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Big Tobacco Accused of ‘Dirty War’ Against Smoking Prevention in Africa

In the past, Big Tobacco has been accused of covering up the true extent of the health risks associated with smoking, as well as fighting government restrictions. Now, a new investigation suggests that Big Tobacco is using strong-arm tactics to resist regulations in many parts of Africa.

http://www.care2.com/causes/big-tobacco-accused-of-dirty-war-against-smoking-prevention-in-africa.html

The Guardian reports that after reviewing court documents and other materials, it has uncovered a systematic wave of bullying and intimidation by British American Tobacco. And BAT is soon to close a deal that would make it the world’s leading tobacco company.

The exposé highlights attempts made by BAT to defang, or resist outright, regulation and restriction. For example, the company used threats of economic damage to fight higher taxes on cigarettes, a plan that is standard in the U.S. and much of Europe.

The Guardian reports:

In one undisclosed court document in Kenya, seen by the Guardian, BAT’s lawyers demand the country’s high court “quash in its entirety” a package of anti-smoking regulations and rails against what it calls a “capricious” tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

But we have seen these tactics before.

Starting as early as the 1970s, health warnings about cigarettes began to grab national attention. At that time, tobacco companies used every advertising and legal mechanism they could to prevent further regulation and to avoid plain packaging. As a result, some 70 years after the health dangers of cigarettes came to light, we are only now restricting tobacco in a way that seems appropriate to its risks.

While tobacco companies are in retreat in the West, African, Latin American and now Asian markets have become key areas of interest. As well as exploiting labor in these regions, tobacco companies now want to ensure that their products last long after the West has rejected cigarettes.

For its part, British American Tobacco has always claimed to abide by strict codes of conduct. The company has defended its use of the courts as a means to clear up ambiguous interpretations in local regulation and to ensure international regulations are being followed where appropriate.

British American Tobacco maintains that it does not oppose regulation per se and believes that reasonable restrictions on tobacco are warranted as, tobacco is a harmful product.

However, campaigners have long said that BAT falls short of that standard. Many African nations have signed on to the World Health Organization’s treaty on tobacco control, but that status still needs to be ratified, meaning that no uniform policies exist. Sub-Saharan Africa in particular has shown its vulnerability to manipulation by outside businesses with money.

The Guardian exposé highlights this clearly in one extract regarding tobacco regulation in Kenya:

Extract – letter
“If these measures are brought into effect, the economic and social impact will be extremely negative. They could even threaten the continuation of our factory which has operated in Bobo Dioulasso for more than fifty years with more than 210 salaried employees.”

Excerpt from letter from Imperial Tobacco to the prime minister of Burkina Faso, 25 January 2016, concerning new regulations on plain cigarette packaging and large graphic health warnings.

The Sunday Times has previously reported on an investigation which found that BAT sold cheaper, highly addictive cigarettes to Africans in the 1990s. The company also allegedly marketed smoking without sufficient health warnings.

BAT may dispute such claims or suggest that these are simply past infractions. However, more recent reports claim that people affiliated with BAT have attempted to bribe African officials to advance tobacco products in sub-Saharan Africa and to avoid certain regulations.

As of 2016, these allegations — made both by former BAT employees and by outside investigators — even prompted lawmakers in the U.S. Congress to call for a full investigation to determine whether BAT breached any laws due to its involvement in Africa.

Overall, tobacco use remains low across Africa. A major “Lancet” study published in 2010 puts cigarette smokers at about 14 percent of the total population — far below that seen in the Americas. However, data suggests that the rate of smoking uptake is rising at an alarming rate — by as much as four percent per year.

Will the Guardian’s revelations prompt further action against British American Tobacco? That remains to be seen, but we must do everything we can to help African nations get the full facts on tobacco’s health impacts and resist Big Tobacco’s strong-arm tactics.

