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Anti-smoking fight heats up

Bringing Hong Kong’s smoking rate down to single digits from one of the world’s lowest will be a slow and difficult drive, with the government considering a two-pronged strategy.

http://www.thestandard.com.hk/section-news.php?id=181900

Undersecretary for Food and Health Sophia Chan Siu-chee said this in an interview with The Standard, as the government is set to gazette an amended law enlarging the size of scare-tactics health warnings to at least 85 percent of the cigarette packets before the current term ends on June 30.

Chan said the government will study new strategies to encourage about 600,000 hard-core smokers to quit and prevent young people from taking up the habit.

Hong Kong’s smoking rate is 10.5 percent – down from 28 percent in the 1980s – but Chan said the long-term goal is to bring down the prevalence rate to single digits, although no deadline has been set for achieving that for several reasons.

“We know that as smoking prevalence decreases to such a low extent – 10.5 is actually one of the lowest rates in the world – the rate of further lowering would be slower than before because many people who are motivated or are prepared to quit have probably already quit,” she said.

But it would be very difficult to get the hardcore smokers to quit.

“But it doesn’t mean we are not doing anything. We just need a different strategy to deal with this group of more hard-core people,” said Chan.

“We need to study the remaining population of smokers more carefully to ascertain how hardcore they are and what strategy we need to deal with the different stages of readiness to quit.”

Chan also said it was very important to prevent young people from picking up the habit.

“That’s why it is also important for us to regulate for example, e-cigarettes which are like a gateway to smoking.”

The Food and Health Bureau is studying the legislative framework to carry that out, she said, but it would not be ready anytime soon.

The Department of Health will study whether the expanded health warnings would have any effect on bringing down the smoking rate once the enhanced warnings were put in place.

“We have international evidence that it would reduce smoking prevalence,” she said.

It would be the first time for pictorial health warnings to be expanded since the warning covering 50 percent of packets was introduced in 2007.

The government will allow the tobacco industry 12 months from the enactment of the law to sell off existing stock and prepare for the expanded warnings that will also include 12 pictures, up from the current six, to be used on a rotation basis.

But she said this did not mean the government had made any concessions to the trade, saying: “Even the last time, we gave 12 months when we first introduced the pictorial warning in 2007.”

She insisted that the plan was “to gazette as soon as practicable before June 30.”

While Chan said plain packaging would not happen in Hong Kong anytime soon, she defended the government’s move to go for 85 percent instead of 100 percent health warnings.

The World Health Organization recommends 50 percent or above, she noted.

But there are legal considerations as seen in countries that have mandated plain packaging being sued by the tobacco giants.

The enhanced warnings also include the Department of Health quit line and a message from the government to quit smoking.

Smoking costs China $57 billion in 2014: WHO calls for national ban

The economic dividends from China’s tobacco industry are a false economy, which is at odds with government’s vision for China’s future, the World Health Organization (WHO) claimed on Friday.

http://www.ecns.cn/2017/04-16/253586.shtml

“The total economic cost of tobacco use in China in 2014 amounted to a staggering 350 billion yuan ($57 billion), a tenfold increase since 2000,” Bernhard Schwartlander, the WHO representative in China, told a press conference in Beijing.

The increase is a result of more people diagnosed with tobacco-related illness and increasing healthcare expenditure, according to a report jointly released by the WHO and the United Nations Development Program (UNDP) at the conference.

“The direct cost of treating tobacco-related diseases in China was about 53 billion yuan and the indirect cost was expected to be 297 billion yuan,” in which the productivity loss from premature deaths was a major concern, according to the report.

Meanwhile, the report said that tobacco represents an economy of the past as China’s tobacco companies do not fit the vision of an innovative, value-added future economy.

“Projected increases in these costs will lead to negative spillovers effects across many sectors, placing increasing challenges to Chinese economy and businesses, in addition to the social welfare and health system,” it said.

Wu Yiqun, deputy director of the Beijing-based Research Center for Health Development, a think tank, told the Global Times earlier that China has huge public support for a nationwide smoking ban, but the timetable to adopt a law has been on the back burner.

“The proposed law has been mainly stymied by tobacco industry officials due to the huge economic interests involved,” Wu said.

The sector handed over 1.1 trillion yuan ($170 billion) to the State in 2015, up 20.2 percent from the previous year, the State Tobacco Monopoly Administration said in 2016.

The revenue from the tobacco industry derives from corporations whose business model is to create dependence on a lethal substance.

China in 2016 adopted the “Healthy China 2030″ blueprint, which says China aims to reduce smoking rates among adults from 28 percent to 20 percent by 2030.

