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If you quit smoking, "Every attempt" counts?



Carl V. Phillips | Contributors










The latest anti-smoking campaign The FDA titled "Every Try Counts" tells smokers not to complain about failed completion attempts. Rather, smokers are told that even attempts that quickly end in resuming smoking – as is the case for about 90 percent of smoking attempts – should be considered positive or part of a process. The campaign consists mainly of point-of-sale advertising and a website with associated online tools.

There is little new about this campaign with the same old "motivational" messages and tools that serve only as focusing events. The new bit tells smokers that it's good to try and not stop. Perhaps this is helpful, as the FDA claims (though there is no obvious research or analysis supporting this claim). It could be that it increases the welfare of smokers and reduces the typical extra effect of being embarrassed to fail. That alone is worth something.

It may even motivate additional demolition attempts, some of which will succeed. Some smokers might think, "Okay, I'll try to quit today, though I expect to fail, because that failure is still a success." This message is in line with established cognitive-behavioral techniques that people associate with and fail (for example, to be rejected by a potential new friend or date or to write a terrible draft chapter of their novel). This can break the crippling hesitation even to try for fear of failure. However, this is typically an explicit exercise to make mistakes, and the FDA's message is not really enough to accomplish that.

As usual for tobacco control, there is no evidence that this news has any advantages. The program will never be seriously evaluated. The efforts to combat tobacco use are based on the vague feeling that the intervention could have a positive impact with a thick rhetorical layer and not with a genuine science.

There is also a serious drawback to this message. For the FDA, this is probably seen as a function and not a mistake that could explain why they are releasing this message now. Thanks to vaping, it is becoming increasingly clear to smokers that switching to a low-risk alternative (if the product is even more attractive to them) is much less likely than other methods of stopping. In fact, this also applied to smokeless tobacco before steaming, but fewer smokers knew it was a good option.

But the FDA (and its partner in this, the National Cancer Institute) is taking the anti-tobacco extremist position, roughly) eliminating the health risk of conversion is far worse than abstinence of all products. The extremist position is that the most important thing is the total number of product users, rather than health risks or other real concerns. Therefore, they report "total tobacco consumer" – a meaningless statistic for every practical purpose – and complain of any increase, even if there is no smoking and there is only (about harmless) steaming.

They would rather have a smoker try to stop by abstinence and probably fail than to switch to vaping. The news that smokers should enjoy their failed exit attempts therefore seems to be designed to prevent a successful move.

This message is deadly. A failed completion attempt is not harmless, as I said in an article titled "Unmasking the Claim that Abstinence is Generally Healthier for Smokers than Switching to a Low-Risk Alternative." This analysis shows that just a few extra weeks of smoking is more harmful than a lifelong low-risk product use. Even assuming that the alternative products are a bit harmful, the transition is still less risky than the failed exit attempts that the FDA is now encouraging.

If we assume that a low-risk alternative such as vaping represents one percent of the risk of smoking (which is a pessimistic assumption), then only a few months of additional smoking poses a greater health risk than using the alternative for a lifetime. A more realistic (ie, lower) estimate of the risk from vaping or smokeless tobacco consumption will shrink to weeks or days. (And, of course, zero risk reduces it to zero time.) Failed End Attempts cause people to smoke more for months or years, and this increases their health risk.

In other words, it is important to give up sooner or later. How likely a smoking cessation method is is much more important than the method. From a health point of view, a failed exit attempt is more harmful than an alternative product such as steaming, even assuming that these products are significantly harmful. Only someone who looks after head counts rather than body counts would recommend a failed attempt to quit for a promising attempt to switch. Dr. Follow Phillips on Twitter

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