Clear The Air News Tobacco Blog Rotating Header Image

August, 2011:

Tobacco trade group chief quits – FT.com

http://www.ft.com/cms/s/0/5174550a-d3d4-11e0-bc6b-00144feab49a.html#axzz1X2KgsAwb

August 31, 2011 10:17 pm

Tobacco trade group chief quits

By Rose Jacobs

The head of the UK tobacco industry’s main trade body has resigned after failing to persuade the coalition government to rescind anti-tobacco measures introduced under Labour.

Christopher Ogden, who joined the Tobacco Manufacturers’ Association in 1997 and became chief executive in 2007, will step down in October following a review of the organisation’s structure initiated by its members, British American Tobacco, Imperial Tobacco and Gallaher, a division of Japan Tobacco.

The resulting revamp, which will see the departure of five of the TMA’s seven employees, is aimed at cutting costs, removing overlaps of work by the association and its members’ public affairs teams, and taking a more localised approach to lobbying and campaigning, said Mr Ogden.

This follows a year and a half of frustrated ambitions as the government resisted pressure to ease restrictions on smoking and tobacco advertising and marketing, including bans on cigarette adverts imposed between 2003 and 2005, the 2007 prohibition on smoking in public places and a forthcoming ban on cigarette vending machines.

The tobacco lobby’s only significant success in recent years has been to delay a ban on displaying tobacco products in shops, a measure supporters say will curb take-up of smoking by young people. Originally set to be introduced at supermarkets this autumn, the ban will now start next April. All other shops are expected to comply by April 2015.

“We would have hoped to achieve more,” Mr Ogden said on Wednesday. “Inevitably, there’s disappointment.”

He attributed some of the government’s reluctance to delay rises in tobacco duty to the state of the economy and ministers’ desire to raise as much revenue as possible from smokers.

But he also said that the governing coalition had been less willing than past Conservative administrations to rely on industry self-regulation.

He was proud of anti-smuggling efforts and “getting our voice heard championing the cause of individual retailers”, citing work by the Tobacco Retailers’ Association, which is funded by the TMA.

The TRA’s tactics during the display-ban battle have been criticised, with anti-smoking activists saying it concealed its links to a pressure group it helped create called Save Our Shop.

Katherine Graham, former TRA campaign manager, left in July to join Japan Tobacco as a regulatory affairs stakeholder relations manager in London.

The only people to survive the TMA restructuring are an office manager and Paul Stockall, a tax and trade expert.

Deborah Arnott, chief executive of Action on Smoking and Health, which campaigns for stricter measures against tobacco, called the shake-out “a sign of how ineffective the TMA has been”, and said congratulations should go to the government for standing up to the tobacco industry.

“The government’s commitment in its recently published Tobacco Plan to protect its public health policy from the vested interests of the tobacco industry and to go ahead with removing tobacco displays in shops must have been the last straw,” she added.

A spokesman for Imperial said on Wednesday that the group had “done a good job” and had “been well led by Chris”.

Mr Ogden said he had not finalised plans for his future. “Half of me wants to give up work and the other half wants another challenge,” he said.

Copyright The Financial Times Limited 2011. You may share using our article tools.

THE HON NICOLA ROXON MP Minister for Health and Ageing Speech

Download PDF : NRSP310811

North Sydney Council bans smoking

http://mosman-daily.whereilive.com.au/news/story/north-sydney-council-bans-smoking/

31 August 2011

NORTH SYDNEY: Smoking will be banned in several public places within the North Sydney Council’s area from October 1 this year. A smoking policy forbidding smoking in outdoor dining areas on public land, covered bus shelters and taxi ranks as well as within 10m of children’s playgrounds and sporting fieldswhen sports are played was approved by North Sydney councillors on Monday.

The council will lobby the state government to introduce a blanket-ban on smoking in public spaces across NSW.

The smoking-ban policy was on public exhibition recently and attracted a 140-signature petition in favour, 30 written submissions in favour and six against, and a video submission via YouTube called Hands Up for a Smoke Free North Sydney.

Of the 583 participants in an online survey, about 92 per cent agreed with the ban.

Cr Veronique Marchandeau’s original motion put up in February this year asked for the council to forbid smoking at all council-controlled lands including public footpaths.

On Monday night, Cr Andrew Robjohns asked the council to consider banning smoking in all parks.

But they opted to look at widening the ban after the policy had been implemented.

Smoking in a prohibited area could attract a $110 fine.

Half of all NSW councils ban smoking in some council-owned or controlled areas.

