SRNT Newsletter, Vol. 4 No. 2, May 1998

A Tale of Two Journals

Not long ago, nicotine and tobacco researchers had to look to

medical, science, and psychology literature to publish their findings.

Then came one groundbreaking journal.

Now comes another. But is two too many?

No, say the editors of both journals:

There’s plenty of good science to go around.

The first page of the first issue of the journal Tobacco Control made this announcement with a silent sigh: "And finally, a journal."

It had been 388 years since King James I of England had indicted tobacco use as a "custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs," and compared it to "the horrible Stigian smoke of the pit that is bottomlesse." Yet despite widespread use of tobacco over the centuries, no major scientific journal emerged to cover nicotine and tobacco exclusively.

"Yes, interest and activity in this field have grown substantially," Tobacco Control editor Ronald M. Davis, a founding member of SRNT, wrote. "Nevertheless, interest and activity in this field are far below what they should be given the enormity of the tobacco problem."

It was baffling, he noted, that it had taken so long for a journal to be launched. At that time, more than 50,000 articles on tobacco and health had been published in biomedical literature and reviewed in 21 reports from a succession of U.S. surgeons general. According to a 1990 report by then-Surgeon General Antonia Novello, smoking "represents the most extensively documented cause of disease ever investigated in the history of biomedical research." But all of that had been documented without a dedicated journal.

Then, in 1992, the quarterly Tobacco Control: An International Journal began publication. Its editorial board included an international all-star list of researchers and experts. Davis commented on other strengths:

"Despite its slow growth, the field of tobacco and health has a lot going for it. There is no shortage of horrifying statistics to justify working in this area. For those who seek challenges, we are fighting a deadly, addictive behaviour supported by a wealthy and powerful industry. The people who work in this area are extremely committed to and passionate about their work."

Now, in 1998, some of those committed, passionate researchers well known to Davis are embarking on a similar endeavor, but with a slightly different charge. This year, the Society for Research on Nicotine and Tobacco finalized arrangements to publish an international journal focused specifically on empirical research. Its journal, Nicotine & Tobacco Research, has begun reviewing papers for the journal’s first issue, due out at the end of 1998. A second issue is also in process.

Tobacco Control has a broad mandate to cover the efforts of the health community, health advocates, and the tobacco industry and its allies. The scope of Nicotine & Tobacco Research does not include such coverage but is limited to reports of empirical research. Both journals, it is important to note, publish only articles that have undergone rigorous peer review. Both journals are edited and reviewed by respected researchers. And they do overlap.

One example of overlap between the two publications is in the area of cessation and prevention research. Tobacco Control has published some reports on these topics and is likely to continue to do so.

Since both journals are quarterly, this means that there are still only a total of eight issues per year, combining the two, published by journals devoted exclusively to tobacco. Comparing this with the output of SRNT members and other scientists still leaves an ample number of submissions that could be sent to either journal.

Last year, Tobacco Control received 95 submissions. Prior to that, the journal received about 75 submissions per year.

"We get a lot of submissions focusing on tobacco control policy and trends in tobacco use throughout the world," notes Davis. "There is plenty of room for two good journals in this area. Besides, it helps lend more credibility and legitimacy to the field of inquiry."

He adds that the types of well-written articles that researchers are sending to other journals can be captured by these two newer journals as their reputations emerge. In this effort, it is useful for a journal to have several years of publication already on the shelf.

Davis adds that he would welcome more articles that deal with the tobacco-control aspects of nicotine research and pharmacotherapy and that he does not receive "as much as I would like" about smokeless tobacco. Also, it can be difficult to find high-quality information about tobacco use in developing countries.

Basically, Davis notes, "We look for good science." Not surprisingly, that is what the editors of Nicotine & Tobacco Research hope to find in their submissions, as well. Editor Gary Swan has generated a wish list of the types of articles he would like to see submitted, offering examples:

Such a list does reflect a certain, if minor, overlap with topics in Tobacco Control. These are titles of some of the major articles published in the most recent issue of Tobacco Control:

Regarding policy, the latest issue of Tobacco Control also published articles on the impact of Australian tobacco health warnings, evaluating the effectiveness of Australian smoke-free legislation, and perceptions of tobacco lobbyists and lobbying. The issue contained a lead editorial, a cover essay, and multiple commentaries, as well as regular features providing interesting and at times amusing quotations and comments. It reviewed three books: on advertising, women’s smoking and social control, and tobacco-control laws.

In contrast, Swan anticipates that Nicotine & Tobacco Research will contain about 95% reports of empirical studies and no more than 5% — "if that" — editorials and opinion pieces.

In short, despite their overlap, the journals are different. Their missions differ; their overall focus differs; and, in large measure, their content differs.

The first issue of Nicotine & Tobacco Research will be mailed to SRNT members and other subscribers this winter. The associate editors have been fielding articles to reviewers as articles have been submitted. Flyers announcing the journal have been mailed to hundreds of researchers who have published in general scientific or medical journals, as well as in addiction and substance abuse journals. The publisher, Carfax Ltd., has generated and distributed an announcement and call for papers.

Plans for a second issue are in place. This "special issue" will incorporate updated versions of papers presented at a conference on tobacco use prevention and etiology, sponsored by the Robert Wood Johnson Foundation at Sundance, Utah, in May 1997. The foundation also is underwriting the publication of this special issue.

A number of factors make starting a new journal a difficult venture. Even after the legal and logistical arrangements are made, which took more than a year for Nicotine & Tobacco Research, assembling an editorial board requires that many already busy researchers commit to the time required to make certain that submissions to the journal are high in quality and are sufficient in number, and adequately represent the overall field. Since it takes at least several years of publishing before a new journal is referenced through indexing systems such as Index Medicus, some authors express reluctance to submit to a new journal before it is established. Tobacco Control was first listed with Index Medicus and Medline in 1996, four years after commencing publication.

On the other hand, submitting to a new journal such as Tobacco Control in the early 1990s or Nicotine & Tobacco Research at present allows a contributor to participate in forming the structure and style of the journal.

