Anti Smoking Essay
National Partnership Agreement on Preventive
Health Tobacco Social Marketing Campaign
Department of Health and Ageing
GPO Box 9848
Sydney NSW 2001
Paul Myers | David Blackmore
The Social Research Centre
Level 1, 262 Victoria St
North Melbourne Vic 3051
3Table of Figures
4Table of Tables
111.2 Campaign strategy
121.3 Campaign elements
131.4 Research objectives
151.6 Campaign context
161.7 About the report
172 Campaign awareness
212.2 Campaign recognition
373. Campaign Impact
373.1 Direct impact
413.2 Beliefs about smoking and its impact on health
433.3 Attitudes to quitting and smoking
453.3 Attitudes to quitting and smoking
483.4 Behaviour and intentions
584.1 Campaign awareness
614.2 Campaign impact
634.3 Performance against campaign objectives
73Appendix 1 Evaluation QuestionnaireTable of Figures
17Figure 1: Recall of anti-smoking information or advertising campaigns
21Figure 2: Recognition of 'Cough' TVC.
23Figure 3: Recognition of Cough in other media.
24Figure 4: Recognition of Health Benefits radio advertising.
25Figure 5: Recognition of NTC Health Benefits advertising - magazine and out of home.
26Figure 6: Recognition of online NTC 'Benefits' campaign.
27Figure 7: Recognition of Luke.
28Figure 8: Overall exposure to National Tobacco Campaign advertising
29Figure 9: Perceived effectiveness of message communication by the 2011 NTC
30Figure 10: Correct estimates of time for health benefits resulting from quitting to occur
31Figure 11: Recognition of Break the Chain
32Figure 12: Agreement with diagnostic statements about the Cough TVC
34Figure 13: Agreement with statements about effects of Benefits advertising
35Figure 14: Agreement with diagnostic statements about Luke
35Figure 15: Agreement with diagnostic statements for each element of the 2011 NTC
36Figure 16: Agreement with diagnostic statements for each element of the 2011 NTC
41Figure 17: Certainty of health damage due to smoking.
42Figure 18: Believe smoking causes certain health problems
45Figure 19: Smokers' overall attitude towards smoking/quitting
46Figure 20: Attitudes towards quitting
47Figure 21: Attitudes towards...
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Imagine for a moment that a sick bigot published an ad insulting blacks, Jews or homosexuals. We might debate the scope and limits of the first amendment and the freedom of individuals to say what they please, so long as they please the lynch mobs.
But what if the government ran it?
Nazi Germany in the thirties? No, America in the nineties. The only difference is that the group out of favor today is smokers. Anyone who dismisses the comparison has not been reading the news. Smokers are banned from universities, libraries, most places of business and the halls of government. They have been denied employment and fired from their jobs for smoking at home. They have been fined and thrown in jail. And the anti-smoking campaign is just getting warmed up: what lies ten years ahead?
There are two fundamental problems here. First, there seems to be a general acceptance that a majority can do anything it likes to a minority. If you are unconcerned or even happy about the present plight of puffers, you should remember that in one respect or another everyone belongs to some minority and that one day, your turn will come.
Second, and more seriously, our government, which was elected to serve (not rule!) us, is now in the business of bashing the politically incorrect. That phrase, once used humorously, is now starting to acquire the sinister tone that it carries in China. Once we allow the state the power to coerce "correct" behavior, it is only a matter of time, given present trends, before we are all clad neck to toe in severe black garments and addressing each other as "thee".
But some states (notably California and Massachussets, with others sure to follow) have a special indignity reserved for smokers: They must pay for their own persecution. In California, an additional 25 cents per pack tax on cigarettes was passed in 1988 to be used for cancer research, 5%; wetlands(!), 5%; indigent medical care, 40%; and "education" - read anti-smoker campaign - 50%. If you have no problem with that, try switching minority groups and see how well it sits. What about 5% for sickle-cell anemia research and 50% for an anti-black campaign, to be funded entirely by taxing blacks?
The argument that this is being done "for smokers' own good" is demeaning: our bodies are not government property. The argument that smokers cost society money is specious: about one third of us considerately die before cashing in on social security. The argument that smoke is harmful to others is nothing but a subterfuge: the risk of second-hand smoke exposure has been so outrageously distorted that it amounts to an outright lie.
For over twenty years I have watched the growing persecution of a minority with discrimination, harrassment, demeaning propaganda, unfair taxes and laws that fly in the face of our country's constitution. This has been made possible by smokers who are, by and large, apathetic and apolitical. The time is long overdue for smokers to stand up for their rights: to become aware of the issues, armed with facts and willing to work to restore their freedom, their dignity and their rightful place in society.
