In the United States, state laws establish a minimum age of legal access (MLA) for most tobacco products at 18 years. We reviewed the history of these laws with internal tobacco industry documents and newspaper archives from 1860 to 2014.
The laws appeared in the 1880s; by 1920, half of states had set MLAs of at least 21 years. After 1920, tobacco industry lobbying eroded them to between 16 and 18 years. By the 1980s, the tobacco industry viewed restoration of higher MLAs as a critical business threat. The industry’s political advocacy reflects its assessment that recruiting youth smokers is critical to its survival.
The increasing evidence on tobacco addiction suggests that restoring MLAs to 21 years would reduce smoking initiation and prevalence, particularly among those younger than 18 years.
In April 2010 the then Prime Minister announced a decision to require all tobacco products to be sold in plain packaging. The regulation also standardised the appearance of the tobacco products themselves.
A Regulation Impact Statement (RIS) was required but not finalised before the decision. Consequently, under the Government’s best practice regulation process a Post‑implementation Review (PIR) was required.
The measure was fully implemented from 1 December 2012.
A PIR was completed by the Department of Health in February 2016 and was assessed as compliant by the Office of Best Practice Regulation (OBPR). Regulatory costings have been agreed with the OBPR.
National smoking bans do reduce the harms of passive smoking, specifically cardiovascular disease, an updated systematic review from the Cochrane Library has found.1
Since the first version of this review in 2010, more countries have introduced national legislation to ban indoor smoking. The authors said that the updated review provided the most robust evidence yet that smoking bans have led to improved health outcomes.
A team of researchers based in Ireland included 77 studies, representing 21 countries, that investigated the effect of introducing a smoking ban on any measures of health or on smoking behaviour. They retained 12 studies from the original review and identified 65 new studies. Health outcomes were reported in 72 studies, of which 44 specifically assessed cardiovascular disease, 21 assessed respiratory disease, and seven assessed perinatal outcomes.
The review found consistent evidence of a positive effect from national smoking bans on improving cardiovascular health outcomes and reducing mortality from associated smoking related illnesses.
The clearest evidence it found was in reduced admissions for acute coronary syndrome. For example, one study in Ireland found a 12% reduction in admissions for acute coronary syndrome in the first year after the smoking ban, and another Irish study found an 18% reduction.
The greatest reductions in admissions for heart disease after smoking bans were identified in populations of non-smokers, the researchers found. Overall, they said that the evidence was of moderate quality in relation to cardiovascular disease.
But the effects of smoking bans on respiratory and perinatal health were found to be less consistent. Six of the 11 studies reported considerable reductions in admissions for chronic obstructive pulmonary disease, and seven of 12 reported considerable reductions in hospitalisations for asthma. In the seven studies looking at perinatal health the data produced conflicting results, and the study authors said that more research was needed in this area.
The review found 24 studies evaluating the effect of national smoke-free legislation on smoking behaviour. Evidence of an effect from legislative bans on smoking prevalence and tobacco consumption was found to be inconsistent, as some studies did not detect any additional change in existing prevalence trends.
Cecily Kelleher, a review author based at University College Dublin, said, “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in secondhand smoke exposure for countries and their populations.
“We now need research on the continued longer term impact of smoking bans on the health outcomes of specific sub-groups of the population, such as young children [and] disadvantaged and minority groups.”
BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i701 (Published 04 February 2016) Cite this as: BMJ 2016;352:i701
Brits worry too many smokers don’t recognize e-cigs’ benefits
Great Britain and the United States haven’t always seen eye-to-eye. The latest example: e-cigarettes. Politicians and public health authorities in the U.S. continue to view e-cigs with caution while England has taken a more positive view — most notably a new report from Public Health England (PHE) that finds e-cigs about 95% less harmful than smoking.
“My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health,” said Professor Peter Hajek of Queen Mary University. Hajek co-authored the report with Professor Ann McNeill of King’s College London.
The expert independent evidence review also finds “no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.” That contradicts a study by the University of California last year that found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking.
Falling smoking rates
The review, commissioned by Public Health England (PHE) — an arm of the British Department of Health — goes further and suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people.
The review found that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes.
It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).
Emerging evidence suggests some of the highest successful quit rates are now seen among smokers who use an e-cigarette and also receive additional support from their local stop smoking services.
Time to reconsider?
The report drew the expected response from the American Vaping Association, which represents manufacturers of the electronic nicotine delivery devices. It called for U.S. organizations and government agencies like the American Cancer Society, American Lung Association, Campaign for Tobacco-Free Kids, and Centers for Disease Control & Prevention (CDC) to reassess their views on vaping.
“This report represents a major win for public health. Smokers need to know that vapor products are far less hazardous than smoking and effective for quitting,” said Gregory Conley, AVA president. “With over 42 million Americans still smoking cigarettes, there is no excuse for major public health organizations to continue to propagandize against these lifesaving products.”
Nothing better illustrates the attitude gap between the U.S. and Britain than the concern expressed by U.K. health officials that too many people think e-cigs are just as harmful as traditional cigarettes.
“The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting. Local stop smoking services should look to support e-cigarette users in their journey to quitting completely,” said Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England. “E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm.”
Ann McNeill, co-author of the review, agreed:
There is no evidence that e-cigarettes are undermining England’s falling smoking rates. Instead the evidence consistently finds that e-cigarettes are another tool for stopping smoking and in my view smokers should try vaping and vapers should stop smoking entirely.
E-cigarettes could be a game changer in public health in particular by reducing the enormous health inequalities caused by smoking.
Electronic nicotine delivery devices, and their impact on health and patterns of tobacco use: a systematic review protocol
E-cigarettes or electronic nicotine delivery systems (ENDS) have recently attracted considerable attention. Among some individuals there is strong debate and a polarisation of views about the public health benefits versus harms of ENDS. With little regulation, the ENDS market is evolving, and new products are introduced and marketed constantly. Rapid developments in manufacturing, marketing and consumer domains related to ENDS will warrant frequent re-evaluation, based on the state of the evolving science. The purpose of this article is to describe a protocol for an ongoing comprehensive review of the published scientific literature on ENDS.
Methods and analysis
We will undertake a systematic review of published empirical research literature on ENDS using the National Library of Medicine’s PubMed electronic database to search for relevant articles. Data from included studies will be extracted into a standardised form, tables with study details and key outcomes for each article will be created, and studies will be synthesised qualitatively.
Ethics and dissemination
This review synthesises published literature and presents no primary data. Therefore, no ethical approval is required for this study. Subsequent papers will provide greater detail on results, within select categories, that represent gaps in the literature base.