Nat sherman discount cigarette

The results of a 20-year, randomized, controlled trial demonstrate that physicians can be instrumental in lengthening the lives of middle-aged male smokers by advising them to quit smoking.(1) Most health care professionals, however, pay little attention to the cigarette brand a smoker prefers. In contrast, Dr. Alan Blum advocates a "consumerist" approach to encourage patients to stop smoking, beginning with the engaging question, "What brand do you buy?"(2)(3) This approach facilitates a mutually informative, relaxed dialogue between physicians and smokers.

Clinicians might take an interest in smokers' brands for many reasons. Brand selection could provide important information for health advocates and for physicians encouraging smokers to quit. For the following reasons, smokers' brands may deserve regular documentation.

The recent flurry of interest in cigarette additives brought the nearly unregulated status of cigarettes to the public's attention. The Federal Trade Commission (FTC) regulates the description of tar and nicotine content in cigarettes, but not the additives. Warning labels on cigarettes give no indication that the lack of industry supervision constitutes a risk beyond the "normal" risk of smoking. For instance, the tobacco industry has had many patents for cigarette components made with asbestos, the most infamous being the Kent "Micronite" filter of the 1950s.(4)(5) Current cigarette flavorings include secret mixtures of chocolate, vanilla, cinnamon and other "natural" ingredients with potentially unusual partial combustion products. American cigarette brands contain widely varying levels of heavy metals.(6) Foreign tobacco, now being blended into domestic cigarettes, can contain high levels of heavy metals.(7)

Consequently, smokers may incur unexpected and brand-specific smoking risks. To identify these risks, epidemiologists will benefit from prospectively collected information about brands and dates of use. If brand-specific risks are identified, physicians who include information about patients' brands in the medical record will be able to notify those patients proactively.

Smokers' brand selection can also alert physicians to misconceptions encouraged by the cigarette industry. Advertisements for some brands, such as Carltons, actually imply health benefits ("Carlton is Lowest. 1 mg tar, 0.1 mg nicotine"). How beneficial are low-tar cigarettes when it comes to lung cancer, coronary artery disease and emphysema?(8) To add to smokers' confusion, "light" versions of popular brands are only light in comparison to the original brand, and only when the tar and nicotine content is measured by the FTC method.

A major determinant of reported tar and nicotine delivery is the cigarette's filter, which smoking machines never occlude. In contrast, human smokers normally defeat the filter by occluding its pores. In fact, some nicotine-replacement dosing strategies ignore stated yields, estimating that all cigarettes deliver about 1 mg of nicotine per cigarette.(9) Most important, and contrary to public expectations, filtered cigarettes apparently do not change smokers' overall morbidity or mortality.(8)(10)(11) Cigarette filters may therefore deserve regulation as flawed medical devices.

Besides the personal risks of smoking, cigarettes can ignite many substrates, causing cigarettes to be the leading cause of fire fatalities.(12) Although the tobacco industry has long resisted calls for a fire-safe cigarette, the National Bureau of Standards reported in 1981 that three brands had relatively low potential for igniting furniture: Carlton (American Brands), More (RJ Reynolds) and Sherman's (Nat Sherman). Subsequent research, performed under government-sponsored efforts to develop a fire-safe cigarette, has been blinded to brand name but continues to demonstrate some differences in ignition propensity among brands.(13) Although all cigarettes will ignite many substrates, some brands may pose less fire risk than others.

Since the lay press discusses none of these issues, many smokers are confused about their exposure and risk. Physicians should prepare to educate patients about their cigarette choices, as well as smoking in general. Systematic brand documentation will also facilitate observational research into the evolution of smoking and smoking-related disease in patients and families.

Switching to a brand that a smoker doesn't enjoy is sometimes advocated as a step toward quitting.(14) A Salem smoker may respond, for example, by buying Newports or Kools. However, these are all filtered menthol cigarettes, and making such a change is a very modest switch. Unfiltered Camels, lacking both menthol and a filter, disgust most menthol smokers. Conversely, the menthol content of full-flavor Kools repulses most regular cigarette smokers. Smokers seldom take such dramatic steps but are impressed when physicians can predict which brands would prove distasteful to a patient who smokes.

