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Parliament adopts Standardised packaging to save lives and prevent suffering

Dec 9th, 2016
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Members of Parliament voted in favour of standardised packaging of tobacco products despite intense lobbying by the tobacco industry to sway politicians against the measure.

http://www.smokefreepartnership.eu/partner-news/item/parliament-adopts-standardised-packaging-to-save-lives-and-prevent-suffering

The snowball that was set in motion in Australia in 2012 rolled through Norway today. An overwhelming majority of Parliament endorsed recommendations formulated on 1 December 2016 by the parliamentary Standing Committee on Health and Care Services. The measure will be introduced at the same time as the EU Tobacco Products Directive measures on packaging and labelling.

Tobacco advertising is deadly. It seeks to addict people to a product that kills almost half of its long-term users. Today, Norway becomes one of the first countries in the world to introduce standardised cigarette packs and the first country to standardise smokeless tobacco boxes. Smokeless tobacco use increased dramatically among young people in Norway during the last decade. The new measure will contribute to ensure that children and young people never start with tobacco and thus avoid tobacco-related suffering and death.

Anne Lise Ryel, Secretary General of the Norwegian Cancer Society said: “Norwegian politicians have taken a historic step forward to reduce the consequences of tobacco advertising. Advertising works, especially with children. Norway was the first country in the world to introduce bans on all traditional forms of advertising of tobacco products. Ever since, cigarette packs have become mini billboards for tobacco industry marketing. With this morning’s event, the tobacco industry loses its last vehicle to lure children into addiction, disease and possibly death. This is truly a ground-breaking public health reform, and a landmark day for the cancer cause”.

The Norwegian Cancer Society congratulated Minister of Health and Care Services Bent Høie for his leadership in support of the measure in the face of persistent pressure and campaigning from the tobacco industry.

Hong Kong leads mainland in war to cut smoking

Dec 9th, 2016
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http://www.ejinsight.com/20161209-hong-kong-leads-mainland-in-war-to-cut-smoking/

When a person goes to buy a packet of cigarettes in Hong Kong, he or she faces two obstacles. One is the price — Double Happiness at HK$43 and Marlboro at HK$57 — the result of a tobacco tax up to 68 per cent of the price.

The other is the hideous image on the packet of the worst consequences of smoking.

A survey by the Economic Intelligence Unit earlier this year ranked Hong Kong as the eighth most expensive city in the world for a packet of branded cigarettes, at US$7.48.

Top was London with US$14.30, followed by New York with US$13.67 and Singapore with US$9.15.

These two measures, along with the creation of smoke-free areas in public and work places, have been effective in cutting the number of smokers.

According to government figures, the percentage of daily cigarette smokers aged 15 and above in Hong Kong in 2015 was 10.5 percent, down from 10.7 percent in 2012 and 23.3 per cent in the early 1980s.

The mainland, the world’s largest tobacco market with 316 million smokers in 2015, has only recently started to learn the lessons of Hong Kong.

Since 2010, the number of smokers has increased by 15 million and cigarette production risen by 35 per cent.

The health warnings are written, not visual, and appear modestly at the bottom of the packet. They would not frighten any first-time user.

In 2015, China increased the tobacco tax to 40 per cent. Consumption tax from tobacco in 2015 was 536 billion yuan, an increase of 60 billion from a year earlier. The recommendation of the World Health Organisation (WHO) is that the tax should be 70 per cent of the retail price.

“There is certainly room for future tobacco tax increase,” said Jian Shi, director of the information office of the Taxation Research Institute at the State Administration of Taxation in Beijing.

“In some western countries, the tobacco tax rate has reached 70-80 per cent. The room for the increase needs to be considered based on the development goal of the industry and the condition of national revenue.”

Health professionals argue that increasing the tobacco tax is the quickest and most effective way to cut smoking — by both preventing young people from starting and encouraging smokers to quit.

According to WHO figures, each increase of 10 per cent in the price will cause 3.7 per cent of adults and 9.3 per cent of teenagers to stop smoking.

Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Public Health, said that selective or modest hikes would not make much of an impression on smoker numbers in Hong Kong.

“Only a 100 per cent increase in tobacco tax would induce people to quit smoking,” he said. If the government accepted this proposal, an average pack would cost HK$119.

The Department of Health has proposed an enlargement of the health warning.

