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Passive Smoking

Number of children exposed to second-hand smoke halved

The Scottish Government published its national tobacco strategy in 2013.

The proportion of children exposed to second-hand smoke at home has almost halved in the last five years.

An NHS Scotland and Edinburgh University review of the Scottish Government’s tobacco control strategy also found a “downward trend in smoking prevalence”.

It also warned smoking continues to be a bigger problem in more deprived areas.

The Scottish Government’s national tobacco strategy, Creating a Tobacco Free Generation, was published in 2013.

The review found the strategy had a positive impact, with smoking rates among adults now at 20% compared to 31% in 2003.

The proportion of children exposed to second-hand smoke at home fell from 11% to 6% between 2014 and 2015.

Smoking rates in the most deprived areas were found to be at 35%, compared to 10% in the most affluent areas.

Dr Garth Reid, principal public health adviser at NHS Health Scotland said: “The evidence shows the positive impact of tobacco policy, ranging from the display ban which put tobacco out of sight in small shops and supermarkets to the introduction on smoke free NHS grounds.

“Yet, levels of smoking are still highest in Scotland’s most deprived areas, with 35% of people living in the most deprived areas smoking compared to ten percent in the most affluent areas.

“It is clear that further action to reduce inequalities in smoking is necessary if the aim of making Scotland tobacco-free by 2034 is to be achieved.”

Dr John McAteer, senior research fellow at Edinburgh University, said: “One of the aims of the 2013 tobacco control strategy was to reduce second hand smoke exposure among children by 2020.

“The most recent Scottish Health Survey shows that second hand smoke exposure fell from 11% to 6% between 2014 and 2015.

“This equates to 50,000 children having been protected from the harms of daily second-hand smoke exposure at home.

“Scotland has some of the most progressive tobacco control policies in the world, and Scottish smoking rates have fallen from 31% in 2003 to 21% in 2015.”

Raise tax on tobacco and make smokers pay for health costs

I support Gauri Venkitaraman’s plea for bans in public areas where the permeation of cigarette smoke is harmful for passers-by or those trying to enjoy the outdoors (“Smoking in public leaves even non-smokers in Hong Kong facing serious health risks [1]”, July 11).

Non-smokers in proximity risk having their asthma flare up. Curious toddlers could become poisoned by ingesting carelessly discarded butts.

The fire contagion risk posed by still-burning cigarette ends is well known during the height of Australia’s bush-fire-prone sizzling summer and hot summers elsewhere.

Less smoking means fewer discarded butts posing a fire hazard. Another reason to impose smoking bans is to prevent adverse lifestyle role modelling for impressionable children.

From a public health perspective, raising tobacco sales tax is likely to reduce daily cigarette consumption and, more importantly, dissuade adolescents from taking up smoking. The cost disincentive of a higher tax holds the potential to improve the community burden of heart and lung disease that consumes avoidable health-care outlays.

It’s about time smokers who adopt unhealthy life habits subsidised the huge expense incurred in treating the acute exacerbation of chronic lung disease, pulmonary community rehabilitation as well as stents and bypass surgery required to alleviate coronary artery disease. Smokers have an addiction requiring an external agency to help them give up.

Imposing higher taxes on fast food and alcohol offers opportunities to improve public health related to “diabesity” (diabetes plus obesity), alcohol-related trauma and interpersonal violence. If we can extend sales tax disincentives to fast food and alcohol, then claims that a tobacco tax discriminates against smokers cannot be justified.

Joseph Ting, associate professor, School of Public Health and

Social Work, University of Queensland, Brisbane, Australia
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Smoking in public leaves even non-smokers in Hong Kong facing serious health risks

Cigarette smoking definitely seems to be on the rise in Hong Kong. I commute to and from work by bus and, of late, the amount of second-hand smoke in the vicinity of bus stops has increased substantially.

There are huge rubbish bins near every bus stop, and people seem to view this as indicating a smoking spot. There have been many instances when I’ve found people smoking while waiting at the bus stops as well. Many times, people simply throw their half-smoked cigarettes in the little receptacle on top of the bins, without stubbing them out. This results in a continuous cloud of cigarette smoke billowing from the many burning stubs on top of the bins.

The other day, I found two schoolchildren hanging around a rubbish bin and one of them was about to surreptitiously pick up one of the burning stubs that someone had tossed away. Kids are, by nature, curious, and burning stubs lying within reach pose the danger of tempting them to try smoking.

Inhaling second-hand smoke is also very harmful and could lead to serious health issues down the line. Humans can be self-indulgent but usually the ill-effects are restricted to that individual. However, when it comes to smoking in public, the ill-effects are not restricted to the smoker. The negative effects of passive smoking has an impact on other people too, an impact that is scientifically proved to be tangible, measurable and, at times, permanent.

Just imposing high tobacco taxes has not really had an impact, as far as pedestrians being forced to inhale second-hand smoke goes. A legal move to increase the size of warnings on the cigarette packs has met with fierce resistance, accompanied by lobbying by tobacco executives and their lawyers.

Many countries have enforced compulsory, graphic health warning signs covering most of the surface area of cigarette packs, along with plain packaging that reduces the effect of branding for drab-looking packs.

The government has laws in place but there needs to be efficient enforcement. When it comes to use of controlled substances like tobacco, there has to be a healthy modicum of respect on the part of users towards the health of non-users, and this is simply not going to be possible as long as effective measures are not enforced.

