Aimee Schiefelbein, Quit Coach, Service Delivery:

Last December, New York City became the first U.S. city to require stores to post 4-square-foot warnings showing the physical effects of smoking near tobacco displays and smaller ones near check-out counters. Last month, a few retailers and the three big companies (Lorillard, R.J. Reynolds, and Philip Morris) filed a lawsuit challenging the New York Board of Health, claiming the regulation violates the First Amendment by requiring tobacco sellers "to undertake graphic advocacy on behalf of the city." In other words, the tobacco companies don't want you to realize what you are doing to your body because if you had a visual, if you heard the words, and if you read the warnings enough times you might quit.

This spring, Massachusetts appeared likely to become the first state to force retailers to prominently display graphic warnings about the health impact of cigarettes. Yet while members of the Public Health Council expressed support in advance of the planned vote, state officials now wait to see what happens in the pending New York lawsuit. The delay keeps Massachusetts from setting a precedent that could significantly decrease tobacco sales.

Why would this tactic work? Imagine for a moment: you smoke a pack a day. Your mother died of lung cancer and you were just diagnosed with COPD (Chronic Obstructive Pulmonary Disease). Intellectually you know quitting smoking is the best thing you can do for your health. You have gotten so used to cigarettes being a part of your life that you hardly notice you get winded quicker than normal because this is "normal" for you. You think, I'll quit eventually, I just need to get through the stress at work. You have all the reasons in the world to stop smoking but there is only one problem; you don't know if you want to. Part of this is because you can't see the long term benefits you would gain by quitting. You can't open up your chest and see the damage you have done to your lungs. You read the surgeon general's warning on a pack of cigarettes that says "Tobacco Smoke Increases the Risk of Lung Cancer and Heart Disease" and to you they are just words. You think to yourself, we're all going to die eventually so why not enjoy myself?
 
Later that day you enter a convenience store and while standing at the counter to buy your next pack of cigarettes you see a life size picture of a darkened and diseased smokers lung. Suddenly you feel a pit in your stomach and you recognize that this picture you are looking at is what you are doing to yourself. There is nothing left to the imagination, there is no way you can deny it. It's not just words on a pack of cigarettes; this is you. You picture your children and grandchildren living on without you. You say to yourself, I will die soon if I don't do something. You throw the cigarettes back on the counter and walk out, proclaiming your desire not to be enslaved by cigarettes any longer.

I wish every state would display graphic images of diseased lungs, rotting teeth, and damaged brains with the urge to quit tobacco. Not that I particularly want to see this as I am going to pay for my gasoline at the convenience store; in fact, it turns my stomach to look at some of the sample posters. However...I do believe these graphic images could prevent that person who is buying their next pack to think about their choice before they follow through. I think of a teenager going in to buy their first pack, only to be confronted by the reality of how smoking could impact their appearance. I think of my family members who struggle with their tobacco addiction, hoping maybe it will encourage them to quit too.

Will graphic displays actually help? Only time will tell. I do know one thing; we are bombarded every day with smoking advertisements. It's about time we see more concrete education challenging the tobacco industry.

Ian Bubenik, Quit Coach, Service Delivery:

As of yesterday, new FDA guidelines state that cigarettes may no longer be branded as light, mild, or low. However, recent changes in product packaging show that tobacco companies will continue to try and trick smokers by color-coding packs of cigarettes, reaching out to people who will associate colors with the packs they used to purchase - people who believe “light” cigarettes are actually healthier to smoke than regular cigarettes. A 2008 UCLA study found that "light" cigarettes deliver nearly as much nicotine to the body as other kinds. They also likely deliver it to the brain just as quickly. In addition, the 4,000 chemicals that are in regular cigarettes are in light cigarettes – whether they are blatantly packaged as such, or merely hinted at with color.

In other words, switching brands or colors won't do nearly as much good for your health as quitting completely. It's important to recognize how the tobacco industry may try to influence the thought process of a smoker.

If you are a smoker, have you had any of these thoughts recently?

1. It's okay to smoke because I'm only smoking light cigarettes.
2. It's okay to have just one cigarette.
3. I need to reward myself for my day. I'll have a cigarette.

We're here to help smokers quit when they're ready to reframe those thoughts and give quitting a try. If you’re ready, feel free to call a Quit Coach at 1-800-QUIT-NOW or visit www.quitnow.net.

