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Episode #1707
Tobacco Use
Holloway: Jay Holloway,
Host
Jefferson: Delmonte Jefferson
Bondaron: Dr. Stuart Bondaron
Heddin: Dr. Saundra Heddin
Muller: Chip Muller
Taylor: James Taylor
Holloway: It's a well-known
killer, a contributor to three of the leading causes of death
in African Americans. We'll talk about the real dangers of
tobacco use and what's being done about it here in North Carolina
next on Black Issues Forum. You stay tuned.
Voiceover: This program
was made possible in part by contributions from UNC-TV viewers
like you.
[MUSIC]
Holloway: Good evening
and welcome to Black Issues Forum. I'm your host, Jay Holloway.
Tonight we hope to shed light on an element familiar to the
black community and talk about some very successful efforts
to neutralize its destructive influence. We're talking about
tobacco and there's no better group to help us understand
what's happening than the people who work with the North Carolina
Tobacco Prevention and Control Branch under the Department
of Public Health. I'd like to welcome Delmonte Jefferson,
director of their Youth Empowerment Program, and also Dr.
Stuart Bondaron, Dean Emeritus of the School of Medicine,
UNC-Chapel Hill. He's also on the Institute of Medicine's
National Academy of Science, the Commission on Assessment
of Tobacco Harm Reduction. And also by telephone today, we
have Dr. Saundra Heddin, Executive Director of the National
African American Tobacco Prevention Network and consultant
with the North Carolina Tobacco Prevention and Control Branch.
Is that correct, Dr. Heddin? Thank you so much for all of
you being with us today and to talk about a very important
topic. I want to talk about that, and also talk about, supposedly,
a safer cigarette and what can be done to combat some of these
problems here. Let's start with you, Delmonte. What are some
of the dangers? All of us think we know, but there really
are some serious dangers to all of us, but African Americans
are very much affected by this, too.
Jefferson: Yeah, as
we know, over 400,000 people every year are dying from tobacco-related
illnesses, and in particular in the United States, about 45,000
African Americans are being affected by this harmful disease.
What we're looking at is trying to find a way to effectively
address issues in the African American communities and looking
at disparities and those gaps. In particular, differences,
things such as lung cancer deaths. How come it's so high among
black males and not white males. So we're trying to identify
some disparities and address those gaps.
Holloway: You mentioned
45,000. That's quite a few. And also, in North Carolina, there
are a lot of people smoking, but the percentages are different.
What I may do is throw this graphic up, if we can, very quickly.
That in North Carolina, smoking in North Carolina, more than
25% of whites smoke in North Carolina. We saw that 45,000
that you mentioned earlier, there, but also, more than 27%
of blacks smoke and more than 28% of Hispanics smoke, and
these are figures in North Carolina. Let me move to you, Dr.
Bondaron. What have you seen over the years? There's this
institute, this commission, going on now, are you all looking
at that? What specific are you looking at?
Bondaron: Well, we
did summarize the total health burden of the use of tobacco
in the United States. Not by state, but by the country as
a whole. And, clearly, tobacco is one of the leading causes
of death, and disability, both, in this country. As Delmonte
said, it kills 400,000 people a year. Especially some of the
diseases that it kills people with, by, are those that the
black community is especially susceptible to. That includes
cancer of the lung, as Delmonte said. But it also includes,
for example, heart disease, and diabetes. Use of tobacco complicates
the heart disease, and diabetes, which is a major problem
for the black community. One of the health problems, which
is not as widely recognized, that tobacco causes, is low birth
weight babies. The infant mortality rate in the black community,
of course, is nearly double that in the white community, and
a large part of that is probably related to the use of tobacco.
There is no question that we could, that the main single thing
we could do to improve infant mortality in North Carolina,
especially, which has one of the highest infant mortality
rates in the country, is to cut down on the smoking of young,
black women.
