Tobacco Documents Online

I am Dr. Sherwin J. Feinhandler, President of Social Sys- tems Analysts, Inc., a social and behavioral research and con- sulting firm, in Watertown Massachusetts. I am a consultant and have run projects for federal, state and local government agen- cies as well as educational institutions and organizations in the private sector. By training I am a Cultural Anthropologist with degrees from the departments of Sociology at Northwestern Univer- sity, Anthropology at Syracuse University and Social Relations at Harvard University. I have been Assistant Professor in the Department of Psychiatry at Boston University School of Medicine and Assistant Professor in the Department of Anthropology at Bos- ton University. More recently I have been a Lecturer in Anthro- pology in the Department of Psychiatry at Harvard Medical School. My research activities have included a focus on social and cultural processes in everyday life, communities and organiza- tions. I have published articles and presented papers on various topics related to these areas. Among my interests is the role of and reactions to tobacco in society. Therefore, I was quite con- cerned when I heard of proposed House Bill 4957. The following statement is based upon data collected over several years from smokers, ex-smokers, nonsmokers and anti- smokers on behavior and meaning systems related to tobacco and its use. The data were generated through: - intensive interviews with people representing all ages, both sexes, and a variety of ethnic, educa- '.tional and social class backgrounds; - intensive and extensive group discussions with the same representative segments of the population; - structured observations of behavior of smokers and nonsmokers in everyday life; - and recent interviews focusing on decisions made by smokers in relation to their understandings of health claims and smoking. In our earlier studies we found that smokers and nonsmokers alike were aware of and generally accepted the claims concerning detrimental consequences of smoking. We learned that smoking occurs as customary patterned behavior and has powerful support in both personal and social needs which cannot be readily abridged without serious consequences. Our purpose in conducting new interviews was to determine whether smokers make decisions about smoking based on their awareness of smoking related health claims and warnings. If so, what is the process and what are their reasons for deciding whether or not to continue smoking. In the course of this investigation several issues emerged in relation to these questions. These will be described below. S.J. Feinhandler, Ph.D. 4th Mar AWARENESS OF HEALTH CLAIMS The Surgeon General's reports their findings have been extremely messages about health and smoking t made it obvious that they were keen smoking, usually without our raisin her views about the relationship of spondent's first words were: "The whatever he says', smoking is bad fc Our studies show no tendency c reject the idea that smoking can be it is a problem". For some it is a about it all the time". Even when t for smokers, their concerns are deeF know the claims about their smoking, of certainty to its consequences whi agreement with the facts: "I think What else can I say about it". Smokers perceive the consequen and often imminent even though they effects. "Smoking doesn't seem to h I have not smoked long enough (to no Responses to Warning Labels In the face of this general awz treat health warnings on cigarette pe evident. When asked about awareness warning on every cigarette package, a we smokers know smoking is bad". In are found to be somewhat insulting tc issues of the motivation behind these consequence, the credibility of the h When confronting a situation in engage in a kind of risk assessment i ^+eigh jointly the seriousness of the 5ility of their occurrence. The ques especia:ly relevant here, since it is relation to specific health claims. Specific statements often raise People have contrary evidence; they ti Of the probability of risk. They are health claims but disbelieve them.

