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Scotland

Fewer Scots are choosing to smoke – but the costs of the habit remain high

National No Smoking Day passed last week with the now routine announcements from health chiefs welcoming the fact that fewer adults are choosing to light up.

http://www.scotsman.com/news/health/fewer-scots-are-choosing-to-smoke-but-the-costs-of-the-habit-remain-high-1-4392433

But the costs of the habit remain high and ensure that neither the Westminster or Holyrood governments will be declaring victory in their battle to stub it out.

Smoking remains the primary ­preventable cause of ill-health, disability and premature death in Scotland.

Each year tobacco use is associated with around 128,000 hospital admissions and more than 10,000 smoking-attributable deaths north of the border.

The average smoker in Scotland spends £1,500 each year on tobacco – and significantly more people in our poorest communities spend at this level compared to our most affluent.

Prevalence rates in Scotland have fallen from around 28 per cent in 2003 to just under 21 per cent in 2015. Among 13-year-olds and 15-year-olds, smoking rates have fallen steadily to their lowest ever levels – two per cent and seven per cent respectively.

“We’ve had ten years of decisive action which has undoubtedly improved our nation’s health – but there is still more to be done,” said public health minister Aileen Campbell. “As a result of our Take it Right Outside campaigns, reported exposure to second-hand smoke in the home among children under 16 has halved between 2013 and 2015 from over 11 per cent to six per cent.

“In December 2016 it became ­illegal to smoke in cars where children are present – and later this year, we will restrict the sale and availability of e-cigarettes to under-18s and introduce an offence for smoking near hospital buildings.

“We believe that by working together, and with the public’s ­support, we can achieve our goal of creating a tobacco-free generation by 2034.”

Data published this month by the Office for National Statistics (ONS) revealed that 17.2 per cent of adults across the UK smoked in 2015 – the lowest level since records began in 1974.

Figures from 2015 also showed the highest level of so-called quitters in more than four decades.

Standardised Packaging and Tobacco Products Directive

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Scotland to launch first safety trial of e-cigarettes and pregnant women

http://www.heraldscotland.com/news/14722004.Scotland_to_launch_first_safety_trial_of_e_cigarettes_and_pregnant_women/

SCOTLAND is to carry out the world’s first study examining the safety of e-cigarettes for pregnant woman and their unborn babies.

The study comes amid growing controversy over e-cigarettes. Last week it was reported that they are as bad for your heart as smoking after research found a similar effect to conventional smoking on the stiffness of the main blood vessel in the body.

Several hundred women will be recruited for a major trial next year which will investigate whether ‘vaping’ can help women who struggle to quit smoking while pregnant, the Sunday Herald can reveal.

Researchers from the UK Centre for Tobacco and Alcohol Studies, a network of 13 universities, will also track the progress of their babies until the age of two to assess if there are any potential harmful effects.

But critics said it was already known arterial stiffness is caused by nicotine – which can also be caused in other ways such as drinking coffee.

In the UK prominent medical bodies – including the Royal College of Physicians (RCP), the British Lung Foundation and Cancer Research UK – say all current evidence suggests e-cigarettes are significantly less harmful than smoking.

A recent report published by the RCP said the risk to health from vaping was unlikely to exceed 5% of the harm from smoking tobacco.

Yet in other countries, including Brazil, Singapore and Austria, the sale of e-cigarettes is completely banned, while many others have restrictions in place.

The use of e-cigarettes before 2010 was rare, but now it is estimated around two million in the UK are ‘vaping’.

Linda Bauld, professor of health policy at the University of Stirling and deputy director of the UK Centre for Tobacco and Alcohol Studies, said perceptions of risk of e-cigarettes had changed in the past five years, with many now believing they were as harmful as smoking. She said this was “not great” for public health experts who believe they could be helpful in trying to tackle the harm caused by tobacco.

“We are primarily interested in adult smokers who struggle to stop – that includes groups like prisoners, people with mental health problems and pregnant women,” she said. “We haven’t made much inroads into reducing smoking rates in these groups, so for these groups e-cigarettes offer real promise.”

