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Commentary: Smoking is an archaic habit with no place in modern society

Mar 11th, 2017
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The move to raise the legal age for smoking gives a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.

http://www.channelnewsasia.com/news/singapore/commentary-smoking-is-an-archaic-habit-with-no-place-in-modern/3584938.html

Shocking as it sounds, many doctors used to smoke.

The groundbreaking study which first confirmed the link between smoking and lung cancer was carried out on British doctors in the early 1950s. UK Medical Research Council member Sir Richard Doll, who conducted the study chose doctors as his research participants because many of them smoked, and it would be easier to observe what happened to them as a result of smoking.

Within three years of observation, 37 died from lung cancer. All were smokers. The number of deaths rose to 70 after five years. His work provided strong evidence of the dangers of smoking and laid the groundwork for future public debates about smoking

Since then, governments around the world have put in place policies and programmes to stop people from picking up the habit and help smokers kick theirs. For instance, the United States introduced the tobacco advertising ban and tax in the 1960s.

Singapore became the first Asian country to ban tobacco advertising in 1971, followed by the banning of smoking in various public places. The Singapore Government has also dramatically increased the excise tax on tobacco since 1983.

The impact of such combination of measures was visibly evident. The proportion of smokers among male Singaporeans aged 18 and above declined from 42 per cent in the late 1970s to 24.3 per cent in 2010, and the per capita consumption of tobacco decreased from 2.36 kilograms to 0.77 kilograms in a short span of 30 years. The incidence of lung cancer also halved from around 60 per 100,000 in the 1980s to 30 per 100,000 today.

Nonetheless, the decline in the proportion of smokers has since hit a plateau over the last ten years, hovering around 23 to 24 per cent in males, and 3.5 to 4 per cent in females, and has not budged since. What this effectively means is that the number of new smokers now equal those who have died from or quit the habit. To lower the proportion of smokers, more aggressive efforts will be required to prevent Singaporeans from picking up the habit.

WILL RAISING THE MINIMUM LEGAL AGE REALLY HELP STEM THE HABIT OF SMOKING?

Senior Minister of State for Health, Dr Amy Khor, announced recently on Thursday that the legal age for smoking and buying tobacco products will be raised from 18 to 21.

This will be a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.

Raising the minimum legal age (MLA) makes it harder for them to get tobacco products either directly or through their social networks. More importantly, it contributes toward de-normalising smoking.

95 per cent of smokers in Singapore had their first puff before age 21. Increasing the legal smoking age to 21 reduces youth exposure to tobacco products during their adolescence – a critical stage of life where they are more susceptible to peer pressure, where their psycho-social maturity, including sensation seeking, impulsivity, and future perspective taking, are still not fully developed.

Detractors may question the rationale for raising the MLA.

Some critics argue that raising the legal smoking age is simply delaying initiation into the habit. But the fact is that those who do not pick up smoking by age 21 are unlikely to ever begin. There is evidence that the younger the adolescent is when he starts smoking, the higher the level of nicotine dependence, and the greater the probability of him becoming a long-term, heavy smoker.

Others may make invidious comparisons. After all, if an 18 to 20 year old can legally marry, drive, consume alcohol or serve national service, why is he not allowed to smoke?

Tobacco smoking is clearly very different from and far outweighs the aforementioned activities when it comes to fatalities. It is deliberately designed to be addictive and is known to cause disease and disabilities in both the smokers, as well as those breathing in secondhand smoke. There is no moderate level of consumption at which tobacco smoking is safe – for the smoker and those around him. It is a unique product that kills its user when used as instructed.

Another objection is that raising the MLA may lead to the emergence of a black market peddling tobacco products to underage smokers. To deal with that, law enforcement efforts can be intensified, and harsher penalties imposed on the sellers. For instance, New York City stepped up its enforcement and increased penalties for supply of illegal tobacco products when it raised the MLA.

Of course, even with these efforts, it is impossible to entirely curtail a black market. However, future generations of youths will be discouraged from smoking, disease will be averted and lives saved albeit with this negative “side effect”.

