness of these campaigns, however,
makes them a target for elimination by the tobacco industry. The experience from California
demonstrates the need for continuing, aggressive intervention by non-governmental organisations in
order to maintain the quality of anti-tobacco media campaigns.
(Tobacco Control 1998;7:397-408)
Keywords: media campaigns; anti-tobacco advocacy; California
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Introduction
In 1988 California voters enacted Proposition 99, an initiative that
raised the tobacco tax by $0.25 and allocated 20% of the revenues
to anti-tobacco education.^ In its first years, this dedicated tax
generated over $100 million per year for anti-tobacco education,
making it the largest tobacco control programme in the world.2 For
- Top
Abstract
• Introduction
▼ Methods
▼ Early controversies over the...
v Legislative attempts to weaken...
Using contracting procedures Io..,
▼ Implementing Pringle's policies...
■ ■ Shutting the public health...
-r Administration secretly toned..,
▼ Public health advocacy groups...
▼ The TEROC purge
t The advertisements are..,
•• Discussion
▼ References
the supporters of the Proposition 99 education programmes,
however, the passing of the initiative was just the first step in
securing a strong anti-tobacco education programme; the
legislature still had to appropriate the money to the programme and
the administration had to implement it. In the first authorising
legislation—Assembly Bill 75 (AB75)—the tobacco industry tried
to prevent any of the education money from being spent on an
anti-tobacco media campaign, but it failed, due to the obvious and heavy-handed tactics it used to
influence the legislature and the nearness of the election.22
The California Department of Health Services (DHS), one of the agencies charged with programme
implementation under AB75, envisioned delivering an aggressive anti-tobacco programme that
combined statewide media with local community-based activities.-^ Under Governor George
Deukmejian (Republican), DHS moved quickly to implement the media campaign. The Request for
Proposals was released on 1 December 1989, 59 days after Deukmejian signed the appropriations bill.
with responses from advertising agencies due on 10 January 1990. The advertising agency
keye/donna/perlstein was selected to run the media campaign on 26 January,£ and the first
advertisements were released 73 days later, on 10 April 1990,2 accompanied by a full-page newspaper
advertisement on 11 April 1990 (figure 1 and box).
The Proposition 99 media campaign took a substantially different approach than previous anti-tobacco
education campaigns had. As recounted by Paul Keye, one of the principals in the advertising firm:
"The cigarette companies were never in any of the advertising agency's original thoughts or
conversations with the Department of Health Services. You can't find the topic in our first
work.. .. What happened was that—as we dug into each topic—there, right in the middle of
everything were the Smokefolk, making their quaint, nonsensical arguments and—by sheer
weight of wealth and power and privilege—getting away with it. ... Frankly, the tobacco
industry pissed us off. They insulted our intelligence."S
So, instead of traditional public health messages that "tobacco is bad for you", Keye started the
campaign on the tack of directly attacking the tobacco industry, a strategy that DHS soon adopted and
advocated.^ - The aggressive tone of the media campaign is credited with contributing to a tripling of
the rate of decline of tobacco consumption in Califomia.SUl
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First, the smoke. Now, the mirrors.
In less than a generation, the bad news about cigarettes has become no news. Most Americans
—even the very young—know the unavoidable connection between smoking and cancer,
smoking and heart disease, smoking and emphysema and strokes.
Today a surprising number of us can tell you that cigarettes are our #1 preventable cause of
death and disability.
So, we seem to know about the smoke. But what about the really dangerous stuff—all those
carefully polished, fatal illusions the tobacco industry has crafted to mess with our minds so
they can mess with our lives?
"Smoking is important. It makes you beautiful andfun and sexy. (Okay, it's dangerous. But
lots of exciting things are dangerous.) Smoking makes you powerful. It says you're sensitive and
grown up."
That's one hell of a message. How can you fight it?
Today, the California Department of Health Services begins a fifteen month advertising
campaign that goes right at the tobacco companies' predatory marketing—the selective
exploitation of minorities, the seduction of the young, the selling of suicide.
Well, won't the tobacco industry fight this campaign?
Sure. The smokescreen has already begun. "This effort pits smokers against non-smokers."
Wrong. This program would have never happened without the active support of California's
smokers. Despite their habit, or maybe because of it, they wanted people to know the truth
about addiction and discomfort and disease and death. (Ask smokers if they want their children
to smoke. Or their grandchildren. Ask them if they'd start smoking if they could have the
decision back.)
"This is a threat to our First Amendment right to advertise a legal product."
On the contrary, we intend to make you more aware of the tobacco industry's advertising.
And, if we pinch the right nerve, we expect them to make you more aware of ours.
This is going to be a media campaign about a media campaign—as much about hype as
hygiene. It's going to talk about a shared community opportunity and a shared community
menace.
There's never been anything quite like it. But this is California. We don't need to do it the way
it was done before.
CALIFORNIA DEPARTMENT OF HEALTH SERVICES
Figure 1 A copy of the full-page advertisement that ran in newspapers to mark the advent of
the media campaign, along with a reproduction of the text from the ad.
The first television advertisement, "Industry Spokesman" (figure 2), portrayed tobacco industry
executives discussing the need to hook kids on tobacco, while laughing that, "We're not in this for our
health". These advertisements generated major controversy, with the tobacco industry complaining
publicly that it was inappropriate for government to attack a legal business.-^
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Figure 2
The first advertisement in the California
campaign, "Industry Spokesman," depicted a group of
tobacco industry executives sitting around a boardroom
joking about recruiting new smokers. Despite being the
advertisement with the highest recall in the California
programme, the Wilson administration refused to air it.
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The internal response of the tobacco industry was immediate. By 18 April 1990, Samuel D Chilcote Jr,
president of The Tobacco Institute, the Washington-based lobbying organisation for the tobacco
industry, sent out a memo to members of his executive committee, providing a "further update on our
efforts to deal with the anti-smoking advertising campaign in California". The Tobacco Institute outlined
a four-part strategy for dealing with the media campaign. The first part was to encourage the California
legislature to intervene, the second part was to cooperate with other groups to encourage them to oppose
the campaign, the third was to convince Ken Kizer, the DHS director, to "pull or modify" the
advertisements, and fourth was to encourage the governor to intercede against the campaign. Because the
Institute believed that Kizer would not modify the advertisements without pressure from the
administration and because Deukmejian, as a lame-duck governor, was unlikely to pressure Kizer, it
concluded: "It is clear that our efforts should center on the first two strategies".-^
Since its inception, the media campaign has remained the source of controversy, with California tobacco
control advocates working to maintain an aggressive tone and the tobacco industry and its allies seeking
to soften the tone and limit the scope of the campaign. These issues marked the debate over the media
campaign in 1996-1997. As this paper will document, while health groups succeeded in stopping the
explicit legislative restrictions against attacking the tobacco industry that the pro-tobacco forces tried to
include in the Budget Act, decisions and processes by the administration of Governor Pete Wilson, who
had succeeded Deukmejian, tried to achieve the same goals. Eventually, by mounting outside pressure on
the administration, public
’ . : llil
V-...
|l ,\1|.
.
■
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health groups were able to push the media campaign back towards its original posture. The experience
from California demonstrates the need for continuing, aggressive intervention by non-governmental
organisations to maintain the quality of anti-tobacco media campaigns.
Methods
The information used to prepare this report was gathered from
interviews with the participants, direct observation, written
correspondence, and media stories. Where media stories have been
based on California Public Records Act requests, we have also
obtained the documentation on which the storied were based to
verify the accuracy of the reported information.
-. Top
Abstract
Introduction
■ Methods
Early controversies over the—
•v Legislative attempts to weaken—
v Using contracting procedures to...
