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April, 2016:

Index of tobacco control sustainability (ITCS): a tool to measure the sustainability of national tobacco control programmes

Apr 20th, 2016
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http://tobaccocontrol.bmj.com/content/early/2016/04/18/tobaccocontrol-2015-052799.short?g=w_tobaccocontrol_ahead_tab

Abstract

Objective

To produce a tool to assess and guide sustainability of national tobacco control programmes.

Method

A two-stage process adapting the Delphi and Nominal group techniques. A series of indicators of tobacco control sustainability were identified in grantee/country advisor reports to The International Union Against Tuberculosis and Lung Disease under the Bloomberg Initiative to Reduce Tobacco Control (2007–2015). Focus groups and key informant interviews in seven low and middle-income countries (52 government and civil society participants) provided consensus ratings of the indicators’ relative importance. Data were reviewed and the indicators were accorded relative weightings to produce the ‘Index of Tobacco Control Sustainability’ (ITCS).

Results

All 31 indicators were considered ‘Critical’ or ‘Important’ by the great majority of participants. There was consensus that a tool to measure progress towards tobacco control sustainability was important. The most critical indicators related to financial policies and allocations, a national law, a dedicated national tobacco control unit and civil society tobacco control network, a national policy against tobacco industry ‘Corporate Social Responsibility’ (CSR), national mortality and morbidity data, and national policy evaluation mechanisms.

Conclusions

The 31 indicators were agreed to be ‘critical’ or ‘important’ factors for tobacco control sustainability. The Index comprises the weighted indicators as a tool to identify aspects of national tobacco control programmes requiring further development to augment their sustainability and to measure and compare progress over time. The next step is to apply the ITCS and produce tobacco control sustainability assessments.

Cohort study of electronic cigarette use: effectiveness and safety at 24 months

Apr 19th, 2016
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Major health, development and economic gains from tobacco tax increases

Apr 18th, 2016
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A study finding published by the World Health Organization recently reveals that tobacco tax increases can prevent millions of smoking-attributable deaths throughout the world and contribute to the achievement of global health objectives.

http://www.asiantribune.com/node/88849

The study points out that tobacco tax increases can provide the fiscal resources needed to finance development priorities, particularly in low and middle income countries.

According to the researchers, raising cigarette excise by USD $.80 per pack in all countries would impact;

The average retail price of cigarettes to increase by 63 percent in low income countries, 25 percent in high income countries and 42 percent globally;

The adult daily smoking rate to decrease by 9 percent;

Fifteen million fewer smoking attributable deaths among the adults who were alive in 2014. Most of the deaths averted would be in low and middle income countries;

The amount of cigarette excise revenue generated globally would increase by 47 percent, generating an extra US$ 141 billion in revenue.

The WHO Framework Convention on Tobacco Control (FCTC) Article 6 and its guidelines obligate Parties to adopt and implement tobacco price and tax policies that will reduce demand of tobacco products.

The WHO study was conducted to investigate the potential for tobacco taxation to contribute to the 2030 agenda for sustainable development by reducing tobacco use, saving lives and generating tax revenue.

The researchers developed a simulation model of the global cigarette market using data for 181 countries that together represented 98 percent of the world’s smokers.

The model projects the impacts of excise tax increases on retail cigarette prices, cigarette excise revenue, the rate of daily cigarette smokers, and the future number of smoking-attributable deaths averted among adults globally in 2014.

Source of information: Campaign for Tobacco-Free Kids, USA

Taxing tobacco and the new vision for financing development

Apr 18th, 2016
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As part of the 2016 World Bank Group-International Monetary Fund Spring Meetings held this past week in Washington, D.C., a fascinating panel discussion, A New Vision for Financing Development, took place on Sunday, April 17. Moderated by Michelle Fleury, BBC’s New York business correspondent, it included World Bank Group President Jim Yong Kim, Bill Gates, Justine Greening (UK Secretary of State for International Development), Raghuram Rajan (Governor of the Reserve Bank of India), and Seth Terkper (Minister for Finance and Economic Planning of Ghana).

http://blogs.worldbank.org/voices/taxing-tobacco-and-new-vision-financing-development

The panel was in consensus about the current challenging economic and social environment facing the world as a whole. That environment includes low rates of economic growth across the world, drastic reductions in the price of commodities that are impacting negatively low-and middle-income countries, rising inequality, frequent natural disasters and pandemics, increased number of displaced populations and refugees due to conflict and violence spilling across national borders and continents, and the ambitious United Nations 2030 Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals (SDGs). A question debated in the panel was, Where will the resources be found to address these challenges? This question is critical under the current scenario if countries are to continue to build on the progress achieved over the last decade and maintain previous gains.