d ae r- at 0 9 us rs 3 ig 377 S.J. Feinhandler, Ph.D. 4th March 1982 - 2 - AWARENESS OF HEALTH CLAIMS The Surgeon General's reports and the related coverage of their findings have been extremely effective in communicating messages about health and smoking to the public. Our respondents made it obvious that they were keenly aware of the warnings about smoking, usually without our raising the question. When asked her views about the relationship of smoking to health, one re- spondent's first words were: "The Surgeon General sayst 'and whatever he says', smoking is bad for you, and I know it". Our studies show no tendency on the part of smokers to reject the idea that smoking can be hazardous: "I am convinced it is a problem". For some it is a highly salient one: "I think about it all the time". Even when the issues are less salient for smokers, their concerns are deeply felt. Clearly, smokers know the claims about their smoking, and some attribute a degree of certainty to its consequences which may not be in technical agreement with the facts: "I think (smoking) gives you cancer. What else can I say about it". Smokers perceive the consequences of smoking to be real, and often imminent even though they themselves feel no negative effects. "Smoking doesn't seem to hurt me. Maybe it is because I have not smoked long enough (to notice any effects)". Responses to Warning Labels In the face of this general awareness, our respondents treat health warnings on cigarette packs and in ads as self- evident. When asked about awareness of the Surgeon General's warning on every cigarette package, a respondent commented: "All we smokers know smoking is bad". In many instances the warnings are found to be somewhat insulting to the intelligence and raise issues of the motivation behind these attempts to inform. As a consequence, the credibility of the health issues is questioned. When confronting a situation involving risk, most people engage in a kind of risk assessment in which they attempt to weigh jointly the seriousness of the consequences and the proba- bility of their occurrence. The question of credibility is especially relevant here, since it is raised by some smokers in relation to specific health claims. Specific statements often raise credibility issues when people have contrary evidence; they then lower their assessment of the probability of risk. They are aware of the specific' health claims but disbelieve them.

378 S.J. Feinhandler, Ph.D. 4th March 1982 - 3 - When asked how they would respond to a warning concerning the relationship between lung cancer and smoking, typical re- sponses of this type were: "I don't feel shortness of breath ... I know of lots of cases where people who never smoked got lung cancer and there are so many smokers who don't get it ... "Changing the warnings -- it would scare but then again I laugh because its just not true. Everyone who smokes doesn't get lung cancer. It is just not enough to give up. Maybe I am just stubborn but I don't like being told what to do. The thing that would make me give it up is my own feelings, what it does to my own body." - A more common response among smokers involves some kind of acceptance or belief in the health claims. It is these smokers who engage in a more complex process of deciding whether or not to smoke. INFORMED DECISIONS TO CONTINUE SMOKING The fact that smokers continue to smoke, although aware of the claims concerning the health consequences of smoking, may lead to the conclusion that they are engaged in an irrational process. This process has often been dismissed as mere habit. Quite the contrary, we have found that smokers engage in a con- scious decision process, not only about whether to continue smoking, but also about whether or not to smoke certain cigar- ettes through the day. We have been struck by the general similarity of the pro- cess used by people from quite different backgrounds when health considerations are the stimuli for reassessing the decision to smoke. We have described above the approach used by people who question the risk of smoking. Others consider its risks and benefits; we have noted two different approaches. One involves the balancing of two sets of risks: that of smoking against that ~ of not smoking. The other weighs the perceived benefits of smoking against the perceived risks of smoking. ;' The first approach involves weighing one or more of the - predicted consequences of not smoking against the predicted consequences of smoking. The smoker assesses the probability of the consequences on both sides of the choice and jointly deter- -_3 mines benefit in terms of choosing which risks are preferred. "I tried to give up smoking 4 or 5 times and went maybe three months and put on like 20 to 25 pounds .. for my own health I went back to smoking." 