Ken Wassum, Senior Product Manager, Tobacco:

Smokeless tobacco products are taking on a new look. No longer is the mug of Tommy Lasorda, former manager of the Dodgers, with a hug “chaw” in the side of his mouth, the face of smokeless tobacco. If R.J. Reynolds gets the market response they are hoping for with their new smokeless products, use of smokeless tobacco will go from hillbilly to hip.

For the past year Reynolds has been test marketing a variety of oral tobacco products. These include Camel Snus, Camel Sticks, Camel Strips, and Camel Orbs. They are clearly hoping for two things. First, they are positioning these as products that can be used in smoke-free environments (“for when you can’t smoke”) since these restrictions are cutting into their bottom line. Second, they are trying to attract new users, as always. Hence the labeling of Orbs as “Mellow” and selling them in a plastic box that looks an awful lot like Tic Tacs. The tobacco industry has a long, long history of packaging and flavoring their products to be attractive to youth. But to listen to Susan Ivey, CEO of R.J. Reynolds, their objective is one of offering a “safe” alternative to cigarettes and offering an olive branch to those in public health who have been unwilling to compromise in the goal of reducing disease and death caused by smoked tobacco.

While these smokeless products are new, R.J. Reynold’s story is old. These new smokeless products do not require that the user spits. With the exception of Camel Snus, the Orbs, Strips, and Sticks are all designed to dissolve in the mouth. The snus product also does not require spitting as it is designed to go under the upper lip and has less salt in it, both of which cause less saliva being produced. And we have absolutely no idea of the health consequences of these products. They are too new and have not been tested for safety.

R.J. Reynolds has a long and disturbing history of releasing misinformation to the public and press. Whether it be the former CEO of R.J. Reynolds testifying that he did not believe nicotine was addictive (despite evidence from internal documents from the Board and R.J.’s research scientists which clearly state otherwise) and the release of Light and Ultra Light cigarettes designed to convince smokers in the 60’s and 70’s to not quit but instead use a “lighter” product. These are simply a couple of the countless other efforts to deceive the public and RJ Reynolds cannot be taken at their word.

R.J. Reynolds continues to aggressively make and market combustible tobacco, targeting specific markets with stylized branding. Examples include Camel No. 9 aimed at young women and American Spirits branded as “natural” and targeted towards youth. So while Ms. Ivey can talk all she wants about R.J.’s efforts to reduce disease and death associated with tobacco use, their actions prove otherwise. The simplest way they could achieve this goal is to stop the production and sale of smoked tobacco, but profits come before the health and welfare of Americans. And actions speak louder than words.

So while Camel Snus, Orbs, Sticks, and Strips may take smokeless tobacco from hillbilly to hip, R.J. Reynolds does not have the health of Americans in mind. It is just more smoke and mirrors.

Here’s the truth: quitting is hip. Switching to smokeless is just changing seats on the Titanic.

What do cereal and tobacco manufacturers have in common?

Walking down the grocery store cereal aisle can be a challenge, especially with kids in tow. Brightly colored cereal boxes with toys and other freebies grab their attention. Cereal manufacturers developed creative and effective ways of marketing toward their most important audience: kids. Unfortunately, tobacco manufacturers are using some of the same tactics to lure kids into trying their products. The tobacco companies claim they are marketing only to adults, but I'm suspicious.

A February 2008 special report outlines how kids are influenced by free giveaways or candy-type flavoring and packaging. R.J. Reynolds' Camel No. 9 promotional giveaways include berry lip balm, cell phone jewelry, cute little purses and wristbands, all in hot pink (see a previous Free & Clear blog post about this topic here). My 9-year-old daughter loves those kinds of things, but I don't know any mature adult that would purchase the product just for the free lip balm.

"R.J." also has new "Orbs, Strips and Sticks," all nicotine laced tobacco products. Interestingly, one of their advertisements features young girl (she doesn't look 18 to me!) with the tobacco packages in the foreground.

Dreams, a line of cigarettes manufactured by Kretek International, Inc., come in candy flavors such as chocolate, strawberry and cherry.

As a Quit Coach with Free & Clear I've talked to many young teen tobacco users. Some try the new tobacco products on the market because of the special flavors or free items that come with the packaging.

As a parent, it's hard enough to prevent kids from being influenced by brightly colored cereal boxes and the free toy inside. It's no wonder why 90% of tobacco using adults started before the legal age.

These are just a few examples of the marketing strategies employed by "Big Tobacco." What's next, free jump ropes?

