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Report: Vaping Has the Potential to Replace Smoking within 30 years

Could Save Nearly a Billion Lives, More than Half of those in Asia

(Hong Kong – 24 August, 2016) A new working paper from Reason Foundation examines how vaping, which is estimated to be 95% safer than smoking, could extend and improve the lives of smokers. But it warns that those benefits will be lost if governments in Asia and elsewhere continue to impose undue restrictions on vapor products. A November meeting in Delhi of the World Health Organization’s Framework Convention on Tobacco Control presents an opportunity for governments to commit to a more positive approach towards vape products.

Vaping is displacing smoking and, if not subject to unnecessary and counterproductive regulations or bans, has the potential to improve and extend the lives of “hundreds of millions” of people in Asia alone, according to a new Reason Foundation working paper that compares the health effects of vaping to smoking, examines the rate at which adult smokers have been switching to vaping and the effect the availability of vape products has on rates of smoking.

Asia has the highest number of smokers yet, ironically, in the continent where the “electronic cigarette” was invented, vaping has not yet taken off because of bans and other egregious regulations. Many countries in the region have prohibited them (Singapore, Thailand) or de facto prohibit them as unlicensed medicines (Australia, India, Japan, Hong Kong, Malaysia, Taiwan). Still others are uncertain how to regulate them (China, Indonesia). By contrast, other countries, such as the United Kingdom, have avoided over-regulation and as a result vapour products have become popular and innovation has been rapid, resulting in dramatic public health improvements.

“If product quality and diversity continue to increase and costs continue to fall, within 20 years vaping could cut smoking rates by 50 percent or more. In 30 years, vaping might eliminate smoking altogether. If that were to happen, it would effectively save most of the billion lives — and perhaps eight of the 10 billion life-years — that might otherwise be lost to smoking,” the Reason Foundation working paper, The Vapour Revolution, concludes.

The research by Julian Morris, vice president of research at Reason Foundation, and Dr. Amir Ullah Khan, a noted Indian economist, shows how vape technologies have developed, their potential to improve lives and their policy implications.

Morris and Khan explain that rapid innovation, driven by competition in a relatively unregulated market, has resulted in vape products that are attracting millions of smokers to switch from
cigarettes. Considered 95 percent safer than smoking, vaping enables smokers to live longer, healthier and more productive lives. Economies also benefit from increased economic activity and lower health care costs. With continued innovation, the authors expect vape products entirely to replace smoking within three decades.

“In less than 10 years, vape products have seen a dramatic increase in quality, efficacy and safety, while prices have fallen. Already, millions of smokers have switched,” said Dr. Amir Ullah Khan, co-author of the paper. “Vaping now has the potential to prevent over a billion smoking- related deaths, extending the lives of smokers and potential smokers by perhaps 10 billion years.”

The authors warn, however, that continued innovation and these massive health benefits may be thwarted by regulations, especially if promoted by the World Health Organization (WHO). Excessively restrictive regulation of vape products will drive up costs, reduce choice, and undermine competition and innovation. While some countries, such as the United Kingdom, have encouraged innovation by avoiding over-regulation, others have already banned the technology or imposed excessive restrictions.

WHO plays a key role providing guidance to countries on tobacco control policies with its Framework Convention on Tobacco Control (FCTC), a global treaty. Unfortunately, to date, WHO has been hostile to the health benefits of harm-reduction products like vaping, instead focusing only on getting smokers to quit entirely. When WHO hosts the seventh conference of the parties to the Framework Convention on Tobacco Control in Delhi this November, Morris and Khan say it should abandon this so-called ‘quit or die’ approach and embrace the potential of vape technology and innovation to reduce smoking and improve health outcomes.

“The WHO’s FCTC should change its approach to vape products, recognizing their life-saving potential,” said Julian Morris, co-author of the report. “At the very least, WHO should include in its deliberations some of the many health experts whose research shows that these vaping innovations can, and do, save lives.”

Working Paper Available Online:

The full report, The Vapour Revolution: How Bottom-Up Innovation Is Saving Lives, by Julian Morris and Amir Ullah Khan is online at: http://reason.org/studies/show/vapour-revolution-working-paper http://reason.org/files/vapour_revolution_working_paper.pdf

For further information or to interview the authors, contact:
Simon Lee +852 9388 5895
Email: simon.lee@advb.com.hk

About the authors

Julian Morris is Vice President for Research at Reason Foundation. Julian graduated from Edinburgh University in 1992 with an MA in economics. He has an MSc in environment and resource economics from University College London, an MPhil in land economics from Cambridge University, and a law degree from the University of Westminster. Julian is the author of dozens of scholarly articles on the relationship between institutions, development and environmental protection, and the editor of several books, including Sustainable Development: Promoting Progress or Perpetuating Poverty (Profile Books, 2002). Prior to joining Reason, Julian was Executive Director of International Policy Network, which he cofounded. Before that, he ran the environment and technology programme at the Institute of Economic Affairs.

Dr Amir Ullah Khan has a PhD in Economics and Business Studies from the Jamia Millia University. He has worked as Researcher for the Ministry of Finance, Government of India and the UNDP at Project LARGE (Legal Adjustments and Reforms for Globalising the Economy). He then was Academic Head at the Indian School of Finance and Management, after which he worked with Encyclopædia Britannica as executive director and editor. He is senior policy advisor to the Bill and Melinda Gates Foundation. Dr Khan is currently a member of the Board of Governors at the Presidency University, Bangalore. He is also a member in the Telangana Government’s Commission of Inquiry on Socio economic conditions headed by G Sudhir. He has been a senior fellow at the India Development Foundation and Adjunct Professor of Business and Law at the Edith Cowan University. He teaches at the Indian School of Business in Hyderabad, the Manipal Institute of Technology, the Indian Institute of Foreign Trade in Delhi.

About Reason Foundation

Reason Foundation is a nonprofit think tank dedicated to advancing free minds and free markets. Reason Foundation produces respected public policy research on a variety of issues and publishes the critically acclaimed Reason magazine and its website www.reason.com. For more information please visit www.reason.org.

