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November, 2015:

Tobacco Atlas Germany 2015: New data, new facts

Nov 14th, 2015
by Editor.
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http://www.healthcanal.com/alternative-therapies/68609-tobacco-atlas-germany-2015-new-data-new-facts.html

In Germany, 121,000 people die from the consequences of smoking each year. This means that smoking is implicated in 13.5 percent of all deaths. The death rate from smoking is higher in the north of Germany than in the south of the country.

These regional variations reflect variations in the smoking behavior in the German states. Across all states, more men than women die from the health consequences of smoking. Following the first report of this type in 2009, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) now presents its second Tobacco Atlas, which again summarizes current data and facts about tobacco use, health hazards that are associated with it as well as consequences for society.

Dr. Martina Pötschke-Langer, head of DKFZ’s Cancer Prevention Unit and the WHO Collaboration Center for Tobacco Control, based at the DKFZ, declares: “The Tobacco Atlas shows that we still have to make great efforts to achieve further progress in our struggle to decrease the rate of smokers and to protect tobacco control policy from the interests of the tobacco industry.”

The Tobacco Atlas summarizes the latest data on regional and gender-specific variations in tobacco use and analyzes how these trends have changed over time. The highest death rates among smokers of both genders are found in the German city states of Bremen and Berlin, where 23 percent of men and 11 percent of women die from the consequences of smoking. The smoking-related death rates among men are lowest in the states of Baden-Württemberg and Bavaria (17 and 18 percent); for women in Saxony and Thuringia (4 and 5 percent).

While the smoking behavior in the age group between 25 and 69 years has remained largely stable since 2009, smoking rates among young adults and minors have been dropping continuously. At the same time, electronic inhalation products such as e-cigarettes and e-shishas have emerged on the market and created new consumer trends. They have become particularly popular among youth: About one third of young people between 12 and 17 years of age has smoked shisha at least once and one quarter of youth in this age group has tried e-cigarettes.

The cigarette has always been and continues to be a toxic mixture and its consumption entails severe hazards to health. Illnesses caused by smoking include, above all, cancer, cardiovascular and respiratory diseases. Cancer accounts for 52 percent of smoking-related deaths in men, and 41 percent in women. In recent years, the list of tobacco-related diseases has been extended by type 2 diabetes, erectile dysfunction, age-related macular degeneration as well as tuberculosis and further types of cancer such as liver cancer and bowel cancer. Nicotine, which is contained in tobacco and electronic inhalation products, is addictive and, as recent research results have shown, anything but a harmless substance. Nicotine is toxic and suspected to promote chronic diseases such as arteriosclerosis as well as the development and progression of cancer and – if consumed during pregnancy – to cause long-term and lasting impairment to the lung and brain development in the unborn child.

Besides causing harm to people’s health, smoking also causes a high financial burden for society at large. In Germany, the societal cost of smoking is about € 80 billion each year. Of these, approximately one third is health care costs (direct costs) and two thirds are economic costs due to productivity loss and early retirement (indirect costs).

The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) publishes this new edition of the Tobacco Atlas in order to present the latest scientific facts and figures to the public and the media as well as to urge political decision-makers to take action based on the information outlined. In 2005, the World Health Organization created the Framework Convention on Tobacco Control (WHO FCTC), which is legally binding also for Germany. Nevertheless, Germany has failed to or only inadequately implemented a number of measures foreseen therein, in particular, regular considerable increases in the tax on tobacco and a comprehensive advertising ban.

The shortfalls in Germany’s tobacco control policy also become obvious in comparison with other European countries. Since 2007, when Germany first introduced non-smoker protection legislation at the federal level – and, soon after, also in the German states –, the country has not taken any substantial new tobacco control measures. Not only has it failed to raise tobacco tax considerably and regularly, it also has not enacted a comprehensive ban on tobacco advertising (Germany and Bulgaria are the only countries in Europe where large-sized tobacco advertising on billboards and advertising pillars is still allowed). In addition, non-smoker protection in catering establishments continues to be patchy and with many exceptions. For this reason, Germany was ranked second to last in a ranking of tobacco control policy of the European countries in 2013.

 

E-cigarettes and children: advocates walking on both sides of the street?

Nov 13th, 2015
by Editor.
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http://blogs.bmj.com/tc/2015/11/13/e-cigarettes-and-children-advocates-walking-on-both-sides-of-the-street/

In a 2014 open letter to the WHO’s director general Margaret Chan signed by 53 researchers, it was argued “Controls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, including protection of the cigarette market and implicit support for tobacco companies. It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal.”

Clive Bates who “had a hand” in organising the letter but curiously did not sign it, is a former director of England’s Action on Smoking and Health. In that role, Bates directed and wrote one of the most excoriating critiques ever published of the tobacco industry’s long standing (and still running) denials of its designs on children.

In the October 2000 Danger in the Playground, Bates documented many of the most telling examples of candid industry talk about the vital role of children to the future of tobacco industry profitability. This accompanying powerpoint presentation (also authored by Bates) rubs it in even harder. These revelations were all made in internal tobacco industry documents released through the US Master Settlement Agreement between US state governments the tobacco industry, millions of which are now freely available here.

The tobacco industry’s business model about the importance of youth smoking was never put more succinctly than in this 1984 document from an RJ Reynolds tobacco official: “If younger adults turn away from smoking, the industry will decline, just as a population which does not give birth will eventually dwindle.” (“younger adults” was industry code from the mid 1970s for children and young adults, to be used in all written communications)

In a 2000 press statement at the time of the launch of the publication, Bates said “When you look at what they say privately, and compare it to their public posturing, the whole idea that tobacco companies might be working against teenage smoking is revealed as sinister self-serving public relations. The more they try to define smoking as only for adults, the more they are saying ‘hey kids, smoking’s for grown-ups’ with a sly nod and a cynical wink.”

