Vol. 4, No. 1, Winter 1998

Members Voice Strong Sentiments

As a group, we are almost three-fourths male. We are primarily middle-aged. We are mostly affiliated with medical schools. And as individuals, many of us have strong opinions.

A SRNT membership survey, which was tallied recently with the assistance of a market-research software company, tells us more than we have known before about members’ preferences. For example, the Society is split on whether or not to hold meetings outside North America. Also, the Society is enthusiastic about the new SRNT journal, and most members responding to the survey are willing to serve as reviewers.

Society members are adamant about the need for the organization to be international in composition. They value their membership in SRNT and, for the most part, endorse the Society’s efforts to have a voice in funding recommendations.

A total of 110 SRNT members, or about 41 percent of the membership at the time the survey was taken, responded to the survey. The Society’s membership rolls have increased since the survey was taken.

Any report of this membership survey should be considered with some reservation, because the sample responding was not random and the respondents do not necessarily represent the membership as a whole. Nonetheless, the results offer a first glimpse into the membership.

The survey indicates that 36 percent of the respondents are psychologists. Physicians comprise 20 percent. The majority of the respondents, 81 percent, live in North America. Some 12 percent are European.

Only one of those who responded to the survey is under age 29. Some 39 percent are ages 40-49. A total of 40 percent report being affiliated with a medical school, and 30 are with a university.

Who We Are and What We Say

Who are we? What are our views about issues that affect the Society? The recent membership survey conducted by SRNT helps answer these questions.

Where do we do our work?

A total of 40 percent report being affiliated with a medical school, in addition to the 30 percent affiliated with a college or university. Nearly 12 percent are associated with corporations or businesses; 10 percent work for a government agency. Another 10 percent work at hospitals or clinics.

Who funds our research?

Many members reported that their research is funded by the U.S. National Institute on Drug Abuse (16 percent) and pharmaceutical companies (18 percent). Nearly 15 percent report having funding from institutions such as the Robert Wood Johnson Foundation. Ten percent report being funded by the U.S. National Cancer Institute. Three percent report being funded by tobacco companies, not including those SRNT respondents who indicated that they are employed by tobacco companies. Nearly 7 percent of respondents report being funded by from non-U.S. government agencies; nearly 8 percent receive funding from the U.S. Centers for Disease Control.

How do we spend our working time?

A larger proportion of women than men spend more than half their time doing research. Although men account for 58 percent of those doing research, only 44 percent of men spend more than half their time in research. Some 73 percent of SRNT women report working primarily in research. Nearly 79 percent of men and 85 percent of women spend one-fourth of their time or less in administrative work. Those spending at least half their time engaging directly in research mostly work in medical schools or in academia.

Do we belong to other societies?

Nearly 94 percent of respondents belong to other professional societies and organizations. Other organizations to which SRNT members belong include the American Psychological Association, College on Problems of Drug Dependence, Society for Neuroscience, Society of Behavioral Medicine, American Society of Addiction Medicine, groups representing other scientific interests (e.g., genetics, chemistry, physiology), and societies specific to countries where members reside.

Do we review grants?

Only 32 percent of respondents serve on "study sections" or committees that review grants. On the other hand, more than 86 percent are willing to review manuscripts for the new journal Nicotine & Tobacco Research. Most propose being willing to complete reviews within three to four weeks.

How much do we value membership?

Participation in the Society is valued either in the "high" or "very high" range by 68 percent of respondents. (The five-point scale ranged from "low" to "very high.") Only 7 percent rate their membership at the "low" level of value. A total of 78 percent of psychologists and 82 percent of physicians rate membership either "high" or "very high."

Are our annual meetings relevant?

Since SRNT members apparently participate in other societies and value SRNT membership, it is not surprising that 53 percent of respondents find the Society’s meetings to be "extremely important," on a five-point scale ranging from "not at all " to "extremely." No respondent rates SRNT meetings as "not at all important."

How should we meet?