Laws Banning Smoking in Vehicles Carrying Children – International Overview

Canadian Cancer Society

August 30, 2011

Summary: Laws prohibiting smoking in vehicles carrying children have been adopted in 9 Canadian provinces/territories (British Columbia, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and the Yukon Territory); 8 Canadian municipalities – Wolfville (Nova Scotia), Surrey (British Columbia), White Rock (B.C.), Richmond (B.C.), Okotoks (Alberta), Athabasca (Alberta), Leduc (Alberta), Medicine Hat (Alberta); 6 Australian states – South Australia, Tasmania, New South Wales, Victoria, Queensland and Western Australia; 4 U.S. states – California, Maine, Arkansas, and Louisiana; 10 U.S. municipalities – Bangor (Maine), Keyport (New Jersey), West Long Branch Borough (New Jersey), Rockland County (New York), Monroe County (Indiana), Rohnert Park (California), Martinez (California), Hawaii county (Hawaii), as well as South Africa, Mauritius, Bahrain, and Puerto Rico.  It may be that other jurisdictions have also adopted laws.

Listed below are the jurisdictions, the applicable age, the date of coming into force.  Applicable age refers to under the age, thus “19” (for example) means that smoking is prohibited in a vehicle carrying someone under age 19.


Countries

1. Mauritius (18+ [i], Mar. 1, 2009)

2. South Africa (12, Aug. 21, 2009)

3. Bahrain 2

Canadian provinces/territories (9 of 13)

1. Nova Scotia (19, Apr. 1, 2008)

2. Yukon Territory (18, May 15, 2008)

3. Ontario (16, Jan. 21, 2009)

4. British Columbia (16, Apr. 7, 2009)

5. New Brunswick (16,   Jan. 1, 2010)

6. Prince Edward Island (19, Sept. 15, 2009)

7. Manitoba (16, July 15, 2010)

8. Saskatchewan (16, Oct. 1, 2010)

9. Newfoundland and Labrador (16, July 1, 2011)

Canadian municipalities (8)

1. Wolfville, Nova Scotia (19, June 1, 2008)

2. Surrey, British Columbia (19, July 31, 2008)

3. Okotoks, Alberta (16, Sept. 1, 2008)

4. White Rock, British Columbia (16, Nov. 1, 2008)

5. Richmond, British Columbia           (19, Nov. 30, 2008)

6. Athabasca, Alberta (18, Mar. 22, 2011)

7. Leduc, Alberta (18, July 2, 2011)

8. Medicine Hat, Alberta (16, Sept. 1, 2011)

Australian states and territories (6 of 8)

1. South Australia (16, May 31, 2007)

2. Tasmania (18, Jan. 1, 2008)

3. New South Wales (16, July 1, 2009)

4. Victoria (18, Jan. 1, 2010)

5. Queensland (16, Jan. 1, 2010)

6. Western Australia (17, Sept. 23, 2010)

U.S. states (4 of 50)

1. Arkansas (if car seat required,3 July 21, 2006)

2. Louisiana (13,4 Aug. 15, 2006)

3. California (18, Jan. 1, 2008)

4. Maine (16, Sept. 1, 2008)

U.S. municipalities (9)

1. Bangor, Maine (18, Jan. 18, 2007)

2. Keyport, New Jersey (18, Apr. 26, 2007)

3. Rockland County, N.Y.  (18, June 21, 2007)

4. West Long Branch Borough, NJ (18, June 9, 2007)

5. Loma Linda, CA (18, July 24, 2008)

6. Monroe County, Indiana (13, April 8, 2009)

7. Rohnert Park, CA (18, May 28, 2009)

8. Martinez, CA (18, June 5, 2009)

9. Hawaii County, Hawaii (18, Aug. 8, 2010)

10. Carpenteria, CA (18, May 16, 2011)

Other

1. Puerto Rico (13, Mar. 2, 2007)

(US Commonwealth in Caribbean)

DOWNLOAD PDF : INTERNATIONAL OVERVIEW international overview-2011-08-30-vehicles with kids



ESC: Tobacco Smoke More Damaging to Women’s Arteries

http://www.doctorslounge.com/index.php/news/pb/22710


The amount of lifetime exposure to tobacco smoke significantly correlates with the thickness of carotid arterial walls in both genders, but the impact is more than double in women than in men, according to a study presented at the European Society of Cardiology Congress held from Aug. 27 to 31 in Paris, France.

TUESDAY, Aug. 30 (HealthDay News) — The amount of lifetime exposure to tobacco smoke significantly correlates with the thickness of carotid arterial walls in both genders, but the impact is more than double in women than in men, according to a study presented at the European Society of Cardiology Congress held from Aug. 27 to 31 in Paris, France.

Elena Tremoli, Ph.D., from the University of Milan in Italy, and colleagues compared the effects of tobacco smoke and other factors on carotid artery wall thickness in men and women. The carotid arteries of 1,694 men and 1,893 women were examined by ultrasound for the presence of wall thickening and plaque.