Today, Bates runs his own consultancy business and is a leading advocate of ecigarettes. Of 220 tweets he posted between Oct 1 and Nov 1, 80% were about ecigarettes. On a recent blog he wrote that when it comes to ecigarettes “There is little evidence of marketing to children, only assertions that certain ads or brands are designed to appeal to children but with no empirical evidence, and apparently minimal understanding of modern advertising.”

On reading this, I was struck by how far Bates appears to have moved in the 15 years since he wrote Danger in the Playground and so tweeted a juxtaposition of the two quotes above, asking “which Clive Bates to believe?”

Bates replied challenging this apparent inconsistency, arguing that his 2000 statement referred to tobacco companies while his 2015 statement referred to ecigarette companies. He argued that currently, the vaping market is worth 100 times less than the cigarette market and that “nearly all vape customers come from the ranks of existing smokers”, which he said explains why adult smokers are the target market for ecigs.

The same analysis can of course be applied to the current contribution of young smokers to the total cigarette market. For example, an early Australian analysis showed that while in one year the value of the underage market to manufacturers was $AUD18.7million, if 50% of young smokers continued to smoke, they would contribute $AUD112 billion at current prices to the industry across their lifetime.

Bates knows perfectly that tobacco companies understand the importance of smoking uptake by children to their future, but seems to believe that such a thought has never crossed the minds of ecig manufacturers.

In an extraordinary statement, he wrote that “there are good reasons why the e-cigarette companies, even tobacco owned ones, would not target adolescents … demand, reputational, legal and regulatory risk etc … it would be bad business.”

In a 2014 open letter to the WHO’s director general Margaret Chan signed by 53 researchers, it was argued “Controls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, including protection of the cigarette market and implicit support for tobacco companies. It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal.”

Clive Bates who “had a hand” in organising the letter but curiously did not sign it, is a former director of England’s Action on Smoking and Health. In that role, Bates directed and wrote one of the most excoriating critiques ever published of the tobacco industry’s long standing (and still running) denials of its designs on children.

In the October 2000 Danger in the Playground, Bates documented many of the most telling examples of candid industry talk about the vital role of children to the future of tobacco industry profitability. This accompanying powerpoint presentation (also authored by Bates) rubs it in even harder. These revelations were all made in internal tobacco industry documents released through the US Master Settlement Agreement between US state governments the tobacco industry, millions of which are now freely available here.

The tobacco industry’s business model about the importance of youth smoking was never put more succinctly than in this 1984 document from an RJ Reynolds tobacco official: “If younger adults turn away from smoking, the industry will decline, just as a population which does not give birth will eventually dwindle.” (“younger adults” was industry code from the mid 1970s for children and young adults, to be used in all written communications)
In a 2000 press statement at the time of the launch of the publication, Bates said “When you look at what they say privately, and compare it to their public posturing, the whole idea that tobacco companies might be working against teenage smoking is revealed as sinister self-serving public relations. The more they try to define smoking as only for adults, the more they are saying ‘hey kids, smoking’s for grown-ups’ with a sly nod and a cynical wink.”

Today, Bates runs his own consultancy business and is a leading advocate of ecigarettes. Of 220 tweets he posted between Oct 1 and Nov 1, 80% were about ecigarettes. On a recent blog he wrote that when it comes to ecigarettes

“There is little evidence of marketing to children, only assertions that certain ads or brands are designed to appeal to children but with no empirical evidence, and apparently minimal understanding of modern advertising.”

On reading this, I was struck by how far Bates appears to have moved in the 15 years since he wrote Danger in the Playground and so tweeted a juxtaposition of the two quotes above, asking “which Clive Bates to believe?”

Bates replied challenging this apparent inconsistency, arguing that his 2000 statement referred to tobacco companies while his 2015 statement referred to ecigarette companies. He argued that currently, the vaping market is worth 100 times less than the cigarette market and that “nearly all vape customers come from the ranks of existing smokers”, which he said explains why adult smokers are the target market for ecigs.

The same analysis can of course be applied to the current contribution of young smokers to the total cigarette market. For example, an early Australian analysis showed that while in one year the value of the underage market to manufacturers was $AUD18.7million, if 50% of young smokers continued to smoke, they would contribute $AUD112 billion at current prices to the industry across their lifetime.

Bates knows perfectly that tobacco companies understand the importance of smoking uptake by children to their future, but seems to believe that such a thought has never crossed the minds of ecig manufacturers.

In an extraordinary statement, he wrote that “there are good reasons why the e-cigarette companies, even tobacco owned ones, would not target adolescents … demand, reputational, legal and regulatory risk etc … it would be bad business.”