Holloway: Okay, I want
to just show this graphic real briefly and then I want to
talk about this safer cigarette, here. Smoking is responsible
for about 87% of lung cancers in North Carolina. Actually,
that's the national, as well as North Carolina, I guess. African
American men are at least 50% more likely to develop lung
cancer than white men, and African American men have a higher
mortality rate of cancer of the lung and bronchus. So, actually,
there is a new, safer cigarette, some people are saying. Dr.
Heddin, I'm going to get you in this conversation in just
a second. But the dangers of tobacco use have opened up a
discussion of the creation of a "safer cigarette."
And now a safer cigarette product is actually being marketed.
Here's more about the safer cigarette from reporter, Chip
Muller. We'll be right back.
Muller: James Taylor
shows off a new cigarette that may point toward the future
of tobacco.
Taylor: It's the first
product that smokes, tastes, burns like a regular premium
cigarette, that offers reduced carcinogens, polycyclic ________
hydrocarbons, nitrocomines ________.
Muller: It's the first
cigarette from Vector Tobacco, a new company in the old Liggett
building in Durham. Vector will roll out the product nationwide
in October.
Taylor: We think it
really is a significant breakthrough in terms of tobacco products,
and we think it has the ability to change the destiny of cigarettes
as we're going forward. Now there's actually a reason to change
brands.
Muller: The prospect
of products and ads like these prompted the U.S. Food and
Drug Administration to ask a panel of experts for advice.
The federal committee was chaired by UNC Medical School professor,
Dr. Stuart Bondaron.
Bondaron: The committee
unanimously and completely judged on the basis of overwhelming
evidence, that there is not a safe cigarette. And the committee
could not imagine that there would ever be a safe cigarette.
The only safe thing to do is not smoke.
Muller: However, the
committee also made the startling conclusion, that reducing
the risk of disease is feasible. They said products which
reduce smokers' exposure to toxins, could have a beneficial
public health impact.
Bondaron: So if there're
going to be between 25 and 50 million people in this country
who continue to smoke, the burden of disease on that 25 to
50 million people, will be very substantial. And if it's possible,
by another product, to reduce that by 10 or 15 or 20 percent,
then one has saved a lot of lives.
Muller: Mark LeBrec
lights an Eclipse, the R. J. Reynolds cigarette he is paid
to promote. He says the cigarette may be less hazardous.
LeBrec: It may present
less risk of cancer, chronic bronchitis, possibly emphysema.
It reduces second hand smoke by 80% and has no lingering odor.
Muller: RJR says they
can make this claim because they took a bit of the smoke out
of the smokes. Most of the tobacco in Eclipse is heated, not
burned. The smoker lights a carbon heat source in the tip.
When the smoker takes a puff, the smoker draws very hot air
across the tobacco, picking up flavor, nicotine, glycerin,
according to the company, and very little smoke.
LeBrec: In the area
of chemistry, we've found, for example, about an 80% reduction
in the level of many carcinogens in smoke.
Muller: Ninety percent
fewer skin tumors in mice, according to corporate data. In
smokers, 70% less exposure to mutagens that may damage DNA,
and less inflammation in the lungs. Impressive data, but not
enough. Both RJR and Vector Tobacco say their new products
may pose less risk. We wanted to know by how much. Neither
Vector tobacco nor RJR would give us a specific figure.
LeBrec: You can't quantitate
the degree of risk, because there are no measures available
currently to allow scientists to do that.
Muller: In fact, neither
Vector nor RJR have the scientific evidence to make definitive,
positive health claims about their products.
LeBrec: The reason
we don't say that it does reduce the risk, is because there
are no tests that the scientific community agrees on that
would definitively prove that. There's no way, basically,
to prove that one cigarette is safer than another, beyond
a shadow of a doubt.
Muller: Vector's ads
for Omni, for instance, carry many messages-the surgeon general's
warning, suggestive slogans, and a second disclaimer, "reductions
in carcinogens have not been proven to result in a safer cigarette."
Taylor: Hey, we don't
think it's a safer cigarette and we don't think that it's
proven in medical terms at this point in time.
Malloy: This worries
me.
Muller: Meg Malloy
heads NC Prevention Partners, a group trying to improve the
health of North Carolina's citizens. She says more people
may start to smoke and fewer may try to quit, if advertising
makes cigarettes look less dangerous.