ADOPT AN APPROACH THAT IS SYMPATHETIC, EDUCATIONAL AND SUPPORTIVE

In meting out consequences for underage smokers, we ought to bear in mind that they too are victims of Big Tobacco advertising strategies directed at the aspirations of impressionable youth.

Our best defence would be to adopt an approach that is sympathetic, educational and supportive of their efforts to quit the habit. To successfully curb smoking initiation in our youths, we would do well to ensure adequate enforcement of the MLA on retailers who sell tobacco to minors.

The debate over the Government’s move to raise the minimum legal age is a reminder that no single silver bullet to reduce smoking prevalence exists. The MLA is only but one of the existing and additional future measures for effective tobacco control. Singapore has banned electronic cigarettes which tobacco companies intentionally market as “safer” to youths. They also claim that heated cigarettes are safer but studies have shown that they have the same nicotine content as traditional cigarettes.

There are other measures that we can consider in the fight against smoking. First, there is evidence that increasing the size of graphic health warnings (GHW) on the cigarette packaging prevents youth smoking initiation, boosts motivation to quit, reduces smoking among adults and sustains smoking cessation. Expanding the size of the GHW is a highly cost-effective control measure that we should consider implementing.

Second, several countries like Australia, France and UK have augmented their GHW with standardised packaging. Also known as “plain packaging”, this requirement removes all branding elements such as colour, image, trademarks, logos and text, and only allows the brand name to be printed in a standardised font, size and location on the pack. This reduces the appeal of the pack, weakens any branding power each product might have, and strengthens the impact of the GHW.

Australia was the first nation in the world to adopt plain packaging in 2012. Even though the health impact of the policy will take years to be fully seen, a post–implementation review published in February 2016 reported that the policy has reduced smoking and exposure to tobacco smoke, and is expected to continue doing so.

Third, price and taxes are effective tools for tobacco control. According to the World Health Organisation, a 10 per cent increase in tobacco prices will reduce consumption by about 4 per cent in high-income countries. We should raise tobacco taxes further as part of our suite of enhanced control measures, if we think that smoking remains a serious issue even after the MLA has been raised.

Last, internationally, there is a movement to go beyond conventional tobacco control strategies and adopt fundamentally different strategies that aim to eliminate smoking altogether. These are broadly classified as “Endgame Strategies”. Singapore should begin thinking about eliminating smoking completely. We would not be the first country to endorse and adopt this approach. New Zealand, Finland, Canada, Sweden and France have all endorsed the goal of achieving a smoke-free society in the next eight to 23 years.

Smoking was introduced commercially in the 1880s. It is an ancient and archaic habit, and has no place in our modern and progressive society.

Professor Chia Kee Seng is Dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Japan’s tobacco lobby seeks to head off indoor smoking ban

Mar 6th, 2017
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Push for country to adopt global norms opposed on grounds of existing outdoor prohibition

https://www.ft.com/content/785b1b46-ffdd-11e6-96f8-3700c5664d30

A Japanese plan to ban indoor smoking in public places before the 2020 Tokyo Olympics, bringing the country in line with most of the developed world, is facing fierce resistance from the country’s powerful tobacco lobby.

Japanese smoking rates fell from 27.7 per cent of adults in 2003 to 18.2 per cent in 2015. But the nation’s remaining smokers, who are still able to pursue their habit inside restaurants, bars and workplaces, enjoy a level of freedom long ago stripped from counterparts elsewhere in the world. Nearly 50 countries have imposed blanket bans on indoor smoking and early drafts of the health ministry’s proposed revisions to Japan’s Health Promotion Law cite the success of legislation in the UK, France, and elsewhere. However, 231 municipalities in Japan, including in Tokyo and other major cities, have since the mid-2000s prohibited smoking in the street. The bans are largely in the name of hygiene and aesthetics, but with more than half an eye to passive smoking. The “manners” drive has created the often bizarre situation where smokers sitting on terraces outside restaurants or bars are obliged to come indoors to light up. Japan Tobacco, the world’s fourth-biggest cigarette maker by sales, which is 33.35 per cent owned by the state, has seized on this oddity in an effort to dilute the blanket ban on indoor smoking initially proposed by the health ministry.: Pragmatism on nicotine could save lives Encouraging safer alternatives to smoking can help end epidemic It is not fair to cite the success of smoking bans in places like the UK, continental Europe and the US, said a JT spokesman, because most Japanese smokers do not have the same option of going outside. JT’s argument appears to have borne fruit. On Wednesday, when the health ministry unveiled a revised proposal, the demands were heavily watered down from earlier versions, allowing exemptions for Japan’s thousands of bars and restaurants occupying less than 30 square metres of floor space. Finance minister Taro Aso, whose state portfolio includes the JT stake, last month expressed doubts over the harmful effects of smoking, referring to “various people” who question the link between smoking and lung cancer. Such views are echoed by Japan’s tobacco lobby, which has the support of an estimated 100 parliamentary members of the ruling Liberal Democratic party.

