Lighting up aspects of the study of tobacco

Worldwide, a half of all men smoke cigarettes. In the United Kingdom, while the numbers are declining, about a third still smoke, a further third are ex-smokers with the wisdom of hindsight, while most of the remainder’s opinions have been formed by having to breathe in the smoke of family, friends and strangers.

The 20th-century ubiquity and cultural acceptance of cigarettes has been a boon and a problem for tobacco studies. A boon because public and media interest in the emerging epidemic has been intense and leading medical journals have been keen to publish. This tradition started with the landmark 1950 papers of Richard Doll and Bradford Hill in the British Medical Journal and Ernst Wynder and Ewart Graham in the Journal of the American Medical Association linking cigarettes with lung cancer. The coverage in general journals continues unabated, with regular special issues focusing on what was the largest public health disaster of the 20th century and threatens to be the same for the coming century. The problem arises because deeply entrenched lay acceptance of smoking as a social habit helped contribute to a climate where the narcotic aspects of smoking remained largely invisible for many years. At the same time as paper after paper in the 1950s and 60s brought the gigantic scale of the tobacco epidemic into closer focus, there was a vacuum in understanding why it was so difficult for smokers to abandon their lethal and self-destructive behaviour.

The key to developing a better framework for understanding was to point to nicotine as the culprit - not in the sense that nicotine directly causes tobacco deaths (in smoking doses nicotine appears relatively non-toxic), but as the drug motivating smoking and for which the cigarette is a uniquely contaminated delivery system. The paradigm of cigarette smoking as nicotine addiction began to emerge c.1970, and the case was perhaps most neatly expressed by William Dunn, the so-called "nicotine kid" from Philip Morris’ s research department, who wrote in 1972 : "The cigarette should be conceived not as a product but as a package. The product is nicotine. Think of the cigarette pack as a storage container for a day’s supply of nicotine... Think of the cigarette as the dispenser for a dose unit of nicotine... Smoke is, beyond question, the most optimised vehicle of nicotine and the cigarette the most optimised dispenser of smoke."

A series of advances, many of which were associated with the work of Michael Russell at the Institute of Psychiatry in London, quickly established nicotine’s pivotal role in smoking behaviour. Measures of blood nicotine levels revealed smokers’ tendency to regulate their nicotine intake fairly precisely (and in so doing showed that compensation for nicotine largely negates the potential health gains from low-yield cigarettes). The development of nicotine chewing gum led to the first effective treatment aid for smoking cessation and further underscored nicotine’s importance. Fast forward to the early 1990s, and an explosion of research, ranging from the molecular pharmacology of brain nicotine receptors, through animal self-administration and brain nicotine reward pathways, to behavioural and economic studies of human smoking, led to a new consensus: cigarette smoking as nicotine addiction, enshrined in the 1988 report of the United States Surgeon General that labelled nicotine as addictive in the same sense as heroin and cocaine.

One can pity the researcher wanting to make sense of the diverse phenomena of tobacco use. Increasingly, it has become necessary to scan not just the mainstream general science and medical journals but also specialist journals in neurochemistry, pharmacology and animal behaviour as well as epidemiology and addiction to keep in touch with developments. Nicotine and Tobacco Research is a response to this challenge. This is a young journal, appearing for the first time in 1999 and published by the Society for Research on Nicotine and Tobacco , itself only formed in 1995. The thinking underlying Nicotine and Tobacco Research, the first academic journal to have a unique focus on tobacco, is that it is becoming ever more apparent that researchers in a wide range of disciplines need to talk to each other and share their insights in order to make progress with the puzzle of nicotine addiction. The journal, therefore, aims specifically to "promote, solicit, review and publish outstanding research that crosses traditional disciplinary boundaries."

How well is it doing? It is early days so far, but the signs are promising. The journal publishes a good mix of reviews and original research. There have been excellent reviews of the brain reward mechanisms underlying nicotine self-administration and of the relevance of animal models for human dependence, and a report of preliminary work on the intriguing possibility of a vaccine to block rewarding effects of nicotine. Human studies include tests of novel nicotine delivery devices that heat but do not burn tobacco. There are data papers on nicotine’s cognitive effects, on potential new pharmacological aids to cessation, and on the relationship between smoking cessation and depression. Work that incorporates a social dimension includes studies on the effects of cigarette advertising, school policies and home smoking restrictions on adolescent smoking. Of course, not all papers reach a high standard, as it takes time to build a reputation that will attract outstanding work, and there are some areas (for example economic issues) that are not well represented. But the range largely meets the ambition and the quality has already earned the journal inclusion in Index Medicus and Medline.

No doubt many researchers will wish to continue to publish their best papers in general journals, which command a wide readership and attract media interest. But Nicotine and Tobacco Research provides a valuable forum for anyone wanting to understand more about nicotine addiction, its mechanisms, social and personal effects, and treatment. One achievement of the nicotine addiction view of cigarette smoking has been to stimulate and to provide an integrating framework for the enormously wide range of tobacco studies. That conceptual framework has permitted the establishment of the journal. Arguably, those who are interested in the world’s most important cause of premature death (and the readership should be appropriately wide) should consider joining the Society for Research on Nicotine and Tobacco , as a copy of the journal comes along free with the society subscription.
 
 Martin Jarvis is professor of health psychology, University College London.