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Youth Smoking

Indonesia’s Child Tobacco Workers in Peril

In the next week, Indonesian President Joko (“Jokowi”) Widodo will decide whether to encourage parliament to move forward with a draft tobacco bill aimed at increasing domestic tobacco production. The bill would gut many important existing health regulations, like the requirement that companies include a health warning with a picture on the label of tobacco products.

Those are troubling proposals given that millions of children in Indonesia start smoking each year, and that 40 million more are “passive smokers” from secondhand smoke. The Indonesian Ministry of Health, 17 prominent health organizations, and many others have denounced the measure as an attempt to undermine Indonesia’s already weak tobacco control laws. Jokowi should reject the bill.

But the draft bill is not the only tobacco policy issue awaiting action by the Jokowi administration. Each year in Indonesia, thousands of children, some just 8 years old, work in hazardous conditions producing tobacco that ends up in products marketed and sold by huge Indonesian and multinational tobacco companies.

My colleagues and I published a Human Rights Watch report documenting hazardous child labor on Indonesian tobacco farms last May. Since then, another tobacco season has come and gone, but the child workers behind Indonesia’s tobacco industry remain unprotected.

We interviewed 132 children who worked on tobacco farms in four of Indonesia’s biggest tobacco-producing provinces. We found that child workers are exposed to nicotine and pesticides—toxins that can be especially harmful to children who are still growing and developing. Half the children we interviewed had experienced nausea, vomiting, headaches, or dizziness while they worked. Those symptoms are consistent with acute nicotine poisoning, which happens when workers handle tobacco plants and absorb nicotine through their skin. Many children said they also mixed and sprayed toxic chemicals on the plants with no protective equipment, and some became violently ill afterward.

The families we interviewed did not intentionally put their children in harm’s way. They were committed to helping their children get an education so they could have a better future.

Indeed, most of the children we interviewed attended school and worked in tobacco farming only outside of school hours.

But direct contact with tobacco in any form is hazardous work for children because of the nicotine in the leaves. Most of the families we spoke with had never received comprehensive information about the hazards for children of work on tobacco farms, so they did not know the risks to their children.

We urged the Jokowi government to take action to protect children from danger in tobacco fields. We called on the Health Ministry to work with other ministries to develop a public education campaign to raise awareness of the dangers to children of work on tobacco farms. In recent meetings with Human Rights Watch, government officials have said they need additional support and resources to get the campaign underway this year.

Indonesia already prohibits children under 18 from work “with harmful chemical substances.” The Ministry of Manpower and Transmigration should explicitly prohibit children from working in direct contact with tobacco in any form and increase labor enforcement efforts to make sure government inspectors check for workers’ safety, especially on small tobacco farms where children might be in danger.

In our meetings with government officials, we have heard many times that the tobacco industry is powerful in Indonesia, and that it is difficult to achieve policy changes the industry opposes. Surely eliminating child labor in tobacco farming is an issue tobacco companies also want to address.

The UN Guiding Principles on Business and Human Rights make clear that companies have responsibilities for addressing human rights abuses in their supply chains. We shared our findings with the largest tobacco companies operating in Indonesia—Djarum, Gudang Garam, Philip Morris International (which owns Sampoerna), British American Tobacco (which owns Bentoel), and others. The large multinational tobacco companies have policies to prevent children from doing the most dangerous tasks on tobacco farms, but their policies are not strong enough, and they should do more to monitor for child labor when they buy Indonesian tobacco on the open market through traders.

The largest Indonesian companies—Djarum and Gudang Garam—do not appear to be taking any steps to prevent or address child labor in their supply chains. They have never responded to our many requests for information and meetings, and they do not make any information publicly available about their child labor policies.

These companies should not be profiting off the backs of Indonesian child workers.

Two months from now, the next tobacco-growing season will be underway, and children will be heading to the fields again. The controversy around the draft tobacco bill likely will not be resolved by then. But with decisive action, the Jokowi administration and tobacco companies could take steps to protect children from dangerous work in tobacco fields. Their futures depend on it.

Curbing teen smoking ‘must go beyond raising minimum age’

Teens below the age of 18 have been barred from smoking legally since 1993 – but the data two decades later tells a different story.

http://www.straitstimes.com/singapore/health/curbing-teen-smoking-must-go-beyond-raising-minimum-age

In 2013, the average age when smokers took their first puff was just 16, according to the National Health Surveillance Survey.

Said Mr Vincent Tng, 21, a non-smoker serving full-time national service: “I have friends who started smoking as young as 14 or 15 – they just got their friends to buy cigarettes for them. There are contraband cigarettes around, so you don’t even have to go to a proper shop.”