- Implementing Pringle's policies—
Shutting the public health—
▼ Administration secretly toned—
•r Public health advocacy groups...
■ The TEROC purge
The advertisements are...
Discussion
” References
a
In addition, internal documents about the 1996-1997 media
campaign were released by the Department of Health Services in
response to requests made under the California Public Records Act
by Americans for Nonsmokers' Rights. These materials document
the internal response to the events occurring outside of the
Department. Finally, a draft of the paper was circulated to 11 observers of the 1996-1997 conflict for
their comments.
Early controversies over the media campaign
The flexibility the media campaign enjoyed under Deukmejian
dissipated with the inauguration of Pete Wilson (R) as governor in
January, 1991. Deukmejian had taken a "hands off policy with
regard to the development and production of the advertisements,
leaving the control of the campaign in the hands of the
professionals in the Department of Health Services.-^ 15 According
to Kizer, once Wilson became governor, there were comments
from Wilson's office that they wanted the subsequent
advertisements toned down and wanted to review them.15 Wilson
eventually attempted to shut the media campaign down completely
and, failing that, imposed increasingly tight political control over it.
• • Top
Abstract
.. Introduction
Methods
■ Early controversies over the—
Legislative attempts to weaken..,
-r Using contracting procedures to...
■v Implementing Pringle's policies—
- Shutting tlie.public health...
-■ Administration secretly toned—
’ Public health advocacy groups...
The TEROC purge
▼ The advertisements are—
Discussion
■ =■ References
Wilson's first overtly hostile action toward the media campaign was to attempt to end it entirely. In his
budget proposal of 10 January 1992, Governor Wilson suspended the media campaign by diverting all
of its funding for the current and subsequent fiscal years, claiming that it was of "secondary"
importance.Hi Dr Molly Joel Coye, who had replaced Kizer as the director of the Department of Health
Services, and Betsy Hite, departmental spokeswoman, claimed that the local programmes funded by
Proposition 99 were a more effective use of resources and that the smoking decrease that followed the
beginning of the media campaign was actually part of a trend that began in 1987, rather than the result
of the anti-smoking advertising campaign.^ 1812 The move was supported by the tobacco industry ,22
which had planned as early as 1990 to work with a variety of minority groups, the hospital groups, the
California Medical Association, and business groups to divert money from the media account into other
health programmes.-^
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The claims that the media campaign was unimportant or ineffective were contradicted a few days later,
on 14 January 1992, when John Pierce, a professor from the University of California al San Diego and
director of the California Tobacco Survey (which is done under contract to DHS), speaking at the
American Heart Association Science Writers Conference, released preliminary data from the survey. The
data demonstrated a 17% drop in the percentage of adults who smoked since Proposition 99 passed, and
Pierce attributed this drop to the combined effects of the tax, educational efforts, and the media
campaign.^! 22
Rather than claiming credit for this success, the administration attacked Pierce's result, asserting that the
conclusions were overstated.12 22 24 j]jte pressured staff members in the DHS Tobacco Control Section
(TCS) to provide data to show that the tobacco control programmes were ineffective. Hite specifically
told Jacquolyn Duerr, then head of the media campaign, to back up Hite's assertion that the rapid decline
in smoking had nothing to do with Proposition 99. Duerr and Michael Johnson, the head of the DHS's
evaluation efforts, and Pierce's contract monitor, refused to comply. (Hite's activities did not come to
light until December 1996.)2526
Wilson and Coye, however, refused to issue the contract of 1 January 1992 to the advertising agency to
continue the media campaign, which shut the campaign down immediately.22 2S Although the local
programme efforts kept the tobacco control programme moving forward,- during the time the media
campaign was suspended, the decline in tobacco consumption did slow-LL (figure 3). The American
Lung Association sued successfully to restore the media campaign,22 30 an(j [|ie administration was
required to sign the contract with the advertising agency for the period 20 May 1992 to 30 June 1993.21
Figure 3 Long-term patterns of cigarette consumption in
California show that when the media (and other aspects of the
tobacco control programme) were suspended or weakened, the
progress in reducing cigarette use was arrested.
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In the fiscal years, 1994-95 and 1995-96, the legislature continued to allocate money—nearly S12
million annually—to the media campaign. The allocation of money, however, did not ensure that a
quality programme would result or even that the money would necessarily be spent. There was little new
anti-tobacco advertising produced during that period, and none at all between September 1995 and
20 March 1997. In 1995-1996, the Wilson administration only spent S6.5 million of the SI 2.2 million
the legislature appropriated for the media campaign. This weakening of the media campaign, in content
and intensity, was associated with a lessening of the effect of the overall anti-tobacco programme on
tobacco consumption and an increase in adult smoking prevalence!! (figure 3).
There was also growing political control and controversy over the content of the campaign. Three
anti-industry advertisements—two for television and one billboard—were pulled from use. One
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advertisement, "Nicotine Soundbites" (figure 4), was constructed from news coverage of the hearing of
14 April 1994 conducted in the United States Congress by Representative Henry Waxman, in which
tobacco industry executives were shown claiming that nicotine is not addictive. The advertisement ended
with the tag line: "Do they think we're stupid?" The advertisement was shown briefly in autumn
1994. RJ Reynolds threatened to sue, claiming defamation,32 but Kimberly Belshe, the new DHS
director, publicly defended "Soundbites", and it remained on the air.33 After this public display of
support, however, DHS quietly shelved "Nicotine Soundbites" in early 1995,34 and it has not been
shown since in California, despite repeated requests to do so by public health advocates, including the
Tobacco Education and Research Oversight Committee (TEROC)which has statutory oversight over
the programme. Another advertisement, "Insurance", pointed out that insurance companies owned by the
tobacco industry charged non-smokers less for life insurance. The advertisement was reportedly finished
but was not being used. Public health advocates held a press conference on 12 December 1995, to urge
that the advertisement be broadcast,but the Wilson administration refused.33
Figure 4 The "Nicotine Soundbites" advertisement was
based on the Congressional hearings at which tobacco
executives denied that nicotine was addictive. The Wilson
administration pulled the advertisement after the tobacco
industry complained, and kept it off the air, despite repeated
demands by public health advocates that it be put back on
the air.
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A billboard was also pulled from use. In September 1994 (although this information did not become
public until two years later), Sandra Smoley, secretary of health and welfare, the cabinet secretary over
DHS and a Wilson appointee, personally ordered that 190 billboards saying: "Are you choking on
tobacco industry lies?" be papered over at a cost of $10 000, even though the billboards had been
approved by Belshe. When challenged on this, and related actions by the American Cancer Society, the
American Heart Association, and Americans for Nonsmokers' Rights, Smoley defended her position,
saying:
"The billboard 'Are you choking on tobacco company [ifc] lies?' was pulled because it was
found to be offensive for government to use taxpayer funds to call a private industry a liar.
... I also supported DHS's decision to stop airing the ad called ’Nicotine Soundbites.' DHS
made the judgment call that continuing to air the ad would raise unacceptable legal risks
.. . Your organisations have given unwarranted emphasis to the decision not to air an ad
known as ’Insurance'. . . . While the ad had much potential, and could have been aired with
further work, DHS dropped the ad immediately after your press conference [emphasis in the
original]."32
Smoley, a registered nurse, did not approve of accusing the tobacco industry of lying.
Legislative attempts to weaken the media campaign
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Following litigation and political action by programme
advocates = 40 jn june 1996, the legislature provided full funding
for the Proposition 99 education and research programmes for the
first time since Proposition 99 passed, including $25 million for
media. Although he acquiesced in the decision to provide full
funding, Assembly Speaker Curtis Pringle (R-Garden Grove)
attempted to include language in the budget to prohibit the media
account from being used to attack the tobacco industry. His
proposed bill language specified that advertisements "be based
solely on the health implications of tobacco use and on the health
implications of refraining from tobacco use."41 Such messages,
- ■ Top
a Abstract
as Introduction
Methods
* Early controversies over the...