Gates noted that new and innovative tools are required alongside the promotion, adoption, and adaptation of good practices to make a difference in dealing with these challenges. Terkper advocated for maintaining official development assistance commitments and adopting flexible risk-sharing financial instruments by multilateral organizations to help countries attract and leverage private investment. The importance of investing in the development of healthy and productive populations as key engines of economic and social development over the medium and longer terms was stressed by Kim, who argued that many governments have to be convinced to invest in “soft sectors” — health, nutrition, and education — compared to the “hard sectors” — roads, ports, and energy infrastructure.

While international financial assistance is necessary to help countries translate into reality the vision for a world free of extreme poverty, where there is opportunity for all, it should be recognized, as observed by Rajan, that domestic resources depend in large measure on economic growth. Growth, in turn, is supported by an enabling economic, social, and environment policy environment, including counter-cyclical fiscal policies, adequate fiscal space, and good governance. But, as highlighted by Greening, national governments must recognize that in accordance with the Financing for Development Addis Ababa Action Agenda adopted in July 2015, the active mobilization and effective use of domestic resources, underscored by the principle of national ownership, are central to the common pursuit of sustainable development.

If development is lifting up lives, and new and innovative approaches for funding development are seen as “game changers,” then I would argue that the development community needs to redouble its commitment to advocate with national governments and society at large for raising taxes on tobacco products. Taxing tobacco is one of the most cost-effective measures to reduce consumption of products that kill prematurely, make people ill with all kinds of tobacco-related diseases (e.g., cancer, heart disease, respiratory illnesses), and cost health systems enormous amounts of money for treating often preventable diseases. In addition, hiking tobacco taxes can help expand a country’s tax base to mobilize needed public revenue to fund vital investments and essential public services that benefit the entire population and help build the human capital base of countries, such as financing the progressive realization of universal health coverage and mental health scale-up as well as education for all and early childhood development initiatives. Indeed, data from different countries indicate that the annual tax revenue from excise taxes on tobacco can be substantial (e.g., close to 1% of GDP or $3 billion in the Philippines in 2015).

We at the World Bank, in partnership with the Bill & Melinda Gates Foundation and Bloomberg Philanthropies, as well as World Health Organization, are already working and committed to support countries in the design and implementation of tobacco taxation policy measures and monitoring their health and fiscal revenue impact, as a critical element of the global development agenda. The time has arrived to make tobacco taxation an important source of domestic resource mobilization that has the potential to generate substantial health and social welfare dividends across the world.

Effects of plain package branding and graphic health warnings on adolescent smokers in the USA, Spain and France

Apr 18th, 2016
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http://tobaccocontrol.bmj.com/content/early/2016/04/18/tobaccocontrol-2015-052583.short?g=w_tobaccocontrol_ahead_tab

Abstract

Objective

The purpose of this study is to provide an experimental test of the effects of plain pack branding and graphic health warnings (GHWs) in three different countries for an important and vulnerable population, that is, adolescents who are experimenting with smoking.

Methods

The effects of plain pack branding (logo present, logo absent), and graphic visual warning level (absent, low, medium, high) are studied experimentally for their impact on adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting in the USA, Spain and France. A total of 1066 adolescents who were experimenting with smoking served as participants in the study. A quota sample produced 375 respondents in the USA, 337 in Spain and 354 in France.

Results

Overall findings indicate that the GHWs were effective in impacting adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting. The plain pack effects were not as strong, yet reduced craving, increased fear, and decreased pack feelings for all three samples combined, and for US adolescent smokers individually, irrespective of the GHWs. For French adolescent smokers, plain pack effects for craving were limited to low/moderate GHW levels. For Spanish adolescent smokers, plain pack feeling effects were limited to the absence of the GHWs.

Conclusions

The results show that plain packs can independently strengthen the more instantaneous, direct effects (short of quitting thoughts) found with the GHWs. Yet, the plain pack results were attenuated for Spanish and French adolescent smokers, who are currently exposed to GHWs.