More than 67 percent of respondents say that the Society should meet in conjunction with other groups, such as SBM or CPDD. However, the respondents are split on whether or not to hold SRNT meetings outside the United States. Less than one percentage point separates those who want to meet outside the U.S. (41 percent) and those who do not (42 percent). All but one of the 13 European respondents, or 92 percent, prefer that some meetings be outside the U.S. Nearly 52 percent of North American respondents do not concur. More than 17 percent of those responding state no preference. Some 53 percent favor competing tracks at conferences; those who disagree do so strongly, citing the need for those in differing disciplines to be aware of each other’s research.

Are our Society communications relevant?

About 65 percent say that the SRNT Newsletter rates either at or near the top of importance in promoting information exchange within the Society. Respondents rate it slightly less important than scientific meetings; however, 32 percent find it "extremely important." Some 46 percent of physicians rate the newsletter as "extremely important." SRNT’s electronic communications, which include e-mail and the Society’s home page, are rated as at least moderately important. Psychologists lead in rating electronic communications as important.

How should we encourage scientific research?

More than half of respondents agree that it is "extremely important" that SRNT encourage scientific research by advocating more research funding. Some 42 percent believe it is also "extremely important" to recommend research priorities to funding bodies. Members endorse fostering the development of junior scientists, facilitating training opportunities, and encouraging collaborative research. Respondents say that the society should provide expert advice to clinicians and to government agencies, but are less enthusiastic about giving advice to voluntary organizations and to the pharmaceutical industry.

The Society needs ‘more Europeans,’ ‘more clinicians,’ and debates of ‘contentious issues’

These were among comments volunteered by respondents in response to several open-ended questions:

The data entry, tabulation, and report summaries for this article were provided free of charge by Computers for Marketing Corp. of San Francisco. In appreciation for their generosity and expertise, the Newsletter has provided a member notice in the advertisement insert.

 

The New SRNT Journal

‘Covering the Field in Its Entirety’

The new journal Nicotine & Tobacco Research, which will launch its first issue early in 1999, will fill a scientific gap.

As the first peer-reviewed journal dedicated to nicotine and tobacco research, the journal will address a need that has gone unmet. Chairman of the SRNT Publications and Communications Council. Ovide F. Pomerleau explained that the journal fills several needs.

"The purpose of the journal is to provide the means by which the Society can promulgate scientific articles of high quality—empirical reports, reviews and theoretical articles, and brief communications—covering the full spectrum of research on nicotine and tobacco."

At present, no scientific journal covers the field in its entirety. "Since research in this area has grown to a remarkable degree, both scientifically and in social and economic importance," Pomerleau noted, "there is a clear need for a publication that can convey integrative thinking and promote interdisciplinary communication."

Since the journal will be offered to SRNT members and will be marketed widely to the research community, medical and scientific libraries, governments, and public health organizations, "it should provide an efficient and effective vehicle for reaching the core of active researchers and policy-makers throughout the world," Pomerleau added.

Presiding over what Pomerleau referred to as "a distinguished editorial board" (see article below) will be Editor-in-Chief Gary Swan of SRI International in Menlo Park, California, and David J. K. Balfour of the University of Dundee and Ninewells Hospital and Medical School in Dundee, Scotland. Swan will be corresponding editor for the Americas, Asia, and Pacific Rim countries; Balfour will be corresponding editor for Europe, Africa, and the Middle East.

An advisory board representing the major population centers of the world is being recruited and assembled. They will solicit journal submissions and assist in manuscript preparation for authors who are less familiar with English.

"At long last, I am pleased to announce the formal and official creation of Nicotine & Tobacco Research," Swan stated. "While we have purposely restricted the focus of the journal to empirically based research, we encourage submissions from a wide range of disciplines and perspectives," he added.

"In recognition of the fact that the determinants of nicotine addiction and tobacco use are biological, genetic, social, behavioral, and environmental in nature, we plan to emphasize the publication of sound papers that integrate theories and methods from converging fields of study."

