America’s new tobacco crisis: The rich stopped smoking, the poor didn’t(washingtonpost.com)
washingtonpost.com
America’s new tobacco crisis: The rich stopped smoking, the poor didn’t
https://www.washingtonpost.com/national/americas-new-tobacco-crisis-the-rich-stopped-smoking-the-poor-didnt/2017/06/13/a63b42ba-4c8c-11e7-9669-250d0b15f83b_story.html
195 comments
Not to mention self-medicating. Cigarettes are expensive but they're cheaper than dealing with mental health issues for the uninsured.
Exactly. Nicotine has mental health benefits (e.g., schizophrenia ) and is a nootropic, stimulant, and feel-good drug. By smoking, the poor are trading years in the future for pleasantness now. Calling them stupid or irrational just makes too many assumptions about their opportunities, situations, and goals.
Perhaps we could sell nicotine patches and gum without a prescription? Also, there are substitutes:
http://www.winnipegfreepress.com/opinion/analysis/harm-reduc...
"Why have Swedes stopped smoking? Because Sweden has adopted a harm-reduction strategy: it has largely replaced deadly cigarettes with a product that supplies users with both nicotine and tobacco yet doesn’t increase the odds of dying the way smoking does. That product is called "snus" (rhymes with goose).
A modern iteration of snuff, snus are little pouches of moist tobacco placed under the upper lip. Scandinavians have been ingesting nicotine via smokeless tobacco since the early 18th century, a habit that changed only during the Second World War, when cigarettes became popular. Smoking peaked in 1980 in Sweden at 34 per cent of the population. Since then, the growing awareness of the dangers of smoking has brought about a steady, year-over-year reduction in the smoking rate, just as it has in much of the western world."
http://www.winnipegfreepress.com/opinion/analysis/harm-reduc...
"Why have Swedes stopped smoking? Because Sweden has adopted a harm-reduction strategy: it has largely replaced deadly cigarettes with a product that supplies users with both nicotine and tobacco yet doesn’t increase the odds of dying the way smoking does. That product is called "snus" (rhymes with goose).
A modern iteration of snuff, snus are little pouches of moist tobacco placed under the upper lip. Scandinavians have been ingesting nicotine via smokeless tobacco since the early 18th century, a habit that changed only during the Second World War, when cigarettes became popular. Smoking peaked in 1980 in Sweden at 34 per cent of the population. Since then, the growing awareness of the dangers of smoking has brought about a steady, year-over-year reduction in the smoking rate, just as it has in much of the western world."
Nicotine patches and gum are available without a prescription in the U.S. Did you intend to be sarcastic?
No, just unaware. I don't smoke or consume nicotine products.
"the poor are trading years in the future for pleasantness now"
This also describes how a lot of people are poor.
This also describes how a lot of people are poor.
No, it really doesn't. Depending on one's discount function, such a trade is perfectly rational.
This thinking also reeks of the 'just world fallacy', in which the predicament of the poor is deemed to be a deserved consequence of their moral failings.
This thinking also reeks of the 'just world fallacy', in which the predicament of the poor is deemed to be a deserved consequence of their moral failings.
No, being born into poor families with poor job opportunities in poor areas is how a lot of people are poor.
You should expand your horizons.
You should expand your horizons.
Maybe those are one and the same thing---being born into a poor family, you inherit the attitudes that kept that family poor. At least, I expect that's a contributing factor. Obviously there's more to it.
> "the poor are trading years in the future for pleasantness now"
> This also describes how a lot of people are poor.
I suppose we should be cheered by your qualification "a lot of," since it seems to indicate that you at least have to acknowledge your growing awareness that some, if not the majority nor vast majority, of the poor are there for structural reasons, rather than shortsightedness.
What of those who are there for reasons other than shortsightedness? What of those for whom shortsightedness is a result of mental health issues? What of those who can see ahead, but see no bright future and are making rational choices in the face of that?
Fortunately, having qualified your remarks in the way you have, you have opened yourself up to a responsibility to think critically about those whom you have dismissed. I wish you the best in that.
> This also describes how a lot of people are poor.
I suppose we should be cheered by your qualification "a lot of," since it seems to indicate that you at least have to acknowledge your growing awareness that some, if not the majority nor vast majority, of the poor are there for structural reasons, rather than shortsightedness.
What of those who are there for reasons other than shortsightedness? What of those for whom shortsightedness is a result of mental health issues? What of those who can see ahead, but see no bright future and are making rational choices in the face of that?
Fortunately, having qualified your remarks in the way you have, you have opened yourself up to a responsibility to think critically about those whom you have dismissed. I wish you the best in that.
"you have opened yourself up to a responsibility to think critically about those whom you have dismissed"
I don't think I dismissed anyone. People make bad decisions on things they are in control of and it makes them more poor. The rich have more self control -- maybe not. Those with good self control tend to be better off -- definitely.
I'm all for the argument that smoking is a rational choice for someone without a lot of money. There is also the compelling argument that poor impulse control, being poor and smoking have a strong correlation. Maybe even as a common cause for poverty and smoking.
Having watched friends spend entire paychecks drinking, smoking, having unprotected sex (with the inevitable consequences), buying new camaros at blistering interest rates, fleetingly fashionable clothes -- I somehow think that my choice to eat mountains of rice and beans and live with roommates somehow had something to do with my relative success.
Sure, you can tell some people it's not their fault, but absolving everyone of responsibility for their choices is not helping them at all.
I don't think I dismissed anyone. People make bad decisions on things they are in control of and it makes them more poor. The rich have more self control -- maybe not. Those with good self control tend to be better off -- definitely.
I'm all for the argument that smoking is a rational choice for someone without a lot of money. There is also the compelling argument that poor impulse control, being poor and smoking have a strong correlation. Maybe even as a common cause for poverty and smoking.
Having watched friends spend entire paychecks drinking, smoking, having unprotected sex (with the inevitable consequences), buying new camaros at blistering interest rates, fleetingly fashionable clothes -- I somehow think that my choice to eat mountains of rice and beans and live with roommates somehow had something to do with my relative success.
Sure, you can tell some people it's not their fault, but absolving everyone of responsibility for their choices is not helping them at all.
Wait, what? I've never felt any of those effects from smoking, and I made sure to inhale deeply. Maybe I'm doing it wrong? Are there people who are genetically unable to get the high?
That's very strange that you've never felt stimulation or increased focus from nicotine! It's possible that you have some genetic variation that causes that or it's possible you're just not self aware, but I couldn't say which.
For an incredible overview of the benefits and harms of nicotine, see Gwen: https://www.gwern.net/Nicotine
For an incredible overview of the benefits and harms of nicotine, see Gwen: https://www.gwern.net/Nicotine
This ... is truly a bizarre revelation. I had no idea people actually got such physical pleasure and stimulation from smoking. [1]
I guess it's one of those things that's so obvious no one actually says it. If you think about it, that benefit is never mentioned in debates about smoking and the appropriate government response. I know because I aggressively scour for such upsides, being the "hipster contrarian". Had I known about the pleasure and stimulation of smoking[3], you can bet I would bring it up every time!
