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3 Military Training is also atypical. (5) There is no validation of smoking or quitting by biochemical markers. As the authors say, more research is needed here. P N Lee 4.4.2000.

1 REVIEW 1099 CONFIDENTIAL Subject ref 5b "An examination of cigarette brand switching to reduce health risks" C K Haddock et al Annals of Behavioural Medicine (1999), 21, 128-134 An important question is whether switching to lower tar/nicotine cigarettes increases the probability of subsequent quitting smoking. In attempting to answer this question one has to take into account the possibility that those smokers who choose to switch will have characteristics that make them inherently more likely to quit than those who do not choose to switch. The paper reviewed here is based on a study of all men and women entering the United States Air Force from August 1995 to August 1996. The population, which was of average age about 20 with about 75% male, including 7998 who smoked regularly up to Basic Military Training. Based on a questionnaire given at the start of Basic Military Training, they were divided into groups: Switchers : Those who answered yes to the question "In the 12 months prior to Basic Military Training had you ever switched to a lower tar/nicotine cigarette just to reduce your health risk?" (1893 males and 627 females) and Non-switchers : Other current smokers (4160 males and 1317 females). (Note that the "Non-switchers" are variously defined in the paper as those who answered "no" to the question and those who had not switched brands, but as the total numbers of Switchers and Non-switchers equals (within one person) the total population of current smokers - it seems that non-Switchers are in fact all other current smokers. Certainly, it is not totally clear what happened to those who switched partly or wholly for reasons other than health - as they should not have answered yes to the question).

2 Compared to Non-switchers, Switchers were found to be of similar age, education, income and, in males, race. Switchers were, however, clearly found to smoke less cigarettes per day, have lower nicotine dependence (Fagerstrom scores), smoke lower tar brands (unsurprisingly), be more likely to have attempted to quit in the last year, and be more confident that they will be able to quit permanently, once out of Basic Military Training. In women, switchers were also more likely to be from an ethnic background. Switchers also tended to have more favourable health and safety factors; e.g. greater fruit and vegetable intake and seat belt use, less high-fat food intake and risk-taking. Of the 7998 current smokers, 5228 were contacted a year after the six-week smoking ban during Basic Military Training. There was a slightly higher quit rate among Switchers, but this was not statistically significant, either as a simple comparison of rates (12.5% vs 11.1%) or as a comparison adjusted for various factors that might affect quit rate (Odds ratio 1.04, 95% confidence interval 0.89-1.21), including age, sex, race, income, education, nicotine dependence and confidence in quitting after Basic Military Training. The last two factors were the most significant (p<0.001) predictors of quitting, with those with low nicotine dependence and high confidence in quitting having an increased probability of quitting. While the study is an interesting one which, based on a relatively large sample, suggests that brand switching to lower tar/nicotine does not itself increase the probability of quitting materially, there are a number of limitations: (1) As noted already, there is confusion about the definition of Switchers and Non-switchers. (2) Ideally one should be able to match for tar/nicotine smoked before switching, i.e. classify subjects into groups by tar/nicotine brand smoked a year before Basic Military Training, then subdivide each group into those who did or did not switch down by Basic Military Training, then compare quit rates of Switchers and Non-switchers within initial tar/nicotine group. However the study did not collect data in this way. (3) The study population, young military recruits, may produce results which might not apply to older smokers. (4) The fact that all the smokers were compelled to give up for six weeks during Basic