Vol. 3 No. 4, Fall 1997

Scientists’ Input Essential in Tobacco-Control Efforts

Tobacco and nicotine scientists should be integral contributors to tobacco-control efforts, according to a policy statement issued recently by the Policy Committee of SRNT.

The July statement details the influence of scientists on tobacco-control policies, and called for the expansion of research effort, particularly related to cessation among highly dependent smokers. It maintains that the Food and Drug Administration needs the authority and resources to regulate nicotine in tobacco, and states that settlement provisions should ensure that policies achieve their intended health goals.

The policy announcement consists of five statements addressing tobacco-control efforts in a broad framework, with specifics regarding research needs, treatment development and accessibility, the role of the FDA, and provisions of the tobacco settlement now awaiting Congressional consideration. (The full text of the statement is on pp. 4-5.)

The policy statement is linked to President Clinton’s Plan for Comprehensive Tobacco Legislation to Protect America’s Children (summarized on p. 3). SRNT President Maxine Stitzer has commented on the Administration plan (see p. 2). Many SRNT members hope that any settlement between Congress and tobacco companies will increase funds research.

"No one knows what will happen" with the settlement, says Kenneth J. Kellar, Ph.D., of the Georgetown University School of Medicine Pharmacology Department. The original provisions allowed between $25 and $50 billion that could be earmarked for research, depending on how the settlement’s terms were interpreted.

Kellar emphasizes that making funds available for addiction-related research will require the work of addictions researchers. "Talk to your congresspeople, write editorials, talk it up," he stresses. "Make sure that those making the decisions know of the need for research into first-causes." The best hope for the usefulness of the settlement provisions depends on input from the nicotine and tobacco research community, Kellar says. "I don’t see it as being clear sailing at all."

 

View from the Top: Remarkable Time

Maxine L. Stitzer, Ph.D.

SRNT President, 1997-1998

We are living through a remarkable time in which anti-smoking agendas are gaining ever increasing strength and impact. Acknowledging the adverse impact of smoking on health, hospitals were the first to ban smoking on their premises; public smoking bans are now nearly universal, and one town in Massachusetts is taking the next step by trying to ban the sale of tobacco products within their jurisdiction. The seeming invulnerability of the powerful tobacco companies is being eroded by legal suits that are forcing them to acknowledge the addictive nature of smoking and the harm caused to the health of users. Thirty-nine states have filed suits against the tobacco companies to recover health-care costs due to smoking-related illness. A federal legal settlement, however, might be the most effective and efficient way to make a large and lasting impact on tobacco company agendas and practices.

Congress is currently considering several versions of a bill for a federal-level settlement. One aim of SRNT and other societies is to support anti-tobacco national legislation and to facilitate its passage through Congress. This is a complex and multi-pronged task. The Policy Committee, headed by John Hughes, has taken an active role in formulating society policy and influencing the settlement process. One product of the Policy Committee’s work, the SRNT Policy Statement: The Importance of Research in the Development of National Tobacco Control Efforts, is printed in the newsletter (pp. 4-5). This is a well crafted piece that emphasizes the importance of supporting — in any national tobacco control policy — available and affordable treatment for tobacco dependence, and FDA authority over regulation of nicotine in tobacco products. It is also important that research be recognized and supported within the context of a tobacco settlement. The research demonstrating that nicotine is an addictive substance and scientific clarification of the adverse health effects of tobacco smoking form the basis for all that is going on today. Notably, President Clinton’s Plan for Comprehensive Tobacco Legislation to Protect America’s Children (summarized on p. 3) does include a plea that resources be made available for health-related research.

In addition to the work of the Policy Committee in formulating the policy statement, several individual SRNT members, including John Hughes, Jack Henningfield, and Ken Kellar, have been networking in Washington to enhance visibility of SRNT. This effort has been coordinated and facilitated by Jude Woodward, the society’s executive director. The SRNT policy goals may also be facilitated by joining larger national coalitions currently being formed. For example, a coalition called Effective National Action to Control Tobacco (ENACT) is being formed by the Campaign for Tobacco-Free Kids. Such coalitions can give a louder, more focused voice to the aims of health-related agencies and societies. SRNT envisions, however, that its primary and unique role, whether acting alone or in concert with other groups, will be to represent research and to speak for it in the tobacco settlement. Overall, this is a very exciting time to be a member of SRNT. We have a window of opportunity in which to make an impact on public policy of a scope and significance that previously could not be imagined. I look forward to following the work of the Policy Commitee and hope that this summary will impress upon members the importance of the work being carried out under its direction.

