Wednesday, August 14, 2013

Banning menthol cigarettes?


First this:

Former smokers earn higher wages than smokers and people who have never smoked, according to new research.
They determined that differences in the characteristics of smokers and nonsmokers, such as educational attainment, as well as unmeasured factors such as an employer’s tolerance to smoking behavior, are mostly driving the wage gap. They noted that education level was the largest contributing variable. Nonsmokers tend to be more educated, are less likely to have spouses who smoke and live in states where cigarette prices are higher than smokers.
The findings suggest that the characteristics of former smokers are more highly rewarded in the labor market than those of smokers and people who have never smoked. “It takes a special person to quit an addictive behavior, and there is a higher reward for smoking cessation than not ever starting it,” said Ms. Pitts. “I think the qualities of persistence, patience and everything else that goes along with being able to quit are valuable to employers.”

OK. Smokers aren't as smart as nonsmokers. People who used to smoke but quit have more positive qualities than those who have never smoked. Reminds me of Shedler and Block (1990), who found that marijuana experimenters were more likely to be well-adjusted than marijuana abstainers.

Here's a report on a study that found that among male recruits in the Israeli Defense Forces, smokers had a mean IQ of 94, versus 101 for non-smokers. (Please don't think that smoking lowered their IQ; they were already lower in IQ, so that made them more likely to take up smoking.)

"People on the lower end of the average IQ tend to display poorer overall decision-making skills when it comes to their health," says Prof. Weiser. He adds that his finding can help address a serious concern among health counsellors at grade and high schools. Schoolchildren who have been found to have a lower IQ can be considered at risk to begin the habit, and can be targeted with special education and therapy to prevent them from starting or to break the habit after it sets in.
"People with lower IQs are not only prone to addictions such as smoking," Prof. Weiser adds. "These same people are more likely to have obesity, nutrition and narcotics issues."
Here's an American study from 1962 that showed the same thing. High school students who smoke have lower IQs than those who don't, and heavy smokers had lower IQs than lighter smokers. Unfortunately, over the past few decades most researchers have ignored IQ and instead only measure correlates of IQ -- socioeconomic status and/or educational attainment. It's a real shame.

And then there's this:

The Food and Drug Administration said Tuesday that menthol-flavored cigarettes likely pose a greater health risk than regular cigarettes, and signaled it is considering regulatory action that could restrict sales, a move that could take years.
In a preliminary assessment of the possible health effects of menthol cigarettes, the federal agency said current data don't show such cigarettes are more toxic or increase the risk of smoking-related diseases compared with regular cigarettes.
But the FDA found that menthol in cigarettes likely increases smokers' addiction, and that menthol smokers "are less likely to successfully quit smoking."

If menthol smokers are less likely to quit smoking than non-menthol smokers, why does that make mentholization more "addictive"? The FDA is doing what B.F. Skinner warned against -- they are observing a behavior (not quitting), labeling it with an adjective (addictive), and transforming the adjective into a noun (addiction) in order to "explain" the behavior.

"He does not quit smoking. That is addictive behavior. He has an addiction. The addiction keeps him from quitting."

("He hits other children on the playground. That behavior is aggressive. He has a lot of aggression. His aggression makes him hit other children.")

It seems to me more probable that the reason menthol smokers don't quit at the same rates as non-menthol smokers is not because menthol is "more addictive" but because menthol smokers are different from non-menthol smokers in some significant way (e.g., intelligence, delay gratification, impulse control, earlier age of onset of cigarette smoker, higher ADHD rates, comorbid substance use, etc.). Remember that smokers are not randomly assigned to smoke menthols or non-menthols, so pre-existing differences between the groups must be in play.

This 2010 study from the journal Addiction is one of the sources for the FDA's claim of the increased addictiveness of menthol cigarettes. They looked at quit rates among Black and White smokers of menthol and non-mentholated cigarettes. Here's the data:

Quit rates (%)

First of all, White and Black smokers of non-menthols quit at the same rates. White smokers of menthols or non-menthols quit at the same rates. The only difference is for Black smokers of menthols, who are less likely to quit than Black smokers of non-menthols. So, if the FDA is going to say that menthols are "more addictive,"  they should actually say that they are "more addictive for Blacks, but not for Whites." Here's another study that found that "menthol smoking can lead to poorer cessation outcomes, but only for non-white smokers."

Just to make things even more complicated, this study found that Black smokers of menthols smoke fewer cigarettes per day than Black smokers of non-menthols -- so banning menthols might increase cigarette consumption! Further, while menthols are no more likely than non-menthols to contribute to lung cancer (according to this study), forcing menthol smokers to smoke non-menthols, and hence consume more cigarettes per day might actually increase lung cancer rates.

The crazy thing is that the tobacco companies will defend against the proposed menthol ban by calling the FDA racist, because 80% of Black smokers smoke menthols (versus 20% of White smokers). They will say it is like how prosecutors go harder against crack cocaine than against powder cocaine.

The European Union just banned menthol cigarettes, by the way. Clove cigarettes and other (non-menthol) cigarettes have been banned in the U.S. since 2009. That ban resulted in the increased popularity of flavored cigars and cigarillos. Ah, the Law of Unintended Consequences -- the bane of the social engineer.

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