Reminds me of "What Universal Human Experiences Are You Missing Without Realizing It?" [2]
Now you might ask, "Did it never seem strange to you that people would suck this disgusting tar into their lungs if it didn't at least feel good or something?"
Well, no. IME, people indulge in a lot of BS without obvious explanation. For example, people claim to like the taste of alcohol[ic drinks], and that is outright ridiculous -- or so I thought, but it was another case of [2]. Also, modern art.
My model of smokers was roughly that, they start doing it to look cool, and then get hooked, so that they have to smoke to fend off the pain of withdrawal. I didn't think the act could feel good itself!
Now that I think about it, people don't mention the good feeling of other drugs in debates about them either. For alcohol, I had a good explanation: those benefits are taboo, and people use the purported taste and refinement of their "fave bev" as "intellectual covering fire" for what they really want, the alcohol high.
In conclusion, the phenomenon in [2] is serious business!
[1] See, for example, the responses to this comment: https://news.ycombinator.com/item?id=14569775
[2] http://slatestarcodex.com/2014/03/17/what-universal-human-ex...
[3] Incidentally, I read Bostrom's Superintelligence, where he mentions writing the book while being powered by caffeine and nicotine, but I wrote that off (like most purported benefits of smoking) as psychosomatic.
I guess it's one of those things that's so obvious no one actually says it. If you think about it, that benefit is never mentioned in debates about smoking and the appropriate government response. I know because I aggressively scour for such upsides, being the "hipster contrarian". Had I known about the pleasure and stimulation of smoking[3], you can bet I would bring it up every time!
Reminds me of "What Universal Human Experiences Are You Missing Without Realizing It?" [2]
Now you might ask, "Did it never seem strange to you that people would suck this disgusting tar into their lungs if it didn't at least feel good or something?"
Well, no. IME, people indulge in a lot of BS without obvious explanation. For example, people claim to like the taste of alcohol[ic drinks], and that is outright ridiculous -- or so I thought, but it was another case of [2]. Also, modern art.
My model of smokers was roughly that, they start doing it to look cool, and then get hooked, so that they have to smoke to fend off the pain of withdrawal. I didn't think the act could feel good itself!
Now that I think about it, people don't mention the good feeling of other drugs in debates about them either. For alcohol, I had a good explanation: those benefits are taboo, and people use the purported taste and refinement of their "fave bev" as "intellectual covering fire" for what they really want, the alcohol high.
In conclusion, the phenomenon in [2] is serious business!
[1] See, for example, the responses to this comment: https://news.ycombinator.com/item?id=14569775
[2] http://slatestarcodex.com/2014/03/17/what-universal-human-ex...
[3] Incidentally, I read Bostrom's Superintelligence, where he mentions writing the book while being powered by caffeine and nicotine, but I wrote that off (like most purported benefits of smoking) as psychosomatic.
I'm glad you had a revelation and took it so well. Although maybe not as extreme as you, I also used to think nicotine/cigarettes had almost no benefits and was surprised to learn otherwise. I'll go so far as to say as nicotine is quite possibly the most successful nootropic, with modafinil a close second.
Same here.
Never got into smoking tobacco or weed, both just made me feel bad.
Never got into smoking tobacco or weed, both just made me feel bad.
You're not alone. I've never felt any effects from smoking cigarettes. I think the effects are incredibly minor compared to those of other substances, to the extent there are effects at all.
Nicotine is also an appetite suppressant. During my leaner days I would often choose cigarettes over food when I could not afford both. (I am no longer poor, nor a smoker. I am about 20 pounds heavier though.)
Nicotine is a drug. And some small studies have hinted at the benefits it confers (along with the risks, both of itself and in the delivery medium, burned (and processed, and adulterated) tobacco).
Their are also significant social and signaling roles.
Until we can have an honest conversation about this, and actually embrace and continuing objective science on it, we aren't going to find the honest and effective solution -- whatever that may be.
Their are also significant social and signaling roles.
Until we can have an honest conversation about this, and actually embrace and continuing objective science on it, we aren't going to find the honest and effective solution -- whatever that may be.
[deleted]
> A pack of cigarettes is one of the most luxurious pleasures available if all you have is $5.
There's nothing luxurious about smelling bad and getting a wicked cough. Unless you're already addicted, nearly anything under $5 is more luxurious than a cigarette. I just ate an orange that cost 50¢ and it was more luxurious than any cigarette I've ever smoked.
There's nothing luxurious about smelling bad and getting a wicked cough. Unless you're already addicted, nearly anything under $5 is more luxurious than a cigarette. I just ate an orange that cost 50¢ and it was more luxurious than any cigarette I've ever smoked.
That was definitely a hyperbole from the OP. $5 of alcohol would yield much more satisfaction
[deleted]
[deleted]
> Unless you're already addicted, nearly anything under $5 is more luxurious than a cigarette.
Completely subjective. I'm not sure the purpose of your post. Are you telling everyone what is more luxurious to them or just giving your singular opinion for yourself? Assuming the latter, it appears to add little to the discussion.
Completely subjective. I'm not sure the purpose of your post. Are you telling everyone what is more luxurious to them or just giving your singular opinion for yourself? Assuming the latter, it appears to add little to the discussion.
I'm offering a reasoned analysis of what the actual effects of smoking a cigarette are and whether those things are widely considered luxurious. If you're addicted, sure, smoking offers a great luxury in taking the money off your back for a while. If you're not addicted and don't have some other physical need (e.g. untreated mental illness), it offers a pretty mild buzz and a lot of negatives.
But regardless, wouldn't this be more appropriate as a reply to the parent, who made the initial claim that cigarettes are luxurious and didn't present any reasons for it?
But regardless, wouldn't this be more appropriate as a reply to the parent, who made the initial claim that cigarettes are luxurious and didn't present any reasons for it?
The assertion which GP responded to -- that cigarettes are luxurious -- is completely subjective as well.
There's some subjective aspect to this as well. I smoked off and on for over 10 years. I quit several years ago and don't want for money. But still, to be 100% honest, I've yet to find anything as enjoyable as a cigarette. Its like a tiny espresso that gives an instant rush that I can revisit as often as I'd like. It fits into my 5 minute break mindset. It gives me a reason to (briefly) talk to people I don't know. I could go on, but overall I wasn't just addicted to them. I honestly enjoyed many things about them. If they weren't so unhealthy, I would be happily smoking today. And I would gladly trade a great majority of the other pleasures in my life for them. I say this because there's two themes so far in these comments, but I didn't notice this one. For many people, smoking is a legitimately enjoyable, cheap experience, on top of being insanely addictive. Its not surprising that they are so hard to be rid of.
>There's some subjective aspect to this as well.
I don't smoke cigarettes. I've probably smoked less than 100. I've smoked less than 40 cigars. I've spent maybe $100 on pipe tobacco total in my life, and most of it has gone stale. I've used a Hookah 5 times, just to round out my experience.