We recommend

The marketing of e-cigarettes: a UK snapshot mhefler, TC News, 2013 –  http://blogs.bmj.com/tc/2013/04/06/the-marketing-of-e-cigarettes-a-uk-snapshot/

Eat, Drink, Smoke, Vape, Run. tomfardon, Thorax blog, 2014 – http://blogs.bmj.com/thorax/2014/01/11/eating-drink-smoke-vape-run/

WHO report on regulation of e-cigarettes and similar products, bfreeman, TC News, 2014 – http://blogs.bmj.com/tc/2014/08/27/who-report-on-regulation-of-e-cigarettes-and-similar-products/

How to dramatically reduce smoking without banning tobacco sales, bfreeman, TC News, 2015 – http://blogs.bmj.com/tc/2015/09/21/how-to-dramatically-reduce-smoking-without-banning-tobacco-sales/

Tasmania: Legislation drafted to implement a Tobacco Free Generation, mhefler, TC News, 2014 – http://blogs.bmj.com/tc/2014/11/04/tasmania-legislation-drafted-to-implement-a-tobacco-free-generation/

Exposing Mr Butts’ tricks of the trade. Introduction. K M Cummings et al., Tob Control, 2002 – http://tobaccocontrol.bmj.com/cgi/pmidlookup?view=long&pmid=11893809

The retail environment for tobacco: a barometer of progress towards the endgame. Lisa Henriksen, Tob Control, 2015 – http://tobaccocontrol.bmj.com/content/24/e1/e1.extract

Tobacco harm reduction and e-cigarettes: setting a unified research agenda, mhefler, TC News, 2013 – http://blogs.bmj.com/tc/2013/05/29/tobacco-harm-reduction-and-e-cigarettes-setting-a-unified-research-agenda/

Taking aim at the bull’s-eye: the nicotine in tobacco products. C E Douglas, Tob Control, 1998 – http://tobaccocontrol.bmj.com/cgi/pmidlookup?view=long&pmid=9825406

Point of Sale Display: A Call to Action on Prohibition of Tobacco Products in Nepal, bfreeman, TC News, 2015 – http://blogs.bmj.com/tc/2015/08/05/point-of-sale-display-a-call-to-action-on-prohibition-of-tobacco-products-in-nepal/

http://www.clivebates.com Clive Bates

Professor Chapman’s blog is largely based on comparing what I said in a report for Action on Smoking and Health (ASH) in 2000 about the conduct of tobacco companies with what I and many others are saying now about e-cigarette advertising. The key weakness in Professor Chapman’s argument is that the statements he compares were about two different things in a completely changed context.

My 2000 ASH report “PR in the Playground” was not just about tobacco companies: it was about about the useless and cynical youth anti-smoking initiatives run by tobacco companies. Tobacco companies running campaigns to persuade young people not to smoke were never going to be convincing or effective and that report shows why. They were mainly about protecting the reputation of tobacco companies – hence the ‘PR’ in the title. I haven’t changed my views about those programmes one bit, though I don’t know if they still exist.

But e-cigarette companies do not have programmes like this to my knowledge and Professor Chapman doesn’t suggest they do. My recent statements were about e-cigarettes, not cigarettes – another important difference. So he is comparing statements I made 15 years ago with statements made recently about something completely different in a radically changed landscape: there were no e-cigarettes in 2000. It’s not that surprising the statements look different.

I hope that Professor Chapman is fully aware of the potential dangers built into the positions he holds. It would be a major public health error to treat cigarettes and e-cigarettes the same way, given the very significant differences in risk – e-cigarettes are likely to be at least 95% lower risk than smoking, based on what we know of the toxic constituents of vapour. For example, an important effect of banning e-cigarette advertising could be to protect the incumbent cigarette trade from competition from a disruptive low-risk technology that helps people to quit smoking – thus increasing harm. In the UK, we have evolved a quite pragmatic approach to controls on e-cigarette advertising, which is similar to that used to control alcohol advertising. You don’t need a total ban to deal with the odd rogue advertisement (and it will always be possible to find these in any sector). The UK Committee on Advertising Practice reports that the e-cigarette code is working well and shaping the behaviour of advertisers in the way intended.

We rightly ban tobacco advertising in the EU because smoking kills 700,000 EU citizens per year. But no such justification exists for banning e-cigarette advertising. The most likely effect of e-cigarettes is to reduce the smoking related death toll in future – a negative death toll – assuming they are allowed to compete.

The problem of unintended consequences goes beyond banning e-cigarette advertising. Much of the hostility towards e-cigarettes in the field of tobacco control, if translated into policies, misinformation or taxes, could have the effect of protecting cigarette sales and supporting smoking. I hope Professor Chapman will reflect carefully on what harms might be caused if his ideas are taken seriously by policy-makers.

I also made what I think is a reasonable point about the incentives of the companies involved: that e-cigarette sector has a very large market of adult smokers to pursue as their potential customer base (this also applies to the tobacco owned e-cigarette companies who are fighting over market share). Adult smokers is where the data shows that they overwhelmingly do find their customers. The e-cigarette sector is small in every country compared to the cigarette trade (about $6 billion globally compared to $800 billion for the tobacco trade) so there is plenty of room to grow by eating into the cigarette trade. These companies would create unnecessary risks for themselves if they targeted teenagers, and they have no need to.

Even if not targeted, some teenagers will use these products. Most public health experts are familiar with the idea that some adolescents engage in risky behaviours and try adult things, and I hope that isn’t a revelation to anyone in the field of tobacco control. The data show that the teenagers who do use these products are almost all smokers already or have ‘risk factors’ that mean they are likely to become smokers. To the extent it is displacing smoking, e-cigarette use may be creating a health dividend. It’s too soon to say if that is actually happening, but the trends are largely consistent with that effect and Professor Chapman should expand his thinking to accommodate that possibility.

As far as consistency is concerned, in 2000 while still Director of ASH I was open-minded about the concept of the tobacco market evolving to low-risk nicotine products and even envisaged the challenge that this would create for some factions in the public health establishment. See my paper ‘What is the future for the tobacco industry” from Tobacco Control journal in 2000 and especially the section “How can the tobacco market evolve”, in which I imagine the rise of products a bit like e-cigarettes…

http://tobaccocontrol.bmj.com/content/9/2/237.full

What I said in 2000 about the future of the nicotine and tobacco market is, I think, a fairer test of consistency of my approach to e-cigarettes than what I said at the time about something completely different.