 

The Clinton Administration Plan for Comprehensive Tobacco Legislation

President Clinton challenged Congress to pass sweeping tobacco legislation to reduce teen tobacco use significantly. The President announced that he will invite Congressional leaders in both parties to the White House in the coming weeks to launch a bipartisan effort to enact federal tobacco legislation. That legislation will build on the extraordinary efforts of the nation's attorneys general, who helped create an historic opportunity for progress in reducing smoking, especially by youth.

In August 1996, the Clinton Administration announced a landmark rule by the Food and Drug Administration to protect children from the harm caused by tobacco products, which was upheld by a federal judge in North Carolina earlier this year. These victories for the public health, along with the aggressive efforts of the attorneys general and leaders of the public health community, extracted concessions that Clinton stated would have been unimaginable just a short time ago.

Since a proposed national settlement was announced June 20, the Administration — led by Vice President Al Gore, Secretary of Health and Human Services Donna Shalala, and Domestic Policy Adviser Bruce Reed — has been working with the public health community, the attorneys general, members of Congress, tobacco farmers, and others to develop a comprehensive tobacco policy.

The President announced five key elements that he stated must be at the heart of any national tobacco legislation:

1.A Comprehensive plan to reduce teen smoking, including tough penalties if targets are not met. The administration is calling for--

2.Full authority for FDA to regulate tobacco prducts.

3.Changes in the way the tobacco industry does business.

4.Progress toward other public health goals.

5.Financial well being protection for tobacco farmers, their families, and their communities.

SRNT Policy Statement

The Importance of Research in the Development of National Tobacco Control Efforts

The Society for Research on Nicotine and Tobacco was founded in 1994 to foster the exchange of information on the entire spectrum of research concerning nicotine use and tobacco dependence, and to stimulate a generation of new knowledge concerning nicotine in all its manifestations.

1. Scientific research findings have been a major driving force in recent advances in tobacco control, including the proposed tobacco settlement in the United States.

Tobacco policy, prevention, treatment, and medication development have been a model of science aiding the public welfare. For example, consider the impact of the following research findings:

All of these findings have influenced the direction of tobacco control efforts. In the next several weeks, when major discussions are taking place about tobacco policy and control, it is essential that decision-makers consult those most familiar with nicotine addiction and smoking cessation —research scientists who can help clarify the public health issues and provide the foundation for rational policy development.

2. Nicotine and tobacco addiction research must be substantially expanded to ensure progress in our ability to curtail the development of nicotine addiction and to effectively treat a broader range of nicotine-addicted people. This includes research ranging from the molecular basis of nicotine's action to genetic influences on the vulnerability to addiction, and the chemical, behavioral, and social modulators of the addictive process.

Continuing research is essential to successful tobacco control and the viability of the tobacco settlement. The population of smokers remaining over the next five to 50 years will require new and innovative approaches to cessation. For example:

3.Effective treatments must be easily accessible and, at the same time, new treatments for highly addicted smokers need to be developed.

Although prevention has been the positive focus of many efforts, pursuing prevention alone abandons the 40 million smokers who want to quit but are unable to do so. We also need to develop and implement a treatment and delivery system to provide scientifically based interventions to smokers who either are more highly addicted or who for other reasons have been unable to stop smoking. It is worth noting that —

4.The FDA must have the same authority to regulate the nicotine in tobacco as it does for nicotine in medications, and it must have the financial and administrative resources to do so.

Nicotine is the addictive agent in cigarettes. Therefore, we believe that –

5. Settlement provisions must include methods to systematically evaluate the effects of all aspects of the agreement and subsequent regulatory actions by the government to ensure that the policies implemented are achieving the intended health goals.