Indonesia tobacco bill would open tap for ads aimed at kids, health official says

By Eveline Danubrata and Stefanno Reinard | JAKARTA

A proposed Indonesian tobacco law will roll back regulations to discourage smoking in a country that already has one of the highest smoking rates in the world and open the floodgates to advertising aimed at teenagers, a health ministry official said.

http://uk.reuters.com/article/us-indonesia-tobacco-idUKKBN18S47O

If the bill initiated by the parliament is passed, companies will no longer have to put grim pictures on cigarette packs of lung cancer or other diseases linked to smoking, said Mohammad Subuh, director-general of disease prevention and control at the health ministry.

Under existing regulations, 40 percent of the front and back of a cigarette pack must contain a “health warning” in the form of pictures and text.

Under the tobacco bill, reviewed by Reuters, cigarette packs would not be required to have a specific portion dedicated to health-related pictures. Cigarette businesses that put up advertisements, either in electronic, printed or outdoor media, do have to include a health warning that is “written with clear alphabets, easily read and proportionate.”

School and playground areas would be designated as “no- cigarette-smoke zones” instead of “no-cigarette zones”, which would allow cigarettes to be sold or displayed there, Subuh said.

“Indonesia is the most liberal country for the tobacco industry,” said Subuh, who oversees the health ministry’s tobacco control efforts.

“Let’s not open again the opportunities for the industry to lure teenagers to party with cigarettes. It’s like jumping from a helicopter without a parachute,” he said in an interview.

OUTPUT INCREASE

Last year, 54.8 percent of males between 15 and 19 years old were smokers in Indonesia, more than double the percentage of smokers in 2001, according to the health ministry. The price of a pack of cigarettes in Indonesia can be less than $2.

A shocking video of a toddler reportedly puffing up to 40 cigarettes a day on the island of Sumatra went viral around seven years ago, firing up anti-tobacco activists who said it underscored the problem of underage smoking in Indonesia.

“Indonesia is terrifying because it has among the most baby smokers in the world. From elementary school until high school, the smoking rate is also one of the highest,” the health ministry’s Subuh said.

Indonesia is the only country in the Asia-Pacific region that has yet to ratify or be a party to the World Health Organization’s Framework Convention on Tobacco Control (FCTC), which seeks to protect against the harmful consequences of smoking.

The tobacco bill mainly aims to sharply increase cigarette output in Indonesia, already the world’s fourth-biggest producer, at a time when other Asian countries are taking measures to curb smoking.

Proponents of the bill say it would safeguard a vital economic sector that employs millions of people and contributes nearly 10 percent of state revenues.

“We don’t mind some regulations, as long as they are not excessive,” said Abdus Setiawan, a board member at the Indonesia Tobacco Growers’ Association. Setiawan said he already considers emblazoning cigarette packs with the message that “smoking kills” to be “excessive.”

To become law in Indonesia, the tobacco bill has to be agreed between the government and the parliament. President Joko Widodo agreed in March to start discussions on the bill with the parliament, but it is unclear when the president will make a decision.

$17 BILLION INDUSTRY

Indonesia, a country of 250 million and the biggest economy in Southeast Asia, is attractive for major cigarette companies at a time when growth is slowing in more developed markets.

Indonesia produced 269.2 billion cigarettes in 2015, while the total market was valued at 231.3 trillion rupiah ($17.3 billion), according to research firm Euromonitor International.

Philip Morris International Inc and British American Tobacco PLC have controlling stakes in local cigarette makers PT Hanjaya Mandala Sampoerna Tbk and PT Bentoel Internasional Investama Tbk, respectively.

Other major domestic players include PT Gudang Garam Tbk and privately held Djarum Group.

Regulations for the industry have been poorly enforced and some companies target young Indonesians with new products such as fruit-flavored cigarettes or clever advertising, activists say.

“A lot of advertisements here send the message that if you don’t smoke, you’re not macho, you’re not cool,” Muhammad Khanavi, a 14-year-old student, said on the sidelines of an anti-smoking event to mark World No Tobacco Day on Wednesday.