My article from 2000 is not perfectly correct about the rise of e-cigarettes, but as a bit of crystal-ball gazing it is not a bad account of what has come to pass. Neither is it inconsistent with what I’m saying now. I was warning even then that we would need to put health first if the market evolved in this way, which it duly has done: leaving the much of the tobacco control community confused about its mission.

Regrettably, this blog contains unfounded innuendo about my purpose that readers should discount. I don’t wish to engage Professor Chapman in personal animus, but I would like to explain my own motivation. I believe the ‘harm reduction’ agenda is a legitimate public health strategy in drugs, sexual health, alcohol and other fields within public health – and there is every reason to apply it to smoking. I have been consistent about this since 1998. I put a lot of time into this issue because I believe it has the potential to avoid hundreds of millions of premature smoking-related deaths in the 21st Century by making the cigarette obsolete for many or most users. Furthermore, I think it is consistent and synergistic with legitimate evidence-based tobacco control policy – the more you press people to stop smoking with punitive or coercive measures, the more important it is to have somewhere for committed or addicted smokers to go. That’s an ethical argument that tobacco control advocates would do well to embrace if they wish to succeed in their mission.

NutmegJunkie

Nicotine, when administered via a tobacco free technology like an electronic vaporiser, is a not a threat to public health. In case you didn’t know, caffeine has also been identified as a causative agent in psychosis[1]. Does that mean we should reclassify caffeine as a threat to public health like you are suggesting nicotine we do with nicotine?

1. http://scholar.google.com.au/scholar?hl=en&q=caffeine+psychosis&btnG=&as_sdt=1%2C5&as_sdtp=

Mister Blog Dog

QUOTE: “In the USA today data from the US National Youth Tobacco Survey show that while cigarette smoking continues to fall in US teenagers, e-cigarette use has been dramatically increasing since 2011 and is now way ahead of cigarette smoking” – Prof Simon Chapman

The survey you cite is badly flawed because it classed a teenage user as someone who had taken as little as a single puff on an e-cigarette in the previous 30 days, with no attempt to establish regular usage or even if the e-cigarette contained nicotine.

The latest CDC survey (published in Nov. 2015) involving 36,000 participants, found that e-cigarette use was largely confined to smokers and former smokers. In fact, the survey found that only 0.04% of never smokers went on to become regular e-cigarette users.

Prof Chapman. If you are going to cite a survey to reinforce your criticisms of people who you disagree with, please first make some attempt verify the quality of the survey.

Many thanks.
—
Simon_Chapman

Clive Bates reiterates his central argument that the tobacco industry and the ecigarette industry and their products are “completely different”, and that therefore what he wrote in Danger PR in the Playground (http://www.ash.org.uk/files/documents/ASH_625.pdf) in 2000 about the tobacco industry is irrelevant to the ecigarette industry.

So how completely different are these industries? Both sell products with the word “cigarette” front and centre. Both sell nicotine delivery systems engineered to rapidly maximise repeat purchasing. Both cigarettes and ecigarettes involve repeated hand-to-mouth activity and the semiotically rich smoking performance of exhaling smoke/vapour. Marketers in both industries understand completely that their future commercial health is dependent on maximising addiction, attracting already nicotine dependent people to their brands, and, critically for the future, attracting those who have never used nicotine before (mostly kids).

Bates fails to engage with my argument about the tobacco industry’s public virtues/private vices duplicity and why the very same public relations strategy would not also suit the ecigarette industry’s commercial goals. Does he really imagine that in the USA where today there are 340,000 children vaping more than 20 days a month, that ecigarette industry investors are anything less than ecstatic?

My blog post was about what I consider the folly of allowing the sort of open slather advertising for ecigarettes we see now in some nations. The 53 signatories of the letter to Margaret Chan agreed that “Controls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified” and that “It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal.”

So when a vaping adult on the couch next to their 10 year old sees a TV ad for a gummy bear flavoured product, how does it target the adult, but go right over the child’s head? Please enlighten us Clive.

He argues that “the odd rogue advertisement” for ecigarettes may get through industry advertising self-regulation systems, but that in England this system is working well. I suggest that Clive should read his own work far more carefully. On page 22 of Danger PR in the Playground he will find a section explaining why voluntary advertising codes have “failed” and that “voluntary agreements have served the industry well and the public badly”.

Blithe dismissals of teenage vaping as some kids just “trying adult things” ignore the unprecedented success that several nations have had in the last decade in dissuading hundreds of thousands of kids from ever just trying cigarettes (or any form of nicotine).

Bates says that ecigarettes help “people to quit smoking.” There are certainly many people who attribute their smoking cessation to ecigarettes, but the best population cohort study we have (from England) shows (http://onlinelibrary.wiley.com/doi/10.1111/add.12917/epdf) that at 12 months “Daily use of e-cigarettes while smoking appears to be associated with subsequent increases in rates of attempting to stop smoking and reducing smoking, but NOT with smoking cessation.” (my emphasis). To the great delight of the tobacco companies, the most common scenario for even daily vapers is dual use. The Brose et al paper from England (http://onlinelibrary.wiley.com/doi/10.1111/add.12917/epdf) reported that at 12 months, 13.9% of daily e-cigarette users reduced cigarette smoking substantially. But let’s turn the last figure around. Even among those smokers who vaped daily, 86.1% did not even cut back smoking substantially. That’s how good e-cigarettes are at just reducing smoking.