Bauld said the first trial in the world to assess the use of e-cigarettes in pregnant women would begin early next year, with one of the sites in Scotland.

She said it was possible as in the UK nicotine replacement therapy (NRT) is routinely given to pregnant women who are struggling to stop smoking, unlike in many countries where it is only prescribed by a doctor.

“We will be recruiting several hundred pregnant smokers and randomising them to use NRT and behavioural support, or an e-cigarette and behavioural support and then we will see how they get on,” she said.

“We will look at ‘does it help them stop smoking, do they like it and is it safe’?”

According to the latest statistics just over 9,900 pregnant women in Scotland are smokers at their first health visit – ranging from nearly 30% from the most deprived areas to just 4.5% from the least deprived.

New guidance for midwives states only NRT products should be recommended, but a woman should not be discouraged from using e-cigarettes if it helps her to quit smoking.

Janet Fyle, policy adviser with the Royal College of Midwives, said any research into the issue would be welcome. “We have to say the jury is still out on e-cigarettes. We do not know what the harm is if any, so we have to be cautious and say to (pregnant) women this is the perfect opportunity to give up smoking, improve your health and stay smoke-free,” she said.

Sheila Duffy, chief executive of anti-tobacco charity ASH Scotland, said all evidence so far suggested that tobacco is much more harmful than e-cigarettes, but cautioned that e-cigarettes were “not harmless”.

She added: “There are still many unknowns, partly because there is such a wide range of different products and liquids, and partly because the research is still ongoing. We are now starting to see some interesting findings, but while we have a really good body of evidence on the vast harmfulness of cigarettes and tobacco, we don’t yet have a complete evidence base on the long-term health effects of using e-cigarettes.”

She raised concerns over multinational tobacco companies buying up e-cigarette brands. “If e-cigarettes can get smokers off tobacco, then I welcome them as harm reduction,” she said. “But if they are used by tobacco companies as a way of reaching out and getting their messages to young people, that could be a real danger.”

Sarah Jakes, of the New Nicotine Alliance UK, a charity set up to promote nicotine products for reducing cigarette smoking, said the debate over vaping safety was a result of a “war of ideologies” between those who favour a ‘quit or die’ approach versus those who took a pragmatic view.

She said: “In my view, the former group constantly manipulate and overblow potential harms in order to undermine the arguments of the harm reduction proponents.”

Highland Council accused of bankrolling killer industry over stake in tobacco trade

A COUNCIL has been accused of bankrolling an industry that kills more than 10,000 Scots every year after its pension fund upped its investments in the tobacco trade.

Highland Council, which promotes healthy living, has been accused of being hypocritical after making multi-million-pound investments in the tobacco industry.

The value of the pension fund’s investment in one of the world’s biggest tobacco funds increased last year.

The fund’s stake in British American Tobacco — producers of the Dunhill, Lucky Strike and Benson & Hedges brands — increased from £12.6 million to £15.15 million last year.

John Finnie, list MSP for Highlands and Islands for the Greens and a former Highland councillor, said:

“The scheme manages £1.5 billion that could provide a secure future for employees while investing in work that benefits society. Instead, it bankrolls an industry that kills over 10,000 Scots every year.”

Council leader Margaret Davidson said the pension fund has a legal obligation to best serve its beneficiaries.

Councillor David Alston, who chairs the council’s health board, said the legal requirements of the pension fund should be changed.

Sheila Duffy: Continuing to make smoking a thing of the past

MSPs can help to change lives across the country says Sheila Duffy

The fifth session of the Scottish Parliament has begun. Once they have settled in to their new offices, found out who’s got which job and recruited their office staff, the new MSPs will have to consider what issues to focus on over the next five years.

I would guess that Scotland’s health, and health inequality, will be at the top of many lists. If someone were able to offer these MSPs a popular, cost-effective means of greatly improving health, saving the NHS money, supporting businesses and putting significant funds into the pockets of our poorest communities, you imagine they would jump at the chance.

I’m hoping that they do, because I have exactly such a proposal for them.

