August 7th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Opinion
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Now that the US Food and Drug Administration has been given the power to regulate tobacco products, one of its new powers is the right to change the health warnings on cigarette packs in the interest of public health.
So the first question is, are the current health warnings perfectly adequate? The answer to that one is clearly “no”. The boring small text warnings printed on the side of the pack have are almost perfectly designed to be ignored.
The second questions is, can we learn anything from the experience of health warnings in other countries? The answer here is a resounding “yes”. Numerous other countries have been using large mandated pictorial health warnings on cigarette packs for years and there is a growing body of research showing that these are much more impactful then prior text-only warnings. The warnings used in Canada present a good example to follow and can be viewed at:
http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/graph/index-eng.php
However, I particularly like the style used in Australia, where they have, since 2006 also added the freephone number of the national stop smoking Quitline to the pictorial health warnings. Graphic images and explanatory messages cover 30% of the front and 90% of the back of the pack. The message “You CAN quit smoking. Call the Quitline 131 848, talk to your doctor or pharmacist, or visit www.quitnow.info.au” is also included on the back of all packs. The Quitline number is also “stamped” on top of the graphic image on the backs of packs.. A recent study by Dr C L Miller of the Cancer Council of South Australia concluded that introducing graphic cigarette packet warnings and the Quitline number on cigarette packets doubled demand for Quitline services, with likely flow on effects to cessation.
Other countries of the world (including the United States) that have not yet introduced large graphic health warnings on cigarette packs or the number to the national quitline should do so as soon as possible.
The research from Australia can be viewed at:
http://tobaccocontrol.bmj.com/cgi/content/full/18/3/235
This post, Should We Put Graphic Warnings on US Cigarette Packs?, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
July 25th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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You may have noticed that over the past few years the cigarette companies have been trying to persuade the pubic that they are really nice people trying to make the world a better place. For example, at the start of this decade in the U.S. we saw ads on T.V. showing that Philip Morris tobacco company was bringing bottled water to flood victims or donating to good causes. Why would I be cynical and call this a P.R. stunt? Well for one thing because they spent more money on telling the public about the good deeds than on the good deeds themselves!
More recently companies like Philip Morris have been involved in such odd activities as providing consumers with booklets designed to help them to quit smoking. Of course, if the tobacco companies really did have their customers best interests at heart they would withdraw their products completely. But that isn’t going to happen. The management of these companies have a duty and a responsibility to do their best to help the company make money and provide value to their shareholders. So when it comes to activities apparently designed to help smokers quit, one can be pretty sure that’s not the long term intent. The intent is to provide a PR benefit that will outweigh any effect of helping smokers to quit.
One thing tobacco companies do have control over is the cigarette pack itself. Right now the United States is one of many countries that has inadequate health warnings on the pack. Compare the rather weak and small written health warning on the side of a US cigarette pack with the powerful (and large) pictorial warnings on cigarette packs in numerous other countries. You can view pictorial pack warnings from around the world here.
The new legislation giving FDA the power to regulate tobacco products in the United States provides a new opportunity for the government to regulate not only the product but also the packaging. At the recent UK National Smoking Cessation Conference, Dr David Hammond of University of Waterloo in Canada gave an excellent presentation on the most effective ways to use the cigarette pack to inform smokers about the harmfulness of tobacco and to encourage them to quit. He showed that strong emotional pictures of the harms from tobacco on the pack itself, combined with limiting brand information, adding direct information about help to quit on the pack (e.g. the national quitline number) plus a quit smoking “onsert” added to the pack will all have the effect of encouraging smokers to make a quit attempt.
He made it clear that every country in the world should be much more active in using the cigarette pack as a means of encouraging smokers to quit. The companies themselves clearly won’t do it voluntarily, so governments need to take control of the packs via legislation and require much more effective warnings and quitting information be included on cigarette packs.
You can listen to Dr Hammond’s full presentation and view his slides by clicking on the appropriate icon at the following website.
