Objective: Inhibitory control training has shown promise for improving health behaviours, however, less is known about its mediators of effectiveness. The current paper reports whether ICT reduces smoking-related outcomes such as craving and nicotine dependence, increases motivation to quit and whether reductions in smoking or craving are mediated by response inhibition or a devaluation of smoking stimuli.Method: Adult smokers were randomly allocated to receive 14 days of smoking-specific ICT or active control training. Participants were followed up to 3-months post-intervention. (...) This trial was preregistered.Results: There were no significant differences between ICT and active control training groups. Specifically, participants in both groups showed significant reductions in craving, nicotine dependence, motivation and a devaluation of smoking-stimuli up to 3-months follow-up compared to baseline. Inhibition and devaluation of smoking stimuli did not act as mediators. Devaluation of smoking stimuli was an independent predictor of smoking and craving at follow-up.Conclusion: Inhibitory control training was no more effective at reducing smoking-related outcomes compared to the active control group, however, significant improvements in craving, dependence indicators and evaluation of smoking stimuli were observed across both groups. A return to basic experimental research may be required to understand the most effective ICT approach to support smoking cessation. (shrink)

Bitton and Eyal's lengthy critique of our article on unassisted cessation was premised on several straw-man arguments. These are corrected in our reply. It also confused the key concepts of efficacy and effectiveness in assessing the impact of cessation interventions and policies in real-world settings; ignored any consideration of reach (cost, consumer acceptability and accessibility) and failed to consider that clinical cessation interventions which fail more than they succeed also may ‘harm’ smokers by reducing agency. Our article addresses each of (...) these problems, concluding that any consideration of the ethics of promoting smoking cessation in low-income nations should begin and end with the question of whether the strategies to be adopted have any prospect of influencing significant numbers of smokers to quit. (shrink)

Experimental vaccines are being developed for the treatment of ‘unhealthy lifestyles’ and associated chronic illnesses. Policymakers and other stakeholders will have to deal with the ethical issues that this innovation path raises: are there morally justified reasons to integrate these innovative biotechnologies in future health policies? Should public money be invested in further research? Focusing on the case of an experimental nicotine vaccine, this article explores the ethical aspects of ‘lifestyle vaccines’ for public health. Based on findings from a qualitative (...) study into a vaccine for smoking cessation, the article articulates possible value conflicts related to nicotine vaccination as an intervention in tobacco control. The ‘vaccinization’ of lifestyle disease piggybacks on the achievements of classic vaccines. Contrary to expectations of simplicity and success, quitting smoking with a vaccine requires a complex supportive network. Social justice and public trust may become important ethical challenges when deciding whether to use further public funds for research or whether to implement these innovative vaccines in the future. (shrink)

The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as “managers” who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that (...) would allow the patient to quit smoking. Although this model could potentially mitigate medicine’s behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present. (shrink)

Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in (...) this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with. (shrink)

Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in (...) this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with. (shrink)

We study smoking-cessation apps in order to formulate a framework for ethical evaluation, analyzing apps as ‘medium’, ‘market’, and ‘genre’. We center on the value of user autonomy through truthfulness and self-understanding. Smoking-cessation apps usually communicate in an anonymous ‘app voice’, with little presence of professional or other identified voices. Because of the fast-and-frugal communication, truthfulness is problematic. Messages in the ‘quantification’ modules may be read as deceitfully accurate. The app voice frames smoking as a useless, damaging habit indicative of (...) weakness of will, in a ‘cold-turkey’ frame of individual mind-over-body heroism. Thus apps contribute to a stigmatization of smokers and culpabilization of relapses. The potential to support user autonomy through diverse meaningful voices and personalized communication remains yet unused. (shrink)