I'm not a smoker, but something about tobacco smoke just smells good to me, cigars and pipes mostly, but there are some good smelling brands of cigarettes.
>I've yet to find anything as enjoyable as a cigarette.
I've yet to find anything as a better trigger for happy, emotional memories of my departed grand mother as cigarettes that smell like her brand.
I don't know where I'm going with this, I guess I'm just saying there can be some appreciation of tobacco even if I don't think people should be smoking regularly at all, and that I possibly have very mixed up signals from 2nd hand exposure to nicotine as a child.
I don't smoke cigarettes. I've probably smoked less than 100. I've smoked less than 40 cigars. I've spent maybe $100 on pipe tobacco total in my life, and most of it has gone stale. I've used a Hookah 5 times, just to round out my experience.
I'm not a smoker, but something about tobacco smoke just smells good to me, cigars and pipes mostly, but there are some good smelling brands of cigarettes.
>I've yet to find anything as enjoyable as a cigarette.
I've yet to find anything as a better trigger for happy, emotional memories of my departed grand mother as cigarettes that smell like her brand.
I don't know where I'm going with this, I guess I'm just saying there can be some appreciation of tobacco even if I don't think people should be smoking regularly at all, and that I possibly have very mixed up signals from 2nd hand exposure to nicotine as a child.
I don't smoke, but certain cigarettes smell good. A Winston smells good. Cloves and menthols are nasty. Pipe smoke is awesome. I'll probably smoke a pipe when I'm older. Smoking cigars on long road trips with the windows down is good.
As a non-smoker who has indulged in the odd cigar, I disagree.
The buzz, alone, is intense and very pleasurable (though probably less so for regular smokers). There's a reason cigarettes and coffee (or alcohol) go so well together.
Which is why I can never casually indulge... I like it too much.
The buzz, alone, is intense and very pleasurable (though probably less so for regular smokers). There's a reason cigarettes and coffee (or alcohol) go so well together.
Which is why I can never casually indulge... I like it too much.
As an ex-smoker, I can say that smoking was one of the most pleasurable experiences I enjoyed. It might be hard to explain to non-smokers, but smoking is indeed luxury that could be enjoyed both, alone and socially. I love sugar. But even the fanciest desserts cannot touch joy of first cigarette & coffee in the morning or smoking in freezing weather outside your dorm at 2AM. Everyone else thinks that smokers are suffering outside in below freezing weather but most smokers I know loved it. And I loved it too.
It sounds like I miss smoking. Just to make it clear, it is enjoyable but it is horrible habit not much different from meth & other illegal drugs.
I quit because I was finally getting addicted and it started to control me. I would be thinking about my next cigarette break at work or pausing a movie to take a smoke break while my wife waited for me inside. I thought I would never get addicted but it happens slowly but surely.
It sounds like I miss smoking. Just to make it clear, it is enjoyable but it is horrible habit not much different from meth & other illegal drugs.
I quit because I was finally getting addicted and it started to control me. I would be thinking about my next cigarette break at work or pausing a movie to take a smoke break while my wife waited for me inside. I thought I would never get addicted but it happens slowly but surely.
> I just ate an orange that cost 50¢ and it was more luxurious than any cigarette I've ever smoked.
Given $5 for a pack, that's double the price. Expenses add up.
Given $5 for a pack, that's double the price. Expenses add up.
An orange includes 10–20 slices, so you could just as well say it's 1/10 the price. Trying to make a 1:1 comparison between oranges and cigarettes is a pretty weird idea in the first place.
A related thing that is often ignored is that nicotine is a stimulant and makes it easier to put your body through physical abuse that it otherwise wouldn't take. Some health conditions are improved by nicotine but I suspect in many cases it clearly makes things worse but also makes it possible to work.
Remember the power of marketing: Freud's nephew hired by Cigarette companiest o make cigarettes "sexy" for women in USA (previously a taboo).
https://en.wikipedia.org/wiki/Public_relations_campaigns_of_...
More on how this guy shaped modern advertising in Century of Self https://vimeo.com/10245146
https://en.wikipedia.org/wiki/Public_relations_campaigns_of_...
More on how this guy shaped modern advertising in Century of Self https://vimeo.com/10245146
I was able to quit my 1/2 pack a day addiction four years ago after 15+ years, but it was challenging. Smoking was expensive (four years ago: 4 packs a week = $40), but quitting smoking was even more expensive. In addition to the expense of Chantix, I also started surfing Amazon for things to reward myself instead of going outside for a smoke break. So it was probably $100 - $200 a week.
Now nicotine-free for 4+ years, it's less costly all around (not to mention the health costs), but I understand all too well the difficulty and economics of quitting.
The long term rewards are the ones that matter most. Congratulations!
I quit cold turkey and ate 2 large bags of sunflower seeds in the first 3 weeks. Quitting was cheap.
Quitting isn't that hard. It's just super annoying.
Things like exercising regularly and eating properly take more discipline and willpower, for example.
Quitting isn't that hard. It's just super annoying.
Things like exercising regularly and eating properly take more discipline and willpower, for example.
> Things like exercising regularly and eating properly take more discipline and willpower, for example.
From what I've read quitting smoking is one of the most difficult things to pull off in general (even compared to 'hard drugs'). Do you have any references in support of your view?
From what I've read quitting smoking is one of the most difficult things to pull off in general (even compared to 'hard drugs'). Do you have any references in support of your view?
I think cigarettes share something in common with the meth epidemic in rural America, and I'm not talking addiction: When you don't have a job or you're seriously underemployed, no money, no hope, no opportunities for upward mobility, you look at things almost as a "why not?" issue. Anything to take the edge off of life, make things a little different. It gets compounded by the addictive nature of cigarettes and meth and other drugs.
Among the nation’s less-educated people — those with a high-school-equivalency diploma — the smoking rate remains more than 40 percent..
This fits what I have always heard: That education is more predictive of smoking than income. I am homeless, as are my two adult sons. We do not smoke. I have about six years of college.
Some random thoughts, in no particular order and not backed up by citations:
Smoking helps control depression. One anti-depression medication has a shockingly high side effect of causing people to stop smoking.
Smoking suppresses appetite. I strongly suspect this is one of the reasons that so many homeless people smoke: Because they sometimes don't eat for up to three days at a time.
Smoking also seems to be common in certain situations where it is the only stress relief. Many years ago, I volunteered at a homeless shelter in Vacaville, CA. All the employees seemed to smoke. They had enormous difficulty giving it up because there was nothing else to do on their breaks but either smoke or sit with co workers and talk, who were themselves smoking.
If you want to combat this, trying to education the least educated peoples is probably a better path than framing it as a poor vs rich thing. Poverty grows out of lack of education, but some very educated people don't have much money for various reasons.
I run the San Diego Homeless Survival Guide in part because I am convinced that good information is sorely lacking and is a genuine means to start solving the difficult problems of the poorest of the poor in the U.S.