It said on Nov. 23 that the area of the graphic health warning shall be of a size that covers at least 85 percent of the two largest surfaces of the packet or the retail container and that the number of forms of health warning should be increased from six to 12.

The situation in the mainland is years behind. The biggest obstacle is that the State Tobacco Monopoly Administration (STMA), the world’s biggest manufacturer of cigarettes, is also the industry regulator.

This is despite years of lobbying by China’s health professionals, the WHO and the norms practised around the world. They argue that the two must be separate institutions.

According to WHO figures, 1.2 million die each year in China from smoking-related diseases; this number will double by 2025.

Jian Shi put it succinctly. “The major difficulty lies in that the related departments have quite different views on this matter, and it is difficult for them to reach agreement on this matter. That will cause obstruction to policy making and implementation.”

The STMA opposes graphic health warnings and higher taxes because they would hurt its sales and profits. Yet, simply due to global population expansion, there will be more smokers in 2040 than there are today, so it is difficult to believe that this concern is genuine.

The health lobby has had some success, in the modest increase in tobacco tax and restrictions on smoking in indoor public areas and workplaces and some outdoor areas introduced in Beijing in June 2015. Other mainland cities have taken similar measures at different times.

On Dec. 6, the Beijing Commission of Health and Family Planning said that more than 2,700 people had been fined for violating these restrictions, with total fines of 142,500 yuan, as of Nov. 30 this year.

Professor Dr Judith Mackay, based in Hong Kong and Asia’s leading anti-tobacco campaigner, said that the price of cigarettes in China is still extremely low.

“The latest small tobacco tax increase, while laudable, will not have a serious, sustained effect on reducing smoking. It is time to review the whole tobacco tax structure in China, significantly increase the price of cigarettes and thus protect the health of the Chinese people.

“In Australia, there is a regular increase of 12.5 per cent tobacco excise tax every year. The cost of a packet could soon rise to A$40 (HK$230). Hong Kong and China should both consider long-term tobacco tax planning in this way, so that tobacco control proceeds in an orderly form, and immense energy and time is not wasted year by year in campaigning for a tax increase. Otherwise, thousands will die.”

WTO Delays Ruling In High-Stakes Tobacco Packaging Battle

Dec 6th, 2016
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The World Trade Organization will not issue a ruling on whether Australia’s “plain packaging” tobacco law usurps foreign companies’ intellectual property rights until May, according to WTO documents circulated Tuesday, delaying a decision that was slated to arrive by the end of 2016.

http://www.law360.com/articles/869566/wto-delays-ruling-in-high-stakes-tobacco-packaging-battle

A single WTO panel is weighing cases launched by the governments of Indonesia, Cuba, the Dominican Republic and Honduras asserting that Australian laws that ban all distinct branding from cigarette packages in favor of graphic warnings about the danger of the products. The case has teed up a high-stakes fight over the intersection of intellectual property rights and public health safeguards.

There is no precedent for such a law being challenged in Geneva, and the panel apparently needs more time to parse through the various legal issues at play.

“The panel wishes to advise that it now expects to issue its final report to the parties not before May 2017, in light of the complexity of the legal and factual issues that arise in this dispute,” the panel said in a statement circulated to the WTO.

Australia passed its packaging law in 2011 despite the protestations of numerous multinational corporations who viewed the measure as a direct threat to their use of trademarks and other branding mechanisms to promote their business. The four countries have said the law violates the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS, as well as the Agreement on Technical Barriers to Trade and the General Agreement on Tariffs and Trade.

At every step of the way, Australia has claimed that it has the right to curtail businesses’ trademarks in the name of public health. For the first time in the WTO’s history, the panel will have to grapple with how the TRIPS Agreement comports with a country’s right to pursue policy objectives that it deems necessary to safeguard the public’s welfare.

The legal battles over the plain packaging law began almost as soon as it went into effect, beginning with a case filed by Philip Morris Asia Ltd. under the Hong Kong-Australia bilateral investment treaty.

In that case, the panel handed a win to Australia, albeit on jurisdictional grounds, meaning that the WTO’s decision will likely be the first ruling to address the issue on the merits. Even when the decision does come down, the case will be far from settled as all parties will be entitled to a round of appeals.

Nevertheless, the case will continue to be closely watched not only by the litigants and others in the tobacco industry, but also by those companies selling products that could e subject to similar public health rules, such as alcoholic beverages or fatty and sugary foods.

–Editing by Katherine Rautenberg.