Malloy: Tobacco is
the number one killer of people in the western world. Even
though I think people know that already, we still have people
who smoke. So if you diminish that, and you take that fear
away, yes, I do think you'll have a greater negative impact.
Muller: Dr. Bondaron's
committee urges federal regulation of any tobacco product
which claims to be less dangerous, and wants the government
to set minimum scientific standards.
Holloway: We're talking
about smoking and it's harmful effects to North Carolinians,
and especially African Americans, and Dr. Heddin, we didn't
get a chance to have you comment before. But, what do you
think now about this supposedly safer cigarette? And even
one of the officials there says he's still not saying that
it's safer, but yet they're marketing it that way.
Heddin: Jay, I would
have to say, that there's no such thing as a safe cigarette.
We know that nicotine in tobacco is addictive and that people
who smoke over a long period of time, experience significant
health consequences. 400,000 of them per year die from these
illnesses, so we know that a cigarette, that tobacco, and
using it is not a safe thing to do. We also can say that there's
no way of predicting how the smoker will actually use a cigarette
that is designated to be safe. We know that when tobacco companies
made cigarettes that were low in tar and nicotine, and had
filters, we know that people who are addicted tend to compensate
by getting the amount of nicotine they need, no matter how
that's done. So that when people had filtered cigarettes that
were low tar, they simply inhaled more deeply, or covered
up the holes that were designed to ventilate the cigarette
and got the same amount of nicotine. So there's no prediction
that a cigarette that is designed to be safe, will actually
be used properly.
Holloway: Let's talk
about this addiction issue, here. It doesn't matter whether
you're a youth or an adult. If you start off as a youth, of
course, this addiction will take you right on through. I'd
like to get both of your reactions to this whole addiction
issue and the new cigarette, or the safer cigarette.
Jefferson: Well, Jay,
nicotine has a 90% addiction rate. As we listened to the report
about the safer cigarettes, no where did they say that they
work to reduce the amount of nicotine that was in cigarettes,
or that you would inhale into your system. They didn't want
to do that, of course, because even though it's supposedly
marketed as a safer cigarette, if you are addicted to the
product, you will still consume it at a higher rate. And like
Dr. Heddin said, you would compensate and you would find ways
to make up for that reduction that you felt wasn't nicotine.
There's no such thing as a safer cigarette. On some of the
warning labels that they had, they said it had reduced carcinogens.
It only takes one really cancer causing agent that can kill
you. Most cigarettes have up to 43 different cancer causing
agents. Just one can kill you, so if you reduced them, you
reduced them 40 from 43, you're still putting your life at
risk.
Holloway: Dr. Bondaron,
you said to me before the program, even all those different
additives there, or different things that cause cancer, that
it actually changes based on the temperature of the cigarette,
or how frequently you puff, and that kind of thing.
Bondaron: Yes, tobacco
smoke typically has something like 3 or 4 thousand different
chemical compounds in it and they change. The chemical compounds
are produced by burning, and so the temperature at which the
tobacco is burned determines exactly which chemical compounds
come out in the smoke. So that by puffing faster or slower,
you can burn the cigarette hotter or cooler, and change the
mixture. That's the basis for the Eclipse, which was pointed
out in the film clip, heats the tobacco rather than burns
it, and produces smoke with a different chemical composition.
There has never been shown to be a smoke, no matter how produced,
that is safe. And it's very unlikely that there ever will
be shown to be smoke, no matter what it's chemical composition,
that is safe. I do have a little different view, I think,
from our colleagues, about the possibility of a safer cigarette.
Let's just say, for example, that there was a cigarette that
no matter how much you smoked, you could only get half of
the carcinogens that you'd get if you smoked a current cigarette.
