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July 22nd, 2015:

A horse, a horse … Turkmenistan president honours himself with statue

Chan said the country had ratified the framework convention on tobacco control in 2011, by which time it had already banned smoking in public places.

Also speaking at the forum, was Vera Luiza da Costa e Silva, the head of the convention’s secretariat, who challenged the central Asian state to drive smoking down to 5% in the coming years.

In 1990, 27% of Turkmen men over 15 and 1% of women smoked.

A decade later Turkmenistan banned smoking in public places, state buildings and the army, and all forms of tobacco advertising.

By comparison, 31.1% of the global male population over the age of 15 smoked in 2012, and 6.2% of women were smokers.

Berdymukhamedov, who trained as a dentist and is a keen horseman, has been in power since the death of his eccentric predecessor, Saparmurat Niyazov, in 2006. Niyazov campaigned against smoking and built a 36km “path of health” into the mountains surrounding Ashgabat which government officials were forced to walk.

In April, the gas-rich country of more than five million held a month of public exercises and sporting events under the slogan “health and happiness”.

Turkmenistan: the health-obsessed country where nobody smokes

The former Soviet republic tops the world’s non-smoking league with fewer than one in 12 people still using tobacco

Agence France-Presse

The health-obsessed former Soviet republic Turkmenistan is the country with the world’s lowest proportion of smokers, the World Health Organisation’s director general, Margaret Chan, said during a visit to the isolated nation on Tuesday.

“Recently a WHO overview showed that in Turkmenistan only 8% of the population smokes,” Chan told the country’s authoritarian president, Gurbanguly Berdymukhamedov, at a health forum in the capital, Ashgabat.

“This is the lowest national indicator in the world. I congratulate you on this achievement.”

The world’s most non-smoking country

Just 8% of the population smoke in this nation


Health-obsessed former Soviet Turkmenistan is the country with the world’s lowest proportion of smokers, World Health Organisation chief Margaret Chan said during a visit to the isolated nation on Tuesday.

Chan said that just 8 per cent of the population smoked, according to WHO figures.

“Recently a WHO overview showed that in Turkmenistan only 8 per cent of the population smokes,” Chan told the country’s authoritarian President Gurbanguly Berdymukhamedov, who is a dentist by training.

“This is the lowest national indicator in the world. I congratulate you on this achievement,” she said at a health forum in the capital Ashgabat.

Cited by state media, Chan noted that the country ratified the Framework Convention on Tobacco Control in 2011 by which time it had already banned smoking in public places.

Also speaking at the forum, Vera Luiza da Costa e Silva, Head of the Convention Secretariat, challenged the Central Asian state to drive smoking down to five per cent of the population in the coming years.

In 1990, 27 per cent of Turkmen males over 15 and 1 per cent of females smoked.

A decade later Turkmenistan banned smoking in public places, state buildings and the army, as well as all forms of tobacco advertising.

By comparison, 31.1 per cent of the global male population over the age of 15 smoked in 2012, while 6.2 per cent of females were smokers.

President Berdymukhamedov, in power since the death of eccentric predecessor Saparmurat Niyazov in 2006, is a keen equestrian, while Niyazov campaigned against smoking and built a 36-kilometre “path of health” into the mountains surrounding Ashgabat which government officials were forced to walk.

This April the gas-rich country of more than five million held a month of public exercises and sporting events under the slogan “health and happiness”.

Low-Nicotine Cigarettes Fail to Sway Smokers

Study Finds Effectiveness of Cessation Aid Slips After 6 Months

By Suzanne Leigh on July 22, 2015

Smokers who successfully lowered their nicotine intake when they were switched to low-nicotine cigarettes were unable to curb their smoking habits in the long term, according to a study by researchers at UCSF and San Francisco General Hospital and Trauma Center.