Patient visits are an important opportunity for general practitioners to discuss the risks of smoking and cessation strategies. In Australia, the guidelines on cessation published by the Royal Australian College of General Practitioners represent a key resource for GPs in this regard. The predominant message of the Guidelines is that pharmacotherapy should be recommended as first-line therapy for smokers expressing an interest in quitting. This, however, ignores established evidence about the success of unassisted quitting. Our analysis of the Guidelines identifies (...) a number of potential conflicts of interest which may have affected the advice provided. These include extensive funding by the pharmaceutical industry of sources cited to support the recommendations, and relations between members of the Guidelines Content Advisory Group and the pharmaceutical industry. Recommendations issued by professional bodies have enormous potential impact upon public health and there is a need for the highest levels of scrutiny and transparency in their development. Information about research cited in guidelines should include funding sources, and developers should be free of obvious conflicts of interest. Smoking remains the leading preventable cause of global mortality. Concerns related to pharmaceutical industry funding of research, scientific integrity and recommendations on smoking cessation by medical advisory groups clearly have implications beyond Australia. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well (...) as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Background: Spirometry for early detection of chronic obstructive pulmonary disease and smoking cessation is criticised because of the potential negative effects of labelling with disease. Aim: To assess the effects of opinions of smokers with mild to moderate COPD on the effectiveness of spirometry for smoking cessation, the justification of early detection of airflow limitation in smokers and the impact of confrontation with COPD. Design: Qualitative study with data from a randomised controlled trial. Setting: General population of Dutch and Belgian (...) Limburg. Methods: Semistructured ethical exit interviews were conducted with 205 smokers who were motivated to quit smoking and had no prior diagnosis of COPD but were detected with airflows limitation by means of spirometry. They received either counselling, including labelling with COPD, plus with nortriptyline for smoking cessation, counselling excluding labelling with COPD, plus nortriptyline for smoking cessation or care as usual for smoking cessation by the general practitioner, without labelling with COPD. Results: Of the participants, 177 agreed or completely agreed that it is justified to measure lung function in heavy smokers. These participants argued that measuring lung function raises consciousness of the negative effects of smoking, helps to prevent disease or increases motivation to stop smoking. Most of the 18 participants who disagreed argued that routinely measuring lung function in smokers would interfere with freedom of choice. Conclusions: Labelling with disease is probably a less important issue in the discussion about the pros and cons of early detection of COPD. (shrink)

Cognitive and behavioral predictors in the process of smoking cessation during pregnancy: Testing for discontinuity patterns in the Transtheoretical Model The aim of the study was to assess predictive power of cognitive variables and health-promoting behaviors for the process of smoking cessation described in terms of the Transtheoretical Model. Participants in the study were 150 women, in uncomplicated pregnancy. Cigarette smokers constituted 29.3% of the sample, while the rest had previously quitted smoking. Beliefs and expectations were measured by means of (...) scales developed by the author, while health-related behaviors were assessed using the Health Behavior Inventory by Z. Juczyński, supplemented with pregnancy-specific behaviors. TTM discontinuity patterns were tested in the study using polynomial-based orthogonal contrasts. Statistically significant linear trends were found for expectations concerning the infant's health state and the course of delivery, for beliefs about the effect of maternal smoking on infant health, as well as for pregnancy health behaviors. The obtained results were confirmed by hierarchical regression analysis, with smoking cessation explained to a larger extent by cognitive factors than by health-related behaviors. This may suggest that the TTM is a "pseudo-stage" model, and a general change of the variables under study is of greater importance for the process of smoking cessation than focusing on the TTM stages. (shrink)

Involving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.

Although the effectiveness of some tobacco programs and policies has been clearly demonstrated in reducing the overall population smoking prevalence, the health benefits are not equally distributed across all socio-economic classes; a situation that clearly runs against the equalitarian ethos of most modern states. In this article, we evaluate the benefits of using Sen’s Capability Approach as a theory of social justice to guide public health program and policy development in a way that would prevent the further increase of inequalities (...) in health outcomes. Starting from four consensual goals of tobacco control practice (i.e. that individuals live a smoke-free life, that smokers quit smoking, that non-smokers are protected from exposure to second-hand smoke and that smoking cessation support is accessible) we found that besides the standard interventions (e.g. education on the harms of smoking, policies to reduce exposure to SHS) an iniquity-proof tobacco control program needs also to address the lack of options of underprivileged people in affordable smoke-free settings and in leisure activities. We conclude that an ethical tobacco prevention program needs to address the broader social determinants of health such as the socio-economic policies that put a strain on people’s capacity to shun or quit smoking. (shrink)

In maternity care, costly high-technology interventions that have never been shown to be clinically effective continue to be used in the United States, while inexpensive and effective low-technology interventions continue to be underused. Three high-technology approaches to risk reduction—electronic fetal monitoring, cesarean section, and home uterine activity monitoring are contrasted with three low-technology approaches—prenatal care, smoking cessation, and nutrition supplementation. These technologies are examined in terms of current controversies over their safety, efficacy, and cost-effectiveness. Examination of these controversies illustrates how (...) the medical technology industry, the regulatory process, and systems of social stratification contribute to social and cultural constructions of what are regarded as reducible birth risks. (shrink)

Next SectionIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives and two types of medical interventions. These were stated to be equally effective in improving outcomes in five contexts: weight loss and smoking cessation programmes, and adherence in treatment programmes for drug addiction, serious mental illness and physiotherapy after surgery. Financial incentives were judged less acceptable and to be less fair than medical interventions (...) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study. (shrink)

