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December, 2016:

Hong Kong leads mainland in war to cut smoking

Dec 9th, 2016
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http://www.ejinsight.com/20161209-hong-kong-leads-mainland-in-war-to-cut-smoking/

When a person goes to buy a packet of cigarettes in Hong Kong, he or she faces two obstacles. One is the price — Double Happiness at HK$43 and Marlboro at HK$57 — the result of a tobacco tax up to 68 per cent of the price.

The other is the hideous image on the packet of the worst consequences of smoking.

A survey by the Economic Intelligence Unit earlier this year ranked Hong Kong as the eighth most expensive city in the world for a packet of branded cigarettes, at US$7.48.

Top was London with US$14.30, followed by New York with US$13.67 and Singapore with US$9.15.

These two measures, along with the creation of smoke-free areas in public and work places, have been effective in cutting the number of smokers.

According to government figures, the percentage of daily cigarette smokers aged 15 and above in Hong Kong in 2015 was 10.5 percent, down from 10.7 percent in 2012 and 23.3 per cent in the early 1980s.

The mainland, the world’s largest tobacco market with 316 million smokers in 2015, has only recently started to learn the lessons of Hong Kong.

Since 2010, the number of smokers has increased by 15 million and cigarette production risen by 35 per cent.

The health warnings are written, not visual, and appear modestly at the bottom of the packet. They would not frighten any first-time user.

In 2015, China increased the tobacco tax to 40 per cent. Consumption tax from tobacco in 2015 was 536 billion yuan, an increase of 60 billion from a year earlier. The recommendation of the World Health Organisation (WHO) is that the tax should be 70 per cent of the retail price.

“There is certainly room for future tobacco tax increase,” said Jian Shi, director of the information office of the Taxation Research Institute at the State Administration of Taxation in Beijing.

“In some western countries, the tobacco tax rate has reached 70-80 per cent. The room for the increase needs to be considered based on the development goal of the industry and the condition of national revenue.”

Health professionals argue that increasing the tobacco tax is the quickest and most effective way to cut smoking — by both preventing young people from starting and encouraging smokers to quit.

According to WHO figures, each increase of 10 per cent in the price will cause 3.7 per cent of adults and 9.3 per cent of teenagers to stop smoking.

Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Public Health, said that selective or modest hikes would not make much of an impression on smoker numbers in Hong Kong.

“Only a 100 per cent increase in tobacco tax would induce people to quit smoking,” he said. If the government accepted this proposal, an average pack would cost HK$119.

The Department of Health has proposed an enlargement of the health warning.

It said on Nov. 23 that the area of the graphic health warning shall be of a size that covers at least 85 percent of the two largest surfaces of the packet or the retail container and that the number of forms of health warning should be increased from six to 12.

The situation in the mainland is years behind. The biggest obstacle is that the State Tobacco Monopoly Administration (STMA), the world’s biggest manufacturer of cigarettes, is also the industry regulator.

This is despite years of lobbying by China’s health professionals, the WHO and the norms practised around the world. They argue that the two must be separate institutions.

According to WHO figures, 1.2 million die each year in China from smoking-related diseases; this number will double by 2025.

Jian Shi put it succinctly. “The major difficulty lies in that the related departments have quite different views on this matter, and it is difficult for them to reach agreement on this matter. That will cause obstruction to policy making and implementation.”

The STMA opposes graphic health warnings and higher taxes because they would hurt its sales and profits. Yet, simply due to global population expansion, there will be more smokers in 2040 than there are today, so it is difficult to believe that this concern is genuine.

The health lobby has had some success, in the modest increase in tobacco tax and restrictions on smoking in indoor public areas and workplaces and some outdoor areas introduced in Beijing in June 2015. Other mainland cities have taken similar measures at different times.

On Dec. 6, the Beijing Commission of Health and Family Planning said that more than 2,700 people had been fined for violating these restrictions, with total fines of 142,500 yuan, as of Nov. 30 this year.