Regular scientific review and progress reports on the effects of the settlement will be essential to guide the national policy on tobacco. In addition, these reports will provide important data for refining and adjusting national policy goals and/or provisions of the settlement. These reports would not take the place of groundbreaking Health and Human Services/Surgeon General reports but would supplement the literature and public information on a more frequent basis.

SRNT members include the world's leading nicotine and tobacco scientists, and we would be pleased to assist in the development of a research agenda that will ensure accelerated progress on the understanding, prevention, and treatment of nicotine addiction and its health consequences.

July 1997

 

SRNT Joins Health and Behavior Alliance

The Society for Research in Nicotine and Tobacco is among 14 research organizations that have joined together in a new Health and Behavior Alliance to raise the profile of health-related research in behavioral, psychological, and social sciences.Alliance activities will be coordinated by the Center for the Advancement of Health, a Washington, D.C., health policy organization.

"We have a clear, single focus," said the center's executive director, Jessie Gruman, Ph.D. "The nation's research and policy priorities must reflect the influence that behavioral, psychological, and social factors have on the onset of some diseases, the progression of many, and the management of nearly all.

"Until now, this field has been fragmented, both by discipline and by profession. Some research societies don't have the resources to weigh in on national research policy questions; for others, increasing the priority given to behavior and health research is only one of many issues they care about. The alliance will allow all of us in the behavioral, psychological, and social sciences who agree on the importance of the contribution we can make to health care to speak with one voice about the value of our research." The Alliance will work through action groups designed to increase awareness among the media, federal agencies, and Congress, of the significant role research can play in solving major health problems. The three action groups currently organized through the Alliance are Public Information, Federal Agency, and Congressional Action .

Other organizations in the Alliance include the Academy of Behavioral Medicine Research, the Academy of Psychosomatic Medicine, the American Psychiatric Association, the American Psychological Association (APA), APA Division 38, American Psychosomatic Society, American Society of Psychiatric Oncology/AIDS, Association for Applied Psychophysiology and Biofeedback, International Psycho-Oncology Society, International Society for Traumatic Stress Studies, Society of Behavioral Medicine, Society for Developmental and Behavioral Pediatrics, and the Society for Public Health Education.
The Center for the Advancement of Health promotes incorporation of science-based behavioral and psychosocial interventions into standard health care. The center was founded in 1992 by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, from which it receives core funding.

Henningfield Elected SRNT President

The SRNT membership has elected Jack Henningfield, Ph.D., as president of the society for the upcoming term, succeeding Maxine L. Stitzer, Ph.D. Henningfield is associate professor of Behavioral Biology in the Department of Psychiatry and Behavioral Sciences of the Johns Hopkins University School of Medicine at Baltimore, MD, and vice-president for Research and Health Policy of Pinney Associates of Bethesda, MD.

Karl Fagerström, Ph.D., of Pharmacia & Upjohn in Helsingborg, Sweden, was elected member delegate, with a term from extending from 1997 through 2000.

Henningfield retired as chief of the Clinical Pharmacology Branch of the National Institute on Drug Abuse’s Addiction Research Center in September 1996. He has served as editor or contributor to several reports of the U.S. Surgeon General and to NIDA’s reports to Congress, and has assisted the Food and Drug Administration in tobacco regulation issues. He has served on international committees related to nicotine and other drug dependence. He has received awards from the World Health Organization, the American Society of Addiction Medicine, and the U.S. Secretary of Health and Human Services. He recently was a co-recipient of the Alton Ochsner award.

SRNT Annual Meeting: March 27-29 in New Orleans

Abstracts are being submitted and plans are underway for the Fourth Annual Meeting of the Society for Research on Nicotine and Tobacco, 27-29 March 1998, in New Orleans, LA. The 1998 meeting will be held in conjunction with the Society for Behavioral Medicine’s 19th Annual Meeting, 25-28 March 1998.

Location for the SRNT meeting will be The Hyatt Regency New Orleans hotel. Several sessions co-sponsored by SRNT and by SBM are planned. SRNT’s program will include invited addresses, symposia, roundtable discussions, individual papers, and poster presentations. Information about the conference was sent to SRNT members in August.