Swan believes that after Nicotine & Tobacco Research has been published for several years, the journal’s identity will solidify. Much of this will be determined by the decisions of scientists who submit to the journal and by decisions of reviewers and editors. The journal’s identity thus is not something the editors alone will determine; it also depends on choices made by those in the research community.

The amount of available research is considerable. A recent online search of the last two years of publications referenced with tobacco-related keywords yielded nearly 11,000 articles. Of the 25 that happened to be listed first, only two were published in the same journal. The others were published by diverse journals representing dozens of disciplines and subdisciplines.

Among the authors listed in the first few hundred entries were dozens of SRNT’s 400 members. Some of the articles were authored by SRNT officers; some were by editors of Nicotine & Tobacco Research.

It would appear that Davis and Swan are correct: There is more than enough good science about nicotine and tobacco to go around.

On the Internet

Comments and Commitment from SRNT’s New President

By Jack E. Henningfield

SRNT President, 1998-1999

It is a privilege to have been elected as your president, and I thank you for giving me the opportunity to serve SRNT in this capacity. I would like to highlight a few of the many challenges that face SRNT. Even as the Society has worked to establish itself in this first few years since its inception, it has been given many opportunities to provide guidance to regulatory agencies, the White House, the U.S. Congress, and international organizations, which have sought guidance on tobacco-related health and science issues. Among scientific organizations, we are young and small, but we have already made significant contributions through our comments on legislation, regulation, research priorities, and treatment development. We have provided a voice for the role of science and research in tobacco control efforts.

The basic idea behind the establishment of the Society was to establish a forum to nurture state-of-the-art research on nicotine and tobacco, and to thereby enhance public health through more effective strategies for preventing and treating tobacco dependence. The research areas that we represent are diverse and range from the most basic biological and molecular research on the mechanisms of nicotine action to epidemiology research on trends in new forms of tobacco product use. Our intervention research spans behavioral and pharmacological treatment approaches to media-based youth prevention approaches. One of our greatest strengths has been the mutual interest and respect among our diverse researchers that is so evident at our annual meetings. Our annual meeting will continue to be our most important forum for scholarly exchange, as well as a spawning ground for new research ideas, transdisciplinary approaches, and collaborative efforts. I look forward to your ideas to improve upon our model.

In addition, it is apparent that our global e-mail list is already proving to be a useful tool for advancing research and science-based clinical practice. Our new Web site should take this ability a step further. For example, our Web site <www.srnt.org> will include the products of our newly formed Research Support Committee, which will be listing resources such as where to obtain placebo medications, hard-to-find reagents, and providers of bioassays. This should also serve as a clearinghouse for identifying research needs and barriers to research that might be most effectively addressed by the Society. It was in part in response to an SRNT request that the National Institute on Drug Abuse is supporting the development of placebo cigarettes for research.

My goals as president are straightforward: I will work with other SRNT officers and members to provide aggressive advocacy for research on nicotine and tobacco. I will do my best to provide a voice for our areas of science when it comes to tobacco-related policy development, treatment evaluation, and prevention strategies. I also hope to contribute to ensuring that our areas of science, which are so relevant to today’s tobacco and health issues, will be equally relevant to tomorrow’s issues. We must build for future needs by promoting training, a stable commitment to research, to diversity, and to enhancing our already strong bridges between basic science and public health application. We will continue to be a scientifically grounded catalyst for change and improved public health. I thank you again for the opportunity to serve, and look forward to working with you.

 

Urgings, Updates from SRNT Policy Committee

Grant Reviews

With the integration of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) into the National Institutes of Health (NIH) several years ago, there was an agreement to eventually transfer ADAMHA study sections (IRG review committees) into NIH. This process has already begun for Neuroscience Research; Alan C. Collins, SRNT member-at-large, is monitoring how this process might affect nicotine research. Thus far, we see no problems. However, SRNT members with concerns or insights about nicotine neuroscience research are encouraged to contact Collins (see contact information on p. 16).

In terms of human laboratory, clinical, and epidemiology research, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) has already integrated its research into the NIH grant review process. Currently, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH) are studying the possibilities. Whether a tobacco/nicotine grant goes to NIDA, NHLBI, or NCI often is controlled by the investigator. Furthermore, differences in opinion exist as to which institutes should be assigned specific types of tobacco/nicotine grants.

In the new plan, institutes would keep institute-specific study sections (e.g., the cocaine treatment study section would function through NIDA). However, at this point, it is unclear whether tobacco/nicotine research is institute specific, and to which institute this research would belong.

One possibility is to have a separate tobacco/nicotine study section not aligned with any single institute that reviews grants for institutes that fund nicotine/tobacco research (e.g., NCI, NHLBI, NIDA). Another possibility is to have all tobacco/nicotine research to go to a newly formed NIH Behavioral Medicine Review Committee. A third possibility is for one institute to review all the nicotine/tobacco research. Other alternatives may exist as well. These are several advantages and disadvantages regarding a separate tobacco/nicotine study section:

PROS: A separate study section may give tobacco/nicotine research higher visibility and greater importance and priority. We are likely to see an increased number of requests for applications specific to this area of research. The study section will be composed of reviewers who have expertise in tobacco research and can give the grant applications informed reviews. Furthermore, it is highly likely that up to 25% of the grants will be funded, whereas if the grants are assigned to other study sections, this high rate of funding may not occur.

CONS: Tobacco/nicotine research will be taken out of the mainstream of scientific review. Prominent scientists in other areas of research will not have the opportunity to witness the exciting, cutting-edge tobacco/nicotine studies that are being conducted. A result of keeping these studies isolated from general review could be diminished credibility and prominence of this area of research. Furthermore, researchers in the tobacco/nicotine area might not have the benefit of reviews from scientists with different perspectives who thus may enrich our knowledge base.

The society asks members to do the following:

Anyone interested is encouraged to contact Dorothy Hatsukami soon: Department of Psychiatry, University of Minnesota, Box 393/Mayo, Minneapolis, MN 55455. Fax: (612) 624-8935.