Secondhand Smoke: The Big Lie
The principal ammunition used in the war on smokers consists of these claims:
All of these falsehoods depend for their general acceptance on the credibility of those disseminating them and upon the inability of the typical listener to perform simple sanity checks using common sense and arithmetic. The simplest is this. It takes 20 years or more for damage to manifest itself in a smoker. ETS is hundreds of times more dilute than mainstream smoke. Non smokers would have to live with ETS for upwards of 2,000 years to incur the same damage. Here's another. Smoke from charcoal contains many of the same components as those most feared in tobacco smoke (carbon monoxide, formaldehyde, carcinogens and so forth). A ten pound bag of charcoal produces as much smoke (and harmful chemicals) as 160 packs of cigarettes. Are you going to quit barbecuing? Probably not. Yet the slightest whiff of tobacco smoke gives many anti-smokers apoplectic fits. Are they being hysterical? Read on and decide for yourself.
CancerThe reason science enjoys such weight and credibility is that it has generally been structured so as to encourage a wide scrutiny of methods, data and findings, peer review and a healthy debate from all viewpoints. In the end, faulty data and fanciful theories are laid to rest, and truth emerges the winner. Usually.
Scientists, like everyone else, are subject to personal bias. They can set out to prove a pet theory, they can ignore data which contradicts a favored hypothesis, and they can read into data facts which simply aren't there. In addition, and perhaps more importantly, their employers can be biased. Employers can put pressure on researchers or even research firms to validate a preordained position or to produce a desired result. Not that they really have to, since it is much easier to hire or retain investigators who agree with them to begin with. And even that is not necessary, since the employer gets to write conclusions and recommendations. Scientists who dissent can effectively be buried simply by not publishing what they have to say.
In an open and honest world, all of this would amount to little, since all sides would have their say and we could count on disinterested observers to wade through the fancy and glean the facts. In the case of secondhand smoke, however, it is near impossible to find anyone who is both disinterested and of sufficient standing to be heard. What we have instead is a war of credibility over conflicting interpretations of biased reports. What we have is politics.
On one side are anti-smokers and the EPA. On the other, smokers and the tobacco companies. At this moment, the antis and the EPA clearly have the upper hand, enjoying as they do a credibility which is just as clearly undeserved. No one is surprised that the tobacco companies have a financial agenda. The same people, on the other hand, express astonishment at the suggestion that the government might actually have a political agenda. Or at the fact that the government, too, is an employer, with more power than most to select and pressure the scientists it employs and to bury the ones that dissent. Nowhere is this power more abused than on the subject of ETS. Last year's EPA report on ETS, the cornerstone of the anti-smokers' arguments, is worse than just bad science.
It is corrupt.
Corrupt science has two salient characteristics. First, instead of starting with a hypothesis and data and deriving from that a conclusion, it does just the opposite: starting with a desired conclusion, it then selects data in order to support the hypothesis. Second, it stifles dissent by excluding dissenters from the process of review and by using ad hominem arguments to question their character and motives. The EPA is guilty on both counts.
Of the 30 studies on spousal smoking referred to in the EPA report, only 6 found any statistically significant association between ETS and cancer in nonsmokers married to smokers, and none found a strong relative risk. The studies actually used by the EPA were limited to 11 studies done in the United States. Using the EPA's own Guidelines for Carcenogenic Risk Assessment, none of these showed a statistically significant risk. These guidelines call for a 95% Confidence Interval. By lowering it to 90%, only one of the 11 studies showed a statistically significant risk. More importantly, the two largest and most recent studies, one of which was partially funded by the National Cancer Institute, were omitted from consideration altogether. Had these two been included, no statistically significant risk would have been found even after lowering the Confidence Interval to 90%. Even after violating its own guidelines, in other words, the EPA could still show no statistically significant risk without selecting data to fit its hypothesis. This cooked data is the EPA's only basis for declaring ETS to be a "Group A" carcinogen. ("Group A", incidentally, does not mean "extra deadly". It simply means "human".)
The EPA's studies on ETS operate under a "zero threshold" hypothesis, or the assumption that if huge quantities of something are dangerous, then microscopic quantities are dangerous also. The data they used, however, fails to bear this out: virtually all of the studies used either found no risk at all or a risk so weak that it would not be considered significant if applied to other subjects.
A "strong" risk is one with an "odds ratio" of 5 to 20 - reflecting an incidence of the problem five to twenty times higher in a group that was exposed to something than in a control group that wasn't. 5 in a population of 100,000, say, compared to 1. (Or 500 vs 100, or 5 in a million vs 1; since it is a ratio, it indicates nothing about the size of the risk itself. Only the relative risk.) A ratio of 1 indicates no risk at all. Odds ratios under 3 are usually considered so low as to be the possible result of random variation or margin of error. The odds ratio of contracting cancer from chlorinated tap water, for example, has been calculated by the EPA to be 1.5 - not enough to worry about, in other words. Yet the EPA used an odds ratio of 1.19 - considerably smaller than that of chlorinated tap water - to classify ETS as a human carcinogen.