This fits what I have always heard: That education is more predictive of smoking than income. I am homeless, as are my two adult sons. We do not smoke. I have about six years of college.
Some random thoughts, in no particular order and not backed up by citations:
Smoking helps control depression. One anti-depression medication has a shockingly high side effect of causing people to stop smoking.
Smoking suppresses appetite. I strongly suspect this is one of the reasons that so many homeless people smoke: Because they sometimes don't eat for up to three days at a time.
Smoking also seems to be common in certain situations where it is the only stress relief. Many years ago, I volunteered at a homeless shelter in Vacaville, CA. All the employees seemed to smoke. They had enormous difficulty giving it up because there was nothing else to do on their breaks but either smoke or sit with co workers and talk, who were themselves smoking.
If you want to combat this, trying to education the least educated peoples is probably a better path than framing it as a poor vs rich thing. Poverty grows out of lack of education, but some very educated people don't have much money for various reasons.
I run the San Diego Homeless Survival Guide in part because I am convinced that good information is sorely lacking and is a genuine means to start solving the difficult problems of the poorest of the poor in the U.S.
So America has massively increased the tax burden on the poorest Americans (ever increasing tobacco taxes) while simultaneously cutting taxes on Capital Gains and Inheritance and now we are considering a large cut to the Corporate rate?
Not to mention all the states with a lottery, which can also be thought of as a tax on poor people who are bad at math.
This seems like class warfare.
Not to mention all the states with a lottery, which can also be thought of as a tax on poor people who are bad at math.
This seems like class warfare.
In California we have a crisis, not enough people are smoking and paying the taxes. So the cigarette taxes have to be raised again and again then other tax sources have to be found.
With that spin, sure it would seem that way. You might consider it "Warfare" if the poor were being forced to smoke, or say there weren't pictures of cancer on the cover of the packages of cigarettes, or minors were allowed to smoke or there wasn't a huge vice tax on cigarettes essentially everywhere in the world, and a ban on cigarette advertising in most countries then yeah if you ignore all of that you might consider it class warfare...
You can apply post-facto justification all you like, but cigarette taxes are still regressive, no matter how you look at it.
Whether it's part of a general attack on the poor is a separate question, but it does fit a pattern of punching downwards.
Whether it's part of a general attack on the poor is a separate question, but it does fit a pattern of punching downwards.
That's not just limited to America. I travel a lot, a few years ago, say 15 or so it would be pretty rare to see young people smoke and now somehow it is 'cool' again. I've had the unfortunate experience of delivering a couple of friends to an early grave courtesy of lung cancer, the one thing that seemed to unite them was that they wished they had never started smoking and that once they did they had the strength to quit. The youngest of those was mid 40's. It's an intelligence test of sorts with a very high price if you fail.
I just got back to the States from Germany. I was struck by how common smoking seems to be there, but I was glad that it was strictly an outside activity.
I smoked when I was younger, but I started as a teenager. (Intelligence test failed.)
Once you are addicted, it operates directly on the brain's reward mechanism, much the same way I imagine opiates would. It seems as vital and necessary as breathing. (I am generalizing from my experience, not everyone is affected as strongly as I was.) I am so glad I quit, and now it is more or less completely out of my system.
On the nine hour flight into Frankfurt, the airline had the flight attendants try to sell duty free cigarettes to the passengers. They walked up and down the aisles offering cheap cartons. Of course you can't smoke on the plane. As a former smoker, that must be torture to people who respond to nicotine the way I did.
I really hope smoking doesn't become cool again here in the U.S. I have kids, and I suspect they have inherited at least some of the tendency toward risk taking I had in my younger years.
I smoked when I was younger, but I started as a teenager. (Intelligence test failed.)
Once you are addicted, it operates directly on the brain's reward mechanism, much the same way I imagine opiates would. It seems as vital and necessary as breathing. (I am generalizing from my experience, not everyone is affected as strongly as I was.) I am so glad I quit, and now it is more or less completely out of my system.
On the nine hour flight into Frankfurt, the airline had the flight attendants try to sell duty free cigarettes to the passengers. They walked up and down the aisles offering cheap cartons. Of course you can't smoke on the plane. As a former smoker, that must be torture to people who respond to nicotine the way I did.
I really hope smoking doesn't become cool again here in the U.S. I have kids, and I suspect they have inherited at least some of the tendency toward risk taking I had in my younger years.
Same thing in Italy and France, in my experience. Quite baffling, really.
The French have it down to an art form. The difference here is smokers still seem to be outside hiking, walking, snowboarding, biking and doing all manner of outdoor things. I'd be interested in how lung cancer rates compare between the US and France.
US: 38.4 per 100,000
France: 35.0 per 100,000
Note there's a very long lag time, and current cancer rates can reflect smoking habits from decades ago.
France: 35.0 per 100,000
Note there's a very long lag time, and current cancer rates can reflect smoking habits from decades ago.
The decline of the middle class and the huge explosion of the riches of the rich class will ensure that rich and poor in 50 and 100 years look and live like different species...
Slum dwellers and "city trash" on one hand, and 150 year old clean shaven organic vegan genetically modified uberlords on the other.
Warlocks vs Elois all over again...
Slum dwellers and "city trash" on one hand, and 150 year old clean shaven organic vegan genetically modified uberlords on the other.
Warlocks vs Elois all over again...
A theory postulated without evidence: Considering throughout history power and wealth inequality was in many ways much worse (monarchies, despotism, no voting rights without land etc) I wonder if the current distribution is simply an artifact of genetic changes that have already occurred. Perhaps the slum dwellers of yesteryear adapted to those conditions and now in some way subconsciously seek them out.
Evidence right here.
https://www.bls.gov/opub/mlr/2017/beyond-bls/income-and-heal...
They note that the average age of individuals in the middle- and high-income groups has increased since the 1976–80 period, while the average age of those in the low-income group has decreased. Ultimately, individuals from families with top incomes overwhelming report being in good health. Indeed, individuals in this group were more than twice as likely to report being in very good or excellent health than individuals in the bottom group.
If that isn't leading to the scenario described I don't know what you think it's leading to, but it can't be good.
https://www.bls.gov/opub/mlr/2017/beyond-bls/income-and-heal...
They note that the average age of individuals in the middle- and high-income groups has increased since the 1976–80 period, while the average age of those in the low-income group has decreased. Ultimately, individuals from families with top incomes overwhelming report being in good health. Indeed, individuals in this group were more than twice as likely to report being in very good or excellent health than individuals in the bottom group.
If that isn't leading to the scenario described I don't know what you think it's leading to, but it can't be good.
This has been my theory, but it'll take longer than 50-100 years. It should coincide with Earth's population decline.
After technology removes another 10-15% of jobs, and we settle into global warming, the population should settle at ~3-4 billion, with ~80% of it being service and maintenance workers, and the rest as the controlling elite.