He cited as an example a genetic study of nicotine addiction that would include consideration of social and environmental perspectives. "Similarly, socially or behaviorally based prevention and treatment programs that incorporate biologically based measures of susceptibility to nicotine addiction are equally desirable."

Because "the design and conduct of integrative research are demanding, the editors owe authors reviews reflecting perspectives relevant to each paper."

Toward that end, the journal’s editors will seek the most informed judgments that they can obtain.

 

Seven Scientists Comprise Journal’s Editorial Board

The list of associate editors for Nicotine & Tobacco Research includes seven scientists who have contributed substantially to research literature and been instrumental in helping formulate tobacco policies.


Associate editors are Naomi Breslau, Henry Ford Health Sciences Center, Detroit, Michigan; Laurie Chassin, Arizona State University, Tempe, Arizona; Neil Grunberg, Uniformed Services University of the Health Sciences, Bethesda, Maryland; John Hughes, University of Vermont, Burlington, Vermont; John Pierce, University of California, San Diego, California; Lorna W. Role, Columbia University, New York City, New York; Michael J. Thun, American Cancer Society, Atlanta, Georgia.

 

Message from the Journal Editor

Gary E. Swan

Editor-in-Chief

We are excited about this new venture. To make it a success, however, we will need your support in the form of paper submissions and willingness to act as a reviewer on submissions from others. We plan to seek submissions from outside SRNT.

The marketing plan for the journal includes the distribution of several thousand flyers to a variety of professional societies and journal subscription lists.

Our new journal will also be listed in a service known as EurekAlert!, an Internet-based information service run by the American Association for the Advancement of Science to inform science journalists of the latest findings.

The journal is also a member of a consortium of health-related journals created by the Center for the Advancement of Health to make findings available on a regular basis to the general media.

We find ourselves today at a unique point in the history of nicotine and tobacco research. Our hope is for the journal to become the premier outlet for high-quality science-based research to which both scientists and policy-makers can look for evidence to support their respective decision-making.

My task at this time is to encourage each of you to submit your best work to the new journal—it is critical that research of the highest quality be published from the beginning.

I also would like to encourage you to serve as area editors when called on by the editorial board, since rigorous methodological review is the best way to ensure the success of the enterprise.

I look forward to your participation in this exciting venture, a milestone in the history of the Society.

Message from the Society President

Maxine L. Stitzer

SRNT President

Gary Swan used the right word when he described start-up of the new SRNT journal as a milestone. The new journal Nicotine & Tobacco Research adds an important dimension to the vision of what our Society can and should be. SRNT acts as an advocate for funding of nicotine and tobacco-related research, a conduit for dissemination of research findings to scientists and policy makers, and a forum for synthesizing research findings across a diverse array of disciplines. Clearly, a scholarly journal will greatly enhance the Society’s ability to provide those functions. At the same time, the new journal will improve visibility of our Society within the scientific, policy, and research funding communities.

Credit for start-up of the new journal goes to Ovide Pomerleau. Ovide had the vision and saw the necessity for a concrete way to disseminate new scientific information between and beyond our annual meetings. It was Ovide who persisted in the tough job of finding agreeable publishers and negotiating the many details covered in publication contracts. He has done a splendid job, and will soon enjoy the fruits of his labor.

Meanwhile, Gary Swan could not be a better choice for editor-in-chief. He shares the vision that this will be a premier journal, and has all the skills necessary to make this happen. the ball is now in Gary’s court, and in the court of every SRNT member who can support the new venture by submitting high-quality papers. I look forward eagerly to the results of this milestone initiative in the life of SRNT.