The Common Health problems that plague Americans today are often the result of people’s choices and behaviors: obesity, cigarette smoking, accidental pediatric head trauma owing to failure to properly restrain children, and failure to adhere to medication regimens. For each problem, there is a well-studied effective behavioral intervention: a healthy diet and exercise for obesity, smoking cessation programs to overcome cigarette addiction, appropriate car restraints to prevent accidental head trauma, and direct observation of treatment and simplification of medical regimens (...) to improve drug adherence. Traditionally, the physician defined the problem and told the patient what she needed to do. In the modern era of .. (shrink)

Considerations of objective-value freedom and status freedom do impose constraints on policies that restrict access to cigarettes. As to the objective-value freedom, something of value is lost when anti-alcohol policies lead to pub closures interfering with valued life styles, and a similar, though weaker, argument can be made for cigarettes. As to status freedom, non-arbitrariness requires consultation with vulnerable populations to learn what might aid them with smoking cessation.

Much of the work on the ethics of climate engineering over the last few years has focused on the front-end of the potential timeline for climate intervention. Topics have included the initial taboo on bringing the discussion of climate engineering into the open, guidelines to put in place before commencing research, and governance arrangements before first deployment. While this work is clearly important, the current paper considers what insights can be gleaned from considering the tail-end, that is, by using (...) the requirement for future cessation as a criterion for any acceptable climate engineering strategy. After showing that time-limited interventions are a key part of the rhetoric of leading climate engineering advocates, the paper examines the implications of imposing a 'cessation requirement' on solar radiation management and carbon dioxide removal strategies. Consideration of a cessation requirement turns out to reveal a great deal about what ought to be happening now, before any decision to proceed with climate engineering deployment has been taken. (shrink)

Recruiting adolescents into smoking cessation studies is challenging, particularly given institutional review board (IRB) requirements for research conducted with adolescents. This article provides a brief review of the federal regulations that apply to research conducted with adolescents, and describes researchers' experiences of seeking IRB approval for youth cessation research. Twenty-one researchers provided information. The most frequently reported difficulty involved obtaining parental consent. Solutions to commonly reported problems with obtaining IRB approval are also identified. Waivers of parental consent can facilitate recruitment (...) of youths into studies; however, researchers must ensure that their protocols comply with federal regulations when requesting a waiver. (shrink)

Aims : The Modified Reasons for Smoking Scale (MRSS) is a widely accepted scale that measures psychological functions of smoking. The scale has been translated in Dutch and has been validated, in order to be used in clinical smoking cessation practice in the Dutch-speaking part of Belgium. This study examined the factorial structure, reliability and validity of the scale in a sample of smokers, who are characterized by a high level of dependence and an explicit motivation to stop smoking. Method (...) : The participants were 383 smokers, who volunteered at the stop-smoking clinic of a Belgian university hospital, and completed the translated scale. They were administered the translated MRSS, the Fagerstrom Test for Nicotine Dependence (FTND). Through a clinical interview, smoking behaviour and smoking history was assessed (daily smoking consumption, years smoking, number of quit attempts, weeks stopped, alcohol and coffee consumption, CO level). Exploratory factor analysis was performed. Internal consistency was studied in order to examine the reliability. The concurrent validity was assessed by means of manova, anova and correlation analysis. Results : Factor analysis identified four factors, named stimulation, pleasure of smoking, social smoking and automatism of smoking. Cronbach's alpha ranged from 0.65 (automatism) to 0.72 (stimulation). manova indicated the influence of the variables age, sex, daily consumption and the FTND (the latter two variables showed a dose-dependent association with each subscale). Regression analysis revealed a relationship with dependence indicators, namely: the daily consumption, the number and duration of previous quit attempts, FTND, CO level and daily coffee intake. Conclusions : The Dutch translation of the MRSS identified four factors and revealed acceptable validity and reliability. The adapted version of the translated scale as a component of the psychological assessment procedure in a smoking cessation treatment in Dutch-speaking areas should be implemented. (shrink)

Freedom to smoke is part and parcel of overall freedom. The former cannot be abrogated without violating the latter. The present paper applies this insight to the regulations placed on the tobacco industry and smoking in general. We find that government interventions into people’s lives regarding smoking are highly incompatible with libertarian principles. We examine many regulations such as prohibiting youths from smoking, preventing second hand smoke, restrictions on advertising, taxing the industry, and liability issues.

