by Carl V Phillips
Mountain Vapor Blog
Research has documented a strong link between smoking and various mental health disorders, including anxiety, depression, schizophrenia and bipolar disorder. The CDC advises that about 20% of American adults had some form of mental illness in 2009-2011, and the smoking rate for that group was 36%, in contrast to 21% for all others (here). There is certainly an association, but there are four distinct possibilities with respect to causality: · Mental health problems cause people to smoke. · Smoking causes mental health problems. · Both pathways exist. · Neither pathway exists. My economist colleague Dr. Nantaporn Plurphanswat is the lead author of an innovative analysis that identifies a potential causal pathway for mental illness and smoking; the work appears in the American Journal of Health Behavior (abstract here). Our co-author is University of Illinois professor Dr. Robert Kaestner. We used data from people in almost all states participating in the federal Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2010. BRFSS collected information on smoking and asked participants “…for how many days during the past 30 days was your mental health [which includes stress, depression, and problems with emotions] not good?” Recognizing that traditional approaches cannot identify a causal pathway between smoking and mental illness, Drs. Plurphanswat and Kaestner employed an instrumental variable approach, in which variation in smoking at the state level is strongly associated with cigarette excise taxes, but the excise taxes are completely unrelated to outcomes like mental health. The IV analysis provides information on whether smoking leads to mental health problems, or vice versa. Our results indicate that smoking may harm mental health: it is significantly associated with 14 or more days of poor mental health. Most of the effect due to smoking is from large increases in the number of mentally unhealthy days and not by small increases among many smokers. The BRFSS data cannot tell us whether smoking is a form of self-medication practiced by those who suffer from specific mental health disorders. However, our analysis confirms that smoking may contribute to anxiety, depression and emotional distress. Thus, policies that reduce smoking may have a positive spill-over effect in improving mental health. Original author: Brad Rodu
by Carl V Phillips
A new report from the Swedish Snus Commission underscores the accelerating human toll of the European Union’s unconscionable ban on smokeless tobacco: “…among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.” Sweden is the only EU nation in which sales of snus are legal. In 2009, epidemiologist Phil Cole and I, analyzing data from the World Health Organization and the International Agency for Research on Cancer, reported in the Scandinavian Journal of Public Healththat 274,000 smoking-attributable deaths would be avoided if men throughout the EU had the smoking prevalence of men in Sweden (here). Four years later, I updated that figure to 291,000 (here). The Snus Commission report, available here, was produced by a distinguished group of Swedes. The commission’s chairman is Anders Milton, a physician and former President and Chairman of the Swedish Medical Association, President of the Swedish Confederation of Professional Associations from 1993 to 2001, and President of the Swedish Red Cross from 2002 to 2005. His collaborators are Christina Bellander, a journalist who previously headed business development at Swedish TV4 and was a Board Member of New Wave Group AB, Mittmedia AB and the Swedish Educational Broadcasting Company; Göran Johnsson, a former member of the Social Democratic Party’s Executive Committee, Board Member of Volvo AB and Chairman of Swedish national television broadcaster SVT from 2011 to 2014; and Karl Olov Fagerström, a WHO-recognized nicotine and tobacco researcher who has authored 150 articles in peer reviewed journals. The casualty list from the indefensible and immoral EU snus ban continues to grow. Original author: Brad Rodu
June 12th, 2017
A special report on tobacco and e-cigarettes published by Eurobarometer, the official polling organization of the 28-nation European Union (here), underscores the remarkable success of what researchers call “The Swedish Experience”. According to the report, the prevalence of smoking in Sweden is just 7%, with no other EU country even remotely close. UK prevalence is 17%, while only Denmark, the Netherlands, Belgium and Ireland are below 20%. The prevalence of daily smoking in Sweden is a bare 5%, as shown in the chart at left (credit to Lars Ramstrom from Sweden), and the prevalence of former smoking is 41%, the EU’s highest by far. Eurobarometer provides an array of impressive statistics: “In all but one country, at least eight in ten (80%) of smokers consume tobacco products daily. The exception is Sweden, where only just over half (52%) give this response. In turn, over a fifth (21%) of smokers in Sweden are irregular smokers, consuming listed tobacco products less than monthly. In all other countries, very few respondents give this answer.” There is only one explanation for Sweden’s remarkable number: the popularity of snus, the sales of which are prohibited in all other EU nations. The new report reveals that 20% of Swedes use snus daily. The only other countries with daily smokeless use are Denmark (1%), home of Oliver Twist chewing tobacco pellets, and Finland (2%). The Eurobarometer report should pressure the EU to end its snus ban. Swedish Match has filed a complaint with the European Court of Justice to compel EU action. For more on “the worst regulation in the EU,” see Clive Bates’ excellent commentaries, such as this (here). Original author: Brad Rodu
