Tobacco: Interview With Michael Siegel

Massachusetts Some group within the tobacco control movement needs to develop the integrity and courage to stand apart from their colleagues and start questioning the justification for smoker discrimination.

Study: Restaurant tobacco bans influence teen smoking
May 5, 2008
By STEVE LeBLANC, Associated Press Writer
BOSTON – A Massachusetts study suggests that restaurant smoking bans may play a big role in persuading teens not to become smokers. Youths who lived in towns with strict bans were 40 percent less likely to become regular smokers than those in communities with no bans or weak ones, the researchers reported in the May issue of the Archives of Pediatrics & Adolescent Medicine.
The findings back up the idea that smoking bans discourage tobacco use in teens by sending the message that smoking is frowned upon in the community, as well as simply by reducing their exposure to smokers in public places, said Dr. Michael Siegel, of Boston University School of Public Health, and the study’s lead author.
“When kids grow up in an environment where they don’t see smoking, they are going to think it’s not socially acceptable,” he said. “If they perceive a lot of other people are smoking, they think it’s the norm.”
Siegel and his colleagues tracked 2,791 children between ages 12 and 17 who lived throughout Massachusetts. There were no statewide restrictions when the study began in 2001 but about 100 cities and towns had enacted a hodgepodge of laws restricting smoking in workplaces, bars or restaurants.
The teens were followed for four years to see how many tried smoking and how many eventually became smokers.
Overall, about 9 percent became smokers — defined as smoking more than 100 cigarettes.
In towns without bans or where smoking was restricted to a designated area, that rate was nearly 10 percent. But in places with tough bans prohibiting smoking in restaurants, just under 8 percent of the teens became smokers.
The study found that having a smoker as a parent or a close friend was a factor in predicting whether children experiment with cigarettes. But strong bans had a bigger influence on whether smoking grew into a habit, reducing their chances of becoming smokers by 40 percent.
“There is really no other smoking intervention program that could cut almost in half the rate of smoking,” Siegel said.
Age was also a factor. Smoking bans had a greater effect on younger teens than on older teens.
The researchers said it’s not clear whether strong bans would have the same effect in other states since local towns adopted their restrictions as part of an aggressive anti-smoking campaign throughout the state.
A statewide workplace smoking ban that included restaurants went into effect in mid-2004. Since then, high school smoking rates in Massachusetts have continued to decline, from about 21 percent of students in 2005 to about 18 percent in 2007.
Many restaurant owners fought the ban, saying it could drive away diners, according to Janine Harrod, director of government affairs for the Massachusetts Restaurant Association, which represents 2,000 restaurant owners.
While some restaurants were hurt initially, the effects have eased over time since the ban applies to everyone, she said.
Bill Phelps, a spokesman for Altria, parent company of cigarette-maker Philip Morris USA, said the study shows that the reasons teens take up smoking are complex.
“There is no single reason why young people engage in risky behaviors like smoking,” he said. “We believe that there should be a multifaceted approach to address youth smoking.”
At least 23 states, the District of Columbia and Puerto Rico require most public places and workplaces, including restaurants and bars, to be smoke free, according to the National Conference of State Legislatures.
Another nine states ban smoking in workplaces but have various exemptions for restaurants or bars.
“We already have more than enough evidence why we should pass these smoke-free laws, but certainly this study should help push them along,” said Danny McGoldick of the Campaign for Tobacco Free Kids.

Just read this in the paper – 2 things here – first off. The sample number is pretty small (2800 teens, 10% became smokers – 10% in towns without bans vs. 8% in towns with bans) and is from 1 state, Massachusetts. Second, most of the towns that already had bans are more affluent than those that didn’t and we know that poorer folks are more likely to smoke. Dr. Siegel is guilty of the same data manipulation that he claims to be against.
– A Newsletter Reader

The USA teen smoking rate is the same now as it was in the year 2000, and look at all more bans these days…. if Siegel were right, teen smoking would be? down substabtially.
– A Newsletter Reader

