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Smokers face breath tests before surgery

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World tobacco experts in Hobart to stamp out smoking

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Have your say on smoke-free places

WE’RE urging Queenslanders to speak out and have their say about smoke-free places across the state to help shape the future of tobacco control in Queensland.

https://www.qt.com.au/news/have-your-say-on-smoke-free-places/3232462/

Cancer Council Queensland, Heart Foundation and Asthma Foundation have launched a statewide survey on smoking, giving Queenslanders the opportunity to share their opinion about current and future smoke-free places.

The survey will gauge support on current tobacco laws and identify additional areas the community would like to see smoke-free, including outdoor public areas and multi-unit housing.

Tobacco is having a detrimental effect on the health of our state. Those who smoke or are exposed to second-hand smoke are at a much greater risk of developing chronic diseases, including heart disease and cancers.

Smoking remains the leading cause of preventable death and disease in Australia. In Queensland alone around 3700 people die from a tobacco-related disease each year.

This survey will give the public a voice to help advocate for stronger tobacco legislation reforms through the extension of statewide smoke-free places in Queensland.

Will you share your views? Have your say to help clear the air for thousands of Queenslanders impacted by second-hand smoke.

If you’re a Queenslander aged 18 and over, please complete our Smoke-free Places Survey at smokefreeplacessurvey by October 16.

All responses are anonymous and confidential.

Ms Chris McMillan

CEO, Cancer Council Queensland

Development of China’s Public Health as an Essential Element of Human Rights

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One of Australia’s richest citizens is preparing to take on big tobacco

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Possible effects of raising tobacco taxes across the EU

Increasing cigarette prices through taxation could reduce cigarette consumption and smoking related deaths across EU countries. This is according to a study published today in BMC Public Health which modelled a 10% tax increase on tobacco. Here to tell us about the model, how different EU countries would be affected, and the potential policy implications is Christian Schafferer, author of the article.

Christian Schafferer 21 Sep 2017

In the European Union (EU), approximately 700,000 people die of smoking-related diseases every year. The reduction of tobacco consumption has thus become one of the major social policies of the EU.

The tobacco control policies (MPOWER) proposed by the World Health Organization (WHO) in 2008 serve as a guideline for the health authorities of the EU member states. The six MPOWER measures mandate (i) increases in the tobacco tax; (ii) monitoring of tobacco usage; (iii) support for quitters; (iv) creation of a smoking-free environment; (v) warning against the dangers of tobacco; (vi) and banning tobacco advertising, promotion and sponsorship.

Numerous empirical studies have demonstrated that most consumers, when confronted with higher retail prices, indeed reduce consumption.

Among the MPOWER measures, taxation is the most common single policy tool to control tobacco use. Economic theory suggests that increasing tobacco taxes will result in higher direct costs for smokers and thus lower consumption.

Theoretically, the tobacco industry could absorb the additional costs to prevent higher retail prices, but, in reality, increased costs are passed on to the consumers.

Numerous empirical studies have demonstrated that most consumers, when confronted with higher retail prices, indeed reduce consumption, while others switch to lower-priced products or turn to smuggled goods.

Modeling a 10% tax increase

In our study, we estimated the effects of a hypothetical cigarette price increase of 10% on consumption, tax revenues and death toll of smoking in 28 EU countries.

Unlike previous studies, our statistical model also accounted for the fact that income affects the responsiveness of consumers to price changes. Research has shown that smokers with high disposable income are less affected by rising cigarette prices than those with lower income. In other words, the price elasticity of demand changes with income (income threshold effect).

The price elasticity of demand is used to measure changes in demand of goods in response to changes in price. It gives the percentage change in quantity demanded in response to a one percent change in price.

Our statistical model separates the observed 28 countries into three income clusters (regimes), assuming that all of the countries within a cluster have about the same response patterns to price increases. Using data for the years 2005 to 2014, our model estimated the price elasticity of each income cluster.

Nicotine use would be reduced by 12.27% in Bulgaria and Romania; by 8.29% in Latvia and Poland; and by 5.03% in the EU24 countries.

Based on the elasticity figures, we were able to estimate the possible effects of a hypothetical price increase of 10% on consumption, tax revenues and the number of averted smoking-attributable deaths. The latter figure derived from the simulated impact of price increments on the reduction in smokers and was adjusted for the fact that smoking cessation still carries considerable risks of early death.

The results of our study revealed that higher taxation would be considerably more effective in reducing consumption as well as incidences of smoking-related deaths in the two less developed regimes than in the remaining 24 countries (EU24) belonging to the third income regime. Specifically, nicotine use would be reduced by 12.27% in Bulgaria and Romania; by 8.29% in Latvia and Poland; and by 5.03% in the EU24 countries.

