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COSH urges the Government to take full account of public opinions Enact Enlargement of Pictorial Health Warnings Promptly

http://smokefree.hk/en/content/web.do?page=news20170116

Hong Kong Council on Smoking and Health (“COSH”) urges the Government and Legislative Council to enact the enlargement of pictorial health warnings promptly in order to reduce the attractiveness of tobacco, motivate more smokers to quit and deter youth from trying the first cigarette. Mr Antonio KWONG, COSH Chairman remarked, “Results from survey conducted by COSH and two rounds of public consultations organized by the Legislative Council showed that majority of citizens and organizations supported the enlargement of pictorial health warnings to 85%. The Government and Legislative Council should take full account of public opinions and enact the proposed tobacco control measure as soon as possible.”

The Government briefed the legislative proposals to strengthen tobacco control on 18 May 2015, including enlarging the size of pictorial health warnings to at least 85% of the two largest surfaces of the packet, increasing the number of forms of health warning from six to twelve and adding the quitline 1833 183. The date of enactment is yet to be scheduled after more than one and a half years.

The Legislative Council collected views of the public and held special meetings on the enlargement of pictorial health warnings twice. Among the hundred submissions received in July 2015 regarding the increase in the size of pictorial health warnings, more than 80% supported. Besides, over 100 submissions were received for the special meeting of Legislative Council Panel on Health Services to be held tomorrow (17 January 2017), in which around 70% agreed the proposed measure.

The School of Public Health of The University of Hong Kong was commissioned by COSH to carry out the Tobacco Control Policy-related Survey 2016. It was found that public support on enhancing the pictorial health warnings was overwhelming, 79.5% of all respondents agreed to display more threatening messages about the health risks of smoking. About 72.5% of all respondents supported to increase the coverage of the health warnings to 85% while about half of the current smokers also supported. Majority of respondents opted for plain packaging* of cigarettes as well. In addition, COSH has collected over 26,500 signatures from citizens and organizations through street counters and online platform supporting the enlargement of pictorial health warnings since May 2015.

In recent years, many countries have successfully introduced more stringent measures to regulate tobacco packaging. Prof Judith MACKAY, Director of Asian Consultancy on Tobacco Control and Senior Policy Advisor of World Health Organization claimed, “Hong Kong ranked the 72nd in the world regarding the implementation of pictorial health warning and behind many developing countries like Laos, Myanmar and Sri Lanka. Hong Kong should enlarge and strengthen the pictorial warnings promptly in order to reduce the use of tobacco.” World Health Organization called for more countries to enlarge pictorial warnings covering more than 85% and implement plain packaging. “Get ready for plain packaging” was designated as the theme of World No Tobacco Day 2016.

Recently, some organizations opposed the proposed enlargement of warnings in the pretext that it would lead to a surge in cigarette smuggling activities. A recent study also claimed that illicit cigarettes composed for around 30% of cigarette consumption in Hong Kong. Prof LAM Tai-hing, Chair Professor of Community Medicine cum Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong said, “the public should express reservation on the results of this tobacco industry-funded study. The data collection methods and calculations of the study were unclear using dubious methods.” The tobacco industry and its allies always express strong opposition against tobacco control measures proposed by the Government under the pretext that it will lead to a surge in cigarette smuggling activities. As recommended by the World Health Organization, the most effective measure against smuggling is tight control and aggressive enforcement.

With the Government’s multi-pronged tobacco control policies over the years, the smoking prevalence in Hong Kong has gradually reduced from 23% in early 80s to 10.5% in 2015. In view of the tobacco epidemic in Hong Kong and the international tobacco control trend, we urge the Government and Legislative Councilors to take account of public opinions and implement the enlargement of pictorial health warnings as soon as possible to safeguard public health. The Government should also actively consider adopting plain packaging within 2 to 3 years and develop long-term and comprehensive tobacco control policies including regulating the emerging tobacco products and e-cigarettes, raising tobacco tax substantially, expanding no-smoking areas, increasing resources on education, publicity, smoking cessation services and enforcement to further reduce the smoking prevalence in Hong Kong and protect people from the harms of smoking and secondhand smoke.