■ Legislative attempts to weaken...
▼ Using contracting procedures to..,
▼ Implementing Pringle's policies...
Shutting the public healih...
▼ Administration secretly toned...
” Public health advocacy groups..,
■v The TEROC purge
▼ The advertisements are'7 Discussion
▼ References
stressing health effects of smoking, are not particularly effective at
preventing young people from smoking or motivating adults to stop.-D- — Pringle's justification was that
taxpayer dollars should not be used to attack a legal industry,— a position similar to that taken by
Smoley.
The governor's office reportedly did not support the proposed budgetary language restricting the media
account,— although the governor reportedly thought Pringle's points were valid. According to the Contra
Costa Times, Governor Wilson said that: "There is not a necessity to defame people in order to send a
very strong message that smoking is not a good thing. "42
Pringle was widely criticised for his stance. The editorial in the Sacramento Bee on 28 June 1996 was
representative. It said:
"Tobacco industry executives plainly don't enjoy turning on the television and seeing ads
telling Californians that the industry profits at the expense of their health. They don't like it
when researchers unmask their marketing and political strategies. It's not hard to understand
why they want the legislature to undermine those elements of Proposition 99. What's harder
to explain, and impossible to justify, is the speaker's willingness to do their work."44
Pringle's language putting limits on the media account was eventually dropped because of opposition
from key Democrats who were involved in the final budget negotiations.
Using contracting procedures to cut the media campaign
The successful defeat of legislative language to restrict the media
account, however, did not mean that public health professionals
would be allowed to run the media campaign without political
interference. As the year unfolded, it became clear that the Wilson
administration was restricting the media account quietly and
behind the scenes without legislation. Before the budget even
passed, those inside the administration were already implementing
restrictions similar to those Pringle had proposed.
a Top
- Abstract
as. Introduction
Methods
as Early controversies over the...
a Legislative attempts to weaken...
• Using contracting procedures to...
” Implementing Pringle's policies...
■v Shutting the public health—
-- Administration secretly toned...
▼ Public health advocacy groups—
’ The TEROC.pu.rge
▼ The advertisements are—
▼ Discussion
▼ References
At the time the 1996-1997 budget was signed, the contract to
administer the media account was held by the advertising agency
Asher/Gould, which had been awarded the contract in May
1994. When the new budget passed in 1996, the Department of Health Services extended Asher/Gould's
contract for producing media through 31 December 1996 and issued a new Request for Proposals (R.FP)
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for the media campaign for the period from 1 January 1997 through 31 December 1999. The new RFP
was not necessary because the existing contract with Asher/Gould had an option by which the state could
have extended it through June 1998 without going through the lengthy process of rebidding the contract.
The short extension that was given to Asher/Gould was done with the anticipation that new media could
be developed by September 1996, and that the placement of advertisements could continue, both
hard-hitting ones from the California archives and ones from other states.^ This effort to bridge the gap,
however, was largely cosmetic, because no new media was produced under the contract extension and
the effort to re-run advertisements from the archives was effectively stopped. Even after Asher/Gould
was issued a new contract on 1 December 1996, at the conclusion of the public bidding process, new
media was not released until 20 March 1997,42 which meant that from September 1995 until March
1997 no new media was released. By the time the new media was released, prevalence rates in adults
had begun to rise, and those under the age of 18 were showing increased susceptibility to smoking. 12
During the period when no new media was being produced, DHS continued to run a few of the most
recently produced advertisements, despite warnings from departmental staff that the advertisements were
so over-exposed that they had likely lost their effectiveness.42 The contracting process was also used as
an excuse to, in effect, cut the size of the media campaign in half; in 1995-1996, only $6.5 million of the
$12.2 appropriated by the legislature for media was spent, because of the delays in approving the
extension.42
Implementing Pringle’s policies administratively
Asher/Gould had been prepared to issue new advertisements under
the contract extension. As early as June 1996, Asher/Gould had
delivered story boards (pen and ink versions of the proposed
advertisements) to TCS for new media production under the
contract extension. Following a presentation of the story boards set
for 1 and 2 July 1996, production was scheduled to begin on
15 July with a proposed air date of 2 September.42
- . Top
Abstract
Introduction
Methods
j*. Early controversies over the...
Legislative attempts to weaken...
* Us.iiig.c.on.tracti.n.g.prpcedurcs to,.,
■ Implementing Pringle's policies...
Shutting the public health..,
■v Administration secretly toned—
” Public health advocacy grpjipji..,
v The TEROC purge
’’ The advertisements arc...
Discussion
■v References
Based on the past successes of the campaign, several of these
proposed advertisements featured attacks on the tobacco industry.
One of these advertisements was "Cattle", which showed cowboys
rounding up children as a metaphor for the tobacco industry
hooking kids on cigarettes. "Cattle" began with the words: "This is how the Tobacco Industry wants you
to see them . ..", and was originally to feature a kid being lassoed by one of the cowboys and dragged to
where another cowboy was waiting with a brand reading, "Tobacco Industry". The brand was to be
photographed moving towards the camera, which represented the child's point of view. The final line
was: "The Tobacco Industry. If you knew what they thought of you, you'd think twice." Another
advertisement: "Thank you", a television advertisement that eventually became a radio spot, was a
sarcastic "thank you" letter from the tobacco industry to kids in appreciation for their loyalty despite
overwhelming evidence that tobacco kills. It began with the line: "The Tobacco Industry would like to
thank ..." and ended with the line: "Sincerely, the Tobacco Industry". Three billboards were also
presented, two of which are shown in figure 5.
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Figure 5 Two billboards produced in March 1997. These
billboards were submitted to the Department of Health
Services by the advertising agency in June 1996. During the
intervening nine months, there was a tug-of-war between
administration officials, who watered down the
advertisements, and public health advocates, who wanted the
advertisements strengthened. The nine-month review
process resulted in no changes in these billboards.
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In July 1996, Mike Genest, assistant deputy director for prevention services at DHS, who was widely
viewed as representing the governor's interests in the department, was concerned that everything that
Asher/Gould had presented for young people was controversial and would need to be approved several
layers up the chain of command. He questioned the efficacy of the approach of attacking the tobacco
industry, prompting Bruce Silverman, president of Asher/Gould, to write to Dileep Bal, Chief of the
Cancer Control Branch (which includes TCS), that: "The only effective method I know of to achieve that
[reduction in tobacco use] via advertising is with the "Manipulation" strategy that we just tested".— In
addition to general concerns about attacking the industry, Genest wanted the words: "Tobacco Industry"
changed to "Big Tobacco".^Nothing was approved to go into production. It would take nearly nine
months for these advertisements to appear, with minor changes from the original proposals. During this
time, the ads would be watered down, then re-strengthened.
In addition to slowing the approval process, the Wilson administration made other changes designed to
tone down and slow down the media campaign. Prior policy had been that once an anti-tobacco
advertisement was approved, it was up to TCS and the media contractor's professional judgement when
to run a given advertisement. In August 1996, when Asher/Gould suggested running "Industry
Spokesman" again because it had not been aired for several years, Genest announced a new policy that
every advertisement, even those previously approved, be cleared for each use.29 Bal described this new
policy as "a fundamental change that I for one was unaware of until now. "51 Between the delay over the
new media and the need for re-approval of the old, there was clearly no intention of getting the media
campaign up and running in a hurry.