Tobacco industry approaches SC to push back pictorial health warning order

Apr 17th, 2016
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According to the industry, the tobacco industry is estimated to suffer a loss of around US$68 million (nearly Rs 452.4 crore) a day due to new health warning rules set by the government.

India’s tobacco industry has sought to delay strict new health warning rules by appealing to the country’s highest court, a move anti-smoking activists say could backfire given that the court has ruled against cigarette makers in the past.

Earlier this month Indian tobacco companies, some backed by “Big Tobacco” firms in the West, effectively went on strike by closing factories in protest against demands that 85% of a cigarette packet’s surface be covered by health warnings, up from the older requirement of 20%.

The industry estimates the stoppages cost it as much as $68 million (nearly Rs 452.4 crore) a day, taking cumulative losses to up to $850 million (nearly Rs 5,654.84 crore).

Similar battles have played out around the world in recent years as governments try to discourage smoking. On a few occasions, major tobacco producers have resorted to drastic action by freezing output.

That tactic worked in India in 2010, when the government delayed a set of warnings proposed at the time after the industry shuttered plants.

But this time New Delhi’s room to compromise is more limited, court documents and interviews with federal health ministry officials and activists suggest.

The documents show how a small group of health activists have outmanoeuvred the US$11 billion (nearly Rs 73,180.25 crore) industry and cornered the government into implementing the rules on April 1.

Their strategy has left the Supreme Court as one of the last avenues of appeal for cigarette makers.

“The tide has turned and the tobacco industry is on a downhill slope,” said one of the activists, Sanjay Seth.

In 2013, the court pulled up the government for not being serious about tobacco-control laws.

The Tobacco Institute of India, an industry lobby group, declined to comment for this story. It has called the packaging rules drastic and impractical, saying the law will increase smuggling of illegal cigarettes.

“Big Tobacco” holding out

One small local producer, Golden Tobacco, has started selling cigarette packs that comply with the new rules.

But the biggest companies – ITC, partly owned by British American Tobacco, and US-based Philip Morris International’s (PMI) India partner Godfrey Phillips – are holding out.

On April 8, an industry group that represents makers of traditional smokes, or beedis, in south India went to the Supreme Court to challenge the rules, according to the filing seen by Reuters on Thursday. It was not previously reported.

The plea, filed by the Karnataka Beedi Industry Association, seeks a stay in enforcing the new rules, saying that they would bring the industry to a “grinding halt” and “cause grave and irreparable harm and loss”. A hearing is scheduled for April 22.

The appeal against the packaging regulations, which are among the world’s strictest, does not directly involve major cigarette makers, but any ruling could also apply to them.

ITC declined to comment on the packaging row. BAT said it would be “inappropriate” to comment as they are “just shareholders in ITC”. PMI referred questions to Godfrey Phillips, which did not respond to requests for comment.

Pressure on government

For Western brands, Indian cigarette sales represent a small yet significant part of global earnings, as they face long-term sales declines in developed markets and eye countries like India and its 40 million cigarette smokers for future growth.

In its 2015 report, BAT said the “adjusted contribution” from ITC was 280 million pounds ( nearly $400 million or Rs 2,661.1 crore), about 5% of its annual profits.

The factory shutdown is hurting government’s coffers as well, costing it more than $10 million (nearly Rs 66.53 crore) a day in tax revenues, according to industry estimates.

More than 8 million workers and their families are affected, and farmers’ groups are among those taking out large advertisements in newspapers criticising the legislation. But the government has kept a low profile.

“We don’t want to get into a duel with the industry on this,” a health ministry official said, adding that public opinion appeared to be in the government’s favour.

Smoking kills more than 1 million people a year in India, said BMJ Global Health, published by London-based healthcare information provider, BMJ. The World Health Organisation says tobacco-related diseases cost the country $16 billion (nearly Rs 1.06 lakh crore) annually.

The new rules, which have been shown to help reduce tobacco consumption, put India, along with Thailand, at the top of the list of countries with the most stringent cigarette labelling.

Favourable venue

The new rules were proposed by Prime Minister Narendra Modi’s government in 2014. Initially, they were to be implemented from April 2015, but a parliamentary panel that included a lawmaker with a tobacco business forced the government to delay them as it assessed their impact on the industry and farmers.

That was when Seth, who works with the non-profit campaign Voice of Tobacco Victims, said he and a handful of other activists got involved.