Tobacco Legislation

Despite the recent negative press about tobacco legislation in the U.S., the SRNT Policy Committee still thinks there is a good likelihood that legislation will be passed this year. The leading bill is that of Sen. John McCain (Republican, Arizona). This bill calls for using settlement and tax hike revenues to provide $300,000 to $500,000 per year for research by the Centers for Disease Control (CDC) and $2.5 billion per year to the National Institutes of Health (NIH) for research, of which about one-third, or $833 million, will be for tobacco research.

Tobacco research does include research both on the consequences of tobacco use (e.g., basic research on lung cancer) and on tobacco use per se (i.e., understanding, preventing, and treating tobacco use, and policy research). How the money will be used will be guided by a research task force composed of the U.S. surgeon general, the CDC, the Agency for Health Care Policy and Research, NIH representatives, public health and tobacco control advocates, and others. Even if the research on tobacco use per se only receives half of the funds, the resulting $400 million would quadruple NIH research funding for tobacco and nicotine.

We were very pleased that our efforts to emphasize research on tobacco use per se and to encourage setting up an oversight board to make sure the money is spent on tobacco-related topics were included. This is an example of the SRNT members’ funds at work. Of course, we have some other specific ways we would like this bill to change (e.g., funds for regulatory research by the U.S. Food and Drug Administration), but overall we like this bill and urge members to contact Congresspersons and Sen. McCain.

The Policy Committee can provide members with analyses of the various pieces of legislation, and can address specific questions. Contact John Hughes by telephone at (802) 696-9610 or by e-mail: john.hughes@uvm.edu .

Seeing Tobacco Through a New Lens: The Behavioral Economics of Smoking

Adapted with permission, from Dying to Quit: Why We Smoke and How We Stop, by Janet Brigham, 1998, Washington, D.C.: National Academy Press. Copyright 1998 by Janet Brigham.

Everything costs, and everyone pays. Often smokers don’t realize what they are paying for smoking, and often they don’t realize the thresholds of what they will pay.

Imagine that someone gives you a choice: Either you can have $100 now or you can have $100 one week from now. Most people would choose to have the money now. But if you are offered $100 in six years or $200 in eight years, most people would take the $200. Their preference has been reversed as a function of the long time it would take to get either amount. Valuation changes as a function of time, and this change then affects their preference.

"People figure it’s such a long ways off, they may as well get the larger amount," explains University of Vermont researcher Warren Bickel. Working closely with Bickel in many projects has been Richard J. DeGrandpre, now an assistant professor at St. Michael’s College. Bickel, professor and vice-chair for research in psychiatry, recently was given a Merit Award from the National Institute on Drug Abuse. This award will provide 10 years of stable funding for Bickel’s research into what is called the behavioral economics of tobacco use.

He and other scientists have applied and expanded economics principles to the field of drug abuse, and specifically to smoking. The commodity of exchange can be tobacco, rather than money. For example, a smoker can have a cigarette now or a better chance for good health in 35 years. Whereas good health today may seem worth more than a cigarette, good health in 35 years seems less valuable. Also, a smoker can pay about $2 for a pack of cigarettes now, or instead can someday use the money he or she would’ve spent on cigarettes to help pay for a luxury car or a house. Given these choices, many smokers still opt for the cigarette now. This is one of many situations in which people "sell" a valuable asset today for very little, if the "delivery" of the consequences seems far in the future.

The logical inconsistency of choosing a harmful behavior can make more sense when viewed through the lens of behavioral economics. "The farther away you are from events, your behavior will seem more self-controlled and rational," Bickel notes. The farther away a cost will come due, the smaller the cost seems. As the time horizon changes, the costs and benefits of present values change.

For example, if someone has a looming deadline, such as a report due first thing Tuesday morning, she might decide on Sunday night that she needs to get up very early Monday morning to get a good start on the work. The cost of getting up early seems less on Sunday night than it seems early the next morning, when she feels too tired to get out of bed early.

"We’ll set the alarm to get up early and get a lot of work done," Bickel explains, "but in the morning, we hit the snooze alarm." The present value of sleep has increased as the cost of writing the report has increased. "It’s not a lot different than a smoker deciding to stop, but then walking down the street and seeing someone smoking a cigarette, and not stopping smoking."

Adapting and expanding on principles from the larger and older field of microeconomics in the 1970s and 1980s, behavioral economists have identified some of the reasons that smokers make the choices they make.

If there are two cigarettes of equal amounts of nicotine but different cost, the buyer’s income could affect preference. If a less desired cigarette costs one-half or one-third of a more desired cigarette, persons of lower income tend to choose the less desired cigarette. Having a choice between these two cigarettes might result in this scenario: If our income increases, we would use the more desirable cigarette that costs more and would use the less desirable cigarette increasingly less. As we get wealthier, we would be buying more expensive cigarettes, or perhaps cigars, and smoking fewer generic cigarettes.

How does this approach relate to cessation? Bickel explains that, in economic terms, tobacco products might be considered preferable to nicotine replacement products that do not provide quite the same experience as smoking. Work by Bickel and his colleagues indicates that smokers tend to perceive nicotine replacement products as what economists call an "inferior good," or one for which demand falls as income rises. The irony is apparent, since nicotine replacement products undergo exhaustive development and testing before being marketed, and are "inferior" only in that most smokers perceive them as less desirable than tobacco.

"What this suggests, if this is representative of how nicotine replacement operates in the real world, is that the only way to make it a viable alternative to cigarette smoking is to radically increase the price of cigarettes and to radically decrease the cost and increase the accessibility of nicotine replacement," Bickel explains.

"You can demonstrate that people consume fewer cigarettes when they have nicotine replacement, but the important question is, under what conditions will they use the products?" Smokers are not electing to quit en masse, and only a minority use nicotine replacement. Perhaps smokers would attempt to quit in greater numbers if nicotine replacement were available in smaller packages that were available at convenience stores, or if the price differential favored the replacement product over cigarettes. "Those are the conditions under which you would engender the nicotine replacement option," Bickel notes.

In laboratory research with human smokers, Bickel found that some smokers would perform considerable "work" (i.e., tasks in the study) for a puff on a cigarette. His all-time hardest-working research subject was willing to engage in 2.5 hours of computer tasks for two puffs on a cigarette. Amazingly, the same subject could have waited only 3 hours for that segment of the study period to end, without engaging in the computer work, and then could have gone outside and smoked.