Other groups aligned against the health ministry on its indoor smoking ban plans include a bar and restaurant industry fearful that business would be devastated. JT approaches the debate from a stated position that it does not believe the case has been proved that second-hand smoking is a cause of diseases such as lung cancer. The World Health Organization has meanwhile awarded Japan’s existing efforts to prevent passive smoking the lowest rating available and the Japanese government’s own research suggests that as much as 40 per cent of people eating or drinking out are exposed to passive smoking. On the subject of imposing an indoor smoking ban to clean up Japan’s image ahead of the Olympics, JT said the event should instead be used to publicise the success of the country’s “smoke segregation” policies that divide smoking and non-smoking zones inside buildings.

Shanghai expands public smoking ban

Mar 1st, 2017
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Shanghai widened its ban on public smoking Wednesday as China’s biggest city steps up efforts to stub out the massive health threat despite conflicts of interest with the state-owned tobacco industry.

http://www.digitaljournal.com/news/world/shanghai-expands-public-smoking-ban/article/486881

Nearly a quarter of adults in the commercial hub of 24 million people are smokers, according to the state-run People’s Daily newspaper, citing data from the Chinese Association of Tobacco Control.

Shanghai has had a limited ban on public smoking since 2010, but the regulation covered only certain spaces such as schools and libraries.

The new rule expands the restrictions to all public indoor areas and some outdoor ones.

In June 2015 Beijing municipality adopted the toughest anti-smoking legislation in the country, banning smoking in offices, restaurants, hotels and hospitals.

The southern city of Shenzhen introduced similar rules in 2014.

China has long said it plans to ban smoking nationwide. In November, government health spokesman Mao Qunan indicated measures would be rolled out across the country by the end of last year.

But the measures, which have been available for public comment since 2014, still have not been put into effect.

Anti-smoking measures pose a dilemma for China.

On one hand, smoking has created an enormous burden on the public health system — leading to as many as one million deaths in 2010, according to a 2015 study in medical journal The Lancet.

On the other, the state-run tobacco industry provides the government with an enormous source of income: 1.1 trillion yuan ($160 billion) in taxes and profits in 2015, according to the most recent figures, up 20 percent year-on-year.

China’s tobacco regulator shares offices and senior officials with the state-owned China National Tobacco Corp — a near-monopoly and by far the world’s biggest cigarette producer.

The China representative of the World Heath Organization, Bernhard Schwartlander, said Tuesday in a statement that “the tobacco economy has all but stopped progress on a national smoke-free law”.

“Largely because the tobacco industry in China, which has a vested interest in maintaining an economy based on the production and use of tobacco, dominates the official government body meant to curb tobacco use,” he said.

 

Tobacco lobby holding back smoking ban

Mar 1st, 2017
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On Wednesday, Shanghai becomes the latest municipality in China, following Beijing and Shenzhen, to launch a 100 percent smoke-free policy in public places and work spaces. Some 60 million people－more than the population of many countries－living in these cities can now enjoy smoke-free public places.

http://www.ecns.cn/2017/03-01/247303.shtml

While we congratulate Shanghai on joining Beijing and Shenzhen as global leaders in tobacco control, we must also ask: How is it that only three cities in China have adopted comprehensive smoke-free policies? What is standing in the way of the rest of the 1.3 billion citizens having the right to smoke-free indoor air in their workplaces and factories, and in restaurants and shopping areas?