The investigators found that the amount of lifetime exposure to tobacco smoke was significantly associated with the thickness of carotid arterial walls in both genders, with the impact more than double in women compared to men. Similarly, the number of cigarettes smoked per day had more than a five-fold impact on the progression of disease over time in women compared to men. The associations were independent of age, blood pressure, cholesterol level, obesity, and social class. Compared to men who were less-educated, men with more education showed a greater thickening of arterial walls, but this effect was not observed in women. Men, but not women, showed a strong relation between arterial wall thickening and the levels of C-reactive protein (CRP) and white blood cells counts. However, women who smoked heavily showed a similar relationship between CRP and arterial wall thickening as men.

“The reasons for the stronger effect of tobacco smoke on women’s arteries are still unknown, but some hints may come from the complex interplay between smoke, inflammation, and atherosclerosis,” the authors state.

Government Inaction on Ratings and Government Subsidies to the US Film Industry Help Promote Youth Smoking

Introduction
Research indicates that exposure to
tobacco imagery in movies is a potent cause
[1] of youth experimentation and progression
to established smoking [2–4], with a
dose-response relationship that indicates
heavily exposed youths are about three
times as likely to begin smoking as lightly
exposed youths [1]. Links between exposure
to tobacco imagery in movies and initiation
of smoking among youth have been documented
in several countries with distinct
cultures, diverse tobacco regulatory regimes
(including varying controls on advertising),
and different smoking prevalences [5–8].
This evidence led the World Health Organization
(WHO) to recommend [2] as part
of implementing Article 13 of the WHO
Framework Convention on Tobacco Control
(FCTC) [9] that all future movies with
scenes of smoking (and other tobacco) be
given an adult content rating, with the
possible exception of movies that depict the
dangers of tobacco use or smoking by an
actual historical figure who actually smoked.
The primary logic for recommending an
adult content rating policy is to create an
economic incentive for producers to leave
smoking out of movies that are marketed to
youths. A 2005 study in the US concluded
that the return on investment for youthratedmovies
was 70%, compared with 29%
for adult content (R-rated) movies [10].
Essentially eliminating smoking and other
tobacco imagery from youth-rated films
would substantially reduce the total exposure
of onscreen smoking images delivered
to youth. (In addition, while youth do see
some adult-rated films, they are less likely to
see them than youth-rated films.)

IntroductionResearch indicates that exposure totobacco imagery in movies is a potent cause[1] of youth experimentation and progressionto established smoking [2–4], with adose-response relationship that indicatesheavily exposed youths are about threetimes as likely to begin smoking as lightlyexposed youths [1]. Links between exposureto tobacco imagery in movies and initiationof smoking among youth have been documentedin several countries with distinctcultures, diverse tobacco regulatory regimes(including varying controls on advertising),and different smoking prevalences [5–8].This evidence led the World Health Organization(WHO) to recommend [2] as partof implementing Article 13 of the WHOFramework Convention on Tobacco Control(FCTC) [9] that all future movies withscenes of smoking (and other tobacco) begiven an adult content rating, with thepossible exception of movies that depict thedangers of tobacco use or smoking by anactual historical figure who actually smoked.The primary logic for recommending anadult content rating policy is to create aneconomic incentive for producers to leavesmoking out of movies that are marketed toyouths. A 2005 study in the US concludedthat the return on investment for youthratedmovieswas 70%, compared with 29%for adult content (R-rated) movies [10].Essentially eliminating smoking and othertobacco imagery from youth-rated filmswould substantially reduce the total exposureof onscreen smoking images deliveredto youth. (In addition, while youth do seesome adult-rated films, they are less likely tosee them than youth-rated films.)

DOWNLOAD PDF : journal.pmed.1001077[1]

IntroductionResearch indicates that exposure totobacco imagery in movies is a potent cause[1] of youth experimentation and progressionto established smoking [2–4], with adose-response relationship that indicatesheavily exposed youths are about threetimes as likely to begin smoking as lightlyexposed youths [1]. Links between exposureto tobacco imagery in movies and initiationof smoking among youth have been documentedin several countries with distinctcultures, diverse tobacco regulatory regimes(including varying controls on advertising),and different smoking prevalences [5–8].This evidence led the World Health Organization(WHO) to recommend [2] as partof implementing Article 13 of the WHOFramework Convention on Tobacco Control(FCTC) [9] that all future movies withscenes of smoking (and other tobacco) begiven an adult content rating, with thepossible exception of movies that depict thedangers of tobacco use or smoking by anactual historical figure who actually smoked.The primary logic for recommending anadult content rating policy is to create aneconomic incentive for producers to leavesmoking out of movies that are marketed toyouths. A 2005 study in the US concludedthat the return on investment for youthratedmovieswas 70%, compared with 29%for adult content (R-rated) movies [10].Essentially eliminating smoking and othertobacco imagery from youth-rated filmswould substantially reduce the total exposureof onscreen smoking images deliveredto youth. (In addition, while youth do seesome adult-rated films, they are less likely tosee them than youth-rated films.)