"This suggested to me that indeed the temporal horizon into which cigarettes are integrated over time is pretty small," Bickel says. To understand how this process works, consider some monetary examples. If, for instance, you are given the option of taking $1,000 now or $1,000 a week from now, the choice is fairly predictable. But what if you can have $980 now or $1,000 in a week? Researchers find that as they manipulate the amount of discount that someone will accept, they can determine how much a person will discount $1,000 in one week. The same question can be posed and the same calculation made at many different time points to provide a picture of the rate of discounting. "It’s almost a psychophysical procedure," Bickel explains, comparing it to measuring such physiological phenomena as heart rate or brainwaves.

"When people keep doing things that are bad for them, it may be because their temporal horizon is short," he states. "Things beyond a certain point don’t matter to them." If comparable questions are asked of heroin abusers and of research subjects who do not abuse drugs, nondrug users will perceive that the $1,000 will lose 60% of its value in about five years; for heroin addicts, $1,000 loses the same amount of perceived value in one week. When the commodity is heroin, no amount of heroin tomorrow is worth any amount of heroin today to a person dependent on heroin. Such questions also can be asked about tobacco.

Any inducement toward a longer time horizon needs to be attractive indeed. Bickel finds that when most people think about the future, they view ahead an average of nine years. Heroin addicts, on the other hand, view the future as being four weeks away. "And those are the ones who are in treatment," Bickel explains. "God knows what it’s like out there on the street."

The work of Bickel and others has shown that virtually all self-administration of drugs, whether by humans smoking tobacco or by laboratory primates self-administering cocaine, fits the same shape curve when the amount used is plotted against the timing of administration. The shape stays constant, whatever the drug, although its parameters vary according to the specific drug. This fact has given behavioral economists an empirical, measurable model on which to base assumptions, "which is a useful contribution of psychological science to economics," Bickel adds.

"Other concepts that may be particularly useful include the notion of reinforced interactions," Bickel explains. "In economics, reinforcers can act as substitutes. For example, if we increase the price of seeing a movie in a theater, its consumption will decrease, but there will be an increase in the use of videos even though their price remains constant."

Another type of interaction is the complement, in which, for example, consumption of soup would decrease as the price of soup increases. The consumption of soup crackers would also decrease, even though their price remains constant. Lack of interaction would indicate independence; for example, the price of a theater ticket would not affect the consumption of soup crackers.

"This way of thinking provides a useful framework for understanding events that interact with cigarette smoking," according to Bickel. An increase in cigarette prices will decrease coffee consumption along with tobacco consumption, for example, but an increase in coffee price will not affect cigarette consumption. "Those events can be confusing when the effects occur together," he admits. Done carefully, however, this behavioral economics approach can "provide a conceptual system for studying how tobacco interacts with other drugs, and also with social interactions." Additionally, it raises valuable questions and provides a useful framework for quantification.

"If you could create an analog of an ideal smoking treatment situation, you would like to have a world in which you would have few complements for smoking, and many pro-social substitutes," Bickel states. "You can test that in a laboratory and test it in the real world." An example of the kind of statistical puzzle that behavioral economics can help solve is the use of multiple drugs sequentially, concurrently, or both. Some drugs are used together, some are used in lieu of each other, and some are used together even though there is no relationship between them. "How do you put that quagmire in functional categories?" Bickel asks. "This is a potential way of doing that."

Additional Reading

 

The Cigar Resurgence

By Jerome Beck, Dr. P.H.

Tobacco-Related Disease Research Program

Dr. Beck is research administrator for Epidemiology and Public Policy Research for the Tobacco-Related Disease Research Program for the state of California. Reprinted with persmission, from TRDRP Newsletter, vol. 1, no. 1.

Although cigars and Camel cigarettes were both included in Advertising Age’s "top 10 Products in the News" for 1997, the reasons behind their newsmaking popularity were quite different. In marked contrast to the litigious problems besetting the cigarette trade, cigar makers were enjoying yet another successful year, unencumbered by the growing number of constraints frustrating their counterparts.

Following a quarter of a century of declining consumption, the 1990s have witnessed an explosive growth in both the popularity and promotion of cigars. The significance of this phenomenon is highlighted by the dramatic growth in cigar sales in the United States, from a low of 100 million cigars sold in 1992 to more than 2 billion sold in 1995. The following year saw sales more than double, with an impressive 4.5 billion cigars sold in 1996.

Although these numbers pale in comparison with the roughly 450 billion cigarettes consumed each year in this country, they nevertheless underscore the rapid reemergence of cigars on the tobacco scene.

It is tempting to dismiss cigars as simply a faddish and relatively benign indulgence with minimal long-term health consequences. However, there are a number of good reasons for public concern and a better understanding of this phenomenon. Foremost among these is the lack of research regarding almost all aspects of cigars, ranging from health effects to the current epidemiology of use. We do know that, as with cigarettes, cigars have become increasingly popular with youth in the last few years. Three recent surveys underscore this trend, with a nationwide study finding over one-quarter of U.S. teenagers reportedly having smoked a cigar in the past year.

Given what we do know about the dangers of tobacco smoke for both users and those exposed to secondhand smoke, it is surprising that cigars have received so little regulatory scrutiny. Despite ample evidence testifying to their growing popularity among youth, cigars are not included under FDA regulations addressing tobacco advertising, warning labels, or sales to adolescents. However, in a sign that this state of affairs may soon be changing, the Federal Trade Commission (FTC) announced earlier this year that the nation’s largest cigar manufacturers must disclose how much they spend on advertising and promotions. The FTC also ordered companies to reveal the tobacco content and additives found in their cigar products.

Contemporary media coverage has generally downplayed or avoided any mention of health risks associated with cigars. Since cigar packages say nothing about health hazards, and since cigar smokers don’t usually inhale, the dangers associated with the use of this tobacco product are viewed by many as negligible. Nevertheless, the health risks of cigars are real and have been amply documented in the medical literature over the past three decades.