379 S.J. Feinhandler, Ph.D. 4th Mar, "I've tried not smoking and fc laden with anxiety. With that smoking." The second approach defines t} terms of the value added to smoking put in achieving certain desired enc The Sources of Value We have observed the use of tc variety of personal and social needs people because of this role. Lighting a cigarette in respon experiences, Such as the company of ;ood meal, is cited frequently. In to heighten the experience and enhan ure and relaxation many associate wi derives from the sensorimotor aspect ling, visualization of smoke and inh -espondent explained: "If I really desire a cigarett it. Its not the nicotine. It smoke going up and down that I experience. A pleasurable fee People feel that smoking serve consequences of negative situations of fear, anxiety or distress. One i ettes as "a constant companion I car Smoking plays an important par individual lives. Smoking after a m• witnessed everyday in American socie light a cigarette and then I know th. don't have a cigarette, then I feel • sore thing." Here the act of smokin sn event. As a structuring mechanisc with it a sense of predictability an< individuals to achieve a sense of se, Smoking serves to impose struc• to have little or no structure of thc have to wait. Its something that he' waiting." Cigarettes can aid in the orgar em writing I will stop and have a cic thoughts." Smoking is also viewed a: time in which to relax. "When I wor} long time, smoking is like a little r break from what I am doing." 0 W ~ ~ ~ ~ 9&-077 0-82-25 (~ ~

379 s.J. Feinhandler, Ph.D. 4th March 1982 - 4 - "I've tried not smoking and found these days to be laden with anxiety. With that choice, I prefer smoking." The second approach defines the benefits of smoking in terms of the value added to smoking by the uses to which it is out in achieving certain desired ends. The Sources of Value We have observed the use of tobacco in fulfilling a wide variety of personal and social needs. Smoking has value for people because of this role. - Lighting a cigarette in response to pleasant or enjoyable experiences, such as the company of friends or at the end of a ;ood meal, is cited frequently. In this instance smoking is said to heighten the experience and enhance good feelings. The pleas- ure and relaxation many associate with the use of tobacco often derives from the sensorimotor aspect of smoking: taste, hand- ling, visualization of smoke and inhaling and exhaling. One -espondent explained: "If I really desire a cigarette nothing can replace it. Its not the nicotine. Its the feeling of the smoke going up and down that I enjoy. It is a unique experience. A pleasurable feeling." People feel that smoking serves to reduce the emotional consequences of negative situations -- when experiencing feelings of fear, anxiety or distress. One informant characterized cigar- ettes as "a constant companion I carry for comfort." Smoking plays an important part in the everyday ordering of individual lives. Smoking after a meal is a common practice, witnessed everyday in American society. "I normally stop eating, light a cigarette and then I know that mealtime is over. If I don't have a cigarette, then I feel compelled to eat at least one more thing." Here the act of smoking serves to mark the end of an event. As a structuring mechanism, the act of smoking brings with it a sense of predictability and familiarity which allows individuals to achieve a sense of security. Smoking serves to impose structure on events which appear to have little or no structure of their own. "I smoke when I have to wait. Its something that helps me get through the waiting." Cigarettes can aid in the organization of thought. "If I am writing I will stop and have a cigarette to collect my thoughts." Smoking is also viewed as a break from activities, a time in which to relax. "When I work steadily in one place for a long time, smoking is like a little rest period. A five minute break from what I am doing." 95-077 0-82-25 0 w ~ 0 ~ ~ a 0

380 S.J. Feinhandler, Ph.D. 4th March 1982 - S' -•:.2 Smoking can serve as a social lubricant by providing a com- mon activity for establishing social relationships. In our soc- iety the act of offering a cigarette or a light is an expression of a desire to be sociable. Smoking can also serve to affirm social bonds for individuals and groups whose relationships have been previously established. ' 3*, "I started smoking in college because there was a real division between smokers and nonsmokers. I was very shy and at certain times after dinner for example people would get together in the smoking room. It was my way to be accepted by these people and to make new . friends. And I made a lot of friends through smoking. In the smoking room there was a feeling of camerad- erie. You would talk to people that you wouldn't normally. Its a very clear thing, you meet a lot of people through smoking. It was easier to meet smokers than nonsmokers because you had something in common -- the vehicle of smoking." 