More than 1 million people die of tobacco-related diseases every year in China, and the number is expected to reach 3 million by 2050 if no action to reduce smoking rates is taken. About 44 percent of the world’s cigarettes were consumed in China in 2014, nearly 26 percent higher than that in India, the report said.

China’s Ministry of Finance announced in May 2015 to raise cigarette taxation from the previous 5 percent to 11 percent, which “led to a reduction in cigarette sales for the first time in 20 years,” according to the report.

However, “cigarettes are increasingly affordable as the increase in cigarette prices has been much lower than the average increase in salaries.”

Smoking Will Kill 200 Million In China This Century, Report Says

The country is the world’s largest producer and consumer of tobacco.

http://www.huffingtonpost.com/entry/smoking-will-kill-200-million-in-china-this-century-report-says_us_58f26221e4b0da2ff8612b55

Habitual smoking in China is set to kill more than 200 million people this century, a new report from the World Health Organization and United Nations Development Program said.

The deaths will come from primarily poor areas of the country, “unless critical steps are taken to reduce China’s dependency on tobacco,” the report, released Friday, said.

Those steps could be difficult in a country that is also the world’s largest producer and consumer of tobacco, according to WHO. Forty-four percent of the world’s cigarettes are smoked in China, and the profits show. In 2015, the smoking industry in China recorded $160 billion in revenue, according to Agence France-Presse.

Dr. Bernhard Schwartländer, China’s WHO representative, said there needs to be more smoke-free policies across the country.

“If nothing is done to reduce these numbers and introduce more progressive policies, the consequences could be devastating not just for the health of people across the country, but also for China’s economy as a whole,” Schwartländer said.

Cigarettes have become increasingly more affordable, according to the report. A 50 percent tax increase on cigarettes could see 47 million fewer male smokers and 20 million fewer premature deaths over 50 years.

“Raising tobacco taxes is one of the most cost-effective measures to reduce tobacco consumption, while also generating substantial revenue for health and other essential programs – investments that ultimately benefit the entire population,” said Bert Hofman, World Bank Country Director for China, Mongolia and Korea, in the WHO press release.

Tobacco firms denied plain pack appeal

The UK supreme court has made a final decision, denying tobacco firms permission to appeal against plain packaging.

http://www.packagingnews.co.uk/news/markets/tobacco/tobacco-firms-denied-plain-pack-appeal-12-04-2017

The decision means that all cigarettes sold in the UK after 20 May must come in the standardised packaging that’s been increasingly appearing in shops during the trial period over the last year.

There will also no longer be packs of 10 cigarettes available in a move designed to deter young people from taking up smoking. For the same reason menthol cigarettes are being phased out but more gradually. They will disappear from shelves by May 2020.

Last November, British American Tobacco, Imperial Brands, Japan Tobacco International (JTI) and Philip Morris International went to the supreme court after the court of appeal claiming that the plain pack law would infringe their human and intellectual property rights but he appeal was rejected.

Any hopes the companies might have had that there was still a slim chance a challenge could be mounted will have been dashed by the final ruling.

The health secretary, Jeremy Hunt, welcomed the supreme court’s decision, saying: “Standardised packaging will cut smoking rates and reduce suffering, disease and avoidable deaths.”

Cigarettes and tobacco: what are the new rules and regulations?

The new rules have been made under new European Union law called the Tobacco Products Directive.

https://inews.co.uk/essentials/news/health/cigarettes-tobacco-new-rules-regulations/

Technically, the law came into force on 20 May last year, but companies were given a 12-month grace period to sell their old packs and bring in standardised packaging.

From next month, all tobacco must be packaged in drab, dark brown packs with no graphic branding.

standardised-packaging

The new packs are the same shape, size and colour, with two thirds of the front and back surfaces covered by pictorial health warnings, and written warnings on the sides.

From 21 May this year, anyone caught selling non-plain packs will face severe penalties.

Smokers will also no longer be able to buy smaller packs of cigarettes and rolling tobacco while menthols will be phased out completely by May 2020.

At the moment, rolling tobacco comes in 10g and 20g packets – but soon 30g will be the smallest size.

The ban includes some flavoured tobacco and cigarettes – including fruit, spice, herbs, alcohol, candy and vanilla.

There are also internal packaging requirements as well as rules for individual cigarette sticks. All other trademarks, logos, colour schemes and promotional images are prohibited.

Cost of cigarettes

A pack of cigarettes is now at least £8.81, which campaigners say is a key factor in making people quit smoking.

Action on Smoking and Health believe that removing the packet of ten cigarettes this means people will have to find that extra money for a packet.

