Quit Smoking Weapons of Mass Distraction

Description

Who keeps telling smokers they can't quit without help? For decades there have been far more ex-smokers than smokers, and an estimated 75% of smokers quit without drugs or professional help. But smoking cessation is a global phenomenon serviced by multibillion-dollar industries, including the pharmaceutical and e-cigarette sectors and health professionals. These industries try to denigrate unassisted cessation and promote their products and services - "weapons of mass distraction" - as essential to successful quitting. This contributes to the medicalisation of a process that, before these products were available, had a natural history where drugs and expertise were absent, yet millions of people around the world still quit. Simon Chapman AO is one of Australia's foremost experts on strategies to minimise harm from tobacco. In Quit Smoking Weapons of Mass Distraction, he reviews the early history of quitting smoking and the rise of assisted quitting, and gives insight into the forces that have tried to undermine smokers' agency to stop. Chapman also provides actionable policy solutions to help people actually quit smoking. Quit Smoking Weapons of Mass Distraction Quit Smoking Weapons of Mass Distraction Contents Acknowledgements Abbreviations Introduction Quitting cigarettes Early Australian efforts at promoting quitting Australia’s first mass-reach quit-smoking campaign We must provide help! Nascent scepticism starts to foment Individuals or populations? Early provocations Outline of this book How do most people quit other addictions? Alcohol Opiates American armed forces heroin users after the Vietnam War Cannabis Problem gambling How we study quitting smoking: a critical look Evidence is not the plural of anecdote Self-selection bias Randomised controlled trials Trial exclusion criteria Hawthorne, attention and social desirability effects in RCTs Trial participant retention strategies Trialists are often paid and drugs are free Blindness integrity problems The pleasures of smoking? Can smokers guess if they have been allocated to the placebo arm? Competing interest bias Positive outcome bias “Intention to treat” analysis Citation bias Real-world observational studies 1: Cross-sectional surveys Low response rates in cross-sectional surveys Self-selecting, motivated samples vs. whole population randomly selected samples Real-world observational studies 2. Longitudinal cohorts Relapse Recall bias Indication bias Ways of quitting smoking Success rates versus intervention and policy reach Quitting unassisted: before and after “evidence-based” methods Enter Nicotine Replacement Therapy (NRT) and prescribed medications How has mass use of smoking-cessation medication affected cessation at the population level? What’s the upshot from RCTs and observational studies of NRT? Australian data Trends in proportion of smokers and ex-smokers who quit unassisted Stop smoking medications in low-income nations The modest impact of most popular interventions Quitlines North American quitlines Stop-smoking groups and counselling The English experience with quit-smoking centres Impact of English quit services on smoking prevalence Workplace smoking-cessation programs GP interventions Online quit interventions Contingency payments Quit and win lotteries How much intervention research is ever “upscaled” to become routine in mass-reach settings? “Don’t try to quit cold turkey” The slow death of the hardening hypothesis Spontaneous, unplanned quitting vs stages of change progression How difficult is it to quit smoking? The shunning and denigration of unassisted quitting Drivers of the medicalisation of smoking cessation The dominance of interventionism The medicalisation and commodification of cessation All smokers should use NRT: a promotional case study Attacks on my work on unassisted cessation: perspectives from the woods and the trees M’lud, the accused is charged with spreading four “fallacies” “Unsupported by the facts” A fourth attack It is “unethical” to not promote treatment for smoking in low-income nations Why does Big Tobacco never attack assisted smoking cessation? Vaping to quit: the latest mass distraction Big Tobacco butts in “95% less dangerous than smoking” Too soon to know the true health risks of vaping PATH data on toxicant exposure: never-tobacco users vs. smokers vs. exclusive vapers vs. dual users Never-tobacco users vs. exclusive EC users Exclusive EC users vs. exclusive smokers Dual users vs. exclusive cigarette smokers Insignificant uptake by teens and no gateway to smoking? Systematic reviews and meta-analyses on youth uptake Flavours and vaping Why aren’t asthma inhalers flavoured? How many puffs a day do vapers take? Evidence on the effectiveness of e-cigarettes in smoking cessation Recent reviews of the evidence on cessation Randomised controlled trials (RCTs) Cessation and dual use (vaping and smoking) US PATH cohort study findings Is vaping the primary cause of falls in smoking prevalence in nations where vaping is prevalent? Schooled by English experts Response to letters from Professors Brown, Shahab and West, and Professor McNeill Further data Response to Professor McNeill’s letter titled “Additional Comment to the Australian Select Committee on Tobacco Harm Reduction” The great English success story of vaping? New Zealand’s dramatic decline in adult smoking and rise in vaping Does vaping reduce smoking frequency (number of cigarettes smoked)? Insights from qualitative research with unassisted quitters Paper 1: The views and experiences of smokers who quit unassisted. A systematic review of the qualitative evidence Research question 1: How much and what kind of qualitative research has explored unassisted cessation? Research question 2: What are the views and experiences of smokers who quit unassisted? Discussion Concepts central to self-quitting Conclusion Paper 2: Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers Summary Introduction Results Prioritising lay knowledge Evaluating assistance against unassisted quitting Believing quitting is their personal responsibility Perceiving quitting unassisted to be the “right” or “better” choice Discussion Implications and future research Conclusion Strategies for reducing smoking across populations The melding of primary and secondary prevention The new narrative: don’t quit … switch! Attribution problems in smoking cessation research The vital importance of promoting quit attempts What “works” in tobacco control? The cauldron of proximal and distal influences A day in the life of Australian smoker Mr Rex Lungs, 2022 Bringing the background into the foreground News media coverage of tobacco control Health concerns Is using scare tactics unethical? Five main criticisms Victim blaming? Stigmatisation Prisoners of structural constraints? Is it always wrong to upset people? Recent neglect of public awareness campaigns Tobacco taxation Controlling tobacco supply and the endgame Regulation of other goods and services Pharmaceutical retailing as a model Restrictions on the number and location of tobacco retailers Be careful what you wish for? Regulating tobacco retail display Floor price controls Limitations on the number of cigarettes a smoker could buy Loss of licensure following breaches of conditions of licence Prescription access to nicotine vaping products Why regulate NVPs? Nicotine should not be exempted from regulation Prescribed access will greatly reduce teenage access to e-cigarettes Will Australian doctors be willing to prescribe nicotine? The end for combusted tobacco? Enter NVPs Reduced-risk products instead of or as well as cigarettes?  Phasing out cigarettes? About the author Also by Simon Chapman References Index