($1 = 13,321.00 rupiah)

(Editing by Ed Davies and Bill Tarrant)

The Law on Labels

Noah Steinsapir, general counsel for Kretek International, offers a legal look at what the FDA’s new warning label requirements mean for manufacturers and retailers.

http://tobaccobusiness.com/fda-law-on-warning-labels/

The FDA’s Deeming Regulations are now in full swing, and several deadlines have come and gone since its implementation on August 8, 2016. Currently, the tobacco industry is working hard to comply with the imminent deadlines in connection to the FDA’s new labeling requirements. Manufacturers/importers of cigars are required to submit a rotational warning plan in compliance with FDA regulations by May 10, 2017, and the new labels must be implemented and in commerce no later than May 10, 2018.

The material aspects of the new FDA warning plan are fairly straightforward. Manufacturers and importers of cigars must rotate six warnings:

  1. WARNING: Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale;
  2. WARNING: Cigar smoking can cause lung cancer and heart disease;
  3. WARNING: Cigars are not a safe alternative to cigarettes;
  4. WARNING: Tobacco smoke increases the risk of lung cancer and heart disease, even in nonsmokers;
  5. WARNING: Cigar use while pregnant can harm you and your baby; or SURGEON GENERAL WARNING: Tobacco Use Increases the Risk of Infertility, Stillbirth, and Low Birth Weight; and
  6. WARNING: This product contains nicotine. Nicotine is an addictive chemical.

These rotated warnings must be permanently affixed to the cigar packaging and advertisements. For packaging, the warning must encompass no less than 30 percent of the two principal display panels of the product’s packaging (a principal display panel being defined by the Deeming Regulations as the panels of the package that are most likely to be displayed, presented, shown or examined by the consumer) and no less than 20 percent of the total display area of the advertisement, with the caveat that the warning on advertisements appear in the upper portion of the advertisement within the trim area of the advertisement. The warnings have some other requirements such as font size, capitalization and color.

Although the rule is relatively straightforward, the industry still remains confused in connection with two looming issues: First, how will this warning coalesce with California’s current Proposition 65 warning requirements? Second, how will the timing of selling through products with older warnings on them work?

Prop 65 vs. FDA Warning

For Prop 65, certain industry groups are working to devise a plan. The purpose of California’s Proposition 65 is to warn the consumer and the public at large that tobacco products contain toxic chemicals. The new FDA warning plan achieves California’s objective and does so in a meaningful manner such that 30 percent of the principal display panels of the product’s packaging will notify the consumer of the health warnings of the tobacco product. In terms of size and visibility, the FDA’s rule goes above and beyond what is required by California’s Proposition 65. Therefore, a proposed and reasonable outcome is that California determines that the additional Prop 65 warning is unnecessary, duplicative and may cause customer confusion in light of the new federal guidelines that require such a clear and conspicuous warning. In either event, hopefully the State of California will provide clarity in connection with this issue.

Products Already in the Retail Pipeline
Another common concern is that the May 10, 2018 deadline for implementing the new warning scheme may create challenges in light of the fact that product can sit in a warehouse or on a retail shelf for extended periods of time. This may result in the sale of product without the adequate warning to the consumer after the May 10, 2018 deadline, which would not be the fault of the manufacturer/importer or the retailer. While the answer is not crystal clear yet, the Deeming Regulations appear to have considered this issue and provide a safe harbor to both the manufacturer/importer, as well as to the retailer. The manufacturer and importer appear to be allowed to introduce product without the current warning requirements into commerce up until May 10, 2018. They then have an additional 30 days after this deadline as a safe harbor to continue selling the last of the product.