I have never made any public statement supporting the prohibition of either cigarettes or ecigarettes. Clive and I have common ground in sharing the belief that committed or addicted smokers should be able to access products that satisfy their craving and that ecigs are almost certainly going to be far less hazardous than smoked tobacco.

But it does not follow from this that such access should be a free-for-all, with unrestricted advertising and unregulated products. Charlotta Pisinger’s updated review of the evidence presented at the recent ecigarette summit (not yet online) should give much pause to those thinking that ecigs are as “harmless as coffee” and should be regulated to an equivalent degree.

There are only two nations in the world – the USA and New Zealand – where direct-to-consumer advertising of prescription drugs is allowed. These drugs are designed to save lives, restore health, ease severe pain etc. Almost every household at any time has people using prescribed drugs. Sometimes these are for life, sometimes for limited periods. These limitations on accessing and publicising these products do not see mass consumer wailing about
heinous restrictions. There are not queues of governments lining up to adopt the US approach to prescribed drug advertising.

We made every mistake possible in how cigarettes were sold and marketed. We need not repeat the same mistakes with ecigarettes.

Big Tobacco: ‘Of all the concerns, there is one – taxation – which alarms us the most’

Nov 12th, 2015
by Editor.
No comments yet

http://theconversation.com/big-tobacco-of-all-the-concerns-there-is-one-taxation-which-alarms-us-the-most-50580

Earlier this week opposition leader Bill Shorten confirmed that should Labor return to government, it was considering raising the tobacco tax further. A planned A$40 billion would be raised by the increases.

There is popular cynicism that governments tax tobacco only because it is an ageless goose that just keeps laying massively lucrative golden eggs. Tobacco tax comprised A$8.28 billion (2.16%) of the A$384.078 billion in total tax raised by the Commonwealth in 2014-15.

90% of smokers regret that they ever started smoking and often strongly support tobacco control measures as they nudge their resolve to stop. Daily smokers in Australia now comprise only 12.8% of the population, the lowest in the world.

Putting these two together, there are likely to be only some 1.3% of the population who smoke daily, who don’t want to quit and probably would oppose hikes in tobacco tax. So raising tobacco tax is not only easy but electorally carries very low risk.

In the 2013 national election a Smokers’ Rights party fielded Senate candidates in all six states. Its candidates attracted just 25,123 first preference votes out of 13,464,123 votes cast in these states. In Victoria, only 78 people voted for two individual Smokers’ Rights candidates out of 3,499,438 who voted – one in every 44,865 voters.

In late April 2010, the Rudd government raised tobacco tax overnight by an unprecedented 25%, making the announcement in the same package it announced its historic plain packaging plans, eventually implemented in December 2012.

A 2010 Treasury paper modelled the impact of the 25% rise. They predicted that the 25% tax increase would see

… a decline in tobacco consumption of approximately 8% and an increase of 15% in tax revenue.

But a Department of Finance paper from 2013 shows that this increase in fact reduced consumption of dutied tobacco products by 11%. Reduced consumption reflects both quitting and smoking less by continuing smokers.

British American Tobacco’s boss in Australia, David Crow, publicly acknowledged the impact of the tax in 2011, telling a Senate committee:

We saw that last year very effectively with the increase in excise. There was a 25% increase in the excise and we saw the volumes go down by about 10.2%; there was about a 10.2% reduction in the industry last year in Australia.

In 2013, a further four annual 12.5% increases were announced and later adopted by the incoming Coalition government. This meant that tobacco tax rises will rise 75% over seven years, on top of the routine rises reflecting changes in the consumer price index. Labor had introduced this, and the Coalition supported it.

Tobacco tax certainly raises revenue, but it is the single most important factor driving down smoking. It is a massively important win-win policy. Over decades, internal tobacco industry documents have repeatedly shown full awareness of this. Tobacco company Philip Morris (Australia) in 1983 said:

… The most certain way to reduce consumption is through price.

Then again in 1985:

… Of all the concerns, there is one – taxation – which alarms us the most. While marketing restrictions and public and passive smoking do depress volume, in our experience taxation depresses it much more severely. Our concern for taxation is, therefore, central to our thinking about smoking and health. It has historically been the area to which we have devoted most resources and for the foreseeable future, I think things will stay that way almost everywhere.

And 1993:

… A high cigarette price, more than any other cigarette attribute, has the most dramatic impact on the share of the quitting population.

The tobacco industry’s stock line on price rises is to argue that smoking rates have not changed, it’s just that many more smokers are now buying illegal duty-not-paid loose tobacco (chop chop) and smuggled brands.

I summarized the many problems with these claims in a recent book on plain packaging (where the industry made exactly the same claims, now tellingly silent).

If illicit tobacco were as easy to obtain as the tobacco industry argues (some of their estimates being as high as one in six of all cigarettes smoked) how is it that ordinary smokers can find them with alleged consummate ease, while the full resources of the Australian federal police and tax office inspectors cannot manage to do so very often?

Most amusing here is the duplicity of Big Tobacco’s unctuous posturing about heinous tax rises encouraging smuggling and tax avoidance, when the industry uses these rises to camouflage increases in its own margins. Financial Review journalist Neil Chenoweth’s exposé and the Cancer Council Victoria’s subsequent research on price changes after plain packaging reveal this.