381 S.J. Feinhandler, Ph.D. 4th March this would work, is silly and wa All it does is to threaten the c of our country. Like prohibitic black market. It becomes common law. It would make law-breakers are otherwise considered good ci are even less dangerous than alc don't have the potential to crea Smoking is a behavior that a smoker shares with a wide sec-_.t.. tor of society. The behavior is patterned and the understandings :,,, are shared. VIEWS OF THE PROPER ROLE OF GOVERNMENT We have illustrated smoking as patterned behavior carried out separately by individuals over space and time, reflecting tradition and organizing concepts in common. Smoking, deeply ingrained in our culture through centuries of tobacco use, has thus become an accepted custom in society. This explains why the majority of smokers and nonsmokers share similar views about the government's role in relation to smoking. These views can be summarized in terms of the social value placed on freedom of individual choice and the absence of arbit- rary regulation when social processes can work out the issues at r;; hand. There is also a feeling that externally imposed regulation b removes responsibility from individuals and natural social -ii' o groups. While some people rather like the idea of avoiding re-_,p sponsibility, they hesitate in agreeing to the inevitable sacri-..A fice of free choice. ' " ! Most respondents feel that the appropriate role for govern- ment in relation to smoking is that of keeping people informed. vail' "I feel that the government has the responsibility to' ;}F.t warn people because no single person can accumulate all knowledge and conduct tests. I feel that govern- ment should conduct studies, I just don't feel that the government has the right to make your choice. :.i4 Telling you you can't smoke is like telling you, 'you :.::J can't have an alcoholic beverage'. No attempt to do 't:e Attribution of Deviance Current attempts to regulate the ;s part of an effort to define smoking Neple recognize that the attribution e smoker himself. "I began to smoke at 24; there w about it then. There was no pub enjoy it now. I feel very weak "It seems to me that people are moral judgements on smokers and backing them. They try to put g it is the smoker who suffers." Noteworthy in this respect are r -•:sinesses to discriminate against smo 3^ablishment of a psycho-diagnostic c ._Sorder". a.nt1-smoking groups and governme: '-.is effort. Smoker and nonsmoker ali s^ti-smoking groups as deviant rather ":ch. They question the motivation of Ic~ribute to them either Messianic,or ~=•zernment attempts to restrict custom "estioned. People thus feel-that gov ';pocrisy, inappropriate exercise of p- :ndividual rights. "I really think that the governm are anti-smokers like to point f feel good. 'I'm not doing that, better than they are. I must be There is no difference between sr To categorize smokers or nonsmok~ have enough discrimination in th~ to create more. But it is anti- rest of the world." "I think that this is all politi there are people out there who a. smoking, not for health reasons . W Q 0 ~

381 S.J. Feinhandler, Ph.D. 4th March 1982 - 6 - this would work, is silly and wastes a lot of money. All it does is to threaten the credibility of the laws of our country. Like prohibition, it would create a black market. It becomes common practice to break the law. It would make law-breakers out of people that are otherwise considered good citizens. Cigarettes are even less dangerous than alcohol because they don't have the potential to create deviant behavior." The Attribution of Deviance Current attempts to regulate the smoking process are seen as part of an effort to define smoking as deviant behavior. Many people recognize that the attribution of deviance is extended to the smoker himself. "I began to smoke at 24; there was nothing terrible about it then. There was no publicity. I can hardly enjoy it now. I feel very weak minded." "It seems to me that people are now trying to make moral judgements on smokers and the government is backing them. They try to put guilt on the smoker and it is the smoker who suffers." Noteworthy in this respect are recent efforts to encourage businesses to discriminate against smokers in hiring and the establishment of a psycho-diagnostic category, "smoking behavior disorder". Ant!