TIME tobacco

Here’s the Best Way to Get Someone to Quit Smoking

Antismoking messaging works differently depending on who's watching, a new study shows

For years, the U.S. government has gone back and forth about whether or not it’s legal to force tobacco companies to use images of cancerous lungs and other graphic pictures on their cigarette packaging. The assumption, of course, is that the images will terrify any smoker into kicking the habit.

However, a new study published in the journal Nicotine & Tobacco Research shows that the graphic tactic might not work on all smokers. The effectiveness of antismoking messaging depends on the attitude of the smoker.

Researchers from the Georgetown Lombardi Comprehensive Cancer Center studied 740 smokers to figure out what type of antismoking campaigns worked best. They discovered that messages that stress the benefits of quitting, like “quitting smoking reduces the risk of death due to tobacco,” were more effective at getting smokers to quit if those smokers thought that quitting would be very hard. The more graphic and negative ads like “smoking can kill you” tended to work best for smokers who thought they could quit whenever they wanted.

One of the reasons motivating messaging worked best among smokers who viewed quitting as a challenge could be that they’re already well aware of the health risks. On the other hand, the researchers speculate that loss-framed messaging — the kind that focuses on the negative consequences of continuing a behavior — worked better for smokers who felt they had more agency in their cessation because the negative ads built up motivation to stop.

Ultimately, the researchers believe that having a mixture of various messaging strategies is the best way to appeal to a broad range of smokers, and that currently there are far more negative messages than positive ones.

That’s not to say that scary ads don’t work. For a couple years, the Centers for Disease Control and Prevention (CDC) has poured resources into an intensive ad campaign called “Tips From Former Smokers” which features real former smokers who have experienced serious setbacks from their habit, like no longer being able to speak properly or having a baby too early. During past campaigns, the CDC has said that their quit lines experience 80% more activity when the ads are running compared with the weeks before.

Terrifying ads aren’t going away anytime soon, but mixing in more motivating messages might appeal to would-be quitters of all kinds.

TIME Retail

CVS Quits Selling Tobacco 3 Weeks Ahead of Schedule

Changes corporate name from CVS Caremark to CVS Health

CVS announced Wednesday that it has yanked cigarettes and other tobacco products from shelves at 7,600 stores nationwide, beating its original goal for ending cigarette sales by almost a month.

The retailer also changed its corporate name from CVS Caremark to CVS Health, a name the company believes “reflects our broader health care commitment.”

CVS pledged tobacco products would be off its shelves by Oct. 1 when it announced its plan to stop selling cigarettes in February, but they’re gone three weeks early.

“Every day, all across the country, customers and patients place their trust in our 26,000 pharmacists and nurse practitioners to serve their health care needs,” Helena B. Foulkes, President of CVS/pharmacy said in a statement posted on the company’s website. “The removal of cigarette and other tobacco products from our stores is an important step in helping Americans to quit smoking and get healthy.”

“We’re the first national pharmacy chain to step up and take this action,” CEO Larry Merlo said in a video accompanying the original statement announcing the halt in sales. “Tobacco products have no place in a setting where health care is delivered.”

Merlo also said the company plans to launch a “robust smoking cessation program” next year, to help the 7 in 10 smokers who say the way to quit achieve that goal.

The move comes as CVS is increasingly trying to rebrand itself as a health-care company, with in-pharmacy clinics and partnerships with hospitals. Now that cigarettes have disappeared, customers can expect to see new signage and an “enhanced selection” of nicotine replacement products.

First Lady Michelle Obama, who has made public health a key priority during her time in the White House, thanked CVS in a Twitter message.

TIME Addiction

WHO Urges Tighter Regulation of E-Cigarettes

A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The United Nations agency acknowledged both the "promise and threat" of the $3 billion industry

The World Health Organization recommended countries adopt a raft of tighter regulations over the sale and use of e-cigarettes Tuesday, including a ban on sales to minors, a ban on “vaping” indoors and tighter controls over advertising and flavored products.

The United Nations agency released a report on Tuesday that acknowledged both the “promise and threat” of the e-cigarette market, Reuters reports. The authors cast doubt on e-cigarette makers’ claims that the devices could help smokers kick the habit. Until those claims had been substantiated by a stronger body of scientific evidence, the U.N. health agency recommended that countries adopt regulations that would “minimize content and emissions of toxicants.”