For many smokers, saving money is an incentive to stop smoking, but smokers often underestimate the amount spent on cigarettes.(15) The cost of cigarettes varies considerably because of differences in state taxes and local mark-ups. A useful benchmark is that a pack a day, at $1.37 per pack, equals $500 per year. Knowing how many packs a smoker buys and the cost per pack allows a rapid estimate of the annual cash outlay. Smokers who buy discount brands (e.g. Basic, Doral, GPC, Prime, Private Stock, Summit) have chosen a relatively inexpensive smoking habit. These patients may be especially responsive to examining the annual and lifetime cost of smoking. Patients smoking premium brands, such as Camel, Marlboro, Virginia Slims and Winston, have chosen an expensive habit. These smokers may be less price-sensitive or may maintain brand loyalty for other reasons.

Proof-of-purchase programs encourage brand loyalty for many smokers who are otherwise price-sensitive. Grocery and convenience stores often display the latest "frequent-smoker" catalogs. These programs allow smokers to collect cigarette proofs of purchase and redeem them for merchandise, which often bears the brand logo. The retail value of a redeemed proof-of-purchase coupon varies from less than 10 cents to perhaps 50 cents, depending on the economic health of the company (Philip Morris is currently more prosperous than RJR-Nabisco). The cost of many items can be measured in pack-years.

The merchandise becomes an advertisement for the brand in the smoker's home, although participants will seldom anticipate the impact on family members, such as children. Many of the premium brands, such as Camel, Marlboro, Virginia Slims and Winston, promoted frequent-buyer catalogs in 1993 or 1994. Coupon collecting with cigarettes began long ago, as many Releigh smokers will recall. The new programs are notable for their stunning popularity, for promoting premium brands, for their relative invisibility to adult nonsmokers and for an impressive ability to drive cigarette volume and attract customers.

Participants enjoy these programs, but most recognize that the purchasing power of money saved after liberation from smoking will buy much more. Physicians presenting an economic argument to stop smoking should be prepared to inquire about incentive programs and to dispel misconceptions about their economic value to the company and the smoker.

Smokers live in a richly diverse world of brand-specific images, incentives and risks, which the medical profession generally does not anticipate in its health efforts to control tobacco use. Recording brand preferences of your patients who smoke is one easy step to take in helping them find their way out of this unhealthy world.

REFERENCES

(1.)Rose G, Colwell L. Randomised controlled trial of anti-smoking advice: final (20 year) results. J Epidemiol Community Health 1992; 46:75-7.

(2.)Blum A. Role of the health professional in ending the tobacco pandemic: clinic, classroom, and community. Monogr Natl Cancer Inst 1992; 12:37-43.

(3.)Blum A. Consumer advocacy: a crafty approach to counseling. Patient Care 1993; 27:80-3.

(4.)When "more doctors smoked Camels": cigarette advertising in the journal. N Y State J Med 1983; 83:1347-52.

(5.)Roemer R. Legislative action to combat the world tobacco epidemic. Geneva: World Health Organization, 1993:143.

(6.)Chiba M, Masironi R. Toxic and trace elements in tobacco and tobacco smoke. Bull World Health Organ 1992; 70:269-75.

(7.)Yue L. Cadmium in tobacco. Biomed Environ Sci 1992; 5:53-6.

(8.)Rickert WS. "Less hazardous" cigarettes: fact or fiction? N Y State J Med 1983; 83:1269-72.

(9.)Cooper TM, Clayton RR. Stop-smoking program using nicotine reduction therapy and behavior modification for heavy smokers. J Am Dent Assoc 1989; 118:47-51 [Published erratum appears in J Am Dent Assoc 1989; 118:274].

(10.)Miller GH. Filter or non-filter cigarettes: which is safer? J Breathing 1977; 40:6-13.