After technology removes another 10-15% of jobs, and we settle into global warming, the population should settle at ~3-4 billion, with ~80% of it being service and maintenance workers, and the rest as the controlling elite.
Except that wealth is consolidating into the cities where you can't hide from poverty within gated communities.
You'd be surprised.
Not sure what you mean by "hide", but you can sure avoid it. You can even have the worst slums next to incredibly luxurious millionaire houses -- like in India for example, without ever bothering to cross paths.
(An urbanist called Mike Davis has written some very important books on the subject I can recommend, e.g. concerning closed communities in LA, modern slums, privatisation of parts of public urban space to keep the poor out, etc.).
Not sure what you mean by "hide", but you can sure avoid it. You can even have the worst slums next to incredibly luxurious millionaire houses -- like in India for example, without ever bothering to cross paths.
(An urbanist called Mike Davis has written some very important books on the subject I can recommend, e.g. concerning closed communities in LA, modern slums, privatisation of parts of public urban space to keep the poor out, etc.).
Sure you can. They're doing such a good job that you didn't notice them.
It's heavy handed, but the movie Elysium portrayed this well. It's a dark timeline indeed.
...or another B- summer block-buster starring Matt Damon?
Spaceships and space-colonies aside, Elysium, for many people in the developing world is more everyday reality than a sci-fi blockbuster.
This, if correctly publicized, would be the best motivation in getting huge amounts of people to stop.
Think of a slogan like "Only the poor still smoke" or "it's what losers do" and how it would impact people. Suddenly you'd be embarrassed of being seen smoking.
Think of a slogan like "Only the poor still smoke" or "it's what losers do" and how it would impact people. Suddenly you'd be embarrassed of being seen smoking.
Uh, what? I know I'm a poor loser, and all the poor losers I know, know we're poor losers. We don't exist in an arena where that's embarrassing. That's just you lot.
That's already more or less the attitude that prevails among those of moderate to high socioeconomic standing. Making it official doesn't seem likely to change anything, especially in light of the fact that you don't really find a lot of cases in which people from different situations mix like that - it's pretty difficult for social opprobrium to exert much pressure upon people who never actually experience firsthand because they're never around those who would express it, or vice versa.
Quite aside from which, as I mentioned before, this is already pretty much the attitude, and the natural response to contempt is resentment. I've gotten any number of sidelong looks and smartassed comments from people who seem to find it a trespass upon their persons that I happen to be smoking within their eyeshot, and I can't say it has made me any more inclined to quit than the perceptible effects of maintaining the habit already do.
Quite aside from which, as I mentioned before, this is already pretty much the attitude, and the natural response to contempt is resentment. I've gotten any number of sidelong looks and smartassed comments from people who seem to find it a trespass upon their persons that I happen to be smoking within their eyeshot, and I can't say it has made me any more inclined to quit than the perceptible effects of maintaining the habit already do.
What a completely tone-deaf, condescending position.
I don't think so. You're talking about a class of people who have been beaten up so much by society for being poor, that I think most will look at that sign and go "yeah no shit" and light up again. Followed by a few more choice words at you and the sign.
>Suddenly you'd be embarrassed of being seen smoking.
Or, you know, even more determined than ever to smoke.
Psychology is not that simple.
(Some english guy, don't remember who, described the same reaction when someone like Princess Diana was on TV telling people to "Say no to drugs").
Or, you know, even more determined than ever to smoke.
Psychology is not that simple.
(Some english guy, don't remember who, described the same reaction when someone like Princess Diana was on TV telling people to "Say no to drugs").
Who do you think would think fund the "Only the poor still smoke" campaign? It looks really bad from a PR perspective.
That is like body shaming someone for eating junk food.
They know they are poor, everyone can see that they are poor, no need to point it out.
They know they are poor, everyone can see that they are poor, no need to point it out.
Or how about a mandatory message like "drinking may decrease libido" on every alcohol-related commercial?
I don't think so. You are correct that there are a large number of people who don't want the social stigma of being poor etc., but for many they see it as one of the few pleasures they can still have. To these people, they smoke, most of their friends and family smoke, and life is a struggle on a day to day basis. To them calling them a loser doesn't shame them, it just makes them more angry towards you.
(Mis-)Quoting John Steinbeck, "the poor see themselves not as an exploited proletariat, but as temporarily embarrassed millionaires".
This can be a powerful driver. And if it gets people to stop smoking, which is a devastatingly unhealthy habit, well, I'm ok with that.
This can be a powerful driver. And if it gets people to stop smoking, which is a devastatingly unhealthy habit, well, I'm ok with that.
But it will help a lot for the remaining ~10% or so of middle class people who smoke, to quit.
I once spent a night in the home of an elderly very poor couple on Tenerife, because they offered some sort of service where the husband would fetch people from the ferry, and bring them to the airport the next day. They were so kind. He was near mentally challenged, a super sweet guy working as a garbage man there, so they could just barely afford it. They lived there because she had horrible arthritis and the climate there was the only thing that had ever helped. They had basically no friends there, lived in a poor village in some outskirts, the broken down look over your shoulder kind.
And I still remember how she offered, just to be hospitable, some watered down fruit juice with like just a whiff of alcohol, and how she pointed to her super cheap cigarettes and said with a voice that was so full of cynicism and despair at the same time, that this was her only pleasure. I still remember that voice, the look her face had at that second, some kind of snarl -- not against me, they were so kind to me.. but against her fate I guess, and/or herself. It's impossible for me to describe, but indelible. Like all that misery, that is mostly pent up and that will follow her into the grave, escaping a bit in a short hiss. There is a German saying, to make a good face in a bad situation, and for just a split second, her face stopped doing that altogether, and I will never forget. God forbid that I do.
None of what I'm writing makes sense to anyone I'm sure, but I so wish I could describe the pang I felt then -- and the pang I felt just now, reading the suggestion that, basically, "they" are beyond help anyway, so let's make advertisements shaming people for smoking, so that those who still have something to lose might fear to be associated with those who don't. Would you also say this in the presence of "the" poor? If I could make one invention, it would be something that swaps the brains of humans around every 5 years, completely randomly. People would sober up rather quickly I'm sure.
And I still remember how she offered, just to be hospitable, some watered down fruit juice with like just a whiff of alcohol, and how she pointed to her super cheap cigarettes and said with a voice that was so full of cynicism and despair at the same time, that this was her only pleasure. I still remember that voice, the look her face had at that second, some kind of snarl -- not against me, they were so kind to me.. but against her fate I guess, and/or herself. It's impossible for me to describe, but indelible. Like all that misery, that is mostly pent up and that will follow her into the grave, escaping a bit in a short hiss. There is a German saying, to make a good face in a bad situation, and for just a split second, her face stopped doing that altogether, and I will never forget. God forbid that I do.
None of what I'm writing makes sense to anyone I'm sure, but I so wish I could describe the pang I felt then -- and the pang I felt just now, reading the suggestion that, basically, "they" are beyond help anyway, so let's make advertisements shaming people for smoking, so that those who still have something to lose might fear to be associated with those who don't. Would you also say this in the presence of "the" poor? If I could make one invention, it would be something that swaps the brains of humans around every 5 years, completely randomly. People would sober up rather quickly I'm sure.