Smokeless tobacco users in the U.S. are constantly under attack for their “bad habit”. Public health officials and organizations deliberately misinform consumers about smokeless health risks, generating undue pressure to quit from friends and families. The truth about smokeless has been hard to come by. Chewers and dippers can watch my informative video interview with Mudjug’s Darcy Compton (here), or they can read or listen to my book, For Smokers Only, How Smokeless Tobacco Can Save Your Life. Now, there’s another option: a downloadable pamphlet from Consumer Advocates for Smoke-free Alternatives Association (CASAA) titled, “Smokeless Tobacco: Separating Fact from Myth” (available here). Save it as a pdf and print copies to share. CASAA is a non-profit organization “dedicated to ensuring the availability of reduced harm alternatives to smoking and to providing smokers and non-smokers alike with honest information about those alternatives so that they can make informed choices… We believe that consumers are best served by ensuring diversity in the marketplace and by being provided with truthful and accurate information so that they can make informed decisions regarding their health and lifestyle choices.” CASAA’s 200,000 members are active in tobacco legislation, litigation and regulation. The group maintains an archive of thousands of testimonials from former smokers who found safer cigarette substitutes (here). Everyone who cares about smokers, smokeless users and truthful information should become a member here. Original author: Brad Rodu
Letter to European Commissioner for Better Regulation on the worst regulation in the EU – the snus ban
Eighteen of us have just written a detailed letter to Mr Frans Timmerman, the EU’s Commissioner for Better Regulation (amongst other things) drawing his attention to one of the worst regulations in the EU, the ban on oral tobacco, better known as snus. This ban is now facing challenge in the Court of Justice of the European Union (case C 151/17) by a producer, Swedish Match, and the consumer group, New Nicotine Alliance (see NNA background on the case).
(Update - 05.20.17)
The letter we are providing urges Secretary Price to delay implementation of the FDA deeming regulations. Without this delay, many in the vapor industry will begin closing down their operations. If action is not taken soon, consumers will be losing access to reliable, affordable, life-saving vapor products.
Why is the Campaign for Tobacco-Free Kids Congratulating a Political Leader Accused of the Murder of Thousands of Innocent Civilians?
Snus use is not associated with pancreatic cancer, according to a study published in the International Journal of Cancer (abstract here). Researchers combined data from nine cohort studies that involved 400,000 men in Sweden. Compared with never users, the risk for current snus users, after adjustment for smoking, was 0.96 (95% confidence interval = 0.83 – 1.11). The new work was conducted by the Swedish Collaboration on Health Effects of Snus Use, which includes researchers from several Swedish universities. (In the past, snus research was largely performed by the Karolinska Institute, whose flawed studies I have previously documented here, here, here, and here.) Their results are almost identical to those in a large study of smokeless use in North America and Europe published six years ago (discussed here), and to findings in another analysis published eight years ago (here). Focus on a purported smokeless tobacco-pancreatic cancer link began after publication of a cherry-picked meta-analysis by Paolo Boffetta in 2008 (discussed here). Dr. Boffetta contradicted his own finding in a later study (here), and epidemiologist Peter Lee refuted it in his comprehensive analysis in 2009 (here). The fact is that there is no credible evidence that American or Swedish smokeless tobacco is linked to pancreatic cancer. Remarkably, the National Cancer Institute persists in asserting a pancreatic cancer link in its smokeless tobacco “fact sheet” (here). That document also asks what should be a rhetorical question: “Is using smokeless tobacco less hazardous than smoking cigarettes?” The NCI’s answer is grossly misleading: “all tobacco products are harmful and cause cancer…There is no safe level of tobacco use.” The agency’s source for this obfuscation is a 31-year-old Surgeon General report that has been eclipsed by three decades of epidemiologic studies. It should be noted that the U.S. Food & Drug Administration is equally culpable. That agency used the bogus smokeless-pancreatic cancer link as a talking point in last year’s $36 million campaign against smokeless tobacco (here). We already knew that moist snuff and chewing tobacco have no measurable risk for mouth cancer (here). Now there is scientific evidence that smokeless isn’t linked to pancreatic cancer. Original author: Brad Rodu