Professor Dr Judith Mackay, based in Hong Kong and Asia’s leading anti-tobacco campaigner, said that the price of cigarettes in China is still extremely low.

“The latest small tobacco tax increase, while laudable, will not have a serious, sustained effect on reducing smoking. It is time to review the whole tobacco tax structure in China, significantly increase the price of cigarettes and thus protect the health of the Chinese people.

“In Australia, there is a regular increase of 12.5 per cent tobacco excise tax every year. The cost of a packet could soon rise to A$40 (HK$230). Hong Kong and China should both consider long-term tobacco tax planning in this way, so that tobacco control proceeds in an orderly form, and immense energy and time is not wasted year by year in campaigning for a tax increase. Otherwise, thousands will die.”

Beer-loving Czechs approve smoking ban in pubs, restaurants

Dec 9th, 2016
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The Czech lower house of parliament on Friday approved a ban on smoking in restaurants, bars and pubs, overcoming years of wrangling and bringing the country in line with most others in the European Union.

http://uk.reuters.com/article/us-czech-smoking-idUKKBN13Y1KT

“This brings the Czech Republic (in line with) civilized countries that care for the health of their citizens,” Prime Minister Bohuslav Sobotka said.

Parliament’s upper house must sign off on the legislation but the lower house vote showed there was enough support to override any potential veto. The law is to take effect on May 31, 2017, the annual World No Tobacco Day.

Seventeen of the 28 EU member states have comprehensive smoking-free laws in place. The ban enjoys support from three in four Czechs, polls show, but is sensitive all the same as Czechs are fervent pub-goers and beer drinkers are often smokers. Moreover, Czechs drink the most beer per capita in the world.

About 28 percent of Czechs are smokers, somewhat above the EU average of 24 percent. About 18,000 Czechs die annually from smoking-related illnesses, the Health Ministry says.

But there has been a clear trend toward less smoking in public places, especially in bigger cities, and many restaurants have voluntarily gone no-smoking in recent years.

In the last decade, several attempts to introduce sweeping anti-smoking legislation failed, most recently in May.

Opponents of a ban have argued it would force bars out of business, especially in villages where they remain a main gathering point for locals, and say it should be up to each restaurant owner to decide.

To push the latest legislation through, the Health Ministry accepted a compromise offering a peek into Czech pub life – it agreed to drop a clause requiring restaurants to serve at least one non-alcoholic drink cheaper than beer, addressing the fact that Czech beer is cheaper than water in some places.

Know the Risks: E-cigarettes & Young People

Dec 8th, 2016
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In Greece’s tobacco culture, passive smoke a serious problem

Dec 8th, 2016
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http://www.ekathimerini.com/214387/article/ekathimerini/news/in-greeces-tobacco-culture-passive-smoke-a-serious-problem

Nearly two-thirds of Greeks are inhaling someone else’s tobacco smoke on a daily basis, making Greece the worst nation in the European Union in exposing its people to the health risks of passive smoking.

The European Union’s statistical office Eurostat said Wednesday that 64.2 percent of Greeks suffered daily exposure to tobacco smoke indoors. Second in the EU is Croatia with 44.7 percent, followed by Bulgaria with 40.5 percent. At the other end, Sweden best protects its people from secondhand smoke with only 5.9 percent exposed, even better than Finland with 6.3 percent.

In a tally of EU smokers aged 15 and over, Bulgaria tops the rankings with 34.7 percent, ahead of Greece with 32.6 percent. Sweden only has 16.7 percent who smoke, with Britain the second-lowest with 17.2 percent.

Tobacco corporations target Africa’s children

Dec 8th, 2016
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http://www.heraldlive.co.za/business/2016/12/08/tobacco-corporations-target-africas-children/

Children in Africa have become a target for tobacco companies‚ research by the African Tobacco Control Alliance (ATCA) has found.