Do cigarette graphic warnings encourage smokers to attend a smoking cessation programme

Dec 2nd, 2016
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Do cigarette graphic warnings encourage smokers to attend a smoking cessation programme: a quasi-experimental study

http://tobaccocontrol.bmj.com/content/early/2016/12/02/tobaccocontrol-2016-053207

Abstract

Objective

This study assessed whether exposure to cigarette graphic warning labels (GWLs) increased attendance to a smoking cessation programme.

Method

From 2014 to 2016, alternating cohorts of smokers in 3 residential drug treatment programmes received either GWLs (experimental) or transparent (control) labels placed on their cigarette packs for 30 days. The primary outcome was the proportion of participants who chose to attend a smoking cessation group after the labelling period.

Results

The sample (N=601) was 72.6% male, with a mean age of 41.9 (SD=11.16) and included African-American (37%), White (29.4%) and Hispanic (19.6%) participants. While similar on most measures, controls were more likely to be married, had been in the treatment programme longer and registered higher on expired carbon monoxide (CO).

After labelling, the proportion attending at least one cessation group was 26% in the experimental condition and 18.8% among controls. In an intent-to-treat analysis adjusting for group differences at baseline, and for 2 levels of nesting, those who received GWLs were more likely than controls to attend the smoking cessation group (OR=1.58, 95% CI 1.02 to 2.44).

Conclusions

Smokers who received GWLs on their cigarette packs were more likely to attend a cessation programme. Thus, this study is one of the first to document a change in a directly observed behavioural outcome as a function of month-long exposure to cigarette pack GWLs.

National Cancer Institute – The Economics of Tobacco and Tobacco Control

Dec 1st, 2016
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Download (PDF, 15.8MB)

Big Tobacco threatens Supreme Court fight after losing plain packaging appeal

Nov 30th, 2016
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http://www.telegraph.co.uk/business/2016/11/30/big-tobacco-threatens-supreme-court-fight-losing-packaging-appeal/

The world’s largest tobacco companies have threatened to take their battle against the Government’s plain packaging policy to the UK’s highest courts after losing their latest appeal against the branding crackdown.

The court of appeal today upheld legislation that forces all tobacco products to use uniform packaging in a ruling described by anti-smoking groups as a “crushing defeat” for the tobacco industry.

The latest blow to cigarette-makers British American Tobacco, Imperial, Japan Tobacco International and Philip Morris International follows their failed court challenge in May this year, one month after the new anti-tobacco legislation came into effect.

Under the new rules all tobacco packaging must be olive green and include large images showing the negative health consequences of smoking as a visual deterrent.

Tobacco companies have repeatedly branded the move unlawful and say it will be ineffective at reducing smoking rates. They will continue to oppose the regulation despite a second legal defeat. The exception to the industry-wide defiance is PMI, which said in May that it would focus on developing its smoke-free products rather than fight the case.

Daniel Sciamma, the UK managing director of Japan Tobacco, said that the company was already considering an appeal to the Supreme Court.

“This commercial vandalism sets a dangerous precedent for other targeted industries, who must be concerned that their brands will now be under threat. We obviously disagree with the court’s decision as it endorses the confiscation of our brands,” Mr Sciamma said.

Meanwhile BAT warned that the court decision “does not necessarily mark the end of the challenge” and a spokesman for Imperial said that it was reviewing the judgement before considering its legal position.

Jefferies analyst Owen Bennett said the impact of plain packaging would weigh most heavily on Imperial and Winston and Camel maker Japan Tobacco, which both rely on the UK for around 15pc of their overall earnings

For Marlboro maker PMI and BAT, the UK market makes up less than 1pc of their business.

Despite the minority exposure to the UK market the tobacco companies still have a strong incentive to fight the clampdown, which could spur similar legislation in other markets.

“Seeing results such as this may actually encourage other markets to follow suit,” said Mr Bennett, adding that should other countries wish to implement plain packaging in the years ahead then the outcome of any challenges would most likely be the same.

Think tanks with ties to tobacco arguing against plain packaging

Nov 17th, 2016
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http://www.theglobeandmail.com/life/health-and-fitness/health/think-tanks-with-ties-to-tobacco-arguing-against-plain-packaging/article32884552/

A tobacco company speaking out against a public-health measure doesn’t have the same credibility as a respected think tank or advocacy group. So those companies often work with or donate funds to organizations that publicly criticize tobacco taxes and other new regulatory measures.