There were other steps taken inside the administration to impose tighter political controls on the media
campaign. On 16 September 1996, the DHS Office of Public Affairs (OP A) released a memo requiring
that all advertising concepts be reviewed by OPA before being focus group tested or shared with
"stakeholders/interested parties''.^! In other words, an official charged with protecting the
administration's political and public relations positions would review proposed advertisements for
political acceptability before any formal evaluation of the advertisements for quality or effectiveness as
public health messages could take place.
Finally, DHS was asked not only to justify media spots attacking the tobacco industry, but was also
required to justify the whole "countering pro-tobacco influences in the community" strategy .52 This
strategy, along with "reducing exposure to environmental tobacco smoke" and "reducing youth access to
tobacco", is one of the three main themes in all of DHS's programming, including media, local
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programmes, and the competitive grants. Robin Shimizu, chief of technical services, TCS, who oversees
the media campaign, warned that:
"These priorities were developed and renewed with the assistance of the tobacco control
communities throughout California and do not simply belong to DHS/TCS. To back away
from, or to have to justify the use of any one of them, or to eliminate one of the priorities
would be viewed harshly by everyone involved in tobacco control in the state as well as
other states, unless there were a very strong rationale for doing so."^
Bal, writing to Don Lyman, chief, Division of Chronic Injury and Disease Control, gave a similar
assessment:
"Countering pro-tobacco influences in the community' is the very signature piece of our
efforts to date, as any of the cognoscenti within or without the state will attest to. To have
that questioned in an issue memo you or I have not seen is beyond anything. Any
fundamental shift of these proportions without community input will produce quite a
mushroom-cloud, besides being ill-conceived. Caveat emptor."$4
Bal further offered to host "a full-scale consensus conference of the national cognoscenti" to discuss the
issue, suggesting that those who were requesting the justification did not really want this level of public
discussion of the issue. He also suggested that the "countering" strategy was being held to a higher
burden of proof that it worked than other interventions pursued by DHS.^
Shutting the public health community out of the process
- Top
Bal's offer to open up discussion of the basic campaign strategy to
•i Abstract
Introduction
include the public health community flew in the face of the general
approach taken by DHS in the fall of 1996. During the first years of ~ Methods
i EaHv cont.rovcrsics over the...
the California anti-tobacco media campaign, DHS and the
Legislative attempts to weaken...
Using contracting procedures to...
advertising agency had actively involved members of the public
a Implementing Pringle's policies...
health community in the development of the advertising
■ Shutting the public health...
campaign.^ Recognising that efforts to slow down and weaken the
▼ Administration secretly toned...
Public health advocacy groups...
media campaign would spark controversy within the public health
t The TEROC purge
community, the administration shut the public health community
■» The advertisements are—
■» Discussion
out of the review process. In the initial stages of the campaign,
-r References
DHS had involved a broad cross-section of the public health
community in the process of developing new media through a
large, somewhat informal media advisory committee. This committee stopped being convened, and the
administration even quit involving TEROC in the review of the story boards.
At its meeting on 10 December 1996, TEROC discussed the delays in the media campaign and the new
closed review process. James Stratton, the state health officer and DHS deputy director for prevention
services, announced that decision making about the media campaign had been removed from TCS and
that he had the final say over the content of the advertisements. TEROC made a formal request to be
allowed back into the process, in particular to have the opportunity to see and comment on the story
boards when new advertisements were being developed.^ Stratton refused.^
The veil of secrecy extended to the advertising firm as well. The new Asher/Gould contract issued on
1 December 1996 contained a new clause barring it from discussing the media campaign with anyone
outside the official process.^
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Administration secretly toned down the ads
»• Top
The administration had, in fact, weakened the June advertisements,
Abstract
Introduction
just as public health advocates had feared. All the story boards
submitted by Asher/Gould in June 1996 had been modified by
Early controversies over the.
removing the words "the tobacco industry" and "addiction". For
Using contracting procedures to.
example, "Cattle" now began: "This is how the guys who make
cigarettes ..." and the final line was: "If you knew what they
thought of you, you'd think twice." The words "tobacco industry"
Administration secretly toned...
Public health advocacy groups,.
did not appear. The advertisement, "Thank you" had also been
The TEROC purge
changed from: "The Tobacco Industry would like to thank .. ." to:
"Those of us who make cigarettes would like to thank you ...".
Discussion
References
The final line: "Sincerely, the Tobacco Industry" was still included
in the presentation attended on 5 December by TCS staff, Lynda
Frost, the deputy director of the office of public affairs, Genest, and Stratton, but it was later deleted.52
A new anti-industry advertisement, "Rain", featured cigarettes raining down on a playground and
discussed the tobacco industry's need to hook kids, but it never mentioned the tobacco industry by name.
The opening line was: "We have to sell cigarettes to your kids" and the final line was: "How low will
they go to make a profit?"
Another proposed new advertisement, "Voicebox", did attack the industry as it was proposed. It featured
a woman smoking through a tracheotomy, stating that the tobacco industry had lied to her about the
addictive nature of its products. In December, the industry attack was deleted, and the advertisement
instead promoted the state's toll-free (freephone) quit line. In the revised December version neither
addiction nor the tobacco industry is mentioned by name. The advertisement instead featured a smoker
who could not quit despite having a tracheotomy, urging others to give quitting a try. An anti-industry
advertisement had been converted into a cessation spot that said that quitting was impossible—a strange
message from a public health department.
In early 1997, Asher/Gould expressed concerns that all the advertisements as approved lacked clarity,
but they were particularly concerned with the way "Rain" had been changed by DHS, because it could be
misunderstood to include tobacco retailers and business in general, as opposed to just the tobacco
industry. TCS's relationship with the retailers was fragile and their cooperation was needed to implement
the state programme designed to reduce tobacco sales to the young.^2
The effort to tone down the attacks on the tobacco industry flew in the face of the research done for TCS
by Asher/Gould. In Asher/Gould's Summary Report^- of its focus group research on different
advertising messages, Christine Steele, an Asher/Gould senior vice president, reported that five
advertising strategies were tested on young people, aged 12 to 18, in focus groups in Sacramento and
Los Angeles.^ The messages tested were: (a) manipulation of kids by the tobacco industry, (b) the
dangers of secondhand smoke, (c) the short term health effects of smoking, (d) the risk of romantic
rejection, and (e) the elimination of risks to the environment caused by smoking, including cleaner
beaches, fewer trees destroyed to produce cigarettes, and fewer animals harmed by eating butts. Of the
five, manipulation by the industry tested very strongly with young people. According to Steele: "The
body language of kids clearly revealed that this strategy [the anti-industry strategy] provided kids with
an emotional wake up call. They sat up straight, they grimaced, they shook their heads, they became
riled up and vocal—they at least became concerned about this formerly 'low interest' topic."42
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Public health advocacy groups begin to protest
On 4 February 1997, the presidents of the American Cancer
Society (ACS), American Heart Association (AHA), and
Americans for Nonsmokers' Rights (ANR) wrote to Smoley to
express their frustration with the "administration's ostensible
defense of an industry responsible for the deaths of more than
42 000 Californians each year—the tobacco industry". The three
organisations protested the long delay in the production of new
media and urged Smoley to release a campaign that featured the
original campaign themes: "the tobacco industry lies", "nicotine is
addictive", and "secondhand smoke kills". Meanwhile, John Miller,
chief of staff to Senator Diane Watson (D-Los Angeles), chair of
the state Senate Health Committee, was threatening to hold
hearings on the conduct of the media campaign.
... Top
Abstract
Introduction
Methods
a Early controversies over the...
.i Legislative attempts to weaken—
Using contracting procedures to...
Implementing Pringle's policies...
Shutting the public health...
js Administration secretly toned..,
■ Public health advocacy groups...
-r The TEROC purge
The advertisements are...
