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January, 2017:

New warnings on cigarettes

Government has taken further steps to protect the public from the harmful effects of tobacco.

According to Minister of Health, John Boyce, producers, manufacturers and distributors of cigarettes will now have to ensure that included in the packaging and labels of cigarettes are graphic illustrations and strong wording to inform persons of the dangers of tobacco, and to discourage its use. Piloting the Health Services (Amendment) Bill in the Lower House yesterday morning, he said they will be given a reasonable timeframe to become compliant.

“Up until now cigarette packages in Barbados have been very liberal in terms of their designs and the packaging… I think there is a mention that the Minister of Health indicates that cigarette smoke is dangerous for your life. However, we’ve always felt we had to move beyond that and the internationally accepted battle is to move to a regime where the packaging is even more stark; and along with the messaging from the Minister of Health or the Chief Medical Officer in the country, we want to add to it some graphic illustration of the conditions which we could find ourselves having to deal with, if we continue to abuse or use cigarettes at all,” he told fellow Members of Parliament.

Those steps, he said are consistent with the guidelines set out in Article 11 of the Framework Convention on Tobacco Control. With that in mind, he explained that the package and label of any tobacco product should not contain any information that is false, misleading, defective or likely to give erroneous information about the characteristics, health effects or hazards of the tobacco product. He speaking particularly in relation to terms used on cigarettes packages such as “low tar”, “light” “mild” and “slim”.

“We do not recognise these are terms that change the form of the cigarette from dangerous to not dangerous. The Ministry of Health does not subscribe and indeed the Framework does not subscribe to that distinction… We’ve decided as a country, we have decided as a region, and indeed we’ve decided internationally that we have to fight back against these marketing forces,” he said.

Minister Boyce went on to say that the package and label will give full disclosure about the harmful and hazardous health effects through graphic pictorial warnings. These warnings, he said, will cover the front and back area of the product to a minimum of 60 per cent. In addition, Boyce said, there will be written warning attributable to the Minister of Health and or the Chief Medical Officer. The warnings, he explained, will speak to such health issues as blindness, impotency, and stillbirth, dangers of second hand smoke and mouth diseases.

He added that the standard for packaging and labelling was adopted out of a CARICOM standard approved by the Council of Health Ministers of the region, and facilitated by the CARICOM Regional Organisation for Standards and Quality and the Barbados National Standards Institution. That work, he stated, started as far back as 2013. (JRT)

Philip Morris International Looks Toward A Smoke-Free Future

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Tripling tobacco taxes: Key for achieving the UN Sustainable Development Goals by 2030

Since the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC) a decade ago, over 180 countries have signed the treaty. Progress has been made in expanding the coverage of effective interventions–more than half of the world’s countries, with 40% of the world’s population have implemented at least one tobacco control measure, and despite increasing global population, smoking prevalence has decreased slightly worldwide from 23% of adults in 2007 to 21% of adults in 2013. How can greater reductions in smoking be achieved in the next decade and contribute to reaching the health and social targets of the UN Sustainable Development Goals (SDGs) by 2030? We review some key issues in the epidemiology and economics of global tobacco control.
Smokers face a three-fold higher risk of death versus otherwise similar non-smokers, resulting in a loss of at least one decade of life. While the hazards of smoking accumulate slowly, cessation is effective quickly. People who quit by age 40 get back nearly the full decade of life lost from continued smoking; quit by 50, get back six years; quit by 60, get back four years. Cessation is now common among adults in high-income countries. For example in Canada there are over 1 million more ex-smokers than just a decade ago. However, due in large part to the marketing and pricing strategies of the tobacco industry, cessation remains a major public health challenge in most low and middle-income countries (LMIC) where 85% of smokers live.

Global annual cigarette sales rose from five trillion cigarettes in 1990 to about six trillion today. Cigarette production has increased by 30% in China since 2000, which consumes 40% of the world’s cigarettes. Global tobacco industry profits of about $50 billion – or $10,000 per tobacco death – enable it to access finance officials, fund pricing research, and run interference against tobacco control–summarised wonderfully by comedian John Oliver. Serious control of tobacco must counter these strategies on the basis of robust health, social and economic data that document the negative societal impact of tobacco use.