 

Submissions to the journal Nicotine & Tobacco Research must follow specific rules governing ethics, content, and style. A submission guideline sheet, inserted in this Newsletter, also can be obtained from the editors:

The Americas, Asia, and Pacific Rim countries:

Gary E. Swan, Ph.D., editor-in-chief
Nicotine & Tobacco Research Center for Health Sciences,
SRI International
333 Ravenswood Ave.
Menlo Park, CA 94025 USA
+1-650-859-5322 telephone
+1-650-859-5099 fax (correspondence only)
gswan@unix.sri.com

Europe, Africa, and the Middle East:

David J. K. Balfour, Ph.D., corresponding editor
Nicotine & Tobacco Research Department of Pharmacology,
University of Dundee
Ninewells Hospital & Medical School
Dundee DD1 9SY, Scotland/UK
+44-382-60111 telephone
+44-382-67120 (fax) correspondence only)
d.j.k.balfour@dundee.ac.uk

Smoking in Chile:

Where Tobacco’s Voice is Powerful, Assistance in Cessation Is Rare

Dr. Daniel Seijas

Pontificia Universidad Catolica de Chile

Chile has a population of 13 million. Several indicators suggest that the country is one of South America's most advanced on public health issues, e.g., low infant mortality and high life expectancy. However, the prevalence of smoking is one of the highest in the region.

The capital, Santiago, suffers from severe air pollution, which led to several health emergencies over the past few years, resulting in traffic and industry restrictions. In contrast, while several reports have shown that indoor pollution (attributable primarily to smoking) is worse than outdoor pollution, moves to tackle smoking as a public health hazard are far less prominent.

Regular smoking prevalence surveys have been conducted since 1986. In the latest National Household Survey, 42 percent of the population reported having smoked over the last month (CONACE,1996). An increase in women smokers has been reported at a rate of nearly 50 percent over the last few years (Berrios et al., 1990). A smaller survey from 1997 showed an overall increase in smoking prevalence, mainly due to an increase in women smokers in the lowest social classes. In parallel with this, there has been some reduction in smoking among men from some social classes (Berrios, 1997).

A considerable part of tobacco advertising in Chile targets children and youngsters by use, for example, of young role models, rebellious themes, etc. Some public concern about tobacco use was raised by epidemiological findings suggesting that tobacco may act as a gateway into alcohol and other drug use. This related particularly to cocaine derivatives such as coca paste (which is smoked in a mixture with tobacco and is considered more toxic than crack) and marijuana. In Chile, these addictions raise much greater alarm than smoking.

The Ministry of Health and Education has been running smoking prevention school-based interventions for over 10 years. These are generally considered useful, but no evaluation of their effects has been attempted so far. They do seem to reach at least some targets. Our smoker clinic clients often cite pressure from their children as one of the reasons for trying to quit. The economic and health costs of smoking in Chile were estimated at US $100 million per year (Ceron & Videla, 1989). Regarding anti-smoking legislation, on 6 January 1996, a set of anti-tobacco laws was approved by the Chilean Congress. It bans the sale of tobacco to those under age 16, makes health warning on cigarette packets mandatory, introduces smoking prevention materials in schools, restricts TV tobacco advertising to late-night viewing (after 10:30 p.m.), and bans smoking in all public buildings (including schools, hospitals, and public offices) and on public transport. No- smoking signs are mandatory. Restaurants have to indicate at the entrance whether they have separate seating for nonsmokers. Unfortunately, the implementation of these laws is not being enforced, and so far, not much change can be observed. For instance, restaurants typically display a sign saying "smokers and non-smokers are respected, common facilities." The Ministry of Health has included smoking among its 16 health priorities for the period 1998-2000. It is unclear so far what practical consequences this will have. In Chile, the tobacco industry has a powerful voice and considerable influence with local economists and decision-makers.

Smoking cessation provision is relatively scarce in Chile. Only one type of nicotine replacement products is available (two brands of nicotine patches). These are relatively expensive, and, on occasion our clients found local pharmacies had run out of stock. Nicotine chewing gum was on the market, but was withdrawn in 1996 due to low sales. It is expected to make a comeback later this year. There is one self-help smoking cessation manual available to the general public, disseminated by the Ministry of Health and other government organizations. There are plans to initiate a Quit and Win program this year.

