Monthly Archives: July 2012

The latest from the "journal", Tobacco Control; what comes after jumping the shark?

It is long past the time when Tobacco Control, an advocacy newsletter that pretends to be a scientific journal, could be said to be jumping the shark.  That happened a very, very long time ago.  But the rag still possesses the power to amuse, if not astound anymore.  I followed a link from Jan Johnson and discovered this gem:

Awareness, perceptions and use of snus among young adults from the upper Midwest region of the USA     

Kelvin Choi, Jean Forster, Division of Epidemiology and Community Health, University of Minnesota, 20 July 2012

Background: Since its introduction in 2006, snus has been aggressively marketed by tobacco companies. However, little is known about the awareness, perceptions and use of snus among young adults after Camel and Marlboro snus were sold nationwide in 2010.

Let’s see…  “Snus” is just the Swedish language word for oral snuff, which means that snus was probably introduced into the “upper midwest region” closer to 6006 BCE (or 1706 if you are being Eurocentric about it).  If we charitably assume they are misusing the term as a shorthand for “products called snus” or “oral snuff made in the Swedish style” (as opposed to them simply not knowing what they are talking about, which really seems like a safer bet), then they are not off by quite so many centuries.  But imported Swedish products that use the word “snus” have been available and popular in some circles (keep in mind the strong Swedish connections in Minnesota) for many decades. 

Methods Data: were collected from 2607 young adults (ages 20–28) who participated in the Minnesota Adolescent Community Cohort Study in 2010–2011. Data include awareness of snus, ever and past 30-day use, perceived potential of snus as a quit aid, and perceived harmfulness and addictiveness of snus relative to cigarettes. The authors assessed the associations between these outcome variables and socio-demographic characteristics.

Kinda picky, but I suspect that the “Minnesota Adolescent Community Cohort Study” took place in Minnesota.  So you have to wonder why they did not just use Minnesota in their title, instead of a misleading regional descriptor that implies they also studied such demographically different places as Michigan and North Dakota.  I have some serious doubts about whether their study really measured “awareness of snus” in a meaningful way, given that the authors do not even seem to know what the word means.  But to find that out, I would have to read beyond the abstract, and I cannot see that being worth my time — besides, if their reporting of their methods is as bad as is typical for their ilk, they probably offer no further explanation of what the survey actually did anyway.

Results: Overall, 64.8% of participants were aware of snus, 14.5% ever used snus and 3.2% used snus in the past 30 days. Men and participants who smoked >100 cigarettes in their lifetime were associated with these three outcomes (p<0.05). Among those who were aware of snus, 16.3% agreed snus can help people quit smoking, 17.3% agreed snus is less harmful than cigarettes and 11.3% agreed snus is less addictive than cigarettes. These perceptions were associated with ever use and the past 30-day use of snus (p<0.05).

Seriously?  Someone at University of Minnesota epidemiology is reporting as an epidemiologic result only the p-value?  That place has really gone downhill in the last 15 years.  Even if the authors have standard tobacco control levels of understanding about their subject matter, you would think they would pick up on the local standards for how to do epidemiology.

Conclusions In this regional sample of US young adults, the majority of young adults were aware of snus, and over one in 10 had used snus. More young adults in the sample than the overall US adult population believed that snus is less harmful than cigarettes. Perceptions of snus are associated with snus use. Strategic health communication interventions targeting young adults to confront the positive perceptions associated with snus may be needed to curb the interest in snus.

In response to that, I will start by quoting Greg Conley’s paraphrase of it (from the above link):

We must lie to these young adults (ages 20-28) so that if they decide to use a tobacco product, they will choose the most hazardous one.

Their anti-tobacco extremism is bad enough, of course — the fact that these people are bothered by the fact that would-be smokers are instead using an alternative that has approximately the same health effects as quitting entirely.  The only “positive perceptions” they report is that a minority understand the basic facts about the benefits of product switching.  So, as Greg pointed out, exactly what they are calling for is for those in power to keep lying to people.  Of course, given the woeful minority who understand the truth, mostly this is just further evidence that their lies have already been remarkably successful, which is presumably the anti-tobacco extremists’ champagne-popping main conclusion from this is (though they are probably bummed that the young are less likely to believe the lies, and are perhaps even smart enough to realize that this points to the fact that they day will come when they will be recognized for what they are).

