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SmokeFree Tasmania and Minister trade barbs

A war of words has erupted between the Health Minister Michael Ferguson and advocacy group, SmokeFree Tasmania, after it accused the government of bowing to the wishes of big tobacco companies.

http://www.examiner.com.au/story/4691300/government-slams-smoke-group-claims/

The stoush comes after Tasmania was named runner-up in the Australian Medical Association’s Dirty Ashtray Award – for governments that make the least effort to reduce smoking.

Responding to the second placing, Health Minister Michael Ferguson said the state would achieve better scores from the association as more policies aimed at reducing smoking rates were implemented.

But SmokeFree Tasmania north member Harley Stanton said the government had included suggestions from big tobacco companies to formulate its Healthy Tasmania Strategic Plan.

“Given that the Tasmanian government, in its healthy Tasmania policy, included advice from Imperial Tobacco it is not surprising that they have been nationally rebuked,” he said.

“This is both embarrassing internationally and bad conduct for any government.”

Fellow SmokeFree Tasmania adviser Kathryn Barnsley said the government needed to distance itself from tobacco companies.

She said the benefit of the government’s crusade on the illicit tobacco market benefited tobacco companies, like Imperial Tobacco.

“The tobacco industry wants the government to crack down on illicit tobacco, but the illicit market is not a health problem,” she said.

But Mr Ferguson slammed the comments as “complete and utter rubbish”.

“I also point out for the record that last year, the government proposed as part of the five-year plan raising the smoking age to 21, and SmokeFree Tasmania aggressively campaigned against it which is inexplicable,” he said.

Dr Barnsley said the government had also failed to provide more money for mass-media campaigns to reduce smoking rates.

Dr Stanton criticised the government’s health expenditure announced in last week’s budget.

“Prevention is better than a cure and reducing the number of people smoking will take pressure off our hospitals,” he said.

Indonesian teachers group declares anti-tobacco stance

Ahead of World No Tobacco Day on May 31, Indonesia’s largest teachers group signed on Wednesday a declaration to underline the role of educators in supporting measures for tobacco control.

http://www.thejakartapost.com/news/2017/05/24/indonesian-teachers-group-declares-anti-tobacco-stance.html

Created by the Indonesian Teachers Association (PGRI), the declaration consists of six points, which include teachers’ commitment to “protect students from the dangers of smoking” and “oppose CSR [Corporate Social Responsibility] campaigns from the tobacco industry.”

Teachers also called on the government to create a comprehensive tobacco control regulations to curb cigarette consumption.

“Teachers have to be role models for their pupils by not smoking […] Exemplary acts by teachers are very strategic in the [anti-tobacco] campaign,” PGRI chairwoman Unifah Rosyidi said at the declaration’s signing event in Kuningan, South Jakarta, on Wednesday.

The event was organized by the National Commission on Tobacco Control (Komnas PT), a coalition of organizations that has been staunchly campaigning for tobacco related issues in Indonesia, one of the world’s biggest tobacco consumers.

Komnas PT chairman Prijo Sidipratomo welcomed the declaration, saying that it was in line with one of PGRI’s missions to support the country’s development.

“Some 25 percent of students’ daily time is spent at school, which highlights the role of teachers in shaping their way of life,” Prijo said. (rin)

Cuba Updates its Regulations Related to Tobacco Consumption

Updating the existing regulations to control smoking in public places is part of Cuba”s campaign to celebrate World No Tobacco Day, to be held on May 31.

http://www.plenglish.com/index.php?o=rn&id=13257&SEO=cuba-updates-its-regulations-related-to-tobacco-consumption

The head of the Department of School Health at the Ministry of Education (Mined), Yanira Gomez, reminded at a press conference held in this capital that since 1974 there is a regulation that prohibits smoking in institutions and state entities, including schools.

The regulations are designed to be effective, taking into account the particularities of each educational system; and despite the existing literature, it is also necessary to promote initiatives that contribute, from the methodology to the stipulated in the legal framework already established, said Gómez.

World No Tobacco Day was established by the World Health Organization and its partners in order to highlight the health risks associated with smoking and to advocate for effective policies to reduce its consumption.