Interview: Michael Siegel
By Waldemar Ingdahl
Michael Siegel is a Professor of Social & Behavioral Sciences at Boston University School of Public Health. He is co-author of a book, entitled Marketing Public Health: Strategies to Promote Social Change and was namned a maverick anti-smoking activist by Jacob Sullum at Reason Magazine. We wanted to get to know more about his views, than we have read on his blog The Rest of the Story so Waldemar Ingdahl asked him some questions on tobacco control policy and harm reduction. What is coming up in the near future?
Waldemar Ingdahl: What are the main issues in tobacco control at present, in your opinion? Is it second hand smoke, harm reduction, smoking bans, or something else?
Michael Siegel: There are several main issues in tobacco control at present. The first is identifying a national strategy that makes the most sense in terms of regulating tobacco products. A large number of organizations have put their resources into an effort to pass legislation that would give the FDA limited regulatory authority over tobacco products. In my view, this would be a grave mistake, as giving FDA the responsibility to approve cigarettes will give these products a government seal of approval. It will create a public perception that these products are safer; yet, there is no evidence that there is anything in this legislation that will make cigarettes any safer. If anything, this legislation will make it impossible for manufacturers of potentially safer products (e.g., Swedish snus) to make any claims that would imply that their products are potentially safer.
The second major issue I see is the extent to which anti-smoking advocates will go to pursue smoking bans. While in the past, the focus has been on protecting nonsmokers in the workplace, including bars and restaurants, there are now movements afoot to ban smoking virtually everywhere – including all outdoors locations, streets, sidewalks, parks, and now in cars and perhaps even inside the private home. As a strong supporter of workplace smoking bans, I feel like I have just completed a marathon and everyone else has continued running. I thought the goal was to provide nonsmokers with a safe working environment. Now the goal seems to be to prevent every possible wisp of smoke from reaching a nonsmoker, even if it is only momentary. I think that the tobacco control movement needs desperately to define its ultimate goal. It also needs to re-examine the science base supporting the policies which it is proposing. The third major
issue I see is the deterioration of the scientific integrity within the tobacco control movement. This has occurred, in part, because the tobacco companies are no longer holding anti-smoking groups accountable for their public statements. For example, in their effort to promote widespread outdoor smoking bans, many groups are claiming that a single 30-minute exposure to secondhand smoke can cause a heart attack or heart disease in an otherwise healthy person. This blatant exaggeration is going to end up hurting the movement by undermining its credibility. This is a scientific crisis within the tobacco control movement, and it must be dealt with immediately.
WI: Earlier this year you published an article in the journal Epidemiologic Perspectives & Innovations in which you faulted the tobacco control movement for misrepresenting the acute cardiovascular effects of exposure to secondhand smoke. What is the misrepresentation concerning in short words? What reactions did you receive after the article?
MS: In short, anti-smoking groups have widely misrepresented the acute cardiovascular effects of secondhand smoke. Nearly 100 groups are disseminating messages which imply that brief exposure to secondhand smoke can cause heart disease, hardening of the arteries, heart attacks, strokes, clogged arteries, or fatal arrhythmias in healthy nonsmokers. These claims are unsupported by scientific evidence. While the evidence shows that chronic exposure can cause all of these conditions, there is no evidence that a single brief exposure can cause any cardiovascular disease in a healthy person. The reaction I have received to my questioning of the accuracy of these statements has been, without exception, ad hominem. I have been personally attacked and my character has been questioned. The only thing I have not received is a substantive response, in which an anti-smoking organization or advocate defends the statements these groups are making by actually providing some scientific evidence to back them up.
WI: What is your opinion of the harm reduction theory and the present discussion about smokeless tobacco? Is it a step in the right direction, or is it something that detracts from complete smoking cessation or the use of NRTs?
MS: Despite my experience in tobacco control, I am humble enough to admit that I don’t have any answers. This is a very difficult question and I don’t think there is a simple answer: thumbs up or thumbs down. For one thing, I think it depends largely on the way in which it would be done. Obviously, if we start promoting smokeless tobacco use, that is not going to be productive from a health standpoint. On the other hand, if we present smokeless tobacco as a “last resort” option for people who want to quit smoking but are simply not able to do so, that may be a very different thing. I don’t have the answers. I don’t pretend to be able to predict exactly what the net public health costs and benefits would be. To me, the important thing is that the tobacco control community be able to have an honest, open, and science-based discussion of this issue without people fearing that they are going to be attacked because of the positions that they take. Unfortunately, I don’t see that happening right now because I find the tobacco control field to be a poisonous one where people are attacked based on their positions, not based on the quality of their arguments.
WI: What is your view of excise taxation on tobacco products? Is it achieving public health objectives, is it just about government revenues- or does it fall in somewhere in the middle?
MS: I believe that the way cigarette excise taxes were originally used (such as in California in 1993 – to fund smoking-related programs such as treatment for tobacco-related diseases and research), they did help to achieve public health objectives. However, in the last 8-9 years, I think cigarette taxes are being used to fund every program under the sun. To me, this is more harmful than beneficial. It creates a government dependence on continued cigarette consumption, and it removes any incentive for the government to do anything serious about reducing cigarette use. The recent proposal to fund SCHIP (children’s health insurance) by increasing the cigarette excise tax is the worst example of a public health policy. The last thing we want to do is to tie children’s health insurance to continued cigarette consumption. The idea is absurd to me. Why would we want to tie the financial health of our nation’s children to the continued consumption of cigarettes? Does it make sense to kill off adults so that kids can have health care coverage? While I think it makes sense to use cigarette tax revenues to fund smoking-related programs – especially treatment for smoking-related diseases – I think it makes no sense to rely upon cigarette consumption to fund all kinds of necessary government programs that have nothing to do with cigarette use.
WI: What developments in tobacco control policies do you see forthcoming in the next five years?
MS: I think there is going to be an expansion of the scope of smoking bans. We are going to see proposals to ban smoking in almost all outdoor locations, including streets, sidewalks, and parking lots. We are also going to see more smoking bans in cars. We will also see the first wave of smoking bans in the private home. There will be further promotion of employment discrimination policies against smokers and housing discrimination policies against smokers. Some group within the tobacco control movement needs to develop the integrity and courage to stand apart from their colleagues and start questioning the justification for smoker discrimination. This is a role that I have been playing, largely through my tobacco policy blog. It looks like I’ll have my work cut out for me for the next five years.

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