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March 12th, 2015:

Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products

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Plain packaging to thank for Australia’s decline in smoking, says Labor

http://www.theguardian.com/society/2015/mar/12/plain-packaging-to-thank-for-australias-decline-in-smoking-says-labor

Tobacco consumption fell 2.9% in quarter and 12.2% over the year, two years after plain-packaging legislation came into effect

Australia’s plain packaging: the British House of Commons has just voted to adopt similar legislation. Photograph: Lukas Coch/AAP

Australia’s plain packaging: the British House of Commons has just voted to adopt similar legislation. Photograph: Lukas Coch/AAP

Australians are ditching cigarettes at record levels, with the latest quarterly figures from the Australian Bureau of Statistics (ABS) showing a fall of nearly 3% in tobacco consumption.

The seasonally-adjusted figures for the December quarter show a 2.9% fall in consumption, contributing to a 12.2% yearly fall from December 2013 to December 2014.

Labor attributes the decline in smoking to its plain packaging legislation, which saw all branding removed from cigarette packs from December 2012.

“That takes the total fall in tobacco consumption to a staggering 12.8% in the two years since Labor’s plain packaging laws came into effect,” the opposition health spokeswoman Catherine King said.

“The minister welcomes any decrease in smoking rates and believes several factors have likely contributed, including education campaigns, excise increases and plain packaging,” a spokesman for the assistant health minister, Fiona Nash, told Guardian Australia.

A spokesman for British American Tobacco Australia, Scott McIntyre, told said plain packaging had little to do with the reduction.

He said successive governments’ decision to hike up prices has meant more smokers are buying cigarettes from the black market or opting for cheaper brands.

“Just because people are spending less money on tobacco doesn’t mean they’re reducing the amount the smoke, in fact many are smoking more for less,” McIntyre said.

“Instead of quitting, smokers are looking for cheaper options. Australia’s three million smokers are speaking with their wallets and literally walking into their local retailers and asking for the cheapest pack on the shelves.”

Overnight, the British House of Commons voted to adopt similar legislation by 367 votes to 113.

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The Australian Council on Smoking and Health said Australia has been a pioneer in the area of plain packaging.

“The British decision is especially important, as many countries still look to the UK as an exemplar. Several other countries are now planning to introduce plain packaging, following Australia – legislation last week in Ireland, and now the UK,” its president, Mike Daube, said.

“The British decision to introduce plain packaging is a massive victory for public health and a tremendous vindication for Australia’s world-leading legislation.”

Branding will be banned from cigarette packets in the UK from May 2016.

“As feared by tobacco companies, Australia’s lead is now creating an unstoppable momentum, with France set to follow and the entire European Union now likely to soon move to plain packaging. Labor’s example in staring down the ferocious legal attacks from big tobacco are now inspiring the rest of the world to follow this major advance in public health,” King said.

“It is understandable why the tobacco industry thinks plain packaging is a bad thing. But the evidence, and the momentum, is clear and Labor now looks forward to other nations joining the UK and Ireland in following Australia’s lead.”

Report: Raising Legal Age for Tobacco Would Stop, Delay Use

http://www.nytimes.com/aponline/2015/03/12/us/ap-us-tobacco-legal-age.html

RICHMOND, Va. — Raising the legal age to buy tobacco to higher than 18 would likely prevent premature death for hundreds of thousands of people, according to a report issued Thursday by the Institute of Medicine.

The report examines the public health effects of increasing the age to 19, 21 or 25. While it doesn’t make any recommendations, officials say, it provides the scientific guidance state and local governments need to evaluate policies aimed at reducing tobacco use by young people.

It also adds backing to government efforts to reduce the death and disease caused by tobacco on the heels of the 50th anniversary of the landmark 1964 surgeon general’s report that launched the anti-smoking movement.

Most states currently have set the age at 18, which is the federal minimum. Four states have set the age at 19 and several localities, including New York City, have raised the minimum age to 21. Increasing the federal age would take an act of Congress, which mandated the report in a 2009 law that gave the Food and Drug Administration authority to regulate tobacco.

The report concluded that if it were to be raised to 21 now, it would result in about 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost for people born between 2000 and 2019 when they reach their 40s and 50s.

Survey results released by the Centers for Disease Control and Prevention in June showed fewer than 16 percent of the teens smoked a cigarette in the previous month — the lowest level since the government started doing the survey in 1991, when the rate was more than 27 percent. Another CDC study had already put the teen smoking rate below 16 percent.

According to Thursday’s report, 90 percent of daily smokers first tried a cigarette before the age of 19 and nearly all others tried their first cigarette before 26.

If the minimum age were to be raised to 19 today, the report says, there’d be about a 3 percent decrease in smoking prevalence in 2100. That decrease would rise to 12 percent if it were to be raised to age 21 and 16 percent if it were raised to age 25.

