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February 22nd, 2010:

In preparation to the Vote on the Budget, an Open Letter to the HK Government on Tobacco Tax

ashtrayPrice measures have been shown around the world to be the single, most effective measure in reducing tobacco use, especially among the young. Tobacco is responsible for 7,000 deaths and community costs of more than five billion dollars annually in Hong Kong. We urge the Government to review its tobacco control strategy and ensure that in particular its legislative and fiscal measures are comprehensive, coherent and rigorously enforced. The protection of young people from addiction to tobacco should be one of our highest public health priorities.

Read the full letter – download the English PDF.

Download the Chinese PDF here.


All designated smoking areas in airports to go


Fiste published: February 22, 2010

Source: Gulf Times

Acting on reservations expressed by the Tobacco Control Cell, the Civil Aviation Authority (CAA) of Pakistan has instructed all airport managers to remove or dismantle the structures of all Designated Smoking Areas (DSAs) functioning within passenger lounges, and to strictly follow and implement laws that prohibit smoking in places of public use or work.

“The structures of designated smoking zones in airport lounges, including VIP lounges, should be dismantled or removed,” instructs a written order issued to all airport managers by Regional Director South Hanif Khattak on Friday.

The letter also states that signs saying ‘Smoking is banned in airport lounges’ should be displayed at prominent places at airport lounges, toilets and other places; and that arrangements should be made to facilitate anti-smoking passengers to be able to complain in case they observe a fellow passenger smoking in an airport lounge, toilet or any other place within the airport.


Bay Area Smokers Beware; a Crackdown Is in the Air

The governator smokes here

First published: February 22, 2010

Source: The New York Times

It was a typical photo of teenage mischief, posted on MySpace last fall, featuring four cheerleaders from California High School in San Ramon at a party. The event did not happen on campus or during class hours, but when the coach saw the picture, her reaction was swift: two-week suspensions from the squad.

The girls’ crime: smoking from a hookah — not any illegal drug either, but tobacco.

“The girls admitted to smoking tobacco,” said Eileen Mantz, the school’s athletic director. “This just holds them and their parents accountable.”


Taiwan to include tobacco in film rating scheme

Three  Caballeros

First published: February 22, 2010

Source: Philippine Daily Inquirer

Taiwan is planning to change its movie rating system to take account of characters who smoke, the government said Saturday, as part of a bid to reduce the number of youngsters taking up the habit.

The Department of Health wants to make tobacco use one of the criteria for deciding what age rating to give a film, a move that could mean some animated movies are out of bounds for children.

“Smoking (in movies) has a much worse impact on health than sex and violence,” the department said in a statement posted on its website.


Risk factors for lung cancer in people with HIV: smoking vastly outweighs HIV

NAM, Keith Alcorn, 2010-2-17

Smoking vastly outweighs HIV infection as a risk factor for lung cancer in people with HIV, a large study of US veterans has revealed.

The findings, from the United States Veterans Administration Aging Cohort Study, were presented today at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco.

The risk of lung cancer is known to be increased in people with HIV, but until now there has been no clarity about the relative contributions of HIV infection and other risk factors to the likelihood of developing lung cancer.

The Veterans Administration provides care for large numbers of ex-military personnel in the United States, and so provides a large population for the study of HIV-related conditions.

This study took individuals with HIV from the Veterans Aging Cohort Study and matched each one with two individuals of similar age, race and gender.

The cohort was then refined by eliminating all those who had not provided detailed smoking information to a 1999 study of health behaviours, to ensure that detailed baseline information on smoking was available for all participants.

The cohort for analysis comprised 3707 people with HIV (98% male) and 9980 HIV-negative controls, who had been followed for a median of eight years.

The only significant differences between the HIV-positive and HIV-negative groups were in smoking habits (32% of people with HIV smoked daily, compared to 28% of people without HIV infection), history of drug or alcohol abuse (16% vs 10%), and in the incidence of lung cancer during the study (see below).

Investigators used cancer data from cancer registries to ascertain the baseline prevalence and longitudinal incidence of cancer in the cohort.

During a total of 28,500 person years of follow-up, the incidence of lung cancer among patients with HIV was 0.26 per 100 person years. There were 76,800 person years of analysis available for the HIV-negative controls, and their incidence of lung cancer was 0.16 per 100 person years.

After controlling for potentially confounding factors, the investigators calculated that patients with HIV had an 80% increase in the risk of lung cancer (risk ratio, 1.80; 95% confidence interval [CI], 1.28-2.15).

However, current smoking hugely outweighed HIV as a risk factor for lung cancer.

Calculation of the adjusted incidence rate ratio showed an incidence rate of 1.80 for HIV, compared to 9.80 (95% CI 4.4-21.4) in current daily smokers, and an incidence rate of 5.1 (95% CI 2.4-11.2) in people who had stopped smoking at least a year prior to entering the study (so-called distant quitters).

