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Another peculiar institution

 Tobacco cultivation dates back to Native American society, yet it did not become an American cash crop until a strong labor force arrived on slave ships in 1619. Tobacco remains a legal recreational drug despite evidence of its harms.
Since the early 1600s, two peculiar institutions evolved hand-in-hand in the American colonies - tobacco and slavery. After 400 years, slavery has long been abolished, yet tobacco still reigns. The fight against tobacco expands in October 2012,  when new graphic pictorial warnings are scheduled to be placed on cigarette packages. The warning labels (which will cover half of both the front and the back of packages) will replace the current labels, which are less conspicuous and only cover a portion of the side of cigarette packs. Experimental evidence explores the likely effects the change in warning labels may have on cigarette sales. Researchers working in four cities (Selinsgrove, PA; Columbia, SC; Tampa, FL; and San Diego, CA) recruited adult smokers who were shopping at grocery stores. 402 participants engaged in experimental auctions where each individual would write down the price he or she was willing to pay for a pack of cigarettes. Auctions included eight participants at a time; each participant was given $15, enough to compensate them for their time and to purchase any cigarettes won through the bidding process. The auctions - unlike the popular conception - did not ask participants to bid against each other. Rather, each participant’s valuation of cigarette price was compared to a random experimental price (from 10 cents to 10 dollars). Any participants who offered to pay more than the random price “won” the auction and took home the cigarette packs; participants offering less than the random price received nothing. The packs included Marlboro Red, Marlboro Lights, and Newport Menthol according to participant preference. Packs varied in one key factor: warning labels affixed to the cigarettes. The warnings included: (1) the current text-only messaging on the side of the pack, (2) text-only message on the lower 50 percent of the front, back, and side, (3) text and pictorial message covering the lower 50 percent of the front, back, and side, and (4) an unbranded package with large text and pictorial warnings. The average bid for a standard cigarette pack (with current warning labels on it) was $3.52 (range: $0 to $8).  Larger text warnings decreased the bid price by 9 cents. Pictorial warnings decreased the bid to $3.11.  Pictorial warnings combined with non-branded plain packing lowered the average bid to $2.92.  In multivariate analysis, the pictorial messaging significantly reduced the bid amount by 61 cents and 92 cents (for branded and unbranded packaging, respectively, p<0.01). Older smokers placed significantly lower bids (by 2 cents per year). People who smoked a greater number of cigarettes daily placed significantly higher bids (by 1 cent per extra daily cigarette smoked). Of note, more than half of all participants intended to quit smoking in the next 6 months. Commentary We have reviewed evidence-based health policy literature that has suggested that banning menthol in cigarettes could save   an American lives. Efforts to increase tobacco taxes can also lower smoking rates and of cigarettes. The current study further adds to the volume of evidence promoting ways to reduce smoking. Unfortunately, 21 percent of American adults still smoke despite decades of knowledge proving that tobacco products have no health benefit and pose dangers ranging from cancer to lung and heart disease. It seems insane that smoking is even legal in the 21st century. Perhaps America has been reluctant to purge itself of this peculiar institution despite having rightfully abolished the other. While progeny of tobacco plants cultivated by African slaves nearly 400 years ago still inflict health consequences on our nation. Without more robust regulation, many will continue to die unnecessarily. The federal government sees fit to criminalize the use of certain opiates, cocaine, and marijuana - substances which actually have medicinal value - while legally allowing its citizens to poison their lungs, choke their hearts, and injure their brains. Thrasher JF, et al. “Estimating the impact of pictorial health warnings and "plain" cigarette packaging: Evidence from experimental auctions among adult smokers in the United States.” Health Policy. 2011 Sep; 102 (1):41-8. Epub 2011 Jul 16.   by Cedric Dark, MD, MPH

Highlights from CDC & WHO

  • Cigarette smoking results in 5.5 million years of potential life lost in the United States annually
  • Tobacco use globally kills 1 person every 6 seconds
  • Cigarette smoking causes heart disease, stroke, chronic lung disease, and cancers of the lung, mouth, pharynx, esophagus, and bladder
  • Cigarette companies spent more than $15.2 billion in 2003 to promote their products
  • There is no risk-free level of secondhand smoke exposure
  • There are more than one billion smokers in the world


Cedric Dark, MD, MPH, FACEP
About Cedric Dark, MD, MPH, FACEP

Cedric Dark, MD, MPH, FACEP is Founder and Executive Editor of Policy Prescriptions®. A summa cum laude graduate of Morehouse College, Dr. Dark earned his medical degree from New York University School of Medicine. He holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University. Currently, Dr. Dark is an Assistant Professor in the Department of Emergency Medicine and a Health Policy Scholar in the Center for Medical Ethics & Health Policy at Baylor College of Medicine. He produces a health policy podcast for the American Academy of Emergency Medicine. Dr. Dark’s commentary and opinions on this website are his own and do not represent the views of Baylor College of Medicine or the American Academy of Emergency Medicine. Contact: Website | Facebook | Twitter | Google+ | YouTube | More Posts

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