Quit Smoking Weapons of Mass Distraction (Public and Social Policy Series)

Who keeps telling smokers they can't quit without help? For decades there have been far more ex-smokers than smokers, and an estimated 75% of smokers quit without drugs or professional help. But smoking cessation is a global phenomenon serviced by multibillion-dollar industries, including the pharmaceutical and e-cigarette sectors and health professionals. These industries try to denigrate unassisted cessation and promote their products and services - "weapons of mass distraction" - as essential to successful quitting. This contributes to the medicalisation of a process that, before these products were available, had a natural history where drugs and expertise were absent, yet millions of people around the world still quit. Simon Chapman AO is one of Australia's foremost experts on strategies to minimise harm from tobacco. In Quit Smoking Weapons of Mass Distraction , he reviews the early history of quitting smoking and the rise of assisted quitting, and gives insight into the forces that have tried to undermine smokers' agency to stop. Chapman also provides actionable policy solutions to help people actually quit smoking. Quit Smoking Weapons of Mass Distraction Quit Smoking Weapons of Mass Distraction Contents Acknowledgements Abbreviations Introduction Quitting cigarettes Early Australian efforts at promoting quitting Australia’s first mass-reach quit-smoking campaign We must provide help! Nascent scepticism starts to foment Individuals or populations? Early provocations Outline of this book How do most people quit other addictions? Alcohol Opiates American armed forces heroin users after the Vietnam War Cannabis Problem gambling How we study quitting smoking: a critical look Evidence is not the plural of anecdote Self-selection bias Randomised controlled trials Trial exclusion criteria Hawthorne, attention and social desirability effects in RCTs Trial participant retention strategies Trialists are often paid and drugs are free Blindness integrity problems The pleasures of smoking? Can smokers guess if they have been allocated to the placebo arm? Competing interest bias Positive outcome bias “Intention to treat” analysis Citation bias Real-world observational studies 1: Cross-sectional surveys Low response rates in cross-sectional surveys Self-selecting, motivated samples vs. whole population randomly selected samples Real-world observational studies 2. Longitudinal cohorts Relapse Recall bias Indication bias Ways of quitting smoking Success rates versus intervention and policy reach Quitting unassisted: before and after “evidence-based” methods Enter Nicotine Replacement Therapy (NRT) and prescribed medications How has mass use of smoking-cessation medication affected cessation at the population level? What’s the upshot from RCTs and observational studies of NRT? Australian data Trends in proportion of smokers and ex-smokers who quit unassisted Stop smoking medications in low-income nations The modest impact of most popular interventions Quitlines North American quitlines Stop-smoking groups and counselling The English experience with quit-smoking centres Impact of English quit services on smoking prevalence Workplace smoking-cessation programs GP interventions Online quit interventions Contingency payments Quit and win lotteries How much intervention research is ever “upscaled” to become routine in mass-reach settings? “Don’t try to quit cold turkey” The slow death of the hardening hypothesis Spontaneous, unplanned quitting vs stages of change progression How difficult is it to quit smoking? The shunning and denigration of unassisted quitting Drivers of the medicalisation of smoking cessation The dominance of interventionism The medicalisation and commodification of cessation All smokers should use NRT: a promotional case study Attacks on my work on unassisted cessation: perspectives from the woods and the trees M’lud, the accused is charged with spreading four “fallacies” “Unsupported by the facts” A fourth attack It is “unethical” to not promote treatment for smoking in low-income nations Why does Big Tobacco never attack assisted smoking cessation? Vaping to quit: the latest mass distraction Big Tobacco butts in “95% less dangerous than smoking” Too soon to know the true health risks of vaping PATH data on toxicant exposure: never-tobacco users vs. smokers vs. exclusive vapers vs. dual users Never-tobacco users vs. exclusive EC users Exclusive EC users vs. exclusive smokers Dual users vs. exclusive cigarette smokers Insignificant uptake by teens and no gateway to smoking? Systematic reviews and meta-analyses on youth uptake Flavours and vaping Why aren’t asthma inhalers flavoured? How many puffs a day do vapers take? Evidence on the effectiveness of e-cigarettes in smoking cessation Recent reviews of the evidence on cessation Randomised controlled trials (RCTs) Cessation and dual use (vaping and smoking) US PATH cohort study findings Is vaping the primary cause of falls in smoking prevalence in nations where vaping is prevalent? Schooled by English experts Response to letters from Professors Brown, Shahab and West, and Professor McNeill Further data Response to Professor McNeill’s letter titled “Additional Comment to the Australian Select Committee on Tobacco Harm Reduction” The great English success story of vaping? New Zealand’s dramatic decline in adult smoking and rise in vaping Does vaping reduce smoking frequency (number of cigarettes smoked)? Insights from qualitative research with unassisted quitters Paper 1: The views and experiences of smokers who quit unassisted. A systematic review of the qualitative evidence Research question 1: How much and what kind of qualitative research has explored unassisted cessation? Research question 2: What are the views and experiences of smokers who quit unassisted? Discussion Concepts central to self-quitting Conclusion Paper 2: Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers Summary Introduction Results Prioritising lay knowledge Evaluating assistance against unassisted quitting Believing quitting is their personal responsibility Perceiving quitting unassisted to be the “right” or “better” choice Discussion Implications and future research Conclusion Strategies for reducing smoking across populations The melding of primary and secondary prevention The new narrative: don’t quit ... switch! Attribution problems in smoking cessation research The vital importance of promoting quit attempts What “works” in tobacco control? The cauldron of proximal