Their strategy, he said, was to find a court that was likely to be sympathetic to their cause and then gets someone to file a case challenging the delay.

The high court in Rajasthan state was that venue, because then-Chief Justice Sunil Ambwani was seen as someone who would favour public health over big business.

Seth’s idea was incorporated into a tobacco-control case that a father-son team of lawyers with a history of such activism, Sita Ram and Rahul Joshi, were filing in the high court in Jaipur city last year.

Within days, Ambwani ordered the government to implement the rules without delay. Ambwani told Reuters he ruled on the merits of the case.

The government won a six-month extension but has so far ignored the parliamentary panel that last month urged it to set warnings at 50%.

E-cigarette seller gets 3-year jail in Mohali

Apr 15th, 2016
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http://www.tribuneindia.com/news/nation/e-cigarette-seller-gets-3-year-jail-in-mohali/222736.html

In the first conviction of its kind in the country, a shopkeeper in Mohali has been sentenced to three years in jail for selling e-cigarettes under the Drugs and Cosmetics Act, 1940. Additional Sessions Judge Saru Mehta Kaushik also slapped a fine of Rs 1 lakh on 25-year-old Parvesh Kumar of Punjab Crockery in Phase 7.

Out on bail, he’s been given a month to appeal.

In 2013, the State Drugs Controller had issued a circular declaring e-cigarette as an “unapproved drug”. The “Electronic Nicotine Delivery System (ENDS)” device uses battery-powered cartridges to produce a vapour considered unsafe.

In the April 7 ruling, the judge noted, “E-cigarette contains nicotine in chemical form, which is highly addictive and potentially lethal. The youth take to such kind of addictive and potentially lethal products, and the offenders involved in promoting and selling such products should be dealt with sternly by law for the welfare of the society.”

Considering the plea of the convict, from whose shop an e-cigarette with eight cartridges was found during an inspection by a Drugs Inspector on July 3, 2014, the court ordered, “So, keeping in view the age, antecedents and character of the convict as well as the gravity and nature of the offence committed by him, he will undergo three years of rigorous imprisonment and pay Rs 1 lakh fine under Section 27(b)(ii) read with Section 18(c) of the Drugs and Cosmetics Act, 1940, and one-year RI under Section 28 read with Section 18A of the Drugs and Cosmetics Act, 1940.”

The substantive sentences would run concurrently and in default of payment, the convict will undergo RI for another six months. “Having done well in the field of tobacco control in general, Punjab, with this conviction, has shown the way to the entire country to end the nicotine-delivery devices sold in the form of e-cigarettes,” Health Secretary Vini Mahajan reacted. Food and Drug Administration Commissioner Hussan Lal said, “E-cigarettes have ushered in a so-called ‘no-smoking revolution’, becoming a fad especially among the youth. They are marketed as a healthy substitute to cigarettes. There are a lot of misconceptions about their potential benefits but all this is farce. The most important ingredient of e-cigarettes is nicotine.”

Besides issuing a health advisory against the use of e-cigarettes, the FDA Commissioner recently wrote to the Union Health Ministry to ensure that Internet sites do not sell e-cigarettes.

This Statistic About Vaping is Going to Shock You

Apr 15th, 2016
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E-cigarette use is skyrocketing.

http://www.teenvogue.com/story/vaping-tobacco-popularity

The good news is that cigarettes are out these days. The bad news is that tobacco in general is still in.

According to data from the Centers for Disease Control and Prevention, millions of kids are now smoking e-cigarettes, leaving the more traditional tobacco products behind. In 2015, around 3 million middle and high school kids used e-cigarettes. That number has grown significantly, according to the CDC, since 2011.

In 2015, about 4.7 million middle and high school students had used tobacco products in the 30 days prior to the National Youth Tobacco Survey studied by the CDC. E-cigarettes were by far the most popular tobacco product with 3 million users, while 1.6 million students reported using traditional cigarettes. Around 1.4 million students had used cigars, 1.2 million used hookahs and 1.1 million used smokeless tobacco.

The number of high schoolers who smoke e-cigarettes has increased from 1.5% in 2011 to 16% in 2015. In 2014, though, e-cigarettes were also the most popular method of using tobacco, which means they’ve been pretty popular for at least a few years.