The survey looked at the way in which tobacco companies in five African countries– Burkina Faso‚ Cameroon‚ Benin and Nigeria – get consumers to keep using their product.

It found tobacco use caused about six million deaths yearly‚ with 80% of them occurring in low- and middle-income countries.

Findings show that in Africa‚ smoking prevalence is about 21% among adult men and 3% among women.

About 21% of young boys and 13% of young girls use tobacco products.

“The aggressive sale and marketing strategies of the tobacco industry targeting young people will be among the key contributing factors to the growing epidemic of tobacco use in Africa‚” the report said.

Four strategies were identified as being used to lure children to smoke‚ a concern that was highlighted at the launch of the report in Johannesburg recently.

Advertising and promotion, the sale of single cigarettes, child-friendly flavoured cigarettes and noncompliance with existing tobacco control laws were the main causes for an increase in young children’s interest in smoking.

Sales of single cigarettes were found to be widespread near schools.

Swiss parliament rejects tobacco advertising ban

Dec 8th, 2016
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According to a study published by the Swiss federal office of public health last December1, two thirds of the Swiss public were in favour of banning tobacco advertising, everywhere except at the point of sale. 58% were even in favour of a blanket ban, while one in six wanted to see cigarette price increases. Switzerland’s parliament does not appear to share this view.

http://lenews.ch/2016/12/08/swiss-parliament-rejects-tobacco-advertising-ban/

A plan put forward by Federal Councillor Alain Berset to restrict tobacco advertising was rejected by parliament today by 101 votes to 75. Those against the plan think it went too far and said there was nothing that proved that banning advertising would reduce tobacco consumption. In addition, they thought a federal ban limited the power of cantons to introduce stricter rules.

A 2013 World Health Organisation report2 said “complete bans on tobacco advertising, promotion and sponsorship decrease tobacco use”. The WHO report also said that the best estimate is that the tobacco industry spends tens of billions of US dollars worldwide each year on tobacco advertising, promotion and sponsorship. In the United States alone, the tobacco industry spends more than US$ 10 billion annually.

Berset’s proposed rules would have banned advertising in public spaces, in cinemas, in the press and on the internet. Distribution of free samples and some promotional price reductions would have also been banned. According to a WHO report these practices are banned in Spain, France, Sweden, Holland, Portugal, the UK and a number of other European countries, but not Switzerland.

Corine Kibora, spokesperson for Addiction Suisse described parliament’s decision as “disappointing” and “proof that the arguments of lobbyists and the economy triumphed over the public’s health”, while adding that as the trend towards favouring individual choice over collective responsibility takes over we seem to have forgotten the central point: business and advertisers are driven to make sales.

According to Swiss federal office of public health, Swiss smokers dropped from 33% of the population in 2001 to 25% in 2015. However, since 2011, the number of smokers has stayed stubbornly high. In addition, it calculates the annual cost of tobacco at tens of billions of francs per year of which CHF 1.7 billion goes on medical treatments and CHF 3.9 billion on compensation for work absenteeism and invalidity. On the other hand, tobacco tax only brings in CHF 2 billion annually.

Surgeon General calls youth vaping a public health threat

Dec 8th, 2016
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http://www.usatoday.com/story/news/nation-now/2016/12/08/surgeon-general-calls-youth-vaping-public-health-threat/95134890/

E-cigarette use among young people is a major health concern, according to a new report from the U.S. Surgeon General on Thursday.

Surgeon General Vivek Murthy said in the report that not enough research has been conducted to prove that use of e-cigarettes among youth are harmless.

“E-cigarettes went from being rare in 2010 to being the most common tobacco product used by our nation’s youth,” Murthy said during a press conference. “This represents a staggering development in a relatively short period of time, and it threatens 50 years of hard-fought progress we have made curbing tobacco use and puts a new generation at risk for … addiction.”