In addition, retailers appear to be provided a safe harbor as long as the retailer purchased the product from a licensed manufacturer, the packaging contains some type of health warning, and the retailer has not altered the packaging. Both the FDA and the industry want to provide clear and conspicuous warnings so that consenting adults may make informed decisions. With time, the new FDA warning plan will be further clarified.

This story first appeared in the May/June 2017 issue of Tobacco Business magazine. Members of the tobacco industry are eligible for a complimentary subscription to our magazine. Click here for details.

Support World No Tobacco Day – say “no” to tobacco

To support the World No Tobacco Day 2017, the Department of Health (DH) today (May 31) held a sharing session to remind the public again of the hazards of smoking and to urge smokers to quit smoking as early as possible.

http://www.info.gov.hk/gia/general/201705/31/P2017053100249.htm

Speaking at the sharing session, the Director of Health, Dr Constance Chan, said that the World Health Organization (WHO) has marked May 31 as World No Tobacco Day annually. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development”, with the aim of demonstrating the threats posed by tobacco to the world’s sustainable development, including public health and the economy. Dr Chan strongly urged members of the public to say “no” to tobacco and to continue supporting the Government’s efforts in tobacco control.

“With the collaborative efforts of the Government and various sectors over the years, the work on tobacco control in Hong Kong has attained pleasing results, with a drop in overall smoking prevalence from 23.3 per cent in the 1980s to 10.5 per cent in 2015. Nonetheless, casualties and economic loss directly and indirectly caused by tobacco remain tremendous. Local studies revealed that tobacco-related fatalities reach nearly 7 000 people annually and the economic loss resulting from tobacco-related health problems is estimated to be about 5.5 billion every year,” Dr Chan said.

“Smoking is a causative agent of many cancers as well as cardiovascular and respiratory diseases. Smoking causes harm not only to the smoker but also to their family members and friends due to the secondhand smoke induced, which increases their risk of cancer and many other chronic diseases as well as the chance of children developing respiratory symptoms,” Dr Chan added.

Sharing the research findings on local smoking-related mortality and morbidity conducted by the University of Hong Kong (HKU), the Chair Professor of the School of Public Health of the HKU, Professor Lam Tai-hing, pointed out that at least one out of every two elderly smokers died of tobacco-related diseases. He said that the Government must continue to adopt various tobacco control measures to encourage smokers to quit the habit.

The Head of the Tobacco Control Office of the DH, Dr Lee Pui-man, introduced in the sharing session 12 new pictorial health warnings on cigarette packets, which better inform the public about the specific hazards of tobacco use to smokers and their families. Experience and evidence from the WHO and around the globe also demonstrate that pictorial health warnings are an effective intervention, and increasing the size of pictorial health warnings on cigarette packets is now an international trend.

“The graphics and designs of health warnings should be updated regularly so as to maintain their salience and enhance the impact. The Government updates pictorial health warnings coupled with multiple tobacco control measures to discourage members of the public from smoking and encourage smokers to quit,” Dr Lee said.

Smokers who intend to quit smoking can call the DH’s Integrated Smoking Cessation Hotline on 1833 183, where registered nurses provide professional counselling services on smoking cessation and will also refer service users to suitable social service agencies for follow-up when necessary. To enhance smoking cessation services to smokers, the DH will launch a pilot public-private partnership programme this year to trial a new mode of smoking cessation service supported by family physicians.

In addition, the DH will collaborate with a renowned medical institution, Mayo Clinic, in the United States to organise an online training programme on tobacco dependence treatment, which will be rolled out within this year. Family physicians joining the programme will acquire skills and knowledge on smoking cessation via e-learning, and their capacity in providing smoking cessation services will be further enhanced through training and assessment. The programme aims to ensure that they can provide quitters with effective evidence-based treatment.

In addition, two patient representatives shared their experience of smoking at the sharing session, ranging from smoking-related diseases to successfully quitting the habit. They urged other smokers to quit smoking as early as possible and to seek help on smoking cessation if necessary.