Current occasional smoking was associated with a threefold increase in incidence (3.4, 95% CI 1.0-11.6), while chronic obstructive pulmonary disease (COPD) was associated with an incidence of 1.50 (95% CI 1.1-2.1).

Dr Keith Sigel of Mount Sinai School of Medicine, who presented the findings, told aidsmap: “Stopping smoking is now my second priority at every HIV patient visit and I raise it with every patient at every visit because of the cancer and the cardiovascular risk. Patients with HIV tend to be younger than the average internal medicine patient and so will have many more years of potential smoking exposure if they continue.”

The researchers plan to conduct further analyses to look at the interaction between immunodeficiency and smoking as risk factors for lung cancer, as well as the influence of duration of smoking.

In a second study on cancer and HIV presented at the conference, Dr Michael Silverberg reported that a low CD4 count was associated with an increased risk of a number of non-AIDS defining cancers.

Investigators from Kaiser Permanente in California identified 20,227 HIV-infected individuals and 202,313 HIV-negative controls who were matched for age and sex.

Cancer registries showed that the most common non-AIDS-defining cancers in individuals with HIV were anal, prostate, lung, melanoma, Hodgkin’s lymphoma, oral/throat, and colorectal cancers.

The incidence of cancers in both the HIV-positive and HIV-negative controls was monitored between 1996 and 2007. The cancer risk for those with HIV was stratified by CD4 cell count and viral load, and the results were controlled for potentially confounding factors including age, sex, smoking, alcohol and drug use, hepatitis co-infections, and diabetes.

The risk of cancers of the anus, lung, mouth and throat and Hodgkin’s lymphoma were all increased in patients with HIV.

Compared to the HIV-negative controls, patients with CD4 cell counts below 500 cells/mm3 had an increased risk of anal cancer (p < 0.001) and Hodgkin’s lymphoma.

A CD4 cell count below 200 cells/mm3 significantly increased the risk of lung cancer (p < 0.001) and cancers of the mouth and throat (p < 0.001).

Compared to HIV-negative controls, the risk of anal cancer was especially high for patients with the lowest (<200) CD4 cell counts (hazard ratio [HR], 164.2, p < 0.001).

But the researchers found that even HIV-infected patients with CD4 cell counts above 500 cells/mm3 were more likely than HIV-negative individuals to develop anal cancer (HR = 34.2, p < 0.05) and Hodgkin’s lymphoma (HR = 11.6, p < 0.001).

Sigel K et al. HIV infection is an independent risk factor for lung cancer. Seventeenth Conference on Retroviruses and Opportunistic Infections, abstract 30, San Francisco, 2010.

Silverberg M et al. Immunodeficiency, HIV RNA levels and the risk of non-AIDS-defining cancers. Seventeenth Conference on Retroviruses and Opportunistic Infections, abstract 28, San Francisco, 2010.

Further information
You can view abstract 30 and abstract 28 on the official conference website.

Healthy tax for New York, Sharon Fischer-February, 2010-2-20

Maintaining adequate funding for New York’s Tobacco Control Program and increasing the tobacco excise tax by $1 are wise strategies to contribute to the health and financial stability of the residents of New York State.

If you think tobacco use and tobacco excise taxes don’t affect you, think again. Both measures are effective in deterring youth from initiating smoking and assisting established smokers to quit. Lower smoking rates, in turn, reduce the costs to treat illnesses caused by tobacco use. Each New York household pays $822 in state and federal taxes for treatment of smoking-related diseases, a burden New Yorkers cannot continue to pay.

New York‘s Tobacco Control Program is one of the few state programs that is required to be assessed annually by an independent evaluator. Research Triangle Institute, the program evaluator states, “The TCP’s efforts have led to declines in youth and adult smoking rates that have outpaced national declines from 2003 through early 2008.” History shows us that when other states have reduced their tobacco control budgets, higher smoking rates among youth and adults resulted, in turn causing increases in health care costs to treat the tobacco-related illnesses that ultimately result.

An increase in the price of tobacco is also an effective deterrent to youth smoking and a strong motivator to quit among adult smokers. Every 10 percent increase in the price of cigarettes will reduce youth smoking by about 7 percent and overall cigarette consumption by about 4 percent.

According to estimates by the Campaign for Tobacco-Free Kids, an increase of $1 per pack would be expected to prevent more than 100,000 children from becoming smokers and cause more than 50,000 adult smokers to quit. In New York, 59 percent of adults support a $1 increase in the cigarette tax. If revenue from the tax is used to help smokers quit, 77 percent of New Yorkers support a tax increase.

Both of these measures – increasing the excise tax on tobacco and maintaining funding for New York’s Tobacco Control Program – directly contribute to the personal and financial health of the residents of New York State.

Sharon Fischer is tobacco control coordinator for the Broome County Health Department