According to the U.S. Centers for Disease Control and Prevention, e-cigarette use among high school students rose from 1.5% in 2011 to 16% in 2015. Federal health officials estimate that about 3 million middle and high school students use e-cigarettes.

The potential safety of e-cigarettes, devices that heat a liquid consisting of nicotine, flavorings and other chemicals to create a vapor, is hotly debated. Unlike traditional cigarettes, e-cigarettes do not contain tar or other chemicals generated by the combustion of tobacco that are responsible for harmful tobacco-related diseases. Proponents of e-cigarettes say they are a safer alternative to traditional cigarettes and can help people quit smoking.

Nicotine is harmful to the developing brain regardless of whether it’s smoked through a traditional cigarette or an e-cigarette, Benard Dreyer, President of American Academy of Pediatrics, said during the press conference.

“Nicotine… regardless of its source is highly addictive and has clear neurotoxic effects especially on the developing brains of adolescent and even into early adulthood,” Dryer said.

For years, e-cigarettes have been largely unregulated, with many consumers unaware of what chemicals are used in their e-cigarette products. In May, the Food and Drug Administration released a rule that requires electronic cigarettes to be regulated much like tobacco cigarettes. The rule requires nearly every e-cigarette on the market — and every different flavor and nicotine level — to submit a separate application for federal approval.

While many may believe that e-cigarettes emit a harmless aerosol, that’s not the case, Dreyer said.

“Aerosol from e-cigarettes is not harmless, it includes nicotine and other potentially harmful chemicals including heavy metals and carcinogens,” Dreyer said, adding that second-hand inhalation should also be avoided. “Because there is no safe level of exposure, it is extremely important to protect children from these.”

E-cigarette use threatens years of US anti-smoking gains, says report

Dec 8th, 2016
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Top US health officials have war ned that the gr owing use of e-cigarettes among young adults will undo decades of pr ogr ess in ending the ‘tobacco epidemic’

Growing e-cigarette use among young people threatens decades of progress in shrinking tobacco use, top US health officials warned in a report released on Thursday.

The US surgeon general’s report is the first federal government review of the public health impact of e-cigarettes on young people across the country.

“Preventing tobacco use in any form among youth and young adults is critical to ending the tobacco epidemic in the United States,” said surgeon general Vivek Murthy.

E-cigarettes don’t contain tobacco, but do contain nicotine and are considered “tobacco products” by the US government.

Advocates say e-cigarettes could replace traditional cigarettes, while critics are concerned they are a gateway to tobacco use – especially in young people, who are more vulnerable to the addictive impact of nicotine.

The debate over the potential harms and benefits of e-cigarettes is a live one in the US and the UK. Many public health professionals in the UK believe that vaping is the best available option for those who would otherwise smoke tobacco, and that it is saving thousands of lives by enabling hardened smokers to quit. Public Health England has said it is 95% safer, and that the young people experimenting with e-cigarettes are the same people who try smoking tobacco.

“Evidence from the US is the same as in the UK in crucial respects,” said Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies at Nottingham University. “Children experimenting with e-cigarettes are by and large those who are already experimenting with cigarettes or are smokers.”

The surgeon general’s report said e-cigarettes are the most commonly used tobacco product among the young and are more popular than cigarettes, cigars and hookahs in the US. The use of e-cigarettes and other nicotine products by under-18s has jumped significantly after decades of declining rates of cigarette smoking.

Young people are not using the products for the same reasons as adults, the report said: “Although adults report using e-cigarettes as a cessation device, the evidence supporting the effectiveness of e-cigarettes as an aid for quitting conventional cigarettes remains unproven and nonexistent among youth.”

The most common reasons for young people to use e-cigarettes are curiosity, to avoid indoor smoking restrictions and as a less harmful alternative to conventional cigarettes, according to the report.

In 2014, use of e-cigarettes by young adults aged 18 to 24 surpassed that of adults aged 25 and older.