This is particularly true for former cigarette smokers who have switched to smoking cigars (often for health reasons). Studies have shown this group to remain at much higher risk for many smoking-related diseases than either nonsmokers or other cigar users. This greater level of risk is believed to result from the deeper and more frequent inhalation of cigar smoke observed among former cigarette smokers seeking a compensatory fix of nicotine from cigars. A similar phenomenon is evident among the millions of cigarette smokers who have switched to "low tar/nicotine" brands, erroneously believing that such a change significantly reduces their health risks.

The issue of cigar-related environmental tobacco smoke (ETS) represents an additional concern, although it remains poorly understood and little addressed at this juncture. The potential significance of secondhand smoke becomes readily apparent, however, when taking into account that a medium-sized cigar emits as many respirable particles as five cigarettes, and as much carbon monoxide as 25 cigarettes.

While the cigar resurgence continues to generate ample amounts of media coverage (see, for example, the July 21, 1997, Newsweek cover story), the public health community has only recently begun to take note.

 

NCI Cigar Monograph Details Numerous Research Avenues That Remain Unexplored

A recently released U.S. National Cancer Institute (NCI) monograph about cigar use does much more than detail the risks and trends of cigar use: it also indicates many possible areas nicotine and tobacco researchers should explore.

Cigars: Health Effects and Trends, number 9 in the Smoking and Tobacco Control series, indicates that much about cigar use remains unstudied, such as the frequency or intensity of nicotine dependence and withdrawal symptoms associated with cigar smoking and cessation.

"The recent increase in cigar consumption began in 1993 and was dismissed by many in public health as a passing fad that would quickly dissipate," NCI Director Richard D. Klausner explains in the preface to the monograph. Recent U.S. Department of Agriculture data, however, indicate that the "fad" is not as temporary as many believed. More than 5 billion cigars were consumed in the U.S. in 1997.

The monograph also indicates, both directly and indirectly, many partially explored areas of cigar research:

Gaps in Minority Research Indicate Need for Studies to Precede Smoking Interventions

By Linda Pederson and Gene McGrady

Morehouse School of Medicine

It has been repeatedly documented that some minority groups bear a disproportionate burden of smoking-related diseases, including cancers of many sites and cardiovascular disease. Data from national surveys have disclosed that smoking among African and Hispanic Americans is higher than among Caucasian Americans. Data on Native and Asian Americans is not as available, but the information that is supports the conclusion that there is more smoking in these groups, as well.

While it appears as if initiation to smoking is lower in adolescents among some of these groups than among Caucasians, recent evidence suggests that the rate of smoking among black adolescents has tripled in the last three years, from 2.3% to 7.0%. What is evident from the figures available is that smoking rates are not declining among these groups, and in fact may be increasing. The interventions that are available have not resulted in a reduction in either incidence or prevalence of smoking in minorities.

Research focusing on minority groups in three specific areas is needed: interventions to prevent smoking onset, interventions to assist smoking cessation, and epidemiological studies that lead to the identification of factors important to initiation and cessation. The research must be culturally sensitive and relevant. This means that these studies may be best designed and conducted in settings where there is awareness of the unique characteristics of these identifiable minority groups and in settings that are accepted by these groups. Hence, this research needs to be conducted by investigators who are affiliated with institutions that meet these criteria.

Preventing Smoking Onset

These interventions can occur at several levels. At one level are the prevention efforts that occur within the context of school health programs. Overall, there appear to be short-term but not long-term impacts of these programs. There is some suggestion that family sanction may be a potent prevention agent for minority youth, but the potential forms that family-centered interventions might take, and their utility and mechanisms, are little explored and need further delineation.

At a macro level are those legislative interventions that prevent sales of cigarettes to minors, limit smoking in public places, and increase taxation. That last element has been shown to be particularly effective as a means for reducing initiation in majority populations; however, much more needs to be learned about the impact of legislated measures on minority youth.

Some recent data (McGrady, Ahluwahlia, and Pederson, 1997) has revealed that smoking onset may occur in African Americans up to age 40. Whether this pattern can be applied to other groups is unknown. Prevention efforts have not typically been designed for use among adults and need to be considered and evaluated as to their efficacy in this use

Assisting Smoking Cessation

African Americans report that they want to quit smoking and intend to try, but are not successful in their attempts. Similar information on other minority groups could not be located. Cessation programs designed specifically for African Americans have shown limited success.

Again, whether similar programs have been designed and evaluated for other minority groups is not known. It is essential that these minorities play an integral role in the development and evaluation of such programs.

The impact on minorities of public policy to restrict smoking in public places and to increase taxation on tobacco is not known. There also are no data on perceptions of or compliance with smoking restrictions. Educational interventions concerning policy need to be designed and evaluated within a culturally relevant context.

Finally, there has been an increased emphasis on developing and evaluating cessation programs for young people. Which programs have been formulated specifically for different cultural groups is not known. Again, research is needed

Factors in Initiation and Cessation

Some information is available on what factors are associated with starting to smoke and with cessation of smoking. However, little is known about those late initiators referred to above, about the specific characteristics of those who quit and of those who start. There is some information on the social context for minority smoking, but again little specific information is available on the interaction of that context with characteristics of the individual, and the possible differential effect of different characteristics and environments for the various cultural minorities.

Recommendations

Although the importance of descriptive research on status and risk factors should not be downplayed, at least some of the studies should be conducted for the purposes of developing and testing theoretical models about the mechanisms underlying both initiation and cessation. These studies are important because they provide a foundation for both the development and evaluation of interventions. Theoretical models must be developed within the cultural context of the groups in question.

Ideally, epidemiological studies and those that are theory driven should be conducted before interventions are systematically developed and evaluated. However, such an ideal is not feasible in this time of increases in smoking. If interventions are to be instituted, the minimum requirement is that this is done while taking account of the unique characteristics of the groups in question.

Reference

Surgeon General Report Spotlights Minorities

A recent report by the U.S. Surgeon General reflecting surprising and unwelcome trends in tobacco use among U.S. minority groups suggests many avenues for new research.