> If I could make one invention, it would be something that swaps the brains of humans around every 5 years, completely randomly. People would sober up rather quickly I'm sure.
A variation on that is that the world where you have no control over who you will be in it is the world that you should strive to create.
A variation on that is that the world where you have no control over who you will be in it is the world that you should strive to create.
We already live in that world though, we just pretend we "made" our lives more than lucking into them. I guess some aspects of some religions are attempts to correct that, not in the least the belief in reincarnation. But one way to reach every last holdout would be to make it so.
And a way to simulate it is social pressure I guess. That's what empathy is for, and why sometimes indignation is "righteous". Though in this case, I didn't mean my post so much as finger pointing, maybe it started with that impulse but I wouldn't want to "use" this anecdote for that, after all it was something that made and makes me deeply ashamed of how lightly I take all my luck and my wealth. In a good but still a bitter way that I insist is necessary. It only feels really bad as long as one isn't actively working on helping in some way, after all.
As long as someone isn't free, we're not free. No man is an island, and all that. I don't mean socialism, as long as everybody has dignity and basic necessities, I don't care if someone has a private space ship; I mean just not trampling on the little and the weak and the unfortunate. An idea that shouldn't just be admired as noble, but implemented thoroughly, while writing tests for it. Upgrade it from warning to error, yesterday preferably.
And a way to simulate it is social pressure I guess. That's what empathy is for, and why sometimes indignation is "righteous". Though in this case, I didn't mean my post so much as finger pointing, maybe it started with that impulse but I wouldn't want to "use" this anecdote for that, after all it was something that made and makes me deeply ashamed of how lightly I take all my luck and my wealth. In a good but still a bitter way that I insist is necessary. It only feels really bad as long as one isn't actively working on helping in some way, after all.
As long as someone isn't free, we're not free. No man is an island, and all that. I don't mean socialism, as long as everybody has dignity and basic necessities, I don't care if someone has a private space ship; I mean just not trampling on the little and the weak and the unfortunate. An idea that shouldn't just be admired as noble, but implemented thoroughly, while writing tests for it. Upgrade it from warning to error, yesterday preferably.
This is called "Veil of ignorance". [1]
[1] https://en.wikipedia.org/wiki/Veil_of_ignorance
[1] https://en.wikipedia.org/wiki/Veil_of_ignorance
Thank you! I never realized it had a formal description.
so when the poor eat the rich and middle classes at least the meat will be of higher quality?
Sadly enough, the poor never eat the middle and upper classes. The upper and the middle may switch and inconvenience the other for a time, but the poor will always be the poor. They never get to go anywhere.
Really can't tell if this is sarcasm or someone who just missed the entire US presidential cycle.
[deleted]
There might be something there with economics, but a government (or any authority) calling people losers I doubt would have any effect.
The "drugs aren't cool" campaign's have never really worked.
The "drugs aren't cool" campaign's have never really worked.
Hahaha, this reminded me of a The Onion video.
I'm sure it would eliminate smoking among kids almost entirely; https://www.youtube.com/watch?v=HjsSVCLxcZ4
I'm sure it would eliminate smoking among kids almost entirely; https://www.youtube.com/watch?v=HjsSVCLxcZ4
Fat shaming works too.
Outstanding! And maybe we can call them "deplorables", because that worked so well last fall.
Some of those anti-tobacco (I'm blanking on the name) commercials targeted at teens/kids use this approach. I forget the actual line, but they mention something about how smokers make less money .. anyone have a link?
Prohibition makes things edgier and cooler, it only makes people want to do it more. Pretty sure there are places that legalized drugs and usage rates went down.
But this isn't prohibition - tobacco products are still for sale (except to minors, where the mechanism you mention definitely is at play).
It's just building a social stigma about the use of the product - which happens to be based on facts.
It's just building a social stigma about the use of the product - which happens to be based on facts.
Doesn't mention e-cigarettes. Hmm.
The smoking cessation class teacher they referenced in the article really made me cringe. She seems like a very positive person, but her ideas about how to quit smoking just seem so very misdirected. I wonder if she has smoked in the past and quit herself?
She's not relating to the people she's trying to help. It's like a wealthy person trying to reason with a poor person.
>“People down here smoke because of the stress in their life,” Seals said. “They smoke because of money problems, family problems. It’s the one thing they have control over. The one thing that makes them feel better. And you want them to give that up? It’s the toughest thing in the world.”
I'm sorry but this is facile. "Stress" and "problems" cause people to smoke only in the broadest sense of the word "cause". Something else is at work, here, and my hunch is that it's cultural. I've found that in much of blue-collar America, smoking is something of a status symbol.
I'm sorry but this is facile. "Stress" and "problems" cause people to smoke only in the broadest sense of the word "cause". Something else is at work, here, and my hunch is that it's cultural. I've found that in much of blue-collar America, smoking is something of a status symbol.
> Cigarette companies are focusing their marketing on lower socioeconomic communities to retain their customer base, researchers say.
> Advocacy groups say funding for smoking cessation is dropping
It seems like an uphill battle to let the tobacco industry tell everyone to smoke, and then try and undo that with anti-smoking campaigns. Is there a reason we can't rein in or eliminate tobacco advertising?
> Advocacy groups say funding for smoking cessation is dropping
It seems like an uphill battle to let the tobacco industry tell everyone to smoke, and then try and undo that with anti-smoking campaigns. Is there a reason we can't rein in or eliminate tobacco advertising?
Seems to me like that's a Freedom of Speech issue.
Case law has established that commercial speech is not the same as other speech and is much more prone to restrictions.
Yep. Short of making tobacco illegal or declaring it to be in a drug class that can't advertise to the public I'm not such there is anything that can be done except consent decrees.
Is is reined in. No ads on TV, for example
I lost my father to lung cancer.
What always puzzles me is if the lower socioeconomic class is disproportionately affected by smoking and money issues, why are sin taxes the only political solution?
Some interesting fact on the quitting front, there are some vape shops that actually help people quit by gradually lowering the amount of nicotine over time.
What always puzzles me is if the lower socioeconomic class is disproportionately affected by smoking and money issues, why are sin taxes the only political solution?
Some interesting fact on the quitting front, there are some vape shops that actually help people quit by gradually lowering the amount of nicotine over time.
It seems smoking could be strongly correlated with the growing life expectancy disparity.
Well, duh. Anyone with their head out of their ass for the past 15 years would have noticed that.
In the documentary, "A Billion Lives", the former spokesman for Winston says he was told by tobacco executives (who did not smoke) that smoking is for "the poor, the black, the young, and the stupid".
This reminds me of the line from The Godfather when the New York mob families are getting into the drug trade, discussing the distastefulness of the business, "In my city, we would keep the traffic in the dark people - the colored. They're animals anyway, so let them lose their souls."