*Remarks: Plain packaging standardizes and simplifies the packaging of tobacco products. The pictorial health warnings on the main sides of cigarette pack are expanded. All forms of tobacco branding should be labeled according to the government prescriptions and with simple and plain format. This means that trademarks, graphics and logos are not allowed on cigarette packs, except for the brand name that is displayed in a standard font size, colour and location on the package. The packaging should not contain other colours and should include only the content and consumer information, such as toxic constituents and health warnings required by law. The quitline number should also be displayed at a prominent position. Australia was the first country to introduce plain packaging in 2012. The measure was also implemented in the United Kingdom, France and Hungary in 2016 and will be implemented in Ireland in 2017.

Bigger graphic health warnings on Hong Kong cigarette packs needed, anti-smoking group says

Survey finds most in favour of move, which advocates say can protect public health and encourage more to quit habit

http://www.scmp.com/news/hong-kong/health-environment/article/2062577/more-graphic-health-warnings-hong-kong-cigarette

An anti-smoking body has pressed the government to speed up legislation on cigarette pack health warnings after a survey revealed almost 80 per cent of people desired sterner messages on smoking risks.

The Council on Smoking and Health made the call ahead of another public hearing held on Tuesday in the Legislative Council to collect views on whether to implement the law.

The legislation will expand the size of health warnings on cigarette packs from the current 50 per cent to 85 per cent of the packaging surface.

The proposal was first submitted by the government in May 2015, and the first hearing was held in July in the same year.

According to a survey commissioned by the council and done between February and September last year, 79.5 per cent of 2,058 respondents – comprising smokers, non-smokers and ex-smokers – want cigarette packs to show clearer and more graphic warnings.

Another 72.5 per cent of them also want to see the graphic warnings enlarged to cover 85 per cent of the packaging surface, a move also supported by almost half of the smokers in the survey.

“The implementation work has dragged on for one and a half years. This measure can protect public health and help more people quit smoking.

“We hope that Legco will not procrastinate on the legislation any further,” council chairman Antonio Kwong Cho-shing said.

He said that Australia recorded a drop of 2.2 percentage points in average smoking rate after introducing plain cigarette packaging in 2012.

Of this amount, 0.55 percentage points, or 108,000 fewer smokers, were due directly to the new measure which only allowed brand names to be displayed in a standard font size, colour and position on the packaging, thereby making them less conspicuous and seemingly less desirable.

Professor Judith Mackay, a veteran tobacco control advocate and senior policy advisor for the World Health Organisation, said a larger graphic warning would have an even bigger visual impact and induce more smokers to quit.

According to a Canadian Cancer Society survey which studied the effectiveness of health warnings on cigarette packs worldwide, Hong Kong ranked 72nd out of 205 places.

“We used to be among the top 12 jurisdictions [in cigarette pack warnings] … now we are lagging very far behind from the international experience,” Mackay said. She has been working on tobacco control advocacy in the city for more than 30 years.

The survey done by the Canadian group looked at various factors, including whether graphic warnings existed on the packaging design, the sizes of the images and when the warnings were introduced.

Mackay attributed the city’s poor ranking partly to outdated warnings, which were first introduced in 2007, and the lack of information on helpline numbers for those seeking to quit the habit.

She said in the long run the government should also further increase tobacco tax to make cigarettes less affordable.

Kwong from the Council on Smoking and Health said it submitted a letter to the financial secretary late last year to suggest increasing tobacco tax to 100 per cent.

Not much proof that e-cigarettes can help people stop smoking

http://www.nst.com.my/news/2017/01/203391/not-much-proof-e-cigarettes-can-help-people-stop-smoking

As people become more aware of the dangers of smoking, many have taken steps to reduce the number of cigarettes smoked or to stop the bad habit. Public and private health centres and pharmacies provide smoking- cessation services, which include evidence-based treatment. These studies were based on large-scale population with medication that has been proven to be safe and effective. Nicotine replacement therapy (Nicorette) and Varenicline (Champix) have been used by those who wanted to quit smoking, and they have done so.

Interestingly, there is not much evidence supporting e-cigarette use as an alternative method for smoking cessation.

Recently, the Institute of Public Health, Health Ministry, conducted a survey on the use of e-cigarettes among adolescents and adults in Malaysia (The Tobacco and E-cigarette Survey among Malaysia Adolescents and The National E-Cigarette Survey 2016).

The results were disturbing. The majority of those who use e-cigarette are dual users. This means that they smoke cigarettes and e-cigarette. This is hazardous as it may result in nicotine overdose, which can lead to death. This can strengthen their addiction to nicotine, which hooked them to cigarettes in the first place.