In a move that one cannot help but suspect is strategically calculated, Big Tobacco has filed suit against the FDA for restricting their First Amendment rights of free speech. The Congress passed legislation this last summer that gives the FDA the ability to regulate tobacco products, including how the industry advertises (Title II; Section 201; Sections a & b) their products. Given the track record of the tobacco industry of putting profits before ethics I fully suspect that this suit will be used to stall implementation of the entire Family Smoking Prevention and Tobacco Control Act, using the First Amendment issue as a red herring.

According to the Wall Street Journal, “The [tobacco] companies object to such provisions as a requirement that cigarette makers expand the size of warning labels so that they cover the top half of the front and back of cigarette packs, and include graphic images such as diseased lungs. This change, they say, would leave manufacturers with only a small and often-obscured portion of a cigarette pack to print their own messages.”

The key part of this is the “…to print their own messages.” The tobacco industry has a long and storied history of misleading the public with their “messages.” A case in point is the marketing of light and ultra-light cigarettes a couple of decades ago. With this effort came nicotine and tar listings on the pack, which were completely inaccurate and gave smokers the idea that these products were less harmful than regular cigarettes. In truth the tobacco industry engineered the products so they passed faulty machine testing for nicotine and tar, but delivered the usual amount of nicotine and tar when smoked by people. Hundreds of thousands of American became sick and died as a result of ads that said things like, “Considering all I’d heard, I decided to either quit or smoke True. I smoke True.”

I am a former smoker. I smoked for almost 25 years before quitting at the age of 41. My father died of lung cancer and for the past 17 years I have worked to help smokers quit using clinically proven treatment approaches. Despite all this, I am not a fan of making cigarettes illegal. This didn’t work with the probation of alcohol in the 1920’s nor has it worked in the past 30 years with street drugs. It won’t work with cigarettes either.

Nevertheless, I am offended when the tobacco industry uses the First Amendment as their justification to continue their assault on the health and lives of the American public. The Courts have ruled that it is illegal to yell fire in a crowded theater because the risk to the public outweighs the right of free speech. Similarly the right of the Tobacco Industry to print their own misleading messages on a product that causes disease and death when used as directed by the manufacturer seems to fall into the same category.

The Tobacco Industry has a clear track record of misleading messages that are well documented. Case in point is their appearance before Congress in 1996 (it is important to remember that date) where they testified that they did not believe that nicotine was addictive. Guess what? Countless documents from their own internal meetings clearly show otherwise. Take the statement by W.L. Dunn, Jr in 1972, senior scientist at Philip Morris: “The majority of conferees would accept the proposition that nicotine is the active constituent of cigarette smoke…The cigarette should be conceived not as a product but as a package. The product is nicotine.”

Or, another statement by WL Dunn, again in 1972, intended for internal use only, “Think of the cigarette pack as a storage container for a day’s supply of nicotine…Think of the cigarette as a dispenser for a dose unit of nicotine…Think of a puff of smoke as the vehicle of nicotine…Smoke is beyond question the most optimized vehicle of nicotine and the cigarette the most optimized dispenser of smoke.”

Or, an internal memo from British American Tobacco as far back as 1964, “There seems no doubt that the ‘kick’ of a cigarette is due to the concentration of nicotine in the bloodstream…and this is a product of the quantity of nicotine in the smoke and the speed of transfer of that nicotine from the smoke to the bloodstream."

I could go on forever, but I think I made my point. Restricting tobacco package labels as the FDA has done is prudent and necessary. Let’s just hope the courts decide this way as well and let’s hope that the courts rule the FDA can proceed with other parts of the Family Smoking Prevention and Tobacco Control Act while this issue is being sorted out.

Last week’s 79 to 17 vote enabling the Food and Drug Administration (FDA) to regulate tobacco products was a historic moment. Forty-five years after the Surgeon General Report in 1964, the Family Smoking Prevention and Tobacco Control Act has the potential to save hundreds of thousands of lives in America. Notice I said “potential to save lives" rather than “will save lives.” We will have to keep an eye on the man behind the screen to make sure the bill does what it is supposed to do.

Without good FDA follow-through the bill will do little. While a step in the right direction it has flaws that will need to be fixed as time goes on. Until we see how it’s practically applied, it’s hard to know how effective the bill will be.

You might be wondering why the passage of this act is such a big deal. I mean, after all, don’t we have smoke-free indoor air in most states now? And, haven’t we raised prices to where cigarettes are getting prohibitively expensive for smokers? And, haven’t we banned cigarette advertising on TV? The answers to these questions are Yes, Yes, Yes, as well as yes to many other important efforts to protect the health of smokers and non-smokers alike. But, what we have not been able to do is the one thing that has real potential to make a difference, and that is to regulate the PRODUCT!