It's much easier to profit of someone else's suffering if you convince yourself of their inhumanity or otherness.
It's much easier to profit of someone else's suffering if you convince yourself of their inhumanity or otherness.
Can you speak to the quality of the documentary at all? That sounds fascinating/worth watching.
would add to that, perhaps, "and for foreigners". Tobacco sales in developing countries are huge. China alone keeps them in so much profit that almost don't care what happens in America.
I think people in developing countries would count as "poor" under this executive's analysis.
Years ago my mother had me buy her a carton. She does not smoke, but was traveling to the 3rd world, and used them as currency; American cigarettes were like gold. Need to hail a taxi? Hold up a pack of American cigarettes.
One of the things that surprised me in Germany was the extremely high smoking rate. Apparently the adult smoking rate is between 40-45%. My experience was that it is by no means limited to poor people either. It was really surprising to me to see a country which presents itself as a modern, progressive force in the world having cigarette vending machines on almost every street in the country.
To contrast, I was recently in South Africa at a wedding full of people of all ages (all white, though). We noted that out of 100+ guests only 2 were smokers. A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%. It's interesting because it shows more of a race divide rather than class divide.
To contrast, I was recently in South Africa at a wedding full of people of all ages (all white, though). We noted that out of 100+ guests only 2 were smokers. A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%. It's interesting because it shows more of a race divide rather than class divide.
> It was really surprising to me to see a country which presents itself as a modern, progressive force in the world having cigarette vending machines on almost every street in the country.
This surprised me, too, the first time I went. Seeing 12 year olds smoking in public spaces was really, really bizarre. The only logical conclusion is that the German government and/or populace simply doesn't care about reducing cigarette usage.
> A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%.
What are "coloureds" in this context? Typically blacks would be categorized as "colored".
This surprised me, too, the first time I went. Seeing 12 year olds smoking in public spaces was really, really bizarre. The only logical conclusion is that the German government and/or populace simply doesn't care about reducing cigarette usage.
> A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%.
What are "coloureds" in this context? Typically blacks would be categorized as "colored".
Coloured, not colored: https://en.wikipedia.org/wiki/Coloureds
I wasn't aware of this ethnic grouping. Thanks.
South Africa has some very specific definitions[1] for this type of thing.
[1] https://en.wikipedia.org/wiki/Coloureds
[1] https://en.wikipedia.org/wiki/Coloureds
Thanks. :)
They still have cigarette vending machines. In Canada I don't think I've seen one since the early eighties.
[deleted]
> A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%.
Worth knowing that "colored" is a loaded term in American vernacular, and may provoke strongly negative responses depending on context - I know that's not how you're using it, but many would not, and might take it amiss therefore. "Black" is a denotative equivalent lacking the same connotations, and what I'd recommend using instead in discourse with predominantly American interlocutors.
To your point, I gather there's a class divide along racial lines in South Africa, just as (albeit more sharply defined than) in the US, and would wonder whether that's more where the correlation lies. I think it must be here - that's my observation, at least, anecdotal though it be.
Worth knowing that "colored" is a loaded term in American vernacular, and may provoke strongly negative responses depending on context - I know that's not how you're using it, but many would not, and might take it amiss therefore. "Black" is a denotative equivalent lacking the same connotations, and what I'd recommend using instead in discourse with predominantly American interlocutors.
To your point, I gather there's a class divide along racial lines in South Africa, just as (albeit more sharply defined than) in the US, and would wonder whether that's more where the correlation lies. I think it must be here - that's my observation, at least, anecdotal though it be.
You misread my post. Black and coloured is not the same thing in South Africa. Coloured has a significantly higher rate than other ethnic groups (black and white). The clash with American terminology is unfortunate, but in this case there is no alternative.
They didn't misread it, they were trying to give you a heads-up.
As an American I didn't know "colored" was used in South Africa and other than context I wouldn't have know that it was distinct from black. I'd be curious to know the difference.
In the US "colored" is an old and derogatory term for black. So your sentence reads like "X and Y are this, but Y is that" where one of the Ys is a word that isn't used.
I don't think they were trying to be mean or attack you, just give you a heads up on how many/most of HN may (miss)interpret your comment.
As an American I didn't know "colored" was used in South Africa and other than context I wouldn't have know that it was distinct from black. I'd be curious to know the difference.
In the US "colored" is an old and derogatory term for black. So your sentence reads like "X and Y are this, but Y is that" where one of the Ys is a word that isn't used.
I don't think they were trying to be mean or attack you, just give you a heads up on how many/most of HN may (miss)interpret your comment.
That's exactly right. Thanks for clarifying.
Mixed-race might work?
Or you could make the effort to understand the American terminology for racial categories isn't universal.
I do. Many don't.
I don't think your numbers for Germany are right. According to [1], the rate is 25% for people aged 15+. It's twice as high for people of low social status compared than people of high social status [2].
[1] https://en.wikipedia.org/wiki/Smoking_in_Germany [2] http://edoc.rki.de/oa/articles/reEi8wDOV3B1g/PDF/25UH9cUwefu... page 4
[1] https://en.wikipedia.org/wiki/Smoking_in_Germany [2] http://edoc.rki.de/oa/articles/reEi8wDOV3B1g/PDF/25UH9cUwefu... page 4
It's about what government can do to promote against smoking. Anti smoking ads, anti smoking packaging laws, school exercises, etc about smoking over the years in Australia have led to a rapid decrease in smokers over there.
Regarding your last point, how do you know that it's not also a class divide? I wouldn't be surprised if South African blacks were more impoverished overall.
Blacks and coloureds tend to be more poor. But maybe many of the blacks are too poor to smoke, while the coloureds are not so poor, but still as poor as a poor American.
As of roughly 5 or more years ago, half of tobacco consumed in the US is by people who are mentally ill and/or substance abusers. For example, people with Schizophrenia are heavy smokers and 90% smoke. Those with clinical depression 60%. They are self-medicating for their underlying illness. We need to ensure that they are getting proper treatment.
Income Disparities in Absolute Cardiovascular Risk and Cardiovascular Risk Factors in the United States, 1999-2014 https://www.ncbi.nlm.nih.gov/pubmed/28593301
This study shows that in the 15 years studied, only the smoking rate of high income individuals has decreased from 14% to about 9%. Those at the poverty level or below has remained about 36.5% who are smokers (some of those will be the mentally ill and/or substance abusers) and middle income is about 24% who are smokers.
Former NYC Mayor Mike Bloomberg with his latest donation of $360 million in December, now donated a total of $960 billion to combat tobacco in low- and middle-income countries (e.g. China, Russia, Bangladesh, but also Turkey). Bill Gates added another $125 million.
The plan is to implement the World Health Organization's (WHO) MPOWER program which has been implemented in NYC since 2001. Raising the cost of tobacco has over half the effect of getting people to quit or never start. Also very important is banning smoking in public places and hard-hitting, scary, advertisements spending about $1 to $2 per capita. Clinical interventions such as doctors speaking with patients about quitting, providing nicotine replacement therapy, and telephone counseling support are also important. But most of the gains are from the public policy initiatives.