"Nicotine and tobacco research has traditionally attracted many talented and creative scientists," comments SRNT President Maxine L. Stitzer. "Because smoking is a prototypic addiction, the research has contributed immensely to a broad understanding of addiction processes, yielding information that is applicable across abused substances. Nicotine and tobacco research has led to major advances in our understanding of the interaction of drugs with receptors, the determinants of drug reinforcement, and the determinants of relapse following cessation attempts.

"Further, research has identified effective treatments using combined pharmacological and behavioral models of treatment intervention. New medical uses for nicotine have been discovered and new treatments for smoking cessation are continually being developed and researched. Our meetings provide a forum for sharing the latest information on these and other related topics," Stitzer says.

Opportunities and topics at the 1998 annual meeting include the following:

"SRNT is still a small society, with only about 300 members. This makes for an intimate and congenial atmosphere," Stitzer notes. "I hope that members will come and invite other colleagues to attend as well."

 

Book Review: The Tobacco Epidemic

International Authors Address Current Issues

Kenneth A. Perkins

University of Pittsburgh

 

Volume 28 of the regular series Progress in Respiratory Research, entitled The Tobacco Epidemic, is a well organized, comprehensive collection of papers on various topics related to tobacco use, effects, and control. Those involved represent a very impressive international array of expertise in the tobacco field, from new series editor C.T. Bolliger and volume co-editor, Karl Fagerström, to the individual contributors, many of whom are SRNT members.

The first two chapters (Slade, Huber and Pandina) essentially set the stage for discussion of current issues in tobacco control and regulation by providing an overview of the history of tobacco use and economics. The casual reader will find these sufficient for gaining an understanding of the historical development of the tobacco industry; those with a deeper interest should seek out Richard Kluger's 1996 Pulitzer Prize-winning book on the topic, Ashes to Ashes.

While most of the chapters are fairly focused papers of about a dozen pages each on a specific topic, Huber and Pandina cover several broad but related areas in 50-some pages, including tobacco use and economics in the developed and developing countries. The latter emphasis, on developing countries, is particularly timely and important, and the following chapter (Ramstrom) provides recent data on prevalence of smoking across most of the countries of the world.

In a chapter particularly relevant to gauging the extent of tobacco use around the world, Ramstrom notes the difficulties involved in surveying prevalence across different countries (poor translation of standard questionnaires into native language, reliance on misleading sales data, etc.). He also suggests an interesting "stage" model for generally characterizing tobacco use and effects in a particular country, from stage 1 (males adopt smoking first, followed about 20 years later by females, few deaths from tobacco—currently fits many developing countries) to stage 5 (smoking declining to low levels and deaths also declining—no country has yet reached this stage). Nevertheless, if there is any facet of this excellent volume that could be considered less than sufficient, it may be that the current trends in tobacco use and potential directions for tobacco control in developing countries do not receive greater attention. Control strategies designed for developed countries, which receive the bulk of attention in this and most other publications, may not be appropriate for developing countries whose experience with widespread tobacco use and the resulting health toll is only now emerging.

Subsequent chapters provide comprehensive overviews of the health effects due to smoking (Wyser and Bolliger) and of passive smoking (Wiebel), information very appropriate for this volume and useful for those wanting citations supporting specific disease risks from smoking. Chapters outlining factors associated with the onset of nicotine dependence follow, including a fine overview of neurophysiological correlates (Pomerleau) and the importance of individual differences predicting smoking prevalence, primarily personality and psychopathology (Gilbert and colleagues).

Current directions in treating tobacco smoking are covered in three chapters, focusing on predictors of unaided cessation (Jarvis), the role of the health care professional in promoting cessation (Fowler), and efficacy of nicotine replacement therapy (NRT) in cessation (Tonnesen). Jarvis contributes the important observation that long-term success after spontaneous quitting is remarkably infrequent, probably under 3%, and that by contrast even the disappointing success rates of 5-10 % for most brief interventions of the type

described by Fowler should be seen as "effective." A useful section of Tonnesen's chapter examines promising directions for NRT, such as combining different methods of NRT, high dose NRT (generally patch), and predictors of success with NRT such as the smoker's level of nicotine dependence. Given the increasing interest of drug companies in developing medications for smoking cessation, expansion of this section and more discussion of non-nicotine pharmacotherapies would have been desirable.