This year’s campaign aims to mobilize the main social actors, as well as adolescent and young children, in the fight against exposure to tobacco smoke and in terms of sustainable development.

CIGARETTE FILTERS MAY INCREASE LUNG CANCER RISK

A study’s authors argue that tiny ventilation holes in virtually all cigarettes sold today are creating a new health risk.

http://ewn.co.za/2017/05/23/cigarette-filters-may-increase-lung-cancer-risk

Cigarette filters, introduced decades ago to reduce the amount of tar smokers inhale, also alter other properties of smoke and smoking in a way that raises the risk of lung cancer, researchers say.

In a review of research on changes in lung cancer rates, and changes in the types of lung cancer that are most common, the study authors argue that tiny ventilation holes in virtually all cigarettes sold today are creating a new health risk.

“The design of cigarette filters that have ventilation can make the cigarettes even more dangerous, because those holes can change how the tobacco burns, allow smokers to inhale more smoke and to think that the smoke is safer because it is smoother,” senior author Dr. Peter D. Shields from The Ohio State University’s Wexner Medical Center in Columbus told Reuters Health by email.

“This applies to all cigarettes, because almost all the cigarettes on the market have the holes, not just the ones that used to be called lights and ultra-lights,” he noted.

Although rates of lung cancer in the population have fallen with declines in smoking overall, rates of lung cancer among smokers have risen significantly, the researchers point out. And the type of lung cancer associated with smoking has also shifted since the 1950s.

Rates of adenocarcinoma of the lung, the lung cancer most associated with smoking, have more than quadrupled in men and increased eight-fold in women along with changes in the design and composition of cigarettes since the 1950s, the researchers write.

Shields and his team review the evidence linking cigarette filter ventilation to these increased rates of lung cancer in a report online 22 May in the Journal of the National Cancer Institute.

Filter ventilation reduces the amount of tar in the cigarette smoke when tested on smoking machines, but the increased ventilation and slower tobacco burn result in more puffs per cigarette and more toxic cancer-causing chemicals being inhaled by smokers, they write.

“The use of the ventilation holes yields lower tar only on a machine,” Shields said. “Machines have nothing to do with actual exposures in humans. The holes let them actually inhale more smoke with more cancer-causing agents.”

Because of the claims of lower tar content, though, smokers develop the false belief that a lower tar cigarette is a healthier cigarette, Shields’ team writes.

Increased filter ventilation also results in smaller particle size, allowing more smoke to reach vulnerable parts of the lung.

Moreover, even though machine-measured tar and nicotine levels have decreased over time, there has been no appreciable change in daily nicotine intake among smokers over the past 25 years, they write.

“The evidence shows that more modern cigarettes are more risky for lung cancer,” Shields said. “There are reasons in addition to the holes that also can contribute to the increasing risk, but one does not preclude the other.”

Cigarette designs could and should be regulated to address all the possible reasons, Shields said.

“The holes have no health benefits; they serve no health purpose,” he explained. “They do not lower tar delivery to people. So, if they have the potential harm, the FDA can act, even if the science is not perfect. The FDA can require cigarette manufacturers to make filters without the holes. This is easy and they are doing it for some brands already.”

Having filters may indeed be safer, Shields clarified. “This study is about the holes on the filters. We are not saying to remove filters, only to change their designs by removing the holes on the filters.”

“The FDA now has the authority to require the elimination of filter ventilation, as ventilation does not serve any public health purpose and instead provides a false promise of reduced risk,” the study team concludes.

“This single action for banning filter ventilation by the FDA is scientifically justified, and within its mandate to improve the public health,” they write.

There is some precedent for the ban Shields and colleagues propose, Jonathan M. Samet and Lilit Aladadyan, both from the Tobacco Center of Regulatory Science at the Keck School of Medicine of USC and the USC Institute for Global Health in Los Angeles, write in an accompanying editorial.

The evidence gathered by Shields’ team seems strong enough to support FDA action, and “given a lack of evidence for countervailing harms, ending filter ventilation could be a ‘no regrets’ action that would benefit public health,” they write.