Notes for editors

• The first vape product was an “electronic cigarette” developed by Chinese pharmacist Hon Lik in 2003.
• Subsequent competition among producers in a relatively unregulated marketplace, combined with user modifications, information sharing, and standard setting has resulted in dramatic improvements in the quality and effectiveness of vape products – and reduced cost.
• Smokers appear to be switching to vaping at a rapid rate, with new devices attracting additional converts year-on-year.
• By 2014, over 6 million people in Europe alone had switched from smoking to vaping.
• Asia-Pacific is home to more than half the world’s smokers.
• According to research conducted by Ipsos in 2015, a large majority of Asian smokers surveyed said they would consider switching to e-cigarettes if they were legal, met quality and safety standards, and were conveniently available.
• Smokers who vape but do not quit smoking, tend to reduce their cigarette consumption.
• In the UK, the proportion of people who vape exclusively has increased, suggesting that as products improve, people are more likely to switch entirely to vaping.
• The vapour produced by heating e-liquids in a vape device contains only a tiny fraction of the number of chemicals in tobacco smoke—and most of those chemicals are harmless.
• The best estimate so far produced puts the risk posed by vaping at approximately 5% that posed by smoking. In other words, vaping with e-liquid is at least 95% safer than smoking.
• People who both vape and smoke (“dual users”) experience dramatic reductions in markers for tobacco use, suggesting that even dual use is healthier than exclusively smoking.
• Contrary to some reports, the availability of vape products appears to reduce smoking initiation among young people.
• Over the course of the next two to three decades, vaping might gradually replace smoking altogether, thereby saving most of the billion lives—and perhaps 8 of the 10 billion life years—that otherwise would be lost to smoking over the coming century.
• Innovations have resulted in vape products that are more effective, safer, and less costly.
• Innovation has been far more rapid in jurisdictions where vape products are regulated as consumer products than in more heavily regulated jurisdictions.
• New products, including fourth generation “mods,” a new generation of cigalikes, and vape devices that heat tobacco without burning it, offer enormous potential to attract smokers to these much less harmful alternatives.
• If innovation is to continue to deliver better, safer, less expensive products—and thereby attract more smokers to switch—it is essential that producers, retailers and consumers be free of excessive regulatory intervention.
• The World Health Organization and its Framework Convention on Tobacco Control (FCTC) exert considerable influence on domestic policies towards tobacco in many countries. In 2014, at the 6th Conference of the Parties to the FCTC, parties left open how best to regulate vape products.
• Since 2014, the evidence of public health benefits from vape products has been mounting — as documented in this study.
• It is important that governments meeting for the seventh Conference of the Parties to the FCTC, which will take place in Delhi in November 2016, take on board this new evidence and support policies that do not impose unnecessary impediments to the development, promotion, sale, and use of vape products.

MMWR- Morbidity and Mortality Weekly Report

Disparities in Adult Cigarette Smoking — United States, 2002–2005 and 2010–2013

Proven interventions, including increasing the price of tobacco products, coupled with evidence-based cessation services, comprehensive smoke-free policies, high-impact media campaigns, and promotion of cessation treatment in clinical settings, are effective strategies in reducing the prevalence of tobacco use and tobacco-related disease and death in all racial/ethnic populations. To assess the prevalence of, and changes in, cigarette smoking among persons ages ≥18 years in six racial/ethnic populations and 10 select subgroups in the U.S., CDC analyzed self-reported data collected during 2002–2005 and 2010–2013 from the National Survey on Drug Use and Health and compared differences between the two periods. During 2010–2013, the overall prevalence of cigarette smoking among the racial/ethnic populations and subgroups ranged from 38.9 percent for American Indian/American Nativesto 7.6 percent for Chinese and Asian Indians. Differences might be due, in part, to variations in socioeconomic status, acculturation, targeted advertising, price of tobacco products, and practices related to the acceptability of tobacco use across population groups. These findings highlight the importance of looking at tobacco use estimates by smaller racial/ethnic subgroups and by sex to better understand and address disparities in tobacco use among U.S. adults.

Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)

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Raising tobacco sales age to 21 is best way to prevent lifelong addiction

Report: Increasing age would cut off supply to high-school students

https://news.osu.edu/news/2016/07/26/tobacco-21/

Raising the national minimum age to buy cigarettes to 21 would save lives by preventing adolescents from ever taking up smoking, a new report suggests.

The minimum age to buy tobacco products in most of the country is 18.

In their analysis, Ohio State University public health experts detail how raising the minimum tobacco sales age would be effective in improving health and note the economic consequences to retailers would be minimal.

If the age were raised nationally, those U.S. residents born between 2000 and 2019 would experience 223,000 fewer premature deaths, 50,000 fewer lung cancer deaths and 4.2 million fewer years of life lost, according to a 2015 Institute of Medicine report cited in the Ohio State white paper. The IOM, the health arm of the National Academies of Science, is an independent organization that works to provide advice to decision makers and the public.

“The key point is that if people get through adolescence without smoking, it is highly unlikely they will ever start,” said Micah Berman, assistant professor of public health and law at Ohio State. “The flip side of that is if they do start smoking in adolescence, everything we have learned about teen brain development shows that it will be much harder for them to quit later.”The IOM report also estimated that raising the smoking age would, by 2100, result in 285,000 fewer pre-term births, 438,000 fewer low-birth-weight babies and 4,300 fewer sudden, unexplained deaths in infancy.

While cigarette smoking has declined among U.S. youth, overall use of tobacco (including e-cigarettes and cigars) has increased or remained stable. Nearly all adult smokers began by the age of 18 – almost no one starts after 21, the experts point out in their argument for changing the law nationally.If current trends continue, 5.6 million young people alive today will die prematurely from tobacco use, the Ohio State report says.

Nicotine’s effect on brain development leads adolescents to heavier daily tobacco use, a stronger nicotine addiction and more trouble with quitting later in life. At least 176 municipalities in 11 states have adopted a policy of restricting tobacco sales to those over 21, as have the entire states of California and Hawaii.

Berman co-authored the paper, published by Ohio State’s College of Public Health, with Rob Crane, clinical associate professor of family medicine; Natalie Hemmerich, an attorney and postdoctoral fellow in public health; and Thomas Geist, regional director of the Preventing Tobacco Addiction Foundation.The Ohio State researchers cite dozens of studies to support their conclusions. For example, previous research has suggested:

Raising the minimum sales age to 21 puts legal purchasers outside the social circle of most high-school students. Most people supplying cigarettes to teens are 18 to 20, and many of them are still in high school.
Raising the legal drinking age to 21 reduced alcohol use, daily drinking and binge drinking by more than a third among high-school seniors.
Raising the legal smoking age can reduce racial and ethnic disparities because nonwhite young adults are more likely than whites to start smoking after turning 18.

In 2005, Needham, Massachusetts, became the first U.S. city to increase its tobacco sales age to 21 – a case study that offers useful data as other cities consider the same change. After the law passed, tobacco use among high-school students dropped almost in half – and also decreased significantly faster in Needham than in the 16 surrounding communities that sold cigarettes to 18-year-olds.

“The Needham example is powerful,” said Berman, who consulted with New York City officials before they adopted a minimum tobacco sales age of 21 in the city in 2013.

