Psychology and Physiological Aspects of Substance Abuse

West (1997) stated that clinicians, researchers, policy makers and others who work in the area of addiction, with addicts or who have to deal with the consequences of addiction, cannot easily ignore the strong ethical dimension to the problem. Ethics is concerned with determining the nature of normative theories and applying these sets of principles to practical moral problems. It is concerned with how we should live, as individuals and societies, what is right and wrong, what is good and bad and what is just and unjust. The bases on which such judgments can be made have been subject to systematic enquiry since before the time of Plato. Utilitarianism is perhaps the strongest thread running through the analysis of ethical and policy decisions in the field of addiction.

(Weissman, 1997) reported the following findings regarding tobacco companies and their advertising, He reported that the tobacco companies are expected to meet their payment obligations by passing through the costs and raising the price of cigarettes from 60 to 70 cents per pack. Although it means the payments will come significantly from consumer price increases rather than diminished company profits, this price increase may be the single most salutary result of the agreement. Wall Street analysts estimate it will result in a 10-to-15% decline in smoking rates.

The advertising restrictions are also less compelling upon close examination. In the deal, the industry agrees to accept the provisions of the August 1996 FDA rule, which were struck down by the federal judge in Greensboro. These provisions include a ban on brand-name event sponsorship, limiting the use of billboards near schools, banning the advertising of non-tobacco products, like clothing and gear, with tobacco names, and limiting advertising in youth-oriented magazines (including such publications as Sports Illustrated). Additionally, in the deal the industry agrees to eliminate all billboard advertising, eliminate the use of human images and cartoons in ads, accept a prohibition on tobacco product placements in movies and on television, and accept a range of other provisions.

In total, the advertising and marketing restrictions go far beyond what U.S. tobacco control advocates envisioned as achievable just a year or two ago. Now that the tobacco control terrain has shifted, many public health critics of the agreement say the industry will easily be able to circumvent the restrictions.

"The advertising requirements in the proposed settlement, as written, will not appreciably inhibit the tobacco industry's ability to influence the 12-to-17-year-old segment of our population," says John Garrison, managing director of the American Lung Association. "In fact, the settlement's ban on the use of human images and cartoon characters in tobacco advertising and promotion would be a mere inconvenience to the tobacco industry."

Other countries' experience with advertising restrictions suggests the tobacco companies are stunningly adept at working around ad limits. In the United Kingdom, for example, tobacco control advocates say a ban on the use of human images has not measurably affected the marketing of Marlboro: Philip Morris has retired the Marlboro Man, but Marlboro Country -- beautiful portraits of the U.S. West -- still appears in Marlboro advertisements that tobacco control advocates say are as effective as any.

Perhaps the most innovative element of the agreement is a "look back" provision, which would require the tobacco companies to pay a fine if they failed to reduce teen smoking rates by 30% in five years, 50% in seven years, and 60% in 10 years. The fines would amount to $80 million for each percentage point the industry fell short of the target and would be capped at $2 billion a year.

There are numerous shortcomings to the look back provision, however, shortcomings so severe that there is consensus in the public health community about the need for reform. The potential fines would work out to little more than a nickel a pack, an amount the industry could easily pass on to consumers. Company would not allocate them, so the incentive for any particular company to curtail marketing to children may be skewed. In addition, the deal would permit individual companies to apply for a 75% rebate of the fine if they could show that they adhered to FDA regulations in good faith.

"As written, the proposal does not include sufficient economic incentives to ensure the industry will meet the targets established in the proposed settlement," asserts the American Cancer Society, one of the few public health groups favorably disposed to a settlement.

There are other benefits to the settlement. While much of the industry's annual payments would go to victims or state government coffers, substantial amounts would go to fund a major counter-advertising campaign and to smoking cessation programs.

Against the moderate public health benefits of the agreement, however, must be weighed the enormous concessions made to Big Tobacco.

Pollack, Lantz, & Frohna (2000), completed a study that assessed the effects of maternal smoking on birth outcomes among singletons and twins. An algorithm was developed to link twins with their siblings. A random-effects logistic regression model was then used to estimate the association between maternal smoking and several adverse outcomes for a random sample of singletons and for all twins with available maternal smoking information. Results indicated that maternal smoking was associated with a significantly increased risk of low birth weight, very low birth weight, and gestation of less than 33 weeks for both singletons and twins and with an increased risk of gestation of less than 38 weeks, infant mortality, and placental abruption for singletons. Among smokers, negative impacts on the risk of low birth weight, very low birth weight, and extreme premature delivery were significantly higher for women carrying twins. Conclusions, Some of the negative effects of smoking on low birth weight and pre-term delivery are greater for twins than for singletons. Women carrying twins should be warned that smoking increases their already high risk of serious infant health problems.