WHO has recommended a 30% reduction in smoking prevalence by 2025, which would avoid at least 200 million deaths by the end of the 21st century among current and future smokers. The only plausible way to reduce smoking to this extent would be to triple tobacco excise taxes in most LMICs. A tripling of the excise tax would roughly double the retail price and reduce tobacco consumption by about 40%. As of 2015, WHO reported that only 28 LMICs had comprehensive policies covering counter advertising, restrictions on public smoking, and on appropriately high taxes, and that few had made progress on raising taxes.

The common strategy of tobacco producers is to lobby governments to keep cigarettes affordable by keeping tax hikes below the rate of income growth, and by taxing different cigarettes at different rates to enable smokers to change to cheaper brands or lengths. Smart taxation needs to simplify taxes by adopting, ideally, a high, uniform excise tax on all types of cigarettes (both filter and nonfilter) to reduce downward substitution (let’s not forget, all cigarettes will kill you!). The Government of India has recently made modest tax reforms in this direction, the 2015 tobacco tax adjustment in China is reducing consumption and increasing fiscal revenue, and in 2016 World Bank teams supported the work of government teams in Armenia, Colombia, Moldova and Ukraine for the undertaking of comprehensive tax reforms that were approved by Parliaments, including reforms on tobacco tax structures and rate levels—additional work is being supported in other countries worldwide. Smart taxes can follow the example of Canada’s tax hike of about 5 cents a pack in 2014, as well as the Sin Tax Reform (both tobacco and alcohol) in the Philippines of 2012 that helped mobilize domestic resources to fund the expansion of universal health coverage. There have been other successes: Botswana, Ecuador, Mauritius, Mexico, and Uruguay, where local political champions, paired with expert taxation advice, achieved large tax hikes. South Africa also raised taxes in the last decade and has curbed consumption per adult by half.

Non-price interventions also play an important role as they help to reduce the social acceptability of tobacco use. Young American women took up smoking in large proportions in the 1960s and 1970s due in part to aggressive advertising (“The “Virginia Slims” epidemic”). Advertising bans or restrictions are likely one reason why young Chinese or Indian women have not yet done so. Australia has adopted plain packaging, and other countries are starting to follow this example. Simple questions on past smoking status to death certificates or to verbal autopsies could enable low-cost monitoring of the consequences of tobacco use in many populations.

Governments and international agencies with accumulated know how and expertise in data sciences such as the World Bank Group and OECD along with WHO could also help countries create accessible and independent sales, revenue and smuggling data sources as a basis for rational tobacco tax policy. Country finance officials should refuse advice from tobacco lobbyists to avoid falling into conflict of interest situations, as WHO recommends for health officials.

Implementing the FCTC more effectively in the next decade is required to raise cessation rates in LMICs. The World Bank recommended taxation as the core strategy in its 1999 publication, Curbing the Epidemic: Goverments and the Economics of Tobacco Control. Similar recommendations follow in recent reports on tobacco taxation by WHO, and by the International Monetary Fund. Building upon accumulated evidence and country experiences, a tripling of the worldwide excise tax might be the only way to achieve the 2030 UN Sustainable Development Goal of reducing non-communicable disease deaths by 30%!

Jamaica to evaluate WHO’s call for heavy taxation on tobacco industry

Health Minister, Dr Christopher Tufton says he along with stakeholders will be evaluating the call by the World Health Organisation (WHO) for heavy taxation on the tobacco industry.

Addressing the WHO’s Executive Board in Geneva, Switzerland, yesterday Director-General, Dr Margaret Chan, said heavy taxation is one way of controlling tobacco use.

According to Tufton, Jamaica, which is a member of the WHO board, shares the concerns about the financial costs to treat tobacco-related illnesses and the associated cost to public health, globally and nationally.

He says any measure to discourage smoking and support public health is worth considering.

In a landmark report on the economics of tobacco and tobacco control, the WHO and the US National Cancer Institute concluded that smoking costs the global economy more than $1 trillion yearly.

The researchers also said smoking will soon kill more than six million people worldwide each year.

They show how tobacco control, through heavy taxation can save lives while generating revenues for health and development.

Will “Heat-Not-Burn” E-Cigs Kill Off Vaping?

With a more cigarette-like experience, the next generation of electronic cigarettes could make vaping obsolete.

The future of cigarettes may be “smoke free,” as Philip Morris International (NYSE:PM) says, but it is a new platform of electronic cigarettes using heat-not-burn technology that may also kill off vaping as we know it.