Experts said the discrepancy shows that efforts to curb teen smoking must go beyond raising the minimum legal age. Issues such as raising awareness and enforcement cannot be sidelined.

Said Sata CommHealth chief executive and anti-smoking advocate K. Thomas Abraham: “We should have a slew of measures that go concurrently with raising the minimum age. How are these young people able to get cigarettes? How do we plug the existing loopholes?”

Last week, the Ministry of Health (MOH) said it plans to raise the minimum legal smoking age from 18 to 21. In Singapore, these are the years when nearly half of smokers become regular smokers. The idea is to put cigarettes out of the reach of underage smokers, who tend to obtain them through their social circles.

A town in the United States known as Needham is often held up as a success story of how this measure can reduce smoking rates.

In 2005, it increased the legal smoking age from 18 to 21. Smoking rates among under-18s dropped by nearly half within five years – from 13 per cent in 2006 to 7 per cent in 2010. At least 215 other locales in the US have followed suit in recent years, including New York City, Boston and California.

Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee for Health, said: “I don’t think that in itself will be enough… but raising the age would help interdict further access to cigarettes amongst the young.”

To complement the move, experts suggested increasing the size of graphic health warnings on cigarette packets, introducing plain packaging to make cigarettes look as nondescript as possible and even raising the tobacco tax.

According to the World Health Organisation, increasing tobacco prices in high-income countries by 10 per cent is estimated to reduce consumption by 4 per cent, said Professor Chia Kee Seng, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Tobacco taxes were last raised in 2014, from $352 per kg to $388 per kg of tobacco, or 1,000 cigarettes. It was reported that out of the $12 for an average pack of cigarettes, $8.50 goes to the Government as tax.

Prof Chia said tobacco taxes should be raised further if smoking remains a serious issue, even after the age limit is raised.

At the same time, said Dr Abraham, even more work needs to be done to drive home the anti-smoking message among young people, as “the long-term effects of smoking are not always immediately apparent to a young smoker”.

Nee Soon MP Louis Ng, who used to smoke, said enforcement needs to be stepped up to ensure cigarettes are not sold to underage teens, and more has to be done to change the image of smoking.

“They think it’s cool to smoke and we need to tackle that mindset with a series of public awareness campaigns,” he said.

Management executive Catherine Ruth Jeyaseelan, 34, suggested involving parents too. “Sometimes parents smoke at home and kids will get curious, they might try it when their parents are out.”

E-cigarettes attracting more youths towards world of tobacco

You might have thought e-cigarettes cut down tobacco consumption, but the reality is a bit different.

A study, by University of California- San Francisco,suggests that it actually attracts more youths towards tobacco consumption.

It has been published in Pediatrics.

Researchers from University Of California in the United States of America said they did not find any evidence of decline in the consumption of tobacco. In fact, the usage of e-cigarettes & cigarettes has gone higher among adolescents in 2014 compared to the numbers from 2009.

“We didn’t find any evidence that e-cigarettes are causing youth smoking to decline,” said lead author Lauren Dutra.

The analysis by the researchers also saw that section of youth who start smoking e-cigarettes are more likely to draw themselves in consuming traditional cigarettes in later part of their lives.

“While some of the kids using e-cigarettes were also smoking cigarettes, we found that kids who were at low risk of starting nicotine with cigarettes were using e-cigarettes,” Dutra said. “Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”

In August 2016, the U.S. Food and Drug Administration, already restricted the purchase of e-cigarettes to adults aged 18 years and older. The FDA also directed to have a warning label on e-cigarettes which will start from August 2018.

The authors also said that there has been a decline in cigarette smoking youth but the decline has not been rapid after the advent of e-cigarettes in the U.S. between the years 2007 and 2009.

The authors performed an in-depth analysis of the psychological characteristics of the consumers of e-cigarettes. The research showed that the smokers tend to display some characteristics which non-smokers are less likely to show.

Characteristics like the tendency to live with a person who smokes or to wear clothing which displays tobacco product logo. The smokers in the national youth survey showed these characteristics, while the youth who were only using e-cigarettes displayed less of these qualities.

“E-cigarettes are encouraging – not discouraging – youth to smoke and to consume nicotine, and are expanding the tobacco market,” said senior author Stanton A. Glantz.

These new results are consistent with a similar study that took place in California last year by the researchers at the University of Southern California. The researchers also found that adolescents who consumed ecigarettes, but not traditional cigarettes have displayed less risk factors which were commonly found among cigarette smokers. (ANI)

Study finds high tobacco usage among students

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college.

http://health.economictimes.indiatimes.com/news/diagnostics/study-finds-high-tobacco-usage-among-students/56731360

Thiruvananthapuram: In Kannur, over 70% of higher secondary school students begin tobacco consumption at a tender age of 15, while in rural Thiruvananthapuram tobacco sales near educational institutions is alarmingly high, finds a study, jointly carried out by Regional Cancer Centre (RCC) here and Kannur Medical College.

