Brazil takes steps to control tobacco.
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Biomedical subjects
Publications and source records attributed to M Raw.
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Governments have recently become concerned about cross border shopping and smuggling because it can decrease tax revenue. The tobacco industry predicted that, with the removal of border controls in the European Union, price differences between neighbouring countries would lead to a diversion of tobacco trade, legally and illegally, to countries with cheaper cigarettes. According to them this diversion would be through increased cross border shopping for personal consumption or through increased smuggling of cheap cigarettes from countries with low tax to countries with high tax, where cigarettes are more expensive. These arguments have been used to urge governments not to increase tax on tobacco products. The evidence suggests, however, that cross border shopping is not yet a problem in Europe and that smuggling is not of cheap cigarettes to expensive countries. Instead, more expensive "international" brands are smuggled into northern Europe and sold illegally on the streets of the cheaper countries of southern Europe.
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The key components of a strategy to prevent tobacco-related disease are outlined. These measures aim to increase the cessation of tobacco use and reduce its uptake. Components are wide-ranging, including a taxation policy, a ban on advertising and promotion, a comprehensive health promotion programme including advice from primary health care professionals and the development of campaigning skills, particularly by the medical profession. The prevention of tobacco-related disease has moved into the domain of campaigners and lobbyists at political, economic and international levels. The key target is countering the activities, especially the unethical trade practices, of the wealthy and powerful tobacco industry.
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The common agricultural policy of the European Community subsidizes tobacco production to the tune of 1,300 million ecu a year (US$ 1,500 million, UK pounds 900 million). This amounts to 2,500 ecu ($3,100, pounds 1,700) per minute, and is more in one year than the total amount spent on tobacco subsidies by the US in the last 50 years. The purpose of this policy was to maintain farmers' incomes and adapt community production to demand. Demand for the dark tobaccos which dominate EC production has fallen, while demand for light flue cured tobacco like Virginia has risen. A complex system of production subsidies and quotas was intended to discourage production of the dark tobaccos, for which there is virtually no market, and lead to more Virginia production. The policy has failed. Expenditure has spiralled out of control, production of unmarketable tobacco varieties has risen enormously, and the EC is the world's largest importer of raw tobacco. As a result tobacco is being bought by the community for intervention storage and surpluses of the dark high tar varieties are being 'exported' to eastern Europe and north Africa at giveaway prices. There has been no effective monitoring or control of this policy. This paper explains how this has happened and argues that, in view of the health risks attached to tobacco, these subsidies should be abolished.
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Two hundred smokers who were judged by their general practitioner to be motivated to stop smoking were allocated to one of two groups. All were offered an initial appointment at which they were advised to stop smoking and offered nicotine gum. One group then received no further appointments. The other was offered four further appointments over three months. Both groups were followed up at six and 12 months. At one year follow up 15.5% overall had stopped smoking, 14% in the low and 17% in the high contact group. This is better than most results so far reported for nicotine chewing gum in general practice, suggesting that general practitioners can use it to good effect. We compare this result with others achieved in general practice.
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This paper reports the results of a postal questionnaire completed by 2343 smokers who had contacted a television company for help with stopping smoking. Of these, 1848 (78.9%) completed a follow-up questionnaire 1 year later. This indicated that 797 had tried to stop, 709 had tried to cut down, and 164 had become abstinent. Analyses show that the intention to try to stop smoking was dependent not only on the perceived health benefit, but also on the subjects' confidence that they would succeed if they tried to stop. As predicted by Weiner's [(1979). J. Educ. Psychol. 71: 3-25] model of achievement motivation, those who attributed other smokers' failures at quitting to stable factors had lower expectancies of success, as had those who saw themselves as more addicted. When the follow-up data are considered, reported attempts at quitting were strongly related to previously declared intentions, and reported abstinence was related to previous confidence (expectancy of success) and perceived addiction. There is no support for hypotheses concerning self-other differences in attribution, or defensive attribution, in subjects' attributions for their own failures at cessation. Implications for antismoking interventions are discussed.
The effectiveness of 2 mg nicotine chewing-gum as an aid to stopping smoking was compared with a placebo containing 1 mg nicotine, but unbuffered, in a double-blind randomised trial. Of 58 subjects given the active gum, 27 (47%) were not smoking at one-year follow-up compared with 12 (21%) of the 58 subjects treated with placebo (p less than 0.025). By the most stringent criterion of outcome, 18 (31%) subjects in the active treatment group and eight (14%) in the placebo group had not smoked at all from the start of treatment to follow-up at one year (p less than 0.05). Subjects receiving the active gum experienced less severe withdrawal symptoms and rated their gum as more helpful than did the placebo group. Minor side effects were common but only gastric symptoms were more frequent with the active gum. Subjects receiving active gum used it for longer than those receiving placebo but most stopped using it within six months and only four (7%) developed longer-term dependence. The number of gums used daily correlated significantly with pretreatment blood nicotine concentrations in the active treatment group and with pretreatment cigarette consumption in the placebo group. A lower pretreatment blood nicotine value was the best predictor of success at one year (p less than 0.001) but there was no significant relation to cigarette consumption, sex, and social class. The results clearly confirm the usefulness of nicotine chewing-gum as an aid to stopping smoking and imply a definite role for nicotine in cigarette dependence and withdrawal. Successful use of the gum requires careful attention to subjects' expectations and clear instructions on how to use it.
The results of using nicotine chewing-gum to treat dependent smokers attending a withdrawal clinic were compared with the results of psychological treatment. At one-year follow-up 26 (38%) out of 69 people who received nicotine gum were abstinent compared with seven (14%) out of 49 who received psychological treatment (p < 0.01). Abstinence was confirmed by the measurement of carboxyhaemoglobin concentrations or expired air carbon monoxide. Blood nicotine concentrations when patients used the gum averaged half the smoking values, and side effects were few. Addiction occurred in only two subjects. Thus nicotine chewing-gum is a useful aid to giving up smoking and is probably acceptable even for people with cardiovascular disease.
Nicotine chewing-gum has recently become available to doctors in Britain for use as an aid to giving up smoking. It produces blood nicotine concentrations similar to tobacco smoking and so relieves symptoms of nicotine withdrawal. Owing partly to the slower rate of absorption of nicotine through the buccal mucosa, however, it does not reproduce the pleasure of cigarette smoking. Indeed, in the early stages it is usually slightly aversive. Optimal use in a skill requiring practice and careful instruction. Since it is an aid rather than easy cure, its use is limited to smokers who want to stop. Earlier trials showed modest advantages over placebo, but improvements in the gum and more experience in its use suggest that long-term success rates of 40% or more can be obtained. It required little time to administer and is therefore a feasible method for busy doctors.