Tourists don’t get smoking message

South China Morning Post – 29 August 2011

Of all the statistics that should make us feel good, those showing that Hong Kong’s smoking rate has fallen to the lowest-ever level are the ones most likely to put an extra spring in our step. The Census and Statistics Department’s latest figures reveal that 11.1 per cent of people aged 15 and over and 19.9 per cent of men smoke, among the lowest levels for developed economies. Better still, the rates are for last year and do not take into account trends since an additional 41.5 per cent tax was imposed on tobacco products in February. Progress is clearly being made.

Smoking, despite the serious impact it has on health, is not the easiest habit to kick. Left to our own devices, rates here would in all likelihood be nearer those on the mainland, where six in 10 people smoke. A number of government anti-smoking policies over the years, starting with tax increases, advertising bans, health warnings on packets and expanded to banning smoking in indoor public areas, are largely what it has taken to make smokers quit. Such measures are necessary as smoking and second-hand smoke are bad for health. Our next target has to be a single-digit figure.

Efforts are also needed on the mainland. There are anti-smoking laws there, but they are so poorly followed and enforced that it is near impossible to avoid clouds of second-hand smoke. With 60,000 mainlanders crossing the border each day to visit Hong Kong, what is working so well here is increasingly being strained. As our rules do not apply to outdoor areas, busy shopping districts at street level often are shrouded in cigarette smoke.

That sends the wrong message to our children and is dangerous to health. While our laws will go some way to educating visitors, they are not going to have an immediate impact. The next stage of the government’s campaign will be television advertisements focusing on blunt messages. That is a worthy strategy, but widening it to places frequented by tourists would make it considerably stronger.

From cigarette smuggling to illicit tobacco trade

Download (PDF, 104KB)

Four Arguments against the Adult-Rating of Movies with Smoking Scenes

http://www.plosmedicine.org/annotation/listThread.action?inReplyTo=info:doi/10.1371/annotation/35daf7d3-4dce-463a-9987-ad456a679b66&root=info:doi/10.1371/annotation/35daf7d3-4dce-463a-9987-ad456a679b66

Demeaning the Science to Support a Philosophical Position

Posted by jdsargent on 28 Aug 2011 at 11:00 GMT

There is no question that Simon Chapman does not approve of giving movies with smoking an adult rating; his essay with Matthew Farrelly in PLoS Medicine [1] is the third time he has made this argument in as many years. While Chapman is certainly free to hold whatever philosophical positions he wants on the movie ratings policies, it is troubling that in the latest essay [1] Chapman and Farrelly demean the science that logically supports the adult rating as a way to reduce youth smoking that results from exposure to onscreen smoking. Furthermore, their insistence that movie ratings systems—which were developed by the movie industry to avoid censorship (see http://www.mpaa.org/ratin…)—are a threat to free speech is misleading. Comparing movie ratings advocates to regimes like North Korea (see Chapman and Farrelly’s response to Millet’s letter in this issue [2]) sounds more like the hyperbole we would expect from a Rupert Murdock tabloid—not a pair of esteemed public health researchers.

Until now, it seemed that Chapman respected the science. In Tobacco Control in 2008 [3] Chapman wrote, “The major challenge comes with adolescent-targeted movies where smoking can have a major presence. As I have argued, it is difficult to be categorical that any smoking in a movie must mean that all such movies ‘promote’ smoking. But it is undeniable that many such movies do, with the exact same consequences for the health of millions that were invoked as justification for controlling tobacco advertising.” In Addiction in 2009 [4] Chapman again accepted the science, writing, “Repeated studies have demonstrated an association between exposure and smoking uptake, even after controlling for variables such as parental and peer smoking and permissive parenting style (which increases access to R-rated movies where smoking is more common). A 2008 US National Cancer Institute report called this association ‘causal’. Just as tobacco advertising promotes positive associations with smoking, it would seem unarguable that movie smoking also makes a major contribution to the cultural iconography and appeal of smoking.”

Despite the continued accumulation of evidence linking exposure to onscreen smoking since 2008, Chapman and Farrelly [1] now question whether residual confounding is a problem. They also question the specificity of the movie smoking effect, arguing that something else packaged in movies besides smoking could be inducing adolescents to smoke. Citing these concerns about confounding and specificity, Chapman and Farrelly object to attributable risk estimates—empirical estimates of the effects of movie smoking on smoking in the population.