“We have reasonable confidence that there will be substantial public health benefits by raising the age,” said the report’s committee chair, Richard J. Bonnie, a medicine and law professor and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville.

Raising the age limit could be one tool in reducing smoking but “powerful interventions are needed to keep youth from life-long addictions to these deadly products,” Chris Hansen, president of the American Cancer Society Cancer Action Network, said in a statement.

Richmond, Virginia-based Altria Group Inc., owner of the nation’s biggest cigarette maker, Philip Morris USA, said in a statement that it was reviewing the report, calling the issue “complex,” but believes state and local governments should wait for the FDA and Congress to act.

In a separate statement, No. 2 tobacco company Reynolds American Inc., based in Winston-Salem, North Carolina, called age limit “an important issue for discussion,” and encouraged states to strengthen laws banning youth purchase and possession and enforce existing laws.

Study Supports Raising Tobacco-Purchase Age to 21

Congress-mandated report says raising age from 18 will cut number of 15- to 17-year-olds who start smoking

http://www.wsj.com/articles/study-supports-raising-tobacco-purchase-age-to-21-1426172582

A government-commissioned study supports increasing the tobacco purchase age to 21 from 18, saying it would decrease early deaths, cut low birth weights and “substantially” reduce the number of 15- to 17-year-olds who begin smoking.

Only Congress, which required that the U.S. Food and Drug Administration commission the report, has the power to increase the tobacco purchase age nationally. States and cities can raise the age in their jurisdictions.

The report by a panel at the independent Institute of Medicine examined the impact of increasing the age to 19 on teenagers. The committee also looked at how raising the age to 21 would affect 18- to 20-year-olds, and how boosting it to 25 would affect 21- to 25-year-olds.

It concluded that increasing the age above 18 would most affect 15- to 17-year-olds, and found the impact of increasing the age to 21 “would be substantially higher than…19,” but the impact of raising it beyond 21 would be “considerably smaller.”

The report adds momentum to a state and local grass-roots movement to raise the legal age for buying cigarettes and other tobacco products to 21, a trend that poses a serious challenge for the $100 billion U.S. tobacco industry.

Raising the age would immediately deprive the industry of as much as 2% of sales, according to an estimate published last year in the American Journal of Public Health by Jonathan Winickoff, associate professor of pediatrics at Harvard Medical School.

Tobacco companies differed in their reactions to the report. Marlboro-maker Altria Group Inc. said Thursday that local governments should let the FDA and Congress weigh in before changing age limits. Newport-maker Lorillard said it supports current minimum age laws. Camel-maker Reynolds American Inc. said it would leave the minimum age up to city, state and federal authorities. In a statement, Reynolds American said, “We are opposed to youth use of tobacco and agree that the minimum age of purchase is an important issue for discussion.”

Several cities recently raised the minimum purchase age to 21, including New York, Evanston, Ill., and Columbia, Mo., as did about 50 towns in Massachusetts. The majority of states have set the minimum age for tobacco purchases at 18. Four states have it at 19. The restrictions typically apply to all tobacco products, including cigars, moist snuff and electronic cigarettes.

The Institute of Medicine report estimates that increasing the tobacco purchase age to 21 would eventually reduce the number of Americans who smoke by 12% and result in 249,000 fewer premature deaths related to cigarette smoking for people born between 2000 and 2019. It also would result in about 286,000 fewer pre-term births and 438,000 fewer babies born with low birth weights.

“We hope and expect there will be substantial consideration at the state and local level of the findings of this report,” said Richard Bonnie, the chairman of the Institute of Medicine committee and a University of Virginia School of Law professor.

An estimated 42 million Americans smoke. About 16% of high-school students reported smoking a cigarette in the 30 days prior to a 2013 survey by the Centers for Disease Control and Prevention. The number of high-school smokers is a record low, down from 19.5% in 2009 and 35% in 1999.

Increasing the legal age would help disrupt cigarette use before it becomes ingrained as an adult habit. Nearly nine out of 10 smokers first light up by age 18, and 99% start by 26, according to a 2012 report by the U.S. Surgeon General. About two-thirds of smokers start lighting up daily before 18, and it appears to take less nicotine for teenagers to become addicted, compared with adults, the Surgeon General’s report added.

“Right now, with 18 as the age, a 16-year old could easily come into contact with an 18-year old, but they’re much less likely to come into contact with a 21-year old,” said Robin Mermelstein, a committee member and psychology professor at the University of Illinois, Chicago.

More than 70% of Americans and 58% of current smokers support raising the purchase age to 21, according to a study published last month in the peer-reviewed journal Tobacco Control. It was the first study to examine Americans’ appetite for changing the status quo. The majority said it was important that teens never experiment with tobacco.

The Institute of Medicine report opened with a quote from Goethe: “Knowing is not enough; we must apply. Willing is not enough; we must do.”