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VOLUME 3, ISSUE 4 PSYCHNEWS INTERNATIONAL December 1998
-- AN ONLINE PUBLICATION --
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SECTION D: THE FIFTH COLUMN
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Note: The Fifth Column is a regular PsychNews column,
managed by Jeffrey A. Schaler, Ph.D.
Opinions and comments are invited. Please send them to
the PsychNews Int'l mailbox: psychnews@psychologie.de
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THE SMOKING CONTROVERSY:
1
A RIGHT TO PROTECT VERSUS A RIGHT TO SMOKE?
Jeffrey A. Schaler, Ph.D. and Magda E. Schaler, M.P.H.
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We begin our discussion on the smoking controversy by asking you
to consider the following question: Which is more important to
you, health or liberty?
Assume these values are mutually exclusive from a public-
policy point of view. Let's phrase the question another way:
Which do you value more, freedom from coercion by a
paternalistic governmental authority at the possible expense of
possible poor health--or freedom from disease or poor health at
the expense of being denied pursuit of certain behaviors and
activities you find enjoyable despite their risk?
Consider our question in still another way: Is it more
noble to secure individual liberty at the risk of harming
ourselves than to allow someone else to make decisions about
risky activities for us? If this is the case, then we see that
liberty and responsibility, again from a public policy point of
view, are positively correlated. To be sure, the more liberty
people exercise, the more responsible they must be. The inverse
is also true: The more responsible people are, the more liberty
they can experience.
If the opposite is true, i.e., if it is more noble to be
healthy and protected from increased probability of harm, then
the correlation between liberty and responsibility is still a
positive one. When we give up our freedom to engage in risky
behaviors we must be regarded as less responsible. We become
"infantilized" by authority. We assume or are assigned a social
role of metaphorical children--even though we are actually
adults. Government then becomes our metaphorical parents. We
cannot increase liberty by decreasing responsibility and vice
versa. While the inverse to our equation is true, the converse
is false.
In fact, there is no "right" answer to the question we are
posing to you here. The question is a moral one requiring an
answer based on personal values. Individual morality is a
heterogeneous quality in the population at large, not a
homogeneous one. The answer to our question, it seems to us, is
"it depends." It depends on whether one is willing to accept
the consequences of one decision or another. We are interested
in the arguments supporting one answer or another in light of
the different consequences integral to one path or another. We
ask you to consider this question in light of the smoking
controversy we face today.
THE IMPORTANCE OF STUDYING TOBACCO REGULATION
Smoking policy presents a unique opportunity to study political,
economic, legal, and social aspects of health and health
behavior. The demonization of the tobacco industry coupled with
the medicalization of addiction, and the high financial stakes
involved in liabilities cases and revenue losses, are virtual
gold mines for analysis and debate.
The recently proposed regulation of smoking and tobacco
products by the U.S. Food and Drug Administration (FDA) takes
diverse forms. These include increasing restriction of smoking
in public and private domains, requirements of health warnings
on cigarette packages, anti-smoking publicity campaigns,
prohibitive taxation strategies, age-restrictive vending
regulation, and sanctions on advertising. The FDA has asserted
that it has a legitimate scientific and legally justifiable
basis for regulating nicotine, and thereby all tobacco products
containing nicotine. A federal court has upheld this authority
--U.S. District Court Judge William Osteen ruled on April 25,
1997 that tobacco products fit the federal definition of a drug,
and in so doing he cleared the way for the potential regulation
of those products by the FDA. (He also gave the tobacco
companies a slight victory, however, in ruling that the
government could not restrict cigarette advertising.) Judge
Osteen's ruling was reversed by the U.S. Court of Appeals for
the Fourth Circuit on August 14, 1998 (1).
Moreover, a plethora of litigation has been launched
against the tobacco industry by a conglomerate of state
attorneys general successfully seeking compensation for the
health care costs incurred by smoking. The tobacco companies
have agreed, in part, to pay for such costs, among many other
concessions (see on-line, http://www.tobaccoresources.com).
Public policy is being crafted to reduce mortality and morbidity
associated with the use of tobacco. But should the elimination
of smoking even be a goal in a free society? Where should the
line be drawn between public dissemination of accurate
information and the legislation of morality in the form of
propaganda?
Tobacco control is the exertion of power by government
grounded in the implied health preferences of the nonsmoking
majority. By societal nature, we are bound to affect others
when we exert our preferences. Rights, depending on ideological
perspective, are therefore viewed as either ensured or infringed
upon by tobacco control. Various tobacco control initiatives
have different goals. Some initiatives aim at reducing public
exposure to smoking behavior--protecting "us" from "others."
