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August 1st, 2015:

The Master Settlement Agreement: An Overview

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The effectiveness of the 85% health warning label cigarette pack on responsive smoking behaviors among Thai teenagers in 2015

Conference: Public Health Conference, At Bangkok, Thailand


Prof. Dr.Pimpan Silpasuwan, Assoc.Prof.Dr. Chukiat Viwatwongkasem, Assoc.Prof.Dr. Pratana Satitvipawee, Assoc.Prof.Dr. Nithat Sirichotiratana, Assoc.Prof. Dusit Sujirarat, Assist. Dr. Malinee Sompopcharoen, Assist. Dr. Naruemon Auemaneekul,Mr.Narin Pandee Abstract Significance and background: The Ministry of Public Health of Thailand planned to increase the size of the graphic health warning (HWG) up to 85% on cigarette pack; however, such attempt was much criticized by major international tobacco companies. Hence, a legal challenge and the court battle has highlighted on whether the increasing of the HWG size is necessary, in other words, whether it be able to help reduce smoking effectively. Then, this field experiment was implemented to test the effectiveness of the 85% HWG size on the reduction of cigarette smoking.


Factorial design was implemented among 724 students from four high schools and five colleges in Bangkok Metropolitan areas in 2015. In June 2015, the research participants were exposed to see eight mock-up cigarette packs, in which, the mock-ups have two size of the HWG (55% and 85%), two types of the cigarette pack (plain pack and branded pack), and two kinds of the selected HWG picture (CA mouth and Weaker sex). All students reported their perceptions, as well as, their intention to quit smoking after seeing eight mock-up cigarette packs via the questionnaire.


The results from the questionnaire revealed that (1) the 85% of CA mouth picture on the plain pack significantly increased the intention to quit smoking among the non-smoke students than the picture of Weaker sex; and (2) the increasing size of The HWG on cigarette pack differently interacted with the intention to quit smoking among smoke students via the fear arousal feeling.


The early indication confirmed that the 85% HWG could help increase the intention to quit smoking; thus, the Thai government policy on changing the HWG size is supported.

Assessing the Consequences of Implementing Graphic Warning Labels on Cigarette Packs for Tobacco-Related Health Disparities.


Population-level communication interventions, such as graphic warning labels (GWLs) on cigarette packs, have the potential to reduce or exacerbate tobacco related health disparities depending on their effectiveness among disadvantaged subpopulations.

This study evaluated the likely impact of nine GWLs proposed by the US Food and Drug Administration on (1) African American and (2) Hispanic smokers, who disproportionately bear the burden of tobacco-related illness, and (3) low education smokers, who have higher smoking rates.

Data were collected online from current smokers randomly assigned to see GWLs (treatment) or the current text-only warning labels (control). Participants were stratified by age (18-25; 26+) in each of four groups: general population (n = 1246), African Americans (n = 1200), Hispanics (n = 1200), and low education (n = 1790). We tested the effectiveness of GWLs compared to text-only warning labels using eight outcomes that are predictive of quitting intentions or behaviors including negative emotion, intentions to hold back from smoking, intentions to engage in avoidance behaviors, and intentions to quit.

Across all outcomes, GWLs were significantly more effective than text-only warning labels more often than expected by chance. Results suggested that African Americans, Hispanics and smokers with low education did not differ from the general population of smokers in their reactions to any of the nine individual GWLs.

The nine GWLs were similarly effective for disadvantaged subpopulations and the general population of smokers. Implementation of GWLs is therefore unlikely to reduce or exacerbate existing tobacco-related health disparities, but will most likely uniformly increase intentions and behaviors predictive of smoking cessation.

Pictorial warnings killing Indian tobacco brands: ITC Chairman

ITC, a diversified conglomerate, is a dominant player in the cigarette manufacturing business and owns popular brands like Wills, Gold Flake and Classic.PTI

KOLKATA: Raising his voice against a “restrictive” regime for the domestic tobacco industry, top cigarette manufacturer ITC’s Chairman Y C Deveshar today said pictorial health warnings are killing the local brands while products smuggled from abroad are flooding the market.

“Today, 28 per cent of the cigarettes consumed in the country are smuggled from countries like China, Indonesia, Pakistan and Bangladesh where there are no pictorial health warnings.

“Even in the United States, there are no pictorial health warnings. In India, the brands made here are being killed due to pictorial health warnings,” he said.

Deveshwar said that cigarette smuggling was also causing loss of revenue to the exchequer to the tune of Rs 7,000 crore as no duties are paid and also leading to foreign exchange outflow through unaccounted means.

ITC, a diversified conglomerate, is a dominant player in the cigarette manufacturing business and owns popular brands like Wills, Gold Flake and Classic.

“The sales volumes of cigarettes manufactured here are going down, while tobacco consumption is rising,” the ITC Chairman told reporters here after the company’s AGM.

In the last three years, taxation has increased 300 per cent and smuggling had gone up, he said.