“It will hit poorer and younger smokers harder who are more likely to buy smaller packs,” a spokesperson said.

Smokers’ rights group Forest said the new rules “treat adults like children and teenagers like idiots”.

New vaping laws will also come into force next month restricting sale of e-liquids and e-cigarettes.

Among the rules are: refillable tanks must have a capacity of no more than 2ml, e-liquids can not be sold in quantities greater than 10ml and e-liquid packaging must be child-resistant and tamper evident.

 

British American Tobacco nabs 40 per cent market share in Bulgaria with its purchase of Bulgartabac brands

British American Tobacco (BAT) has agreed to buy some of Bulgarian cigarette maker Bulgartabac’s top brands in a deal worth more than €100m (£84.8m).

http://www.cityam.com/262852/british-american-tobacco-nabs-40-per-cent-market-share

The move to buy Victory, Eva Slim and GD brands will bring BAT’s market share in the country to 40 per cent from just 12 per cent previously. The deal will include retail and distribution assets in the country and the wider Adriatic region.

BAT, which has operated in Bulgaria for 25 years, said it is proud to be making the biggest investment in the country this year.

“We are committed to the Bulgarian market and are very excited about this investment in a country which is increasingly demonstrating that it has a very bright future. This significant investment demonstrates our confidence both in Bulgaria and our future growth here,” said Richard Widmann, general manager of BAT’s central European cluster.

Subject to regulatory approval, the deal will be complete by mid-2017, BAT said.

A spokesperson for BAT added the transaction aligns financially and strategically with the business objectives for the central European region. The group will grow its business in Bulgaria and further enhance its position in the Balkans, following its acquisition of TDR in 2015.

What the new tobacco and cigarette packaging laws mean

Ten packs and smaller tobacco bags are out, while standard plain covers are in

http://www.theweek.co.uk/83551/what-the-new-tobacco-and-cigarette-packaging-laws-mean

New laws that standardise the appearance of tobacco packets and limit the range of products on offer come into force next month after a bid to halt the legislation was thrown out by the Supreme Court.

What was the Supreme Court ruling about?

Four tobacco giants took legal action in a last-ditch attempt to stop the introduction of mandatory plain packaging on cigarettes sold in the UK.

They argued the law would infringe their human and intellectual property rights by making their products indistinguishable. In addition, they also questioned evidence that plain packaging would deter smokers.

However, Judge Nicholas Green, who heard the original application for a judicial review of the 2015 legislation, ruled the regulations “were lawful when they were promulgated by parliament and they are lawful now in the light of the most up-to-date evidence”.

What happens on 21 May?

All cigarette packets will come in a single shade of “opaque couche” – a muddy green which The Sun describes as “the world’s ugliest colour”.

Brand names will be written in a standard font, size and location on the pack, while health warnings will cover at least 65 per cent of the box or packet. They can also no longer carry words such as “lite”, “natural” or “organic” and menthol cigarettes will be phased out completely by 2020.

Smokers will additionally not be able to buy smaller packs of cigarettes or rolling tobacco. Packets of ten are being axed, as are 10g (a third of an ounce) and 20g packs (0.7oz) of rolling tobacco.

Amanda Sanford, spokeswoman for Action on Smoking and Health (Ash), told the Liverpool Echo that banning smaller packers was intended to deter younger smokers who are more likely to buy them because they are cheaper.

Technically, the law came into force on 20 May 2016, but tobacco companies were given a 12-month period to standardise packaging and dispose of old stock. From 21 May this year, anyone breaking the new rules faces strict penalties.

Is this a good move?

Health Secretary Jeremy Hunt said standardised packaging “will cut smoking rates and reduce suffering, disease and avoidable deaths”, while government chief medical officer Dame Sally Davies says she was “thrilled” the tobacco industry was not allowed to appeal.

However, smokers rights group Forest said the new rules “treat adults like children and teenagers like idiots”.

Is the UK the first country to do this?

No. Australia led the way with a law that meant tobacco products on sale after 1 December 2012 had to carry plain packaging and French packaging legislation came into effect at the start of 2017. Similar laws in Ireland, Hungary and New Zealand have not yet been rolled out.

How tobacco firms flout UK law on plain packaging

Brands use competitive price labels to avoid restrictions on marketing

https://www.theguardian.com/society/2017/apr/09/tobacco-companies-flout-law-plain-packaging

An insider in the tobacco industry has revealed some of the unscrupulous tactics it is using to avoid new restrictions governing the marketing of cigarettes that come into force next month.

