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Biomedical subjects

K E Warner

Publications and source records attributed to K E Warner.

At least 37 records · Page 2Linked to original sources
PubMed1997

What should be the elements of any settlement with the tobacco industry?

Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti-tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.

Adolescent↗
PubMed1996

Employment implications of declining tobacco product sales for the regional economies of the United States.

OBJECTIVE: To determine whether declines in tobacco product sales significantly reduce employment in the United States, as the tobacco industry claims. DESIGN: Computer simulation of the economies of the Southeast Tobacco region and 8 nontobacco regions of the United States, with domestic tobacco expenditures eliminated or reduced and the equivalent spending redistributed, according to consumers' normal spending patterns. We compared these results with baseline forecasts of the regional economies that include normal tobacco expenditures. MAIN OUTCOME MEASURE: Number of jobs. RESULTS: Had there been no spending on tobacco products in the United States in 1993, the Southeast Tobacco region would have had 303 000 fewer jobs. Collectively, however, the 8 nontobacco regions would have gained enough employment to completely offset losses in the Southeast Tobacco region, with every nontobacco region gaining jobs. By the year 2000, the absence of tobacco spending would mean a loss of 222 000 jobs in the Southeast Tobacco region, but a gain of 355 000 throughout the rest of the country. In the more realistic scenario of doubling the downward trend in tobacco consumption, the Southeast Tobacco region would lose 6300 jobs in 1993 (0.03% of regional employment) and 36 600 jobs by 2000 (0.2%). The 8 nontobacco regions would gain 6400 jobs in 1993 and 56 300 jobs in 2000, with each of the nontobacco regions gaining employment in every year. CONCLUSIONS: Contrary to the tobacco industry's claims, reductions in spending on tobacco products will boost employment in every one of the 8 nontobacco regions and will not diminish employment in the Southeast Tobacco region by as much as the industry estimates. The primary concern about tobacco should be the enormity of its toll on health and not its impact on employment.

Commerce↗
PubMed1996

Health and economic implications of a work-site smoking-cessation program: a simulation analysis.

In this article, we examine the health and economic implications of a workplace smoking-cessation program by using a simulation model that includes, among its novel features, consideration of long-term as well as short-term implications and evaluation of the effects of employee turnover on benefits derived by both the firm and the broader community. As a result of employee turnover, approximately half of the program-generated benefits are realized by the community outside the firm. Still, smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit-cost ratio of 8.75. Saving life-years at a cost of $894 each, the program is more cost-effective than most of the conventional medical care covered by the firm's insurance. Nevertheless, the intervention successfully addresses only a fraction of the costs that smoking imposes on the firm.

Absenteeism↗
PubMed1996

Toward a more realistic appraisal of the lung cancer risk from radon: the effects of residential mobility.

OBJECTIVES: A consideration of the effects of residential mobility produces much more realistic estimates of typical individuals' radon exposures and mortality risks than those of the Environmental Protection Agency (EPA). METHODS: A model linking residential mobility, the distribution of radon in US homes, and lung cancer risk is used to simulate lifetime radon exposure, with and without mitigation of high-radon homes, for typical mobile individuals. Radon-related lung cancer mortality risks are then estimated for smokers and never-smokers. RESULTS: Most individuals residing in high-radon homes have equivalent lifelong radon exposures well below those they are currently experiencing. Consequently, actual lung cancer risks are generally well below those implied in the EPA's radon risk charts. For most people who mitigate high-radon homes, risk reduction is modest. CONCLUSIONS: Radon may indeed be responsible for as large a population risk of lung cancer as the EPA estimates. However, caution must be used in interpreting the EPA's risk assessment for individuals; in many cases, mitigation will have little effect on residents' health risks.

Adult↗
PubMed1995

Effects of residential mobility on individual versus population risk of radon-related lung cancer.

The U.S. Environment Protection Agency (EPA) does not consider the effects of normal patterns of residential mobility in estimating individual radon-related lung cancer risks. As a consequence, the EPA's population risk estimates may have little bearing on individual risks, and remediation of high-radon homes may have only small health benefits for the individual who remediate their homes. Through a stimulation analysis, we examine the effects of residential mobility on random exposure and lung cancer risk. Given normal mobility, only 7% of eventual radon-related mortality among current 30 year old will occur in the 5% currently living in homes above pCi/l (the EPA's action level for remediation) in contrast with you estimate of 31% of deaths when mobility's ignored. About 10 pCi/l the no-mobility assumption implies 10.3% of deaths, compared to only 0.4% when mobility taken into account. We conclude that knowledge of one's current random exposure not necessarily a useful guide to one's risk, especially for residents of the high-radon homes targeted for remediation by the EPA. The risk of such individuals is like to be substantially lower than that implied in the EPA's risk charts. If people currently living in high radon homes remediate their houses, the majority of the resulting health benefits will accrue to future occupants of their homes.