President Xi Jinping has announced his vision for China’s future. First, he announced the Chinese Dream; then he called for the Chinese economy to reinvent itself, led by industrial innovation; and last summer, he announced his Health China 2030 initiative, a bold declaration that made public health a precondition for all future economic and social development.

As evidenced in this remarkable series of policy announcements, Xi’s vision for China is one in which economic growth enhances, rather than sacrifices, individual well-being.

Unfortunately, there remains a glaring obstacle to realizing the Chinese Dream and Healthy China 2030 vision－an obstacle which has resisted the considerable efforts of China’s public health authorities, advocates and citizens: the tobacco economy.

Tobacco represents an economy of the past. China’s tobacco companies do not fit the vision of an economy driven by innovative, value-added manufacturing and a strong service sector. Its very reliance on Chinese smokers undermines efforts to build a healthy China by 2030.

We celebrate the smoke-free laws in Beijing, Shanghai and Shenzhen. But they are among the wealthiest cities in China, which raises the question of inequality. Smoke-free indoor air should not be a luxury for the wealthy, rather an entitlement for all Chinese citizens who are working hard to realize the Chinese Dream.

Why is this not happening? The reason is largely because of the short-sighted economic interests that are not aligned with the President’s vision.

The small but successful tobacco tax adopted in 2015, which reduced smoking and increased government revenues, should be drastically increased so that the tobacco companies pay more tax and farmers start growing alternative crops.

Instead, there is continued resistance to further tobacco taxes and stronger advertising restrictions. Most concerning is that progress has all but stopped on a national smoke-free law.

To those who doubt whether rural governments are capable of implementing a comprehensive smoke-free law, I would point to the hundreds of millions of people China pulled out of poverty in three decades－a much tougher implementation challenge, achieved through strong government leadership and coordinated action at all levels.

Xi’s vision for China’s future is clear. The country’s leadership should pass comprehensive legislation against tobacco to ensure all Chinese citizens, not just those in the wealthiest cities, can breathe smoke-free air indoors.

Local leaders like those in Shanghai are taking bold decisions to ensure the health of citizens. And even in the absence of national legislation, they are breathing new life into the Chinese Dream to make Xi’s Healthy China 2030 vision a reality and relegate the tobacco economy to a place it deserves－in the past

Slovenia adopts plain packaging

Feb 15th, 2017
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Congratulations to SFP Coalition Partners No excuse Slovenia and Slovenian Coalition for Public Health, Environment and Tobacco Control for their tireless advocacy to support this legislation in the last year.

http://www.smokefreepartnership.eu/partner-news/item/slovenia-adopts-plain-packaging

On 15 February the Slovenian Parliament adopted the draft law proposed by the government without a single vote against. Plain packaging is expected to enter into force in 2020.

Briefly, the new Slovenian Tobacco law includes:

– Plain packaging (65% coverage with health warnings and quitting information)
– Introduction of license for selling tobacco products,
– Total display and Tobacco advertising, promotion and sponsorship (TAPS) ban
– Prohibition of selling tobacco products with aromas and other additives
– Prohibition of smoking in cars with a minor present
– Prohibition of smoking indoors including E-cigarettes
– Mystery shopping/test purchasing by underage,
– Measures of prevention of illicit trade

Shisha bars to be banned

Feb 13th, 2017
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The government soon will announced a complete ban on commercial use of shisha to protect the country’s youth, according to the Pakistan Observer.

http://www.tobaccojournal.com/Shisha_bars_to_be_banned.54070.0.html

Shisha sales and hookah use in bars, cafes and lounges would cease. Shisha sales would be banned in bazars, the Observer said. Authority for the expected ban from the Ministry of National Health Services, Regulations and Coordination is contained in the Prohibition of Smoking and Protection of Non-smokers Health Ordinance of 2002, the newspaper said on its website.