” Discussion
References
a
Cook called an emergency meeting of TEROC for Monday, 10 February 1997, to follow up on Stratton's
refusal to share information about the media campaign with TEROC and to decide what action TEROC
should take in response.
The TEROC purge
- Top
On the Friday before the emergency TEROC meeting, Stratton
.- Abstract
announced a major shakeup of TEROC. Three physicians on
Introduction
Methods
TEROC who had been strong advocates for the anti-tobacco
Early controversies over the...
education campaign, were replaced with individuals closely allied
Legislative attempts to weaken...
with the Wilson administration. Lester Breslow, former dean of the
Using contracting procedures to...
Implementing Pringle's policies..,
UCLA School of Public Health and former director of DHS, who
i Shutting the public health...
had been on TEROC since its formation in 1990, and Reed
Administration secretly toned—
Z. Public health advocacy groups...
Tuckson, president of Drew University of Medicine and Science in
■ The TEROC purge
Los Angeles, were told that they had been replaced in an action
▼ The advertisements are...
allegedly taken three months earlier by Assembly Speaker Pringle
▼ Discussion
t References
(R), the day before the Democrats took over the Assembly. Neither
Pringle nor DHS had given any indication of these changes before
7 February, even though TEROC had met in December, after the date that Pringle supposedly made the
appointments. Jennie Cook, TEROC chair, had been unaware of them. Spokesmen for Pringle and the
Governor said that either DHS was not informed or the appointment letters had been lost.^2 In the
physicians' places, Pringle appointed Hal Massey, a retired Rockwell executive who had been active in
ACS, and Doug Cavanaugh, the president of Ruby's Restaurants, who was, according to Pringle.
"familiar with the tobacco debate, balancing regulations with people's right to smoke"DHS also
announced that Governor Wilson had replaced Dr Paul Torrens of the UCLA School of Public Health
with Dr George Rutherford, who had been the state health officer in the Wilson administration and
responsible for the Proposition 99 programme until he left to join the faculty at the University of
California. Wilson also appointed Stratton to TEROC, making him a member of his own oversight
committee.
On Monday morning, before the TEROC meeting scheduled for that afternoon, ACS, AHA, ANR, and
the American Lung Association (ALA) called a press conference to protest the changes in the TEROC
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membership and to express their concerns about the administration of the programme. Alan Henderson,
president-elect of ACS, Carolyn Martin, a volunteer with ALA and former chair of TEROC, John
Schaffer, of AHA, and Stanton Glantz, of the University of California at San Francisco, spoke at the
press conference. They pointed out that it was inappropriate for Stratton to sit on TEROC, because he
had asserted direct responsibility for the day-to-day management of the DHS tobacco programme,
particularly the media campaign, setting up a potential conflict of interest. Indeed, Stratton, at the
meeting on 10 December, had claimed responsibility for putting in place the secrecy policies that had led
to the TEROC emergency meeting in the first place.
Between the controversy caused by the lack of a media campaign and the controversy over the purge of
the three widely respected committee members, the media gave substantial coverage to the meeting,
particularly to the absence of the media campaign and the lack of information about it.32J>£ Well over a
hundred people came to the TEROC meeting on the afternoon of 10 February. TEROC normally meets
in a conference room and has 10-15 non-members in attendance; this meeting was held in an auditorium.
Audience members included the heads of a number of county programmes for tobacco use prevention,
who emphasised the key role the media campaign played in their efforts. Without the "air cover" created
by the media, the impact of their local programmes was more limited. Steve Hansen, a member of the
board of the California Medical Association, suggested Stratton was guilty of "public health
malpractice" .32
TEROC agreed that Cook should write to Belshe, informing her of the committee's unanimous vote
(including Stratton, the person who was refusing to make the story boards available to the committee) to
request a meeting to review the story boards for the current media and to request other, similar meetings
to include the committee in the media development process. TEROC also voted that it favoured "the
most aggressive media ads possible" and "sustaining of continuous media coverage, using, if necessary,
the strongest existing ads currently available."3?
The advertisements are strengthened
In February 1997, DHS responded to the pressure about the
advertisements by again revising them, although this fact was not
made public at the time. For example, Frost approved putting "The
tobacco industry" back into the "Cattle" advertisement, changing:
"If you knew what they thought of you, you'd think twice" to: "The
Tobacco Industry. If you knew what they ...". In "Rain", the voice
over at the end was changed to: "The tobacco industry. How low
will they go to make a profit?" In addition, "Thank you", which had
become a radio spot, had the words "Tobacco Industry" added back
in, both in the opening sentence and in the last line.
Abstract
Introduction
.. Methods
•i Early controversies over the...
- .Legislativc_attempts to weaken...
Using contracting procedures to..,
~ Implementing Pringle's policies...
■ - Shutting the public health— Administration secretly toned—
- Public health advocacy groups—
The TEROC purge
• The advertisements are—
▼ Discussion
- References
By the time Asher/Gould prepared the final story boards on
3 March 1997, two versions of "Voicebox" were planned. In addition to the cessation advertisement, a
version was re-created that emphasised addiction and the behaviour of the tobacco industry. In it, the
actor says: "They say nicotine is not addictive. How can they say that?" while the tag line al the end
reads: "The tobacco industry denies that nicotine is addictive."
On 7 March, ACS, ALA, and ANR received a response to their letter of 4 February to Smoley, which
had criticised the administration's management of the media campaign. Smoley responded by saying
that: "It was found to be offensive for government to use taxpayer funds to call a private industry a liar".
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although she did state that it was appropriate to counter industry tactics. In response, AHA, ACS, and
ANR took out a full-page advertisement in the New York Times, accusing the Wilson administration of
refusing to release hard-hitting television spots and removing the "Lies" billboard to protect the tobacco
industry. Smoley, with Governor Wilson's explicit approval, was implementing Pringle's programme of
refusing to attack the tobacco industry, even though the legislature had refused to pass it.2Q
Despite movement in private on the media campaign by TCS, the public health community was still
shut out of the review process. On 19 March, Belshe responded to the TEROC letter, indicating that
TEROC would not be involved in the process of developing the media.21 The administration argued that
TEROC was a "security risk" and that sharing the advertisements with TEROC would increase the
likelihood that the tobacco industry would gain access to them. Cook expressed her disappointment in a
letter on 2 April, commenting that: "The TEROC is not an outside party; it is to be part of the process;
and it is being deprived of the tools necessary to function".^ One of the other TEROC members stated
that it appeared that the department considered 12 year olds in a focus group less of a security risk than
the members of TEROC.
TEROC was finally shown the new advertisements at its meeting on 25 March, after they were released
to the public, and Cook indicated that their reactions were mixed.^2 Only the version of "Voicebox" that
W
emphasised addiction and the industry was shown. The advertisements as released, nine months after
Asher/Gould originally proposed them, were similar to those originally proposed by the advertising
agency.
At the TEROC meeting on 25 March, John Pierce, director of the California Tobacco Survey, presented
the latest California smoking prevalence data, which showed that smoking rates for young people and
adults appeared to be going up. Overall, youth smoking, which had been as low as 8.7% in 1992, rose to
11.9% in 1995 and remained flat in 1996 at 11.6%. The annual Behavioral Risk Factors Survey
conducted in-house at DHS showed that adult smoking prevalence had increased from 16.7% to 18.6%
from 1995 to 1996,22. reversing a downward trend that had existed for nearly a decade.22 The increase
in smoking rates received wide media coverage.73~7^ Public health groups blamed the increase on the
fact that the administration had not fully funded Proposition 99's anti-tobacco education programmes and
on its reluctance to attack the tobacco industry. Sean Walsh, the Governor's press secretary, commented
that he was frustrated with Wilson being blamed for everything "including [the comet] Hale-Bopp".23
He referred to criticisms by the public health groups as "Chicken Little-like comments made by zealots
in the anti-smoking community".^ The actions by the public health groups, however, far from reflecting
"Chicken Little" zealotry, did call attention to and partially block the administration's attempt to run a
poor quality tobacco control programme.