The study, published online July 22 in the journal Addiction found that levels of cotinine, a derivative of nicotine measured in the blood, plummeted six months after smokers’ regular cigarettes were replaced with low-nicotine ones. But levels started to rebound later into the study when smokers returned to regular cigarettes, suggesting that use of low-nicotine cigarettes alone may be ultimately ineffective in weaning smokers off tobacco.

Researchers led by Neal Benowitz, MD, recruited 135 smokers who had no imminent plans to quit, but were interested in trying low-nicotine cigarettes. Fifty-five of the smokers were told to continue smoking their regular brand, which was provided at no cost, while 80 were instructed to smoke “research cigarettes” with progressively lower levels of nicotine, also provided free of charge. The nicotine was eventually tapered to just 5 percent of that used in regular cigarettes.

Both groups were asked to smoke as desired, but the research cigarette smokers were told to avoid regular cigarettes and other tobacco products. Smoking cessation manuals were given to participants interested in quitting.

At 12 months, provision of both regular and research cigarettes was terminated and both groups’ cotinine levels continued to be monitored for a further year. At the start of the study, the research cigarette group had an average cotinine level of 250ng/ml, which dropped to 113ng/ml at six months. But an upswing was evident at the 12-month mark, which continued to rise as smokers returned to their usual brands, and approximated that of the group that had consistently smoked regular cigarettes.

A total of 68 participants completed the two-year study. Just one participant in the research cigarette group had quit smoking, versus zero in the regular cigarette group.

“We don’t know that very low nicotine cigarettes will not reduce nicotine dependence, but progressively reducing nicotine content of cigarettes in the way that we did, without other means of supporting smokers, did not produce the desired results,” said Benowitz, a professor in the UCSF departments of Medicine and of Bioengineering and Therapeutic Sciences, who conducts research at the San Francisco General Hospital and Trauma Center (SFGH) Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service.

The authors attributed the rebounding cotinine levels in the research cigarette group to noncompliance.

“Cotinine levels were higher than expected given that nicotine content of the very low nicotine cigarettes was only 5 percent of that of conventional cigarettes,” said Benowitz, the paper’s first author. “We know that at six months, 30 percent reported that they had supplemented with conventional cigarettes and this had increased to 43 percent at 12 months.

“The results might have been different if regular cigarettes were not freely available, as would be the case if all cigarettes were mandated to be low in nicotine,” he added.

Smokers who received research cigarettes had stated that they consumed an average 20 cigarettes daily at the start of the study. This fluctuated slightly during the first 12 months and plunged to a reported 13 cigarettes at the two-year mark.

Federal regulation of the nicotine content of cigarettes was proposed in 1994 by Benowitz and colleague Jack Henningfield, PhD, at Johns Hopkins Medicine, as a tool to reduce nicotine dependency. The researchers hypothesized that very low levels of nicotine would prevent new smokers from becoming hooked and facilitate quitting for long-term smokers. The Family Smoking Prevention and Tobacco Act of 2009 authorized the FDA to reduce cigarette nicotine content.

“While reduction of the nicotine content in cigarettes is being considered as a national regulatory intervention to make cigarettes less addictive, our study indicated that this reduction is not likely to be effective if alternative, higher nicotine-containing cigarettes are readily available,” Benowitz said.

“Nicotine reduction would work best in the context of public education, easy access to smoking cessation services and the availability of non-combustible sources of nicotine for those who have difficulty stopping nicotine completely.”

Approximately 18 percent of American adults smoked in 2013, according to the latest figures from the Centers for Disease Control and Prevention.

Co-authors of the study are Natalie Nardone, PhD; Katherine Dains, PhD; Delia Dempsey, MD; and Peyton Jacob, PhD, from the Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service at San Francisco General Hospital and Trauma Center. Jacob and Sharon Hall, PhD, are from the UCSF Department of Psychiatry. Susan Stewart, PhD, is from the Department of Public Health Sciences at UC Davis.