Not your father’s e-cig

Traditional e-cigs and personal vaping systems (PVS) heat a nicotine-infused liquid to create a vapor that is inhaled. Whether it’s a glowing point of light or a massive cloud of vapor being released that can make a user look as if he’s starring in a Cheech & Chong movie, the devices have been critiqued as falling short of being fully satisfying.

Users have complained of a chemical aftertaste from the heated e-liquid, while those nearby to someone vaping are annoyed by the billowing clouds in which they’re enveloped.

However, the new heat-not-burn technology promises to resolve both problems. By using real tobacco to deliver the flavor and nicotine hit users crave, these next-generation devices give a more cigarette-like experience to the user while emitting a vapor more confined to one’s personal space. And because they are more like combustible cigarettes than either traditional e-cigs or PVS, they may have the advantage of weaning more people off of smoking, which would be a societal gain in terms of cost and health (there are nicotine-free e-liquids available, too).

Philip Morris is even pursuing a “reduced risk” label in the U.S., which, with the help of the FDA, will give it a major competitive advantage over the competition. Yet with many of the global tobacco companies also pursuing heat-not-burn (HNB) alternatives, it’s worthwhile to look at the different products they will offer.

Philip Morris (iQOS)

For a company that produces some 850 billion combustible cigarettes annually, Philip Morris’ call for a “smoke free” future is a big deal. But since HNB products will use real tobacco, it (and the other manufacturers) aren’t really straying too far from home.

The iQOS is actually a two-part device, a tobacco-filled miniature cigarette and a heating unit. The cigarette, marketed with Altria (NYSE:MO) as Marlboro HeatSticks, is inserted into a device that looks something like a PVS, which is itself inserted into the iQOS heating device. The e-cig is heated to 350 degrees Celsius (662 degrees Fahrenheit), which differs from combustible cigarettes that burn tobacco at 800 degrees Celsius, or almost 1,500 degrees Fahrenheit. The whole device is then removed and “smoked” just as you would a combustible cigarette, and when it’s finished, the HeatStick is discarded.

British American Tobacco (iFuse glo)

Next to the iQOS, British American Tobacco’s (NYSEMKT:BTI) iFuse glo is arguably the next biggest HNB device that will be coming to market. Like the iQOS, a tobacco-filled cigarette, which it will market as NeoStiks under the Kent brand, is similarly inserted into a PVS-like device that is then inserted into the iFuse heating element.

BAT bills itself as the first international tobacco company a vapor product in the U.K., the Vype e-cig, and it followed that with an early iFuse HNB product that heated an e-liquid, but passed the resulting vapor through tobacco to give it real tobacco flavor. The glo is the next stage of development in e-cig technology, and it gives smokers a range of alternatives.

Reynolds American (Eclipse, Revo, Core)

Reynolds American (NYSE:RAI), which just agreed to be acquired by British American for $50 billion, was one of the pioneers in HNB technology with its Eclipse back in the early 1990s. It relaunched the product in 2014 as Revo, but it once again failed to gain much traction with consumers. Although it’s apparently still available in very limited quantities, Reynolds has been working on a new product called Core, which BAT was supposedly very interested in. It’s said that the delay in Reynolds agreeing to BAT’s takeover offer was related to the Core technology. Core, which is similar to Revo, recently completed the first phase of test marketing in Japan.

Japan Tobacco (Ploom Tech)

Despite Japan’s tobacco market falling dramatically over the years, heat-not-burn technology is more successful there than just about anywhere else. It is the first market manufacturers enter when launching their products. When Philip Morris introduced the iQOS there in early 2016, it quickly shot to the top, which had Japan Tobacco (NASDAQOTH:JAPAF) quickly following with its Ploom Tech HNB device. Its own products have been so successful that it has at times had to suspend taking orders for it because it couldn’t keep up. Ploom markets the cigarettes under its popular “Mevius” brand.

PAX Labs (PAX)

PAX Labs used to be Ploom Tech until Japan Tobacco bought the name and technology in 2015. Pax subsequently bought back its partner’s minority stake to focus on the PAX loose-leaf vaporizing product.

Unlike the other HNB technology, users of PAX fill the PAX device with loose-leaf tobacco and place it on a heating unit that plugs into your computer’s USB port. When the unit is hot enough, users attach a mouthpiece to it to draw in the vapor. There are three different devices — the Pax 1, 2, and 3 — that are all similar in function, plus the PAX Era, which is filled with oil. It may be one of the first purpose-built marijuana e-cigs, and it’s available in the U.S., but only in California and Colorado.