There are only a few stop-smoking clinics in Chile. The main ones are in Santiago, at the Hospital del Torax (run by Dr. Bello), and the Smokers Clinic of the Universidad Catolica de Chile (run by the author since 1993). They charge for treatment. Health insurance does not cover these costs, as smoking is considered to be "self-inflicted." In our clinic, the treatment costs less than smoking a pack of cigarettes per day for its duration. These pioneering clinics report that about 50 percent of participants are abstinent for at least one year. Our own data are based on more than 100 patients followed for four years, with self-reports validated by expired air carbon monoxide and an informant (spouse or colleague) report (Seijas et al., 1997). Our treatment is based on the Withdrawal-Oriented Therapy model developed at the Addiction Research Unit in London (Hajek, 1993). The unusually high success rates could be due to the fact that we attract highly motivated clients and possibly also due to the novelty of intensive treatment provision in this area of Chile. It may be worth noticing that most clinic patients (some 95 percent) have tried the nicotine skin patch before, usually with inappropriate expectations and usage, and did not find it helpful. Many of them also have tried acupuncture, laser therapy, hypnosis, etc. We attribute our good results to a combination of generating realistic treatment expectations, effective NRT use, and behavioral support, together with treating any psychiatric comorbidity.

Community-based interventions by health professionals rarely have been practiced so far. Primary care physicians are normally not expected to address smoking. Our smoker's clinic runs annual training courses for doctors and nurses on helping smokers to quit. These attract a few enthusiastic colleagues, but overall, doctors seem skeptical about their potential in assisting patients to stop smoking, and generally lack skills in counseling smokers and in using NRT. The Cardiological and Thoracic Societies, together with religious and other organizations (such as Seventh Day Adventists), run annual nonsmoking campaigns. These usually center on the No Smoking Day (31st of May). The impact of these measures has not been evaluated.

Little smoking research currently exists in Chile, although this may start to change. The Universidad Catolica's Laboratory in Santiago plans to start providing cotinine assays in 1998. Expired air carbon monoxide monitors are available. Our clinic recently completed a study of nicotine dependence and psychiatric comorbidity, and we are also investigating the use of motivational and general health questionnaires to tailor different treatment approaches to patient needs. The Department of Public Health at the Universidad Catolica studied the relation between lifestyles and tobacco smoking, and has been developing and evaluating preventive interventions to reduce or delay initiation of smoking and alcohol use (Berrios, 1993). This intervention was modeled on the Finnish approach (Puska, 1992).

Overall, despite some of the gloomier facts noted above, there is a feeling here that the awareness of the smoking problem is increasing, and that the relevant legislation, smoking cessation provisions, and research may all become a higher priority in the near future.

References and Sources

Alonso, C., Diaz, R. (1989). Consumo de tabaco en un grupo de medicos de la V region. Revista Medica de Chile, 117, 867-871.

Berrios, X., Jadue, L., Zenteno, J., Rose, M.I. (1990). Prevalencia de factores de riesgo en nefermedades cronicas. Estudio en poblacion general de la region metropolitana. Revista Medica de Chile, 118, 597-604.

Berrios, X. 1997. (1997). Letter to the Editor. Revista Medica de Chile, Noviembre 1997.

Ceron, I., Videla, M. (1989). Evaluacion del Costo Social del tabaquismo en Chile Mideplan.

Consejo Nacional para el Control de Estupefacientes (CONACE). (1996). Encuesta nacional sobre el consumo de drogas. Informe preliminar, Ministerio del Interior, Santiago, Chile.

Hajek, P. (1994). Helping smokers to overcome tobacco withdrawal: Background and practice of withdrawal-oriented therapy. In R. Richmond (Ed.), Interventions for smokers: An international perspective. Baltimore: Williams & Wilkins

Newhouse, P., Hughes, J. (1991). The role of nicotine and mechanisms in neuropsychiatric disease. Addiction, 86, 521-526.