Sylvia Burwell, the US Department of Health and Human Services secretary, said the US must ensure progress in combatting traditional cigarette use isn’t compromised by the use of new tobacco products like e-cigarettes.

“The findings from this report reinforce the need to support evidence-based programs to prevent youth and young adults from using tobacco in any form, including e-cigarettes,” Burwell wrote. “The health and wellbeing of our nation’s young people depend on it.”

Kevin Fenton, national director of health and wellbeing at Public Health England, said the group recognised the concern in the US, where it had proved difficult to impose restrictions on the marketing of e-cigarettes. By contrast, England had put in place a ban on marketing to under-18s, advertising controls and quality standards. But, he said, “our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year.

No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence.”

The US report’s findings pull from existing research on e-cigarette use among people aged between 11 and 24 to show patterns of use and how it affects health.

This report was crafted in a similar vein to earlier surgeon general reports on youth tobacco use. The most recent of those was released in 2012, when e-cigarettes were less popular than they are now.

E-cigarette sales in the US grew to an estimated $3.5bn in 2015, according to Nielsen, but have been falling significantly since the end of last year.

The e-cigarette industry is dominated by traditional tobacco companies, who were targeted in the report for using similar tactics as those used to lure young users to tobacco. “Companies are promoting their products through television and radio advertisements that use celebrities, sexual content, and claims of independence to glamorize these addictive products and make them appealing to young people,” said Centers for Disease Control and Prevention director, Thomas Frieden, in the report’s foreword.

The report concludes with recommendations for combatting e-cigarette use among young people, including incorporating e-cigarettes into smoke-free policies, preventing youth access to e-cigarettes and significant increases to taxes and prices affiliated with e-cigarettes.

Murthy said: “Preventing tobacco use in any form among youth and young adults is critical to ending the tobacco epidemic in the United States.”

The report was launched on Thursday morning in Washington DC at an event where the surgeon general unveiled a new e-cigarette website and public service announcement. Speakers included Murthy, 16-year-old health activist Tyra Nicolay and American Academy of Pediatrics president Benard Dreyer.

Tyra, a member of the Navajo Nation, described how she was first introduced to e-cigarettes with a sour green apple flavored product but has since quit using e-cigarettes.

“Today, I call on my peers to reject tobacco products, including e-cigarettes,” she said.

Dreyer said e-cigarette use “has raised alarm among pediatricians, tremendously”.

In October 2015, the AAP issued recommendations for e-cigarette public policy and regulations and guidance for physicians on how to speak with families about tobacco and “nicotine delivery devices” such as e-cigarettes.

“That’s why this report is so necessary and welcome at this time,” Dreyer said. “Because as you’ve heard, e-cigarettes have the potential to addict the next generation of children. It’s a major public health crisis, as far as we’re concerned.”

The British campaigning organisation Action on Smoking and Health said it was puzzled by the surgeon general’s concerns. “In the US as in the UK, young people are experimenting with e-cigarettes but vaping has not been associated with an increase in smoking, a point which is not made sufficiently clear in the report,” it said.

“While nicotine is not completely harmless, it is smoking that is lethal. In the UK we have a regulatory system that restricts advertising and controls sales to young people.

There is no evidence of significant regular use by nonsmoking children and, as in the US, smoking rates are going down, not up.”

Britton, the Nottingham University academic, attributed a drop in the UK smoking rate, down three percentage points in three years, to people taking up e-cigarettes in order to quit. “It is falling fast in the UK, almost certainly related to e-cigarettes.”