Robust action on tobacco from successive Scottish administrations has helped sustain a steady decline in the smoking rate. Yet the latest Scottish Household Survey still indicates an adult smoking rate of 20 per cent in 2014. That translates into nearly 900,000 people in Scotland who have significantly increased risks of cancer, heart disease, dementia, stroke and diabetes.

Smoking remains far and away our largest preventable cause of ill health and death, so that around 300,000 people in Scotland will currently be living with serious illness due to tobacco use. They each spend an average of £125 a month on tobacco and smoking costs push an extra 32,000 Scottish households over the poverty line, while deepening the poverty experienced by many others.

Crucially, surveys year after year show that most people in Scotland who smoke say that they want to stop. The harm caused by tobacco arises from engrained habit and addiction rather than from lifestyle choice.

The Scottish Government has set a target of a “tobacco-free generation” by 2034. This is defined as a 5 per cent smoking rate by 2034 – which ASH Scotland articulates as achieving a situation where cigarettes are out of sight, out of mind and out of fashion and the only people who smoke are the small number of informed adults who
actively choose to do so.

The national tobacco strategy sets an intermediate target of a 12 per cent smoking rate by 2021, the lifetime of this Parliament. If this goal can be achieved then, over time and compared with the latest survey figures 350,000 people in Scotland will benefit from the single, largest gain which anyone who smokes can achieve for their health

Reduced smoking-related admissions would lead to annual savings of between £100 million and £170m from NHS budgets, to be spent on other priorities. Scotland’s economy will benefit, with employers hit by 1 million fewer sick days each year

The poorest fifth of communities will gain an extra £100m of disposable income every year

All of these gains would result from meeting an existing Scottish Government commitment. To ensure that these gains are successfully delivered we need robust political action, of the sort which has helped achieved the reduced smoking rates to date.

In this session of the Parliament we need to see clear recognition that tobacco use is part of the problems faced by people with mental health issues, and a commitment that stop smoking support should be offered as part of the care provided. We need robust, well-resourced action from police, trading standards and others to keep tobacco out of the hands of our children and illicit tobacco out of our communities. We need to ensure financial support services, from money advice to food banks, understand that smoking is not a lifestyle choice but a further burden on the already disadvantaged and that stop smoking support is one element of the road to financial stability.

Recently Scotland celebrated ten years of smoke-free enclosed public spaces, a move that seemed risky at the time yet which has been uniquely successful and smoothly implemented and remains one of the Scottish Parliament’s most popular actions. As of last month all tobacco manufactured for use in the UK must come in plain, standardised packaging. Soon packets without brand imagery will present consumers with a more honest presentation of the product.

There is a long way to go on Scotland’s journey towards being tobacco-free in 2034. But the evidence is clear that a tobacco-free generation will not just be healthier, but wealthier and fairer too. Our successes to date, achieved against huge opposition from vested commercial interests, should inspire us that we can get there.

• Sheila Duffy, chief executive, ASH Scotland

Scotland Votes Regulation for E-cigarettes

http://www.utahpeoplespost.com/2016/03/scotland-regulation-e-cigarettes/

Recent years have brought a rapid rise in popularity to e-cigarettes, so much so that researchers and regulators haven’t had the time to decide on their benefits and health side effects.

Consequently, e-cigs are now the subject of heated debate: do they indeed provide helpful a cessation treatment for smokers? Or do they actually make smoking more attractive to young people?

At the same time, some group advocates claim that e-cigarettes are Big Tobacco’s way of protecting its profits in markets, seeing that smoking is declining in some markets.

While their benefits continue to be debated, and the potential risks to non-smokers remain under-explored, politicians across the world and regulators must still decide what to do.

Scotland is among the latest countries confronted with this question, where parliament has just banned people under 18 years old from using e-cigarettes. This decision – which imposes the same age limit as for traditional cigarettes – brings Scotland into line with England and Wales.

Countries across the globe take different approaches to vaping – the broadly used term for using e-cigarettes. In Canada, sales have technically been made illegal, although regulation is still largely unenforced.