The study was supported by U.S. Public Health Service grants from the National Cancer Institute, National Institute on Drug Abuse and the FDA Center for Tobacco Products. Research cigarettes were provided by Philip Morris, which had no involvement in the design and implementation of the study. First author Benowitz is a consultant to several pharmaceutical companies that market smoking cessation medications. He has served as a paid expert witness in litigation against tobacco companies. Co-author Hall has received material support for a clinical trial from Pfizer. The other authors have no conflicts to declare.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.

Is Britain ready for outdoor smoking bans?

As Brighton considers a ban, smokers and non-smokers in Bristol give their verdict on a trial scheme already up and running

Steven Morris

The idea of not being able to light up even in the open air gives Jo, a 30-a-day smoker from Bristol, the heebie-jeebies. “I wouldn’t be able to survive,” she said. “I’d have to find somewhere. It’s an addiction for me, not fun. I’d have to bring my car into work and smoke there. I’ve tried to give up a few times but I just can’t. A total ban just wouldn’t be fair.”

A ban on smoking in public open spaces is on the agenda after Brighton city council announced that it is to consult on such a measure in its parks and beaches.

Two harbour-side squares in Bristol are ahead of the game, trialling a voluntary ban, politely asking smokers to take their habit (or addiction) elsewhere. The move seems to be having some success though Jo, huddled in a shelter on one of the squares involved, was not aware of the ban. “That’s the first I’ve heard of it. I’m glad I didn’t know.”

When the Guardian visited at lunchtime on Tuesday there were few people openly smoking in the squares or on the al-fresco bar and restaurant tables – though workers in high-vis jackets were scooping hundreds of butts off the pavements following the weekend’s Bristol Harbour Festival.

One of the few smokers spotted was Peter Skirrow, a 26-year-old office worker, who was strolling in the sunshine with a roll-up. He admitted he did know about the voluntary scheme and still exercised his right to smoke but did not get close to anyone else. “I make sure I’m not close to children or people eating and I don’t smoke in queues. But I don’t think I do any harm to others by smoking outside.”

Smokers’ group Forest is furious both at the idea of a ban in Brighton and the voluntary scheme in Bristol. “Outdoor smoking bans make no sense,” said its director, Simon Clark. “There’s no evidence of risk to non-smokers and if the idea is to stop children seeing adults light up why ban smoking in adult-friendly pubs and clubs, forcing people to smoke outside?

“Litter can be a problem but it’s not helped by councils removing cigarette bins for fear it ‘normalises’ smoking. They can’t have it both ways. Provide cigarette bins and most smokers will use them.

“Smokers don’t need self-righteous campaigners regulating their behaviour. You’ll always get a few inconsiderate smokers but that’s no reason to punish the overwhelming majority. We’re in danger of creating an incredibly censorious society in which regulations are based not on potential harm to others but on people’s personal preferences. It’s worrying and it has to stop.”

Kate Knight, the deputy director of Smokefree South West, which is behind the Bristol scheme, said early research suggested a third of smokers who were aware of the scheme did change their behaviour. The six-month pilot ends next month but Knight hopes it will continue in some form and that other places will introduce similar schemes.

The approach here is softly-softly. Eleven signs dotted around the squares ask smokers not to light up and thank people for helping “keep Bristol smoke-free, healthy and clean”. Bars have been invited to ask their customers not to smoke and at events such as the Harbour Festival teams have gone around Millennium Square and Anchor Square explaining the ban to smokers and wondering if they can stub their cigarettes out or wander off.

Friends Jenni O’Connor and Jenny Brindley were in Millennium Square watching their children clamber over the statue of one of the most famous Bristolian actors, Cary Grant, often photographed posing cigarette in hand.

“I think there has been a reduction in smoking here,” said O’Connor. But Brindley said she did not support complete bans backed by the law. “That would be too much. I don’t like to see things being banned. It becomes a civil rights issue.”

Marton Modis, manager of the Las Iguanas restaurant and bar on Millennium Square, said staff had been asked to tell customers about the ban. Most respected it – though the restaurant still provides ashtrays in one section of its outdoor seating.