“Current public health policies offer smokers only two choices: to continue to smoke despite knowledge of adverse health consequences, or to quit, which often proves very difficult. “In a review of the avoidable causes of cancer, Doll and Peto observed that ‘No single measure is known that would have as great an impact on the number of deaths attributable to cancer as a reduction in the use of tobacco or a change to the use of tobacco in a less dangerous way.’ Unfortunately, the second part of this observation has not received attention. Because smokeless tobacco causes far fewer and considerably less serious health effects than does smoking, it should be promulgated as an alternative to cigarettes for smokers unable or unwilling to overcome their nicotine addiction.” Brad Rodu DDS, Professor, University of Alabama at Birmingham July 1, 1994 An Alternative Approach to Smoking Control. American Journal of the Medical SciencesVolume 308: pages 32-34. (here) “Thus, both the 35-year-old non-user of tobacco and the smokeless-tobacco user will live on average to be 80.9 years of age compared with 73.1 years for the smoker. Only 67% of smokers will be alive at age 70, compared with more than 87% of smokeless-tobacco users and nonusers of tobacco. “…abstinence is not the only approach to reducing tobacco-related mortality: for smokers addicted to nicotine who would not otherwise stop, a permanent switch to smokeless tobacco could be an acceptable alternative to quitting.” Brad Rodu DDS and Philip Cole MD, DrPH, Professors, University of Alabama at Birmingham July 21, 1994 Tobacco-related mortality. Nature Volume 370: page 184. (here) “Among these and many other opportunities, there’s probably no single intervention, or product we’re likely to create in the near future that can have as profound an impact on reducing illness and death from disease as our ability to increase the rate of decline in smoking. “We need to redouble efforts to help more smokers become tobacco-free. And, we need to have the science base to explore the potential to move current smokers – unable or unwilling to quit – to less harmful products, if they can’t quit altogether.” Scott Gottlieb MD, Commissioner, US Food and Drug Administration May 15, 2017 Remarks to FDA Staff (here) Original author: Brad Rodu
Comedian-cum-philosopher Stephen Colbert has opined, “Facts matter not at all. Perception is everything.” Actual British researchers have gone a step further, finding that, with e-cigarettes and vaping, perception changes behavior. British health authorities have consistently told smokers the truth about vaping since 2011 (here, here, here and here), while American officials, in their pursuit of a “tobacco-free society” or a “tobacco endgame,” have emphasized the negative, or simply perpetuated untruths and urban myths. Survey data in the U.K. and U.S. demonstrate that truth-telling results in more accurate perceptions about vaping than do obfuscation and scaremongering (here). Now, a survey from the U.K.’s Action on Smoking and Health (ASH) (here) shows that favorable perception translates into positive behavior. In this case, facts do matter. The U.K. vaping population has ballooned, from 700,000 in 2012, to 2.9 million this year. Importantly, the majority (52%) are former smokers – a sharp contrast to American data showing that most vapers are current smokers (here). Within these encouraging U.K. figures are reasons for concern. First, the prevalence of vaping is currently 5.8%, which is only a 12% increase since 2015. This suggests that e-cigarette use may be leveling out. With some nine million Brits smoking today (here), vaping momentum will have to grow in order to drive down smoking. A major barrier to the success of e-cigarettes is misinformation (here). The ASH report documents that 22% of smokers believe that e-cigarettes are more or equally harmful than cigarettes – a 9% increase from four years ago. Anti-vaping propaganda, discussed here, may be a contributing factor. Interestingly, 16% of smokers who tried but don’t use e-cigs said they would try them again if they were sure they were safe to use. The ASH report also documents that e-cigs don’t work for all smokers. Of smokers who tried but no longer use e-cigarettes, 25% said the devices didn’t feel like smoking, and 20% said they didn’t help with cravings. Smokers should be given access to a range of safer smoke-free substitutes, including smokeless tobacco and heat-not-burn products, in order to help them quit their deadly smoking habit. Original author: Brad Rodu