Stub it out: Smoking challenge for hospitals in Wales

Feb 1st, 2017
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On a crisp afternoon a group of school children stand outside Prince Charles Hospital holding their handmade no smoking posters.

http://www.bbc.com/news/uk-wales-38692344

“Please don’t smoke outside our hospitals”, they shout in unison.

As ambulances pull up outside the Merthyr Tydfil A&E department, the 10 and 11 year-olds watch as patients and visitors light up, puffing smoke into the air.

“We’ve seen a number of people smoking next to no smoking signs”, their teacher Kelly-Anne Crane said.

In the last six months alone 783 smokers at Prince Charles and Royal Glamorgan hospitals, in Llantrisant, have been asked to stub it out by security guards.

Cwm Taf University Health Board – who manage the sites – say they are doing everything they can but people have a “total disregard” to the signs plastered across their NHS grounds.

And they are not alone. While all seven health boards in Wales have smoke free policies in place they say they are “powerless” to stop people lighting up, as they are not yet backed by legislation and so smokers are not breaking any laws.

The Public Health Wales Bill – which is currently going through the Assembly for the second time – would make it illegal to smoke on hospital grounds, giving the board’s the much needed legal backing to issue fines to smokers flaunting the rules.

The Welsh Government said the bill will “build on existing voluntary smoking bans in order to aid enforcement”.

Betsi Cadwaladr University Health Board – who manage hospitals across north Wales – said the public “do not respect” requests to not smoke on their sites.

They said that without legislation to back them up they had to rely on the “courtesy and consideration of smokers” not to light up, and despite extensive signage and recorded messages triggered a cigarette is sensed nearby, people still ignored their policy.

A spokesman said: “We do encourage members of staff to challenge smokers who are causing a nuisance but unfortunately this can provoke a negative or aggressive reaction, which understandably makes busy colleagues reluctant to continue asking people to put out their cigarettes or move away from entrances.”

It is not just the contradictory image of patients in dressing gowns smoking outside the place they are being treated which concerns health boards and bodies like the British Medical Association (BMA).

Health boards have concerns about smoke drifting through windows into wards, passive smoking, and the impressionability of the growing number of young people receiving treatment on their sites.

Cwm Taf are now hoping the words of children will make people think twice about smoking outside their buildings.

Local school children like those from Cyfarthfa High, have designed special posters detailing the dangers of smoking.

If the posters fail the board is considering introducing push-button tannoys – which staff, patients and visitors can trigger if they spot someone defying the rules – which could use children’s voices to tell smokers to stub it out.

Dr Chris Jones, chair of Cwm Taf, said: “Hospitals are for people who are sick and smoking causes illness.

“I don’t think the health board is enforcing anything, we are encouraging people do to the right thing.

“We offer support and advice: it is not about being oblivious to the fact that giving up is difficult, but there is evidence that adults listen to children.”

Hywel Dda University Health Board already has a push-button system at the entrances to their acute hospitals, but said it has not stopped some people.

A spokesman said: “Everyone has the right to breathe fresh air, especially when visiting a healthcare facility, and we regularly receive complaints about people smoking on our sites.

“We understand that visiting a hospital can sometimes be a stressful experience but we expect smokers to adhere to our smoke free policy and they should anticipate being asked to leave our hospital sites if they wish to continue smoking.”

Cardiff enforcement officers challenged 6,708 smokers outside the University Hospital of Wales and University Hospital Llandough, in two years.

Trina Nealon, principal health promotion specialist for Cardiff and Vale University Health Board said hundreds of people were challenged every month.

While there have been no reported cases of verbal or physical abuse against staff challenging smokers, the board said it knows some staff feel uncomfortable challenging visitors and patients who are dealing with stressful situations.

“We are not taking away anything from anyone,” Ms Nealon said, adding that patients were given support to try and quit smoking on admission.

“How we see it is smoking is an addiction, and we are giving people an opportunity to actually give up that addiction.

“Generally speaking people are receptive and they put out their cigarette, understanding that they are in a hospital where people are there to get better and are there to get treated.”