“I think it has changed things a bit but you won’t change it completely unless the law is changed,” he said. “That’s what people think the next step is really. I’m for it – but then I’m a non-smoker. I know a lot of people won’t be happy if they are told they could be breaking the law if they smoke.”

Jail time for gang of illicit tobacco smugglers

Gaelle Walker

UK enforcement agency efforts to disrupt illicit tobacco sales are bearing fruit – with a string of high profile arrests and jail sentences issued in the past two weeks.

A criminal gang, who used their freight company as a cover to smuggle more than 14 million cigarettes inside boxes of fruit and vegetables, were jailed for a total of more than 15 years yesterday.

The three men were arrested in May 2012 after HM Revenue and Customs (HMRC) discovered that they had been shipping illicit cigarettes from Dubai through East Africa into the UK, evading over £3m in duty.

John Cooper, assistant director, criminal investigation, HMRC, said: “This was a major investigation into the exploits of three criminals attempting to flood the UK with illicit cigarettes. They thought their set-up was undetectable, but they were wrong and our investigation has led to them being brought to account.”

HMRC investigators uncovered the smuggling ring after working closely with UK Border Force and the Serious Organised Crime Agency (now the National Crime Confiscation proceedings to reclaim the criminal profits are under way.

Gang leader Feroz Abubakar Batliwala was sentenced this week to eight years, six months in prison and banned from being a company director for 12 years.

The two other men, Krishan Kumar and Ashiquir Rohman, were jailed for seven years and 20 months in prison respectively.

The sentencing following a string of other victories for HMRC as it seeks to clamp down on illicit tobacco sales.

Last week six men were arrested as part of an investigation into a suspected £22m tobacco smuggling, tax evasion and money laundering fraud.

Officers from HMRC carried out simultaneous searches of 11 premises in Essex, Cambridgeshire, Hertfordshire, London and the West Midlands in an investigation codenamed Operation Nipper.

The same week saw two lorry drivers, who attempted to smuggle almost 200,000 illegal cigarettes into the UK by hiding them in the wheel space of their lorry, were sentenced to eight months in prison.

E-cigarettes are just as addictive as the real thing and most are mislabeled, researchers warn

  • Currently more than 400 brands of e-cigarettes available in the US
  • The e-cigarettes contain the most addictive form of nicotine
  • Found levels of nicotine contained in e-liquids often didn’t match the label

By Mark Prigg For

E-cigarettes are just as a addictive as the real thing, researchers have found.

A new study warned that because e-liquids contain the most addictive form of nicotine and many bottles of the liquid are mislabeled as to their level of the drug, they are causing major problems.

It comes as a separate study found that gradually decreasing the amount of nicotine in cigarettes did not help smokers to quit, finding that only one person did so over the course of a year.

E-cigarettes were found to be just as addictive as ‘normal’ cigarettes.


There are currently more than 400 brands of ‘e-cigs’ available.

E-cigs contain far fewer cancer-causing and other toxic substances than cigarettes, however their long-term effects on health and nicotine dependence are unknown.

The popularity of e-cigarettes, which typically deliver nicotine, propylene glycol, glycerin and flavorings through inhaled vapor, has increased in the past five years.

Electronic cigarettes are seen as a healthier alternative for smokers who don’t want to actually kick the habit because rather than burning tobacco, liquids containing nicotine and flavorings are heated and vaporized.

In a study published in Chemical Research in Toxicology, the team from the American University of Beirut and the Center for the Study of Tobacco Products worked to find the levels of nicotine in the liquids and what type of nicotine they contained.

Of the three types of nicotine, researchers found that all the brands of e-liquid they tested were the strongest form – free-base nicotine that is easily absorbed by the body.

More significantly, the researchers wrote that levels of nicotine contained in e-liquids often didn’t match the label.