No matter how much you smoked. So, what that would mean is,
it would cut the lung cancer mortality rate, for example,
by 50%. So, if there're people who are going to be smoking
anyway, if there's no way that we can stop them from smoking,
that person would be better off to smoke the cigarette that
will have only half the chance. If you turn this around, you
could say, is it fair to that person, is it ethical to the
person who is addicted to tobacco, to nicotine beyond any
possibility of change, to not let them have access to a product
that will give them a 50% less chance of having cancer. That's
the kind of logic that led the committee of the Institute
of Medicine to the judgment that a cigarette that had less
harmful health effects was conceivable. But they felt very
strongly that, before anyone should make a claim of that kind,
it should meet scientific standards of proof, none of which
has been yet met by any product, and that the federal government
should assure that those standards were met.
Holloway: Dr. Heddin,
would you like to respond to that?
Heddin: Yes, I'd like
to agree with Dr. Bondaron, that if it were possible to have
a cigarette that definitely reduced the amount of nicotine,
or harmful effects that a smoker could get, we certainly should
have that product available. But at the same time if that
is done, I think it should be done in an atmosphere where
there's an aggressive advertising campaign by the public health
community that communicates the dangers of using tobacco at
all. And particularly, target these messages to young people.
Three thousand young people a day become regular smokers.
A third of those will eventually of smoking related diseases.
And if we put any product on the market that is considered
to be safe, then we certainly have to communicate to those
people who are starting to smoke, that there really is no
such thing as safe exposure to tobacco.
Holloway: Dr. Bondaron,
you want to respond, and then I want to go to Delmonte about
the youth effort.
Bondaron: I simply
want to say I agree 100% with the thing Dr. Heddin just said.
Holloway: Okay. You
work with a youth empowerment group and you have a Ujima project.
Explain that please.
Jefferson: The Ujima
product is an African American initiative. It's designed to
try and reduce the disparity and the gaps in African American
smoking and to get youth more involved in this whole effort
of tobacco prevention and control. Ujima targets youth with
a culturally specific theme. The theme is around the principles
of Kwanza, which is, of course, an African American holiday
and celebration, and Ujima is a word that means collective
work and responsibility. And so, collectively, African American
youth are working, of course, to reduce the burden of tobacco
in their communities. The event itself-there is a summer retreat
that we have for youth. We usually have it up in Brown Summit,
North Carolina. Approximately 100 youth from various organizations
across the state come for about four days. They get information,
training in skills on tobacco prevention and control, and
then they get an opportunity to actually go out into the community
and to try and do some interventions in order to stop others
from smoking.
Holloway: Let's talk
about the advertising. I heard Dr. Heddin mention that the
public health community should be aggressive in marketing,
but we know that the tobacco companies are aggressive in marketing,
and many people think, are aggressive to marketing to African
American consumers. Dr. Bondaron, you've done some research
on that, and have some feelings on that. Is that true?
Bondaron: Yes. It's
true. And it's one of the reasons, as we mentioned, that I
feel, and many others, too, that tobacco advertising should
be very carefully regulated by the federal government, and
no claims should be allowed that don't have solid, scientific
proof to back them up. As you heard in the film clip, claims
are now being made to the effect that this might, or might
not, happen. The tobacco companies are very careful not to
say that it will happen, because they know if they say that,
and it turns out not to be the case, they will be in deep
trouble.
Holloway: Let me just
say that we did invite some of the tobacco companies to come
on, and specifically RJR (Reynolds), responded and said, "Adult
smokers who are African American and other adult minority
groups have the same ability and right as the rest of the
population to evaluate and make informed decisions about whether
or not they want to use tobacco or any other consumer product."
Who would like to respond to that statement?
Jefferson: Let me respond
to that. 7.1 billion dollars a year is spent by the tobacco
companies to advertise their product.
Holloway: You said
with a "b"-billion.
Jefferson: Billion-with
a "b." 7.1 billion. That's a lot of money. You don't
spend that kind of money if you don't expect some tremendous
returns. Nicotine has a 90% addiction rate. So, if you can
get a customer, a consumer, addicted to nicotine, and then,
there's no doubt about it in your mind that you're going to
make up that money. You're going to make up the 7.1 billion
dollars that you may have spent in advertising. So, of course,
they say it's choice, but this is a product that contains
nicotine that's addictive.