But let’s just set aside their anti-public-health goals and look at the “science” alone.  How can they possibly conclude what they concluded?  There can be no evidence in their results that these “strategic health [sic] communication interventions” would do anything to change snus use.  None.  Zero.  Zilch.  Their conclusion has absolutely nothing to do with their data.

Of course, I am sure many of you are thinking that this is really nothing new for Tobacco Control.  Conclusions that are in no way supported by the analysis (even apart from political issues) are standard there.  So why did I bother to write about this particular dreck.  Well, what pushed me over was that when I followed the link to the “journal’s” webpage, I found not just that abstract, but this survey in the sidebar, like it was some kind of movie fan site or tabloid newspaper:

Should tobacco control organisations use online social media, like Twitter and Facebook, to help smokers quit?

No – only time wasting teenagers are online anyway.
Maybe – if it can be shown to actually work.
Absolutely – embracing new technology is essential.
Huh? What’s a Twitter?

Your first thought might be to wonder who among those who are on the website where the survey appears would not know what Twitter is.  But your second thought should be, “what is a supposed scientific journal doing sponsoring a survey about advocacy strategies?”  And your third should be, “what kind of pathetic excuse for a journal puts a cutesy sidebar survey on their website?” (perhaps a survey to ask questions about the journal or the website itself to improve their activities would be fine, but this?). 

Next week can we look forward to them doing a reader survey about the latest bestseller/movie: Should [ingenue du jour] choose [her noble but flawed suitor] or [the dark and brooding but ultimately golden-hearted suitor]?  And at that point, you might circle around to “time wasting teenagers? who do they think are the smokers are who are good candidates for cessation? do they really know that little about the field they write about?”

And in case you were wondering, at the time I looked at the page, there were 1762 votes, and they were divided among the four answers, respectively: 62%, 22%, 11%, 4% (yes, they do not add to 100 because of rounding, as is frequently the case; unlike them I was not going to report the percentages to the nearest 1/10,000th for a total of less than 2000 — that would be a Tobacco Control level of innumeracy that I am just not going to be guilty of, even though that was easiest to copy and paste). 

Should you wish to vote, perhaps because you are someone who does not know what Twitter is ;-), let’s say, here is the link.

Random thought about how epidemiology is analyzed

It just occurred to me that if physics were done the same way that epidemiology is done, then most of the people involved in the Higgs boson research would, as their educational background in the subject, have just read Stephen Hawking’s books and done a few college course level labs.

One possible corollary of that might be that they would not have discovered the Higgs boson as now claimed.  More likely, however, is that they would have “discovered” it, as well as a hundred other particles that do not exist, every time they ever collected data.

That is all.

Unhealthful News 216 – Smuggled cigarettes and an insightful lack of health news

An article in today’s NYT reports on cigarette smuggling in Europe, and its impact on reducing tax revenue.  It is a breezy feature piece with no new information, though the story probably comes as news to people who are not expert on the topic — which includes average people who have never thought about it, as well as clueless anti-tobacco industry people like Simon Chapman, who thinks that cigarette smuggling is no big deal.  One interesting thing about the topic is that unlike other economic news — like why we are in a depression — that the average person does not understand (and the mainstream media does nothing to improve that situation), this is a story that is pretty intuitive to everyone.  It is also a phenomenon that is quite familiar to the perhaps 10% of the population that participates in this grey market.

Aside:  The term “grey market” is sometimes, though not always, used to refer to a lawbreaking (most often, tax evading) market for a legal good, in contrast with using “black market” for products that are illegal.  Sometimes “black market” is used for both.  Indeed, the degree of lawbreaking varies continuously, from mere tax evasion, to violence and counterfeiting, and on through versions of the products that would indeed be illegal to sell, an thus the border between the two is, well, grey.  The grey/black market for cigarettes consists of a combination of legitimate name-brand product that is diverted from low-tax markets to be sold below retail prices in high-tax markets, unbranded product that is completely evading taxes and may or may not be inferior to the branded product, counterfeit product which is like the previous but is passed off as a name-brand product, and to a lesser extent stolen name-brand product.  The NYT misleadingly implied that the black market is mostly the second of these, with only a bare mention of the third.