Chapman and Farrelly state, “Movie smoking may be largely artifactual to the wider attraction that those at risk of smoking have to certain genres of films.” In other words, they are concerned that some yet unmeasured characteristic of the adolescent—that draws him to films with smoking and also causes him to smoke—is the true culprit, not the movie smoking. Their statement articulates concern about potential confounding, and Chapman and Farrelly are not the first to think about it. In fact, this possibility has been a central issue in the design of all the empirical studies in the published literature, all of which included covariates (which vary from study to study) to control for characteristics of the adolescent and his or her environment. The potential confounding variables already considered in this literature includes sociodemographics; smoking and alcohol use by friends, siblings, and parents; other media exposures (television and internet time, number of movies watched per week); personality characteristics (sensation seeking, rebelliousness, self esteem, depression, attention deficit disorder), school function, participation in sports and other extracurricular activities (like church and team sports), spending money, exposure to tobacco marketing, and authoritative parenting style. This is an extensive list of empirically tested covariates, more than one would find in a review of tobacco marketing studies [5]. After accounting for these potential confounding influences, these studies have consistently documented a movie smoking effect on youth smoking in the United States [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], Mexico [23,24], Scotland [25,26], Germany [27,28], Iceland [26], Poland [26], Italy [26], The Netherlands [26], and India (where smoking in Bollywood movies has been linked with youth smoking) [29].

Moreover, Chapman and Farrelly ignore sensitivity analyses published in two of the studies [11,12] that demonstrate a yet to be identified, unmeasured third (confounding) variable would need to have a relationship with smoking (and movie smoking exposure) as strong as that of friend smoking to confound the adjusted relation. The plausibility that such a high powered variable exists but has totally escaped detection is low. In fact, it is likely that published research in this area has, if anything, over-controlled for other influences by including friend smoking, a variable that mediates the effect of movie smoking on youth smoking [30,31].

Chapman and Farrelly also conveniently ignore the consistent observation that the movie smoking effect is stronger for lower vs. higher risk adolescents; for example, adolescents with lower sensation seeking scores [16] or whose parents do not smoke [7,28] have a significantly larger response to movie smoking. If residual confounding on other smoking risk factors was an issue, there would be a larger estimated movie effect among the higher risk adolescents. Thus, Chapman and Farrelly would have the reader believe that researchers have paid little attention to confounding or that they used dated measures. In fact, attention to possible confounders has been a central theme in the empirical research on movie effects.

In questioning the specificity of the observed link between exposure to smoking in movies and smoking behavior Chapman and Farrelly argue that there are many risky behaviors in addition to smoking depicted in movies and that these behaviors cluster, making it difficult to empirically disentangle the direct modeling effect (seeing movie smoking prompting adolescents to smoke) from the effect of seeing other behaviors (seeing people killed might prompt adolescents to smoke) or the movie as a whole (seeing movies high in excitement might prompt adolescents to smoke).

While everyone recognizes that movies are complex stimuli, Chapman and Farrelly fail to start with the most parsimonious theoretical explanation for the consistently observed association between movie exposure and youth smoking—the social modeling effect. The conclusion that children and adolescents model behaviors they observe is backed by years of behavioral research that supports the social cognitive theory of Bandura [32], and what is known about how adolescents assimilate the social images they see and eventually model them [31,33]. Social cognitive theory also emphasizes that, although children see many other images of smoking in their lives, images transmitted by people important to them (friends, parents, siblings) and people they admire (movie stars) will have much more impact than people they see smoking on the street outside smoke free bars and restaurants [34,35]. We have discussed in several places the concept that social influences are complex and that persons do not necessarily reproduce any behavior they observe in a knee-jerk fashion [30,31]. Nevertheless, social modeling and consensus effects are one of the most reliable phenomena for psychology in general and adolescent smoking in particular [36].

The sole piece of empirical evidence supporting the Chapman and Farrelly essay is a draft manuscript Farrelly and colleagues [37] posted on the internet. Farrelly and colleagues assessed smoking onset in a cohort of 1511 youth followed up annually between 2005 and 2008 and found an association between exposure to smoking in movies and youth smoking. Exposure was assessed to a fixed sample of 71 films over that period, some of which had smoking in them and some of which did not, using data from the Thumbs Up! Thumbs Down! Project of Breathe California of Sacramento-Emigrant Trails (www.SceneSmoking.org), whereby adolescents watched movies and counted screen shots of smoking, to create a continuous movie smoking index. Other adult content was obtained from a site developed for parents (Kids-in-Mind.com) and captured in three categories—sex/nudity, violence/gore, and profanity. They tested the relation between seeing smoking in moves and smoking onset, controlling for several covariates, including sensation seeking propensity (i.e., “I like to do frightening things”, a measure the Chapman and Farrelly now describe as “rather dated and of dubious validity”), whether the parents restricted access to R-rated movies, friend smoking, and use of other substances.

Surprisingly, given Chapman and Farrelly’s arguments [1], Farrelly and colleagues [37] reported that, consistent with the peer-reviewed scientific literature, “we find that exposure to smoking in the movies is correlated with youth initiating smoking and becoming susceptible to smoking. Although the magnitude of these relationships diminished after controlling for an extensive set of potential confounders, the results were robust and suggest that smoking initiation would have been roughly 20% lower if this cohort had no exposure to smoking in the movies.” Even though seeing movie smoking is the most parsimonious explanation for the findings (particularly since controls for confounding included parental oversight of adult movie content) Farrelly and colleagues [37] rejected their own conclusion, citing the high correlation between movie smoking and other adult content.