Because sales to people under age 21 account for only 2 percent of total cigarette sales, the economic impact to retailers would be minimal, the authors noted.

“The percentage of cigarettes sold to people who are underage or even people who are 18, 19 and 20 is pretty small. But smoking at those ages sets them up for lifelong addiction,” Berman said.

The tobacco industry is sure to dislike this national movement because it knows that recruiting new “replacement smokers” is key to its survival, the authors wrote. In Ohio, the tobacco industry spends more than $1 million every day marketing its products. Meanwhile, Ohio spends less than nearly any other state on the delivery of messages that counter tobacco advertising.

Adult smokers have nothing to fear if the minimum sales age changes, said Berman, also a researcher in Ohio State’s Center of Excellence in Regulatory Tobacco Science.

“This has no impact on anyone who’s over the age of 21,” he said. “It’s really about preventing the next generation from starting to smoke.”

Contact: Micah Berman, 614-688-1438; mberman@cph.osu.edu

Written by Misti Crane, 614-292-5220; Crane.1@osu.edu

E Cigarettes & Vapourizer Market to Reach $28.57 billion with 21.1% CAGR to 2022

E Cigarettes & Vapourizer Market 2016 Global Trends, Market Share, Industry Size, Growth, Opportunities, and Market Forecast to 2020

http://www.einnews.com/pr_news/334281145/e-cigarettes-vapourizer-market-to-reach-28-57-billion-with-21-1-cagr-to-2022

PUNE, INDIA, July 7, 2016 /EINPresswire.com/ — According to researcher, the Global E-Cigarettes & Vapourizer Market accounted for $7.47 billion in 2015 and is anticipated to reach $28.57 billion by 2022 growing at a CAGR of 21.1% from 2015 to 2022. Growing demand for distribution channels of e-cigarettes and accessories is the primary factor favouring the market growth. Furthermore, increasing number of brands, innovative product launches and product customizations are some of the drivers favouring the market growth. However, uncertain regulatory framework, increasing incidents of e-liquid poisoning and compatibility issues are some of the restraints hampering the market growth. New taxes on e-cigs in cities like Washington, D.C., are damping sales, as are new regulations, like measures passed this year in Indiana that require manufacturers to secure permits and list ingredients. The industry also is awaiting final rules from the Food and Drug Administration, which could require federal approval for nearly all flavored liquid nicotine juices and e-cig devices.

Complete report details @ https://www.wiseguyreports.com/reports/e-cigarettes-vapourizer-global-market-outlook-2015

Disposable E-Cigarette segment commanded the largest share in 2015, while Rechargeable E-Cigarettes is growing at the highest CAGR durig the forecast period. North America is expected to witness highest growth rate over the forecast period. Europe being one of the largest markets in the e-cigarette industry it is hub to provide conflicting regulatory regimes.
Some of the key players in this market include Japan Tobacco, Inc., First Union, International Vapor Group, Inc., Marlboro, Lorillard, Inc., Pacific Smoke International, British American Tobacco Plc (Bat), Cloudcig, Steamlite, Smokefree, Victory Electronic Cigarettes Corporation, Altria Group, Inc., Reynolds American Inc., Puff Ecig, Bull Smoke, Feellife Bioscience International Co. Ltd, Fontem Ventures, Philip Morris International, Inc., Ballantyne Brands, Llc and Nice Vapor.

E-cigarettes – where are we now? Update

http://www.lexology.com/library/detail.aspx?g=2fd418f1-e1d9-4d19-ac31-e9228c3c2b91

E-cigarettes have become ever more popular since they first appeared on the market in 2007, and regulators have struggled to keep up. There has been much debate about the advantages and risks of using them. Community pharmacy is playing a significant role in the way the debate plays out, because many sell e-cigarettes, yet others regard such sales as unethical.

Increasingly, e-cigarettes are being seen as a positive tool in the ongoing battle to reduce smoking and last year research published by NHS England concluded that e-cigarettes were 95% safer than conventional cigarettes. The Royal College of Physicians published its own report at the end of April 2016 entitled “Nicotine without Smoke – Tobacco Harm Reduction”. The report explains that due to the negative impact on health of smoking tobacco, combined with other undesirable effects such as a reduction in economic productivity, smoking is responsible “for more loss of quality and quantity of life in the UK than any other avoidable cause” and concludes that the use of non-tobacco nicotine products, particularly e-cigarettes, has “huge potential to prevent death and disability from tobacco use.”

The number of people who smoke tobacco has already reduced considerably over recent decades. In 1972 51% of men and 41% of women smoked. By 2014, those figures had reduced to 21% of men and 16% of women. However, even these reduced percentages mean that there are still 8.7 million current smokers in the UK. According to the Royal College, the resulting direct cost to the NHS from smoking related illness is currently exceeds £2 billion each year. Taking into account other associated costs, such as social care and a decrease in economic productivity, the overall annual cost to the tax-payer is estimated to be approximately £14 billion. The Royal College has been involved in reviewing the effect of smoking for many years although, at first there was little enthusiasm at Government level for any real control over tobacco. The College published a report in 1962 identifying tobacco smoking as the main cause in the significant increase of cases of lung cancer, but, it was not until 1998 that a comprehensive tobacco control policy in the UK was published.

Because approaches to reducing the number of smokers have not been wholly successful, together with the fact that nicotine, in itself, is not a highly dangerous drug (although the smoke which is inhaled when smoking tobacco is), has led the Royal College to conclude that the use of e-cigarettes is, on balance, beneficial. This approach is consistent with Public Health England’s research that “While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals present pose limited danger.

The views of Public Health England and the Royal College of Physicians will not mean that sales of e-cigarettes will be unregulated. Ministers in Wales attempted, unsuccessfully, to ban e-cigarettes from public spaces this year, and in the UK, the MHRA recently licensed e-Voke as the first e-cigarette to have a licence as a medicinal product, opening up the possibility of vaping on prescription. However, given the costs of obtaining the necessary licence – which the Royal College of Physicians puts at between £252,000 and £390,000 plus annual costs of up to £249,000, this is unlikely to be a particularly popular option, despite the credibility having a licence gives the product.

For those e-cigarettes that do not have a licence, the EU Tobacco Directive will came into force on 20 May. This regulates the content of e-cigarettes and imposes labelling and leaflet requirements. E-cigarettes must not contain more than 20 mg nicotine per ml; there are restrictions on additives; child resistant packaging is mandatory; and information leaflets must include possible adverse effects, addictiveness and toxicity. E-cigarettes must also continue to comply with advertising codes enforced by the Advertising Standards Authority.