Study: China Struggles to Kick World-Leading Cigarette Habit

Most smokers in China, the world’s largest tobacco consumer, have no intention of kicking the habit and remain unaware of some of its most damaging health effects, Chinese health officials and outside researchers said Wednesday.

http://www.voanews.com/a/china-smoking/3879050.html

An estimated 316 million people smoke in China, almost a quarter of the population, and concerns are growing about the long-term effects on public health and the economy.

The vast majority of smokers are men, of whom 59 percent told surveyors that they have no plans to quit, according to a decade-long study by the Chinese Center for Disease Control and Prevention and Canadian researchers with the International Tobacco Control project.

Such numbers have prompted efforts to restrict the formerly ubiquitous practice. Major cities including Beijing and Shanghai having recently moved to ban public smoking, with Shanghai’s prohibition going into effect in March. In 2015, the central government approved a modest nationwide cigarette tax increase.

But Chinese and international health officials argue that more is needed, including a nationwide public smoking ban, higher cigarette taxes and more aggressive health warnings. Such actions are “critically important,” Yuan Jiang, director of tobacco control for the Chinese Center for Disease Control, said in a statement released with Wednesday’s study.

A public smoking ban appeared imminent last year. The government health ministry said in December that it would happen by the end of 2016, but that has yet to materialize.

“They have to figure out what’s important as a health policy,” said Geoffrey Fong of Canada’s University of Waterloo, one of the authors of Wednesday’s study. “Every third man that you pass on the street in China will die of cigarettes. …When you have cheap cigarettes, people will smoke them.”

In line with global trends, smoking rates among Chinese have fallen slowly over the past 25 years, by about 1 percent annually among men and 2.6 percent among women, according to a separate study published in April in the medical journal The Lancet.

Yet because of China’s population growth — 1.37 billion people at last count — the actual number of smokers has continued to increase. Rising prosperity means cigarettes have become more affordable, while low taxes keep the cost of some brands at less than $1 a pack.

Sixty percent of Chinese smokers were unaware that cigarettes can lead to strokes and almost 40 percent weren’t aware that smoking causes heart disease, according to the study, which was released on World No Tobacco Day, when the World Health Organization and others highlight health risks associated with tobacco use.

Judith Mackay, an anti-tobacco advocate based in Hong Kong, said China has made strides with the public smoking bans in some cities and a similar ban covering schools and universities, but that’s not enough.

“This is the first time there has been a report looking at the overall picture of where China stands,” said Mackay, senior adviser at Vital Strategies, a global health organization. “The reality is, it’s falling behind.”

Mackay blamed behind the scenes lobbying by China’s state-owned tobacco monopoly for impeding efforts to toughen tobacco policies. The State Tobacco Monopoly Administration did not immediately respond to a request for comment.

Government agencies and research institutes in China, Canada and the United States funded the study.

Support World No Tobacco Day – say “no” to tobacco

To support the World No Tobacco Day 2017, the Department of Health (DH) today (May 31) held a sharing session to remind the public again of the hazards of smoking and to urge smokers to quit smoking as early as possible.

http://www.info.gov.hk/gia/general/201705/31/P2017053100249.htm

Speaking at the sharing session, the Director of Health, Dr Constance Chan, said that the World Health Organization (WHO) has marked May 31 as World No Tobacco Day annually. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development”, with the aim of demonstrating the threats posed by tobacco to the world’s sustainable development, including public health and the economy. Dr Chan strongly urged members of the public to say “no” to tobacco and to continue supporting the Government’s efforts in tobacco control.

“With the collaborative efforts of the Government and various sectors over the years, the work on tobacco control in Hong Kong has attained pleasing results, with a drop in overall smoking prevalence from 23.3 per cent in the 1980s to 10.5 per cent in 2015. Nonetheless, casualties and economic loss directly and indirectly caused by tobacco remain tremendous. Local studies revealed that tobacco-related fatalities reach nearly 7 000 people annually and the economic loss resulting from tobacco-related health problems is estimated to be about 5.5 billion every year,” Dr Chan said.