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control or MCII condition. Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The (...) primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive. Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant. Per an exploratory analysis, we observed that stress significantly moderated the condition effect, such that MCII facilitated reduction among those experiencing high, but not low stress. Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools. (shrink)

This paper examines two full-page A3 poster advertisements in mass magazines produced at two time points over a 60-year period depicting smoking and its effects, with particular relation to lung cancer. Each poster represents the social and cultural milieu of its time. The writings of Foucault are used to explore the disciplinary technologies of sign systems as depicted in the two posters. The relationships between government, tobacco companies and drug companies and the technologies of production are examined with regard to (...) the development of smoking cessation strategies. The technologies of power are associated with the constructions of risk and lifestyles. The technologies of the self locate smokers as culpable subjects responsible for their individual health. Finally, the meshing of these technologies places the doctor in the frame as ‘authoritative knower’ and representative of expert systems. (shrink)

Advances in immunotherapy pave the way for vaccines that target not only infections, but also unhealthy behaviors such as smoking. A nicotine vaccine that eliminates the pleasure associated with smoking could potentially be used to prevent children from adopting this addictive and dangerous behavior. This paper offers an ethical analysis of such vaccines. We argue that it would be permissible for parents to give their child a nicotine vaccine if the following conditions are met: (1) the vaccine is expected to (...) result in a net benefit to each individual vaccinated, (2) the expected harms from the side effects of the vaccine are lower than the non-voluntary harms of smoking, and (3) there are no less manipulative methods available that are as effective at preventing smoking initiation. Finally, we show how the framework developed here could be used to analyze the ethics of other chemical interventions designed to modify children’s behavior. (shrink)

Freedom to smoke is part and parcel of overall freedom. The former cannot be abrogated without violating the latter. The present paper applies this insight to the regulations placed on the tobacco industry and smoking in general. We find that government interventions into people’s lives regarding smoking are highly incompatible with libertarian principles. We examine many regulations such as prohibiting youths from smoking, preventing second hand smoke, restrictions on advertising, taxing the industry, and liability issues.

This paper shows how one major area of health education work (smoking cessation) involves powerful, but currently largely implicit, philosophies of action. The analysis draws on empirical data derived from a previous study of would-be non-smokers' private explanations for their success or failure. Will-power, or the lack of it, emerged as a central theme in this study—a theme equally prevalent in almost all ‘How to Stop Smoking’ books and related health education pamphlets. The nature of will-power has long been discussed (...) by philosophers. However, will-power remains largely undefined and unresearched in health education. The would-be non-smokers also claimed to feel that they were making inauthentic or non-genuine choices (a theme which has also been the subject of philosophical analysis). If health educators were to develop a deeper understanding of will-power and authenticity (and were to appreciate that these ideas are complex rather than simple) this might have a considerable effect on the design of practical health education initiatives. (shrink)

A spate of legislations prohibiting cigarette smoking in enclosed public spaces, mainly on grounds of public health protection, recently swept across cities around the world. This is in tandem with a raft of increasingly restrictive national laws that emerged on the back of the ratification of the WHO Framework for Tobacco Control by more than one 168 countries in 2005. The central debate on the increasingly restrictive tobacco laws revolves on the extent to which public health interests justification should ground (...) political intervention in a private right as basic as tobacco smoking, which interestingly is often lumped in the food and beverage category. The pertinent legal and ethical questions therefore are the following: Is or should there be a general unrestricted right to tobacco smoking? If there were such a right, should public health or ethical considerations trump private right to smoke in enclosed public spaces? And if public health interests were so paramount, should they go farther and ground tobacco smoking proscription in all private and public spheres? Using ethical principles and rights-based arguments, the paper critically examines the legal and ethical ramifications of public health justification for tobacco smoking proscription in enclosed public spaces. (shrink)

Empirical evidence suggests that mindfulness, psychological flexibility, and addiction are interrelated in decision making. In our study, we investigated the relationship of the behavioral profile, composed of mindfulness and psychological flexibility, and smoking status on delay and probability discounting. We demonstrated the interaction of the behavioral profile of mindfulness and psychological flexibility and smoking status on delay discounting. We found that individuals who smoked and displayed higher mindfulness and psychological flexibility devalued rewards at a slower rate, compared to smokers with (...) a lower profile. Importantly, in those with a higher profile, smokers discounted rewards no differently than nonsmokers. Smokers with a lower profile did display, however, increased impulsivity, compared to nonsmokers. These results suggest that behavioral interventions aiming to modify the behavioral profile with regard to mindfulness and psychological flexibility can indeed support the regulation of elevated impulsivity in smokers to equate with that of nonsmokers. In probability discounting, we observed that individuals with a higher profile displayed lower discounting rates, i.e., were less risk-averse, with no other significant main effect or interaction. (shrink)