Previous studies have controlled for propensity of youths to seek out movies by including youth’s self-report of how many movies they watch each week as a covariate [11,16]. Other studies [25], including the one by Farrelly and colleagues [37], have controlled for youth access to adult movie content. Morgenstern and colleagues [26] improved on studies that rely on self-report by controlling the number of movies that a youth has seen, derived from the Beach method [38] assessment of exposure to movie smoking. They found an association between seeing smoking in movies and youth smoking even after controlling for number of movies the adolescent had seen. Morgenstern and colleagues were able to separate the smoking effect from movie exposure because the sample was adequately powered to test that hypothesis, despite the higher correlation between movie smoking and number of movies seen; they had data from over 16,000 youths from 6 European Union countries (compared to just 632 at the end of the Farrelly et al [37] study).

Chapman and Farrelly question the reliability of attributable risk estimates in the case of complex processes, like onset of smoking, despite the fact that Farrelly et al concluded that “smoking initiation would have been roughly 20% lower if this cohort had no exposure to smoking in movies” [37]. Attributable risk estimates, like the one Farrelly conducted and others already published [7,11,21], are useful because they allow epidemiologists to assess the public health importance of a risk factor. Once a judgment of causality has been rendered, as it has been by the National Cancer Institute for the effects of smoking in movies [39], attributable risk estimates are routine, including for complex and poorly understood medical outcomes. For example, even though we do not know all the causes of breast cancer, and these unmeasured risk factors could confound known risk factors, the National Cancer Institute provides an attributable risk estimate based on known risk factors to help women determine their own risk for breast cancer using the Gale Model (see http://www.cancer.gov/bcr…). Combining estimates from peer reviewed studies on movie smoking, Millett et al[40] found that the attributable risk is 44% (95 percent confidence intervals 34% to 58%), meaning that youth smoking would be 44% lower if they were not exposed to smoking in movies. The excess risk attributable to smoking in movies is this high because the adjusted relative risk for individuals is close to 2.0 and the exposure almost universal.

Finally, it is important to emphasize that, in addition to the epidemiological studies discussed here, there is a body of experimental literature supporting the effect of smoking in the movies on smoking behavior. For example, one study investigated whether exposure of young adult smokers to images of smoking in films stimulated subsequent smoking behavior [41]. Viewing smoking scenes stimulated immediate smoking behavior. Another study compared the fMRI response to images of smoking in movies in smokers vs. nonsmokers [42]. The response in smokers indicated that smokers have higher activity in reward centers and also spontaneous action representation while watching smoking. In other words, they not only crave, but they prepare to light up. Because these are experiments in which the environment is controlled, confounding is less of an issue and movie prompts isolate the smoking as the specific element of the exposure.

In summary, Chapman and Farrelly would have us believe that the truth is so complicated that we could never unravel it with a scientific questionnaire or an experimental study. We disagree. Any theoretical confounder is irrelevant unless it can be measured, and researchers have already shown that the specificity concern can be addressed in studies that are adequately powered and employ reliable measures of movie characteristics. To demonstrate that their concerns about confounding are real, Chapman and Farrelly need to actually develop the set of items that reliably assess the measures of character—“irreverence,” “attitude,” and “fashion sense”—that they demand and, more importantly, to demonstrate with actual data that these constructs a) predict youth smoking, b) are related also to movie smoking exposure, and c) explain relation between movie smoking exposure and youth smoking, something no potential confounder studied to date has been able to do.

In Chapman’s 2009 commentary in Addiction [4], to argue against the science supporting an adult content rating, he posed the question, “If movie smoking is such a problem, then why is adolescent smoking declining?” He dropped that argument after it was shown that the decline in youth smoking over the last decade parallels a decline in movie smoking [43]. It is time to acknowledge the strength and consistency of all the studies linking onscreen smoking to adolescent smoking and to stop denigrating the science in an effort to promote a philosophical position.

James D. Sargent, M.D.

Norris Cotton Cancer Center, Dartmouth Medical School

Mike Stoolmiller, Ph.D.

Department of Education, University of Oregon

Thomas A. Wills, Ph.D.

University of Hawaii Cancer Research Center

REFERENCES

1. Chapman S, Farrelly MC (2011) Four arguments against the adult rating of movies with smoking scenes. PLoS Medicine 8: e1001078. doi:1001010.1001371/journal.pmed.1001078

2. Millett C, Polanksy JR, Glantz SA (2011) Smoking in movies: Arguments vs. evidence. Comment in PLoS Medicine, http://www.plosmedicine.o... Accessed 28 August, 2011.

3. Chapman S (2008) What should be done about smoking in movies? Tob Control 17: 363-367.

4. Chapman S (2009) With youth smoking at historic lows, how influential is movie smoking on uptake? Addiction 104: 824-825.