Those financial relationships create the possibility for bias. Yet most of the organizations on the receiving end of tobacco donations do not clearly disclose that information when speaking about related issues.

The latest example is the current debate over plain packaging.

The federal government wants to pass new regulations that would strip brand colours and logos from tobacco products and instead require them to carry a standard plain colour and font in addition to the graphic health warnings that are currently used. The government hopes the move can stop some of the nearly 90,000 Canadians who pick up the deadly habit each year. Across the country, nearly 40,000 people die annually from tobacco-related illnesses

Not surprisingly, the three biggest tobacco companies in Canada, Imperial Tobacco Canada; Rothmans, Benson & Hedges; and JTI-Macdonald, are all opposed to the measure.

But they aren’t the only ones against the proposal. Some think tanks and advocacy groups with tobacco funding are also speaking out against plain packaging. And yet, these groups typically don’t mention their financial ties when speaking about policy.

For example, the Montreal Economic Institute published a report in September saying plain packaging “attacks the value of brands.” It included a disclaimer saying the report was “in no way” financed by tobacco. In September 2015, institute president Michel Kelly-Gagnon authored a Huffington Post article saying plain packaging drove consumption higher in Australia, where it was adopted in 2012. The article didn’t mention an industry connection.

But in an e-mail, Kelly-Gagnon said the institute has “proudly received” tobacco funding since 1998 in amounts between 2 and 4 per cent of its budget. He said in an interview that the organization recently decided to stop accepting donations from the industry because health groups use that information to criticize its work.

Then there’s the National Coalition Against Contraband Tobacco, which issued a press release in September warning about the prevalence of illegal cigarettes and how the problem will worsen with plain packaging. A letter to the editor from the coalition and published in The Globe and Mail in September also stated that plain packaging will increase the contraband market. In its official comments to the federal government on plain packaging, the coalition said there is “no doubt” the new measure “will increase the availability of the illegal product.” The document doesn’t mention financial ties to tobacco.

Online, the coalition lists its members, which include the Ontario Chamber of Commerce, Toronto Crime Stoppers and the Canadian Tobacco Manufacturers Council.

But according to documents obtained by The Globe and Mail, the coalition works closely with the country’s three major tobacco companies to shape its public statements and reports. The coalition declined an interview request and did not respond directly to questions about its ties to tobacco.

Another example dates back to May, when the Atlantic Institute for Market Studies (AIMS), a Halifax think tank, hosted a talk by Sinclair Davidson, an Australian professor and vocal plain-packaging critic. According to articles in the Sydney Morning Herald, the Institute of Public Affairs, where Davidson is a fellow, has received tobacco funding and some experts have criticized Davidson’s work as flawed.

In an e-mail, Davidson defended his work and said he was invited to speak in Canada by the Canadian Convenience Stores Association (CCSA). But according to the AIMS Facebook page, Davidson’s Halifax visit was organized by the institute in partnership with Crestview Strategy, a public-affairs firm. According to the Office of the Commissioner of Lobbying of Canada, Crestview currently lobbies on behalf of Rothmans, Benson & Hedges. (Crestview and Rothmans did not respond to questions about the visit.)

The CCSA said it does receive funding from the tobacco industry but declined to state an amount or respond to questions about Davidson’s visit.

Imperial Tobacco Canada; Rothmans, Benson & Hedges; and JTI-Macdonald declined requests to name the groups they fund, but said they work with groups that share their views.

Julia Smith, a postdoctoral research fellow at Simon Fraser University who studies tobacco control, said she is concerned organizations with financial ties to tobacco will help derail plain packaging and other health measures, in part because many believe their views are independent and unbiased. “We’ve seen the tobacco industry use these tactics in the past,” she said, noting that “in some cases, they have been successful.”

Beyond engaging vocal sources, the tobacco industry has also commissioned several reports that say plain packaging is ineffective. But independent research tells a different story.

An Australian government survey found the number of daily smokers fell from 2.7 million in 2010 to 2.5 million in 2013. The average age young people reported smoking their first full cigarette rose from 15.4 years in 2010 to 15.9 years in 2013. And a 2013 study published in the journal Tobacco Control found only a small number of retail stores sold illicit cigarettes. Before plain packaging, researchers found about 2 per cent of cigarette packages to be illicit, compared to 0.6 per cent in the months after implementation.