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college. While 41% of the sample population got tobacco products from nearby shops, 27% of them got it from friends. According to 79% of students, it was “fairly easy” and “very easy” to obtain these products.

Dr Paul Sebastian and Dr R Jayakrishnan of RCC, who led the study in the rural parts of the state capital, presented a similarly bleak picture.

Nearly 19% of boys between 15 and 18 years use tobacco in any form. Of the 1,114 students of 10 random government schools surveyed, 7.4% were ‘ever users’, persons who have used tobacco at least once during the academic year.

The findings reflected the gravity of the issue and also underscored the expert opinion that called for measures to control the menace, said Shoba Koshy, chairperson of commission for protection of child rights.

Dr Elizabeth K E, president, Indian Academy of Pediatrics said, “The World Health Organisation has termed tobacco a global pediatric concern. Once initiated, it becomes very difficult to come off it; the key is to prevent it at a young age.”

Hong Kong Department of Health Tobacco Control Zero Efforts

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Starting with e-cigs triples odds of starting cigarettes among college students; the evidence just keeps piling up

Tory Spindle and colleagues at VCU recently published a study, “Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students,” that followed 3757 students at Virginia Commonwealth University for a year to examine the relationship between e-cigarette use among never cigarette smokers at the beginning and whether they were smoking conventional cigarettes a year later. They found, controlling for a wide range of demographic and behavioral variables, that e-cigarette users at baseline were about 3.4 times as likely to be smoking cigarettes a year later as young adults who were not using e-cigarettes.

This effect is consistent with a similar study of young adult males in Switzerland as well as all the studies of adolescents.

Here are the highlights and the abstract:

HIGHLIGHTS

• E-cig and cigarette use has not been studied in college students longitudinally.
• Ever and current e-cig use increased non-smokers chances of trying cigarettes.
• Historically internalizing/externalizing factors predict cigarette uptake strongly.
• Most internalizing/externalizing factors examined did not predict e-cig uptake.
• Males and marijuana users were more likely to initiate e-cig use.

ABSTRACT

Introduction:

Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce.

Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of ecigarettes in college students has not been explored.

Methods:

3757 participants from a Mid-Atlantic university (women: 66%; White: 45%; Black: 21%; Asian: 19%; Hispanic/Latino: 6%) were surveyed in 2014 and again in 2015.

Results:

Among participants reporting never smoking at time 1, those who had ever tried e-cigarettes or were currently using e-cigarettes (at least one use in past 30 days) were more likely to have ever tried cigarettes by time 2 relative to individuals who had not used e-cigarettes. Ever use of e-cigarettes (but not current use) also increased participants’ likelihood of being current cigarette smokers at time 2. Among initial never users of e-cigarettes or cigarettes, males and ever marijuana users had an increased probability of trying e-cigarettes by time 2. Furthermore, less perseverance (an index of impulsivity) and ever use of other tobacco products increased initial never users’ chances of trying both cigarettes and e-cigarettes by time 2.

Conclusions:

Given that never-smoking participants who had tried e-cigarettes were more likely to initiate cigarette use later, limiting young adults’ access to these products may be beneficial. As the long-term health implications of e-cigarette use become clearer, predictors of e-cigarette use could help identify future populations likely to use and abuse these products.

Here is the full citation: Spindle, et al. Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students. Addictive Behaviors 2017; 67:66-72. http://dx.doi.org/10.1016/j.addbeh.2016.12.009

 

Nicotine’s Highly Addictive Impact on Youth Underestimated

http://www.medscape.com/viewarticle/873955

Although smoking trends among youth have shifted in recent years from tobacco cigarettes to e-cigarettes, the highly addictive culprit nicotine remains constant, a fact that should be underscored in discussion of risk with youth and their parents.

“I think most people realize nicotine is addictive, but I don’t know if there’s an understanding of just how addictive it is – particularly for youths,” said Lorena M. Siqueira, MD, MSPH, lead author of a new report on nicotine, addiction, and youth that was released by the American Academy of Pediatrics (AAP).

“People think, for instance, only having a few cigarettes a week may be fine and they can quit any time, but they don’t realize that they are already well on their way to dependency,” Dr Siqueira, a member of the AAP Committee on Substance Use and Prevention, told Medscape Medical News.

The report was published in the January issue of Pediatrics.

