Clear The Air News Tobacco Blog Rotating Header Image

February 25th, 2015:

Flavour chemicals in electronic cigarette fluids

Download (PDF, 523KB)

Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips.



We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia.


Between October and April 2011-12 (pre-plain packaging, pre-PP) and 2012-13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression.


Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79-0.91, P < 0.001], driven by a 23% decline in active smoking (IRR = 0.77, 95% CI = 0.71-0.84, P < 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status (SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre-PP to 73.6% of plain packs post-PP (IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre-PP and 9.5% of plain packs post-PP; IRR = 2.33, 95% CI = 1.72-3.17, P < 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P < 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation.


Following Australia’s 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion.

Tobacco industry ‘should be sued by government’ over smokers’ health costs

Australian Council on Smoking and Health says new research showing smokers’ mortality rates is ‘a national catastrophe’

The Australian government should sue the tobacco industry after landmark research found Australian smokers have a three times greater chance of dying today than a lifelong non-smoker, the president of the Australian Council on Smoking and Health says.

Up to 1.8m of Australia’s 2.7m smokers are likely to die from their habit if they continue to smoke, losing an average of 10 years of life expectancy, the first Australian large-scale study on smoking and mortality, published in the international journal BMC Medicine, found.

The study findings highlighted the extreme hazards faced by the 13% of Australians who smoked, an author of the study and director of the University of Melbourne’s global burden of disease group, Professor Alan Lopez, said.

“Australia still has a smoking problem,” he said. “Saying Australians are getting fatter, and shifting the focus towards diet and obesity should not mean we forget about tobacco, which is still a major public health problem.”

The research was led by Sydney’s Sax Institute using data from their 45 and Up study. Researchers linked health information from 204,953 study participants aged 45 and over from NSW, with data from the register of births, deaths and marriages.

Previous research from the Sax Institute found pack-a-day smokers had a fourfold risk of dying early, while the risk of death for lighter smokers was more than doubled.

The president of the Australian Council on Smoking and Health, Mike Daube, said the study revealed smoking as a “national catastrophe” because even though Australia had among the lowest smoking rates in the word, its effects were widespread.

“That smoking will kill 7.5% of Australians means it deserves a massively increased focus, and we need to keep increasing taxes on tobacco, step up public health campaigns and limit the number of outlets that sell it,” Daube said.

“It is time for the Australian government to follow what the US did about 20 years ago and sue the tobacco industry for costs incurred because of smoking, and force them to make internal documents public.

“That would bring in tens of billions of dollars which would help the budget, and enable stronger action on smoking.”

Known as the Master Settlement Agreement, the 1998 court action involved 46 US states and several of the largest US tobacco companies. The tobacco industry was forced to pay the states more than US$200bn in compensation and make public previously secret documents.

The chief executive of the Public Health Association of Australia, Michael Moore, said the research confirmed smoking as Australia’s most preventable cause of death and disease, killing even more people than previously believed.

It meant politicians and policymakers must do “everything possible” to encourage smokers to quit, he said.

“We cannot stand by and see yet more generations of Australians dying, often painful deaths, because they smoked,” he said.

“Public health leaders campaign on smoking not because of any moral fervour, but because it kills people. Now we know that it kills even more than we had thought. That is cause for deep concern and a call for strengthened action.”

Smoking ‘worse than previously thought': two thirds expected to die early

Two thirds of Australian smokers will be killed by their habit unless they are able to quit, according to a new study from the Australian National University.

The research, which was published in the international journal BMC Medicine, found smoking just 10 cigarettes a day doubled the risk of dying prematurely and that on average, smokers died 10 years earlier than non-smokers.

ANU researcher Professor Emily Banks said the study was “a huge wake up for Australia”.

“We knew smoking was bad but we now have direct evidence from Australia that shows it is worse than previously thought.

“Our findings show that up to two in every three of these smokers can be expected to die from their habit if they don’t quit and this highlights the importance of staying the course on tobacco control.”

The four-year study assessed the health outcomes of more than 200,000 people who participated in a program coordinated by the Sax Institute in Sydney.

Professor Banks said Australians should be proud of reducing smoking rates to just 13 per cent of the population – a world leading result – despite around 2.7 million people continuing to smoke.