One of the largest and most recent studies of ETS is the Brownson study, partially funded by the National Cancer Institute. This study found odds ratios varying from .7 in non-smoking spouses of smokers exposed for fewer than 40 years, to 1.3 in those exposed for over 40 years. .7 is a negative correlation, meaning that those exposed to ETS for less than 40 years experienced fewer cancers than the control group. Since the implication that ETS actually protected those subjects from cancer is biologically implausible, the only other conclusion that can be drawn is that the study's margin of error, caused by random variation, is .3 or higher. This means that the 1.3 figure is equally suspect. The total risk for all groups averages out to exactly 1, or no risk at all.
The Brownson study was available to the EPA, but was not used in its report. Had it been included, the conclusions would have had to have been revised downwards to show no risk.
Though the EPA claims a "19% increase in risk", the actual order of magnitude is less than intimidating. Even if the odds ratio of 1.19 is eventually found to be accurate and not the result of random variation, what this would mean is that instead of the 6 lung cancers per year normally expected in a population of 100,000, we might find 7. Put another way, the average lifetime risk of dying from exposure to ETS (as opposed to eventually dying of something else) would be about 1 in 700. Furthermore, the risk (if real) is concentrated among the non-smoking spouses of smokers exposed to ETS (a heavier exposure than that found elsewhere) for upwards of 40 years, and cannot be extrapolated to include the general population. By way of comparison, the December, 1989 study by the Department of Transportation estimated the probability of contracting cancer from the cosmic radiation at cruising altitude as being some 2,000 times greater than the risk posed by ETS while on the aircraft. The question is, is this sufficient grounds to justify the subjugation of 50 million people? Before you answer, consider this: driving across town to your favorite restaurant entails a risk many times higher - 17 to be exact - than inhaling any secondhand smoke once you get there. If you include the risks associated with the food and drink you are likely to consume there, that multiple rises to over 450. And if you choose one of the many non-smoking restaurants provided by a free market, you get no exposure at all.
A look at the people who worked on this study explains this twisted methodology. Leading anti-smokers pervade both the EPA and the Science Advisory Board responsible for reviewing its analysis, and some of the work was contracted to the founder of a prominent anti-smoking group. It should come as no surprise that the EPA's Workplace Policy Guide was written well before the ETS risk study was completed.
The underlying philosophy at work here is that the end justifies the means; that since a smoke-free society is deemed to be a worthy goal, manipulation of data and even lies are permissible in achieving it. The EPA official responsible for the report admitted in "Science" magazine (7/31/92) that "she and her colleagues had engaged in some fancy statistical footwork" in order to arrive at the indictment of ETS. The opinions of dissenting EPA scientists were ignored, and references to works not in accordance with the EPA position were omitted from the bibliography of the report. Finally, those gainsayers who actually manage to make themselves heard are refuted not with data and reason but with character assassination.
Corrupt scientists have always been eager to ride the bandwagon of popular opinion. Early in this century, Russian scientists drew diagrams purporting to show that the skulls of Jews were smaller than average, reflecting a smaller brain and therefore a lowered intelligence and moral sense. This "justified" the pogroms. In our own country, studies claiming a lower IQ among African Americans (referred to in the studies as "Negroes") "justified" segregation. The damage done by these studies took decades to undo, while millions suffered. Both conclusions share an insidious and horrifying circularity: if the subject of the slur has the temerity to question the evidence, the response is "You can't believe him, he's stupid. Look: my charts prove it!" And that is exactly what is being repeated today. Using corrupt science, the EPA has manufactured a conclusion which states, in effect, that smokers and the tobacco companies are killing 3,000 Americans each year and are by implication morally corrupt. When anyone disagrees, the anti-smokers have the perfect counter argument: "You can't believe them, they're morally corrupt. Look: the EPA report proves it!"
"Political science" has taken on a whole new meaning.
Heart DiseaseWith the appellation of "Doctor" and his little black bag of anti-smoking calculations, Dr. Stanton Glantz is generally assumed to be a medical doctor. Nor is he eager to dispel that notion among his listeners. Actually, he has a PhD in Mechanical Engineering, and no medical training at all. His field of expertise notwithstanding, he gets paid handsomely for doing what he loves most: slandering smokers.
In the not too distant past, researchers (using smokers' tax dollars, naturally) claimed that non-smokers exposed to secondhand smoke over a long period of time exhibited a tiny but measurable increase in fatty deposits on their arterial walls. Given the bias of such researchers, their tendency to make leaps of faith when interpreting inconclusive data and the difficulty of eliminating confounding factors, one cannot accept with any degree of certainty that what they claim is true. However, let us assume for the sake of argument that the phenomenon is real, and proceed.