Think tanks and advocacy groups regularly seek to influence public policy. But policy-makers and the public deserve to know when those organizations may be representing the interests of others.

WITH MIXED PROGRESS, NATIONS REVIEW WAR VS. TOBACCO INDUSTRY

Nov 14th, 2016
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http://macaudailytimes.com.mo/mixed-progress-nations-review-war-vs-tobacco-industry.html

In Nepal, health warnings cover 90 percent of cigarette packs, while Australia requires those packets be wrapped in drab, plain paper. Indonesia’s new ban on outdoor advertising brought down tobacco billboards depicting smiling, smoking youths. And India wants scary photos of rotting lungs and mouth tumors covering packets sold in the country.

Still, national drives to discourage smoking and cut back tobacco sales haven’t done enough, campaigners say. Smoking-related deaths are still rising worldwide, with 80 percent of them expected to occur in developing country populations by 2030.

“Most people in the United States think tobacco is over and done with, but it’s still the largest preventable cause of disease on the planet” killing 6 million people a year — or one person every six seconds, said John Stewart, deputy campaigns director at the Boston-based lobbying group Corporate Accountability International.

Starting Monday, representatives from at least 178 countries are meeting for five days in the Indian capital to discuss how they can further the fight against smoking and push back against tobacco company lobbyists.

Since they set down stiff regulations and guidelines in a landmark 2003 treaty called the Framework Convention on Tobacco Control — the first and only global treaty dealing with public health — most of the 180 signatories have ratified it and passed laws restricting tobacco advertising or sales.

Still, many governments remain entangled with powerful tobacco companies, while industry lobbyists continue attempts to stymie efforts to implement anti-smoking laws through bribery, misinformation and even suing national governments for lost profits, campaigners say.

“The tobacco industry is definitely feeling the heat,” Stewart said. “They’ve got their back against the wall.”

Indian courts are currently grappling with 62 lawsuits filed by tobacco companies or cigarette makers challenging laws requiring that 85 percent of all cigarette packets be covered with photos of medical horrors.

In Japan, a 10-percent hike in taxes on cigarettes has led to a 30-percent decline in smoking. But the country still has some of the lowest tax rates on cigarettes among industrialized nations, while its finance ministry owns 33 percent in Japan Tobacco.

The anti-tobacco campaign has had some success. It is widely accepted, at least among national leaders, that smoking causes cancer, cardiovascular and respiratory disease, along with a host of other harmful health impacts.

That awareness still has not trickled down to national populations, though. And campaigners say tobacco interests have shifted their focus to poorer, less educated populations in the developing world.

India — among the first to ratify the anti-tobacco treaty in 2004 — is still considered one of the biggest battlegrounds in the fight against the tobacco industry, public health specialists say.

Despite harsh laws passed more than a decade ago banning smoking in public and sales to children, smoking is still common across the country. A government survey in 2010 showed nearly 35 percent of adults were either smoking or chewing tobacco.

Meanwhile, more than 1 million Indians die each year from tobacco-related diseases that cost the country some $16 billion annually, according to the World Health Organization.

“The revenues that the government earns from tobacco taxes are far less than the billions that are spent on health care,” said Bhavna Mukhopadhyay of the Voluntary Health Association of India, a public health organization.

“Public health and the health of the tobacco industry cannot go hand in hand,” she said, noting that campaigners are now pushing for countries to make tobacco companies and their shareholders civilly and criminally liable for the harm done by tobacco.

Part of the trouble in India is “the Indian consumer is spoilt for choice,” she said, with cigarettes sold alongside chewing tobacco and cheap, hand-rolled smokes known as bidis.

The easy availability and wide choice means many smokers get hooked at a young age. Some are initiated early through the common, cultural practice of chewing something called gutka, which combines tobacco with spices, lime and betel nut and is widely sold as a mouth freshener.

Putting pictorial warnings on cigarette packets is an attempt to educate people about the risks.

“The idea was that even an illiterate person, or a child, would understand the message about the health risks from smoking,” said Monika Arora of the Public Health Foundation of India, who runs an anti-smoking campaign aimed at young Indians. Nirmala George, New Delhi, AP

SCORECARD LAUNCHED ON FCTC IMPLEMENTATION IN THE ASEAN REGION

Nov 10th, 2016
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Singapore leads the way in a 10-country race in the ASEAN to protect public health from the harms of tobacco use according to the Framework Convention on Tobacco Control (FCTC) Scorecard launched by the Southeast Asia Tobacco Control Alliance (SEATCA).