Tobacco Companies Seeking To Influence Policy Are Violating the Framework Convention on Tobacco Control

Dec 7th, 2016
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Tobacco industry representatives are continuing to meet with and are attempting to influence government officials in many countries.

http://www.cancertherapyadvisor.com/iaslc-2016/tobacco-control-companies-seeking-influence-policy-violations-cancer/article/577761/

Tobacco industry representatives are continuing to meet with and are attempting to influence government officials in many countries, which is a direct violation of those countries’ commitments under the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), according to a report presented at the International Association for the Study of Lung Cancer (IASLC) 17th World Conference on Lung Cancer (WCLC) in Austria.1

Luke Clancy, MD, of the Tobacco Free Research Institute in Dublin, Ireland, said that the tobacco industry’s access to tobacco control policy makers has had a harmful impact on public health and provides the companies with a direct avenue to influence public policy.

The tobacco industry manipulates contacts in government under the guise of helping national governments negotiate harmonization of tobacco excise tax deadlines, for example, but Dr Clancy said that this directly contravenes FCTC Article 5.3, which aims to prevent industry from influencing policy development.

Tobacco use remains “stubbornly high” in Europe, despite the existence of widely recognized and effective interventions, such as raising the price of tobacco products through taxation, adopting smoke-free legislation to prevent exposure to secondhand smoke in the workplace, and banning advertising and promotion of tobacco use, said Dr Clancy.

In a related press conference, Dr Clancy indicated that although all 27 European Union member state countries have initiated some type of strategy to become smoke free, there is still much work to be done.2

“Despite this progress, the prevalence of smoking in Ireland is 18.5%. The prevalence of smoking in Europe as a whole remains at approximately 29% of the adult population, and seems to be increasing among females in some European countries,” he said. “Ireland hopes to be tobacco free by 2025. Full implementation of the WHO FCTC recommendations may not be enough to achieve this in Ireland.”

WHO recommends the monitoring of smoking and the provision of cessation programs, but the implementation of services to support cessation of tobacco use in line with Article 14 of the FCTC “can and should be significantly improved,” said Dr Clancy. He contended that the tobacco industry and its allies have worked to oppose price increases by attempting to persuade finance ministers that a price increase will lead to a loss of revenue through an increase in smuggling despite evidence to the contrary.

Smoke-free policies can achieve their positive effect by educating the public about the health benefits of quitting smoking, limiting opportunities to smoke, and promoting an attitude of denormalization of smoking, he concluded.

References
1. Clancy L. Tobacco Control. Paper presented at: 17th World Conference on Lung Cancer; December 2016; Vienna, Austria.
2. Clancy L. Press Conference at: 17th World Conference on Lung Cancer; December 5 2016; Vienna, Austria.

Philip Morris (PM) Seeks FDA Approval for IQOS Products

Dec 7th, 2016
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http://www.nasdaq.com/article/philip-morris-pm-seeks-fda-approval-for-iqos-products-cm718365

Tobacco giant Philip Morris International Inc. PM has filed an application with the US Food and Drug Administration (FDA) for its IQOS products (heatsticks that heat tobacco instead of burning it).

Once the Modified Risk Tobacco Product (MRTP) claim is approved by FDA, the company will be able to enjoy a significant marketing advantage over other reduced risk tobacco products that are being sold currently. The regulatory authority is expected to take a minimum of 60 days for completing an administrative review of the application.

The heatsticks are already available in several test markets. Philip Morris launched these products in fiscal 2015 in Japan and Italy where it became very popular. Further, there is a steady increase in the number of iQOS purchasers who have predominantly or fully converted to these reduced risk products.

Once these products get a go ahead from the FDA, Altria Group Inc. MO will also be able to sell these products in the U.S.

Altria and Philip Morris have been working on reduced risk tobacco products for quite some time. In 2015, the two companies had entered into a strategic agreement under which Philip Morris markets Altria’s MarkTen e-cigarettes internationally. Altria in turn distributes two of Philip Morris’ heated tobacco products in the U.S.

Further, the companies have decided to partner on a regulatory engagement related to the products. The joint venture has made excellent progress on branding and go-to-market strategies for non-conventional cigarettes in the U.S. market. Additionally, the two companies were working together on the above mentioned modified-risk tobacco product claim.

 

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