Provided by Harvard School of Public Health on, /29/2005, by Healthy News Service

 
Analysis of Industry Documents Reveals How Mistaken Health Beliefs and Behavioral Differences Were Exploited in Order to Enlarge Female Cigarette Market

Boston, MA --A new analysis of tobacco industry documents provides evidence that cigarette companies intentionally modified their products to promote female smoking by emphasizing attributes they knew would appeal to women - stylishness and taste, as well as perceived health benefits. According to the authors, the study presents particularly troubling implications for world health, as tobacco companies seek to increase smoking among women in developing countries. The documents, made public following the 1998 Tobacco Master Settlement Agreement, are examined in a paper in the June 2005 issue of ADDICTION, an international scientific journal.

Previous studies demonstrated that marketing strategies have contributed to the association of smoking with appealing attributes including female liberation, glamour, success and thinness. Until now, however, the role of product design in targeting cigarettes to address how and why women smoke was less well understood.

"These internal documents reveal that the tobacco industry's targeting of women goes far beyond marketing and advertising," says lead author Carrie Murray Carpenter, M.S., Research Analyst, Tobacco Control Research and Training Program, Harvard School of Public Health. Carpenter and colleagues reveal that, for more than 20 years, the industry undertook a major effort to identify gender-based differences in motivational factors, smoking patterns, and product preferences in order to promote smoking among women and girls.

The Carpenter team say the resulting products exploited mistaken health notions about the relative safety of light cigarettes; created false perceptions of social and health effects through reduced sidestream smoke, appearance and odor and improved aroma and aftertaste; matched female taste preferences through flavored, smooth and mild-tasting cigarettes; and targeted physiological and inhalation differences between women and men with greater ease of draw, increased sensory pleasure and altered tar and nicotine levels. The documents also show that cigarette makers went so far as to explore the use of appetite suppressants in cigarettes to promote smoking-mediated weight control, according to the researchers.

"Carpenter and her group reveal that cigarette designs and ingredients were manipulated to make the cigarettes more palatable to women and to complement advertising allusions of smooth, healthy, weight-controlling, stress-reducing smoke," according to an accompanying editorial in ADDICTION by Jack E. Henningfield, Ph.D. and colleagues at The Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health. "For example, so called 'light' and 'reduced tar' cigarettes were designed to undermine prevention and cessation efforts by addressing smokers' concerns about the health effects of smoking -- but not by reducing the adverse health effects." Henningfield, who serves as director of The Robert Wood Johnson Foundation's Innovators Combating Substance Abuse program at Johns Hopkins University, is Adjunct Professor of Behavioral Biology, Department of Psychiatry and Behavioral Sciences in the university's School of Medicine.

Quotes from tobacco industry documents are sprinkled throughout the paper. One, from a 1987 internal Philip Morris report, describes a rationale for designing longer, slimmer cigarettes and creating the illusion of a "healthier" product:

"Most smokers have little notion of their brand's tar and nicotine levels. Perception is more important than reality, and in this case the perception is of reduced tobacco consumption."

The documents reveal that, beginning in the 1970s, the companies undertook internal research to identify numerous psychological and behavioral factors contributing to female-specific needs and motivations to smoke. As brand preferences shifted between the 1970s and 1990s the tobacco companies modified their product designs accordingly. "While the tobacco industry continues to target female smokers today, their current strategies are more multi-faceted and less readily identifiable than they were decades ago," the authors note.

The new paper's analysis suggests that the tobacco industry's behavior has particularly troubling implications for health officials in the developing world. While male smoking rates are declining throughout the world, female smoking rates are expected to continuing increasing and reach 20 percent by 2025, driven by the growth of female markets in developing countries. Published research predicts the rapid growth of tobacco-related disease among women in these countries, and establishes that industry efforts to target women have resulted in the elevated female smoking and related disease rates that we see today.

