BU epidemiologist says good-news smoking stats are a smoke screen

The good news, according to a study released last month by the National Association of Attorneys General (NAAG), is that cigarette sales in the United States dropped 4.2 percent in 2005 and have declined more than 20 percent since tobacco companies reached a $246 billion settlement with 46 states in 1998. The bad news, according to health researcher Michael Siegel, a School of Public Health associate professor, is that the good news is not as good as it could have been. Siegel, who has served as an expert witness in several major tobacco litigation cases, insists that the drop in tobacco sales would be far greater if the case against Big Tobacco had not been settled, and the 46 separate state lawsuits had gone to court. If those cases had proceeded, he says, tobacco companies would have been forced to raise prices even more to reimburse the states for expenses related to the treatment of smoking-related illnesses.

Siegel’s research has included the health effects of secondhand smoke, evaluations of tobacco-control policies, and studies on cigarette advertising and marketing practices and their impact on youth. In 2000, he published a report on research conducted with scientists at the University of Massachusetts–Boston that found that youngsters exposed to the state’s antitobacco ads are half as likely to start smoking than those who haven’t seen the commercials. Each semester Siegel and Ed Carfano, an SPH adjunct professor and a film producer, teach graduate students how to conduct effective mass communication campaigns to confront public health issues, including tobacco use. BU Today talked with Siegel about the real meaning of the recently released NAAG study and the progress being made in efforts to curb smoking, both nationally and locally.

BU Today: NAAG attributes the national decline in smoking to its Master Settlement Agreement (MSA) with the cigarette industry. Do you think it was much of a factor?

Michael Siegel: It is likely that a significant part of the decline in cigarette consumption was attributable to the price increases that occurred in association with the payments required by the Master Settlement Agreement. But I suspect that part of it was also due to the proliferation of smoking bans in the workplace, including bars and restaurants, which have been shown to decrease cigarette consumption. There is good evidence that the bans played a role, and the spread of those laws is something for which the NAAG cannot take credit. The rest of the story is that cigarette consumption in the United States has dropped every year since 1980. So the announcement that it dropped sharply last year means very little. They should have said that smoking has declined every year for the past quarter-century. You simply can’t look at overall trends in cigarette use and credibly make claims about specific factors that are affecting the changes in consumption without doing a careful, rigorous analysis that attempts to account for a large number of factors that influence cigarette consumption.

What about higher cigarette prices and taxes? You have been critical of the settlement, but didn’t it result in increasing the cost of cigarettes, thereby reducing demand?

Yes, it did. I think it did result in cigarette price increases, which contributed towards reducing cigarette consumption. However, to evaluate whether the settlement was actually a wise policy decision, one would have to determine whether or not the result that has occurred with the settlement is better than what would have occurred without it. Without it, we would have had 46 separate state lawsuits against the tobacco industry. There is no doubt in my mind that the costs of litigating 46 separate lawsuits would have been far worse for the companies, both financially and in terms of unfavorable public opinion and bad publicity, than occurred with the MSA. This is why I think the companies were so anxious to reach a settlement of this litigation. In addition, it created economic predictability. The companies know how much they owe and when they owe it. With 46 state lawsuits, they would have complete unpredictability. This would have hurt their stock prices and forced them to increase prices even more than they did with the MSA in place.

You published a report with researchers at UMass-Boston that found that young people exposed to antismoking ads are half as likely to pick up the habit than those who don’t see them. Are you disappointed with Massachusetts spending $4.2 million on tobacco control programs — which would include advertising — in fiscal year 2006, compared to $48 million four years ago?

Definitely. It’s tragic that the state has cut funding to a program that was one of the most important and effective public health interventions ever. More importantly, the voters mandated that the money be used for tobacco education and prevention programs. So it is dishonoring the wishes of state voters to ignore this mandate and divert the money to other causes.

With decreased funding for antismoking programs, do you think the state will lose ground in its fight to reduce deaths from smoking-related cancer and heart disease?

There’s no question about it. You get what you pay for. If you cut funding for antismoking programs, you are going to lose ground in efforts to reduce smoking rates, which ultimately will translate into increased deaths from preventable cancer and heart disease.

Do you see the federal government meeting its goal of cutting smoking rates to 12 percent by 2010?

No way. We’re still at around 20 percent, and there’s no way we’ll get down to 12 percent in another four years, especially since the MSA has created a scheme in which the states must protect Big Tobacco’s profits. They cannot take any significant policy actions that might risk reducing their MSA payments by seriously impeding upon cigarette sales.