Tobacco companies tried to prevent the Tobacco Directive coming into force. In May, the European Court of Justice rejected this challenge, holding that human health requires a high level of protection that descriptions such as ‘low-tar’, ‘light’, ‘ultra-light’, ‘natural’, ‘organic’, ‘without additives’, ‘without flavours’ or ‘slim’, could mislead consumers, by suggesting that the products concerned are less harmful or that they have beneficial effects. An argument by the tobacco companies that their descriptions were helpful to consumers was dismissed by the court, which said the descriptions were “intended more to exploit the vulnerability of consumers of tobacco products who, because of their nicotine dependence, are particularly receptive to any element suggesting there may be some kind of benefit linked to tobacco consumption, in order to vindicate or reduce the risks associated with their habits.”

Despite any residual disquiet about the long term effects of e-cigarettes, it looks as though they are here to stay, and this is reflected in the increasing number of pharmacies which are now selling them.

Charles Russell Speechlys LLP – Rachel Warren

“The Harvest is in My Blood” Hazardous Child Labor in Tobacco Farming in Indonesia

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Summary

Ayu is a petite, soft-spoken 13-year-old girl from a village near Garut, in the mountains of West Java, Indonesia.[1] She is one of five children in her family, and her parents are farmers who cultivate tobacco and other crops on a small plot of land. “Since I was a kid, I’ve been going to the fields,” she said. “My parents plant tobacco. Mostly I help my parents and sometimes my neighbors. I have an older sister, an older brother, and two younger siblings. They help too.”

Ayu is in her first year of junior high school, and she mostly helps on the farm outside of school—early in the morning before classes, in the afternoons, and on weekends and holidays. But she told Human Rights Watch she occasionally missed school to work in tobacco farming. “My mom asked me to skip school last year when it was the harvest,” she said.

She told Human Rights Watch she vomits every year while harvesting tobacco:

I was throwing up when I was so tired from harvesting and carrying the [harvested tobacco] leaf. My stomach is like, I can’t explain, it’s stinky in my mouth. I threw up so many times…. My dad carried me home. It happened when we were harvesting. It was so hot, and I was so tired…. The smell is not good when we’re harvesting. I’m always throwing up every time I’m harvesting.

The symptoms she described—vomiting and nausea—are consistent with acute nicotine poisoning, an occupational illness specific to tobacco farming that occurs when workers absorb nicotine through their skin while having contact with tobacco plants.

Ayu also helps her father mix the toxic pesticides he applies to the tobacco. “I just put three or four cups of the chemical in the bucket, put in the water, and mix it with [a piece of] wood, and my dad puts it in the tank,” she explained. “The smell is so strong. It makes my stomach sick.” Like most of the farmers in her village, Ayu’s parents sell the tobacco they grow to the leader of their village, who pools together tobacco from dozens of farmers, transports it to a warehouse in Central Java, and sells it to a tobacco trader there. The trader buys tobacco from many different suppliers, repackages it, and sells it on the open market to Indonesian and multinational tobacco manufacturing and leaf supply companies.

This report—based on extensive research including interviews with more than 130 children who work on tobacco farms in Indonesia—shows that child workers are being exposed to serious health and safety risks. The dangers include acute nicotine poisoning from contact with tobacco plants and leaves, and exposure to toxic pesticides and other chemicals. Few of the children we interviewed, or their parents, were trained on safety measures or knew the health risks of the work. While Indonesian child labor laws are generally in line with international standards, our research shows that inadequate regulations and poor enforcement of the law, particularly in the small-scale farming sector, leave children at risk. The report concludes with detailed recommendations to the Indonesian government, tobacco companies, and other relevant players in the tobacco industry, including that authorities should immediately prohibit children from performing any tasks that involve direct contact with tobacco, and that companies should improve their human rights due diligence procedures to identify and end hazardous child labor on tobacco farms.

Indonesia is the world’s fifth-largest tobacco producer, home to more than 500,000 tobacco farms nationwide. Though domestic and international laws prohibit children under 18 from performing hazardous work, thousands of children like Ayu work in hazardous conditions on tobacco farms in Indonesia, exposed to nicotine, toxic pesticides, extreme heat, and other dangers. This work could have lasting consequences on their health and development.

The government of Indonesia has a strong legal and policy framework on child labor. Under national labor law, 15 is the standard minimum age for employment, and children ages 13 to 15 may perform only light work that is not dangerous and does not interfere with their schooling. Children under 18 are prohibited from performing hazardous work, including any work in environments “with harmful chemical substances.” Indonesia’s list of hazardous occupations prohibited for children does not specifically ban work handling tobacco. Human Rights Watch believes that available evidence demonstrates that any work involving direct contact with tobacco in any form constitutes work with harmful chemical substances, and should be prohibited for all children.

Nicotine is present in all parts of tobacco plants and leaves at all stages of production. Public health research has shown that tobacco workers absorb nicotine through their skin while handling tobacco, particularly when the plant is wet. Studies have found that non-smoking adult tobacco workers have similar levels of nicotine in their bodies as smokers in the general population. Nicotine is a toxin, and nicotine exposure has been associated with lasting adverse consequences on brain development. The use of protective equipment is insufficient to eliminate the dangers of working with tobacco and may lead to other dangers, such as heat illness.

Despite the domestic and international prohibitions on hazardous child labor, Human Rights Watch documented children engaging in hazardous work in tobacco farming in four Indonesian provinces, including the three provinces responsible for almost 90 percent of tobacco production each year: East Java, Central Java, and West Nusa Tenggara. Children we interviewed worked directly with tobacco plants, handled pesticides, and performed dangerous physical labor in extreme heat, putting them at risk of short and long-term health consequences.

Some of the hazards faced by child tobacco workers in Indonesia are not unique to tobacco farming. Children working in other crops may also be exposed to pesticides, work in high heat, and face other dangers. However, handling tobacco is inherently hazardous work for children, due to the nicotine in the plant, and tobacco farming inevitably requires workers to have significant contact with the plant during cultivation, harvesting, and curing.

Many Indonesian companies and the largest multinational tobacco companies in the world purchase tobacco grown in Indonesia and use it to manufacture tobacco products sold domestically and abroad. Several of the largest multinational tobacco companies in the world have acknowledged the risks to children of participating in certain tasks on tobacco farms. These companies ban children under 18 from performing some of the most hazardous tasks on farms in their supply chains, such as harvesting tobacco or applying pesticides to the crop. But none of these companies have policies and procedures sufficient to ensure that tobacco entering their supply chains was not produced with hazardous child labor. As a result, these companies risk contributing to the use of, and benefitting from, hazardous child labor.