The report, Tobacco Use Among U.S. Racial/Ethnic Minority Groups, documents tobacco-use trends among four major racial and ethnic minority groups in the United States: (1) African Americans, (20 American Indians and Alaska natives, (3) Asian Americans and Pacific Islanders, and (4) Hispanics.

Smoking increased in the 1990s among African American and Hispanic adolescents, despite previous decline. Contributing to patterns of tobacco use are many demographic, cultural, biological, environmental, advertising, and social factors. Recommended areas of research include these:

Initiation

"The initiation of tobacco use and early tobacco use among members of the various racial/ethnic minority groups seem to be related to numerous categories of variables—such as sociodemographic, environmental, historical, behavioral, personal, and psychological—although the predictive power of these categories or of specific risk factors is not known with certainty because of the paucity of research" (p. 240).

Acculturation Effects

"The data in general suggest that acculturation influences smoking patterns in that individuals tend to adopt the smoking behavior of the current broader community; however, the exact effects of acculturation on smoking behavior are difficult to quantify because of limitations on most available measures of this cultural learning process" (p. 94).

"More research is needed on the effect of culturally appropriate programs to reduce tobacco use among racial/ethnic minority groups. Interventions should be language appropriate; addressing psychosocial characteristics such as depression, stress, and acculturation may increase the acceptance of programs by...racial/ethnic groups" (p. 299).

Interventions

"Over the next 50 years, the population of the four groups is expected to increase dramatically, reaching close to one-half of the country’s population.... These estimates underscore the need to develop appropriate interventions to avert disturbing tobacco addiction patterns in this large segment of the population" (p. 10).

 

Surveillance, Prevention, and Control

"Rigorous surveillance and prevention research are needed on the changing cultural, psychosocial, and environmental factors that influence tobacco use to improve our understanding of racial/ethnic smoking patterns and identify strategic tobacco control opportunities. The capacity of tobacco control efforts to keep pace with patterns of tobacco use and cessation depends on timely recognition of emerging prevalence and cessation patterns and the resulting development of appropriate community-based programs to address the factors involved" (p. 6).

"Available data indicate that racial/ethnic groups support smoking restrictions.... Additional research is needed to evaluate how best to build on this base of public opinion support to strengthen existing tobacco prevention and control programs within racial/ethnic communities" (p. 300).

Health Effects

"Future research is needed and should focus on how tobacco use affects coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease, and other respiratory diseases among members of racial/ethnic groups. Studies also are needed to determine how the health effects of smokeless tobacco use and exposure to environmental tobacco smoke vary across...minority groups" (p. 185).

John Pierce Awarded Doll-Wynder Honor for Population-Based Epidemiology Research

John P. Pierce of the University of California at San Diego’s Cancer Prevention and Control Center has been awarded the 1998 SRNT Doll-Wynder Award for Epidemiological Research.

This award, given every two years for outstanding nicotine and tobacco work in public policy or epidemiology, honors scientists who make groundbreaking advances in research. The recipient receives $2,000 and an expenses-paid trip to the next SRNT annual meeting to present a plenary lecture on his or her research.

Pierce is currently the Sam M. Walton Professor for Cancer Research at UCSD and serves as associate director of the UCSD cancer center. He also serves as an associate editor for the new SRNT journal, Nicotine & Tobacco Research. From 1987 to 1989, he was chief of the Epidemiology Branch of the Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control (CDC).

Prior to his work with the CDC, he was acting head of the Department and Preventive and Social Medicine at the University of Sydney School of Public Health in Australia. He earned undergraduate and graduate degrees in Australia and received a Ph.D. in communication research from Stanford University in 1981.

A review of his published papers while he was in Australia shows the beginning of his significant, high-profile papers on the evaluation of anti-smoking efforts, as well as a concern for the influence of tobacco sponsorship on medical research. These papers also reveal his early focus on using population-based samples to identify broad-scale behavioral changes associated with governmental policies and tobacco industry advertising.

In the late 1980s, he contributed two documents whose findings were included in the U.S. surgeon general’s reports of 1988 and 1989. These works have become authoritative reference standards. His papers on trends in tobacco use in adults and adolescents have been published in The Journal of the American Medical Association, American Journal of Public Health, and Preventive Medicine.

Pierce has been influential at a national level in two countries and continues to be influential in the state of California through a central role in the evaluation and monitoring of several hundred million dollars worth of public education aimed at reduction of smoking in the state. California now has the second-lowest overall smoking rate in the United States.

He has documented not only patterns of consumption among smokers, but also attitudes of nonsmokers toward environmental tobacco smoke, tobacco use among adolescents, the role of physicians in cessation programs, and the efficacy of public ordinances and worksite restrictions.

Most recently, his epidemiological evaluations of adolescent smoking have shown an increase in prevalence and incidence, the susceptibility of teenagers to tobacco advertising, and the relationship between advertising and an increase in teenage smoking.

International Meeting Abstracts Due June 1

A call for abstracts has been issued, and plans are in place for the first international meeting of the Society.

This August 22-23, members from throughout the world will meet in Copenhagen, Denmark, for plenary symposia and poster presentations.

The conference is co-sponsored by the World Health Organization, The International Council on Alcohol and Addictions, and The European Medical Association Smoking or Health. Support for the conference is provided by Glaxo Wellcome, Novartis, Pharmacia & Upjohn, and SmithKline Beecham.

Sessions of the conference will be at the Medical School of the University of Copenhagen, in the central part of the city.

The call for abstracts has been mailed to SRNT members. Additional copies of the call for abstracts are available from Karl Olov Fagerström:

Fagerström Consulting

Berga Alle 1

S-254 52 Helsingborg, Sweden

Telephone: +46 42 15 06 50

Fax :+46 42 16 57 60

E-mail: karl.fagerstrom@swipnet.se

Submission deadline for abstracts is June 1. The registration fee for SRNT members, US $125, will be US $150 for members who register after July 20. President of the international conference will be John Hughes of the University of Vermont. A keynote address, "Current trends in U.S. smoking control policies," will be given by SRNT President Jack Henningfield.