-smoking groups and government are felt to be active in this effort. Smoker and nonsmoker alike view the efforts of anti-smoking groups as deviant rather than viewing smoking as such. They question the motivation of people in these groups and attribute to them either Messianic or power seeking desires. Government attempts to restrict customary behavior are similarly questioned. People thus fee1that government demonstrates hypocrisy, inappropriate exercise of power and undue manipulation of individual rights. "I really think that the government and the people who are anti-smokers like to point fingers. It makes them feel good. 'I'm not doing that, therefore I must be better than they are. I must be a better person'. There is no difference between smokers and nonsmokers. To categorize smokers or nonsmokers is ridiculous. We have enough discrimination in the U.S. now. Why try to create more. But it is anti-smokers against the rest of the world." "I think that this is all political. I think that there are people out there who are violently anti- smoking, not for health reasons and they have money

S.J. Feinhandler, Ph.D. 4th March 1982 - 7 - and a lobby. If it was for health reasons they would be on the bandwagon for a hell of a lot of other things. People are bothering me and it is a personal insult. They shouldn't be allowed to bother me. Anti-smokers have no personal consideration or sen- sitivity. It is a legal way for them to relieve a lot of aggression. I may hate a woman wearing strong perfume but I don't pour water on her or tell her to get off the elevator because she is bothering me. There has to be something more going on. Its looking only after themselves; I am good and they're bad." Most people reject the attributions of deviance applied to smokers because they recognize that smoking is part of customary behavior and place a high value on free choice in matters of cus- tom. Many nonsmokers, even those who have experienced discomfort as a result of others' smoke in specific situations, have said that interpersonal processes are to be preferred to legislative restrictions. S UMDlA RY Smokers are keenly aware of the publicity surrounding th relationship between health and smoking and the warnings on cigarette packs. Given this awareness, they show no tendency reject the idea that smoking can be hazardous, whether or not they have any desire to give up smoking. The sheer volume and intensity of the warnings has led many to question the motivat behind them, and the validity of their content. Specific warnings encourage smokers to consider easily found counter- examples. This kind of behavior is often dismissed as irrational, however, it is a highly logical response to social needs and realities. Smoking is an indispensable aid in encouraging po tive social behavior, and enabling individuals to deal with situations in the world about them. . . _ . The fact that people continue to smoke in the face of seemingly overwhelming publicity against smoking is proof, in itself, of its social importance. It follows that attempts, Citizenship: U.S. 383 RESL?1E Soecialization: Cultural anthropology; lingui cation; cognitive & meaning s health; tobacco, alcohol & dr ation; ethnography of everyda Cjucation: Harvard University 9/58-12/6 Makere College (East 7/60-12/6 African Institute of Social Research) London University 7/60-12/6 Syracuse University 9/56-6/58 aorthwestern University </53-6/56 :.enguages: French: speaking, reading German: apeaking, reading Swahili: fluent Kikamba: speaking -ployment and Research Experience: es Title Institution - 77-pres President Social Systems Analysts, Inc. e '7-6/80 Lecturer in Harvard Medical s to Anthropology Dept. of Psychiat '-6/80 Assistant Dept. of Psychiat ion Anthropol- ogist Mass. General Hos '2-6/77 Lecturer --Simmons School of Social Work ' '~-6/73 Adjunct Dept. of Anthropo si- Assistant Professor Boston University -~Ee-12/69 Assistant Division of Psych F ....~.tr Professor B.U. School of Me °~='-12/69 Assistant Dept. of Anthropo Professor Boston University which smokers perceive to be unjustifiable coercion and hypo- critical at best, involves social consequences whose costs are incalculable. S.J. Feinhandler, Ph.D. SHER1iIN J. FEINHANDLER .4,

Name: SHERWIN J. FEINHANDLER 383 RESL~tE Citirenship: U.S. Scecialization: Cultural anthropology; linguistics; language & communi- cation; cognitive 6:neaning systemsr community mental health; tobacco, alcohol & drug research; program evalu- ation; ethnography of everyday lifei Africa, United States Education: Harvard University 9/58-12/67 Ph.D., Social Relations Makere College (East 7/60-12/62 Associate African Institute of Social Researchl London University 7/60-12/60 Special Student Syracuse University 9/56-6/58 M.a., Anthropology Northwestern University 4/53-6/56 B.A., Sociology Languages: French: speaking, reading German: speaking, reading Swahili: fluent Kikamba: speaking Employment and Research Experience: Dates Title Institution 2/70-pres President Social Systems Analysts, Inc. 1/70-6/80 Lecturer in Harvard Medical School Anthropology Dept. of Psychiatry 1/70-6/80 Assistant Dept. of Psychiatry Anthropol- Mass. General Hospital ogist 9/72-6/77 Lecturer Simmons School of Social Work 1/70-6/73 Adjunct Dept. of Anthropology Assistant Boston University Professor 6/68-12/69 Assistant Division of Psychiatry pr~fessor 3.U. School of Medicine 9/67-12/69 Assistant Dept. of Anthropology Professor Boston University Responsibility Administration, research and consulting Research in verbal and non-verbal behavior Coordinator of Alcoholism Training Program '70-'71, consultant to Street Youth Program '72-'73, consulting 70-'80 Research Seminars Teaching Director of evaluation of a housing program Teaching V