In a separate two-year study, published in the journal Addiction, reducing the level of nicotine in cigarettes was not shown to help people quit the habit.

‘We don’t know that very low nicotine cigarettes will not work to reduce nicotine dependence and enhance quitting, but progressively reducing nicotine content of cigarettes in the way we did, without other means of supporting smokers, did not produce the desired results,’ said Dr. Neal Benowitz, a professor at the University of California San Francisco, in a press release.

Researchers recruited 135 smokers who were not interested in quitting, asking some to smoke cigarettes they were given and the rest to continue smoking their regular brand.

Those in the experimental group were given cigarettes with progressively less nicotine in them over the course of 6 months, and then were asked to smoke the free, lower-nicotine cigarettes for 6 months.

Participants were followed for another year after the 6 months of low-nicotine cigarettes. Researchers found that almost none of the 153 people — who had not been interested in quitting in the first place — had reduced or quit their smoking.

The participants reported smoking about 20 cigarettes per day at the start of the study, and many who received research cigarettes reported this had plunged to about 13 per day.

In many cases, researchers reported, people returned to their former brand and nicotine level when no longer being provided with the lower-nicotine option.

Benowitz said the study shows reducing nicotine alone doesn’t help with nicotine addiction, but that a combination of tactics, including e-cigarettes, which have benefits over burning paper and tobacco., is required.

‘Nicotine reduction would work best in the context of public education, easy access to smoking cessation services and the availability of non-combustible sources of nicotine for those who have difficulty stopping nicotine completely,’ Benowitz said.

A sepeate recent study warned E-cigarettes could be luring teens into trying smoking – and lead them onto smoking ‘real’ cigarettes, researchers have warned.

They found one-third of Hawaiian teens have tried e-cigarettes – half of whom have never used another tobacco product.

They claim if a similar pattern was repeated in the US, it could lead to a ‘epidemic of teen tobacco use’.

‘The concern is that e-cigarette advertising is recruiting intermediate risk adolescents to nicotine use- kids who would not otherwise have started smoking,’ said James Sargent, of Dartmouth Hitchcock’s Norris Cotton Cancer Center in a paper published in the journal Pediatrics.

 ‘These are kids who might go on to smoke cigarettes, which are much better at delivering nicotine than e-cigarettes.

‘If this pattern of use is adopted by adolescents in the continental U.S., we could be in for an epidemic of teen tobacco use in this country that could greatly reduce the overall benefits to public health of e-cigarettes.’

Researchers from Dartmouth and the University of Hawaii Cancer Center collaborated in the 2013 survey-based study of 1,941 adolescents aged 14-15 years old in public and private schools in Hawaii.

Cigarettes are highly taxed in Hawaii and e-cigarettes, with their potent combination of lower cost and kid-friendly flavours such as mango and pineapple, may be more attractive to teens.

Thomas Wills, PhD, of the UH Cancer Center, said e-cigarettes, which are widely available in Hawaii, marketing is ‘very aggressive here.’

He added that manufacturers place ads in venues such as movie theaters where adolescents socialize, as well as on radio and television.

Nearly nine per cent of eighth graders have admitted using an e-cigarette, compared with four per cent who have taken a normal cigarette.

Professor Lloyd Jonson of the University of Michigan said: ‘I worry that the tremendous progress that we’ve made over the last almost two decades in smoking could be reversed on us by the introduction of e-cigarettes.’

E-cigarettes have been on sale in the United States since 2006, but this is the first year that the Centers for Disease Control has measured their use.

‘This is a markedly different pattern of use compared to their peers in the continental U.S., where teen e-cigarette use is less than half that rate and e-cigarette users are mainly also cigarette smokers (dual-users),’ reported the team.

Sargent and collaborators were so concerned about the findings that they submitted them to the FDA docket to inform proposed regulations on e-cigarettes.

They note that favouring packaging, and marketing of e-cigarettes is not regulated, and that manufacturers’ opportunities to target adolescents are wide open, absent FDA regulation of these products.