Up in smoke

Every tobacco company understands the combustible cigarette market is dying, which is why they’re broadening their horizons into electronic cigarettes and vaping products. The heat-not-burn technology, though, promises to vastly expand the manufacturers’ lifecycle as the use of real tobacco allows them to continue profiting from their primary cash crop. It might also serve to effectively snuff out any remaining vaping competition.

E-cigarettes attracting more youths towards world of tobacco

You might have thought e-cigarettes cut down tobacco consumption, but the reality is a bit different.

A study, by University of California- San Francisco,suggests that it actually attracts more youths towards tobacco consumption.

It has been published in Pediatrics.

Researchers from University Of California in the United States of America said they did not find any evidence of decline in the consumption of tobacco. In fact, the usage of e-cigarettes & cigarettes has gone higher among adolescents in 2014 compared to the numbers from 2009.

“We didn’t find any evidence that e-cigarettes are causing youth smoking to decline,” said lead author Lauren Dutra.

The analysis by the researchers also saw that section of youth who start smoking e-cigarettes are more likely to draw themselves in consuming traditional cigarettes in later part of their lives.

“While some of the kids using e-cigarettes were also smoking cigarettes, we found that kids who were at low risk of starting nicotine with cigarettes were using e-cigarettes,” Dutra said. “Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”

In August 2016, the U.S. Food and Drug Administration, already restricted the purchase of e-cigarettes to adults aged 18 years and older. The FDA also directed to have a warning label on e-cigarettes which will start from August 2018.

The authors also said that there has been a decline in cigarette smoking youth but the decline has not been rapid after the advent of e-cigarettes in the U.S. between the years 2007 and 2009.

The authors performed an in-depth analysis of the psychological characteristics of the consumers of e-cigarettes. The research showed that the smokers tend to display some characteristics which non-smokers are less likely to show.

Characteristics like the tendency to live with a person who smokes or to wear clothing which displays tobacco product logo. The smokers in the national youth survey showed these characteristics, while the youth who were only using e-cigarettes displayed less of these qualities.

“E-cigarettes are encouraging – not discouraging – youth to smoke and to consume nicotine, and are expanding the tobacco market,” said senior author Stanton A. Glantz.

These new results are consistent with a similar study that took place in California last year by the researchers at the University of Southern California. The researchers also found that adolescents who consumed ecigarettes, but not traditional cigarettes have displayed less risk factors which were commonly found among cigarette smokers. (ANI)

Study finds high tobacco usage among students

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college.

Thiruvananthapuram: In Kannur, over 70% of higher secondary school students begin tobacco consumption at a tender age of 15, while in rural Thiruvananthapuram tobacco sales near educational institutions is alarmingly high, finds a study, jointly carried out by Regional Cancer Centre (RCC) here and Kannur Medical College.

A total of 775 students (336 boys and 439 girls) of two schools in Kannur were subjected to study by the medical college. While 41% of the sample population got tobacco products from nearby shops, 27% of them got it from friends. According to 79% of students, it was “fairly easy” and “very easy” to obtain these products.

Dr Paul Sebastian and Dr R Jayakrishnan of RCC, who led the study in the rural parts of the state capital, presented a similarly bleak picture.

Nearly 19% of boys between 15 and 18 years use tobacco in any form. Of the 1,114 students of 10 random government schools surveyed, 7.4% were ‘ever users’, persons who have used tobacco at least once during the academic year.

The findings reflected the gravity of the issue and also underscored the expert opinion that called for measures to control the menace, said Shoba Koshy, chairperson of commission for protection of child rights.

Dr Elizabeth K E, president, Indian Academy of Pediatrics said, “The World Health Organisation has termed tobacco a global pediatric concern. Once initiated, it becomes very difficult to come off it; the key is to prevent it at a young age.”

Cautious on heat-not-burn

The European Commission is in favor of a cautious approach to heat-not-burn products because it believes that there is a lack of evidence relating to the short- and long-term health effects of using such devices.

This was part of the answer given by the Commission to questions raised by the Belgian MEP, Frédérique Ries.

In a preamble to her questions, Ries said that Philip Morris International had said that it intended to market its new ‘device for smoking’ in the UK, following its initial launch in Japan, Italy and Switzerland.