In the US, regulation is mixed, but San Francisco has just raised the minimum buying age to 21 years. Across Europe, countries like Ireland, Poland, and Bulgaria have yet to regulate sales and advertising, while Wales takes a more restrictive approach, looking to introduce a ban on e-cigarettes in public places.

But which approach is the most sensible? While voting on the new Scottish Health Bill, opponents of e-cigarette regulations argued that vaping is significantly less harmful than traditional cigarettes and help smokers to quit.

According to this group, restrictions will only prevent smokers from trying safer alternatives, and reduce the chances of lowering tobacco consumption.

On the other side of the debate, supporters of regulation say claim that children and young people need to be protected from developing a nicotine addiction.

They advocate a precautionary approach until researchers offer evidence that e-cigarettes do not undermine the country’s recent successes at curbing smoking.

More than just banning sales of e-cigs to under-18s, the new Scottish laws requires retailers to ask customers who look under 25 to offer proof of age. They also ban selling e-cigarettes from vending machines, make it illegal to buy on behalf of someone under 18.

Even though there might be some years before we have any clear evidence about the risks of e-cigarettes, the Scottish Parliament can, at least, say it has done what the country wants. Back in 2014, a large majority of respondents supported the regulation.

We’re unsure if e-cigarettes are harmful, but it still makes sense to restrict them

https://theconversation.com/were-unsure-if-e-cigarettes-are-harmful-but-it-still-makes-sense-to-restrict-them-55777

E-cigarettes have rapidly risen in popularity in recent years and are now the subject of heated debate as to whether they are effective in helping smokers quit tobacco or whether they are actually making smoking attractive to young people. Are they a way for Big Tobacco to protect its profits in markets where smoking is declining and lure people back into nicotine addiction or are they just a fashion that will quickly lose its appeal?

Given that vaping has been around for barely a decade and studies into the long-term effects take time, we cannot answer these questions with certainty yet. The benefits of e-cigarettes’ continue to be debated – and the potential risks to non-smokers and young people remain under-explored.

This makes it difficult to make recommendations, but politicians across the world are nonetheless having to decide what to do. The latest country to confront this question is Scotland, where the parliament has just voted to ban under-18s from using e-cigarettes. One of a raft of restrictions, this imposes the same age limit as for traditional cigarettes, bringing Scotland broadly into line with England and Wales. Was it the right thing to do?

Different countries have taken different approaches to vaping. Canada has technically made sales illegal, though regulation remains largely unenforced. While regulation across the US is mixed, San Francisco has just raised the minimum buying age from 18 to 21 years.

In some European countries, – among them Bulgaria, Ireland and Poland – sales and advertising are unregulated. In May, however, new EU regulations will impose standardised quality control on liquids and vaporisers across the union as well as requiring disclosure of ingredients in vaping liquids and child-proofing and tamper-proofing for liquid packaging. They will also restrict cross-border advertising. Wales meanwhile looks likely to extend its restrictions by introducing a ban on e-cigarettes in public places.

The ayes and the noes

In the run up to the vote on the new Scottish Health Bill, opponents and supporters of e-cigarette regulations fiercely debated which approach was the most sensible. Opponents usually argue that vaping is less harmful than traditional cigarettes and effective in helping smokers to quit. They want minimal restrictions on availability and complete freedom for advertising, promotion and the use of e-cigarettes in public. Restrictions, they argue, might prevent smokers from switching to safer alternatives and reduce the chances of curbing tobacco consumption.

Supporters of regulation say that children and young people need to be protected from using products which imitate smoking and from developing nicotine addiction. They also favour regulation to ensure product safety and quality. They advocate a precautionary approach until there is evidence that e-cigarettes do not undermine our recent successes at controlling tobacco.

As well as banning sales to under-18s, the new Scottish laws require retailers to ask for proof of age when selling to someone that looks under 25 (similar to alcohol). They ban the sale of e-cigarettes from vending machines, make it an offence to buy on behalf of someone under 18, and require retailers to put their names on a product register. Scottish ministers will also have the power to further restrict or prohibit advertising and promotions in future.