From August 2011 to February 2013, while excise duty rose 24¢ for a pack of 25, the tobacco companies’ portion of the cigarette price (which excludes excise and GST), jumped A$1.75 to A$7.10. While excise had risen 2.8% over the period, the average net price had risen 27%. Philip Morris’ budget brand Choice 25s rose A$1.80 in this period, with only 41¢ of this being from excise and GST. (See Figure below)

unnamed

It’s often erroneously argued that those on low incomes are impervious to tobacco control measures like price rises, and suffer further deprivation with each price rise. The figure below shows smoking status of Australians aged 14 and over by social disadvantage in 2010. As can be seen, there is not a lot of difference in the proportion of ex-smokers across the five quintiles.

Low socioeconomic smokers quit at around the same rates as those in higher quintiles. The big differences are in the proportions who smoke (and have never smoked). Those in the lowest social disadvantage quintile have nearly double the smoking prevalence of those in the highest quintile because of higher uptake, not because of lower quitting.

unnamed (1)

Rumored tobacco plan criticized

Nov 11th, 2015
by Editor.
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http://www.taipeitimes.com/News/taiwan/archives/2015/11/11/2003632199

The nation’s premier anti-smoking lobby, the John Tung Foundation, yesterday said that it is against a rumored Ministry of Health and Welfare policy to increase a surcharge on tobacco products.

The Chinese-language China Times reported that the ministry is mulling a proposal to increase the Health and Welfare Surcharge on Tobacco Products from NT$20 to NT$40 because the Executive Yuan adjusted its distribution of the funds, with the National Health Insurance (NHI) to have NT$6 billion to NT$7 billion (US$182.6 million to US$213.1 million) cut from its budget annually.

The report said the NHI estimated that medical expenses for treating diseases caused by smoking accounts for between 6 and 15 percent of the nation’s total medical expense — about NT$50 billion per year, while the Health Promotion Administration (HPA) estimated an increase in income from NT$30 billion to NT$54 billion if the surcharge is doubled, with smoking rates predicted to drop.

Lin Ching-li (林清麗), head of the foundation’s tobacco control division, said the foundation is against the policy because there is no mechanism to monitor how the ministry allocates the funds it collects.

“Cigarette prices and tax revenue is falling behind [that in other nations], because the tobacco tax has not been adjusted in 28 years,” Lin said.

“The average price of cigarettes should be immediately increased to NT$75 per pack,” Lin said, adding that the price of cigarettes is relatively cheap when compared with other countries.

The foundation believes that an increase in the tobacco tax, rather than the surcharge, would be a better way to effectively discourage smoking, she added.

Separately, former ministers of the department of health Yaung Chih-liang (楊志良) and Yeh Ching-chuan (葉金川) said if the surcharge is to be increased, the funds should not be included in the tax system, but used to protect public health.

Later yesterday, HPA Deputy Director-General Yu Li-hui (游麗惠) said that while a proposal to amend laws regarding tobacco were sent to the Legislative Yuan in May, “actually there is no agenda to amend any tobacco-related law scheduled for discussion in the current legislative session.”

Banned e-smoking devices sold online

Nov 11th, 2015
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http://www.straitstimes.com/singapore/health/banned-e-smoking-devices-sold-online

Users’ identity not needed to buy vaporisers, e-liquids from sites like Carousell, Gumtree

SINGAPORE – Electronic smoking devices including e-cigarettes are banned in Singapore, but sellers have found a way around the law by hawking them in cyberspace.

Young people, including teens below 18, are finding it easier to find such battery-run devices, which heat up a chemical, called an e-liquid, and turn it into vapour.

Also called “vaping” devices – as vapours are inhaled – these vaporisers and e-liquids can be obtained from online marketplaces like Carousell, Gumtree and Qoo10, as well as social media like Instagram and online forums here.

On Carousell, there are more than 30 such posts daily, with most selling e-liquids under vague search terms like “juice”. E-liquid refills, sold for about $13 for a 10ml bottle and $25 for a 30ml bottle, come in flavours including bandung, root beer float and caramel macchiato, and may be laced with nicotine.

Vaping starter sets are also sold on Carousell for about $170 each.

After a deal is made, the listing would be deleted immediately.

Sellers on Carousell said they rely on the platform for fast deals, and it does not require users to reveal their identity. Their customers range from those in their mid-teens to people in their 50s.

One seller who did not give his name started selling vaporisers a year ago, but moved on to e-liquids “to help regulars continue their vaping lifestyle”.

He has been “vape smoking” for the past three years and said the activity is growing in popularity here.

According to the Health Sciences Authority (HSA), there were more than 15,000 cases involving people bringing vaporisers, which include electronic cigarettes, cigars and pipes, into Singapore illegally between 2012 and September this year. In the same period, 39 peddlers were caught for selling vaporisers here.

HSA said the vaporisers were found in parcels mostly ordered online, and on people entering Singapore. The Tobacco (Control of Advertisements and Sale) Act here prohibits the import, distribution, sale or offer for sale of any item designed to resemble a tobacco product, including vaporisers.

Buying e-cigarettes from overseas websites or bringing them into the country in hand luggage is also considered importing.

Offenders may be fined up to $5,000 for the first offence, and up to $10,000 subsequently.

Veteran lawyer Amolat Singh said the owners and operators of the online sites can be charged with “aiding and abetting” the offences under the Tobacco Act.

“In a sense, it is no different from allowing someone to sell something illegal in one corner of one’s shop,” he said.

The online marketplaces said they are monitoring the situation.

Gumtree told The Straits Times that sellers who put up prohibited items for sale will be warned.

Those who continue to flout the rules will be banned and blocked.

“Sellers often try to find ways to work around our defences. We… will continue to update our filters to better clean our site,” said a Gumtree spokesman.