Complementing these treatment chapters are two exploring the goal of smoking reduction, rather than complete abstinence, with the aid of NRT (Kunze) and smokeless tobacco (Bolinder). Kunze notes the low effectiveness of abstinence-based treatments and the long delays before primary prevention efforts have an impact, arguing that methods to reduce smoking may take effect fairly quickly. Both chapters also comment on the reduction in health risk of NRT and smokeless tobacco even when combined with lower frequency smoking. On the other hand, there has been little clinical research demonstrating that either NRT or smokeless tobacco will substantially and durably reduce smoking, suggesting that implementation of these approaches may be premature.

Rounding out this collection are three somewhat overlapping chapters on prevention and regulation of smoking. Each discusses the importance of regulating tobacco prices, access, and advertising, although each has a different focus--primary prevention with children (McNeill), community interventions (Melihan-Cheinin and Hirsch), and public policy (Sweanor). The need for demand reduction and inadequacy of relying solely on "supply-side" approaches (i.e., price, restricting access) is also discussed by each, as tobacco is likely to remain legal even if more strictly regulated, and raising prices seems to have little impact on smoking among the poor (those most likely to gain financially by quitting). Sweanor outlines potential complementary strategies to reduce demand, including legislation to require full disclosure of additives, health risks, and addictiveness of tobacco smoking by the industry, efforts to educate the public about these factors, increasing assistance to those who want to quit, and legislation to control tobacco products themselves (e.g., ban additives and flavorings).

The chapter by Sweanor is a particularly appropriate way to conclude the volume and is very informative regarding policy directions for controlling tobacco use in developed countries. In a comment relevant to harm reduction, he notes that current regulation of nicotine products pushes those interested in long-term use of nicotine toward tobacco since long-term use of non-tobacco nicotine products is discouraged. Sweanor echoes a comment made by several contributors, that the safest forms of nicotine seem to have the greatest restrictions, putting them at a substantial marketing disadvantage relative to tobacco. He caps off the volume by cogently arguing that the most effective and practical policies regarding smoking control will have to treat all nicotine-containing products on an equal basis rather than making artificial distinctions between tobacco and pharmaceuticals.

A final side comment concerns use of the term habit by a number of this volume's authors, as well as many others in this field, to describe tobacco smoking behavior. Given that smoking meets established medical criteria for drug dependence, it would seem that calling it a habit fails to distinguish smoking from other frequent behaviors that are more amenable to change, such as television watching or biting one's fingernails. Using dependence or a similar term does make this distinction, conveying the very strong persistence of smoking despite its profound health risks and the often extensive treatments used to help smokers quit. It thus seems a more accurate and appropriate description for this behavior.

In summary, The Tobacco Epidemic is a well-organized collection of papers by leading researchers covering the current status of tobacco use, effects, and control. It would serve as a very useful resource for anyone in the field of smoking research, treatment, or policy.

 

‘Smoking Don’t Get No Respect’

John Hughes

University of Vermont

Ever feel like your work is under-appreciated? Here you are, working on (a) the receptor that has contributed the most to our understanding of the brain, (b) the most preventable cause of mortality in the world, or (c) the greatest commercial scam in modern times, but you still don't receive the most attention at your department cocktail parties!

In the last few years, I have been collecting humorous and sad examples of authors, speakers, bureaucrats, and others who forgot to mention smoking or nicotine when they spoke of health hazards, drug dependencies, psychiatric problems, economic wastes, etc. (Hughes and Howard, 1994).

With this column, the newsletter begins publishing such faux pas. I would very much encourage our readers to send me examples you have seen or experiences you have had in which nicotine or tobacco use is overlooked (fax me at [802] 660-3065 or email me at at john.hughes@uvm.edu). The more humorous and sarcastic the better. Remember, sarcasm may not change anything, but it does make you feel better.