Some strategies attempt to protect "us" from "ourselves"
(included here are even the inclinations we may have toward
smoking) through tobacco taxation and regulation of tobacco as
an addictive substance. Still other regulations are designed to
dismantle the tobacco industry's public image by restricting
advertising.
Proponents of increased smoking regulation who favor
restriction of smoking in public places emphasize the collective
right of nonsmokers to be free from the effects of smoking or
the behavior of smokers. This position rests on acceptance of
the scientific reports of the federal Environmental Protection
Agency (EPA) conclusively associating second-hand smoke with
adverse respiratory health effects. Economic analysts have
addressed second-hand smoke as an externality leading to market
failure and tend to steer away from criticism of second-hand
smoke regulation. For regulation proponents, it follows, then,
that the government should issue regulations protecting the
health of nonsmokers and limiting the behavior of smokers. It
is further asserted that agencies (especially the U.S.
Department of Health and Human Services) should enforce rules
governing smoking in what pro-regulationists consider public
places, i.e., restaurants, workplaces, and theaters, in an
attempt to guarantee the implied health rights of nonsmokers.
An example of this approach is the recent prohibition of smoking
in private restaurants in California to protect workers from
second-hand smoke. Allies in these endeavors include various
professional health organizations (e.g., the American Public
Health Association) and an array of citizen-action groups.
Anti-regulation advocates, however, have interpreted
liberty to imply just the opposite, declaring the rights in
question to be those of smokers rather than nonsmokers. Their
arguments rely on the constitutional ideal of avoiding
government intrusion in, and the restriction of, personal
behavior. Anti-regulators claim that especially in the
circumstance of restaurants, as private rather than public
establishments, government intrusion is unconstitutional. These
assertions, voiced most strongly by the tobacco industry and
various smokers' rights groups (often funded by the tobacco
industry), cite studies rejecting EPA findings that second-hand
smoke is a health risk. Accordingly, there is debate over
"good" and "bad" science--leaving many people with questions
over what to believe. U.S. District Court for the Middle
District of North Carolina Judge William L. Osteen rejected the
EPA's claim that second-hand smoke was a known carcinogen in an
important case decided on July 17, 1998. (2)
THE VOLUNTARY NATURE OF ADDICTION
The debate about smoking rights and regulation also rests on the
meaning of addiction. Groups and individuals supporting
government regulation of tobacco products contend that nicotine
is addictive and that once smokers become addicted they can no
longer choose not to smoke. Therefore, they argue, government
must intervene to protect citizens from tobacco companies which
allegedly enhance the nicotine content of their products to
addict smokers. Pro-regulationists assert that smokers are
unwittingly "hooked" and can become addicted by smoking.
The claim that addictive behavior is involuntary is a
controversial one. Many experts disagree. By definition,
addiction refers to behavior. Consequently, it is voluntary.
Involuntary "behavior" is not behavior--it is pathological,
e.g., an epileptic seizure. The distinction between behavior
and disease is important in public policy considerations.
Smoking is a behavior. Cancer is a disease. The former refers
to mode of conduct, deportment. Behavior is the expression of
choice. Disease is defined through signs, tests, physiological
lesions, and chemical imbalance.
BEHAVIOR VERSUS DISEASE
The distinction between behavior and disease is also crucial
when we consider the difference between what tobacco smoke does
to the body and how the smoke gets into the body. The former is
concerned with physical and chemical interactions. Tobacco
products are inert substances. They cannot purposefully invade
a person's body. The latter refers to conduct, volition.
People choose to purchase, ignite, and inhale the smoke from
tobacco products. We must keep these distinctions in mind
throughout the course of our discussion. Smoking policy is
fraught with controversy, and we must agree on terms and issues
at hand in order to communicate meaningfully.
Again, the facts about smoking behavior do not appear to
support the assertion that addictive behavior is involuntary.
People quit smoking all the time. Most people quit on their
own, without help from others (Fiore et al., 1990). And many
people moderate their smoking, i.e., they only smoke one or two
cigarettes, at specific times and places, without developing an
uncontrollable desire to smoke more (Hennrikus et al., 1996,
Gilpin et al, 1997). If adults start smoking because they
choose to do so, and moderate their smoking because they choose
to do so, and quit smoking--sometimes after fifty years of
smoking heavily--because they choose to do so, doesn't it seem
reasonable to conclude that people who continue to smoke after
many years--even when they know they are suffering health
consequences by their behavior--are choosing to do so?