Beware of Big Tobacco’s plain pack puffery

Move to change law in Scotland will face same well-funded opposition as in Australia, warns Sheila Duffy

In June, ASH Scotland ran an international conference and welcomed delegates from the United States, South-east Asia, Australia, Canada, New Zealand and from across Europe.

They came to Scotland to hear about our work in tackling tobacco and to share their experiences with us.

At the start of our conference we heard that globally, tobacco use has killed around 100 million people in the 20th century, much more than all deaths in the First and Second World Wars combined. In the 21st century the death toll could easily reach one billion. Even for smokers who consume ten or fewer cigarettes a day, their life expectancy is on average five years shorter and their lung cancer risk is up to 20 times higher than in never-smokers. We believe the work we do saves lives.

We discussed a wide range of topics over the two day event, from smoking in pregnancy to how tobacco keeps people poor; from tackling the illicit tobacco trade to appropriate regulation for e-cigarettes; from the possible consequences of international trade agreements on people’s health to the devastating exploitation of tobacco farmers by the industry that employs them. Our conference gave us the chance to compare experiences with and learn from people working on similar issues in very different cultural contexts.

As the Westminster government has this year committed to bringing in legislation for standardised, plain tobacco packaging throughout the UK (the Scottish Government has been committed to this measure since 2013), I was particularly interested to hear from colleagues from nations like Ireland, New Zealand and Finland who like us are committed to bringing in plain packs legislation, and in particular interested to hear from Australian colleagues for whom tobacco has been served in sludge green packs with boring fonts and prominent picture health warnings since December 2012.

Professor Melanie Wakefield shared Australia’s experiences as the first and so far the only nation in the world to introduce standardised tobacco packaging. It was encouraging to hear that smokers said they were less inclined to pick up plain packs. Her stories about the tobacco industry’s manipulative and obstructive responses to this legislation, and their strident predictions of economic disaster should it be implemented, sounded very familiar from our own experiences of progressing smoke-free laws in Scotland. In Australia, a thorough body of careful and well-designed research work has shown that the industry’s predicted dire consequences have failed to materialise. Two and a half years down the line, all the signs are reassuring.

Despite industry claims being disproved in Australia, I expect them to be deployed here when our own legislative debate kicks off, so it’s worth a quick look at what we might hear.

I’d like to pick out just two of the dire consequences predicted by the tobacco industry and its commercial allies in Australia. These were messages that seem crafted to scaremonger small businesses and to seek to intimidate elected representatives out of following through on their democratic decision. Big Tobacco and its commercial allies said there would be disruption to small businesses and catastrophic losses; and they predicted there would be an explosion in counterfeiting and in the illicit tobacco trade. Both are terrifying predictions for small businesses struggling on the margins of survival, and both messages were amplified by orchestrated front groups and paid-for public relations companies.

Tobacco companies claimed finding plain packs on shelves would increase retailer transaction times and put customers off. Researchers found on average ahead of plain packaging being introduced, it took between ten and 11 seconds to retrieve a branded pack in shops. It took a second or so longer immediately after the introduction of standardised packaging but within a week or two retrieval times had returned to normal. There was no change in the percentage of smokers purchasing their tobacco from small businesses.

According to researchers and the Australian government, illicit tobacco did not increase following the introduction of plain packs. More than two years on, the proportion of illicit tobacco seized that is in plain packs is hardly worth counting.

Of course the industry has not given up – probably in large part because it is fighting tooth and nail against this effective measure being adopted elsewhere. Big Tobacco is still trying to trip up the Australian legislation, through ongoing costly challenges under international trade and intellectual property treaties. It is trying to go under it and round it by spicing up the brand names, and throwing extra free cigarettes into packs.

In Australia as in Scotland, the tobacco industry has a poor track record with the truth and a proven drive to put its profits far above the people who buy and those who retail its lethal products.

• Sheila Duffy is chief executive of Ash Scotland