Almost 70 per cent of the dual users stopped e-cigarette but continued smoking conventional cigarettes.

Most school children and adolescents started using e-cigarettes out of curiosity.

The main pull factors were the flavours and smell of e-liquids.

Many other dangerous substances can be introduced by drug pushers and dealers by just lacing the liquids.

Nearly 75 per cent of the study population felt that e-cigarettes were not useful to stop smoking and more than half wanted these to be banned.

DR RASHIDI MOHAMED PAKRI MOHAMED Nicotine Addiction Research Group, Universiti Malaya

Brand Loyalty Low Among Teen E-Cig Users

Half of surveyed users did not know which brand they used

Half of teens who use e-cigarettes reported vaping no particular brand, and about a third reported using e-cigarette devices for substances other than nicotine, according to an analysis of recent survey data by researchers from the CDC.

The most commonly reported e-cigarette used by the middle school and high school students participating in the 2015 National Youth Tobacco Survey (NYTS) was the heavily promoted brand ‘blu’, manufactured by Fontem Ventures-Imperial Brands (formerly Imperial Tobacco Group).

Roughly one in four surveyed teen e-cigarette users (26.4%) reported using that brand, while 12.2% reported using the next most popular brand, ‘VUSE’, manufactured by R.J. Reynolds.

The survey results were reported Thursday in the CDC’s Morbidity and Mortality Weekly Report.

“Electronic cigarettes are now the most commonly used tobacco product among U.S. youths; in 2015, 5.3% of middle school students and 16% of high school students reported using e-cigarettes in the past 30 days,” CDC researcher Tushar Singh, MD, PhD, and colleagues wrote, adding that not much has been known about the brands preferred by teens and the substances used in e-cigarette devices.

The analytic sample of the 2015 NYTS included 4,021 students who reported ever using e-cigarettes, “even once or twice.” Respondents were asked what brands of e-cigarettes they had used, with eight specific brands listed, and whether they had ever used an e-cigarette device for vaping a substance other than nicotine.

Data were weighted to account for the complex survey design and to adjust for nonresponse. Prevalence estimates were also reported for the type of e-cigarette ever used, brands, and whether e-cigarettes were used for substances other than nicotine.

A total of 13.5% of sixth through eighth graders and 37.7% of ninth through 12th graders reported ever-use of e-cigarettes.

Among the adolescents reporting ever having used an e-cigarette, 14.5% used only disposable e-cigarettes, 53.4% used only rechargeable/refillable e-cigarettes, and 32.1% used both types.

Half of the student respondents (50.7%, representing 3.18 million teens) did not know the brand of the e-cigarette they had used.

Use of e-cigarettes for a substance other than nicotine was similar among middle school (33.7%) and high school (32.2%) users, and it was higher among males than females (37.3% of high school male e-cigarette users versus 26.2% of high school female respondents).

In a separate survey of high school age e-cigarette users in Connecticut, reported last year in Pediatrics, 18% of respondents reported using cannabis in an e-cigarette device.

“In the present analysis, it is unknown whether students who had used an e-cigarette for a non-nicotine substance had also used an e-cigarette for nicotine, which might underestimate nicotine use,” Singh and colleagues wrote.

“Nicotine content in e-cigarettes is of public health concern because exposure to nicotine is the main cause of tobacco product dependence, and nicotine exposure during adolescence, a critical period for brain development, can cause addiction, can harm brain development, and could lead to sustained tobacco product use among youths.”

Study limitations cited by the researchers included the self-reported nature of the survey, the limited number of specific e-cigarette brands included in the survey, and the lack of data on which substances other than nicotine were being used.

The researchers concluded that increased monitoring of product types, brands, and ingredients preferred by adolescent e-cigarette users is warranted, “to guide measures to prevent and reduce use of e-cigarettes among youths.”

Tobacco corporations target Africa’s children

http://www.heraldlive.co.za/business/2016/12/08/tobacco-corporations-target-africas-children/

Children in Africa have become a target for tobacco companies‚ research by the African Tobacco Control Alliance (ATCA) has found.

The survey looked at the way in which tobacco companies in five African countries– Burkina Faso‚ Cameroon‚ Benin and Nigeria – get consumers to keep using their product.

It found tobacco use caused about six million deaths yearly‚ with 80% of them occurring in low- and middle-income countries.