Henningfield views these revelations as a "call to action" for the tobacco control community: "Now that we know tobacco companies designed cigarettes to addict women, we need to look at prevention and cessation strategies to counter these efforts. Our most pressing priority should be to examine how Carpenter's findings can be used to counter the rising tide of smoking in women in developing countries, so that we don't see the corresponding increase in smoking-related deaths that we've already seen in the developed world."

For further information contact:
Robin Herman
617-432-4752
[email protected]

  Butting Out

- By Debbie Adams

Facts and Stats

More than 45,000 Canadians will die this year due to smoking related diseases.

Tobacco smoke contains over 4,000 chemicals, including at least 50 that cause, initiate or promote cancer. These include tar, ammonia, carbon monoxide, oxides of nitrogen, and benzopyrene.

Although the amount of chemicals in each cigarette is small, it is cumulative - the amount stored in the body actually increases with each puff of a cigarette.

There is a little bit of chemical in each cigarette puff, and there are over 10 puffs per cigarette. Over a year, at one pack of cigarettes a day, a smoker will inhale 73,000 puffs of dangerous chemicals.

Research has found that children of smokers were almost twice as likely to smoke as children with parents who never smoked.

These reasons alone should be enough to make you never touch a cigarette again. Did you know that the day after you stop smoking your body begins to rid itself of tobacco toxins? Unfortunately, smoking is extremely addictive; some people try again and again to quit, but end up back smoking after a few days or months. However, by choosing the right method, having a lot of determination and support you will be able to stop smoking for good. There are many options to choose from when you decide to quit smoking and it may take a few tries. The important thing to remember is: don’t give up!

Taking the First Step

Talk to your physician or Live Well Pharmacist about your decision to quit smoking. Together you can determine which smoking cessation method is right for you.

Patch It

A nicotine patch continuously delivers a small amount of nicotine through your skin to help take the edge off the effects of quitting. However, because you don't get large amounts of nicotine and it is delivered continuously (instead of the peaks and valleys in nicotine levels that occur with smoking), you may still have cravings to smoke or experience some withdrawal. People typically start with a patch strength that delivers close to the same amount of nicotine as they usually get smoking. After 4-6 weeks, step down to a lower strength to slowly wean off.

Nicotine Gum

The gum works by replacing nicotine when you get a craving you can't ignore. Rather than lighting up, you chew a piece of gum. It has little pockets of nicotine so with each chew you get the nicotine that you would get with one puff. One piece of gum is about equal to one cigarette in nicotine and duration. The act of chewing gum can be a soothing distraction. Don’t chew it like bubble gum, though; proper technique requires a couple bites, parking it between your cheeks and gums for 30 seconds, and repeating the cycle until the craving passes. Each piece only has enough nicotine to last 30 minutes.

Inhaler

Oral inhalers are a newer form of nicotine replacement therapy. The inhaler delivers nicotine into the mouth and produces a sensation in the back of the throat similar to that produced by tobacco smoke. This form of cessation sends nicotine to the bloodstream in a matter of minutes, and dosage can be adjusted to individual withdrawal symptom levels. Using the inhaler also helps with the “hand to mouth�?habit many smokers rely on. It is important not to smoke cigarettes or use other forms of tobacco if you decide to use an oral nicotine inhaler.

Medication May Help

Zyban�?(Buproprion), is a medication originally developed to treat depression but has been found to help people with cravings. The drug must be started prior to your quit date, usually 7-10 days, as it takes time to build up in your bloodstream. A medical prescription is required for Zyban�?and it can be used with other smoking cessation methods such as the nicotine patch.

Support Group

Look for a smoking cessation support group in your community. Often, having others with the same goal to lend support and share their experiences can be helpful in maintaining commitment to personal goals.

For information on the above methods and other ways you can quit smoking, talk to your doctor or Live Well pharmacist.

Sources:

Dear Reader, Every time I see a gaggle of smokers standing around the entrance to an office building I feel profoundly grateful that I'm not out there with them.