Humans↗
PubMed1994

The economic implications of tobacco product sales in a nontobacco state.

OBJECTIVE: The tobacco industry claims that tobacco makes a significant economic contribution to each of the states in the United States. We sought to determine whether Michigan, a nontobacco state, would reap more economic benefits from the presence or absence of tobacco product sales. DESIGN: Computer simulation of the Michigan economy, with and without tobacco product sales, for the years 1992 through 2005. INTERVENTION: We simulated Michigan's economy with tobacco expenditures eliminated or reduced and the equivalent spending redistributed to other goods and services, according to consumers' normal spending patterns. We compare these results with baseline forecasts of the economy. MAIN OUTCOME MEASURES: Numbers of jobs and tax revenues. RESULTS: Michigan would have had 5600 more jobs in 1992 had there been no expenditure on tobacco products, with equivalent spending redistributed to other goods and services (and to other taxes, to replace half of lost cigarette excise tax revenues). By the year 2005, a tobacco-free Michigan would still have almost 1500 more jobs than it will have if sales trends for tobacco products continue (ie, gradually declining over time). If, instead of tobacco expenditures ceasing, the contemporary rate of decline in tobacco consumption had doubled, the state would have had over 300 more jobs in 1992 and would have nearly 800 more in 2005. With cigarette excise tax revenues not replaced, the elimination of spending on tobacco products would have decreased Michigan's tax revenues by $254 million in 1992. The more realistic doubling of the expected decline in smoking would have decreased revenues by $14 million that year. CONCLUSIONS: Reducing or eliminating tobacco product spending in Michigan will increase employment in the state, as well as health.

Commerce↗
PubMed1993

Patterns of absolute risk of lung cancer mortality in former smokers.

BACKGROUND: It is well known that the relative risk (RR) of lung cancer mortality decreases following smoking cessation compared with the risk in persons who continue to smoke. However, changes in the absolute risk of lung cancer death following smoking cessation are not well documented. Further, few studies have examined the effect of age at smoking cessation on subsequent lung cancer death risk. PURPOSE: The purpose of this study was to examine and compare absolute and relative lung cancer death risks in former smokers as a function of age at cessation. METHODS: Using the American Cancer Society's Cancer Prevention Study II, a prospective cohort study with 6 years of follow-up, we modeled absolute risk of lung cancer mortality in individuals who had never smoked and in current and former smokers. The model was fit with the use of person-years logistic regression analysis. RESULTS: Similar patterns of absolute risk of lung cancer death by age were found for all ages of smoking cessation up to the mid-60s. Lower lung cancer death risk was observed for those quitting earlier in life, and the risk for all former smokers was significantly lower than that for current smokers. For those quitting between ages 30 and 49, lung cancer death risk rose gradually with age at a rate slightly greater than that for those who had never smoked. Lung cancer death risk for former smokers quitting between ages 50 and 64 leveled off near the risk attained at the time of quitting until around age 75, when it rose sharply. At age 75, the RR for former smokers compared with current smokers was approximately 45% for those quitting in their early 60s, approximately 20% for those quitting in their early 50s, and less than 10% for those quitting in their 30s. For those who had never smoked, the RR at age 75 is less than 5%. CONCLUSIONS: In terms of reduced risk of lung cancer mortality, smoking cessation is beneficial at any age, with much greater benefits accruing to those quitting at younger ages. Unlike previous research, which has primarily examined the effects of cessation as a function of years since quitting, our results demonstrate that age at cessation has a major impact on subsequent lung cancer risks. IMPLICATIONS: Smokers of all ages should be encouraged to quit because cessation at any age decreases lung cancer risk relative to that of current smokers.

Adult↗
PubMed1993

Motivations for smoking cessation: a comparison of successful quitters and failures.

