The Scream Test Revisited

On Monday, the Foundation for a Smoke-Free World released the findings of a global survey about smokers. Most surveys claim to seek a “better understanding” of the target audience – in this case, smokers – and this one is no different.

Arguably, the methodology behind this particular survey; the “Worldwide State of Smoking Survey”, appears to be very robust in its approach by researching existing surveys (such as the Eurobarometer, the Global Audit Tobacco Survey and the Global Youth Tobacco Survey, among others. In essence, looking at how other surveys are constructed and selecting the most relevant questions for inclusion in the “Worldwide State of Smoking Survey”.

I am not sure if the other surveys listed in the appendix of the methodology statement had a pilot testing program or not, but this one interviewed 96 participants from each country to be surveyed. The participants were selected by their current smoking status (current, ex and never), this is deliberate as it mostly avoids the usual problems with surveys about smoking.

I say mostly because there will always be an inherent selection bias.

According to respondents, the questions were phrased in a concrete way and dealt with a topic of the day-to-day life, which respondents could easily relate to.

This is exactly how a survey should be. Especially a survey about smoking habits. It absolutely has to reflect the individuals’ day-to-day experience, not some researchers idea of what that experience is. As stated in the methodology:

The objective was to understand the barriers and drivers behind quitting smoking and switching to alternative products.

We know that the Foundation is essentially after the same thing that tobacco control is, the key difference between the two is that the Foundation is (quite literally) putting its money where its mouth is and getting down and dirty with research. Research that, when complete, will make the research from tobacco control seem amateurish (which it mostly is anyway).

This can only be surmised by the continuing screaming from tobacco control quite succinctly here:

Marita_Hefler_FSFW

Still screaming

For those that don’t know who Marita is, she is currently the news editor for the laughable journal Tobacco Control. The very same journal that insists debate can only be conducted via its ‘Rapid Response’ system. An editorial that sparked a number of comments and articles, myself included.

So what exactly has the Foundations’ survey highlighted that caused the screaming to ratchet up a notch?

According to a press release from the New Zealand Taxpayers’ Union, exactly what you would expect to see. One of the key points in that article is about how smokers are forgoing necessities to buy smokes:

A new global survey of smokers just released from the Foundation for a Smoke-Free World, has found that 36% of New Zealand smokers admit to spending money on tobacco that they know ‘would be better spent on household essentials like food’

This isn’t unexpected in the slightest. Taxation on tobacco products is thoroughly regressive. The theory behind taxation is to reduce demand by raising the price so that the product is ‘out of reach’ of those that are economically inefficient. But as the results from Q38 of the survey show, it hasn’t worked:

Q38.png

Source: Foundation for a Smoke-Free World

In Brazil, for example, a massive 87% of smokers (and ex-smokers) consistently spend money on smokes rather than household essentials like food. While in the UK, that figure is 34%.

This is a clear case of unintended consequences brought about by tobacco control, and their useful idiots in raising socioeconomic inequalities, yet those in tobacco control can’t won’t see this.

Question 41 of the survey asks about the effect of tobacco pricing, including increases, on current smoking. The results are, as expected, rather telling:

Q41.png

Source: Foundation for a Smoke-Free World

Brazil, once again, shows an interesting insight into the mind of the smoker with the vast majority of smokers (54%) saying that pricing increases would not change their habits. While 62% of smokers in Lebanon say the same. Interestingly, in countries that are ‘wealthy’ – such as the UK, US, Japan and Israel a significant number of smokers stated that they would reduce their tobacco consumption.

This is likely due to the concerted efforts of a variety of tobacco control policies and not just price. Many tobacco control policies are about denormalization of smoking, and in extreme cases, the denormalization of smokers.

The harm perception chart illustrates this nicely.

Q30.JPG

The substances that are covered in this question are:

  • Cigarettes
  • Soda drinks
  • Wine
  • Candy
  • Salty Appetizers
  • Junk Food

Aside from an oddity with Indian smokers believing that wine and cigarettes are harmful to health (8.3 vs 8.2 respectively on a 1-10 scale), all respondents state that cigarettes are very harmful to health.

Q33.jpg

Source: Foundation for a Smoke-Free World

This chart shows just how much of an effect the bollocksy headlines have on the perception of harms from e-cigs. Surprisingly, respondents from South Africa have a clear view that e-cigs are not harmful, or at least not as harmful as combustible tobacco. As shown in the next chart.

Q34.jpg

Source: Foundation for a Smoke-Free World

It would seem, from the data presented on question 34, that participants from New Zealand and Japan have a much greater understanding of the relative risk of cigarettes and e-cigarettes.

This is crucial data in understanding why smokers are not switching to reduced risk products such as e-cigs, heat-not-burn and snus. Question 36 asked the participant about the comparative harmfulness of heat-not-burn and cigarettes. The results are markedly different to the perceptions of harm of e-cigs.