A frustration I have with the healthcare system in the US is that too little is sent on public health interventions such as MPOWER compared with the spending on clinical interventions. If you want to lower healthcare costs, ultimately more effort has to be put in public health interventions which is much more scalable and more effective than clinical interventions.
Under ObamaCare, smokers can be charged premiums 50% higher than non-smokers because the healthcare costs of smoking are so high, yet most insurance plans don't charge the premium nor does the ObamaCare let insurers really verify if someone is a non-smoker.
If you want to lower the high costs of healthcare, nationally implement MPOWER in the US as well as other public health interventions. ObamaCare made a huge mistake when they did not implement the tobacco tax policies of Canada, UK, France and other nations which have universal care which is pay for the healthcare partially with high tobacco taxes in the range $5 to $7 per pack or more. Our federal tax is about $1. Raising that of these other nations would result in tens of billions of dollars for paying for healthcare while helping people, especially the poor, to quit smoking.
Income Disparities in Absolute Cardiovascular Risk and Cardiovascular Risk Factors in the United States, 1999-2014 https://www.ncbi.nlm.nih.gov/pubmed/28593301
This study shows that in the 15 years studied, only the smoking rate of high income individuals has decreased from 14% to about 9%. Those at the poverty level or below has remained about 36.5% who are smokers (some of those will be the mentally ill and/or substance abusers) and middle income is about 24% who are smokers.
Former NYC Mayor Mike Bloomberg with his latest donation of $360 million in December, now donated a total of $960 billion to combat tobacco in low- and middle-income countries (e.g. China, Russia, Bangladesh, but also Turkey). Bill Gates added another $125 million.
The plan is to implement the World Health Organization's (WHO) MPOWER program which has been implemented in NYC since 2001. Raising the cost of tobacco has over half the effect of getting people to quit or never start. Also very important is banning smoking in public places and hard-hitting, scary, advertisements spending about $1 to $2 per capita. Clinical interventions such as doctors speaking with patients about quitting, providing nicotine replacement therapy, and telephone counseling support are also important. But most of the gains are from the public policy initiatives.
A frustration I have with the healthcare system in the US is that too little is sent on public health interventions such as MPOWER compared with the spending on clinical interventions. If you want to lower healthcare costs, ultimately more effort has to be put in public health interventions which is much more scalable and more effective than clinical interventions.
Under ObamaCare, smokers can be charged premiums 50% higher than non-smokers because the healthcare costs of smoking are so high, yet most insurance plans don't charge the premium nor does the ObamaCare let insurers really verify if someone is a non-smoker.
If you want to lower the high costs of healthcare, nationally implement MPOWER in the US as well as other public health interventions. ObamaCare made a huge mistake when they did not implement the tobacco tax policies of Canada, UK, France and other nations which have universal care which is pay for the healthcare partially with high tobacco taxes in the range $5 to $7 per pack or more. Our federal tax is about $1. Raising that of these other nations would result in tens of billions of dollars for paying for healthcare while helping people, especially the poor, to quit smoking.
They are self medicating because there is no proper treatment. We can roll the dice with treating mental illness, but it's not very consistent or reliable and often produces undesirable side effects. At least, that's what I've seen when family members have gone to psychiatrists to treat various things.
Well, there are many levels and types of mental illness and in some cases, people aren't even aware that they have it. What I know is that there is more that we can be doing today to help those who have mental illness, both in terms of diagnosing those who don't know they have it and treatment (both therapy and pharmacologic) for those that are diagnosed.
> Raising the cost of tobacco has over half the effect of getting people to quit or never start. Also very important is banning smoking in public places and hard-hitting, scary, advertisements spending about $1 to $2 per capita. Clinical interventions such as doctors speaking with patients about quitting, providing nicotine replacement therapy, and telephone counseling support are also important. But most of the gains are from the public policy initiatives.
Statistically, empirically, which of those things actually work? I've heard time and time again that scary ads don't seem to do a damn thing, while raising prices actually seems to have an overly large impact.
Statistically, empirically, which of those things actually work? I've heard time and time again that scary ads don't seem to do a damn thing, while raising prices actually seems to have an overly large impact.
This article co-authored by NYC's then Health Commissioner and Mayor Bloomberg (which I believe is a free download) provides the evidence of the various interventions along with footnotes.
http://www.thelancet.com/article/S0140-6736(07)60782-X/abstr...
> I've heard time and time again that scary ads don't seem to do a damn thing
Whenever the TV ads are run, a number of people call to quit. Dr. Frieden has given sworn testimony how cost effective the TV ads are.
http://www.thelancet.com/article/S0140-6736(07)60782-X/abstr...
> I've heard time and time again that scary ads don't seem to do a damn thing
Whenever the TV ads are run, a number of people call to quit. Dr. Frieden has given sworn testimony how cost effective the TV ads are.
Sworn testimony is anecdotal. And while anecdotal evidence does have some credence, it doesn't beat a real study.
Frieden and Bloomberg are very, very data driven. He provided data to back up his statements. He showed the cost/benefit analysis.
Also, the Frieden, Bloomberg article I cited has additional information from a Lancet peer-reviewed article.
Also, the Frieden, Bloomberg article I cited has additional information from a Lancet peer-reviewed article.
High tobacco taxes killed Eric Garner.
Raising prices in poor countries with unaccountable Governments smells a lot like serfdom. We should give to the world's poorest before we pick their pockets.
Raising prices in poor countries with unaccountable Governments smells a lot like serfdom. We should give to the world's poorest before we pick their pockets.
> High tobacco taxes killed Eric Garner.
No, thuggish police killed Eric Garner. He was just doing basic arbitrage on tobacco tax differentials.
No, thuggish police killed Eric Garner. He was just doing basic arbitrage on tobacco tax differentials.
[deleted]
anovikov(7)
since poor people have shitty or no jobs at all, why does it matter if they die off of smoking?
I understand that this comment may be an expression of exasperation, but please post civilly and substantively on HN or not at all.
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
Nice pay wall
I wish! If there's any publication we could stand to read less of, it's WaPo.
Short term gratification vs. long term thinking may be a common factor in both smoking and poverty.
Perhaps in the past more rich smoked because it wasn't so manifest how bad smoking was for a person.
Also culture. In more well off circles being a smoker may raise an eyebrow or two now as opposed to the past.
Perhaps in the past more rich smoked because it wasn't so manifest how bad smoking was for a person.
Also culture. In more well off circles being a smoker may raise an eyebrow or two now as opposed to the past.
Also, the pleasures available to the impoverished are by definition fewer and smaller than the wealthy. Cigarettes should appear undesirable by those than can easily afford superior enjoyable experiences. A pack of cigarettes is one of the most luxurious pleasures available if all you have is $5.
The poor aren't stupid. They are just making the best of poor hand they were dealt.