VAPORISERS CAN CONTAIN CANCER-CAUSING AGENTS

Carousell said it works very closely with regulatory and enforcement agencies to identify prohibited products.

It also encourages users to flag products and sellers who do not abide by its guidelines.

There is a sizeable group of vaporiser users here, going by an online e-cigarette forum for people in Singapore, which has more than 200,000 registered members.

Users say the lack of a foul smell is a draw.

“My fingers no longer stink and I can confidently hold my loved ones,” said a 28-year-old man.

Said the seller on Carousell of his customers: “Vaping helps smokers transit away from smoking traditional cigarettes, and all of my regulars have no intentions of reverting to smoking.”

But Dr Wong Seng Weng, medical director of The Cancer Centre, said e-cigarette users are exposed to nicotine, which is addictive, as well as heated and aerosolised propylene glycol and glycerol, which may turn into carcinogens.

In a joint statement, HSA and the Health Promotion Board advise the public “against using vaporisers to quit smoking or reduce their nicotine addiction”.

They cited a report by the World Health Organisation last year that said vaporisers can contain cancer-causing agents and toxicants and, in some cases, as much as those in conventional cigarettes.

They advised quitters to join the iQuit club at www.iquitclub.sg

Why you smoke when you drink alcohol

Nov 10th, 2015
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http://www.independent.co.uk/life-style/health-and-families/health-news/scientists-find-social-smoking-when-drinking-may-be-due-to-nicotine-offsetting-sleepiness-induced-by-a6726246.html

Scientists in Missouri tested the joint effects of alcohol and nicotine on rats

The stimulating effects of nicotine can offset the sleep-promoting effects of alcohol

Scientists may have discovered the reason why people become social smokers while drinking alcohol – and it is primarily to do with staying awake.

Researchers at the University of Missouri believe that people crave the effects of nicotine – a stimulant – when drinking, as it helps to offset the feelings of sleepiness induced by alcohol, Medical Daily reports.

The study, published in the Journal of Neurochemistry, saw researchers monitor the effects of alcohol and nicotine on rats’ brains.

In studying the basal forebrains of the animals, the area of the brain associated with reflexes, learning and attention, the researchers found that nicotine helped to supress the sleep-promoting effects of alcohol.

The researchers said: “One reason why people use nicotine, a stimulant, with alcohol is to enhance recreational [or] pleasurable sensations while suppressing alcohol’s aversive effects such as sleepiness.

“Here, we demonstrate that nicotine acts via the basal forebrain to suppress sleep-promoting effects of alcohol further implicating the basal forebrain as a key substrate in nicotine alcohol co-use.”

Tobacco use fueled by e-cigs, hookah remains high among US Hispanics/Latinos

Nov 10th, 2015
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http://www.eurekalert.org/pub_releases/2015-11/aha-tuf103015.php

Tobacco use remains a serious problem among Hispanic/Latino adults, with increasing use and acceptance of e-cigarettes and hookah among younger tobacco users living in the United States, according to a study presented at the American Heart Association’s Scientific Sessions 2015.

Hookah, also known as a water pipe, consists of a bowl, a chamber partially filled with water, hose and mouthpiece. It is designed to burn specialty tobacco which is typically flavored.

To better understand Hispanics’/Latinos’ knowledge, attitudes and behaviors regarding the use of tobacco products, as well as how these might differ across Hispanic/Latino ethnicities, researchers conducted 26 focus groups with smokers and nonsmokers. The focus groups included 180 Hispanic/Latino participants, 18 to 64 years of age, residing in varying U.S. locations where particular ethnic subgroups have settled: Chicago (Central and South Americans), New York City (Puerto Ricans and Dominicans), San Diego (Mexican/Mexican Americans) and Miami (Cubans). Participants were recruited based on their birthplace (mainland U.S. vs elsewhere) and use of the English language as an index of acculturation (gradual process whereby immigrants incorporate the beliefs and behaviors of the mainstream culture).

Researchers found that regardless of the specific ethnic background and geographic location:

Hispanic/Latino participants reported substantial use of e-cigarettes and/or hookah.
Spanish-speaking immigrants who were 36 to 64 years were least likely to use these alternative tobacco products, whereas younger Latino smokers who were 18-35 reported significantly greater use.
Easy access to these products, the appeal of flavored tobacco products’ taste and smell, minimal restrictions on public use, and use while socializing were cited as reasons contributing to these products desirability.

###

Note: Actual presentation is 4:45 p.m. ET, Tuesday, Nov. 10, 2015.

Additional Resources:

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Global Epidemic: Consumer Product causes Tooth Loss, Cancer & Male Impotence

Nov 10th, 2015
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Global Epidemic:

  • Consumer Product causes Tooth Loss, Cancer & Male Impotence
  • Kills half of uses, even when used as recommended
  • Aggressively marketed through litigation, millions spent on lawsuits
  • If cars killed half of its users, there would be an uproar
  • The leading cause of preventable death that no one talks about
  • Without action, one billion people will die from tobacco this century

Indonesia’s Shame: Documentary shows SHOCKING images of Indonesian children addicted to cigarettes

Nov 9th, 2015
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http://jakarta.coconuts.co/2015/11/09/indonesias-shame-documentary-shows-shocking-images-indonesian-children-addicted

Seeing Indonesian children smoking unfortunately isn’t such a shock to us anymore. After all, Indonesia is home to Aldi, arguably the most famous smoking baby in the world, who, for all the wrong reasons, became a viral sensation and was even featured on HBO’s “Last Week With John Oliver”.

But Aldi’s case is just one snapshot of a much bigger problem of underage smoking in Indonesia.