Tighter shackles, please

While the evidence about the risks of e-cigarettes is likely to remain unclear for several years, the Scottish parliament can at least say it is doing what the country wants. A large majority of respondents backed regulation in the consultation of 2014, including representatives of health bodies, local authorities, charities, academics and members of the public. As well as supporting a ban on sales to under-18s or adults buying e-cigarettes on their behalf and preventing young people from seeing advertising and promotions, respondents also widely endorsed restricting the use of e-cigarettes in public places.

‘Save me from myself’ Milles Studio

The Scottish public’s desire for these kinds of rules is also reflected in research I co-published that looked at debates about e-cigarettes in the UK media and found that supporters of regulation greatly outnumbered opponents. I have also been involved in a new study, about to be published, which investigates the views of UK adolescents on regulation. We found they have a very sophisticated understanding of the advantages and disadvantages. While aware of the potential benefits of e-cigarettes to smokers – including those teenage smokers who want to quit – young people overwhelmingly support strong e-cigarette regulation. This includes restrictions on sales to minors, marketing and the use of e-cigarettes in public places.

The reality is that, until the jury returns, it makes sense to trust the public to reach a view from the best information on e-cigarettes that is available. Even if current regulations were to end up looking disproportionate in years to come, no one will be able to accuse the Scottish government of ignoring people’s concerns and taking public health issues lightly. In a situation where no one really knows what to do for the best, regulation which restricts access and promotion to young people looks like the best policy.

Truth about illicit tobacco reveals decline

http://www.scotsman.com/news/sheila-duffy-truth-about-illicit-tobacco-reveals-decline-1-3989150

BUT IT still needs robust enforcement to keep it in check, says Sheila Duffy

Illicit tobacco is one of those subjects (like e-cigarettes) where the quantity of the media coverage is not always matched by the quality.

To be fair to hard-pressed journalists it is hard to resist a succession of helpful public relations companies providing them with ready-made news stories which can support dramatic headlines on the “booming” illicit trade, corner shops closing, “unhealthy” fake fags and international crime networks.

At the same time leaked documents have revealed details of tobacco industry plans to use the media to scaremonger over illicit as part of their effort to oppose plain, standardised packaging for tobacco.

Those seeking an unbiased estimate of the scale and trends in illicit tobacco should use the annual figures from Her Majesty’s Revenue and Customs (HMRC), which is as close as we’re going to get to an expert, unbiased voice. So we’re always keen to see the annual Tax Gaps report from HMRC, and the 2014-15 figures were published recently.

Anyone who had been following the tobacco-industry sourced media stores must have found the figures a bit surprising. So let’s set them out clearly.

The best estimate of the illicit market remains static at 10 per cent of manufactured cigarette sticks.

The best estimate of the illicit share of the hand-rolling tobacco market was down from 39 per cent to 35 per cent.

These are percentages of an overall tobacco market which continues to decline.

So a static percentage of the market actually relates to a decline in the amount of illicit tobacco used (for example, the reported rise in illicit market share in cigarette sticks from 9 per cent to 10 per cent in 2013-14 actually related to a 7 per cent drop in numbers of illicit cigarettes).

These figures indicate that the illicit tobacco market is at historically low levels – in 2000-1 HMRC estimates were that 22 per cent of cigarettes and 61 per cent of hand-rolling tobacco was illicit.

The decline in overall volume since then has been 76 per cent in illicit cigarette sticks and 33 per cent in illicit hand-rolling tobacco. Could any unbiased observer conclude that these figures are “booming”?

This is not to play down the importance of illicit tobacco, which brings criminal elements into communities, bypasses health regulations we have worked long and hard to achieve and deprives the Exchequer of much-needed tax revenue.

Nor is it to say that everything’s in hand – the reduction in illicit tobacco is the planned and deliberate result of robust enforcement measures, including restrictions on the tobacco companies themselves.

To keep the lid on illicit tobacco we need to ensure that robust enforcement is not hampered by budget cuts and austerity.

And we need to generate a community discussion, to lower the demand for the product, with NHS Greater Glasgow and Clyde having created useful tools to support that. What it does mean is that the idea of a “booming illicit trade” at the centre of tobacco company campaigns against public health measures is, appropriately enough, not the real deal.