This post, Advertising On Cigarette Packs May Help Smokers Quit, was originally published on
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May 21st, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Patients I’ve seen who succeeded in quitting, sometimes tell me what it was that enabled them to quit this time when they had been unsuccessful many times before. Sometimes it was a change in personal circumstances, sometimes an aspect of the treatment we gave them, but sometimes they tell me there was a single thought, tip or piece of information that stuck in their mind and really helped.
So I thought I’d share a few of those thoughts or tips that helped others, and ask readers to share the things that helped them most. Here are a few:
1. “Move a muscle, change a thought”
This phrase stuck on one patient’s head as a reminder that when he was sitting and bored and starting to crave a smoke, he should get up, and get busy to help shake the thought of a cigarette from his mind.
2. “My cigarettes are radioactive”
The information that cigarette smoke contains radioactive chemicals like polonium-210 really stuck in the mind of one ex-smoker and helped her stay off them.It is estimated that smokers of 1.5 packs of cigarettes a day are exposed to as much radiation as they would receive from 300 chest X-rays a year.
In case you don’t mind polonium, here are some other substances found in cigarette smoke:
Ammonia: Household cleaner
Arsenic: Used as a poison
Benzene: Used in making dyes
Butane: Gas; used in lighter fluid
Cadmium: Used in car batteries
Cyanide: Deadly poison
Lead: Poisonous in high doses
Formaldehyde: Used to preserve dead specimens
3. “Get rid of ALL tobacco and lighters from the house and car”
Many smokers have told me that this was the single most important piece of advice they followed. They said that many times the cravings were so strong that if they had cigarettes in the house they would have smoked them. But having very thoroughly cleared them out of the house gave them some peace of mind and bought them enough time to deal with the cravings when they occurred.
I’d be interested to hear from readers what their most helpful tip or piece of information was when quitting smoking. Feel free to use the comment section to post your favorites.
This post, Tips To Help You Quit Smoking, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
May 18th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network
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I’ve previously written about what face-to-face smoking cessation services typically do, largely based on my own experience. However, while at the SRNT annual conference I met two Smoking Cessation Advisors working in Lancashire, England who appeared to have a successful service, so thought it worth sharing some of their information.
Jan Holding and Eileen Ward manage a UK National Health Service (NHS) Stop Smoking Service in Lancashire in the north of England. Both are nurses by training and many of the 14 staff providing the treatment have primarily a nursing background. Their service sees around 450 new clients per month (i.e. over 5000 new clients per year). Services are provided at “community sessions” at various locations all over their catchment area, and clients are given their own hand-held record which they keep, and take with them to sessions, enabling them to attend whichever community location suits them at the time. While clients can make scheduled appointments, the service is also flexible, allowing clients to “drop-in” to community sessions without an appointment. Although some initial assessment sessions take place in a group format, most of the sessions are delivered in a one-to-one format via a relatively brief discussion with a smoking cessation advisor. These community sessions often take place in a large community room from 4pm to 8 pm in the evening, with multiple types of services being provided in the same room at the same time at different corners (e.g. initial assessments in one corner, prescribing of varenicline in another, and nicotine replacement therapy in another). It is not uncommon for around 200 clients to attend a single community session.
Clients are frequently encouraged to use NRT prior to quitting smoking (about half do this) and usually use more than one smoking cessation medicine (more than half do). Nicotine replacement therapy is provided via a voucher system requiring either no cost to the client, or just a co-pay (around $10 USD).
The service runs 6 days per week and includes evening sessions, and aims to reduce most of the usual barriers to entering treatment. Their “3 As” approach emphasizes “Accessibility, Availability and Adaptability”. They also specifically try to develop smoking cessation advisors who are passionate about their role, have a positive attitude to the importance of quitting smoking, and are therefore very committed to that work, as well as being knowledgeable about it.
My understanding is that the quit rates at this service are pretty good. But perhaps the best testimony to its success is the fantastic volume of clients who attend…..largely influenced by positive word-of-mouth via other clients. The success of this service reminds us that there isn’t just one way to do it, that all smoking cessation counselors and systems may need to be flexible and adaptable in order to help as many smokers to quit as possible.
For further information on what a smokers’ clinic does, see: What does a tobacco treatment clinic do?
This post, Smoking Cessation Programs: Lessons From The UK, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