Since smoking is voluntary, isn't it accurate to conclude
that the controversy surrounding smoking rights and regulation
is a political, not a strictly medical one? Smoking is a
behavior based on personal choice and values. Thus, the
regulation of smoking behavior through institutional control
such as government, is, in fact, the regulation of individual
choice and behavior.
Since behavior indeed refers to mode of conduct, and the
control of conduct can occur in only one of two ways--through
internal or external control--then smokers and nonsmokers can
either control themselves or be controlled by others. How many
people would credit the federal government for their personal
decision not to smoke? They probably would prefer to take
responsibility for not smoking themselves because it is
dehumanizing to abdicate their responsibility for not smoking to
others.
FORMAL VERSUS INFORMAL SOCIAL CONTROLS
Under what circumstances are institutional forms of social
control legally acceptable?
No matter how carefully rights are drawn and assigned,
there remains some potential for conflict. The fact that
my preferences extend to your behavior over activities that
are well within your defined rights, and vice versa,
insures that my satisfaction is influenced by the way that
you behave and that your satisfaction is also affected by
my behavior. (Buchanan, 1986, pp. 108-109)
James Buchanan's insight reveals a central focus of the
debate surrounding tobacco control. Buchanan alludes to the
level of interaction inherent in any social environment.
"Liberty" can be viewed as the foundation for either pro-
or anti-tobacco regulation arguments. Often the two terms
"liberty" and "rights" are used interchangeably, which, to a
number of philosophers is a mistake. For the purposes of this
discussion, liberty represents either the "preferences" which
smokers wish to assert by smoking, or those which nonsmokers
wish to assert by being free from smoke. Rights, according to
traditional rule of law ideology, are constitutionally appointed
entitlements, politically secured by the intentions of the
Founding Fathers, and now subject to a great deal of
interpretation. Since nowhere in the Constitution was smoking
or tobacco explicitly mentioned, there has been an enduring
dispute surrounding those issues.
Furthermore, as rights are claimed or established, either
for nonsmokers or smokers, it is assumed that the opposing group
will accept the responsibility of according the other those
rights--either by not smoking or by tolerating smoking. In
fact,
with respect to these debates over competing "rights" to
smoke or not smoke, most economists would not pose the
issue in this manner. What we are seeking is an efficient
outcome, not the preservation of assigned rights in a
situation in which there is no market exchange.
Determining the optimal smoking "rights" outcome involves
establishing the benefits and costs of different forms of
restriction. This approach takes the problem out of its
more strident and inconclusive ideological context in
which the debate has been waged. (Viscusi, 1992)
Ultimately, the debate over tobacco regulation continues to
challenge any conclusions regarding liberty and rights, pitting
the interests, expressed through their preferences, of smokers
and nonsmokers against each other indefinitely.
HARM TO SELF VERSUS HARM TO OTHERS
We must, for purposes of clarity and accuracy in our discussion,
differentiate here between harm to oneself versus harm to
others. The primary controversy concerning the right to smoke
is focused on whether individuals should be free to harm
themselves. Let us agree that no one has the legal right to
pursue liberty at the expense of others. Liberty at the expense
of others is criminal behavior. Our issue here is this: Do
smokers have a right to harm themselves, when they harm no one
but themselves? As Lysander Spooner wrote, "vices are not
crimes."
The problem we confront next has to do with drawing the
line on what constitutes harm. Some argue smokers incur greater
health care costs. Who should bear the burden of those costs?
If smoking does incur greater costs, and those costs are passed
on to nonsmokers in the form of higher health insurance premiums
and/or higher taxes to fund Medicare and Medicaid, doesn't that
constitute (economic) harm to others? If such is in fact the
case, it seems, at first glance, smokers should bear the burden
of those expenses.
But that conclusion seems simplistic to us and may set an
unfair precedent. If smoking is willful, and responsibility for
the consequences of smoking behavior belongs to the smoker,
i.e., the health-cost consequences, an equitable health care
policy would necessarily discriminate against other people who
engage in willful activities incurring greater health care
costs. It has been suggested that the health insurance industry
could play an integral and interesting role in tobacco
regulation. A libertarian approach could advocate the potential
for deterrence of smoking by the private sector through
assigning smokers to higher risk categories and higher premiums
(Halpin and Schauffler, 1993). Public health advocates have
sought allies among the health insurance companies by including
smoking cessation benefits in health plans. By shifting the
costs of their behavior directly to smokers, it is assumed that
economic disincentives would significantly reduce smoking rates.