In a region where nearly half of all adult men smoke and where 10% (125 million) of the world’s smokers live, it is indeed a race to reverse the smoking epidemic and its devastating impacts that claims about 500,000 deaths every year.

“The scorecard acknowledges achievements and progressive efforts of ASEAN governments while also identifying implementation gaps that need further action. It also encourages comparisons between countries to further motivate the strengthening of FCTC implementation. Overall, there is significant room for further progress,” said Dr. Ulysses Dorotheo, SEATCA FCTC Program Director.

Over-all, Singapore scored the highest (80.5%), followed by Brunei (71.2%) and Thailand (67.1%). Two key areas for improvement are in policies on tobacco taxation and protecting health policies from tobacco industry interference.

While raising tobacco taxes is recognized as among the most effective means of reducing consumption, this measure is the least well implemented among ASEAN countries. The region’s most expensive cigarettes are found in Brunei and Singapore, but cigarettes are still generally very affordable in all countries.

Most countries are experiencing tobacco industry interference and do not have a FCTC Article 5.3 policy or code of conduct to address this problem. Only Singapore has a FCTC Article 5.3 policy or code of conduct that is enforced by the whole government, while the Philippines has a FCTC Article 5.3 policy or code of conduct that applies to the whole government but needs improved enforcement.

Enforcement of smoke-free policies needs to be strengthened further to achieve the full health benefits of such policies. All countries restrict or ban smoking in many settings, but only Brunei enforces a smoking ban in all indoor workplaces, indoor public places, and public transport, as well as some outdoor public places.

While standardized packaging of tobacco or ‘plain packaging’ is widely regarded as the best way to package tobacco, no ASEAN country has yet implemented this measure.

All countries, however, require pictorial health warnings on packages, although some require them only for cigarettes and not for other (e.g. smokeless) tobacco products.

Thailand leads with the largest pictorial health warnings (85% front and back).

All ASEAN countries except Indonesia, a non-party to the FCTC, enforce a complete ban on tobacco advertising in print media, TV, radio, and cinema. Regrettably, only half of the ASEAN countries (Brunei, Malaysia, Singapore, Thailand, and Vietnam) enforce a ban on tobacco advertising at points of sale (POS).

The scorecard is available at www.seatca.org.

MORE THAN 100 COUNTRIES/TERRITORIES HAVE REQUIRED PICTURE HEALTH WARNINGS

Nov 10th, 2016
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A global milestone has been achieved. More than 100 countries and territories —105 in total —have required picture warnings on cigarette packages.

This finding comes from an international report released today at COP7. This new report, Cigarette Package Health Warnings: International Status Report, provides an overview ranking of 205 countries and territories based on warning size, and lists those that have finalized requirements for picture warnings. Regional breakdowns are also included.

Copies of the report are available at the Framework Convention Alliance booth.

Delegates are welcome to take as many copies of the report as they would like for use in their home countries.

Fifty eight percent of the world’s population is now covered by final requirements for picture warnings, and many more countries are in the process of doing so. One hundred and five countries is an increase from the 77 countries that had implemented picture warnings by the end of 2014.

For size, Nepal is the new world leader with warnings that cover 90 percent of the package front and back. Vanuatu will require 90 percent in 2017. India and Thailand are next, tied for third with 85 percent India has improved its global ranking considerably, moving from 136th in 2014 to third in 2016.

There are now 94 countries and jurisdictions (up from 66 in 2014) requiring warnings to cover at least 50 percent (on average) of the package front and back, and at least 142 requiring a minimum size (on average) of at least 30 percent.

Enormous progress continues to be made around the world.

Well-designed package warnings are a highly cost-effective means to increase awareness of the health effects and to reduce tobacco use. Picture-based messages are far more effective than text-only messages. Indeed, a picture says a thousand words.

Pictures attract more attention, and reach individuals who are illiterate or who cannot read the national language(s). For size, the effectiveness of warnings increases with size. Larger ones allow for bigger and better pictures, additional information and/or a larger font size.

The new report, currently available in English and French, was prepared by the Canadian Cancer Society, in collaboration with the Framework Convention Alliance.

The Campaign for Tobacco-Free Kids is assisting with translations for Arabic, Chinese, Portuguese, Russian and Spanish.

Rob Cunningham and Meaghan Dunn
Canadian Cancer Society

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