Suggested regulations include restrictions on advertisements promoting e-cigarettes as a healthy alternative to smoking, prohibitions on sales to minors and sweetened flavors that might appeal to minors and a ban on using the devices indoors. The Food and Drug Administration proposed similar restrictions on sales to minors and advertising of e-cigarettes in April, but stopped short of banning television advertising or sweetened flavors.

The report comes amid a widening divide in the scientific community as to whether e-cigarettes constitute a help or a hindrance in the battle to stop people smoking. A group of 53 scientists signed an open letter to the WHO earlier this year urging officials to resist any measures that might suppress sales of e-cigarettes, calling them “part of the solution” in the fight against smoking.

[Reuters]

TIME E-Cigarettes

Toronto Bans E-Cigarettes From City Workplaces

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Mayor Rob Ford reportedly voted against the ban

The Toronto City Council voted 36-2 in favor of banning e-cigarettes from all city workplaces on Monday.

According to a Toronto Sun reporter, Mayor Rob Ford was one of the two votes against the ban.

The vote was part of a marathon session for the city council which could last several days and will address some 400 items from e-cigarettes to traffic lights.

Toronto is not the first major city in North America to issue a prohibition on e-cigarettes. In March, Los Angeles became the third city after New York and Chicago to outlaw e-cigarettes at the office, and Philadelphia followed soon after.

But the L.A. ban extended further than city workplaces with bans in place for bars, restaurants, and parks. In New York, e-cigarette smokers cannot vape anywhere where conventional smoking is also banned, and in Chicago, there’s an indoor smoking ban in place. Smaller cities have also taken up the issue, and it’s expected that more cities will consider similar bans.

Health Canada, the government’s public health department, advised Canadians not to buy e-cigarettes as long ago as 2009, CTV News reports, but there are no formal prohibitions on the sale of e-cigarettes unless they are “expressly intended” for nicotine delivery. That allows many retailers to circumvent a crackdown by regulators.

Earlier this year, the FDA said it would increase its regulation over e-cigarettes, and on Sunday night, the American Heart Association called for stricter oversight, especially when it comes to marketing to kids.

TIME Heart Disease

E-Cigs Should Be Last Resort for Quitters, Heart Group Says

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

The American Heart Association calls for tighter e-cigarette regulations, but gives the OK for a small amount of smoking cessation use

Electronic cigarettes should be used to help smokers quit only if proven cessation methods like nicotine patches fail, the American Heart Association said late Sunday.

The AHA acknowledged that e-cigs haven’t yet been proven to be good tools for quitting smoking, though some research has suggested they may be about equal to or slightly better than nicotine patches. The new recommendation is part of the AHA’s policy statement on e-cigarettes. The AHA calls for more regulation of e-cigs, which is something the FDA has promised in the past. The AHA says it fears any further delay in these regulations could have serious public health consequences.

Specifically, the AHA calls for new and stronger regulations for how e-cigarettes are marketed, especially to young people. It recommends a ban on sales to minors, since some research has shown that young people consider using e-cigarettes as a convenient method for smoking. Public health experts have long worried that e-cigarettes could serve as a gateway to other tobacco products, like the much unhealthier conventional cigarettes.

The group says some research suggesting e-cigarettes could normalize smoking are troubling, especially data showing youth exposure to e-cigarette advertising has spiked 250% from 2011 to 2013. “These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored,” AHA CEO Nancy Brown said in a statement.

Whether e-cigarettes are just another vector for nicotine exposure to American youth is a hotly debated topic among public health experts. Some hold the belief that pushing smokers toward lower-level nicotine carriers could ultimately help people quit, while others say there’s no space for more addictive products in the U.S. market.

TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME tobacco

$23.6 Billion Lawsuit Winner to Big Tobacco: “Are You Awake Now?”

Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City.
Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City. Bebeto Matthews—AP

The widow who won a $23.6 billion lawsuit against R.J. Reynolds talks to TIME about the suit and what she hopes the victory will accomplish

“Are you awake now? Do you hear what the jury is saying? You have to stop,” Cynthia Robinson wants to tell the tobacco industry. The Florida widow recently won a $23.6 billion lawsuit against tobacco company R.J. Reynolds, one of the largest recent judgments on the industry, and in an interview with TIME, she says she hopes they listen to the jury’s message.