The report found the average duration of a smoking habit was 38.5 years with the majority smoking for more than 35 or more years, consuming at least 15 cigarettes a day.

“In Australia, male and female smokers were estimated to have the same risks of death 9.6 and 10.1 years earlier than 75-year-old non-smokers, respectively,” the report said.

“Death rates in current smokers were around three times those of people who had never smoked, in both men and women.

“On average, smokers died around 10 years earlier than non-smokers, over the ages examined.”

The report also found mortality rates among heavy smokers were even higher.

“Mortality rates approximately doubled in those smoking around 10 cigarettes per day and four to five-fold those of never-smokers in current smokers of 25 or more cigarettes per day,” the report said.

The survey demonstrated continuing harms of smoking despite tobacco control measures and the need for continuing attention and controls.

“The introduction of plain packaging for cigarettes in Australia in 2012 is an example of the continuing efforts required,” the review said.

Despite the alarming findings, the chief executive of Heart Foundation Kerry Doyle said the government was driving down smoking rates through tax increases and plain packaging.

“Higher tobacco prices have been shown to be the most effective intervention available to governments to reduce demand for tobacco,” she said.

“With smoking being a major cause of cardiovascular disease, including heart attack, stroke and peripheral vascular disease the more deterrents people have between them and smoking, the better.”

The Cancer Council’s tobacco control manager, Scott Walsberger, said it was never too late to stop smoking “no matter what your age or how much you smoke”.

“People often underestimate the urgency for quitting and many are not aware of how damaging even light smoking is for cancer and other preventable illnesses,” he said.

Public Health Association of Australia president Mike Daube said the report demanded a strategic rethink and a ban on all tobacco industry promotion, including lobbying and public relations.

“If anything else caused that death toll it would be seen as a national catastrophe,” he said.

“Australia is a global leader, but 1.8 million deaths – 7.5 per cent of the Australian population – demands a different level of action

“We need a clear plan from governments to reduce that toll to an absolute minimum – further tobacco tax increases, strong mass media campaigns, protection for non-smokers and support for disadvantaged groups.”

Two thirds of smokers will die of the habit – study

The new study from the Australian National University, published in BMC Medicine, provides what the researchers say is the first large-scale direct evidence on the relationship of smoking to mortality in Australia.

It said of Australia’s 2.7 million smokers, 1.8 million would die from preventable cancer.

The paper’s author, epidemiologist Emily Banks, said she studied a sample size of 200,000 people over a four-year period.

“We found that people who were current smokers during that time had around a three-fold increase in the risk of dying over that period, compared to people who had never smoked.

“This means that up to two-thirds of smokers will die from their habit.”

Professor Banks said the study also found even light smoking was lethal.

“People who smoke on average, say, ten cigarettes a day have a doubling in their risk of dying prematurely.

“That’s equivalent to being morbidly obese, so having a body mass index of 35 or more, or drinking a bottle of vodka a day.”

Stopping smoking reduces the risk and the earlier smokers give up the greater the reduction in mortality.

Read the full report here.

Professor Banks said the research showed how the deadliness of smoking had evolved over time, as people continued to smoke for longer.

The President of the Australian Council on Smoking and Health Professor Mike Daube said the research adds pressure on governments to step-up anti-smoking campaigns.

“Seven and a half percent of the population now alive will die because they smoked. It will be pretty similar in New Zealand. If that’s not a top priority for governments I don’t know what can be,” said Professor Daube.

“We’re calling for (increased anti-smoking campaigns) in Australia and I hope that in New Zealand this will determine the government to move towards that smokefree by 2025 target.

“I hope it will ensure they maintain any action they’re taking and that they move ahead with the introduction of tobacco plain packaging, which is such an important step forward,” he said.

The New Zealand Cancer Society’s Health Promotion Manager Jan Pearson said it was a wake up call for the New Zealand government, which she said was not on track to meet its 2025 smokefree target.

“We need more mass media, and we need comprehensive cessation services tailored to community needs. We need effective legislation and regulation, which means higher taxes. We need a sudden increase which tobacco companies can’t manipulate.

“We can achieve the goal, we’ve only got ten years,” Dr Pearson said.

Flavour chemicals in electronic cigarette fluids

Download (PDF, 523KB)