The mini-documentary above, which comes to us from Seeker Stories, manages to provide greater insight into the magnitude of the problem. It showcases the work of Canadian photojournalist Michelle Siu, who travelled to Jakarta to snap photos of children – from teenagers to those as young as four – who are hooked on cigarettes.

In addition to the damning stories about boys throwing tantrums if they don’t get their fix, or how almost all the Indonesian men addicted to cigarettes started smoking before the age of 19, what really makes these images so shocking is how these small children appear so at ease with lit cigarettes in their hands, as if they’re seasoned smokers.

As Siu writes on her website, “Young smokers begin the cycle of addiction but at a health cost for generations to come. The juxtaposition of young boys smoking like seasoned addicts is jarring yet this project is intended to not only shock and inform viewers but to demonstrate the lack of enforcement of national health regulations and to question the country’s dated relationship with tobacco.”

Sadly, there seems to be little in the way of new tobacco regulations in Indonesia to prevent children from smoking. The government at least added graphic warning on cigarette packs, but ours are arguably quite tame by comparison to the graphic warnings in other countries.

Meanwhile, tobacco advertisements and sponsorship are still plentiful and underage smoking is still a common sight. Indonesia has still got a long way to go and some very powerful tobacco companies to beat if it’s ever going to quit its addiction to the world’s deadliest drug.

To view Michelle Siu’s ‘Marlboro Boys’ photo series on Indonesian children smoking, visit her
website at http://www.michellesiu.com

Yale to go tobacco-free

Nov 9th, 2015
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http://yaledailynews.com/blog/2015/11/09/yale-to-go-tobacco-free/

Over the next year, Yale will become the fifth of 26 universities in Connecticut to take steps toward eliminating tobacco from its campus.

On Thursday, University President Peter Salovey sent an email to the Yale community announcing that the University would become tobacco-free. Students widely criticized the timing of the email announcement, as the administration had at that point remained silent about two controversial incidents that drove campus discussion on race and discrimination. The email came around 4 p.m. on Thursday, less than an hour after a three-hour protest held on Cross Campus about issues of race and discrimination on campus. Salovey told the News he wishes the long-scheduled date of release had been changed, but still thinks the initiative is important for the health of students, faculty and staff on campus. Salovey said that the Schools of Public Health and Medicine have long been interested in establishing the initiative, which will include awareness events and smoking cessation support programs. Organized by the Department of Human Resources and Administration, the initiative will hopefully benefit both smokers and the rest of the Yale community, Salovey added.

“The idea is not just to have cleaner air for everyone to breathe, but to make it easier for people to quit,” Salovey said.

Two posts on “Overheard at Yale” — a popular Facebook page — expressed student frustration with administrative silence on two incidents: allegedly discriminatory behavior at a Sigma Alpha Epsilon party on the weekend of Halloween and a controversial email sent by Silliman College Associate Master Erika Christakis about culturally appropriative Halloween costumes. One contained a screenshot of President Salovey’s announcement and another showed an edited version of the email, altered to announce that Yale would “become a racism-free campus.”

Tobacco researchers and public health activists have applauded the announcement of Tobacco-Free Yale, with many calling it a positive step forward for the well-being of the University community.

Director of Yale Health Paul Genecin did not respond to multiple requests for comment on the nature and structure of the campaign.

In a Sunday email to the News, Ruth Canovi, director of the American Lung Association for Connecticut, said she welcomed the initiative. She said that the program would not only reduce risks to campus associated with secondhand smoke but would also prevent students from starting to smoke cigarettes, adding that college students were among the most likely members of the population to smoke for the first time.

“We know that cigarette smoking rates are higher in the 18-25 age population than in youth,” Canovi said. “In 2012, almost 32 percent of 18-25 year-olds nation-wide smoked cigarettes, while 6 percent of 12-17 year-olds smoked cigarettes. College is often a time that people pick up the habit of smoking; tobacco-free policies on our college campuses can help change that.”

Sherry McKee, psychiatry professor and director of the Yale Tobacco Treatment Clinic, said that she expects the initiative to be well-received by smokers among the student body, staff and faculty.

She noted that nicotine replacement methods are not as effective for women as they are for men but that varenicline, the most effective medication approved by the Food and Drug Administration, works equally well for men and women.

Marc Potenza, director of the Yale Program for Research on Impulsivity and Impulse Control Disorders, said that the Tobacco-Free Yale campaign marks an important step in the University’s historical attitude toward tobacco.

He noted that 100 years ago, certain tobacco brands carried the Yale name, and called the current initiative a “stepwise progression from [Yale’s] idle perspective [on tobacco-related health issues]” that has resulted from an increasing understanding of the negative health effects of tobacco consumption.

Grace Kong, an associate research scientist in psychiatry at the Yale School of Medicine who is involved with Yale’s Tobacco Research in Youth, said now is the appropriate time for a campaign of this nature due to the increased use of non-cigarette tobacco products among college students. She added that she expects the campaign will not only focus on cigarettes but other popular tobacco products including hookah, cigars, cigarillos, e-cigarettes and smokeless tobacco.

Stephanie O’Malley, director of the Division of Substance Abuse Research in Psychiatry at the School of Medicine, said that now was a great time for the implementation Tobacco-Free Yale because of recent anti-tobacco measures instituted by the city of New Haven, which include steps toward the prohibition of smoking in schools, parks and other city-owned property.

The rate of tobacco use among adults in Connecticut is 16.5 percent, according to the Center for Disease Control and Prevention’s 2014 Behavioral Risk Factor Surveillance System. The rate of tobacco use among Connecticut high school students is 13.5 percent.

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