Unlike other measures, such as bans on tobacco advertising, taxation not only effectively decreases tobacco consumption but, in general, also has the beneficial side effect of increasing national tax revenues. Our simulation showed that although tax revenues increased by 7.03% in Latvia and Poland, and by 3.15% in the EU24 area, revenues dropped by 1.41% in the least developed countries, Bulgaria and Romania.

Different policies for different countries

What are the policy implications? As the results of the study show, there are three income regimes among the observed 28 European countries. Since each regime is differently affected by cigarette taxation, different policies must be adopted to fight nicotine use. Specifically, other measures to control tobacco use, such as restrictions on advertisements, pictorial warning labels and cessation assistance, are necessary in high-income countries to compensate for the income threshold effect.

Moreover, as the study has shown, higher taxation leads to significant increases in tax revenues in high-income regimes, but in poorer countries it is more likely to lead to considerable losses in tax revenues. Health authorities in less developed countries may thus lack crucial funding to implement anti-smoking measures. External funding (donations from other European countries) would thus be required to ensure success in combating cigarette use.

Illicit trade of tobacco products has not been included in the study, as reliable data could not be obtained for all countries. Moreover, data on cigarette consumption analysed in this study refer to factory-made (FM) cigarettes. Roll-your-own (RYO) tobacco products have become popular in the EU in recent years and may influence consumption behavior. Further research on price effects may thus address the issue of illicit trade and RYO cigarette use.

The effects of a rise in cigarette price on cigarette consumption, tobacco taxation revenues, and of smoking-related deaths in 28 EU countries

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‘Quitting tobacco can decrease cancer chances eight times’

Increase in tobacco consumption has led to rise in cancer cases among the youth in recent years. “It is most common in people between 25 and 40 years of age,” said Dr Satsheel Sapre, HoD of Head and Neck Cancer Department at Rashtrasant Tukdoji Regional Cancer Hospital (RST).

http://timesofindia.indiatimes.com/city/nagpur/quitting-tobacco-can-decrease-cancer-chances-eight-times/articleshow/59814866.cms

Sapre was speaking at an awareness programme organized by RST and Indian Medical Association (IMA) to mark Head and Neck Cancer Day, on Thursday, on the premises of the hospital. “Vidarbha is world capital of tobacco related cancers. Quitting tobacco can decrease chances of cancer eight times,” he said.

“Young people mostly start smoking or chewing tobacco due to peer pressure or perceive it as something glamorous. But smoking causes lung cancer and increases development of unwanted, uncontrolled and abnormal cells,” Sapre added.

Making an appeal about quitting smoking, Sapre said, “Our body does not need tobacco. It only harms our body, still many youths take the suicidal path. According to WHO, one among every eight persons is likely to be affected with cancer before death.”

Talking about symptoms of cancer, Sapre said, “Bleeding from mouth, constipation, change in voice, stink from mouth and fever or cough for more than 15 days can be symptoms of cancer. Patients must visit doctors for fighting cancer, it will not disappear by itself.”

A cancer survivor Shrimad shared his experience. “In 2000, I developed a small lump on my chick, which was due to cancer. I use to chew tobacco but I didn’t lose hope and fought it. Now I am living a normal life. I will suggest everyone not to eat tobacco and never lose hope because you can fight cancer. Doctors are your closest friend against diseases like cancer,” he said.

A small play on banning tobacco, alcohol and smoking was also staged at the programme. It illustrated cancer as the ‘boss’ of all addictive materials that are driving people towards destruction.

Dr BK Sharma, director of RST, and Dr Avinash Wase, president of IMA, were also present at the programme.

UN Reports More People Warned Against Tobacco Use

Despite measures protecting a majority of people from tobacco-related illness and death, the tobacco industry continues to hamper Government efforts to fully implement life and cost-saving interventions, the United Nations health agency reported.

http://www.womenofchina.cn/womenofchina/html1/features/health/1707/4690-1.htm

“One-third of countries have comprehensive systems to monitor tobacco use. While this is up from one-quarter of countries monitoring tobacco use at recommended levels in 2007, Governments still need to do more to prioritize or finance this area of work,” according to the UN World Health Organization’s WHO report on the global tobacco epidemic, which was launched today on side-lines of the UN High-level political forum on sustainable development in New York.

The report shows that some 4.7 billion people – more than 60 per cent of the population – are protected by at least one “best practice” tobacco control measure from the WHO’s Framework Convention on Tobacco Control (WHO FCTC). These measures include no smoking areas and bans on advertising tobacco products, for example.