Findings show that in Africa‚ smoking prevalence is about 21% among adult men and 3% among women.

About 21% of young boys and 13% of young girls use tobacco products.

“The aggressive sale and marketing strategies of the tobacco industry targeting young people will be among the key contributing factors to the growing epidemic of tobacco use in Africa‚” the report said.

Four strategies were identified as being used to lure children to smoke‚ a concern that was highlighted at the launch of the report in Johannesburg recently.

Advertising and promotion, the sale of single cigarettes, child-friendly flavoured cigarettes and noncompliance with existing tobacco control laws were the main causes for an increase in young children’s interest in smoking.

Sales of single cigarettes were found to be widespread near schools.

Ban on flavoured tobacco products will hurt business: Retailers

Retailers have strongly objected to a proposal to ban the sale of flavoured tobacco products such as menthol cigarettes, as it could hit their businesses hard.

http://www.todayonline.com/singapore/ban-flavoured-tobacco-products-will-hurt-business-retailers-0

A survey of 1,475 independent general trade retailers by a group of trade associations — such as the Foochow Coffee Restaurant & Bar Merchants Association and Singapore Mini Mart Association — found that 99 per cent of the respondents stated that such a prohibition would negatively affect their business, while 97 per cent were concerned that the move could lead adult smokers to turn to illegal sources.

The proposed ban was among a suite of tobacco-control measures — which also included raising the minimum legal age for smoking and enhancing graphic health warnings — put up for public consultation early this year by the Health Promotion Board, the Ministry of Health, and the Health Sciences Authority.

Pointing to how some stores had closed after they were badly affected by the new liquor laws, which started last year, Mr Hong Poh Hin, who chairs the Foochow Coffee Restaurant & Bar Merchants Association, said: “It is important to ensure any proposed tobacco-control measures are supported by evidence of effectiveness in reducing smoking incidence in Singapore, while addressing the impact on the affected retailers.”

“Our members, many of which are small- and medium-enterprises, have been bearing the brunt of escalating operating costs, manpower constraints and a flurry of increasing regulations that directly impacted their biggest sources of income,” he added.

Among other things, the new laws bar supermarkets and convenience stalls from selling takeaway alcohol from 10.30pm to 7am.

“We fear that such recurrent regulations will lead many more to shut down their businesses. This prompted our associations to launch this (survey),” Mr Hong added.

Other associations involved in the survey were Kheng Keow Coffee Merchants Restaurant and Bar-Owners Association, and Singapore Provision Shop Friendly Association.

Ninety-eight per cent of those surveyed said almost half of their customers who buy tobacco products only request the flavoured variants. The survey, which was conducted between July and September, also uncovered concerns that adult smokers would turn to illegal sources to have a puff.

Noting that the illicit cigarette trade is “substantial” here, Singapore Mini Mart Association chair Alan Tay said: “These illegal activities have a huge adverse impact on legitimate traders like us, that operate within the parameters of the law.”

The trade associations are also in the midst of another study on the efficacy and impact on trade of the proposed ban on flavoured tobacco products, and plan to share its results with the Government. KELLY NG

New evidence e-cigarettes are gateway to tobacco

http://6abc.com/health/new-evidence-e-cigarettes-are-gateway-to-tobacco/1594753/

There’s more evidence that electronic cigarettes may be enticing teens to try the tobacco ones.

A nationwide survey of teens who never smoked shows that nearly 60 per cent who tried the flavored electronic ones intend to start smoking tobacco.

And the majority of e-cigarette users started out with sweet, candy-like flavors.

“Due to a proliferation of e-cigarette flavors on the market, flavored e-cigarette use among youth in the U.S. has increased significantly,” study author Hongying Dai said.

The number of teens who use e-cigarette devices to “vape” has nearly quadrupled since 2013.

Flavored e-cigarettes aren’t prohibited in the United States.

Although the F-D-A has imposed new rules on electronic cigarettes, it doesn’t have legal authority to regulate the flavors.

Nearly 500 brand with more than 7-thousand flavors are currently on the market.

Dai’s team looked at the nearly 16,500 teens answering the survey who had never smoked cigarettes but used e-cigarettes.

The researchers also looked at more than 1,300 current smokers and assessed if they intended to quit. Finally, the investigators looked at nearly 21,500 teens to assess their perception of the dangers of tobacco.