5. Dalton M, Beach M, Adachi-Mejia AM, Longacre MR, Matzkin AL, et al. (2009) Early exposure to movie smoking predicts established smoking by older teens and young adult. Pediatrics 123: e551-e558.

6. DiFranza JR, Wellman RJ, Sargent JD, Weitzman M, Hipple BJ, et al. (2006) Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality. Pediatrics 117: e1237-1248.

7. Dalton MA, Sargent JD, Beach ML, Titus-Ernstoff L, Gibson JJ, et al. (2003) Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet 362: 281-285.

8. Distefan JM, Gilpin EA, Sargent JD, Pierce JP (1999) Do movie stars encourage adolescents to start smoking? Evidence from California. Prev Med 28: 1-11.

9. Distefan JM, Pierce JP, Gilpin EA (2004) Do favorite movie stars influence adolescent smoking initiation? Am J Public Health 94: 1239-1244.

10. Jackson C, Brown JD, L’Engle KL (2007) R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents. Arch Pediatr Adolesc Med 161: 260-268.

11. Sargent JD, Beach ML, Adachi-Mejia AM, Gibson JJ, Titus-Ernstoff LT, et al. (2005) Exposure to Movie Smoking: Its Relation to Smoking Initiation Among US Adolescents. Pediatrics 116: 1183-1191.

12. Sargent JD, Beach ML, Dalton MA, Mott LA, Tickle JJ, et al. (2001) Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study. BMJ 323: 1394-1397.

13. Sargent JD, Dalton MA, Beach ML, Mott LA, Tickle JJ, et al. (2002) Viewing tobacco use in movies: does it shape attitudes that mediate adolescent smoking? Am J Prev Med 22: 137-145.

14. Sargent JD, Gibson J, Heatherton TF (2009) Comparing the effects of entertainment media and tobacco marketing on youth smoking. Tob Control 18: 47-53.

15. Sargent JD, Hanewinkel R (2009) Comparing the effects of entertainment media and tobacco marketing on youth smoking in Germany. Addiction 104: 815-823.

16. Sargent JD, Stoolmiller M, Worth KA, Dal Cin S, Wills TA, et al. (2007) Exposure to Smoking Depictions in Movies: Its Association With Established Adolescent Smoking. Arch Pediatr Adolesc Med 161: 849-856.

17. Song AV, Ling PM, Neilands TB, Glantz SA (2007) Smoking in movies and increased smoking among young adults. Am J Prev Med 33: 396-403.

18. Tanski SE, Stoolmiller M, Dal Cin S, Worth K, Gibson J, et al. (2009) Movie character smoking and adolescent smoking: who matters more, good guys or bad guys? Pediatrics 124: 135-143.

19. Tickle JJ, Hull JG, Sargent JD, Dalton MA, Heatherton TF (2006) A Structural Equation Model of Social Influences and Exposure to Media Smoking on Adolescent Smoking. Basic Appl Soc Psych 28: 117-129.

20. Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton TF (2001) Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking. Tob Control 10: 16-22.

21. Titus-Ernstoff L, Dalton MA, Adachi-Mejia AM, Longacre MR, Beach ML (2008) Longitudinal Study of Viewing Smoking in Movies and Initiation of Smoking by Children. Pediatrics 121: 15-21.

22. Wilkinson AV, Spitz MR, Prokhorov AV, Bondy ML, Shete S, et al. (2009) Exposure to smoking imagery in the movies and experimenting with cigarettes among Mexican heritage youth. Cancer Epidemiol Biomarkers Prev 18: 3435-3443.

23. Thrasher JF, Jackson C, Arillo-Santillan E, Sargent JD (2008) Exposure to smoking imagery in popular films and adolescent smoking in Mexico. Am J Prev Med 35: 95-102.

24. Thrasher JF, Sargent JD, Huang L, Arillo-Santillan E, Dorantes-Alonso A, et al. (2009) Does film smoking promote youth smoking in middle-income countries?: A longitudinal study among Mexican adolescents. Cancer Epidemiol Biomarkers Prev 18: 3444-3450.

25. Hunt K, Henderson M, Wight D, Sargent JD (2011) Exposure to smoking in films and own smoking among Scottish adolescents: a cross-sectional study. Thorax. ;thoraxjnl-2011-200095 Published Online First: 15 July 2011. Available at http://thorax.bmj.com/con...

26. Morgenstern M, Poelen EA, Scholte RH, Karlsdottir S, Jonsson SH, et al. (2011) Smoking in movies and adolescent smoking: cross-cultural study in sex European countries. Thorax. doi:10.1136/thoraxjnl-2011-200489. Published Online First: 26 August 2011. Available at http://thorax.bmj.com/con....

27. Hanewinkel R, Sargent JD (2007) Exposure to Smoking in Popular Contemporary Movies and Youth Smoking in Germany. Am J Prev Med 32: 466-473.