I used to be one of them - a slave to the habit. And without question, quitting cigarette addiction was the healthiest thing I've ever done. It was also one of the HARDEST things I've ever done. And I know I wouldn't have succeeded without the daily support of my husband.

But my husband can't be there to help everyone stop smoking, so I guess that's why Pfizer developed Chantix - only the second smoking cessation drug with FDA approval that doesn't use nicotine.

No nicotine - that's sounds good. But after reading the details (and reading between the lines), you might wonder why any clear thinking person would choose this regimen over a non-pharmaceutical method.

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The old switcheroo
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Before we look at Chantix (holding it at arm's length so we don't get any on us), I'll tell you a little secret about that other FDA-approved non-nicotine smoking cessation drug.

It's called Zyban and it's been on the market since 1997. But its active ingredient has actually been around quite a bit longer, going by the name Wellbutrin, an antidepressant that has a history of increased seizure risk when used in high doses, according to the National Alliance on Mental Illness. You have to wonder how many smokers out there are trying to quit by using Zyban, completely unaware that they're actually taking a powerful antidepressant.

Ah, but there's more. The Zyban information flyer warns: "Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior." And according to the Wellbutrin web site, the "most common side effects" with Wellbutrin XL include skin rash, sweating, stomach pain, anxiety, dizziness, trouble sleeping, nausea, sore throat and fast heartbeat.

Classic! The cure might be worse than the habit.

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In the pleasure center
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Nicotine binds to certain brain receptors, prompting a release of dopamine in the brain's pleasure centers. This creates the sensation that cigarette smokers chase relentlessly. Chantix binds to the same brain receptors, blocking the nicotine and the pleasant sensation. The drug also cuts cigarette cravings by slowing dopamine release.

Studies show that this method works on a little over 20 percent of smokers who take Chantix for a year. Only 16 percent of Zyban users were successful over the same test period. And Chantix was even more effective in a 12-week test, although the subjects' long-range success in quitting for good was not monitored.

And of course, there were side effects. Chantix will launch later this year, but Pfizer has already put up a Chantix web site that lists these side effects as the most common: nausea, constipation, gas, vomiting and changes in dreaming. (I wonder if "changes in dreaming" is a sly euphemism for "nightmares.")

But that list just gets things started. There are quite a few side effects listed as "frequent," including diarrhea, gingivitis, chest pain, back pain, dizziness, anxiety, depression, emotional disorder, polyuria (excessive urination), menstrual disorder and hypertension.

And then there's this intriguing note: "Fewer than 1 out of 1,000 patients reported euphoria in clinical trials with Chantix." Euphoria? Hmm...sounds like a little dopamine might be slipping through to the pleasure centers for a few blissfully happy Chantix users.

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Creating an aversion
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In the December 2000 HSI Members Alert, we told you about a botanical called Plantago Major. About 15 years ago, Dr. Mary Cody, a physician and researcher, found that Plantago Major creates a natural aversion to tobacco when inhaled or ingested.

In a 1992 study, 24 heavy smokers were given Plantago Major tincture in a nasal spray and then instructed to smoke. More than 80 percent of the subjects reported an aversion to tobacco shortly after receiving the dose, and the effect lasted as long as 24 hours for some of the subjects.

Dr. Cody's Plantago Major formula was patented shortly after that trial and is now available as a product called CIG-NO, which is sprayed under the tongue and creates an almost immediate reduction in cigarette cravings, with no reported side effects. You can find more information at cigno.com.

In the e-Alert "Tool Time" (8/17/05), I told you about CIG-NO and several other methods that HSI members (including myself) have used to quit smoking. You can find that e-Alert on our web site at hsibaltimore.com.

To Your Good Health, Jenny Thompson

May 23, 2006  
Sources:

"FDA OKs Pfizer Anti-Smoking Pill" Associated Press, 5/11/06, ap.org

"Charles Tells Doctors of the World to Use Alternative Treatments" Severin Carrell, The Independent, 5/15/06, news.independent.co.uk

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