• Sheila Duffy is chief executive of ASH Scotland

Law Society welcomes ban on smoking in cars with children

https://www.lawscot.org.uk/news/2015/12/law-society-welcomes-ban-on-smoking-in-cars-with-children/

Smoking in cars where children are present will now be a criminal offence, after the legislation was passed by the Scottish Parliament today, 17 December.

The Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill was debated this afternoon at stage 3 by MSPs. When the legislation comes into force, it will be a criminal offence to smoke in a car where a child is present. An amendment to the bill tabled by Jackson Carlaw MSP proposed a review of the legislation after 5 years.

Alison Britton, convener of the Law Society of Scotland’s health and medical law committee said:

“The passing of this bill is great news for the health and wellbeing of children, the harmful effects of tobacco and smoking are undisputed, as well as the effects of second hand smoke. We had hoped that the legislation be extended to expressly prohibit the use of e-cigarettes as well as conventional cigarettes, especially in relation to young people, so it is disappointing to see this hasn’t been included.

“We also proposed a review of the legislation within five years to ascertain how well it was working, and we are disappointed that MSPs voted against such a review. Taking into account there will undoubtedly be an updating of research, not only into the effects of e-cigarettes, but the harmful effects of tobacco in general in the next few years, this would have potentially given us the opportunity to ensure that the legislation remained fit for purpose.”

Scotland to ban smoking in cars with children

http://www.bbc.com/news/uk-scotland-scotland-politics-35126453

Scotland is to ban smoking in cars that are carrying children after MSPs voted unanimously in favour of a change in the law.

The new legislation will mean fines of up to £100 for anyone who smokes in a car which has a passenger under the age of 18.

It aims protect children from the harmful effects of second-hand smoke.

The Smoking Prohibition (Children in Motor Vehicles) Bill was introduced by Liberal Democrat MSP Jim Hume.

Mr Hume’s mother died of cancer caused by second-hand smoke.

‘Healthiest start’

He told MSPs that the concentrations of harmful tobacco particles in the very close confines of a car were far greater than from smoke in bars, which had already been banned.

He added: “Around 60,000 children are put in this position each week in Scotland.

“This legislation will, of course, address that situation and help to ensure that all our children and young people have the best and healthiest start in life.”

The bill was backed by the Scottish government and opposition parties in the Scottish Parliament.

Public health minister Maureen Watt said the legislation would contribute to the Scottish government’s drive to cut the number of children exposed to second-hand smoke from 12% to 6% by 2020.

And she said that Scotland had shown itself to be a “world leader on tobacco control”.

Publicity campaign

A publicity campaign will be carried out to raise awareness of the change in the law.

The new legislation has also been supported by public health and anti-smoking campaigners, who have said that second-hand smoke can reach very high levels when someone lights up in a car.

They have also said that about a fifth of 13 and 15-year-olds in Scotland are exposed to tobacco smoke during car journeys.

Sheila Duffy, chief executive of health charity Ash Scotland, said: “This is a victory for doctors, nurses, parents and, most of all, for children.

“We know the immense harm done to children by second-hand smoke. Meningitis, lung cancer and even cot death have been linked to tobacco smoke.

“I’m delighted that we’ve introduced this sensible measure to protect children’s health.”

‘Strong signal’

Dr Peter Fowlie, officer for Scotland for the Royal College of Paediatrics and Child Health, said: “Scottish Parliament’s move to ban smoking in cars carrying children not only protects children from terrible conditions linked to second-hand smoke such as bronchiolitis, pneumonia and asthma, but also sends a strong signal that smoking is not cool – it kills.

“Today’s decision is something to be celebrated and we as paediatricians applaud parliamentarians for taking such bold steps to protect child health.”

But smokers’ group Forest had argued that the bill was the “worst kind of gesture politics” and represented a worrying intrusion into people’s private space”.

A ban on smoking in cars carrying under-18s came into force in England and Wales earlier this year.

Northern Ireland is also looking at introducing a similar ban.