‘Culture change’

Aneurin Bevan University Health Board said that while there had been a significant reduction in smoking at their hospitals “disappointingly there are some people who will continue to smoke despite all the messages.”

Powys was the only health board who said they had little difficulty with smoking – “possibly as a result of only having community hospitals”

While there is hope that the new legislation would help health boards to challenge smokers, they appear to be under no illusion that the threat of fines will stub out the problem for good.

“It may not stop them smoking. We are hoping that it will lead to a culture change and people will accept that smoking in a hospital setting shouldn’t be allowed,” said Ms Nealon.

Reducing Smoking Prevalence through Tobacco Taxation in Ukraine

Feb 1st, 2017
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Modeling the Long-Term Health and Cost Impacts of Reducing Smoking Prevalence through Tobacco Taxation in Ukraine

Download (PDF, 5.31MB)

Don’t head to Finland if you fancy sitting out on a veranda with a beer and a smoke.

Jan 20th, 2017
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https://www.joe.co.uk/fitness-health/one-major-european-country-looks-set-to-be-completely-cigarette-free/108228

The European country looks set to be the first in the world to become completely cigarette-free. The country originally proposed a goal of being smoke-free by 2040 but new legislation today says the goal can be achieved by 2030.

According to the Nordic version of Business Insider, the government looks set to achieve the health goal by coming down hard on smokers and retailers.

Housing associations can now enforce a smoking ban on balconies and yards belonging to the housing complex. Capsule cigarettes that activate a taste such as menthol or blackcurrant when squeezed are getting banned outright.

Retailers are charged fees for selling nicotine products and the hike in costs means selling smokes is verging on non-profitable.

Finland is the first country in the world to enforce such stringent legislation on smokers. It has been committed to reducing smoking since 1978 when it first banned the advertising of nicotine products. Smoking at the workplace has been banned since 1995 and in bars and restaurants since 2007.

According to Finland’s National Institute for Health and Welfare, smoking statistics have consistently decreased over the past 20 years. Only 17% of the population consider themselves smokers.

Up in Smoke: Finland on the Way to Completely Eradicating Tobacco Use

Jan 19th, 2017
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Finland has stepped up its efforts to completely ban tobacco smoking within its borders. A new law calling for tobacco smoking to be ended entirely by 2030, has introduced several new regulations on smokers and tobacco retailers.

https://sputniknews.com/europe/201701191049745363-finland-smoking-tobacco-eradicate-law/

The most recent regulations allow housing associations to ban smoking on lawns and balconies that they own. Cigarettes with flavor capsules embedded into their filters have been banned entirely. The fees that municipalities can charge on retailers selling tobacco has been drastically increased, as much as €500 per point of sale.

Some stores in Finland’s second largest city of Espoo have seen increases in fees in excess of 1,800 percent, and even 2,600 percent. Many retailers have claimed that the fee increases have made it unprofitable for them to sell cigarettes, and they would cease retailing the product entirely if smokers did not also buy food items alongside tobacco.

The Finnish smoking ban is so strict that it even extends to “imitation products” that do not contain tobacco or nicotine. Lakupiippu is a popular Finnish candy, a stick of liquorice shaped to look like a smoking pipe. The National Supervisory Authority for Welfare and Health (Valvira) has banned the pipes from being used in retailer loyalty programs as they “promote smoking.” Valvira’s opinion on candy cigarettes is unknown.

Finland has long led the world in banning and regulating smoking. The country banned advertisement of nicotine products in 1978, smoking in the workplace in 1995, and smoking in bars and restaurants in 2007.

The number of Finns who are smokers has steadily declined over the last 20 years, likely due to the costs and difficulties of the habit. A study with the Finnish Cancer Registry claims that “practically all Finnish men… born before the 1930’s practiced smoking.” Reports show that 18.6 percent of Finnish adults were smokers in 2009. That dropped to 17 percent in 2014 and 16 percent in 2015.

Finland is neck-and-neck with fellow Nordic country Denmark, who announced in 2016 their intention to create “the first smoke-free generation” by 2030 with a $334 million program to end smoking and other cancer risks to Danes.

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