The Hole Story: Ventilated Filters Make Smoking More Deadly

The ventilation systems built into cigarette filters in the mid-1960s to reduce tar and make smoking ‘smoother’ and ‘safer’ were responsible for the paradoxical rise in rates of lung adenocarcinoma — even as rates of other lung cancer subtypes dropped along with the number of smokers. These conclusions were in the 2014 US Surgeon General’s report on the health consequences of smoking.

http://www.medscape.com/viewarticle/880383

Now, two new weight-of-evidence reviews have pinpointed 25 “causation analysis evidence blocks” that could support an outright ban of filter ventilation, according to lead author, Peter G. Shields, MD, deputy director of the Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, in Columbus, and colleagues.

The review found that between the 1960s and the 1980s, the health risks associated with smoking jumped almost 2-fold in men and increased 10-fold in female smokers. At the same time, the relative risks for adenocarcinomas rocketed from 4.6 to 19.0 in men and from 1.5 to 8.1 in women — even though the risks for other lung cancer subtypes didn’t increase. “Thus, there was a paradoxical increase for lung adenocarcinomas while squamous cell cancers decreased with decreased smoking rates,” the review authors write.

“The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers,” they say in a report published online May 22 in the Journal of the National Cancer Institute.

“Based on these weight-of-evidence reviews, the FDA [Food and Drug Administration] should embark on a regulatory process of data evaluation and consider regulation(s) for the use of ventilation in filters, up to and including a ban on their use,” the authors conclude.

“The prime point is to rally the troops to get the FDA to focus on this,” Dr Shields told Medscape Medical News. “To me, this is a policy paper. Physicians can’t be silent.”

This is a policy paper. Physicians can’t be silent. Peter D. Shields

Ventilation holes in filters are now found in nearly every brand of cigarettes, and they make smoking even more deadly, Dr Shields elaborated in an interview.

The tiny filter holes slow down tobacco combustion, giving smokers more puffs per cigarette but also allowing more toxic constituents to form, increasing the mutagenicity of the smoke, the review authors explain. To get the requisite nicotine hit from a cigarette with a ventilated filter, a smoker must also inhale more deeply, drawing smoke farther into the lungs and exposing cells vulnerable to adenocarcinoma.

Increasing amounts of tobacco-specific nitrosamines can also be found in new blended tobaccos that provide a “smoother” smoking experience, albeit with more carcinogens, Dr Shields commented. This makes smoking more dangerous than ever before, and patients need to know this, he emphasized.

“As part of your risk counseling, tell patients who smoke that the cigarettes today are more deadly than the cigarettes from 30 or 40 years ago. We need to take away smokers’ perception that any cigarette is safe. It’s like putting your head in a chimney,” Dr Shields said.

Increased Risk for Adenocarcinoma

In an accompanying editorial, Jonathan M. Samet, MD, and Lilit Aladadyan, MS, MPH, say that ending filter ventilation “could be a ‘no regrets’ action that would benefit public health.”

Dr Samet is professor and Flora L. Thornton Chair for the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California (USC) in Los Angeles, and Aladadyan is center director for the USC Tobacco Center of Regulatory Science.

The editorialists note the review looked at a “large and somewhat poorly circumscribed body of literature” and that the evidentiary threshold required for the FDA to take action is not supported by any record of precedents.

However, they also say that the review’s conclusion about the contribution of filter ventilation to rising rates of lung adenocarcinoma in smokers “is well justified” and supports “the indictment of filter ventilation as increasing risk for adenocarcinoma.”

Filter ventilation was originally designed to lower smoking machine tar yields in so-called light cigarettes marketed primarily to women as a “healthier” alternative to regular cigarettes. “This was done to fool smokers and the public health community into thinking that they actually were safer,” Dr Shields said in a statement.

In 2009, the Family Smoking Prevention and Tobacco Control Act gave the FDA authority to ban tobacco companies from labeling and marketing cigarettes as “low tar” or “light.”

Dr Shields has served as an expert in class action suits against tobacco companies marketing light cigarettes as a healthier alternative. He’s also heard lawyers for Big Tobacco say peer-reviewed evidence was needed. “From our perspective, there is more than enough data to start the process and it’s time for regulation,” he said. “We believe that such an action would drive down the use and toxicity of conventional cigarettes and drive smokers to either quit or use less harmful products. There are some open questions about unintended consequences for enacting a ban, which provides for an important research agenda.”