To a query, he said ITC will never exit from the tobacco business despite the restrictive regime and its effort would be to minimise smuggling.

The tobacco business contributed more than 40 per cent of the company’s revenue and also a substantial contribution to profits.

Flavoring, other additives increase cigarettes’ addictiveness: study

Ingredients that help enhance the appeal of “light” and “low-tar” cigarettes may contribute to the addictiveness of smoking, a study suggests.

Researchers scoured more than 7 million tobacco industry documents to see how additives known as pyrazines were being used and found these ingredients were introduced after consumers in the 1960s rejected the first “low-tar” cigarettes as being flavorless.

While nicotine, a stimulant in tobacco, has long been known to be addictive, the study offers fresh evidence that tobacco companies may have added pyrazines to cigarettes to support this addiction, said Dr. Maciej Goniewicz, a researcher at Roswell Park Cancer Institute in Buffalo, New York.

“They may facilitate delivery of nicotine to the brain, thus smokers may experience stronger effects of nicotine or these effects may happen faster,” Goniewicz, who wasn’t involved in the study, said by email.

Pyrazines may also stimulate pleasant senses of smell, taste or vision, he added. “Smokers associate these pleasant experiences with their cigarettes and this may lead to developing a stronger dependence on cigarettes.”

Smoking is the leading cause of avoidable deaths, according to the U.S. Centers for Disease Control and Prevention. Smoking dramatically increases the risk of coronary heart disease, stroke, and lung cancer. It can also contribute to cancers almost anywhere in the body, according to the CDC.

Cigarette manufacturers started heavily marketing “light” and “low tar” cigarettes after a landmark 1964 Surgeon General’s report warned of the health risks of smoking. Companies often described these options as safer than regular or “full-flavor” cigarettes, according to the CDC.

But there is no risk-free level of exposure to tobacco smoke, or any safe cigarette, the CDC says. In the U.S., terms like “light,” “low,” and “mild” can no longer be used to promote cigarettes.

For their study, published in Tobacco Control, Dr. Hillel Alpert and colleagues at the Harvard School of Public Health explored the history of additives like pyrazines and manufacturers’ knowledge of how these ingredients might act on the brain to make cigarettes more addictive.

They found documents showing cigarette manufacturers specifically added pyrazines to cigarettes to make them more appealing to consumers.

The industry documents also showed that companies had some evidence that pyrazines could trigger reactions in the brain that make people more likely to crave cigarettes and smoke more often.

Alpert didn’t respond to requests for comment on the study.

Irina Stepanov, a researcher in cancer and environmental health at the University of Minnesota in Minneapolis, told Reuters Health that smokers may not be able to avoid pyrazines because just about any commercially produced cigarette might contain them.

These additives can make cigarettes more flavorful and reduce the harshness of the smoke, causing people to inhale more deeply and receive more nicotine, Stepanov, who wasn’t involved in the study, said by email.

“That alone can contribute to the addictiveness of cigarettes,” she said.

Pyrazines may also help flood the brain with dopamine, a chemical involved in regulating sensations of pleasure, she added.

“The case of pyrazines adds support to previous findings that “low-tar” cigarettes are not safer than regular brands,” Stepanov said. “All cigarettes are addictive and harmful.”

In an unrelated study in the same journal, researchers found that raising the minimum age for buying cigarettes to 21 could discourage adolescents from smoking

The study compared smoking trends of more than 16,000 high school students in Needham, Massachusetts, the first town in the U.S. to raise the minimum tobacco sales age to 21 in 2005, and 16 surrounding communities. Between 2006 and 2010, smoking fell from 13 to 7 percent among the Needham students but only from 15 to 12 percent among kids in the surrounding communities.

“Most experts agree it’s a combination of strategies that will achieve the greatest impact . . . but our study shows increasing sales age to 21 can further decrease youth smoking,” lead author Shari Kessel Schneider of Education Development Center, Inc. in Waltham, Massachusetts told Reuters Health by phone.

Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use



Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence.


Information on e-cigarette and cigarette psychosocial factors (use and attitudes about use in the home and among friends) was collected from 11th- and 12th-grade participants in the Southern California Children’s Health Study during the spring of 2014.


Of 2084 participants, 499 (24.0%) had used an e-cigarette, including 200 (9.6%) current users (past 30 days); 390 participants (18.7%) had smoked a combustible cigarette, and 119 (5.7%) were current cigarette smokers. Cigarette and e-cigarette use were correlated. Nevertheless, 40.5% (n = 81) of current e-cigarette users had never smoked a cigarette. Psychosocial factors (home use of each product, friends’ use of and positive attitudes toward e-cigarettes and cigarettes) and participant perception of the harm of e-cigarettes were strongly positively associated both with e-cigarette and cigarette use. Most youth who reported e-cigarette use had friends who used e-cigarettes, and almost half of current users reported that they did not believe there were health risks associated with e-cigarette use.


Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use.