Symposia topics will include epidemiology of tobacco use, nicotine safety, nicotine replacement, behavior therapy and brief advice, genetics, and harm reduction.

Poster displays with no competing sessions will allow time for discussion between presenters and attendees.

 Annual Meeting Documents SRNT Growth

The message at this year’s annual meeting in New Orleans, Louisiana, was clear: SRNT has grown.

The hundreds of presentations at the March 27-29 gathering were a testament to the commitment and breadth of research interests of members.

Even media coverage of the conference reflected the society’s growth. News of the meeting was posted on a Web science-news site, EurekAlert!, produced by the American Association for the Advancement of Science.News events at the meeting included a keynote address by Jeffrey S. Wigand, former tobacco industry scientist turned whistleblower. Wigand, who has been teaching science since parting company with the tobacco industry, recently has started a nonprofit organization whose mission is to draw on his experiences to inform school children about tobacco products and nicotine addiction.

‘The perfect experiment should be completed in one day’

Warm Sentiments for an Astute, Wry Mentor

Researcher Murray Jarvik was honored at an SRNT symposium as a scientist whose questions come from keen observations of the world around him, and whose answers come through rigorous and innovative work.

Several former students recounted how Jarvik’s research at the University of California at Los Angeles and the Brentwood Veterans Administration Medical Center typically begins with his curiosity. The former students recalled lighter moments working with Jarvik, who was unable to attend:

On parsimony: "One of Murray’s key principles of research design [is that] the perfect experiment should be completed in one day.... I notice they’re still doing that." (Ellen Gritz, recounting that Jarvik hired her on the spot as she was conducting a mouse experiment running nine subjects at once.)

On creativity: "Ellen and Murray and I...were driving to a very serious meeting when Murray suddenly detoured to a garage sale, because he had spotted a little piece of a used pulmonary device. He bought this to go create a little smoking topography [device] in the lab. He was very excited that he paid a quarter....

"He had Chuck [Lee] build a clock that went off every ten minutes. We asked him why, and he said, ‘To remind us that ten minutes has passed!’" (Nina Schneider, explaining Jarvik’s fondness for custom-made laboratory devices.)

On curiosity: When told once that a missed telephone call had gone directly into a new voice-mail system, Jarvik responded by asking, "‘Doesn’t he understand how the phones work?’ And not a second later, he though [aloud], ‘How do they work?’

"Murray is not afraid to ask a simple question, and he’s constantly questioning things." (Richard Olmstead, recalling a 1996 telephone transition.)

In videotaped comments, Jarvik told those attending the symposium that his interest in nicotine started when he was a laboratory research assistant:

"One of the oldest chimpanzees there was a female named Alpha. Every morning, one of the keepers would give her a cigarette and light it.... She would inhale deeply and blow smoke out of her nose, reminding me of a dragon or of King Kong. But she certainly seemed to be enjoying it.

"Unfortunately, neither I nor anyone else made a formal study of this behavior at that time.

"I kept it in mind for later on."

Web Site Now Has New Look, New Features

The curtain has risen on SRNT’s newly reconstructed World Wide Web site, which has undergone major changes and enhancements.

The site’s location is <http://www.srnt.org>. Members and other visitors may want to "bookmark" the site and check it often, since it is evolving, and since Society events and news are posted as soon as information is available.

Enhancements—many of which are now in place— include a searchable archive of the SRNT Newsletter, a searchable archive of abstracts from SRNT scientific meetings, an on-line membership form where potential members can submit a membership application electronically, an interactive Web bulletin board forum where members can post messages, and an on-line member directory. The design and interface are being completely revamped to accomplish these goals. The work is being conducted by a team led by Rick Brown of Brown University, operating under the jurisdiction of the Publications Committee. Webmaster Michelle Ricci of Brown’s team has been instrumental in the site’s design and implementation.

Brown’s team will update the contents of the completed site frequently to provide the latest news regarding events, meetings, information, and research.

Members not wanting to have their membership information (name, institutional affiliation, and contact information) posted on the site should notify Brown as soon as possible.

Suggestions are welcomed by Brown; phone: (401) 455-6254, e-mail: Richard_Brown@brown.edu.

 ‘Smoking Don’t Get No Respect’

Tobacco Use—Addiction, Habit, Disease, or Sin?

By John Hughes

University of Vermont

This issue’s feature is actually an old study that sheds some light on why nicotine often is neglected as a drug of abuse. In it, Ed Sellers combines the results of two studies form Canada’s Addiction Research Foundation about how the general public (attendees at a science museum) and health professionals (primary-care physicians) viewed drug dependence in the early 1990s. His table is reformatted below.

First, the good news is that even though tobacco use is slightly less likely to be seen as an addiction than alcohol or cocaine dependence, more than 70% in each group saw tobacco use as an addiction.

Second, only 30-40% of both groups saw tobacco use as a disease, compared with 67% and 80% for alcohol. Interestingly, the major evidence cited for considering alcoholism a disease—i.e., genetic diathesis, long-term craving, withdrawal, and loss of control—also apply to tobacco dependence. But many within the scientific, clinical, and public health communities have not endorsed the disease concept for tobacco.

Third, 56% and 76% characterized tobacco use as a habit, compared with 27% for alcohol. This might reflect the greater frequency of use of tobacco, compared with alcohol. Another possibility is that some may see the word habit as implying a problem one can cure on one’s own. In fact, two population surveys by Linda Sobell, John Cunningham, and Mark Sobell (1996) found that 78% of alcoholics stopped on their own. (However, 38% in one study and 63% in the other also reported moderate drinking after "resolving their problem" with alcohol.)

Fourth, only 29% and 13% saw tobacco use as a sin, probably because of the legality of cigarette use. Of course, this brings up the vexing question put to me by my daughter of whether doing something legal can be unethical or sinful.

The optimist in me looks at this survey and notes that most people and physicians see smoking as an addiction with habit features, and not as a disease or a sin. The pessimist in me notes that 27% of physicians still don’t believe smoking is an addiction, and that 29% see it as a sin. So we still have some work to do.

References

Comparison of percent of general public and health professionals endorsing etiologic concepts of drug dependence (adapted from Sellers).