On three research trips between September 2014 and September 2015, Human Rights Watch interviewed a total of 227 people, including 132 children ages 8 to 17 who reported working on tobacco farms in 2014 or 2015, and 88 other individuals, such as parents of child workers, tobacco farmers, tobacco leaf buyers and sellers, warehouse owners, village leaders, health workers, representatives of nongovernmental organizations, and others. In addition, we met or corresponded with officials from several government bodies, including the Ministry of Manpower and Transmigration, the Ministry of Health, the Ministry of Agriculture, the Ministry of Education and Culture, and the Indonesian Child Protection Commission.

Human Rights Watch sent letters to four Indonesian companies and nine multinational tobacco manufacturing and leaf supply companies, to share our research findings and request information on each company’s policies and practices regarding child labor in Indonesia. As detailed below, seven multinational companies responded in detail. We sent several letters and made numerous phone calls to each of the four Indonesian companies in an effort to secure a meaningful response, but none provided any substantive response. Human Rights Watch analyzed the human rights due diligence procedures of those companies that responded in detail to our letters as thoroughly as possible, based on information provided by the companies, publicly available information on their websites, and interviews with child workers, tobacco farmers, and traders in Indonesia.

Most of the children interviewed by Human Rights Watch started working in tobacco farming before age 15, the standard minimum age for employment in Indonesia. Approximately three quarters of the children we interviewed began working in tobacco farming by age 12. Most children worked on tobacco farms throughout the season, from planting through the harvest and curing process.

Children interviewed for this report typically worked on small plots of land farmed by their parents or other family members. In addition to working on land farmed by their families, many children also worked on land farmed by their neighbors and other members of their communities. Some children did not receive any wages for their work, either because they worked for their own families or exchanged labor with other families in their communities. Other children received modest wages.

Children in all four provinces said that they worked in tobacco farming to help their families. The World Bank reports that 14.2 percent of Indonesia’s rural population lives below the national poverty line, almost double the urban poverty rate. According to the International Labour Organization (ILO), “poverty is the main cause of child labor in agriculture” worldwide. Human Rights Watch research found that family poverty contributed to children’s participation in tobacco farming in Indonesia. “I want to help my parents make a living,” said 11-year-old Ratih, who worked on her parents’ tobacco farm in Jember, East Java. Sinta, a 13-year-old girl who worked on tobacco farms in her village in Magelang, Central Java, said, “I work so I can help my parents, to make life easier. To make it not such a difficult life.”

“My kids are helping me in the field so I can save money on labor,” said Ijo, a farmer in his mid-40s and father of four interviewed in Garut, West Java, in 2015. He said he was conflicted about his 12-year-old son helping him on the farm: “Of course I don’t want my kids working in tobacco because there’s a lot of chemicals on it, and it could harm my kids. But they wanted to work, and we are farmers.… I need more money to pay the laborers. But my son can help all season. You can imagine that I can save a lot of money when he joins me in the field. It’s complicated.”

Hazardous Work in Tobacco Farming

While not all work is harmful to children, the ILO defines hazardous work as “work which, by its nature or the circumstances in which it is carried out, is likely to harm the health, safety or morals of children.” The ILO considers agriculture “one of the three most dangerous sectors in terms of work-related fatalities, non-fatal accidents, and occupational diseases.”

Human Rights Watch found that many aspects of tobacco farming in Indonesia pose significant risks to children’s health and safety. Children working on tobacco farms in Indonesia are exposed to nicotine, toxic pesticides, and extreme heat. The majority of children interviewed for this report described sickness while working in tobacco farming, including specific symptoms associated with acute nicotine poisoning, pesticide exposure, and heat-related illness, as described below. Some children reported respiratory symptoms, skin conditions, and eye irritation while working in tobacco farming.

All children interviewed for this report described handling and coming into contact with tobacco plants and leaves containing nicotine. In the short term, absorption of nicotine through the skin can lead to acute nicotine poisoning, called Green Tobacco Sickness. The most common symptoms of acute nicotine poisoning are nausea, vomiting, headaches, and dizziness. Approximately half of the children we interviewed in Indonesia in 2014 or 2015 reported experiencing at least one symptom consistent with acute nicotine poisoning while working in tobacco farming. Many reported multiple symptoms. For example, Nadia, a 16-year-old girl in Bondowoso, East Java, said she vomits every year in the harvest season while bundling and sorting harvested tobacco leaves with other women and girls in her village. “Sometimes I get a headache. Sometimes I’m even throwing up … [It happens] when we string the leaves because we’re sitting in the middle of a bundle of tobacco.… It happens when the tobacco is still wet and just coming from the fields.… Every time it’s the beginning of the season, we’re throwing up.”

Rio, a tall 13-year-old boy, worked on tobacco farms in his village in Magelang, Central Java, in 2014. He told Human Rights Watch, “After too long working in tobacco, I get a stomachache and feel like vomiting. It’s from when I’m near the tobacco for too long.” He likened the feeling to motion sickness, saying “It’s just like when you’re on a trip, and you’re in a car swerving back and forth.”

The long-term effects of nicotine absorption through the skin have not been studied, but public health research on smoking suggests that nicotine exposure during childhood and adolescence may have lasting consequences on brain development. The prefrontal cortex, the part of the brain responsible for executive function and attention, is one of the last parts of the brain to mature and continues developing throughout adolescence and into early adulthood. The prefrontal cortex is particularly susceptible to the impacts of stimulants, such as nicotine. Nicotine exposure in adolescence has been associated with mood disorders, and problems with memory, attention, impulse control, and cognition later in life.

Many child tobacco workers interviewed for this report also said they handled or applied pesticides, fertilizers, or other chemical agents to tobacco farms in their communities. Some children also reported seeing other workers apply chemicals in fields in which they were working, or in nearby fields. A number of children reported immediate sickness after handling or working in close proximity to the chemicals applied to tobacco farms.

Sixteen-year-old Musa, for example, said he used a tank and handheld sprayer to apply a liquid chemical to his family’s tobacco farm in Garut, West Java, in 2015. He said he became very ill the first time he applied pesticides, after mixing the chemicals with his bare hands: “The first time, I was vomiting.… For two weeks, I couldn’t work. I went to the doctor. The doctor told me to stop being around the chemicals. But how can I do that? I have to help my parents. Who else can help them but me? … I mixed it with my hands. Suddenly I was dizzy. My parents told me to go home. I stayed home for two days, and my dad told me to rest for longer. It was a terrible feeling. For two weeks, I was always, always vomiting.”

Rahmad, a 10-year-old boy, described being exposed to pesticides while working on his family’s farm in Sampang, East Java, in 2015, “When my brother is spraying, I am cleaning the weeds. It stinks…. It smells like medicine. I feel sick. I feel headaches, and not good in my stomach. I’m in the same field…. Every time I smell the spray I feel dizzy and nauseous.”