In the foreword to the report, the head of WHO urged Governments to incorporate all the provisions of the WHO FCTC into their national tobacco control programmes and policies, and to fight against the illicit tobacco trade.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness, and save billions of dollars a year in avoidable health-care expenditures and productivity losses,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

The report, funded by Bloomberg Philanthropies, noted that systematic monitoring of tobacco industry interference in government policymaking protects public health by shedding light on tobacco industry tactics.

Such tactics include “exaggerating the economic importance of the tobacco industry, discrediting proven science and using litigation to intimidate governments.”

Douglas Bettcher, director of WHO’s Department for the Prevention of Noncommunicable Diseases (NCDs), said tobacco industry interference in government policy making represents “a deadly barrier to advancing health and development in many countries.

Controlling tobacco use is a key part of the 2030 Agenda for Sustainable Development. The Agenda includes targets to strengthen national implementation of the WHO FCTC and a one-third reduction in premature deaths from NCDs, including heart and lung diseases, cancer and diabetes, according to a press release launching the report.

“The progress that’s been made worldwide – and documented throughout this report – shows that it is possible for countries to turn the tide,” said Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and founder of Bloomberg Philanthropies.

Furore over tobacco harm-reduction efforts

Most countries all over the world have banned smoking in public places and the popular advice is, “smoking is dangerous to your health… smokers are liable to die young.”

https://guardian.ng/features/furore-over-tobacco-harm-reduction-efforts/

Researches indicate that most deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease and pneumonia.

In Nigeria, most cities including Lagos have outlawed smoking backed with legislation but poor enforcement has been the pitfall. People still smoke in public places in all the nook and crannies in the country exposing the non-smoker and tender ones to secondhand smoke, which has also been associated with cancer of the lung and other ill-health effects.

According to the World Health Organisation (WHO), the tobacco epidemic is one of the biggest public health threats, killing more than seven million people a year. There are currently one billion smokers worldwide, with nearly 80 per cent of them living in low and middle-income countries, where the burden of tobacco-related illness is greatest.

Indeed, several studies have shown that smoking tobacco is the most harmful way of using nicotine, with the tars and gasses in cigarette smoke being harmful to health, however, many people find it difficult to stop smoking because they find it hard to go without nicotine.

A school of thought suggests that making lower risk products available may help people switch from smoking, ultimately helping avoid the risk of smoking known as “tobacco harm reduction”.

Tobacco harm reduction is a pragmatic approach to reducing the harm of smoking related diseases. People smoke because they are addicted to nicotine and seek a “hit”, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness, from smoked tobacco (that is cigarettes) at the top end of the harm/addiction spectrum, to medicinal nicotine (that is nicotine replacement therapy products) at the bottom end.

A harm reduction approach to tobacco control encourages those smokers that cannot, or are unwilling to, stop smoking, to switch to using nicotine in a less harmful form, and ideally would result in them ultimately quitting nicotine use altogether.

Potential harm reduction products include: Smokeless Tobacco (Snus); E-cigarettes; and Nicotine Replacement Therapy (under construction). The use of safer nicotine products is a rapidly evolving area, with many new non-combustible products emerging. The rapid development and use of these products raises a number of challenging scientific questions about their safety, who uses them and why, and the impact on smoking. These products also raise challenges for governments who seek to understand what kind of policy and regulation is appropriate.

To address these issues, the Global Forum on Nicotine (GFN) 2017 was held last month in Warsaw, Poland.

Reflecting commitment to the development and promotion of evidence-based policies and interventions, the theme of this year’s meeting was “Reducing Harm, Saving Lives”, drawing attention to the potential of safer nicotine products, such as e-cigarettes, oral tobaccos and “heat-not-burn” tobacco products, to reduce the global health burden of smoking.

Participants comprised of policy analysts, regulators and standards experts, academics and researchers, parliamentarians, public health professionals, consumer advocates, and makers and distributors of alternative nicotine products – all with an interest in nicotine and its uses.

This year’s programme examined the rapidly developing science in relation to nicotine use and the changing landscape, including policy responses and the influence of different stakeholders in this. The programme comprised plenary sessions, symposia, panel discussions and poster presentations – including video posters.

Several studies have shown that tobacco harm reduction has been controversial and divisive in public health, in particular where the debate has focused on a possible role for other tobacco products such as Snus, within a tobacco harm reduction strategy. One of the reasons harm reduction is a sensitive topic is that it could involve engaging with the tobacco industry, which has a history of manipulating public debate and public health policy.

Critics posit that to fully understand the harmfulness of potentially reduced risk products and their effectiveness for smoking cessation, tobacco industry investments and research into harm reduction and potentially reduced risk products should be carefully scrutinised. Who has paid for the research, which scientists, organisations and institutions are involved?