This bill can drastically reduce the level of nicotine in cigarettes to make them much less addictive, but nicotine cannot be eliminated entirely. It can stop the industry from labeling cigarettes light and low tar, when in fact cigarettes so labeled have NEVER had less tar or nicotine than regular cigarettes. It can further restrict the tobacco industry in their advertising strategies, which are still designed to make cigarettes sexy and sophisticated, especially to children. But, it will not do any of these things on its own. FDA regulators and administrators will have to be on their toes to keep the tobacco industry from manipulating the law to their own advantage.

One shortfall of the bill is that it provides for 3 industry representatives on the FDA tobacco advisory board. While these individuals will not have a vote, they will be able to influence decisions. And that is what the tobacco industry does the best - working behind the scenes to achieve their goals.

In the final analysis it is up to us to make sure this bill makes a difference. You can do this by paying attention to what the FDA does to act on the intent of the bill, and by keeping an eye on the man behind the screen. If we don’t, we may find our children having this same conversion forty-five years from today. And that indeed would be tragic.

The recent increase in the Federal Tobacco Tax (62 cents), coupled with a price hike by the tobacco industry, is causing a lot of smokers to ask for help in their effort to quit smoking.

This is bad news to Big Tobacco. Steven Stanek in The National Newspaper quotes Maura Payne, a spokesperson for RJ Reynolds, as “vigorously opposed” to the tax hike because it “will disproportionately impact poorer families.” Hmm….this is a population that the tobacco industry has targeted for years, selling them a product, that when used as directed by the manufacturer (and that’s you, Philip Morris and RJ Reynolds) results in disease and death. So while actively helping to kill poorer families she’s now concerned those cigarettes may cost them a little more? It would seem she is more concerned about the Almighty Buck flowing into Big Tobacco’s coffers!

But this is what Big Tobacco does best. They try and confuse the issues so they come off looking like the good guy --- the protector of human rights, the warrior against unfair taxes --- and sometimes they are successful. But, in fact, they are only interested in their bottom line regardless of who dies as a result. A good example recently occurred in the State of Oregon where they mounted a multi-million dollar campaign to defeat a tobacco tax that would have paid for health care for uninsured children.

Cigarette tax and price increases, including this last one, have been very effective in prompting smokers to make a decision to quit smoking. No argument there! One reliable measure of smokers trying to quit is calls to Tobacco Quit Lines. By calling 1-800-QUIT NOW a smoker will be automatically routed to the Quit Line in their state – and all 50 states have one. There they can get help quitting this deadly addiction. And phones are ringing off the hook!

Some would argue that every smoker needs help quitting. Others would argue that there is no magic bullet to quitting and all it takes is will power. So who’s right? You could say both are right or you could say neither is right. The truth is that some smokers need help to quit and some don’t.

As a smoker, if you decide to quit on your own and you succeed, then you didn’t need help. Great, you’re done and you can get on with your life. Plus, you’ve just added years to your life span! Congratulations.

But if you have tried to quit, maybe many times, and have not been able to quit, then there is help available.

Quit smoking programs are an essential component of tobacco control policies. In fact, without treatment programs, many would argue that tobacco control policies are unethical, and I would agree. To not offer help to those who need it is to doom them to a life of smoking related disease and an early death.

So if you quit on your own, pat yourself on the back. If you have not been able to quit, there is help available. Call 1-800-QUIT NOW. To be clear, there’s no promise of magic bullets, just proven programs that can help smokers achieve a healthier (and less expensive) life. Best of all, the programs are free.

Here in India at the 14th World Conference on Tobacco or Health, the Framework Convention on Tobacco Control is center stage.  The WHO FCTC is a treaty negotiated under the auspices of the World Health Organization. Since being adopted on February 27, 2005 it has since become one of the most widely embraced treaties in UN history and, as of today, has already 163 Parties.

While the US is a party to the treaty we are not bound by it.  Why?  Because the treaty has never been sent to Congress for ratification.  As a result of our lack of action we are in the company of such nations as Afghanistan, Cuba, Haiti, & Liberia.  As an American who has worked the past 16 years to help smokers quit their deadly addiction to cigarettes I am deeply embarrassed by our failure to ratify the treaty.

You might ask yourself why the US has never ratified the treaty.  You have only to look at the influence of Big Tobacco on the White House and Congress.  The previous administration was deep in the pockets of Big Tobacco.  The Tobacco Industry is a major contributor to the election campaigns of senators and congress person in tobacco growing states.  Over the past several years the White House could have sent the treaty to Congress for ratification at any point in time, but it did not.