Holloway: Dr. Heddin
I think is trying to come in. Go right ahead, please.
Heddin: The tobacco
companies say that smokers have a choice regarding whether
to use their product, but what we know is, most, almost 60%
of adult smokers will tell you that they were regular smokers
before the age of 18. So smoking, technically, is a habit
that is adopted during the teenage or adolescent years. In
fact, we know that young people start to experiment with tobacco
when it is not legal for them to buy cigarettes. Around the
age of 12 or 13, and now it's going down as young as 10 year
olds, beginning to experiment with tobacco. After about two
years of experimentation, many of those young people will
become addicted. We also know that cigarette advertising does
influence young people to smoke the brands that are most heavily
advertised. So the idea that to smoke their product is a decision
that is made by an adult, is incorrect. We have evidence from
studies that have been done, that smoking is taken up during
adolescent years and that these young people are influenced
by cigarette advertising.
Holloway: How do you
combat that, Delmonte?
Jefferson: I agree
totally with what Dr. Heddin said. I would like to just say
that, if you really want to find out if you've got a safer
cigarette, or if you want to find out if it's adult choice,
or youth choice, as far as if you're going to start smoking
or not, neutralize the effects of nicotine. If you can neutralize
nicotine, take nicotine out of the equation, then let's see
how many people actually smoke and continue to smoke.
Holloway: And you did
say there's no nicotine, or there was nicotine in this supposedly
safer cigarette.
Jefferson: Oh, of course.
Bondaron: In fact,
there is a school of thought among public health and other
people, that the safest thing to do would be to have a cigarette
that was the equivalent of a nicotine patch or nicotine gum.
That it was all nicotine, and didn't have anything else in
it. And that probably would be a safer cigarette to use, if
it had all nicotine and no other components in that, because
you would then lose all the carcinogens, all of the things
that cause low birth weight babies, all of the things that
cause heart disease to be more severe. Nicotine is not the
major cause of morbidity and mortality that comes from the
use of cigarettes.
Jefferson: Let me just
comment on that real quick, Jay.
Holloway: Please.
Jefferson: Excuse
me. And he's absolutely right. The cigarette itself is simply
a nicotine delivery device. So the reason you've got the cigarette
is to deliver the nicotine into your system so that you become
addicted to it. All the other chemicals that they add into
it are just to enhance that delivery and make it more effective.
Holloway: Just in the
last minute or so, here, one issue that seems to be pretty
controversial, but I want to get you response to it, there's
tobacco settlement money, or tobacco money being used also
for non-profits to help fight this thing. Does anybody want
to speak very briefly, about 20 seconds each, maybe about
the tobacco settlement money or tobacco money being used to
fight this?
Heddin: The tobacco
settlement money is the result of the efforts of many people
in public health, over many, many years, trying to get the
tobacco companies to pay for the health consequences of tobacco
use. Now that that money is in the states, we certainly need
to use it to prevent young people from starting to smoke.
Many people are dying of tobacco use, but we certainly don't
need to replace them with new smokers. So, if we can target
that money to prevent teens from starting to smoke, it's a
very important use.
Holloway: Is that happening
at all? Is that happening at all, though? Is that money being
used for that purpose?
Heddin: It varies in
different states. Each of the states has money from the settlement
and it's up to the states' legislatures to decide how that
money is to be spent.
Holloway: Time is running
completely out, guests, believe it or not, and we certainly
want to thank you so much for participating on this very important
issue to our state. Each of us is the sum total of the choices
we have made, but hopefully tonight's program has helped you,
to better inform you about the use of tobacco. The choice
is yours to use tobacco products or not.
For more information on tonight's
topic, [ON SCREEN GRAPHICS] please visit us online at www.unctv.org,
or email us with your comments at bif@unctv.org.
You can also call us at 919/549-7167. For Black Issues
Forum, I'm Jay Holloway. Join us again every Friday night
at 9:30 right here only on UNC-TV. You have a blessed evening.
[THEME MUSIC]
Voiceover: This program
is made possible in part by contributions from UNC-TV viewers
like you. Thank you.
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