Tobacco Alcohol Cocaine

General

Health

General

Health

General

Health

Construct

Public

Professionals

Public

Professionals

Public

Professionals

Addiction

71

73

90

88

87

89

Disease

33

38

80

67

51

56

Habit

76

56

27

27

50

36

Sin

13

29

21

29

52

36

Upcoming Events

College on Problems of Drug Dependence Annual Meeting, June 13-18, Scottsdale, Arizona; information available at <http://views.vcu.edu/cpdd/announce98.html>.

Cigar Smoking Health Risks: A State-of the-Science Conference, June 15-16, Renaissance Hotel, Washington, D.C.

Addicted to Nicotine: A National Research Forum, July 27-28, Bethesda, Maryland. Presented by the National Institute on Drug Abuse, the National Institutes of Health, and the Robert Wood Johnson Foundation; co-sponsors are National Cancer Institute (NIH) and Office on Smoking and Health, Centers for Disease Control and Prevention. Two-day national conference focused on latest research findings about behavioral, cognitive, and neurobiological sources of nicotine addiction, prevention of tobacco use, and treatment. Contact Robyn Bowie Semsker, Capital Consulting Corp., (301) 468-6004, x431; email: rsemsker@md.capconcorp.com; information at NIDA’s Web site: <www.nida.nih.gov>.

World Congress of Behavioral and Cognitive Therapies, July 21-26, Acapulco, Mexico. SRNT members will discuss nicotine and tobacco addiction in a symposium called State of the Art Treatment of Addictive Disorders. Information is available at:

<http://www.unam.mx/terapia/WCBCT98/wcbct98e.html>.

First International Meeting of the Society for Research on Nicotine and Tobacco, August 22-23, University Medical School, Copenhagen, Denmark; Additional copies of the call for abstracts are available from Karl Olov Fagerström: Fagerström Consulting, Berga Alle 1, S-254 52 Helsingborg, Sweden; Telephone: +46 42 15 06 50; Fax :+46 42 16 57 60; E-mail: karl.fagerstrom@swipnet.se. Submission deadline for abstracts is June 1.

The International Health Promotion Conference, Working Together for Better Health—New Partners and New Approaches for a New Millennium; 23-25 September 1998, Cardiff, Wales, UK. For information contact Amanda Price or Jon Pontin at Health Promotion Wales, Ffynnon Las, Ty Glas Ave, Llanishen, Cardiff, Wales, UK, CF4 5DZ. Telephone: +44 1222 681287 / 681246 / 752222; fax: +44 1222 756000 / 755813. E-mail: Conference.98@hpw.wales.nhs.u. Web site:

<www.hpw.org.uk/conf98/index.htm>.

American Society of Addiction Medicine, 11th National Conference on Nicotine Dependence, November 5-8, Marina Del Rey, California. Abstract submission deadline July 1. ASAM, 4601 North Park Ave. Suite 101, Arcade Level, Chevy Chase, MD 20815; call (301) 656-3920.

News and Other Offerings

The Ferno Grant for Innovative Research has been awarded to Lori Karan of the University of California at San Francisco to examine neuroendocrine responses to nicotine. The selection committee noted that Karan’s grant proposal was selected from a dozen excellent applications. The award, given every two years by SRNT to support innovative ideas in any area of nicotine and tobacco research, is designed to attract high-risk, high-impact proposals. The award consists of $25,000 per year for two years. Karan, a physician, has been active in SRNT, serving a term as membership chair. Her proposal is titled "Neuroendocrine Responses to Intravenous Nicotine as a Probe of Individual Differences in Tobacco Addiction."

Travel Awards for the Addicted to Nicotine conference (see above) are available. The society will give four awards of $750 each to undergraduate, graduate, or postdoctoral students to attend the Addicted to Nicotine conference. Preference will be given to students who reside outside the Baltimore-Washington area. Each applicant is asked to submit a resume and cover letter indicating why he or she wants to attend this conference. Application deadline is June 29. Send applications to: Maxine Stitzer, Ph.D., Behavioral Pharmacology Research Unit, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224.

The Newly Formed Research Support Committee welcomes the ideas and assistance of SRNT members. Researchers can contact committee Chairman Ken Kellar or Jack Henningfield (contact information on p. 16) to volunteer information or offer to help the committee list research resources and identify research needs. Committee members are Kellar, Henningfield, and Wallace Pickworth.

If it’s autumn, this must be Sydney. And if it’s the SRNT Newsletter, the issue will now be identified according to the month in which it is published, rather than according to the seasonal weather outside the editor’s North American window. Thus, this current issue, which would have been called the Spring 1998 issue under the old nomenclature, is now identified as the May 1998 issue. Also as part of an effort to accommodate the increasingly international nature of the Society, the administrative office in Maryland is now termed the Central Office, rather than the National Office.

Advertising is being accepted for inserts in the SRNT Newsletter. Inserts have been included with this issue and the previous two issues. The costs for paid advertising are as follows: $50 for quarter page; $90 for half page; $175 for full page; $300 for full page, both sides; classified ads are $20 per column inch (full width of page).

  

SRNT Newsletter

Published quarterly

by the Society for Research on Nicotine and Tobacco

Editor

Janet Brigham, Ph.D.
Center for Health Sciences
SRI International
333 Ravenswood Ave.
Menlo Park, CA 94025 USA

Phone: (650) 859-2797

Fax: (650) 859-5099

E-mail: jzb@unix.sri.com

The editor welcomes suggestions for articles, book reviews, meeting notices, and other information that would be useful to SRNT members. News of events and issues both outside and inside the United States is appreciated. Materials may be submitted by mail, fax, or e-mail, and may be submitted as a file attached to e-mail.


Deadline for August 1998 issue:

15 July 1998


Contributing Editors

International News

Robert West
sgjt600@sghms.ac.uk

Peter Hajek
p.hajek@mds.qmw.ac.uk

Biobehavioral Research

Kenneth J. Kellar
kellark@gunet.georgetown.edu

Clinical Research

Ray Niaura
raymond.niaura@brown.edu

Public Health Research

Linda Pederson
lindap@mindspg.com