Opinion: Mass. Should Follow Bloomberg, Ban Cigarette Displays

(State Archives of North Carolina/Flickr CC)

(State Archives of North Carolina/Flickr CC)

Last month, New York City Mayor Michael Bloomberg announced a new public health initiative: He called for legislation that would require stores to keep cigarettes and other tobacco products out of sight, so they’d present less of a temptation. Here, Ilana Knopf, director of the Center for Public Health and Tobacco Policy at New England Law | Boston, argues that Massachusetts should follow his lead.

Ilana Knopf (Courtesy)

Ilana Knopf (Courtesy)

By Ilana Knopf
Guest contributor

Walk into virtually any convenience store in your town and you will have trouble avoiding colorful, prominent cigarette displays. They’re almost always located at eye-level, behind the registers, formed into a power wall of cigarettes that resemble an in-store billboard. It’s not an accident that these tobacco product displays are so visible. Tobacco companies spend billions of dollars on point-of-sale advertising. The reason is simple: it works.

If you have never noticed these displays or don’t think they’re a big deal, it’s probably because you’re more than 18 years old and outside of the tobacco industry’s true target audience: teenagers. In its quest to preserve and grow market share, tobacco companies are heavily invested in recruiting new users, and these new users are overwhelmingly (90 percent) our teenage sons and daughters.

Don’t take my word for it; take it from the tobacco companies themselves. As one Philip Morris report put it, “[t]he ability to attract new smokers and develop them into a young adult franchise is key to brand development.”

Tobacco companies are extensively invested in the point-of-sale strategy. They spend nearly $8 billion each year on this type of marketing (93 percent of their marketing budget), which is five times more than junk food, soda and alcohol manufacturers spend combined.

The tobacco industry already focuses on influencing youth decisions about tobacco use. Isn’t it time we caught up?

Point-of-sale displays are particularly effective in attracting young people. Tobacco companies rely upon the fact that teenagers are open to experimentation and move from experimenting to addiction far more quickly than for adults. The companies’ goal is to get young people to try tobacco with the intent of converting them into lifelong users. Research has found that adolescents are more influenced by tobacco marketing than peer pressure in their decision to start smoking.

In New York City, Mayor Bloomberg has proposed significantly restricting tobacco displays. Under his proposal, retail stores will still be permitted to sell cigarettes and other tobacco products — and advertise that such products are available for sale — but would have to do away with the large display of cigarette packs and other tobacco products that customers see behind the checkout counter in many convenience stores, pharmacies, and other retail establishments. Tobacco products would remain out of sight until a customer has asked for them and the salesclerk has verified that the customer is at least eighteen years old.

The mayor’s proposal makes sense. Continue reading

P.S. On Nicotine Gum And Patches: This Study ‘Shakes Up The Field’

You know the old joke: “I’m great at quitting smoking: I’ve done it more than a dozen times!” That’s what I thought of when I saw the Harvard/UMass study earlier this week questioning the hundreds of millions of dollars spent on nicotine gum, patches and other forms of “nicotine replacement therapy.”

I caught up a bit late with Boston University School of Public Health professor Michael Siegel, a leading tobacco control researcher whom I’ve seen quoted in the Boston Globe dozens of  times. So mea culpa for tardiness, but I still want to put his considered perspective on the record. Some of the coverage made it sound like the new study is just the latest salvo in a long debate over whether nicotine replacement therapy is worthwhile, but my impression from Prof. Siegel — who, granted, has long been a skeptic of nicotine replacement — is that this may be more of a game-changer.

His take on the study, lightly edited:

Strictly speaking, what this study looked at was smoking relapse. These were smokers who had quit, so from a strict perspective, this study can only conclude that nicotine replacement was not effective in helping prevent relapse.

‘In the field, generally there’s a dogma that nicotine replacement therapy is the state of the art.’

However, when you think about it, the smoking cessation process almost always involves relapse, so in a sense, you can infer from the study that nicotine replacement is not effective for quitting because quitting involves being sustained. If you took a bunch of quitters at a given time and you wanted to predict whether they were going to sustain their quitting, those on nicotine replacement therapy were no more likely to sustain their quitting. I do think that this study does provide evidence that in general, nicotine replacement therapy is not effective for quitting.

Is this new, did we know this? Yes and no. Continue reading

Study Raises Major Questions About Nicotine Patches And Gum

A friend of mine has been chewing nicotine gum for about a decade now. I used to joke that we should buy stock in the makers of Nicorette, but it stopped being funny when he backslid into smoking a few weeks ago. I’d thought the gum was supposed to help wean you. Instead, in him, it seems to have maintained an addiction that eventually reverted back from gum to butts.

A new Harvard/UMass study seems to bear out his experience, and raises major questions about nicotine replacement. It found hundreds of smokers who had just quit and followed them over several years; relapse rates were the same whether the quitters used nicotine replacement — gum or patches — or not.

The evidence looks fairly strong in the medical literature that nicotine replacement does help people quit. So does this study mean, I wondered, that the replacement methods help people quit but do not prevent relapse? Harvard researcher Hillel Alpert responded: “The evidence for NRT helping people is for short-term quitting and not long-term abstinence; and it does not necessarily capture the experience in the real world, as our study demonstrates.”

The study’s press release:

Nicotine replacement therapies may not be effective in helping people quit smoking

Boston, MA – Nicotine replacement therapies (NRTs) designed to help people stop smoking, specifically nicotine patches and nicotine gum, do not appear to be effective in helping smokers quit long-term, even when combined with smoking cessation counseling, according to a new study by researchers at Harvard School of Public Health (HSPH) and the University of Massachusetts Boston. Continue reading