Evidence shows that the earlier in life a person is exposed to nicotine, the less likely they will be able to quit using tobacco and the more likely they will consume increasingly greater quantities.

The vast majority of tobacco-dependent adults – up to 90% – started smoking before age 18 years. The authors also point out that the earlier a child starts smoking, the greater the risk of continuing to smoke in adulthood.

Approximately two thirds of children who smoke in sixth grade, for example, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults.

In addition, compared to adult smokers, youths require more attempts to quit smoking before being successful. In addition, only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year, the authors report.

Although e-cigarettes are marketed as a tool for smoking cessation, there is no strong evidence to support these claims, the authors note.

In fact, research, including a study published in JAMA Pediatrics in 2014, indicates that e-cigarettes, which contain nicotine, encourage, rather than discourage, tobacco use in youth.

Since that study’s publication, a number of other studies have shown similar harms, the study’s coauthor, Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, told Medscape Medical News.

“There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later,” he said.

“So clearly, e-cigarettes are acting as a gateway to conventional cigarette smoking.”

Instead of making quitting easier, e-cigarettes make it harder, Dr Glantz added.

“What the evidence shows is youths who use e-cigarettes are much less likely to stop smoking than youths who don’t use e-cigarettes, so not only are they not beneficial, as promoted, or even useless, they actually [work against] cessation.”

Among key attractions to e-cigarettes – and arguments that adolescents are likely to raise with parents ― is the idea that at least they are not as harmful as tobacco, Dr Siqueira said.

“It’s not unlike the prescription drug epidemic – adolescents think, ‘If my grandmother takes it, then it must be safe,’ so this is sort of the same thing,” she said.

The report also notes that e-cigarettes are not without toxic hazards of their own. Accidental poisonings associated with e-cigarette use have increased from one per month in 2010 to 215 per month in 2014, including one death.

“The take-home message is that there’s no arguing that nicotine is highly addictive, and it’s not just in cigarettes but it’s in all of these other products that are being cleverly marketed to youths to include ingredients and flavors to increase the palatability,” she said.

A new report from the University of Michigan’s Monitoring the Future study shows some encouraging trends regarding e-cigarettes. According to the study, after gaining popularity earlier in the decade, the percentage of US teens who use e-cigarettes declined for the first time from 2015 to 2016. The percentage of adolescents who used e-cigarettes in the past 30 days declined from 16% to 13% for 12th graders, from 14% to 11% for 10th graders, and from 8% to 6% among 8th graders; each change was statistically significant.

The report had even more encouraging news for cigarette smoking. The levels of smoking among 8th-, 10th-, and 12th-grade teens are the lowest they have been since annual tracking began 42 years ago.

“Since the peak year in 1997, the proportion of students currently smoking has dropped by more than three quarters — an extremely important development for the health and longevity of this generation of Americans,” principal investigator Lloyd Johnston, PhD, University of Michigan, Ann Arbor, said in a release.

The authors have disclosed no relevant financial relationshps. Dr Glantz has received research funding from the National Institutes of Health and from the Truth Initiative, a tobacco use prevention nonprofit organization.

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.

National Cancer Institute – The Economics of Tobacco and Tobacco Control

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Duterte urged to sign EO vs public smoking

http://interaksyon.com/article/134751/duterte-urged-to-sign-eo-vs-public-smoking

An anti-tobacco group is urging President Rodrigo Duterte to sign an executive order banning smoking in all public places across the country to fulfill a promise he made.

“We appeal to our dear president, who we know is an ardent anti-smoking advocate, to please sign the smoke-free Philippines EO now. Each day of delay would bring your people closer to becoming victims of the ills of smoking like me as well as those who are not even smoking,” New Vois Association of the Philippines president Emer Rojas, a former chain-smoker who lost his vocal cords due to cancer, said in a statement.

Rojas said the EO would, in particular, help protect non-smokers from second-hand smoke.

He also said it would help save Filipinos, especially the youth, from smoking-related illnesses. He cited the Tobacco Atlas of 2016, which shows 14.5% of Filipinos aged 13 to 15 and 23.8% of adults smoke regularly.

Records show an estimated 240 Filipinos die from tobacco-related diseases daily.

Aside from banning smoking in public places, Rojas said the EO would be the perfect complement to already existing tobacco control measures, specifically Republic Act No. 10351 (Sin Tax Law) and Republic Act No. 10643 (Graphic Health Warning Law).

Health Secretary Paulyn Ubial earlier said Duterte, who has buergers disease, is more than willing to sign the EO. Buerger’s disease is an ailment linked to heavy smoking.

The EO closely follows the smoking ban implemented in Davao City where Duterte was a long-time mayor.