Children are uniquely vulnerable to the adverse effects of toxic exposures as their brains and bodies are still developing. Pesticide exposure has been associated with long-term and chronic health effects including respiratory problems, cancer, depression, neurologic deficits, and reproductive health problems. In particular, many pesticides are highly toxic to the brain and reproductive health system, both of which continue to grow and develop during childhood and adolescence.

Few of the children interviewed by Human Rights Watch said that they had received any education or training about the health risks of working in tobacco farming. Very few children said that they wore any type of protective equipment while handling tobacco, and many said they wore no or inadequate protective equipment while working with pesticides or other chemicals.

Many children described working in high heat on tobacco farms. Some children we interviewed said that they had fainted, and others said that they felt faint or dizzy or suffered headaches when working in very high temperatures. Working in extreme heat can place children at risk of heat stroke and dehydration, and children are more susceptible than adults to heat illness.

Most children interviewed reported that they suffered pain and fatigue from engaging in prolonged repetitive motions and lifting heavy loads. Some children also said they used sharp tools and cut themselves, or worked at dangerous heights with no protection from falls.

Impact on Education

Most children interviewed by Human Rights Watch said they attended school and worked in tobacco farming only outside of school hours—before and after school, and on weekends and school holidays. However, Human Rights Watch also found that work in tobacco farming interfered with schooling for some children.

A few children had dropped out of school before turning 15—the compulsory age for schooling in Indonesia—in order to work to help support their families. These children often said their families could not afford to put them through school, or relied on them to work. Even though the Indonesian government guarantees free public education, and interviewees in most communities said they did not have to pay school fees to attend public schools, the costs of books, uniforms, transportation to and from school were prohibitive for some families. For example, Sari, a bright-eyed, 14-year-old girl in Magelang, Central Java, told Human Rights Watch she dreamed of becoming a nurse, but she stopped attending school after sixth grade in order to help support her family. “I want to go back to school to achieve my dreams for the future, but we don’t have much money to do that.”

Some children said they missed some days of school during busy times of the growing season. Eleven-year-old Rojo, the oldest child in his family, said he missed school to work in tobacco farming three or four times during the 2014 harvest season in Sampang, East Java: “My dad asked me to go to the field earlier, and not go to school,” he said. “I was worried I wouldn’t pass the exams.”

Some children interviewed said they found it difficult to combine school and work, and described fatigue and exhaustion or difficulty keeping up with schoolwork. Awan, a slender 15-year-old boy from Pamekasan, East Java, described how he balanced school and work during the high season: “When the harvest is coming, I have to wake up early in the morning, and I have to be [work] in the fields until 6:30 a.m., then go to school, and then continue in the fields in the afternoon…. We go [to the fields] around 4:30 or 5 a.m. It’s still dark, but I use a headlamp. I feel like I want to sleep longer. It’s tiring.” He told Human Rights Watch that this grueling schedule made it difficult for him to keep up with his schoolwork: “It’s harder to study than it is before the harvest,” he said. “It makes me so tired.”

Government Response

Under international law, the Indonesian government has an obligation to ensure that children are protected from the worst forms of child labor, including hazardous work, which is defined as “work which, by its nature or the circumstances in which it is carried out, is likely to harm the health, safety or morals of children.”

Indonesia has ratified several international conventions concerning child labor, including the ILO Worst Forms of Child Labour Convention, the ILO Minimum Age Convention, and the United Nations (UN) Convention on the Rights of the Child (CRC). The ILO Worst Forms of Child Labour Convention requires member states to take immediate action to prevent children from engaging in the worst forms of child labor and to provide direct assistance for the removal of children already engaged in the worst forms of child labor.

Indonesia has strong laws and regulations regarding child labor, aligned with international standards, and has implemented a number of social programs to address child labor. Under Indonesian law, the general minimum age for employment nationwide is 15. Children ages 13 to 15 may participate in light work as long as the work does not interfere with their physical, mental, or social development. Indonesian labor law prohibits hazardous work by everyone under 18, and a 2003 decree from the Minister of Manpower and Transmigration details the list of specific tasks that are prohibited for children under 18. The list explicitly prohibits children from working in environments “with harmful chemical substances.” Under this provision, any work involving direct contact with tobacco in any form should be considered prohibited due to the high probability of exposure to nicotine and pesticides.

However, gaps in the legal and regulatory framework, and inadequate enforcement of child labor laws and regulations leave children at risk. The Indonesian government’s hazardous work list does not specify that the prohibition on children’s work with harmful chemical substances includes work handling tobacco, despite the dangers of nicotine exposure. This ambiguity leaves children vulnerable.

In addition, the government of Indonesia does not effectively enforce child labor laws and regulations in the small-scale farming sector. The Ministry of Manpower and Transmigration—the agency responsible for the enforcement of child labor laws and regulations—has about 2,000 inspectors carrying out labor inspections nationwide, in all sectors, far too few for effective labor enforcement in a country of more than 250 million people. In a meeting with Human Rights Watch, a ministry representative explained that labor inspections are done only in large-scale agro-industry, not in the small-scale agricultural sector where the vast majority of children interviewed for this report worked.

Tobacco Supply Chain and Corporate Responsibility

While governments have the primary responsibility to respect, protect, and fulfill human rights under international law, private entities, including businesses, also have a responsibility to avoid causing or contributing to human rights abuse, and to take effective steps to ensure that any abuses that do occur are effectively remedied. This includes a responsibility to ensure that businesses’ operations do not use, or contribute to the use of, hazardous child labor.

The United Nations (UN) Guiding Principles on Business and Human Rights, which the UN Human Rights Council endorsed in 2011, maintain that all companies should respect human rights, avoid complicity in abuses, and ensure that any abuses that occur in spite of these efforts are adequately remedied. The guidelines, widely accepted as an authoritative articulation of businesses’ human rights responsibilities, specify that businesses should carry out effective human rights due diligence, a process to identify potential risks of human rights abuse connected to their operations and take effective steps to prevent and mitigate negative human rights impacts linked to their operations. Businesses also have a responsibility to ensure that the victims of any abuses that occur in spite of these efforts are able to secure an appropriate remedy.

Tobacco grown in Indonesia enters the supply chains of Indonesian tobacco companies of various sizes, as well as the world’s largest multinational tobacco companies. The largest companies operating in Indonesia include three Indonesian tobacco manufacturers—PT Djarum (Djarum), PT Gudang Garam Tbk (Gudang Garam), and PT Nojorono Tobacco International (Nojorono)—and two companies owned by multinational tobacco manufacturers—PT Bentoel Internasional Investama (Bentoel), owned by British American Tobacco (BAT), and PT Hanjaya Mandala Sampoerna Tbk (Sampoerna), owned by Philip Morris International. Other Indonesian and multinational companies also purchase tobacco grown in Indonesia, as described below.

