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Artillery Row

Sometimes a cigar is just a cigar

The public health fanatics have a new enemy in their sights

Three researchers from the SPECTRUM Consortium — which, hilariously, stands for Shaping Public hEalth poliCies To Reduce ineqUalities and harM — have published a study which is blatantly aimed at getting Rishi Sunak to include everything and the kitchen sink in his generational tobacco ban. 

Using the monthly Smoking Toolkit survey, the study claims that 1.68 per cent of the adult population smoke “non-cigarette tobacco”. This amounts to approximately 772,800 consenting adults using cigars, pipes, water pipes or cigarillos, but never smoking cigarettes. Of these, cigars are most popular. The authors claim that the proportion of English adults who smoke but never smoke cigarettes has risen from 0.36 per cent in 2013 to 1.68 per cent today and yet if you look at the data (below), the sudden spike in 2020 indicates that something odd is going on. Sure enough, this was the moment when the survey went from being conducted face-to-face to being conducted by telephone (because of the pandemic). Regular readers will know that moving gambling surveys online had a similarly dramatic, and equally spurious, effect on the reported prevalence of problem gambling.

As a rule of thumb, any sharp rise or fall in a longstanding data series is due to a change in methodology. When it comes to surveys, you reach different groups of people depending on whether you knock on their door, phone them up or use an online questionnaire. People may be more or less likely to confess to bad habits depending on whether you ask them face-to-face, over the phone or on a website. The abrupt rise in the number of people claiming to smoke non-cigarette tobacco in this study is obviously the result of the change in methodology and yet the authors refuse to admit this. Instead, they put forward a bunch of unlikely explanations for why people suddenly started smoking cigars and hookah in March 2020, including the fear that smoking cigarettes increased the risk of getting Covid-19, the ban on menthol cigarettes that was introduced two months later and economic pressures that meant people could only afford to smoke cigars (!). 

You have to scroll down to the “strengths and limitations” section before there is any acknowledgement of the obvious problem. Although the authors claim that people tend to give similar answers in substance abuse surveys regardless of whether they are asked face-to-face or online, they admit that when they used both surveys in a one-off test in March 2022, they found “the prevalence of exclusive non-cigarette smoking was 1.24 percentage points higher in the group surveyed via telephone than face-to-face (2.03 per cent [95 per cent CI = 1.42–2.90] vs. 0.79 per cent [0.48–1.31])”. This is clear evidence that people are nearly three times more likely to say “yes” when you ask them over the phone and yet the authors still insist that the fivefold increase in non-cigarette tobacco consumption is real. 

The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people.

They then get down to brass tacks by making their political demand:

The inclusion of non-cigarette combustible tobacco products under the proposed ‘smokefree generation’ policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.

The assertion that cigars and pipes are “similarly harmful to health” has no basis in fact. Since the smoke from pipes and cigars is generally not inhaled, it would be surprising if the risks were similar to those of smoking cigarettes. Sure enough, they are not. According to a study of American males published in 2010, there is no difference in mortality risk between cigar smokers and non-smokers once you adjust for cigarette smoking and other confounding variables. A subsequent study, also from the USA, found that pipe and cigar smokers have a higher rate of mortality than non-smokers but a much lower rate than cigarette smokers, with the risks of cigar smoking being 80 per cent lower and the risks of pipe smoking 90 per cent lower.

These are not “similar” risks and yet the SPECTRUM authors are knocking at an open door when they tell the government to include these products in the Tobacco and Vapes Bill, which will ban people born after 2008 from ever buying tobacco products. Not only has the government provisionally included pipes, cigars and shisha, it has also included heated tobacco products which have a risk profile closer to e-cigarettes and have been extraordinarily successful in reducing smoking rates in Japan. Even snuff is also included.

The generational tobacco ban is the culmination of decades of anti-smoking rhetoric. You know the kind of thing: “cigarettes are the only product that kills when used as directed by the manufacturer”, “cigarettes are the only product that kills half its users”, etc. Rishi Sunak and the “public health” lobby’s justification for the ban is that cigarettes are uniquely dangerous and that if people don’t start smoking when they are young, they never will. But this only really applies to cigarettes. Pipes, cigars and heated tobacco are not uniquely dangerous. The risks of using them are well within the range of risk that normal adults happily tolerate and they are not dissimilar to the risks of consuming alcohol and bacon (and you can be sure that temperance and vegan activists will point this out if the ban is introduced).

There has been no great surge in cigar and pipe smoking in recent years and these products have no particular appeal to children. Even the authors of the SPECTRUM study admit that smoking among people who do not smoke cigarettes is “rare”. In any case, surely the important fact is that they are not smoking cigarettes? The other important fact is that they are adults. If future generations of hipsters want to smoke a pipe, why shouldn’t they? Why shouldn’t a grown man be able to enjoy a cigar at a wedding? Even cigarette papers are included in Sunak’s ban! This is institutionalised fanaticism and it is no wonder the government is trying to rush the legislation through before people notice what is going on. 

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