“Smoking is a causative agent of many cancers as well as cardiovascular and respiratory diseases. Smoking causes harm not only to the smoker but also to their family members and friends due to the secondhand smoke induced, which increases their risk of cancer and many other chronic diseases as well as the chance of children developing respiratory symptoms,” Dr Chan added.

Sharing the research findings on local smoking-related mortality and morbidity conducted by the University of Hong Kong (HKU), the Chair Professor of the School of Public Health of the HKU, Professor Lam Tai-hing, pointed out that at least one out of every two elderly smokers died of tobacco-related diseases. He said that the Government must continue to adopt various tobacco control measures to encourage smokers to quit the habit.

The Head of the Tobacco Control Office of the DH, Dr Lee Pui-man, introduced in the sharing session 12 new pictorial health warnings on cigarette packets, which better inform the public about the specific hazards of tobacco use to smokers and their families. Experience and evidence from the WHO and around the globe also demonstrate that pictorial health warnings are an effective intervention, and increasing the size of pictorial health warnings on cigarette packets is now an international trend.

“The graphics and designs of health warnings should be updated regularly so as to maintain their salience and enhance the impact. The Government updates pictorial health warnings coupled with multiple tobacco control measures to discourage members of the public from smoking and encourage smokers to quit,” Dr Lee said.

Smokers who intend to quit smoking can call the DH’s Integrated Smoking Cessation Hotline on 1833 183, where registered nurses provide professional counselling services on smoking cessation and will also refer service users to suitable social service agencies for follow-up when necessary. To enhance smoking cessation services to smokers, the DH will launch a pilot public-private partnership programme this year to trial a new mode of smoking cessation service supported by family physicians.

In addition, the DH will collaborate with a renowned medical institution, Mayo Clinic, in the United States to organise an online training programme on tobacco dependence treatment, which will be rolled out within this year. Family physicians joining the programme will acquire skills and knowledge on smoking cessation via e-learning, and their capacity in providing smoking cessation services will be further enhanced through training and assessment. The programme aims to ensure that they can provide quitters with effective evidence-based treatment.

In addition, two patient representatives shared their experience of smoking at the sharing session, ranging from smoking-related diseases to successfully quitting the habit. They urged other smokers to quit smoking as early as possible and to seek help on smoking cessation if necessary.

Ends/Wednesday, May 31, 2017
Issued at HKT 15:18

Big Tobacco is losing the fight to stop plain packaging of cigarettes

Dr Enrico Bonadio, a Senior Lecturer in the City Law School, says the tobacco industry’s bid to avoid plain packaging by relying on legal arguments around trade and intellectual property rights, is being systematically dismissed by courts around the world.

https://www.city.ac.uk/news/2017/may/big-tobacco-is-losing-the-fight-to-stop-plain-packaging-of-cigarettes

You may already have seen the tobacco packs currently sold in the UK: a dark, murky green colour with large graphic health-warning images and scary messages aimed at informing current and potential smokers about the devastating consequences of tobacco consumption. They have no colourful logos, with the brand name just displayed in small characters in a standard font.

These packs are now required by new regulations which entered into force in May 2016. There has been a one-year transitional period for the sell-through of old stock – and from May 20 2017 all tobacco products on sale in the UK must comply with the new rules.

The legislative move has been recommended to all countries by the World Health Organisation to reduce the attractiveness of smoking and eventually reduce consumption. Australia was the first country to introduce such strict packaging requirements in December 2012. France and, of course, the UK have since followed suit.

It follows significant research that shows these new standardised cigarette packs are much less appealing to consumers – and young people especially.
The industry’s legal defeats

No wonder tobacco companies have challenged the measure in the courts. They have argued that it is useless, too harsh – and is an infringement of their fundamental and intellectual property rights, especially trademarks. Yet, their claims are based on weak arguments and have been rejected by both the High Court of England and Wales and the Court of Appeal.