One strategy – sticking competitive pricing labels on packets, a move designed to attract cost-conscious poorer smokers who make up the majority of the market – is already in breach of the regulations, according to legal advice obtained by Action on Smoking and Health (Ash).

The whistleblower, until recently employed by Imperial Tobacco, one of the UK’s largest companies, told the Observer that all four of the industry’s main players were employing a range of branding initiatives involving pack design to differentiate their products before the new regulations come into force on 20 May. From this date, cigarettes must be sold in dark green packs of 20 that carry health warnings covering at least 65% of the box.

Plain packaging was first introduced in May last year. “Any branded stock you see out there now will have been produced before 20 May last year,” said the whistleblower who used the pseudonym, Martin Sempah. “So the cigarette companies have been on a massive stock building exercise to make sure they have their branded packs in the market for as long as possible, to leverage the brand benefit.” But, under the new regulations, any packs manufactured after 20 May last year must be devoid of eye-catching price labels, something that severely limits the tobacco companies’ ability to market them aggressively.

“Price with cigarettes is massive,” Sempah said. “It’s what drives growth in market share. You get your price mark wrong and you can lose market share and millions. The issue for Imperial was that from 20 May 2016 until 20 May 2017 they’d have branded packs out there but no way of controlling the price on them.”

The solution was to employ a separate agency to add promotional price stickers to the packets’ cellophane wrappers, a practice known in the trade as “stickering”, that, according to Sempah, involved “millions and millions” of packs and which the tobacco firms insist is not in breach of the regulations because it is not part of the manufacturing process.

Imperial employed an agency called Clipper to add the stickers, Sempah said. Ash has written to the other three major tobacco companies –JTI, BAT and PMI – saying it is aware that they have been employing a similar strategy.

The health organisation has received a legal opinion from Peter Oliver, a barrister at Monckton Chambers, that suggests the strategy breaches the regulations which state that cigarette packets must be wrapped in cellophane that is “clear and transparent” and must not be “coloured or marked”.

“Once again, the tobacco companies seem to be stretching the law to snapping point,” said Deborah Arnott, chief executive of Ash. “They have already wasted thousands of legal hours and millions of pounds in fees trying to get the standardised packaging rules scrapped and failed miserably. Now it seems they are trying to get round the rules, by adding stickers to cigarette packs after the 20 May 2016 and claiming that this is not part of the production process. But, as our legal opinion confirms, such claims are false and the behaviour unlawful. We would like to see appropriate enforcement action taken against any tobacco manufacturer engaged in this practice without delay.”

Stickering is only one weapon in the industry’s arsenal, Sempah suggested. “When the regulations came out they started to look for loopholes. They said: how can we use particular varnishes and finishes on our plain packs to make them more tactile in a person’s hands, to make them more attractive? Do we use a different type of foil? If you look at a pack of Marlboro Gold it has got a trademark type of foil – it’s resealable. There are methods they are using to get round the regulations to increase the brand equity in their packs.”

Another strategy is to use key words to signify different “strengths” of cigarette – something that is banned. The word “real” is being used to suggest “full flavour” while “bright” denotes cigarettes that were once labelled ‘light’.

Two, separately wrapped, packs of 10 cigarettes inserted inside a 20-size pack have been developed to appeal to smokers who prefer smaller packs.“They’re going to be investing a lot more in festivals and nightclubs,” Sempah said. “You can’t say ‘sponsored by’ but you can create a fantastic experience which kind of looks like a cigarette brand.

“For example, last year Golden Virginia did stuff at the Latitude festival. They had a bar and a smoking area – all green furniture and green T-shirts for staff. It was a slightly different green from Golden Virginia and it was called Roll and Rock rather than Golden Virginia but at the bar you could only buy Golden Virginia.”

In their written responses to Ash all four tobacco companies and Clipper insisted that they complied with all the regulations. Sempah said most in the tobacco industry doubted the marketing strategies would have much of an impact in the long run. “Nobody really expects this to work, but there’s so many big salaries tied up in marketing in the tobacco companies they have to try to make it work.”

Smoking causes one in ten deaths globally, major new study reveals

Efforts to control tobacco have paid off, says study, but warns tobacco epidemic is far from over, with 6.4m deaths attributed to smoking in 2015 alone

https://www.theguardian.com/society/2017/apr/05/smoking-causes-one-in-ten-deaths-globally-major-new-study-reveals

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30819-X/fulltext?elsca1=tlpr

Summary

Background

The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.

Methods

We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).

Findings

Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.

Interpretation

The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking’s global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

Funding

Bill & Melinda Gates Foundation and Bloomberg Philanthropies.