384 S.J. Feinhandler - 2 - Employment and Research Experience (cont'd): Dates Title Institution 1/68-5/68 Research H.S.G. Cutter Associate Brockton V.A. Hospital Brockton, MA 3/65-12/67 Research L.J. Sherman Assistant Brockton V.A. Hospital 1/61-11/62 Ethnographer East Africa C.O. Frake, Supervisor 9/59-6/60 Research R.F. Bales Assistant Harvard University 1/59-6/60 Researcher M. Orne, Mass. Mental Health Center 1/59-9/59 Research M. Orne, Mass. Assistant Mental Health Center 10/57-4/58 Researcher N.Y. State Mental Health Research Unit, Syracuse 10/56-6/58 Instructor Syracuse University 10/56-12/57 Researcher G. Agogino . 12/54-4/55 Statistical R.F. Winch Assistant Northwestern University Responsibility Research on alcoholism ~ and communications Research on alcoholism and hospital social structure Research, primarily cognitive anthropology, sociology. social structure and medicine Research on inter- personal behavior Field study of Penecostal churches Experiments on trance Research in schizophrenia Teaching Archeological Digs Data Analysis ., Consulting Experience: Dates Client Responsibility 9/76-10/78 Philip Morris, Inc. Historical and structur- alist studies on tobacco 8/78-9/78 Tobacco Institute 11/73-2/74 National Institute on Alcohol Abuse and Alcoholism 6/73-10/73 Mass. Committee on Criminal Justice 6/72-6/73 Cross-National Drinking Practices Consultant on tobacco legislation Study of bar behavior tvaluation of delinquency prevention practices Survey of drinking practices 9/72-4/73 Commonwealth Member of Governor's Advisory of Massachusetts Committee on Drug Abuse Research 3.J. Feinhandler _onsulting Experience (cont'd): -ates Client 3'72-12/72 Mass. Committee on Criminal Justice 3.?1-9/72 Division of Drug Reha- bilitation, Comm. of Yass. 1/71-6/72 Beth Israel Hospital 3E 5/71-7/71 Boston University School of Medicine, Division of Psychiatry ..'9-12/70 Harvard University Program on Technology and Society .7o-ei71 Barss, Reitzel • -and Associates ._ 11;68-10/69 Harold Cabot Co. .67-6/67 Boston Stata Hospital S.o6-7/66 Harvard University School of Education 5 Charles aacArthur Harvard University Health Services Pro'essionally Related Experience: Leading therapy group of alcoholics Leading therapy group of wives of alcc Leading therapy group of married coupl Leading "T' group of Psychology Traine Evaluating referrals on closed circuit Cnrriculum development , . Assistant Editor, The Deltan =curse-ht. >yracuse University: _ Introductory Anthropology - Introductory Sociology Introductory and Intermediate Sta Demography

5.J. Feinhandler Consulting Experience (cont'd): Dates Client 3/72-12/72 Mass. Committee on Criminal Justice 3/71-9/72 Division of Drug Reha- bilitation, Comm. of .vass. 4/71-6/72 Beth Israel Hospital 385 5/71-7/71 Boston University School of Medicine, Division of Psychiatry 4/70-12/70 Harvard University Program on Technology and Society 9/70-B/71 Barss, Reitxel and Associates 11/6B-10/69 Harold Cabot Co. 1/67-6/67 Boston State Hospital 5/66-7/66 Harvard University School of Education 3/65-9/65 Charles MacArthur Harvard University Health Services Professionally~ Related E xperience: Responsibility Evaluation of methadone day-care program Evaluation of Marathon House, a drug rehabilitation program Department of Labor study of job improvement - Proposal for comprehensive treatment program for alcoholism Designed and conducted survey of public attitudes on technology Consultant, Office of Education libr•ary program evaluation . Studies of consumer cognition and behavior Design of treatment and research in alcoholism Curriculum develop- ment on East Africa Study of smoking, behavior and cognition Leading therapy group of alcoholics Leading therapy group of wives of alcoholics Leading therapy group of married couples Leading "T" group of Psychology Trainees (graduate students) Evaluating referrals on closed circuit Telediagnosis System Curriculum development Assistant Editor, The Deltan Courses :aught: -Syracuse University: Introductory Anthropology Introductory Sociology Introductory and Intermediate Statistics Demography