Obviously, the large numbers of un- and underinsured smokers
would present a large problem under this model, since they would
probably not be subject to the same incentive system, and even
more low-income smokers would be priced out of the insurance
market altogether.
WHO IS RESPONSIBLE?
If we consider smoking behavior involuntary, then to hold
smokers responsible for the consequences of their behaviors
seems equivalent to punishing persons for self-inflicted crimes
they did not commit. Who is responsible then? Many people
today, notably those favoring governmental regulation of
nicotine, assert the responsibility belongs to the tobacco
industry. The U.S. Department of Health and Human Services
ranks tobacco use as the single most preventable cause of
mortality in the United States. Tobacco use is a leading cause
of diseases of the heart and blood vessels; chronic bronchitis
and emphysema; and cancers of the lung, larynx, pharynx, oral
cavity, esophagus, pancreas, and bladder, as well as respiratory
infections and stomach ulcers. Some argue that smoking behavior
is involuntary and that smokers should be held accountable for
the greater share of health care costs resulting from smoking.
"Sin tax" policies are ways of holding smokers accountable for
the consequences of their behaviors and simultaneously are
designed to discourage people from smoking. Yet these policies
seem contradictory, too.
If smoking is regarded as involuntary, i.e., the result of
an addiction that causes an individual to lose the ability to
stop smoking, then the attempt to discourage smoking by making
smokers pay higher prices for cigarettes and related tobacco
products seems to be a cruel and unusual punishment. The
Americans with Disabilities Act (ADA) should, at least
theoretically, protect smokers against such policies.
Obviously, smokers can be discouraged by high prices only if
smoking is voluntary behavior. If, on the other hand, smoking
is involuntary, high prices will not discourage smoking and will
penalize smokers for behaviors they cannot control.
Faced with these apparent contradictions, proponents of
tobacco regulation, rallying to the defense of children, assert
government must protect children from becoming smokers. This,
they often argue, should be done by enforcing age minimums on
the sale of tobacco products to minors, eliminating advertising
directed toward children, educating children about the dangers
of smoking, and so on. Here is a question we must answer in
light of these assertions and the policies that are implemented
because of them: Who are the more appropriate persons to teach
children about the possible dangers of smoking, parents or
government? Again, this seems to us to be an ethical issue.
Most would answer that parents are the proper persons to do so.
However, many tobacco regulationists believe they know what is
better for children than the children's own parents. Don't
parents have the right to teach their children as they see fit?
Clearly the danger in tobacco regulation is the creation of
what has come to be known as the "slippery slope": When
government mandates personal behavior in one area, what areas of
personal conduct can be immune from regulation? Benevolent
paternalism has been shown historically to be a road to serfdom.
If smoking is banned or regulated because of the dangers it
poses, what's next? High-fat diets?
As Morris E. Chafetz has remarked elsewhere, one-third of
the population does everything "right," i.e., behaves in health-
enhancing ways, complies with recommendations made by health
care professionals, and still dies early. One-third of the
population does everything "wrong," i.e., behaves in unhealthy
ways, refuses to comply with health recommendations, and lives
long and meaningful lives. Everyone else seems to fall
somewhere in-between. We don't know why some people get cancer
and others don't. We also don't know what the consequences of
tobacco regulation may be. Yet, just as it seems there is a
high probability that increased smoking will lead to increased
health problems, there seems to be a concomitant risk that
increased control of conduct by others, notably government,
will lead to abuse of power. Where paternalism, under the
masquerade of "public health," imposes formal social controls,
informal ones, i.e., relational and self-controls, are the
morally, if not legally, appropriate ones.
The validity of some of these conclusions, however, has
come under great scrutiny in recent years as confidential
tobacco industry files--the Brown and Williamson documents--have
been made public, documenting significant differences between
public industry statements and private industry knowledge of
health risks associated with tobacco use. These documents,
released by a "whistle blower" (formerly a Brown and Williamson
employee), documented the results of tobacco industry research
initiatives and their intentional release of contradictory
information.
BACK TO THE FUTURE
In light of the current smoking controversy, which is more
important, health or liberty? Much has been written to support
the medicalization of smoking and the criminalization of the
tobacco industry. Most anthologies and books presenting
arguments against regulation are dismissed as tobacco-industry
apologia, if not funded by the tobacco industry itself. We
believe the soundness of an argument should not be dismissed
simply on the basis of who supported the publication of these
views. If that were the case, one should simply dismiss the
arguments for regulation because they come from the federal
government.