Future clinical trials could assess smokers switching to filtered cigarettes without ventilation, using a panel of biomarkers to measure exposure to carcinogens and lung toxicants, markers of oxidative damage and inflammation in lung, blood, or/and urine, the review authors suggest. At present, human exposure biomarker studies do not appear to support a causal relationship, they didn’t measure exposure in the lung or “utilize known biomarkers of harm,” they note.

Smokers’ perceptions, and transition to alternate products, should also be assessed, looking at differences by race and ethnicity, sex, age, and vulnerable populations. The effect of filter ventilation on the risk for other diseases, such as chronic obstructive pulmonary disease, could also be studied, they say.

This study was supported by the National Cancer Institute of the National Institutes of Health and the FDA Center for Tobacco Products. Dr Shields and coauthors Neal L. Benowitz, MD, and Theodore M. Brasky, PhD, disclose they have served as consultants and expert witnesses in litigation against tobacco companies. Coauthor K. Michael Cummings, PhD, MPH, declares a relationship with Pfizer Inc. The study authors and editorialists have disclosed no relevant financial relationships.

Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

https://academic.oup.com/jnci/article-abstract/109/12/djx075/3836090/Cigarette-Filter-Ventilation-and-its-Relationship?redirectedFrom=fulltext

The 2014 Surgeon General’s Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from “lighter” smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.

Doctor honoured for fight against tobacco

Cancer specialist U.S. Vishal Rao of Bengaluru has been honoured with the 2017 Judy Wilkenfeld Award for International Tobacco Control Excellence for his role in combating tobacco use. Dr. Rao was presented the award on Wednesday at an event organised by the Campaign for Tobacco-Free Kids in Washington D.C.

http://www.thehindu.com/todays-paper/tp-national/tp-karnataka/doctor-honoured-for-fight-against-tobacco/article18443143.ece

His efforts led to a ban on gutka, chewing tobacco and e-cigarettes in Karnataka. However, the State government recently overturned the ban on chewing tobacco.

Dr. Rao is a member of the High-power Committee on Tobacco Control instituted by the government of Karnataka. He is the inventor of a Rs. 50 voice box prosthetic for throat cancer patients whose larynx has been removed.

Speaking over telephone from Washington DC, Dr. Rao said, “The committee gave the award in recognition of the steps taken towards implementing the Cigarette and Other Tobacco Products (Prohibition) Act, and how Karnataka led the way. Another was implementation of the ban on gutka and chewing tobacco by the government of Karnataka.”

The Wilkenfeld Award was established in honour of Judy Wilkenfeld, founder of Tobacco-Free Kids’ international program. Dr. Rao is the second Indian to receive the award, the first being Pankaj Chaturvedi of Tata Memorial Hospital in 2013.

What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Anti-smoking group seeks to raise legal smoking age to 20

Around one billion people will die from tobacco-related causes by the end of the 21st century if current smoking patterns continue…

http://www.taiwannews.com.tw/en/news/3159764

Taiwan’s anti-smoking group held a press conference on Wednesday calling for higher legal smoking age and completely smoke-free workplaces and indoor public places.

The group has called on the Legislature to revise the nation’s Tobacco Hazards Prevention Act comprehensively to correspond to the requirements of the WHO’s Framework Convention on Tobacco Control (WHO FCTC).

WHO FCTC is the first treaty negotiated under the auspices of the World Health Organization that was developed in response to the globalization of the tobacco epidemic.

Democratic Progressive Party (DPP) legislator Chen Man-Li (陳曼麗) and Kuomintang (KMT) legislator Ko Chih-En (柯志恩) both showed up to the press conference today in support of the group.

Taiwan Heart Foundation’s Chairman Lue Hung-chi (呂鴻基) said today that around one billion people will die from tobacco-related causes by the end of the 21st century if current smoking patterns continue.

Major changes that the group has called for include bans on smoking in all workplaces and indoor public places, increase the size of warnings on tobacco packs to 85% of the surface area and with mandatory plain packaging, bans on sponsorship from tobacco companies, bans on the sale of flavored cigarettes, extend all the smoking-related bans to include e-cigarettes, and raise the legal age for smoking from 18 to 20.

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.