The tobacco industry has faced numerous courtroom defeats of late. Last year Uruguay won a landmark case against the Swiss giant Philip Morris International. The company had sued the Latin American state after it introduced two measures affecting tobacco packaging and trademarks. These were mandatory graphic health warnings covering 80% of cigarette packets (a measure very close to plain packaging) and the obligation for tobacco companies to adopt a single presentation for their brands, dropping for example the “gold” and “blue” descriptors, that could lead smokers to believe one variant was safer than another.

The fact that the courts sided with Uruguay would have been encouraging to other countries aiming to introduce controls on tobacco packaging. And even greater encouragement came recently from a World Trade Organisation ruling which deemed that the plain packaging requirements introduced by Australia as compliant with international trade and intellectual property rules – and are therefore a legitimate public health measure.

The decision has not been officially announced, but a confidential draft of the interim ruling was leaked to the media and the final decision is expected later this year. The Australian measure had been challenged at the WTO tribunal by Cuba, Dominican Republic, Indonesia and Honduras, countries whose economies strongly rely on the tobacco industry.

A domino effect

This is a blow to the industry. The short-term consequences of the WTO ruling – Imperial Tobacco’s shares fell more than 2% after the decision was leaked – reflects the longer-term danger that this ruling poses. It will likely convince other states to introduce plain packaging legislation without fear of violating international trade and intellectual property laws. It basically gives them a green light by removing the regulatory chilling effect that such legal action has produced on countries that wanted to follow Australia’s example.

After all, more and more countries seem interested in adopting standardised packaging. As well as France and the UK, Ireland and Norway will introduce packaging restrictions later in 2017, and Hungary in 2018. Many other states are debating similar measures, including New Zealand, Canada, Belgium, Slovenia, Belgium, Singapore and Thailand.

So, a legislative trend has started which aims to restrict the ability of tobacco manufacturers to make their products appealing to consumers by using eye-catching words, logos or ornamental features on the pack. And attempts by Big Tobacco to stop it by relying on legal arguments around trade and intellectual property rights are being systematically dismissed by courts around the world.

Ultimately, the industry needs to accept the fact that its ability to use fancy brands, especially on packaging, may be reduced by governments for public health reasons. Also that a company’s property rights are not absolute or untouchable. Not only does it not have enough legal basis – as has now been confirmed by several courts and tribunals – but it also disregards legitimate policies adopted by democratically elected governments.

Effect of message congruency on attention and recall in pictorial health warning labels

Abstract

Objective

The nine pictorial health warning labels (PWLs) proposed by the US Food and Drug Administration vary in format and feature of visual and textual information. Congruency is the degree to which visual and textual features reflect a common theme. This characteristic can affect attention and recall of label content. This study investigates the effect of congruency in PWLs on smoker’s attention and recall of label content.

http://tobaccocontrol.bmj.com/content/early/2017/05/16/tobaccocontrol-2016-053615

Methods

120 daily smokers were randomly assigned to view either congruent or incongruent PWLs, while having their eye movements recorded. Participants were asked to recall label content immediately after exposure and 5 days later.

Results

Overall, the image was viewed more and recalled better than the text. Smokers in the incongruent condition spent more time focusing on the text than smokers in the congruent condition (p=0.03), but dwell time of the image did not differ. Despite lower dwell time on the text, smokers in the congruent condition were more likely to correctly recall it on day 1 (p=0.02) and the risk message of the PWLs on both day 1 (p=0.01) and day 5 (p=0.006) than smokers in the incongruent condition.

Conclusions

This study identifies an important design feature of PWLs and demonstrates objective differences in how smokers process PWLs. Our results suggest that message congruency between visual and textual information is beneficial to recall of label content. Moreover, images captured and held smokers’ attention better than the text.

What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”