Robinson’s husband Michael Johnson died in 1996 at age of 36 from lung cancer, and in her lawsuit against R.J. Reynolds, she and her attorneys argued that the company was aware that cigarettes were addictive and caused lung cancer, but was negligent in telling smokers like Johnson about those risks.

Johnson got hooked on cigarettes when he was just 13-years-old, and eventually smoked up to three packs a day, often lighting his next cigarette with the burning end of the one he just finished. “He was a quiet person. He read the Bible every day, he took the kids swimming, he mowed the yards of all the elderly neighbors,” Robinson says. He was diagnosed with lung cancer in 1995 and lived for almost a year in constant pain. “The pain [from the cancer] was always there. When you’re on oxygen and you have to step outside for a cigarette, you can’t stop. You’re addicted.”

Johnson tried multiple times to stop smoking with no success. During one of her husband’s hospital visits, Robinson knew something was wrong when he began sweating and one of his eyes started to droop. The doctor said he would live for only a couple of months, but he survived for 10 more months. “He suffocated and died for so long, it was awful,” says Robinson, recalling how hard it was for her husband to breathe in the months before his death.

The day Johnson died, he could not stop coughing up blood. His brother tried to hold him up, and Robinson wanted to get him into an ambulance, but his mother told her that he was already gone. “The blood was everywhere, it was awful. Only 36 years old and he was already gone,” says Robinson.

Ten years later Robinson filled her lawsuit. It’s one of many Florida lawsuits referred to as an “Engle progeny,” stemming from a 2000 $145 billion verdict in a class action suit led Dr. Howard A. Engle, a Miami Beach pediatrician who smoked, and eventually died of chronic obstructive pulmonary disease. The case was overturned in appeals court, and it was ruled that smokers could not make up a class. But the Engle case established that the tobacco industry had deceived Americans, by knowingly putting addictive and cancerous products on the market, and paved the way for thousands of individual Florida cases to take on Big Tobacco. On Friday July 18, Robinson did, and won her bittersweet victory.

“It was justice. It was time, and it had been a long time,” Robinson says. “I thought, oh my God, we did it. We may have to keep fighting, and will. It’s for Michael, and anyone who lost their lives to lung cancer. There are thousands right now dying of lung cancer. Michael died so young, he missed graduations and weddings.”

“We expected every dime and more,” says Robinson’s attorney Willie E Gary. “Johnson started smoking when he was a teen. How aware of the risks can you be at that age? But [the tobacco industry] would market and target kids. To this day they are going after our youth, stuffing their pockets. It’s all about the profits and it’s nothing about the health and safety of the people.”

As TIME reported earlier this week, R.J. Reynolds plans to appeal, and based on the industry’s track record with lawsuits, the damages will likely be lowered. Gary isn’t deterred: ” We expect to win. Winning is not about getting everything that you want. We know that we made a difference.”

It’s small consolation for losing her husband, but Robinson is satisfied that her time, effort, and daily prayers were enough to topple Goliath, at least in court last Friday. “We had to go all the way no matter how many years it took. Life has been lost,” she says. For the thousands of other pending lawsuits, she urges plaintiffs to persevere. “Don’t give up no matter how much they try to discourage and belittle you, you fight them to the very end, and you’ll succeed,” she says.

 

TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Culture

Up in Smoke: The Rise and Fall of Big Tobacco

"According to this survey, more doctors smoke Camels than any other cigarette," is just one of the phrases we no longer hear in commercials

Earlier this week, a $27.4 billion deal was announced that will merge two of the largest American tobacco companies, Reynolds American and Lorillard.

The deal comes at a time when cigarette smokers are at a steady decline. Even so, Marlboro still makes some lists of most valuable brands in the world.

And while it’s hard to remember the days when Camels were advertised as the most preferred cigarettes by doctors, a small segment of the industry is quickly growing: e-cigarettes.

Above, take a quick look at the history of America’s complicated relationship with the addictive habit.