Tobacco farmers interviewed by Human Rights Watch sold tobacco in a number of ways. Most farmers sold tobacco leaf on the open market through intermediaries, or “middlemen.” In this system, small farmers described selling tobacco to a central farmer or leader in the village, or a local buyer, who would pool tobacco from many small producers and sell it to warehouses owned by local businessmen or by larger national or multinational companies purchasing tobacco leaf.

As an alternative to this system, some farmers had relationships with individual tobacco companies and had opportunities to sell tobacco directly to representatives of the company, rather than through intermediary traders. Under this system, some farmers signed written contracts to sell tobacco directly to tobacco product manufacturing or leaf supply companies.

Human Rights Watch interviewed more than 60 tobacco farmers, tobacco leaf buyers and sellers, and warehouse owners in the four provinces where we conducted research. We identified human rights risks, including child labor and occupational health and safety hazards, in both the open market system and the direct contracting system.

Most farmers and traders selling tobacco exclusively through the traditional open market system acknowledged that it was common for children to work in tobacco cultivation. Most of them stated that neither the government nor those purchasing tobacco leaf had ever communicated with them regarding child labor standards or expectations. Interviewees said that they were not aware of any attempts on the part of buyers, including companies with explicit policies that prohibit child labor, to verify the conditions in which tobacco was grown or inspect for child labor.

Farmers producing and selling tobacco through the direct contracting system said that they had received some training and education about child labor and health and safety from the tobacco companies with whom they contract. At the same time, Human Rights Watch found that companies’ human rights due diligence practices were not sufficient to eliminate hazardous child labor in the supply chain. Most farmers in the direct contracting system reported that children under 18 still participated in many tobacco farming tasks, and some farmers insisted there were no restrictions at all on children’s work in tobacco farming. Most farmers said there was no meaningful consequence or penalty if children were found working, even in the event of repeated violations. In the absence of any meaningful penalties, many farmers largely disregarded any efforts by companies to dissuade them from allowing children to work.

Human Rights Watch found that companies purchasing tobacco on the open market and through the direct contracting system risk purchasing tobacco produced by children working in hazardous conditions.

Human Rights Watch sought information regarding the human rights due diligence policies and procedures of 13 companies, including four Indonesian tobacco product manufacturers, seven multinational tobacco product manufacturers, and two multinational leaf merchant companies. Ten companies responded. Of the four Indonesian tobacco companies, two replied (Nojorono and Wismilak), but neither provided a detailed or comprehensive response to the questions we posed. A representative of Wismilak sent an email to Human Rights Watch stating that the company could not respond in detail because it is not “directly connected with the tobacco farmers,” but did not identify other actors in the supply chain who are directly in contact with growers. Nojorono replied in a letter and referred Human Rights Watch to GAPPRI (Gabungan Perserikatan Pabrik Rokok Indonesia), a cigarette manufacturer’s association, for information regarding tobacco farming, including child labor. Human Rights Watch subsequently wrote to GAPPRI, but they declined to meet with us. The largest Indonesian tobacco companies, Djarum and Gudang Garam, did not respond to Human Rights Watch, despite repeated attempts to reach them.

All of the multinational companies purchasing tobacco from Indonesia that responded to Human Rights Watch have child labor policies that are largely aligned and appear consistent with international standards, in particular key ILO conventions. However, none of the companies prohibit children from performing all tasks that could pose threats to their health and safety. This means that none of the companies have policies sufficient to ensure that all children are protected from hazardous work on tobacco farms in their supply chains.

Human Rights Watch analyzed the information on human rights due diligence provided by those companies that responded to our letters. Few of the companies are sufficiently transparent regarding their human rights due diligence procedures, particularly regarding their monitoring of their child labor policies throughout the supply chain, as well as the results of internal monitoring and external audits. Transparency is a key element of effective and credible human rights due diligence. Among the companies we studied, Philip Morris International appears to have taken the greatest number of steps to be transparent about its human rights policies and monitoring procedures, including by publishing on its website its own progress reports as well as several detailed reports by third party monitors.

Most multinational tobacco companies operating in Indonesia source tobacco through a mix of direct contracts with farmers and purchasing tobacco leaf on the open market, with some companies relying more heavily on one or the other purchasing model. Many companies acknowledged that they carry out little or no human rights due diligence in the open market system. However, all companies sourcing tobacco from Indonesia have responsibilities to carry out robust human rights due diligence activity and ensure that their operations do not cause or contribute to human rights abuse, even in complex, multilayered supply chains. Although most of the companies who responded to Human Rights Watch acknowledged child labor and other human rights risks in the open market system, none of the companies described having procedures in place that are sufficient to ensure that tobacco entering their supply chains was not produced with hazardous child labor.

The Way Forward

Based on the findings documented in this report, our analysis of international standards and public health literature, and interviews with experts on farmworker health, Human Rights Watch believes that any work involving direct contact with tobacco in any form should be considered hazardous and prohibited for children under 18, due to the health risks posed by nicotine, the pesticides applied to the crop, and the particular vulnerability of children whose bodies and brains are still developing.

We recognize that small-scale farming is an important part of Indonesia’s agricultural sector, and that in some areas, children have participated in family farming for generations. Though it may take time to change attitudes and practices around children’s role in tobacco farming, significant change is possible. In Brazil—the world’s second-largest tobacco producer and a country, like Indonesia, where tobacco is cultivated largely on small family farms—Human Rights Watch found that a strict and clear government ban on child labor in tobacco farming, and comprehensive health and safety education and training, were helping to eliminate hazardous child labor in the crop. The Brazilian government had established meaningful penalties for child labor violations, applied both to farmers and the companies purchasing tobacco from them, and the penalties pushed people to end or limit their children’s work on the farm. Indonesian authorities should take note of this approach.

As part of its efforts to eradicate the worst forms of child labor by 2022, the government of Indonesia should update its list of hazardous occupations for children, or enact a new law or regulation, to prohibit explicitly any work involving direct contact with tobacco in any form. There may be some light work on tobacco farms that is suitable for children, particularly in the early stages of tobacco production. For example, planting tobacco while wearing suitable gloves or watering tobacco plants with small, lightweight buckets or jugs could be acceptable tasks for children, as long as they were not working in extreme heat or dangerous conditions, and the work did not interfere with their schooling. However, Human Rights Watch believes that many aspects of tobacco farming in Indonesia constitute hazardous child labor under international standards, particularly most tasks involved in topping, harvesting, and curing tobacco, as there is no viable way to limit children’s direct contact with tobacco during these stages of production.