Our first example is taken from the September/October issue of NIDA Notes, the major public relations outlet for the National Institute on Drug Abuse. As you can see, evidently some people do not believe that nicotine is a drug of abuse that acts on our brain reward systems. Maybe they think it is the taste. To record your dismay at the omission of nicotine, you could write to the following individual: Gerald Soucy, Editor, NIDA Notes, room 10A-39, NIDA, 5600 Fishers Lane, Rockville, MD 20857, or send a fax to (301) 294-5401. You could copy your letter to Alan Leshner, NIDA Director, Room 10-05, 5600 Fishers Lane, Rockville, MD 20857.

The second item examines the lack of consideration of nicotine/tobacco in the Institute of Medicine's Pathways to Addiction. Given the almost complete absence of consideration of nicotine in the last Institute of Medicine book on drug abuse, Treating Drug Problems (North Dakota was listed in the index, but nicotine, smoking, and tobacco were not), I thought this book also might under-emphasize nicotine. My fear was heightened when I saw the composition of the 16-member committee on Opportunities in Drug Abuse Research. This committee had an amazing lack of expertise in nicotine/tobacco. For example, the 16 committee members had a grand total of three publications on smoking or nicotine in the last four years, i.e., they averaged .047 publications on nicotine per expert per year!

Initially, I thought the book would be different, as in the introduction it stated: "continued separation of alcohol, nicotine, and illicit drugs in everyday speech"—as if this doesn't occur in scientific speech—"is an impediment to public education, prevention, and therapeutic progress." And, "The term drug, unmodified, refers to all psychoactive drugs, including alcohol and nicotine." Indeed, I was pleased that there were at least some token references to nicotine in several sections of the book, and that the chapter on prevention cited much smoking research.

However, even this charitable optimism was not justified. For example, as early as the third page of the first chapter, the bias became evident. Here the book stated, "Neuroscientists have identified receptor types in the brain for opioids, cocaine, benzodiazepines and marijuana. . ." Somehow, the receptor that is the best characterized and has spawned the greatest amount of research, i.e., the nicotinic/acetylcholinergic receptor, was not mentioned.

Later, the chapter on "Consequences" listed HIV infection, child development, and violence as the three most important consequences. Somehow the 450,000 (U.S.) deaths per year from nicotine were thought not to be important enough to cover. The section on pharmacotherapy discussed methadone, LAAM, and buprenorphine, which have, at most, been prescribed to 200,000 persons, but failed to mention nicotine replacement, which has been used by over 8 million patients.

Looks like we have some work to do at the Institute of Medicine.

Hughes, J.R., and Howard, T. (1994). Nicotine don't get no respect. Journal of the American Medical Association, 271, 585.

 

 

News and Other Offerings

INVEST: The National Institute on Drug Abuse is sponsoring a fellowship program for scientists from outside the United States to work with established U.S.-based scientists engaged in NIDA-supported drug abuse research. The program, called INVEST, involves a non-U.S. scientist with at least two years of postdoctoral research experience working with a potential U.S. scientist mentor to develop a research plan. Information about the INVEST program is available from NIDA/INVEST Program, 11900 Parklawn Drive, Suite 350, Rockville, MD 20852-2624. Telephone: (301) 468-3613. Fax: (301) 468-3856. Email: INVEST@md.capconcorp.com.

 

Officers and Committees

President
Maxine L. Stitzer

Member Delegates

Past President
Neal Benowitz
Murray Jarvik

President-Elect
Jack Henningfield
Allan Collins

Secretary-Treasurer
Harry A. Lando
Karl Fagerström

Council Chairs

Membership and Development
Scott Leischow

Program, Public Information, and Training
Steve Heishman

Publications and Communications
Ovide F. Pomerleau

Scientific Liaison and Public Policy
Neil E. Grunberg

Standing Committees

Finance
Ray Niaura

Long-Range Planning
Neal Benowitz

Nominations
Martin Jarvis

Committees under Council Jurisdiction

Development
John Pinney

Membership
Lori Karan

Education/Training
Tom Payne

Newsletter and Journal
Editor
Gary Swan

Public Information
Janet Brigham

Liaison
David J.K. Balfour

Program
Scott Leischow

Public Policy
John R. Hughes †