To foster successful smoking cessation, public health professionals need to understand better the reasons why smokers quit smoking. Although researchers have studied smokers' characteristics that may predict smoking cessation, few studies have examined the relationships between reasons stated for quitting and successful smoking cessation. We examined six reasons for smoking cessation and their association with successfully quitting among approximately 7,700 current and former smokers who participated in the 1986 Adult Use of Tobacco Survey (AUTS). Using logistic regression analysis, we found that successful cessation was associated with having personal concerns regarding the health effects of smoking and with wanting to set a good example for children. In contrast, concerns about the cost of smoking, the effect of smoking on others, and pressure from friends and family to quit were associated with decreased likelihoods of cessation. Furthermore, the relative importance of a reason (somewhat important vs. very important) also influenced the association of that reason with smoking cessation.

Adolescent↗
PubMed1993

Profits of doom.

Explore the source record for details and available documents.

California↗
PubMed1992

Cigarette advertising and magazine coverage of the hazards of smoking. A statistical analysis.

BACKGROUND: Health professionals have charged that magazines that depend on revenues from cigarette advertising are less likely to publish articles on the dangers of smoking for fear of offending cigarette manufacturers. Special concern has focused on magazines directed to women. Restricted coverage of smoking hazards could lead readers to underestimate the risks of smoking in relation to other health risks. METHODS: Using logistic-regression analysis of a sample of 99 U.S. magazines published during 25 years (1959 through 1969 and 1973 through 1986), we analyzed the probability that the magazines would publish articles on the risks of smoking in relation to whether they carried advertisements for cigarettes and in relation to the proportion of their advertising revenues derived from cigarette advertisements. We controlled for other factors that might influence coverage. RESULTS: The probability of publishing an article on the risks of smoking in a given year was 11.9 percent for magazines that did not carry cigarette advertisements, as compared with 8.3 percent for those that did publish such advertisements (adjusted odds ratio, 0.73; 95 percent confidence interval, 0.42 to 1.30). For women's magazines alone, the probabilities were 11.7 percent and 5.0 percent, respectively (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.02 to 0.69). When the proportion of revenues derived from cigarette advertising was the independent variable, the probability of publishing an article on the risks of smoking in a given year was reduced by 38 percent (95 percent confidence interval, 18 percent to 55 percent) for magazines with the average proportion of total advertising revenues derived from cigarette advertising for the entire sample of magazines (6 percent) as compared with magazines with no cigarette advertising. This relation was particularly strong in the case of women's magazines. An increase of 1 percent in the share of advertising revenue derived from cigarette advertisements decreased the probability of covering the risks of smoking by three times as much as in other magazines. CONCLUSIONS: This study provides strong statistical evidence that cigarette advertising in magazines is associated with diminished coverage of the hazards of smoking. This is particularly true for magazines directed to women.

Advertising↗
PubMed1991

Tobacco industry scientific advisors: serving society or selling cigarettes?

According to industry documents, the tobacco industry has executed a "brilliantly conceived" strategy to "creat[e] doubt" in the public's mind about whether cigarette smoking is in fact a serious cause of disease. A component of this strategy has been the funding of scientific research "into the gaps in knowledge in the smoking controversy." Grant review and selection are performed by a group of independent scientists. Knowledgeable observers believe that the existence of this research funding program in general, and the Scientific Advisory Board in particular, is intended by the industry to reinforce doubts in the public mind about the severity of the hazards posed by smoking. Because the Advisory Board has never taken a public stance against the industry's position that the causal relationship between smoking and disease remains unproven, I polled these scientists to determine whether they believed that smoking is a cause of lung cancer. Despite repeated opportunities, only four of 13 board members responded, all affirmatively; two others have expressed their judgment that smoking causes lung cancer in their professional publications. Thus, over half of the Board members, and the Board as a whole, have not gone on record as rejecting the industry's "party line." It might be hoped that the American scientists would follow the lead of the members of a similar body of scientists in Australia who have taken a strong and public stand against the industry position that smoking is not an established cause of disease.

Advertising↗
PubMed1991

Legalizing drugs: lessons from (and about) economics.

Although applications of cost-benefit analysis (CBA) to the problem of drug policy are few in number and relatively primitive, they illustrate both the potential and limitations of CBA to produce critical insights that might improve drug policy making. But even the ideal CBA of drug policy could never produce a definitive conclusion about the desirability of drug legalization. Another tool of economics, analysis of price elasticity of demand, holds the potential to generate understanding of the likely effects of policy changes in the monetary and psychological prices associated with policy reforms.

Cost-Benefit Analysis↗