The study found that just over 2,000 teens said they had used e-cigarettes in the last 30 days.

Among current tobacco smokers, 68 percent of those who also “vaped” said they had used flavored e-cigarettes.

Nearly two-thirds of smokers also use e-cigarettes, CDC says

http://www.omaha.com/livewellnebraska/health/nearly-two-thirds-of-smokers-also-use-e-cigarettes-cdc/article_bfd5256e-a2d8-11e6-a78c-5323b0e6b11c.html

Many American adults who use electronic cigarettes also smoke tobacco cigarettes, a U.S. Centers for Disease Control and Prevention survey reveals.

The survey found that in 2015, 59 percent of all adult e-cigarette users were also current cigarette smokers. The survey also showed that 30 percent of e-cigarette users were former smokers and 11 percent using the devices had never smoked.

Among young adults ages 18 to 24, 40 percent of e-cigarette users were never smokers, 43 percent were current smokers and 17 percent were former smokers.

“If there is a public health benefit to the emergence of e-cigarettes, it will come only if they are effective at helping smokers stop using cigarettes completely, responsibly marketed to adult smokers and properly regulated to achieve these goals,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

Altogether, 3.5 percent of all U.S. adults were e-cigarette users in 2015, down slightly from 3.7 percent in 2014, the CDC survey found.

Myers said these findings raise concerns that many adults using e-cigarettes are using the devices in addition to tobacco cigarettes, rather than in place of them.

Myers’ organization also said the finding that 40 percent of young adults who use e-cigarettes have never been smokers raises concerns that e-cigarettes may be introducing young nonsmokers to tobacco use and nicotine addiction.

There has been a sharp increase in use of e-cigarettes by youth. In 2015, 24 percent of high school students were current users of e-cigarettes, compared to 11 percent who smoked cigarettes, a previous CDC survey found.

E-cigarettes “will not benefit public health if smokers use them in addition to cigarettes instead of quitting or if they re-glamorize tobacco use among young people and attract nonsmokers,” Myers said in a Campaign for Tobacco-Free Kids statement.

Current evidence on whether e-cigarettes help smokers quit is limited and inconclusive, he said.

QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group

Download (PDF, 177KB)

Study finds perception of e-cigarette harm growing among US adults

http://medicalxpress.com/news/2016-10-perception-e-cigarette-adults.html

The proportion of American adults who perceive e-cigarettes to be equally or more harmful than traditional cigarettes has tripled over the last few years, highlighting the need for more accurate public health messaging, according to a study led by tobacco researchers in the School of Public Health at Georgia State University.

“Although the impact of long-term use of e-cigarettes on health is still unknown,” the study stated, “the available scientific evidence indicates that e-cigarettes are less harmful than combustible cigarettes, and that smokers switching to e-cigarettes could benefit from a decrease in health risks related to smoking combustible cigarettes.”

Researchers looked at data from the Tobacco Products and Risk Perception surveys from 2012 through 2015 to examine changes in how adults in the United States perceived the relative harm and addictiveness of e-cigarettes. The surveys were conducted nationally in 2012, 2014 and 2015 by the Tobacco Center of Regulatory Science (TCORS) at the School of Public Health. Nearly 16,000 adults completed the surveys.

The study results are published in the American Journal of Preventive Medicine in an article titled “Changing Perceptions of Harm of E-Cigarettes among U.S. Adults, 2012-2015.” The study’s lead author is Dr. Ban Majeed, a postdoctoral research associate with TCORS in the School of Public Health.

According to the survey, 35 percent of adult smokers perceived e-cigarettes to be equally or more harmful than combustible cigarettes in 2015—a sizeable increase over the nearly 12 percent who reported that perception in 2012. Also, the proportion of adult smokers who thought e-cigarettes were addictive more than doubled from 25 percent in 2012 to nearly 57 percent in 2015. Similar trends were seen in non-smoking adults.

“The findings underscore the urgent need to convey accurate information to the public, especially adult smokers, about the available scientific evidence of the harm of e-cigarettes compared to combustible cigarettes,” the study stated.

“Our public health messages should accurately convey to cigarette smokers that switching completely to e-cigarettes would reduce their risks even if e-cigarettes are addictive and not risk-free,” said one of the study’s authors, Dr. Michael Eriksen, dean of Georgia State’s School of Public Health and a globally recognized expert in tobacco control.