Q36.jpg

Source: Foundation for a Smoke-Free World

In countries where the “less harmful” response for e-cigarettes is (correctly) significant, many of the respondents state that heat-not-burn is equally as, or more harmful than cigarettes.

The survey asked about the perceived impact of smoking on health and how informed they felt about the impact. The results are as you would expect.

Q17.jpg

Source: Foundation for a Smoke-Free World

In countries where there are numerous tobacco control policies, participants felt they were very well informed about the risks associated with smoking.

Q26-1.jpg

Source: Foundation for a Smoke-Free World

Here’s a kicker regarding the warning labels – which as regular readers will know, will now be increased in size in EU Member States thanks to the revised Tobacco Products Directive. However, as many predicted prior to the introduction of these warnings, most smokers don’t bother reading them.

Q26-3.jpg

Source: Foundation for a Smoke-Free World

There’s also a significant proportion of smokers that think the health warnings are exaggerated.

Q26-4.jpg

Source: Foundation for a Smoke-Free World

Similar results as found in the Special Eurobarometer 429 where a significant number of respondents state that the packaging is not at all important when choosing a brand of cigarettes.

Eurobarometer_QC5.JPG

Source: Special Eurobarometer 429

As highlighted by the Foundation, a key finding from this survey is:

  • Smoking isn’t an isolated habit. Smokers consider it deeply integrated with their basic pleasures of life, such as eating, drinking, and socializing.

No tobacco control policy ever considers this and the impact it will have on the lives of the smoker.

Smoking is a pleasurable past-time. It may not have any health benefits, but it does have other influences on the life of smokers. As covered in The Pleasure of Smoking report, smokers are increasingly seen as a deviant group, despite the pleasure that smoking brings.

Unfortunately, the way the results of this survey is being presented suggests that smokers are poor, ignorant addicts that are tragically misinformed about reduced risk products which will undoubtedly lead to a public health type campaign vilifying smoking and extolling the virtues of e-cigs, heat-not-burn, snus and any other reduced risk product.

The survey does contain interesting information, much of which many of us already knew, either through research or instinctively.

Along with the release of this report, Aaron Biebert released a new promotional film entitled “Ending Global Confusion” and it highlights many of the points made in the survey results.

I just wish the Foundation weren’t so intent on the total eradication of smoking.

This is a case where “the enemy of my enemy” is most certainly not my friend.

Update

Since posting this, I have received a communication from the Foundation:

I wanted to clarify the Foundation’s goal:

The Foundation’s goal is to catalyze progress toward ending combustible tobacco smoking. The survey findings highlight that although smokers are aware of their poor health compared to non-smokers, they are unable to easily quit smoking cigarettes. To help smokers quit or reduce their health risks, while addressing their emotional and behavioral needs, we advocate for further research into the safety of reduced harm products, and support efforts that lead to innovation and improved approaches for both harm reduction and cessation.

Yes, I am well aware of what the Foundation’s end-game is. For me, that is part of my problem with it. I have no problems with the Foundation actively performing good research into reduced risk products; something that tobacco control isn’t doing as it is always agenda driven. One could argue that the research conducted by the Foundation is also agenda driven because it is. It is driven to ensure that smokers have the best available knowledge and the widest array of choices – something tobacco control just do not get.

While in this survey the Foundation asked some pertinent questions about the perceived health of the individual, i.e. ‘To what extent do you agree or disagree with the following statement? Your smoking is harmful for your health.’; although I would tender a more accurate question would be “To what extent do you agree or disagree with the following statement? Your smoking is potentially harmful for your health?”. But.

There’s a glaring omission from the survey, and that is why do smokers choose to smoke? As mentioned in the Pleasure of Smoking report in the section entitled Enjoyment of Smoking, showed that newer smokers enjoyed it, regardless of age or gender.

Sadly, and as Simon Clark rightly points out:

By omitting this crucial question (‘Why do you smoke?’) and focussing instead on the question of addiction (self-perceived) the strong inference is that the overwhelming majority of smokers smoke only because they’re addicted.

This is important because it feeds the idea that smokers need help – or better choices – in order to quit (and quit they must).

Smokers, by and large, aren’t ill. They neither require or want interventions. What some want are good alternatives and the majority, most importantly, want to be left alone.

The Foundation is providing entertainment value thanks to all the screaming coming from tobacco control; especially in the last major conference where Derek Yach was banned from attending (and so too were any affiliated researchers) while those in tobacco control held a standalone session to belittle the Foundation.

It’s all well and good trying to understand the perceived harms and impact on health that smoking may have, but it is rather pointless if you fail to understand why a smoker chooses to smoke.

2 thoughts on “The Scream Test Revisited

  1. I’ve been banned from commenting on the Tobacco Control blog for several years now. I don’t think I wrote anything offensive – just disagreed with an article.

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