The government should vigorously investigate and monitor child labor and other violations in small-scale agriculture, including through unannounced inspections at the times and locations at which children are most likely to be working.

In addition, Indonesian authorities should take immediate steps to protect child tobacco workers from danger. The government should implement an extensive public education and training program in tobacco farming communities to promote awareness of the health risks to children of work in tobacco farming, particularly the risks of exposure to nicotine and pesticides.

All companies purchasing tobacco from Indonesia should adopt or revise global human rights policies prohibiting hazardous child labor anywhere in the supply chain, including any work in which children have direct contact with tobacco in any form. Companies should establish or strengthen human rights due diligence procedures with specific attention to eliminating hazardous child labor in all parts of the supply chain, and regularly and publicly report on their efforts to identify and address human rights problems in their supply chains in detail.

Taxing To Promote Public Goods: Tobacco Taxes

EXPANDING THE GLOBAL TAX BASE: “Taxing To Promote Public Goods: Tobacco Taxes”

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Tobacco industry delaying tactics criticised as new tobacco laws come into force

http://www.ashscotland.org.uk/media/news/2016/05/tobacco-industry-delaying-tactics-criticised-as-new-tobacco-laws-come-into-force/

As standardised “plain” packaging and other tobacco regulations come into force (20 May), health campaigning charity ASH Scotland has released a new report, Dodgy Cigs, detailing the way the tobacco industry has raised ill-founded concerns about illicit tobacco to oppose public health measures.

Big Tobacco has claimed in the past that new public health laws will cause rises in the market for illicit tobacco, such as smuggled tobacco and counterfeit cigarettes. This has been particularly prominent in Australia, the first country to introduce plain packaging. The tobacco industry claimed that the policy would cause rises in illicit tobacco use, but official figures in the years since implementation have not agreed.

In the UK, the illicit tobacco market has declined since the year 2000, despite new laws protecting people from tobacco and increases in the price of a pack of twenty cigarettes.

dodgycigs-fig-1_500x299

Figure 1 – HMRC’s estimate of the size of the illicit tobacco market in the UK, plotted alongside to the price of a pack of 20 cigarettes (in 2014 GBP). The illicit market has consistently fallen at a time when tobacco prices have increased.

Commenting on the release of Dodgy Cigs, ASH Scotland Chief Executive Sheila Duffy said:

“The tobacco industry has often predicted that public health measures will cause rises in illicit tobacco. But this stance looks increasingly bizarre as illicit continues to reduce while regulation and price increase.

“We need to be wise to these tactics, and support proven public health measures. Standardised packaging will help put tobacco out of sight, out of mind and out of fashion for the next generation, making smoking less attractive for our children. Although it will take many years to see the full effects of this policy, the evidence from Australia, where plain packs have been used since 2012, shows that they can help to protect children from starting smoking and could help adults to quit.

“These new laws won’t single-handedly solve the problem of tobacco addiction. But they are another step on the journey to a tobacco-free Scotland by 2034.”

Ends

Notes –

Dodgy Cigs isavailable from www.ashscotland.org.uk/dodgycigs. A two-page key points report is available at /media/547507/dodgy-cigs-key-points-nt.pdf.

For further information please contact ASH Scotland on 0131 225 4725 or enquiries@ashscotland.org.uk Out of hours mobile 07776 142 299

Standardised “plain” packaging

From 20 May, plain packs of cigarettes will start to appear in the shops. These packs (above) feature drab colours and graphic health warnings to show the real impact of smoking tobacco. By 20 May 2017, all tobacco sold in the UK will have to be in plain packs.

Plain packs have led to a significant drop in the smoking rate in Australia, and are a key component in putting tobacco out of sight, out of mind and out of fashion to meet the Scottish Government’s target of a smoke-free Scotland by 2034.

Plain packs are not blank, white packs,but instead feature drab colours and graphic health warnings about the dangers of smoking (see picture above). Print quality images are available – please contact enquiries@ashscotland.org.uk.

EU Tobacco Products Directive (TPD)

The TPD will make certain changes to all tobacco products sold in every country in the EU:

All products in the EU must have 65% of the front and back of their packaging covered by health warnings
No cigarettes will be able to use misleading descriptions like “light” or “natural”, which promote the false idea that some cigarettes are less harmful
Cigarette packs will contain a minimum of 20 sticks, with hand-rolling tobacco pouches containing at least 30g of tobacco
There will be new regulations on the sales of e-cigarettes containing nicotine, including:

Television and other “cross-border” advertising will no longer be permitted
Mandatory warning labels about the addictive nature of nicotine
All products must be registered with the UK Government by 20 May 2017

HIQA to achieve ‘world first’ on e-cigarettes

http://www.imt.ie/news/latest-news/2016/05/hiqa-to-achieve-world-first-on-e-cigarettes.html

HIQA’s latest health technology assessment (HTA) on smoking cessation will be the first in the world to include electronic cigarettes among the interventions examined.

“This has not been done by a national HTA agency up to now,” HIQA’s Director of HTA Dr Máirín Ryan told IMT.

Dr Ryan was speaking after the release last week (April 28) of a major new report from the Royal College of Physicians (RCP) in London, which concluded that e-cigarettes were much safer than smoking and likely to be beneficial to public health.

The report, ‘Nicotine without smoke: tobacco harm reduction’, found that e-cigarettes were not a gateway to smoking, nor did they result in normalisation of smoking behaviour. And while the possibility of some harm from long-term e-cigarette use could not be dismissed, this was likely to be very small.

“The available data suggest that [the long-term health risks] are unlikely to exceed 5 per cent of those associated with smoked tobacco products, and may well be substantially lower than this figure,” it suggested.

Reviewing the report in The BMJ (BMJ 2016;353:i1745), Prof John Britton, Chair of the RCP’s Tobacco Advisory Group, and colleagues argued that e-cigarettes and other non-tobacco nicotine products offered the potential to “radically reduce harm from smoking” in society. “This is an opportunity that should be managed, and taken.”

Dr Ryan remarked that this was one of the first endorsements from any clinical advisory body on the use of e-cigarettes, and was probably driven by the fact that E-Voke electronic cigarettes was licensed in the UK last year. She said HIQA’s expert advisory group was to have its first meeting at the start of July, so there was plenty of time to consider this latest report.

The smoking cessation HTA will examine the clinical and cost-effectiveness of a number of different treatments to help people quit smoking. “At the moment we are gathering the clinical effectiveness information in terms of the comparative clinical effectiveness and we will use that then to populate the economic model.

“It is a big budget area, but there is no shortage of evidence,” Dr Ryan added.

A public consultation on a draft HTA report is expected in October before it is finalised and submitted as advice to the Minister for Health and the HSE and published, most likely in December.

dara.gantly@imt.ie