The key role played by tobacco activists was confirmed in October 1998, by asher & partners (the new
name of the Asher/Gould agency), when they responded to questions from the Senate Judiciary
Committee regarding censorship of the media campaign. The Judiciary Committee subpoenaed asher
& partners to allow them to speak frankly despite the "gag clause" that the Wilson administration had
added to their contract. They said: "We were told in 1997 that we should not use the words The Tobacco
Industry in our advertisements.. . . After intense pressure from tobacco control activists, the
administration finally allowed us to use the phrase the tobacco industry and asked us to quickly redo all
of our creative materials to reflect the reneging of this restriction [emphasis in the original]."^
Since 27 March 1997, the policies of secrecy and the cumbersome approval process surrounding the
media campaign have remained in place. On 15 April 1997, ACS, AHA, and ANR wrote to Governor
Wilson, asking him to intervene personally to get the programme back on track. They specifically
requested that he allow "Nicotine Soundbites" and "Insurance" to the air and that he actively support the
implementation of Assembly Bill 13 (ABB), California's law mandating smoke-free workplaces. The
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governor's deputy chief of staff wrote back on 16 May 1997, saying that Belshe and Smoley
"forthrightly" represented the governor's position.^ Public health professionals within TCS still do not
control the content of the advertisements.
Smoley took several actions to prevent the media campaign from interfering with the tobacco industry's
efforts to overturn smoking restrictions in California. In 1994, Smoley prohibited use of the advertising
campaign to publicise AB 13/2 because Philip Morris was mounting an initiative campaign, Proposition
188/8 to overturn California's workplace smoking restrictions. Even after Proposition 188 was defeated,
however, there was still no advertising to educate the public that virtually all workers had a right to a
smoke-free workplace. In 1997, Smoley delayed advertisements to implement California's smoke-free
bar law (which went into effect on 1 January 1998) for several months. Those advertisements, first
proposed in May 1997, were not approved until October, because Smoley did not want advertisements
on the air promoting the smoke-free bar law while the tobacco industry was attempting to get the law
overturned in the legislature. In late November 1997, DHS began running two advertisements promoting
smoke-free bars—one on the radio and one on television.
Discussion
Anti-tobacco media campaigns are key components of effective
tobacco control programmes/ With adequate funding, it is possible
for tobacco control professionals to pursue a sophisticated
marketing strategy that includes market segmentation and research
on the effectiveness of anti-smoking messages.— — These
advertisements can then be professionally produced and aired in
prime television and radio times, providing "air cover" for other
tobacco control efforts, such as community-based programmes or
policy interventions.
- Ton
Abstract
Introduction
Methods
a. Early controversies over the—
■a. Legislative attempts to weaken...
i Using contracting procedures to..,
- Implementing Pringle’s policies—
Shutting the public health—
— Administration secretly toned—
Public health advocacy groups—
. The TEROC purge
a The advertisements are—
■ Discussion
•v References
The recent influx of tobacco control monies into the public sector
has, in fact, allowed this kind of marketing effort to occur, and the
marketing research that has been conducted by professional firms has indicated that the media messages
that are likely to be effective for prevention are not those that emphasise the health consequences of
tobacco use but instead appeal to other emotions, such as resentment at being manipulated by the
tobacco industry.42 This need to appeal not to facts or reason but instead to emotions and feelings has
long been recognised by the tobacco industry as a key to its success at selling tobacco products.^
The efforts of the tobacco industry to curtail or end various media campaigns indicates that it
understands that media campaigns, correctly designed and run, can help to lower prevalence and
consumption, and thus, it uses its political influence to weaken media campaigns (if it cannot simply
prevent them from being funded). In California, it worked through the legislature and the administration
to limit the scope and aggressiveness of the media campaign. In Arizona, another state with a large
anti-tobacco advertising campaign funded by a dedicated tobacco tax, the Arizona Department of Health
Services has mounted a large campaign that does not mention or attack the tobacco industry and avoids
the word "addiction".Si When the tobacco industry settled the Florida and Texas lawsuits designed to
recover the state's smoking-induced Medicaid costs, the settlement included funding for an anti-tobacco
education programme, but explicitly prohibited advertisements that attack specific tobacco companies or
brands.J-1
Effective advertisements must personify and expose industry manipulation, but the experience of
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California and other states demonstrates that these advertisements are precisely the ones that the industry
will work the hardest to stop. Given the importance of media to tobacco education programmes, tobacco
control advocates must be aware of the industry's efforts to place controls on anti-tobacco media
campaigns, and be willing to take strong actions to see that executive branch officials charged with
implementing the campaign do not succumb to this pressure.
The California experience also illustrates the key role that programme advocates in non-governmental
organisations can play in protecting media campaigns. The public health professionals who work in
government agencies will be subject to the limits set by their politically appointed superiors. Thus,
advocates outside of government must carefully monitor the quality and scope of government funded
media campaigns and be ready to pressure these agencies to run effective advertisements. Public health
interventions that are opposed by the tobacco industry will survive only through the continuing
advocacy efforts of the public health community.
W
In California, with no experience in running an advertising campaign, the Department of Health Services
in 1989-90 launched its media campaign—including writing the Request for Proposals, awarding the
advertising contract, developing, approving, producing, and placing the first round of ads—in 189 days,
or a little over six months after the governor signed the budget. By 1996-97, with seven years of
experience and a seasoned advertising firm, it took the department eight months from the signing of the
budget to produce an advertisement. The process slowed rather than becoming more routine because of a
variety of political manoeuvres, including adding layers of approvals for the advertisements, rescinding
approvals of advertisements that had successful negotiated the approval process, adding in requirements
for approvals by political appointees instead leaving the decision in the hands of public health and
advertising professionals, and re-bidding contracts that could have been extended. The new DHS
procedures have reduced the effectiveness of the anti-tobacco media campaign, once the centerpiece of
Proposition 99, and this reduced effectiveness, combined with overall programme budget cuts,’ is
reflected in a failure to make progress in reducing tobacco use (figure 3).—
It is clear, however, that the public health groups have been effective in forcing the Wilson
administration to run a more aggressive campaign than it wanted. Their repeated requests to be involved
in the review process were denied, although by the end of the year the pressure they brought on the
programme from the outside, combined with the threat of a legislative hearing, appeared to have had a
positive effect on the quality of the media campaign. Through use of paid and free media to call
attention to the administration's behaviour, public health advocates succeeded in forcing the
administration to strengthen the advertisements to reflect good public health practice.
W
The use of these kinds of outsider strategies are essential in protecting public health programmes from
powerful insiders, like the tobacco industry. Outsider strategies are typically used by non-governmental
organisations who have popular support and fewer resources, such as campaign contributions, for
lobbying elected officials. Among the key outsider strategies that have been used successfully by
advocates in California have been using the public forum provided by TEROC, creating print
advertisements to call attention to programme problems, taking advantage of free media, and monitoring
internal departmental activities through use of the public records act.
TEROC was established legislatively to provide oversight for the tobacco education and research
programmes funded by Proposition 99. By having programme advocates among its members and,
importantly, having one as its chair, TEROC has been able to question publicly the conduct of the
programme. As its meetings are open to the public, it also creates a venue for members of the press to
follow programme controversies. For public health advocates, the existence of oversight bodies for
public programmes can create an opportunity for putting public accountability into public health
programmes. When such bodies are created by legislation or by administrative action, their
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responsibilities, powers, and membership are potentially important for the conduct of the programme
and should be treated as such by programme lobbyists. It is important who is eligible for membership,
who makes appointments to the body, and what responsibilities the body is given.