The arterial deposits in question are caused by diets rich in fats and cholesterol, and by lack of exercise. When coronary arteries become so clogged up that sufficient blood can no longer pass, a fatal heart attack can result. Clearly, this does not happen until a critical degree of obstruction, or "threshold", has been reached. A microscopic buildup in an otherwise healthy person is simply a curiosity, nothing more.
Enter Stanton Glantz, PhD. Each year some 1,000,000 Americans die from heart disease. Ignoring the concept of a threshold, Glantz "reasoned" that if the fatty buildup claimed by the researchers to be attributable to ETS was only one-twentieth as thick as that required to produce a heart attack, then surely it must be producing a twentieth of the heart attacks, or 50,000 of them. He then wrote a thick paper saying so. This is like saying that if a million people cross a body of water ten feet deep and 100,000 drown, then 1,000 would drown if the water were an inch deep. This claim is not just absurd. It is pure fantasy.
Stanton Glantz knows this.
No matter. His paper was his ticket to the lucrative anti-smoker lecture circuit, where his adoring audiences hear what they most want to hear, namely that smokers are killing people. He also found a receptive audience in the American Heart Association, which acts as a sort of wholesale distributor for his misinformation. AHA representatives are to be seen and heard at every City Council hearing on proposed anti-smoking ordinances, where they parrot this pernicious poppycock ad nauseum.
Doubtless the more educated members of the AHA realize what is going down. Perhaps they justify this to themselves by rationalizing that the claim is not really theirs, but rather the "work of a credible expert". Warranties, in other words, are the responsibility of the manufacturer, not the distributor. And since smoking itself is associated with heart disease, and since the goal of the AHA is to get smokers to quit, by outlawing tobacco if necessary, the end justifies the means. Doesn't it?
Respiratory IllnessesThe phrase "respiratory illnesses", when used in connection with ETS, is usually found appended to a list of other claims, as in "cancer, heart disease and ...". It seems to round off the list nicely and is purposely left vague. If pressed, anti-smokers will, as if by rote, recite "... such as asthma, colds, influenza and pneumonia". But none of these ailments is caused by smoking, much less by ETS. Pressed further, the antis will backpedal to the claim that ETS "aggravates" these conditions. The degree of this "aggravation" I shall examine in a moment. First, however, some interesting numbers bear looking at.
Since 1979, the number of smokers has declined significantly, from about 33% of adults, or higher, to a proportion varyingly reported as being from 20% to 25%. During the same period, a host of anti-smoking laws have dramatically curtailed smoking in public places. Today, exposure to ETS is not one tenth of what it was in 1979. Yet, according to an article in the San Jose Mercury News (October 12, 1993), fatal asthma attacks have nearly doubled in that time. More than 5,100 Americans suffered fatal asthma attacks in 1991, up from about 2,600 in 1979. Clearly, some scapegoat other than ETS will have to be found.
So where are the mystery deaths caused by "respiratory illnesses" that can be blamed on ETS? There aren't any. The diabolical innuendo of the phrase "... cancer, heart disease and respiratory illnesses" causes many to believe people die this way and to repeat the rumor. But it is akin to saying "nuclear bombs, biological warfare and firecrackers."
So far, in this country anti-smokers have enjoyed free rein to make wild claims about ETS without having to back them up with rigorous evidence in an objective, impartial setting such as a court of law. With the pending challenge to the EPA's report, that is about to change. For a preview of the truth likely to emerge, we have only to look at a recent Australian court case in which the Australian Department of Occupational Health, Safety and Welfare was pressing a complaint against a casino in an attempt to enforce a no-smoking law.
The question of "respiratory illnesses" quickly became a question of whether the effect of ETS should more properly be characterized as an "irritation" [the defense] or an "inflammation" [the prosecution]. After considering the evidence and witnesses from both sides, the judge likened it to "the experience of ordinary people who sneeze, or whose eyes water when peeling onions." The infamous "respiratory illnesses", in other words, were boiled down in the crucible of truth to simple runny noses.
In addition, the prosecution introduced as part of their evidence the January '93 EPA report on lung cancer and ETS. About this report the judge had these words: "I would have thought that these reports would be those which supported the prosecution case most strongly, but they appear not to. One of these reports is the American EPA report... Chapter 7.9 of the report covers passive smoking and respiratory symptoms and lung function in adults. Table 7.11 tabulates 6 studies and their results, which really show the contrary to what the prosecution witnesses say." The decision, handed down in Perth on September 17, 1993, concluded: "Whilst ETS is annoying and of discomfort to non smokers it has not been proved at the required standard, or at all, that it is a risk to the health of the employees at the Casino."