Features, Science

Beyond the nicotine: Q&A with tobacco control expert Michael Siegel

Boston University School of Public Health Professor Michael Siegel said Massachusetts should keep revenue from cigarette taxes focused on anti-smoking programs. PHOTO COURTESY OF MICHAEL SIEGEL
Boston University School of Public Health Professor Michael Siegel said Massachusetts should keep revenue from cigarette taxes focused on anti-smoking programs. PHOTO COURTESY OF MICHAEL SIEGEL

It’s Lung Cancer Awareness Month, and to shed light on the possible perils of smoking, The Daily Free Press spoke with Michael Siegel, a physician and professor of community health sciences at the Boston University School of Public Health.

Siegel, whose research specializes in tobacco use and cigarette marketing, talked about the social climates that shape nicotine addiction.

The Daily Free Press: Is smoking still a huge public health concern nowadays?

Michael Siegel: Absolutely. It is still the number one preventable cause of death. It still causes more than 400,000 deaths per year in the United States. So yes. Absolutely. It should be a top public health priority.

FreeP: Why are people inclined to smoke nowadays?

Siegel: The role of cigarette advertising and marketing is critical. Cigarette advertising plays a crucial role in getting people to associate smoking with positive images: identity, core values, rebellion and independence. Marketing is a huge part of it. Social norms also play a role. When people see other people smoking…that has a big effect as well. It’s a combination of social influences, the [impact of] media and marketing.

FreeP: Could you describe a specific advertisement relating to tobacco that stands out to you?

Siegel: If you just look at the whole Marlboro campaign — the Marlboro Man. The Marlboro man is a cowboy. [He’s] a symbol of individualism, freedom and rugged independence. That’s what Marlboro is all about. It’s selling freedom. That’s a very appealing core value to adolescents. That’s a great example of an advertising campaign designed to appeal to youth.

FreeP: Do you think the younger generation is more targeted?

Siegel: It [the advertising] targets the whole population. Freedom is a core value that is important for everyone. It just especially speaks to younger people because they don’t like to be controlled.

FreeP: What makes tobacco addicting and how does it affect the body?

Siegel: There are a few things that make it addicting. The first is the nicotine, a highly addictive drug. The second is the repetitive behaviors and associations that go with smoking. There’s a hand motion and an oral sensation, a throat sensation and simple associations with different behaviors. In terms of how if affects the body, smoking causes a host of diseases. The major categories are chronic lung disease, heart disease, stroke and cancer.

FreeP: Are there any developing methods or technologies that make addictions easier to reverse?

Siegel: Absolutely. There’s a new product called electronic cigarettes. Basically, they look like cigarettes, but they don’t contain any tobacco. They deliver nicotine, but without the tens of thousands of other chemicals. Many thousands of smokers have successfully quit [smoking by] using these devices. These devices certainly have the potential to make in-roads into smoking addictions like we’ve never seen before.

FreeP: Would you say they [electronic cigarettes] reverse addiction to smoking?

Siegel: They address the behavioral aspects of the addiction. Unlike a nicotine patch, which can only address the drug component, electronic cigarettes address behavior components. You use it, hold it, blow on it and inhale from it like a cigarette. Because it mimics the behavior, it goes a long way to satisfying peoples’ addiction and allows them to get off cigarettes.

FreeP: Are e-cigs harmful to the body though?

Siegel: There still needs to be more research to find out exactly what the ramifications are, but it is seen to be much safer than smoking. The question is whether there might be chronic risks from long-term use over many years, and that’s something we don’t know yet.

FreeP: WalletHub just released their 2014 “Best and Worst” rankings regarding state smoking standards. According to the list, Massachusetts has the 5th highest average price for cigarettes. Does this policy strategy of increasing prices work?

Siegel: Absolutely. There’s very strong evidence that increasing the price of cigarettes decreases cigarette consumption. That’s one of the most effective interventions that can be done to reduce smoking among youths and adults. The higher the cigarette price, the less people smoke. It’s a very clear relationship.

FreeP: What do you think this ranking says about Massachusetts as a whole in relation to cigarette policy?

Siegel: There have been a number of cigarette tax increases in Massachusetts. The problem is that originally, the money from the cigarette taxes was going towards anti-smoking programs. In recent years, legislators have diverted funding to other causes to fulfill budget shortfalls. That’s not a wise practice. First of all, I don’t think it’s fair that smokers should have to shoulder the burden of balancing the budget. If we are going to tax smokers, at least the benefits from revenues should go to smokers. Money should go to anti-smoking and treatment programs.

One Comment

  1. It’s Lung Cancer Awareness month, yet your story focused 100% on smoking and told us nothing about lung cancer. Did you know that 15% of the people diagnosed with lung cancer today never smoked a single cigarette in their life? What’s worse, another 50% are people who stopped smoking–some of them decades ago. So the majority–65% of all new lung cancer cases–are not current smokers. Also, it seems to be a well-kept secret that the excess risk for smokers developing lung cancer hangs on for 20 years. What does this mean?

    For one thing, it means that the stigma associated with lung cancer is undeserved. Never-smokers did nothing to cause their own cancer, and the former smokers who struggled and succeeded in their fight to achieve abstinence, are punished anyway–first by the disease and second by society. The campaign created by the anti-tobacco industry to demonize smokers has worked so well that society seems to believe that anyone who gets lung cancer “brought it on himself.” That may be why lung cancer gets a fraction of the research dollars, despite being the Number 1 cancer killer.

    For another thing, it means that time is critical where smoking cessation is concerned. Some anti-tobacco groups are urging smokers to avoid e-cigarettes because “We aren’t sure they’re safe.” What we are sure of is that continuing to smoke is unsafe and that risk levels increase with the total number of cigarettes smoked. Countless numbers of smokers who tried every other method to quit in the past and failed have found success with e-cigarettes. So smokers don’t have time to wait around for scientists to declare e-cigarettes to be 100% safe. Advising smokers to avoid e-cigarettes is like telling people on a sinking ship to avoid getting into life rafts because they don’t have the Good Housekeeping Seal of Approval.