Friday, June 23, 2017

Smoking May Harm Mental Health

Research has documented a strong link between smoking and various mental health disorders, including anxiety, depression, schizophrenia and bipolar disorder.  The CDC advises that about 20% of American adults had some form of mental illness in 2009-2011, and the smoking rate for that group was 36%, in contrast to 21% for all others (here).

There is certainly an association, but there are four distinct possibilities with respect to causality:

·       Mental health problems cause people to smoke.
·       Smoking causes mental health problems.
·       Both pathways exist.
·       Neither pathway exists.

My economist colleague Dr. Nantaporn Plurphanswat is the lead author of an innovative analysis that identifies a potential causal pathway for mental illness and smoking; the work appears in the American Journal of Health Behavior (abstract here).  Our co-author is University of Illinois professor Dr. Robert Kaestner.  We used data from people in almost all states participating in the federal Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2010.  BRFSS collected information on smoking and asked participants “…for how many days during the past 30 days was your mental health [which includes stress, depression, and problems with emotions] not good?”

Recognizing that traditional approaches cannot identify a causal pathway between smoking and mental illness, Drs. Plurphanswat and Kaestner employed an instrumental variable approach, in which variation in smoking at the state level is strongly associated with cigarette excise taxes, but the excise taxes are completely unrelated to outcomes like mental health.  The IV analysis provides information on whether smoking leads to mental health problems, or vice versa.

Our results indicate that smoking may harm mental health: it is significantly associated with 14 or more days of poor mental health.  Most of the effect due to smoking is from large increases in the number of mentally unhealthy days and not by small increases among many smokers. 

The BRFSS data cannot tell us whether smoking is a form of self-medication practiced by those who suffer from specific mental health disorders.  However, our analysis confirms that smoking may contribute to anxiety, depression and emotional distress.  Thus, policies that reduce smoking may have a positive spill-over effect in improving mental health.


Friday, June 16, 2017

EU Snus Ban Costs More Lives

A new report from the Swedish Snus Commission underscores the accelerating human toll of the European Union’s unconscionable ban on smokeless tobacco: “…among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.”  Sweden is the only EU nation in which sales of snus are legal.

In 2009, epidemiologist Phil Cole and I, analyzing data from the World Health Organization and the International Agency for Research on Cancer, reported in the Scandinavian Journal of Public Health that 274,000 smoking-attributable deaths would be avoided if men throughout the EU had the smoking prevalence of men in Sweden (here).  Four years later, I updated that figure to 291,000 (here).       

The Snus Commission report, available here, was produced by a distinguished group of Swedes.  The commission’s chairman is Anders Milton, a physician and former President and Chairman of the Swedish Medical Association, President of the Swedish Confederation of Professional Associations from 1993 to 2001, and President of the Swedish Red Cross from 2002 to 2005.  His collaborators are Christina Bellander, a journalist who previously headed business development at Swedish TV4 and was a Board Member of New Wave Group AB, Mittmedia AB and the Swedish Educational Broadcasting Company; Göran Johnsson, a former member of the Social Democratic Party’s Executive Committee, Board Member of Volvo AB and Chairman of Swedish national television broadcaster SVT from 2011 to 2014; and Karl Olov Fagerström, a WHO-recognized nicotine and tobacco researcher who has authored 150 articles in peer reviewed journals.

The casualty list from the indefensible and immoral EU snus ban continues to grow. 

Thursday, June 8, 2017

The Swedish Miracle Continues

 A special report on tobacco and e-cigarettes published by Eurobarometer, the official polling organization of the 28-nation European Union (here), underscores the remarkable success of what researchers call “The Swedish Experience”.

According to the report, the prevalence of smoking in Sweden is just 7%, with no other EU country even remotely close.  UK prevalence is 17%, while only Denmark, the Netherlands, Belgium and Ireland are below 20%.  The prevalence of daily smoking in Sweden is a bare 5%, as shown in the chart at left (credit to Lars Ramstrom from Sweden), and the prevalence of former smoking is 41%, the EU’s highest by far. 

Eurobarometer provides an array of impressive statistics: “In all but one country, at least eight in ten (80%) of smokers consume tobacco products daily. The exception is Sweden, where only just over half (52%) give this response. In turn, over a fifth (21%) of smokers in Sweden are irregular smokers, consuming listed tobacco products less than monthly.  In all other countries, very few respondents give this answer.”

There is only one explanation for Sweden’s remarkable number: the popularity of snus, the sales of which are prohibited in all other EU nations.  The new report reveals that 20% of Swedes use snus daily.  The only other countries with daily smokeless use are Denmark (1%), home of Oliver Twist chewing tobacco pellets, and Finland (2%).

The Eurobarometer report should pressure the EU to end its snus ban.  Swedish Match has filed a complaint with the European Court of Justice to compel EU action.  For more on “the worst regulation in the EU,” see Clive Bates’ excellent commentaries, such as this (here).