The Tobacco Industry has worked tirelessly in the US and elsewhere in the world to dilute and delay any tobacco control legislation.  As always, they are subtle about how they go about doing this. They put on the face of caring about the little guy (the tobacco farmer) or preventing the erosion of personal rights (so-called Smokers’ Rights), but in the end is all about huge corporate profits at the expense of the health of US citizens and hundreds of millions of smokers worldwide.

Article 14 of the Framework Convention on Tobacco Control (FCTC) states, "Demand reduction measures concerning tobacco dependence and cessation."  While the US has a National Tobacco Dependence Guideline that is a model for much of the world, what we lack is a real national strategy.  States are left to develop their own tobacco control policies with minimal funding from the Feds.  As a result we have a patchwork of substandard policies, legislation, and treatment services.

We have a long way to go in the United States if we really want to prevent nearly a half million smoking related deaths each year.  A first step would be to call your US Senators and Congress Persons and tell them you want the US to ratify the FCTC treaty.

To learn more about the treaty go to http://www.who.int/fctc/about/en/index.html.

Tobacco manufacturers recently disclosed a new list of additives found in tobacco products to the U.S. Health and Human Services Department. While similar lists have made the rounds for years now, such information never ceases to amaze me.

Of the list of 599 additives, you can find surprisingly pleasant additives intended to enhance flavor and aroma, such as chocolate, cinnamon, clover top, dill seed, fig juice, honey, lemongrass, nutmeg, rose; even rum and wine! But take a look at what else can be found in any given cigarette (special thanks to the Richmond Times Dispatch for providing the list and definitions):

• Acetanisole: Found in a glandular secretion of beavers that smells sweet and can taste like vanilla or cherry.
• Ammonia: Used in cleaning fluid. Makes eyes sting and can cause dermatitis.
• Butyric acid: Found in rancid butter, vomit and Parmesan cheese, it has an acrid taste but sweet aftertaste.
• Capsicum oleoresin: Active ingredient in pepper spray.
• Diacetyl: An artificial butter flavoring that can be hazardous when heated and inhaled over a long period.
• Ethyl acetate: A solvent.
• Farnesol: An alcohol that is also a natural pesticide for mites and is a pheromone for several insects.
• Galbanum: An aromatic gum, with a disagreeable, bitter taste.
• Glycerol: A colorless, sweet liquid that bonds with water.
• Isobutyl acetate: A solvent used in lacquer.
• Lauric acid: A fatty acid that smells slightly of bay oil or soap.
• Magnesium carbonate: A mineral used in flooring, fireproofing, cosmetics and toothpaste that may be a laxative in high doses.
• Methoprene: A hormone used in drinking water cisterns to control mosquitoes that spread malaria.
• Nonanoic acid: Used to make plasticized lacquer and as a herbicide.
• Oleic acid: Emitted by the decaying corpses of some bees and ants to signal living workers to remove bodies from the nest.
• Potassium sorbate: A food preservative.
• Skatole: A compound generated in mammals’ digestive tracts and in beets that has a strong fecal odor.
• Soda ash (sodium carbonate): Used as a water softener and in making glass.
• Tartaric acid: Found in wine and bananas, it gives foods a sour taste and is used as an antioxidant.
• Thiazole: A flammable liquid used to make fungicides.
• Urea: A chemical used in fertilizer that can irritate the eyes, skin and respiratory tract.
• Xanthan gum: A food additive used as a thickener.

To test more of your tobacco knowledge, check out last month's Smoking Quiz at CNN.com.

As October’s Breast Cancer Awareness Month came to a close, antismoking groups registered their protests at Philip Morris USA’s plan to launch the new pink “purse packs” of Virginia Slim “Super Slim” cigarettes. Part of the outrage, according to protestors, is the timing of Philip Morris's announcement. Pink abounds in October in support and memory of those who have battled breast cancer. 

It's insulting that anyone--even Big Tobacco--would think it appropriate to sell "cancer sticks" packaged in the same female-friendly color for such a contrary purpose.

Back in August we made note of the company’s use of feminine colors and sophisticated design to market Camel No. 9 cigarettes, which have received criticism for their female-targeted marketing and allusion to the name and sophistication of a fragrance by Chanel.

Now there is a “slimmer” product on the market that can be neatly tucked away in one’s purse. Convenient and petit, these cigarettes also claim to be "light," and target those women who'd like to think they represent a slimmer, health-conscious consumer.

Can't wait to see what they think up next.