In this paper, we examine the importance of two different peer effects as determinants in the adolescent’s decision whether or not to smoke. One is measured at the class level and the other reflects the smoking behaviour of the adolescent’s best friends. A nationally representative wave of Spanish data, collected in different state and private centres of secondary education and vocational training, and several linear probability models are used to estimate the role of peer effects. We find that a 10 (...) % increase in the proportion of classmates is associated with a 3.6 points increment in the probability of smoking. Similarly, if the smoker’s friends go from “only some” to “the majority”, the probability of smoking increases by 39 points. Although both peer effects are significant if introduced separately, the class peer variable is not significant once the closer peer effect is introduced. Our work provides evidence to support the hypothesis that peer effects are important determinants of smoking among adolescents. This has implications for policy-makers, since the existence of peer effects would amplify the effects of interventions. (shrink)

A central issue confronting both philosophers and practitioners in formulating an analysis of causation is the question of what constitutes evidence for a causal association. From the 1950s onward, the biostatistician Jerome Cornfield put himself at the center of a controversial debate over whether cigarette smoking was a causative factor in the incidence of lung cancer. Despite criticisms from distinguished statisticians such as Fisher, Berkson and Neyman, Cornfield argued that a review of the scientific evidence supported the conclusion of a (...) causal association. Cornfield's odds ratio in case‐control studies — as a good estimate of relative risk — together with his argument of ''explanatory common cause'' became important tools to use in confronting the skeptics. In this paper, I revisit this important historical episode as recorded in the Journal of National Cancer Institute and the Journal of the American Statistical Association. More specifically, I examine Cornfield's necessary condition on the minimum magnitudes of relative risk in light of confounders. This episode yields important insight into the nature of causal inference by showing the sorts of evidence appealed to by practitioners in supporting claims of causal association. I discuss this event in light of the manipulationist account of causation. (shrink)

This study aimed to investigate the status and risk factors of post-traumatic stress disorder in patients with acute myocardial infarction after emergency percutaneous coronary intervention in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent (...) patients, respectively. The risk factors related to PTSD were door-to-balloon time, left ventricular ejection fraction, smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI. (shrink)

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to (...) plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. (shrink)

This paper offers a relatively comprehensive assessment of government anti-smoking policies (both taxation and other regulatory measures). I conclude that interventions to engender in smokers and prospective smokers an accurate perception of tobacco's health risks are justified, that except in the case of adolescents addiction by itself does not justify intervention beyond providing adequate information, that the proper goal of tobacco taxation policy should be to recoup only the extra costs that smokers place on others (at most a $1/pack (...) tax on cigarettes), and that passive smoke's imposition of harm on unconsenting others strongly supports at least the development of a safe-to-others smokeless cigarette, if not direct intervention. (shrink)

BackgroundIn many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too intrusive, an unfree society can emerge. Which lifestyle interventions that use pressure or coercion are justifiable and which are not? We tried to develop an assessment model that can be used for answering this question, (...) on a generally acceptable way, for all sorts of lifestyle interventions.MethodsThe intended assessment model was developed in three phases. In the first phase the model was theoretically developed on the basis of literature study and reasoning. In the second phase the model was empirically tested by assessing two detailed cases from everyday practice using the model. The model was improved again and again. In the third phase the 10th version of the model was developed while writing this article.ResultsAn assessment model for the justification of intrusive lifestyle interventions. It comprises three components: 12 assessment criteria ; an assessment structure with three filters ; a way of assessing.ConclusionsWe have developed an assessment model for the justification of lifestyle interventions that use pressure or coercion to promote health. The correctness, completeness and practicality of the model are likely. Important principles for the justification are the logic and completeness of the underlying argumentation and the proper use of the available scientific information. Parties for and against a particular intervention could use the model to test and strengthen their argumentation and to improve the quality of the intervention. (shrink)

The purpose of this article is to examine the tenets of expressionism as developed by robin collingwood and phenomenology as developed by eugene kaelin, for the ways in which they may be combined to analyze the process and products of art. the concept of expression is found to be of value in determining the nature of the process in making an art object, while phenomenology in terms of imagination, perception and "context of significance," are found to be useful in analysis (...) of the product once finished. these two domains are suggested as a philosophic base for programs in aesthetic education. (shrink)

A bracing and ambitious work of practical philosophy, tightly argued and beautifully written.