In fact, a number of scientists leading the debate on harm reduction and/or potentially reduced risk products are allegedly funded by the tobacco industry. Examples include: Jed E. Rose is director of the Center for Nicotine and Smoking Cessation Research (CNSCR) at Duke University in the United States (US), an institution with a long history of tobacco money. He is the inventor of the nicotine patch, and a nicotine aerosol technology. The Center, his research and his career are closely interlinked with the tobacco industry, more specifically Philip Morris.

The story on Duke University, US, and the Tobacco Industry shows Philip Morris actively promoting the nicotine patch as a quitting strategy, with the research funded by the company and with the endorsement of scientists involved.

A 2012 editorial in the public health journal Addiction suggested we should not be fooled by industry investments in potentially reduced risk products like snus, highlighting that Philip Morris US is currently advertising its Marlboro snus “for when you can’t smoke”, thus encouraging dual use instead of smoking cessation.

Further evidence from the US, where smokeless tobacco is freely available, confirms that smokeless tobacco is being marketed as a tobacco alternative in smoke-free environments. This would suggest that contrary to the industry’s discourse on harm reduction, and the favoured approach by public health experts advocating tobacco harm reduction, the industry appears to have little intention of promoting Snus use as a permanent switch from smoking.

However, the GFN is changing that perception. Chair of GFN, Prof. Dave Sweanor from Canada, told participants at 2017 GFN: “GFN is the only international conference to focus on the role of safer nicotine products that help people switch from smoking. Safer nicotine products include e-cigarettes, oral tobaccos such as Swedish snus, and ‘heat-not-burn’ tobacco products. This is a rapidly evolving area with many new non-combustible products emerging.

“The first conference was held in 2014 and this year we see the fourth annual renewal. All the conferences to date have been in Warsaw. The conference is funded by registration fees and does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies.”

Sweanor said the programme is developed by an international programme committee and is supported by a Polish Host Committee. Knowledge-Action-Change (KAC) provides the administration for the conference. New data released at the GFN showed low risk nicotine product snus is 95 per cent safer than smoking and has the potential to stop 320,000 premature deaths across Europe each year.

The latest evidence, presented by Peter Lee, epidemiologist and medical statistician, indicates that snus is at least 95 per cent safer than smoking.

Analysis by Lars Ramström, snus researcher in Sweden, shows that if snus were made available in Europe –where it is currently banned with the exception of Sweden –and similar use levels to Sweden were adopted, up to
320,000 premature deaths could be avoided among men every year.

While 46 per cent of deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease and pneumonia, there is no evidence that using snus increases risk of these diseases. Nor does snus appear to increase the risk of other smoking related diseases including heart disease, stroke and a range of cancers.

In addition, the public health benefits of snus versus cigarettes are not only much lower, but the role of snus in both reducing initiation of smoking and increasing cessation of smoking is a key element in defeating the actual cause of tobacco-related ill-health caused by the cigarette.

Current European legislation does not allow snus to be marketed in any European country except Sweden. However, due to strong evidence behind its potentially life saving benefits, The New Nicotine Alliance (NNA), a United Kingdom (UK) consumer group supporting access to safer nicotine products, is calling for its legalization and has joined legal action case against the banning of snus, which has now been referred to the European Courts of Justice.

Gerry Stimson, Chair of the NNA stated, “Snus is a tobacco product that has consistently been proven to be less harmful to health than cigarettes. The ban on snus limits smokers choices of safer alternatives and has a significant negative impact on public health”.

Phillips Morris International (PMI) in its presentation at the Forum noted: “Harm reduction policies are based on the view acknowledged by virtually all public health organizations that tobacco use will continue well into the future. As the United Nation (UN) stated in 2004, even assuming current rates of decline in consumption, ‘the number of tobacco users would still be expected to increase to 1.46 billion by 2025.’

“The recognition that people will continue to smoke has led many public health authorities to the conclusion that developing tobacco products that have a reduced risk of causing disease is a crucial element of tobacco policy. This is contrasted with those groups who take an abstinence-based approach that focuses solely on preventing people from beginning to use tobacco products and encouraging people to quit using tobacco products.

“Following a harm reduction policy does not preclude governments from pursuing the objectives of prevention of initiation and encouraging cessation. On the contrary, most proponents of harm reduction are vigorous supporters of those important goals. As we see it, tobacco harm reduction should complement prevention and cessation efforts — not compete with them.

“Our support of harm reduction follows two paths: one is through our research and development of products with the potential to reduce the risk of tobacco related diseases. The other path is through our support of regulation based on the principle of harm reduction.”