The bottom line is this: We are each responsible for the
consequences of our actions, whether we favor health at the
expense of liberty, or vice versa.
FOOTNOTE (TO TITLE).
1. Schaler, J.A. and Schaler, M.E. (Eds.) (1998). Smoking:
Who has the right? Amherst, N.Y.: Prometheus Books. Reprinted
by permission of the publisher.
NOTES.
1. On August 28, 1996, the FDA published a final rule entitled
"Regulations Restricting the Sale and Distribution of Cigarettes
and Smokeless Tobacco to Protect Children and Adolescents."
Cigarette and smokeless tobacco manufacturers, convenience store
retailers, and advertisers (the plaintiffs) challenged the FDA's
legal authority in the U.S. District Court for the Middle
District of North Carolina at Greensboro and Winston-Salem,
William L. Osteen, Sr., District Judge, to regulate and restrict
tobacco products in this manner. Their lawyers argued that
Congress has withheld from the FDA the jurisdiction to regulate
tobacco products and that the Federal Food, Drug, and Cosmetic
Act does not permit the FDA to regulate tobacco products either
as drugs or as devices (cigarettes were labeled "nicotine-
delivery devices" by the FDA). Judge Osteen held that Congress
did not "[intend] to withhold from FDA" the jurisdiction to
regulate tobacco products. He also concluded the FDA had the
authority to regulate tobacco products under the device
provision of the Act and that the FDA lacked the statutory
authority to restrict advertising of tobacco products.
Plaintiffs appealed Judge Osteen's ruling. On August 14, 1998,
the U.S. Court of Appeals for the Fourth Circuit reversed Judge
Osteen's decision stating "For the purposes of these appeals,
plaintiffs do not dispute the factual findings of the FDA.
Based on our review of the record and the relevant legal
authorities, we are of opinion that the FDA lacks jurisdiction
to regulate tobacco products . . . [A]ll of the FDA's August 28,
1996 regulations of tobacco products are thus invalid . . . This
is not a case about whether additional or different regulations
are needed to address legitimate concerns about the serious
health problems related to tobacco use, and particularly youth
tobacco use, in this country. At its core, this case is about
who has the power to make this type of major policy decision.
As the Supreme Court has previously stated about a different
agency and its enabling statute, neither federal agencies nor
the courts can substitute their policy judgments for those of
Congress . . . Accordingly, we do not, indeed cannot, pass
judgment on the merits of the regulatory scheme proposed by the
FDA . . . [T]he FDA has exceeded the authority granted to it by
Congress, and its rulemaking action cannot stand . . . We are
thus of opinion that Congress did not intend to delegate
jurisdiction over tobacco products to the FDA. Accordingly, the
judgment of the district court is REVERSED." (Opinion written
by Judge Emory H. Widener Jr., Circuit Judge, U.S. Court of
Appeals for the Fourth Circuit, August 14, 1998; Brown &
Williamson Tobacco Corporation et al. v. Food & Drug
Administration et al. From 1998 U.S. App. LEXIS 18821). Two
FDA regulations are still in effect: Tobacco products may not
be sold to anyone under 18 years of age and retailers are
required to check photo IDs of purchasers under age 27 (The
Nation's Health, Volume 28, No. 8, 1).