But, more kids smoking e-cigarettes doesn’t mean more kids overall are using tobacco. According to the CDC reports, there has been no significant change in the amount of students overall who report using tobacco. What’s interesting here is the CDC says educational campaigns about the risks of tobacco use are likely to thank for a reduction in cigarette smoking between 2011 and 2015, but e-cigarettes are probably the reason the number of kids consuming tobacco is still the same.

The CDC pays so much attention to the number of kids using tobacco because those early years are when addictions form.

“Nicotine exposure during adolescence, a critical period for brain development, can cause addiction, might harm brain development, and could lead to sustained tobacco product use among youths,” the CDC reports. In fact, they say 80% of adult smokers first tried smoking by age 18.

Tobacco is the leading cause of preventable disease and death in the United States, according to the CDC, which is why you shouldn’t try smoking in any form. Smoking can cause cancer, is bad for your skin and can cause a whole bunch of other nasty side effects. Studies have come back with mixed reports on whether or not e-cigarettes are any safer than regular ones, but the fact is that nicotine is still addictive no matter how you get it.

Your best bet is to avoid tobacco all together because no way of consuming it is totally safe.

E-cigs seen to benefit smokers

Apr 15th, 2016
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http://www.thestandard.com.hk/section-news.php?id=168341&story_id=46478558&con_type=1&d_str=20160415&sid=4

Electronic cigarettes may benefit public health, an Italian medical professor says, as they drive smokers away from more harmful cigarettes.

University of Catania’s Institute for Internal Medicine and Clinical Immunology director Riccardo Polosa said it will be “irresponsible” to ignore academic reviews that show e-cigarettes help smokers quit.

“E-cigarettes have been a gateway away from the harmful effects of smoking for millions of smokers around the world. I can’t see any reason why this cannot be the case in Hong Kong,” said Polosa, who is visiting the SAR.

Polosa, a specialist in respiratory diseases, quoted figures from Public Health England which show e-cigarette use is around 95 percent less harmful to health than smoking.

The same figures were criticized last year after the Guardian newspaper reported PHE had taken the data from a separate study, co-authored by Polosa, which was sponsored by those with links to the tobacco industry. Polosa is also an adviser for Italian anti-smoking organization Lega Italiana Anti Fumo, which helped fund the study.

Undersecretary for Food and Health Sophia Chan Siu-chee last month said the government is considering banning the import, manufacture, sale, distribution and advertising of e-cigarettes.

The Hong Kong Council On Smoking And Health is also calling for a complete ban.

“Less harmful does not mean zero harm,” Antonio Kwong Cho-shing, chairman of the anti- smoking council, told The Standard. “If e-cigarettes are harmful, they should be banned.”

Baptist University research shows several e-cigarettes contain harmful chemicals including formaldehyde and poly-brominated diphenyl ethers, he said.

Inhalation of the latter has been associated with a reduction in fertility, affecting fetal development and can cause cancers.

Meanwhile, the government has extended the smoking ban to eight bus interchanges at tunnel portal areas including Lion Rock Tunnel Bus Interchange.

Perspectives of US military commanders on tobacco use and tobacco control policy

Apr 15th, 2016
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http://tobaccocontrol.bmj.com/content/early/2016/04/15/tobaccocontrol-2015-052829.short?g=w_tobaccocontrol_ahead_tab

Abstract

Background

Tobacco use among members of the US military service is unacceptably high, resulting in substantial healthcare and personnel costs. Support of military command is critical to the success of tobacco control policies because line commanders are responsible for implementation and enforcement. This study is the first to examine US military line commanders’ perspectives about current tobacco control policies and the impact of tobacco on readiness.

Methods

We conducted key-informant interviews with 20 officers at the US Army’s Command and General Staff College about military tobacco use and tobacco control policy.

Results

Participants identified the long-term impact of tobacco use on military members, but were unaware of proximal effects on health and readiness other than lost productivity due to smoke breaks. Officers also discussed nicotine addiction and the logistics of ensuring that an addicted population had access to tobacco. Regarding policy, most knew about regulations governing smoke-free areas and were open to stronger restrictions, but were unaware of current policies governing prevention, intervention and product sales.

Conclusions

Findings suggest that strong policy that takes advantage of the hierarchical and disciplined nature of the military, supported by senior line and civilian leadership up to and including the secretaries of the services and the Secretary of Defense, will be critical to substantially diminishing tobacco use by military personnel.

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