Quit Smoking Weapons of Mass Distraction

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