Rose, J. (1996). Nicotine treatment review. Annual Review of Medicine, 47, 493-507.

Puska, P. (1992). The North Karelia project: Nearly 20 years of successful prevention of CVD in Finland. Hygie, 11, 33-35.

Russell, M., Wilson, C., Taylor, C. , Baker, C. (1979). Effect of general practitioners’ advice against smoking. British Medical Journal, 2, 231-235.

Seijas, D., Santander, J., Ferrer, V., Ramos, A. (1997). Nicotine dependence and psychiatric comorbidity: One-year follow up. Poster presented at the annual meeting of the Society for Study of Addictions, November 1997, Bath, U.K.

Sepulveda, C. (1990). Prevencion y control del tabaquismo: Antecedentes y propuestas de accion, Unidad de Cancer, Ministerio de Salud Chile. Tabaco o Salud, Programa de la OMS, Noviembre 1990, serie de informes tecnicos No 695 OMS.

Dr. Daniel Seijas is head of the Addiction Unit, Department of Psychiatry, Pontificia Universidad Catolica de Chile, Casilla 114-D, Santiago, Chile; Phone (562) 686 6959; Fax (562 ) 686 6960;e-mail dseijas@med.puc.cl.

 

‘Smoking Don’t Get No Respect’

A Puff, a Kiss, a Bite of Chocolate Cake?


John Hughes


University of Vermont


Earning a place in this month’s column is the article entitled "Getting the Brain’s Attention," in the 3 October 1997 issue of the journal Science. This article, part of a series on drug dependence, begins with the following:

"A bite of moist chocolate cake, a romantic kiss, or a puff of the day’s first cigarette will send the hedonist in many of us coming back for more. For 20 years, neuroscientists thought that they understood why people succumb to these cravings, as well as the more dangerous ones for addictive drugs such as heroin and cocaine."

Now, Science is a journal that is supposed to be, well, scientific, and a friend toward scientists. But here we have the premier journal in our field indicating that nicotine dependence is similar to chocolate use, is a function of hedonism (i.e., is not part of an addictive process), and involves cravings that are "less dangerous" than those from heroin and cocaine. Unfortunately, the writer must not have read the U.S. Surgeon General’s 1988 report that compiled hundreds of studies to conclude that smoking is not a hedonistic habit but a true drug dependence, and that nicotine is every bit as addictive and dangerous as heroin and cocaine.

Science is also supposed to be about science, not about parochial, lay views. But you know how it is: a writer’s gotta have a catchy first line, even if it means trashing the results of scientific experiments.

I can guarantee that the tobacco industry will cite volume 278, page 35, of Science in future trials and public relations efforts. I can hear it now: "Isn’t it true, Dr. Hughes, that even prestigious journals such as Science think that smoking is more like chocolate eating than like a drug dependence?"

It’s tough to go up against your enemies when you still have to educate your friends.

Response from the Editor of Science

Floyd Bloom, editor of Science magazine, responded to a request from the editor of the SRNT Newsletter that he address John Hughes’ concerns. Bloom expressed appreciation for the opportunity to comment, discussed the article with his news staff, and issued the following statement:

 

"Hughes is taking out of context and out of proportion an introductory phrase that our correspondent intended as a device for literary highlighting. By no means does that statement imply that the scientific judgment of Science equates tobacco with chocolate.

"In fact, the point of the paragraph was to introduce a discussion of changing views of the transmitter dopamine as a regulatory factor in the reinforcement of cravings of various kinds. The article went on to say, ‘This new view [of dopamine’s role] may help explain why many addictive drugs...can drive continued use without producing pleasure—as when cocaine addicts continue to take hits long after the euphoric effects of the drug have worn off or when smokers smoke after cigarettes become distasteful.’

"Therefore, far from our ‘indicating nicotine dependence is similar to chocolate use,’ as Hughes suggests, our article in fact indicates that nicotine dependence is neurochemically similar to cocaine addiction."

 

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