The remarkable thing about the NYT article is what it said about how the tax and tax evasion issue relates to public health:


Yes, I mean that it said nothing at all.  There was no suggestion by the reporter or anyone interviewed that this has anything important to do with public health.  I cannot help but see this as a recognition that governments really do not care much about discouraging smoking, and are really in the cigarette business for the money (and they are most definitely in the business:  in Europe, North America, and much of elsewhere in the world, the government makes far more profit from the sale of cigarettes than do the manufacturers or retailers).  Presumably some pseudo-public-health people from the anti-tobacco industry were interviewed for the story, but it was clear to the reporters that they had nothing useful to contribute.

Or perhaps the reporter talked to one of the minority among anti-tobacco industry people who is clever and thoughtful, rather than one of the public nutcases or their cadres of useful idiots.  Such a person would realize that it was a bad idea to call attention to the fact that this tactic — taxes to discourage use — is played out.  That industry cannot afford to let people know that they have nothing further to offer that is useful, and that the only remaining promising way to reduce smoking (harm reduction) is something they oppose.  To mention the anti-smoking goal of taxes in a piece about how taxes have driven smokers to embrace an inexpensive grey market might have the annoying impact of causing people to question whether the tactic can continue to work.

Whatever the reason, it is quite interesting that the article did not mention health and made clear that government’s interest in the cigarette market was ensuring that they could keep collecting taxes.

Sadly, the article still managed to get a few things wrong, even within the context of having an unusual accurate take on the subject.  I have to think that most of these were a forced tack-on by some editor, since they are at the end, and completely out of sync with the tone of the article and out of context.  For example, the article is primarily about people who are not career criminals seizing the opportunity to make some money smuggling cigarettes.  But there is a random couple of sentences about organized crime that includes the line:

While governments fret about lost revenue, law enforcement officers are concerned about how smuggling profits are reinvested in other criminal activities.

It is not terribly surprising that law enforcement officers do not understand how business works, but you would think that the reporters writing this story would figure it out.  Here is a basic lesson for them:  A business activity (say, selling heroin or loansharking) is either profitable or it is not.  If it is profitable and someone realizes that that and knows how to engage in the activity, it will be done and it will self-perpetuate.  The exception might be if it is capital intensive to start it up, and there is no access to the necessary investment funds.  The above quote is trying to imply that this is the case, but that is obviously false since (a) these organized crime activities mostly do not need a huge initial investment, and (b) in any case, most organized crime operations are not hurting for cash to invest.  The whole “you are funding this other activity” argument is such transparent bullshit; it is really sad that the press always lets government get away with it.

If they had wanted to make a legitimate argument, they could have pointed out that once a business is operating illegally, then such things as contract enforcement and competitive disputes are often settled with violence, since legal channels are not available, and regulation is absent.  But this would tend to point out to the reader that the real negative side effects of black markets are caused not by the business itself, but by the fact that the government has banned the activity (or, in this case, moved in that direction — a ban, after all, is just a much higher price and so excise taxes differ from prohibition only in degree).

The reason for the tack-on seems to be that the reporters, or someone twisting their arms, did not want the story to completely be about relatively nice mom-and-pop cigarette smuggling operations.  They wanted to at least throw in a message to smokers that when they buy these products, they might be supporting something they would find objectionable.

Of course, if that is the message, then what smokers might really want to consider is the extent to which their purchase of taxed cigarettes funds the anti-smoking industry, and its campaigns to make smokers’ lives miserable and to prevent them from pursuing harm reduction, to say nothing of whatever government activities a particular individual might object to (large standing armies, subsidized housing, assassinations using drone aircraft, wind power subsidies, etc.).  Perhaps if they really thought about it, most smokers would rather support their friendly neighborhood smuggler.