TIME mergers

Tobacco Mergers Are Creating a More Efficient Killing Machine

Several brands of cigarettes are arranged for a photograph in Tiskilwa, Illinois, U.S., on April 17, 2012.
Several brands of cigarettes are arranged for a photograph in Tiskilwa, Illinois, U.S., on April 17, 2012. Bloomberg/Getty Images

It’s been a year of colossal mergers or proposed mergers among some consumer goods and services companies. Comcast wants to take over Time Warner Cable (not affiliated with TIME) to form the nation’s largest cable company. AT&T and DirectTV want to combine to compete against them. The market also expects T-Mobile and Sprint to hook up, further reducing competition in mobile phone service.

Now add to that the tobacco industry. Reynolds American announced a deal to acquire Lorillard Inc. which it values at $27.4 billion. It’s a combination of the second and third largest cigarette makers after Altria Group, which owns Philip Morris USA. As part of the deal, British American Tobacco Plc retains its 42% stake in Reynolds by providing $4.7 billion in funding.

That’s a lot of dealmaking for the Federal Trade Commission and the antitrust division of the Justice Department to bless or deny. The goal of antitrust statutes is to preserve competition in any industry segment. Trustbusters don’t care who provides that competition, just as long as enough of it exists. That’s the ongoing debate in the proposed cable combination. It’s axiomatic that when two dominant players mergers prices rise and consumers suffer.

The proposed tobacco merger has a similar competitive profile. Combining the second and third largest companies will certainly reduce competition, giving Reynolds a 34.1% market share after divestitures. Unlike the media mergers, though, this one takes place in a shrinking market, as smoking continues to decline. Consolidation in a declining market certainly makes sense from an economic point of view. And there’s a clever wrinkle in this deal, in that Reynolds will sell off the KOOL, Salem, Winston, Maverick and blu brands to Imperial Tobacco for $7.1 billion—the idea is to create a stronger No. 3 competitor to keep the antitrust forces at bay.

There’s one other big difference, though: the merger will allow these two companies to be more efficient in killing people with their products. In its merger document, Reynolds says the deal would produce $800 million in cost savings and produce double digit profit gains by the second year. Not that Reynolds is a laggard. The company had already doubled its operating profit margin to 36.7% since 2004. And its 10–year return to shareholders of 542.2% has dwarfed the S&P’s return. This is a profit machine, even if a lethal one. According to the American Cancer Society, about 224,210 new cases of lung cancer will be diagnosed this year and 159,260 people will die from lung cancer—that’s more than colon, breast, and prostate cancers combined, says the ACS.

The new company will feature brands including Camel, one of the top premium smokes, and Vuse, a fast growing e-cigarette, but the prize in deal for Reynolds is Lorillard’s Newport, now the No. 1 menthol brand. Newport now owns a 12.6% share of the entire cigarette market in the U.S. and it’s growing —33.7 billion menthol “sticks” were sold last year. According to the Reynolds’ presentation, Newport has an “attractive demographic profile.” That profile, says smokefree.gov, includes blacks, women, Hispanics and younger people, all of whom are higher-than-average consumers of menthol cigarettes. These very characteristics have put menthol under the regulatory spotlight, leading to speculation that the Food and Drug Administration might ban menthol. But Reynolds clearly doesn’t believe that the feds will make any such move. “While cigarettes are dangerous there is not a significant difference between a menthol cigarette and a non menthol cigarette,” noted Murray Kessler, Lorillard’s CEO. “And ultimately the science will prevail.”

The same science holds the view, which none of these companies disputes, that tobacco use is deadly. And smoking costs our health care system billions of dollars annually to treat smokers. Should the FTC or Justice factor public health considerations into the deal? For instance, if the FTC believes that cigarette prices will increase, would it still bless the deal because rising prices might help ration demand—force more smokers to quit. Conversely, would blocking the deal, and keeping the competitors in place, have the opposite effect and lower prices, thus attracting more smokers?

That’s not necessarily an analysis that antitrust regulators are willing to make. Typically the antitrust agencies look only at the competition effects. As a former FTC official told me: “The traditional view has been that if the health and safety regulators wish to impose conditions, that’s their call entirely.” Expect the FTC to stick to the economics, which will be great for the tobacco companies, and their investors. The customers are on their own.

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