The media—both paid advertising and free media—are important vehicles for putting pressure on
public agencies. By running their own advertisements, programme advocates can create a forum in
which they are able to frame issues publicly in a way that reflects their viewpoint. This is a particularly
powerful strategy if other forums, such as legislatures or oversight bodies, have not been responsive.
Such advertisements reach decision makers, the public, and reporters, and call attention to the fact that
there are problems with the programme. This may also be an important avenue to obtaining free media
in the form of news coverage. According to Steve Scott, managing editor of the California Journal," A
lol of times what we look at as journalists to sort of guide us in determining what's a real issue and
what's not a real issue is the attitude of the constituent groups. ... [T]he assumption was that if nobody's
making any noise about this then it's just not that big a deal."S2 By taking an action as public as running
an advertisement, public health groups can alert the media to an interesting story and thus provide
heightened monitoring of programme implementation.
In recent years, the tobacco industry has been using public records acts to try to impede agency
functioning and to discredit agency programmes.^ Public records acts, however, can also be used by
W
programme advocates to monitor how programme monies are being spent and the ways in which
political appointees may be impeding the work of public health professionals. If information on
programme implementation is not freely shared with programme advocates, then it may be necessary for
them to force such information into the public domain.
The challenge for the public health community is maintaining this level of outsider pressure over long
periods of time, because the industry will continue its pressure on the inside to protect its interests. As
more states embark on anti-tobacco advertising campaigns, either due to state and local initiatives or due
to settlements of industry lawsuits, public health advocates need to understand the importance of helping
to establish the rules by which this money will be spent and monitoring the process of spending it. Public
health groups can help campaigns if they are allowed to be involved; if they are not, however, they can
still protect the quality of the programme through outsider, advocacy strategies designed to hold public
agencies accountable for mounting high-quality campaigns.
Acknowledgments
"
This work was supported by the National Cancer Institute (Grant CA-61021).
References
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Top
Abstract
Introduction
- Methods
Early controversies over the...
Legislative attempts to weaken...
Using contracting procedures to...
Implementing Pringle's policies...
Shutting the public health...
*■ Administration secretly toned...
Public health advocacy groups—
.. The TEROC purge
The advertisements are...
“ Discussion
■ References
-
1.
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State study lauds anti-smoking drive. San Francisco Examiner 1992 Jan 25:A5.
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Aguinaga S. Glantz SA. The use of public records acts to interfere with tobacco control. Tobacco
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C> 1998 bv Tobacco Control
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-J?.; nee trom hti;;..'.w,wtf.tho»acic’ne<.vcine.org on Tuesday, June 18 2G13. IP. 27.7.37.106) |l Click here to download free Android application for this jourr
A case-control study of tobacco
smoking and tuberculosis in India
R. Prasad, Suryakant, R. Garg, S. Singhal, R. Dawar, G. G. Agarwal’
| Abstract:
■ OBJECTIVES: To evaluate the role of smoking as a risk factor for the development of pulmonary tuberculosis.
! MATERIALS ZkND METHODS: A to<ni of 1.11 sputpHi smear-positive patients of pulmonary tuberculosis and
| 333 controls matched for age and sex Were ;n|erv;e .- ed according to a predesigned questionnaire.
I was 3.8 (95% confidence interval, 2.0 to 7.0; Rvalue. <.0001). A positive relationship between pack years, body
' mass index and socioeconomic class was also observed.
j CONCLUSION: There is a positive association between tobacco smoking and pulmonary tuberculosis.
| Key words:
| Diagnosis, India, smoking, tobacco, tuberculosis1*
virus infection and malignancy; and those on any
immunosuppressive drugs were also excluded
from the study.
therefore, a case-control study was carried out.
to determine the association between pulmona
■! tuberculosis and smoking.
Materials and Methods
I M inaraj Medical University... VV$ included
I subjects from Uttar Pradesh only, whereas
me rest were excluded. Thus a population pl
| 166,197,921 subjects (total population of Uf'J
I was surveyed and was the source for.cases arid
| controls for the present study. Patients were
recruited from September 201)4 to August 2005.
Sputum smear- positive pulmonary tuberculosis
patients were taken as cases. For each case,
3 controls were taken from among the
I healthy bystanders of that patient. They were
Awals of
Informed consent was taken from all subjects.
Approval for this study was also obtained from
the review board of our institution. A predesigned
questionnaire enquiring about smoking history/,
household smoke exposure, environmental
smoke exposure, tobacco chewing, alcoholism,
housing characteristics and score on the modified
Kuppuswamy socioeconomic status scale was
used as instrument for data collection. This
modified Kuppuswamy socioeconomic status
classification contemplates five social classes:
Upper (I), upper middle (II), lower middle (III),
upper lower (IV; and lower (V) Details of smoking
were noted carefully with regard to type, current
smoking status, age of starting smoking, duration
of smoking and quantity of smoking. Trained MD
students (trained in the subject of Tuberculosis
and chesl.disease') interviewed the subjects in the
hospital. 'Smoker' was defined as a person who
had smoked more than 100 cigarettes/ bidis during
his/her lifetime. 'Nonsmoker' was defined as a
person with exposure less than that stated above.
Statistical analysis
Data was entered into Microsoft Excel and
subsequently converted to an SAS file for
performing univariate and multivariable
analysis. Univariate analysis was carried out
by computing unadjusted matched odds ratios
(ORs) and ‘heir 95% Cis to compare cases ano
controls for tach categorical variable of interest,
where a> i test statistics was used to make the
corresponding comparison lor the continuous
variables. Multivariable analysis was conducted
through conditional logistic regression to
identify .risk iactors independently associated
Vol 4 Issue 4. October-December 2C09
b;tp 'vAvw.thrirac'Cmedicine oig on Tuesday. June 18. 2013. IP '•■! 7.37.1061 l| Click here to download free Android application for this journ
with pulmonary tuberculosis and to calculate their adjusted
matched odds ratios.
Results
A total of 111 patients and 333 controls were enrolled in the
study. Smoking history was present in 33.3% of tire patients
as compared to 13.8% of controls. The mean pack/year was
4.71 among patients and 0.88 among controls. After con trolling
for the effect of other variables in the model, the odds of
developing pulmonary tuberculosis among smokers was
3.8 times more than that among nonsmokeis [OR - 3.8 (95% CI,
2.0 to 7.0), P < .0001 ].
social class type III. Alcohol intake was also found to have
an association with the occurrence of pulmonary tuberculosis
[adjusted OR - 1.7 (95% CI, 0.9 to 3.3)]. Having BMI < the
median value of 19.4 was strongly associated with pulmonary
tuberculosis [adjusted OR = 4.1 (95% CI, 2.5 to 6.8)].
Persons living in kuchcha or semi-pucca houses [adjusted
OR -- 3.2 (95% CI, 1’4 to 7.5)] had almost similar odds of
developing pulmonary tuberculosis when compared with
persons living in pucca houses [adjusted OR = 2.3 (95% CI, 1.0
to 5.1). Other factors like chewing tobacco, alcohol, mosquito
coil and biomass fuel were not found to be associated with
pulmonary tuberculosis in the univariate analysis [Table 3].