‘The distinctive feature of this new product, which has been named iQOS, is that it stands on the borderline between traditional cigarettes and electronic cigarettes,’ she said.

‘The major difference between iQOS and electronic cigarettes is that while the latter use a liquid transformed into vapor, IQOS heats the tobacco and keeps it burning [iQOS has been designed so as not to burn the tobacco it contains, only to heat it, as is implied in part of the Commission’s reply], which is very harmful to health.’

Ries asked whether the Commission concurred with health experts who claimed that marketing a hybrid tobacco product of this kind was a ploy to circumvent legislation in force and, in particular, all the requirements laid down in Article 19 of Directive 2014/40/EU concerning novel tobacco products.

‘What steps will the Commission take to thwart the strategies employed by cigarette manufacturers to sell alternative products that are still just as harmful to people’s health?’ she asked.

‘Will the Commission take this opportunity to alter its negative views on electronic cigarettes, which, as a growing number of cancer experts in the EU are now pointing out, do not contain any tobacco or tar and are helping many people to stop smoking?’

In reply, the Commission said it was closely monitoring the developments related to new tobacco products, including “heated not burned” tobacco products.

‘Currently, there is lack of evidence relating to short-term and long-term health effects and use patterns of these products,’ it said. ‘Therefore the Commission is in favour of a cautious approach.

‘At the same time, the Commission would like to underline that with regard to the sale, presentation and manufacturing of these products within the European Union, the relevant provisions of the Tobacco Products Directive apply and should be enforced. This includes the ban on misleading elements foreseen by Article 13 and notably any suggestions that a particular tobacco product is less harmful than others.

The Commission oversees whether member states fully and correctly apply the provisions of the directive.

‘With regard to e-cigarettes, given the lack of conclusive evidence relating to the long-term health effects, use patterns and potential to facilitate smoking cessation, Article  20 of the directive contains their regulation with an emphasis on safety, quality and consumer protection.

‘The rules for e-cigarettes nevertheless allow these products to remain widely available to consumers. A recent Commission report COM (2016) 269 underlines a number of  potential risks to public health relating to the use of ecigarettes, at the same time highlighting the need for further research.’

Health Minister’s call to raise legal smoking age to 21 receives cloudy reviews

It’s the number-one preventable form of death in B.C.

“You look at cancer, heart disease, other vascular strokes, they’re all related to smoking,” said BC Health Minister Terry Lake.

Earlier this week Lake tweeted the idea of raising the minimum legal smoking age in B.C from 19 to 21.

According to Lake, Hawaii, California, and more than 120 jurisdictions in the United States have already made the move.

“In a study, they looked at one jurisdiction where they had raised the age verses surrounding jurisdictions where it was a younger age,” said Lake. “There was a 47% reduction in smoking in high school students in the jurisdiction that had raised the minimum smoking age to 21.”

The current legal age to buy cigarettes across Canada varies.

Alberta, Saskatchewan, Manitoba and Quebec’s legal age is 18.

The rest of the provinces are 19.

While B.C has the lowest smoking rate at 14%, Interior Health Smoking Reduction Coordinator Jeff Connors says raising the legal smoking age to 21 could lower that number even further.

“85% of people who smoke for life start before 19 years of age, so that’s highschool,” said Connors. “I think by sending the message you’re not allowed to, it puts an onus on staff and consumption agencies that tobaccos is a bigger problem. It’s not 19 it’s 21 now, that’s a big difference, so it will reduce the availability to it.”

Along with increasing cigarette buying age, Connors says Health Canada is toying with the idea of making health warning signs larger and even more visible on cigarette packs in an effort to get more people to butt out.

“Looking at plain packaging is another piece, just to reduce the sexiness of the drug,” added Connors.

The majority of the people CFJT-TV spoke to in downtown Kamloops Friday say raising the cigarette buying age won’t deter smokers.

“It’s a bad idea. I see 12-year-old kids smoking, kids are going to still do it,” said one man.

“I think it’s a great idea, anything you can do to deter smokers,” said one woman.

“I don’t think it’s necessary. If a teen wants to smoke, he’s going to smoke,” said another man.

The Health Minister says there’s still plenty to discuss before any changes are made to the smoking market.

“We don’t want to have unintended consequences,” added Lake. “The black market is always something you have to consider when you put in policies like this. It really is just a conversation starter.”

Hong Kong Department of Health Tobacco Control Zero Efforts

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