28. Hanewinkel R, Sargent JD (2008) Exposure to Smoking in Internationally Distributed American Movies and Youth Smoking in Germany: A Cross-cultural Cohort Study. Pediatrics 121: e108-117.

29. Arora M, Mathur N, Gupta VK, Nazar GP, Reddy KS, et al. (2011) Tobacco use in Bollywood movies, tobacco promotional activities and their association with tobacco use among Indian adolescents. Tob Control.

30. Wills T, Sargent J, Stoolmiller M, Gibbons F, Gerrard M (2008) Movie smoking exposure and smoking onset: A longitudinal study of mediation processes in a representative sample of U.S. adolescents. Psychol Addict Behav 22: 269-277.

31. Wills TA, Sargent JD, Stoolmiller M, Gibbons FX, Worth KA, et al. (2007) Movie exposure to smoking cues and adolescent smoking onset: a test for mediation through peer affiliations. Health Psychol 26: 769-776.

32. Bandura A (1986) Social Foundations of Thought and Action. A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall. 617 p.

33. Wills TA, Cleary SD (1999) Peer and adolescent substance use among 6th-9th graders: Latent growth analyses of influence versus selection mechanisms. Health Psychol 18: 453-463.

34. Gibbons, F. X., Gerrard, M., & Lane, D. J. (2003). A social reaction model of adolescent health risk. In J. M. Suls & K. A. Wallston (Eds.), Social psychological foundations of health and illness (pp. 107-136). Oxford, UK: Blackwell.

35. Gibbons FX, Houlihan AE, Gerrard M (2009) Reason and reaction: The utility of a dual-focus perspective on prevention of adolescent health risk behavior. British Journal of Health Psychology 14: 231-248.

36. Wills, T. A., Ainette, M. G., & Walker, C. (2007). Social influence. In M. Gerrard & K. D. McCaul (Eds)., Health Behavior Constructs: Theory , Measurement and Research. National Cancer Institute Website:http://cancercontrol.canc.

37. Farrelly M, K. K, Nonnemaker J, Crankshaw E (2011) Movie smoking and youth initiation: parsing smoking imagery and other adult content. Social Science Research Network.

38. Sargent JD, Worth KA, Beach M, Gerrard M, Heatherton TF (2008) Population-based assessment of exposure to risk behaviors in motion pictures. Communication Methods and Measures 2: 1-18.

39. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008.

40. Millett C, Glantz SA (2010) Assigning an ’18’ rating to movies with tobacco imagery is essential to reduce youth smoking. Thorax 65: 377-378.

41. Shmueli D, Prochaska JJ, Glantz SA (2010) Effect of smoking scenes in films on immediate smoking: a randomized controlled study. Am J Prev Med 38: 351-358.

42. Wagner DD, Dal Cin S, Sargent JD, Kelley WM, Heatherton TF (2011) Spontaneous action representation in smokers when watching movie characters smoke. J Neurosci 31: 894-898.

43. Sargent JD, Heatherton TF (2009) Comparison of trends for adolescent smoking and smoking in movies, 1990-2007. Jama 301: 2211-2213.

Smoking is drug taking and should be banned, warns anti-doping chief

http://www.dailymail.co.uk/sport/golf/article-2030877/Smoking-drug-taking-banned-warns-anti-doping-chief.html

28 August 2011

The sight of European golfers puffing on cigarettes during rounds could soon become a thing of the past.

A leading anti-doping expert is recommending that nicotine be added to the list of banned substances for sportsmen.

This would mean an end to scenes like last month at Royal St George’s, where Ulsterman Darren Clarke smoked his way through four rounds to win The Open.

Open smoker: Darren Clarke

Open smoker: Darren Clarke

And it would put an end to the pictures of pony-tailed Spaniard Miguel Angel Jimenez drawing on his massive cigars.

The campaign for a ban is being led by Olivier Rabin, sports director of WADA, the world anti-doping agency.

He claims to have extensive evidence that nicotine is a stimulant that can be used to boost athletes’ performance.

And he is recommending that WADA create new sanctions.

It was only in 2009 that the European Tour introduced random testing at all golf tournaments, adhering to the WADA list of banned substances.

Cigar man: Miguel Angel Jimenez

Cigar man: Miguel Angel Jimenez

If nicotine is added to that list the European Tour will enforce the ban.

But a grey area could be the issue of passive smoking.

Many caddies chain-smoke on the course, so what would happen to a player who was drug-tested after passively breathing in the smoke?

News of the potential ban came as a surprise to Denmark’s Thomas Bjorn, who finished fourth behind Clarke at The Open and who is chairman of the European Tour players’ committee.

A heavy smoker himself, Bjorn said: ‘I don’t think nicotine is performance-enhancing. It’s a habit on and off the course. But I suppose I’d have to give up and eat more.’

Read more: http://www.dailymail.co.uk/sport/golf/article-2030877/Smoking-drug-taking-banned-warns-anti-doping-chief.html#ixzz1X8ct706Y