2. In Flue-Cured Tobacco Cooperative Stabilization et al. v
U.S. Environmental Protection Agency (EPA) (4 F. Supp. 2d 435;
1998 U.S. Dist.), Decided July 17, 1998, the U.S. District Court
for the Middle District of North Carolina, Winston-Salem
Division, Judge William L. Osteen, lawyers for the tobacco
industry argued against the EPA claim that Environmental Tobacco
Smoke (ETS) was a Group A carcinogen, a designation meaning
there is sufficient evidence to conclude ETS causes cancer in
humans. Plaintiffs argued the "EPA exceeded its authority under
and violated the restrictions within the Radon Research Act;
EPA did not comply with the Radon Research Act's procedural
requirements; EPA violated administrative law procedure by
making a conclusion regarding ETS before it concluded its risk
assessment, and EPA's ETS Risk Assessment was not the result of
reasoned decision making." (1998 U.S. Dist. LEXIS 10986). The
EPA denied this claim by the Plaintiffs and asserted "the
administrative record . . . demonstrates reasoned decision
making." (Ibid.). In his conclusion, Judge Osteen made the
following ruling: "In 1988, EPA initiated drafting policy-based
recommendations about controlling ETS exposure because EPA
believed ETS is a Group A carcinogen . . . Rather than reach a
conclusion after collecting information, researching, and making
findings, EPA categorized ETS as a 'known cause of cancer' in
1989. EPA's Administrator admitted that EPA 'managed to confuse
and anger all parties to the smoking ETS debate' . . . The
Administrator also conceded, 'beginning the development of an
Agency risk assessment after the commencement of work on the
draft policy guide gave the appearance of . . . policy leading
science . . . .' In conducting the Assessment, EPA deemed it
biologically plausible that ETS was a carcinogen. EPA's theory
was premised on the similarities between MS [mainstream smoke],
SS [sidestream smoke], and ETS [environmental tobacco smoke. In
other chapters, the Agency used MS and ETS dissimilarities to
justify methodology. Recognizing problems, EPA attempted to
confirm the theory with epidemiologic studies. After choosing a
portion of the studies, EPA did not find a statistically
significant association. EPA then claimed the bioplausibility
theory, renominated the a priori hypothesis, [and] justified a
more lenient methodology. With a new methodology, EPA
demonstrated from the selected studies a very low relative risk
for lung cancer based on ETS exposure. Based on its original
theory and the weak evidence of association, EPA concluded the
evidence showed a causal relationship between cancer and ETS.
The administrative record contains glaring deficiencies. . . In
this case, EPA publicly committed to a conclusion before
research had begun; excluded industry by violating the Act's
procedural requirements; adjusted established procedure and
scientific norms to validate the Agency's public conclusion, and
aggressively utilized the Act's authority to disseminate
findings to establish a de facto regulatory scheme intended to
restrict Plaintiffs' products and to influence public opinion.
In conducting the ETS Risk Assessment, EPA disregarded
information and made findings on selective information; did not
disseminate significant epidemiologic information; deviated from
its risk Assessment Guidelines; failed to disclose important
findings and reasoning; and left significant questions without
answers. EPA's conduct left substantial holes in the
administrative record. While so doing, EPA produced limited
evidence, then claimed the weight of the Agency's research
evidence demonstrated ETS causes cancer. Because EPA exceeded
its authority under the Radon Research Act and also failed the
Act's procedural requirements, the court will direct the entry
of judgment in favor of Plaintiffs' motion for summary judgment
and vacate Chapters 1 thru 6 of and the Appendices to EPA's
Respiratory Health Effects of Passive Smoking: Lung Cancer and
Other disorders." (Opinion written by Judge William L. Osteen
U.S. District Judge, 4 F. Supp. 2d 435; 1998 U.S. Dist.. LEXIS
10986). This ruling is important for several reasons, however,
it is most likely to bear significantly on the authority of
government to impose smoking restrictions in public and private
places due to alleged carcinogenic effects of second-hand smoke.
REFERENCES
Buchanan, J.M. (1986). Politics and meddlesome preferences.
In R.D. Tollison (ed.) Smoking and society: Toward a more
balanced assessment (pp. 333-342). Lexington, MA.:
Lexington Books.
Fiore, M.C., Novotny, T.E., Pierce, J.P, Giovino, G.A.,
Hatziandreu, E.J., Newcomb, P.A., Surawicz, T.S., and
Davis, R.M. (1990). Methods used to quit smoking in the
United States: Do cessation programs help? Journal of the
American Medical Association, 263(20), 2760-2795.
Gilpin, E., Cavin, S.W., and Pierce, J.P. (1997). Adult smokers
who do not smoke daily. Addiction, 92(4), 473-480.
Halpin Schauffler, H. (1993). Health insurance policy and the
politics of tobacco. In R.L. Rabin and S.D. Sugarman
(eds.) Smoking policy: Law, politics, and culture. New
York: Oxford University Press.
Hennrikus, D.J., Jeffery, R.W., and Lando, H.A. (1996).
Occasional smoking in a Minnesota working population.
American Journal of Public Health, 86(9), 1260-1266.
Viscusi, W.K. (1992). Smoking: The risky decision. New York:
Oxford University Press.
Jeffrey A. Schaler, Ph.D. is Fifth Column Editor of the PsychNews
International. [jschale@american.edu]
Magda E. Schaler, M.P.H., received her B.A. degree in sociology
with a program concentration in Law, Medicine and Health Policy
from Brandeis University; and her M.P.H. degree from the
Division of Health Policy and Management at Columbia University
School of Public Health. She is currently a law student at
Columbia University School of Law. [mes67@columbia.edu]
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