and distal influences A day in the life of Australian smoker Mr Rex Lungs, 2022 Bringing the background into the foreground News media coverage of tobacco control Health concerns Is using scare tactics unethical? Five main criticisms Victim blaming? Stigmatisation Prisoners of structural constraints? Is it always wrong to upset people? Recent neglect of public awareness campaigns Tobacco taxation Controlling tobacco supply and the endgame Regulation of other goods and services Pharmaceutical retailing as a model Restrictions on the number and location of tobacco retailers Be careful what you wish for? Regulating tobacco retail display Floor price controls Limitations on the number of cigarettes a smoker could buy Loss of licensure following breaches of conditions of licence Prescription access to nicotine vaping products Why regulate NVPs? Nicotine should not be exempted from regulation Prescribed access will greatly reduce teenage access to e-cigarettes Will Australian doctors be willing to prescribe nicotine? The end for combusted tobacco? Enter NVPs Reduced-risk products instead of or as well as cigarettes? Phasing out cigarettes? About the author Also by Simon Chapman References Index Now, For The First Time, The Economic Aspects Of Tobacco Control Are Assessed In A Single Concise Report That Reviews International Experience. The Report Concludes That Raising Taxes On Tobacco Could Save Millions Of Lives While Raising Government Revenues In The Medium Term, And That Other, Non-price Measures, Such As Comprehensive Bans On Cigarette Advertising And Promotion, Could Also Significantly Reduce Smoking. The Analysis Examines The Effects Of Tobacco Control Policies On Employment, And Finds That Most Countries Would Not Suffer Permanent Job Losses.--book Jacket. Global Trends In Tobacco Use -- The Costs And Consequences Of Tobacco Control -- Rising Consumption In Low-income And Middle-income Countries -- Regional Patterns In Smoking -- Smoking And Socioeconomic Status -- Age And The Uptake Of Smoking -- Global Patterns Of Quitting -- The Health Consequences Of Smoking -- The Addictive Nature Of Tobacco Smoking -- The Disease Burden -- Long Delays Between Exposure And Disease -- How Smoking Kills -- The Epidemic Varies In Place As Well As In Time -- Smoking And The Health Disadvantage Of The Poor -- The Risks From Others' Smoke -- Quitting Works -- Do Smokers Know Their Risks And Bear Their Costs? -- Awareness Of The Risks -- Youth, Addiction, And The Capacity To Make Sound Decisions -- Costs Imposed On Others -- Appropriate Responses For Governments -- Dealing With Addiction -- Measures To Reduce The Demand For Tobacco -- Raising Cigarette Taxes -- Nonprice Measures To Reduce Demand: Consumer Information, Bans On Advertising And Promotion, And Smoking Restrictions -- Nicotine Replacement Therapy And Other Cessation Interventions -- Measures To Reduce The Supply Of Tobacco -- The Limited Effectiveness Of Most Supply-side Interventions -- Firm Action On Smuggling -- The Costs And Consequences Of Tobacco Control -- Will Tobacco Control Harm The Economy? -- Is Tobacco Control Worth Paying For? -- An Agenda For Action -- Overcoming Political Barriers To Change -- Research Priorities -- Recommendations -- Tobacco Taxation: A View From The International Monetary Fund. Prabhat Jha, Frank J. Chaloupka. Includes Bibliographical References And Index. Tobacco will kill 4 million people in the next 12 months. By 2030 it will be killing 10 million people a year, more than any other single cause, and 7 million of these deaths will be in low-income and middle-income countries, where cigarettes were once rare. As educated and prosperous people abandon smoking, the practice is becoming increasingly concentrated among the poor in most societies. In the rich countries at least, its damaging effects on health are responsible for a large part of the ill health and premature death of the poor. Yet many governments have hesitated to act to control tobacco because of concerns about the economic effects of their action. For example, many policymakers fear that by reducing tobacco consumption they will cause permanent unemployment.Now, for the first time, the economic aspects of tobacco control are assessed in a single, concise report that reviews international experience. The report concludes that raising taxes on tobacco could save millions of lives while raising government revenues in the medium term, and that other, non-price measures, such as comprehensive bans on cigarette advertising and promotion, could also significantly reduce smoking. The analysis examines the effects of tobacco control policies on employment, and finds that most countries would not suffer permanent job losses.The report examines the costs of control policies, and sets out an agenda for action for governments, including help for poor tobacco farmers. It also points to roles for the international agencies in reducing the avoidable toll of smoking-related premature death and disability. For decades, there have been far more ex-smokers than smokers — an estimated 75% quit without any drugs or professional help. But smoking cessation is a mass global phenomenon which is serviced by multibillion-dollar industries (pharmaceutical and e-cigarette industries, as well as health professionals). These try to denigrate unassisted cessation and promote their products and services as essential to successful quitting. This discourse promotes smoking cessation 'weapons of mass distraction' and the medicalisation of a process that, before these products were available, had a natural history where drugs and expertise were absent, yet many millions quit around the world. The book reviews the early history of quitting smoking, the rise of assisted quitting and the forces that have tried to undermine smokers' agency to stop. Since The 1950s When The Evidence On Smoking Causing Serious, Fatal Diseases Began Consolidating, Hundreds Of Millions Of Smokers Have Quit. Overwhelmingly, The Great Majority Quit Unassisted Without Any Professional Or Pharmaceutical Help. But From The Late 1970s, Massive Campaigns Have Urged Smokers Not To Go The Cold Turkey Route And Instead Take Nicotine Replacement Therapy, Prescribed Drugs And Most Recently, To Vape. Simon Chapman Is A Veteran Researcher, A Global Public Health Advocate And An Australian Skeptic Of The Year. In This Book He Analyses The Relentless Push To Medicalise And Commodify Quitting And Sets Out Those Policies And Campaigns Which Have Collectively Driven Smoking Rates Down To Record Low Levels.