Discussion
The risk was higher for the persons who Were smoking
>5 pack years [adjusted OR ■ 4.6 (95% Cl, 2.1 to 10.1)] than
persons who were smoking ^5 pack years [adjusted OR = —
2.9 (95“., Ci, 1.2 to 6.0)]. Persons smoking more number of bidis
or cigarettes per day and for lesser duration and vice versa can
have the same pack/year [Table 1], Analysis was also done to
answer the question, which is more hazardous, a large number
of bidis or cigarettes per day or a long duration of smoking
[table 1[? Die odds of developing pulmonary tuberculosis
among persons who smoked <10 bidis or cigarettes per day
[adjusted OR = 4.0 (95% Cl, 1.7 to 9 1)] was slightly more in
comparison to persons who smoked >10 bid is or cigarettes per
day [adjusted OR = 3.6 (95% CI, 2.4 to 13.1)]. However, the odds
of developing pulmonary tuberculosis among persons who
smoked lor a duration of a 10 years [adjusted OR = 5.7 (95% CI,
~.4 to 13 1 >| was more in comparison to persons who smoked for
a.duration of < 10 years [adjusted OR = 2 5 (95%CI, 1.1 to 5.7)].
These analyses reveal that long duration of smoking is more
hazardous than a large number of bidis or cigarettes per day.
Analyses were also done to assess the association
between pulmonary tuberculosis and various factors
like socioeconomic status, body mass index (BMI), type
of housing, alcohol intake and environmental exposure
[Tables 2 and 3], The odds of developing pulmonary
tuberculosis among social class V [adjusted OR = 5.3 (95%
Cl, 1 8 to 16 0)[ was more than that among social class IV
[adjusted OR - 2 3 (95% CI, 0.8 to 6.7)) with reference to
Table 1: Association of pulmonary tuberculosis with
smoking
____________
Variables
Cases Controls
Matched
Adjusted*
111
333
(100%) (100%)
OR
(95% Cl)
OR
(95% Cl)
P value
Pack year*
<5
15(13.5)27(8.1)2.4(1.1,5.0)2.9(1.2,6.8) 0.02
>5
22 (19.8) 19 (5.7) 4.6 (2.3, 9.2) 4.6 (2.1. 10.1) 0.0001
No ol bidis
oi cigareites
per day’
sio
19 (17.1) 24 (7.2) 3.4(1.7,70) 4.0(1 7,9.1) 0.001
18(16.2) 22(6.6) 34 (1.7.6.8) 3.6(1.7.79) 0.001
>10
Duration
of smoking
(years)*
15(13.5)30(9.0) 2.0 (1.0, 4.2) 2.6 (1.1, 5.7) 0.03
S10
>10 _ 22(19.8) 16(4.8) 5.6 (2.7, 11.8)5.7(2.4. 13.1)<0.00C1
•Reference category is ’nonsmoker'; 'Adjusted lor BMI social class and
Annais of
■ Vo' 4. issue <t. Oclober-DecemOer 2009
In our case-control study of 111 sputum smear-positive
pulmonary tuberculosis (TB) patients and 333 controls, the
odds Of.developing pulmonary tuberculosis among smokers
was 3.4 times more than that among nonsmokers, a figure
that increased to 3.8 after controlling for the effect of other
confounders like socioeconomic status, body mass index
and house type [OR = 3 8 (95% CI, 2.0 to 7.0)]. Most of our
subject? belonged to low socioeconomic class, in which bidi
smoking is the prevalent mode of smoking. The relatively
low combustibility and nonporous nature of the tendu leaves
(used in manufacturing of bidis) require more frequent
and deeper puffs by the smoker to keep bidis lit, which is
therefore more harmful to active smokers as compared to
passive smokers.
The above result is in agreement with the previous Indian
studies, which also report the higher odds ratio of developing
tuberculosis among smokers as compared to nonsmokers.1'' ''1
Recent meta-analysis'"'1 also showed that OR for TB disease
ranged from 2.3.3 (95% CI, 1.97 to 2.75) to 2.66 (95%.CI,
2.1.5 to 3 28). The reason for the increased risk of developing
Table 2: Multivariable logistic regression model for the
factors associated with pulmonary tuberculosis _____
Adjusted
P value
Matched
Variables
OR (95% Cl)
_ OR (95% Cl)__
3.8 (2.0, 7.0)
< 0.0001
3.4 (210, 5.8)
Smoking
Social class*
0.04
3.6 (1.0, 12.8)
5.3 (1.8, 16.0)
Type V
1.9 (0.6, 6.4)
0.3
2.3 (0.8. 6.7)
Type IV
House type**.
2.8 (1.1.7.2)
0.03
3.2 (1.4, 7.5)
Kuchcha
0.07
2.3 (0.9, 5.6)
2.3 (1.0, 5.1)
Semi-pucca
< 0.0001
4.2 (2.4, 7.3)
4.1 (2.5, 6.8)
Body mass
index**’'___
•Reference category Is 'type III socioeconomic status ’; "Reference category
is 'pakka house.’; ’"Reference category is 'BMI > 19.4 (median value)
Table 3: Univariate analysis of various other factors for
their possible association with pulmonary tuberculosis
Variables
Chewing
tobacco'
Alcohol
Mosquito coil
Biomass fuel_
Cases
__ 111 (100.0%)
24 (21.61
19(17.1)
25 (22.5)
29(26 1)
Controls
333 (100.0%)
76 (22.8)
Matched
OR (95% Cl)
0.9 (0.6, 1.6)
37(11.1)
70(21.0)
92 (27.6)
1.7 (0.9, 3.3)
1.1(0.7,1.9)
0.9 (0.6,1.5)
209
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pulmonary tuberculosis among smokers is not clear, but
the increased risk among smokers may be explained by the
effects of smoking on pulmonary host defenses. Chronic
exposure to tobacco, as well as to a number of environmental
pollutants, impairs the normal clearance of secretions on
the tracheobronchial mucosal surface and may thus allow
I he causative organism, Mycobacterium tuberculosis, to
escape the first level of host defenses, which prevent bacilli
from reaching the alveoli.11'1 Smoke also impairs the function
of pulmonary alveolar macrophages (AMs), which are not
only the cellular target of M. tuberculosis infection but also
constitute an important early defense mechanism against
the bacteria; AMs isolated from the lungs of smokers have
reduced phagocytic ability and a lower level of secreted
proinflammatory cytokines than do those from the lungs
of nonsmokers.1121 Recent work has suggested a novel
mechanism for the effect: Nicotine is hypothesized to act
directly on nicotine acetylcholine receptors on macrophages
to decrease production of intracellular tumor necrosis factor
and thus impair killing of M. tuberculosis.1 n| These effects
of smoking on pulmonary host defense support a causal
link between smoke exposure and either an increased risk
of acquiring TB or progression of TB to a clinical disease
In our study, duration of smoking was found to be more
significantly associated with development of pulmonary
tuberculosis in comparison to quantity of bidis or cigarettes.
According to other studies, stronger association was found
to be present between numbers of bidis or cigarettes per
day and development of pulmonary tuberculosis.16’1 This
difference may be due to the difference in sample size. In
our study, socioeconomic status, alcohol and BMI were also
found to have significant association with the development
of tuberculosis, whereas the type of house in which one lived
and non-inhalation mode of tobacco exposure were not found
to be significantly associated. This is in conformity with other
studies.1’11*1 Recent meta-analysis found substantial evidence
that passive smoking and indoor air pollution increased
the risk of TB disease.111,1 It can be concluded that smoking
is associated with high prevalence of tuberculosis in India.
Therefore, in India, where both smoking and tuberculosis are
common conditions, preventing initiation of smoking and
promoting quitting of smoking are important TB-preventive
measures.
Limitation
Most of the patients attending our hospital are of low and
middle socioeconomic class. 'Therefore, our sample may not
be the true representative of the population
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Source of Support: Nil, Conflict of Interest: None declared
Annals Of P
Modicnu* -Vol 4. Issue 4 October-December 2009
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