Gauri Venkitaraman, Lam Tin

Tobacco-growing Cuba marks World No Tobacco Day

Despite its world-famous tobacco crop, Cuba on Wednesday celebrated World No Tobacco Day with zeal, launching anti-smoking campaigns in the media, at schools and in healthcare centers.

“Statistics show that 54 percent of Cuban families, 55 percent of children, 51 percent of pregnant women and 60 percent of adolescents are exposed to this polluting agent.

These figures rank us as the Latin American country with the highest exposure to tobacco smoke in the home,” the daily Granma cited Elba Lorenzo Vazquez, national coordinator of the state anti-smoking program, as saying at a press conference.

Cuba has Latin America’s third highest rate of smokers, with some 24 percent of the population smoking.

The anti-smoking campaign is directed mainly at young Cubans, hoping to prevent them from picking up the habit in the first place, though the government is also promoting programs to help those addicted to tobacco quit smoking.

Laws that restrict smoking have been around in Cuba since the early 1970s. In 1974, the government banned smoking in government offices and institutions, and in 1986, the ban was expanded to other areas.

The World Health Organization (WHO) declared May 31st World No Tobacco Day to raise awareness about the dangers of smoking, which can lead to lung cancer, respiratory diseases and other ailments.

Half of all smokers die prematurely, according to the WHO.

Under the banner “Tobacco — a threat to development,” the WHO released a video that warns “tobacco endangers our health, economies and environment and undermines our effort to build … a more prosperous world for all.”

Still No Tobacco Standardised Packaging Regulations

Imperial Tobacco New Zealand wants to know why the Government still hasn’t released Regulations to implement standardised packaging of tobacco.

Parliament passed the Bill for tobacco products for standardised packaging in September 2016, but Regulations that set out exactly how and when the measure will be implemented still haven’t been released.

Head of Corporate and Legal Affairs for Imperial Tobacco New Zealand, Louise Evans McDonald, says Imperial and tobacco retailers are becoming increasingly frustrated with the delay.

“While we have made our objection to standardised packaging known, we will obviously need to comply with the new law. That is going to be extremely difficult to do if the Government won’t tell us exactly what the new law is.

“Retailers have joined us in calling for at least 12 months lead time until implementation – but that has clearly fallen on deaf ears. The legislation says that we must have standardised packaging in March next year, which is now less than 10 months away.

“We need to see the Regulations immediately so that we can source and prepare packaging materials ready to meet the deadline. If we don’t know what those materials must contain because we don’t have Regulations, then exactly what is the Government going to expect of us and, importantly, of retailers?”


Timeline of key dates:

31 May 2016 – Exposure draft of regulations for consultation
30 June 2016 – Bill’s second reading
8 September 2016 – Bill’s third reading
14 September 2016 – Bill received Royal assent

Indonesia’s Child Tobacco Workers in Peril

In the next week, Indonesian President Joko (“Jokowi”) Widodo will decide whether to encourage parliament to move forward with a draft tobacco bill aimed at increasing domestic tobacco production. The bill would gut many important existing health regulations, like the requirement that companies include a health warning with a picture on the label of tobacco products.

Those are troubling proposals given that millions of children in Indonesia start smoking each year, and that 40 million more are “passive smokers” from secondhand smoke. The Indonesian Ministry of Health, 17 prominent health organizations, and many others have denounced the measure as an attempt to undermine Indonesia’s already weak tobacco control laws. Jokowi should reject the bill.

But the draft bill is not the only tobacco policy issue awaiting action by the Jokowi administration. Each year in Indonesia, thousands of children, some just 8 years old, work in hazardous conditions producing tobacco that ends up in products marketed and sold by huge Indonesian and multinational tobacco companies.

My colleagues and I published a Human Rights Watch report documenting hazardous child labor on Indonesian tobacco farms last May. Since then, another tobacco season has come and gone, but the child workers behind Indonesia’s tobacco industry remain unprotected.

We interviewed 132 children who worked on tobacco farms in four of Indonesia’s biggest tobacco-producing provinces. We found that child workers are exposed to nicotine and pesticides—toxins that can be especially harmful to children who are still growing and developing. Half the children we interviewed had experienced nausea, vomiting, headaches, or dizziness while they worked. Those symptoms are consistent with acute nicotine poisoning, which happens when workers handle tobacco plants and absorb nicotine through their skin. Many children said they also mixed and sprayed toxic chemicals on the plants with no protective equipment, and some became violently ill afterward.

The families we interviewed did not intentionally put their children in harm’s way. They were committed to helping their children get an education so they could have a better future.

Indeed, most of the children we interviewed attended school and worked in tobacco farming only outside of school hours.

But direct contact with tobacco in any form is hazardous work for children because of the nicotine in the leaves. Most of the families we spoke with had never received comprehensive information about the hazards for children of work on tobacco farms, so they did not know the risks to their children.

We urged the Jokowi government to take action to protect children from danger in tobacco fields. We called on the Health Ministry to work with other ministries to develop a public education campaign to raise awareness of the dangers to children of work on tobacco farms. In recent meetings with Human Rights Watch, government officials have said they need additional support and resources to get the campaign underway this year.

Indonesia already prohibits children under 18 from work “with harmful chemical substances.” The Ministry of Manpower and Transmigration should explicitly prohibit children from working in direct contact with tobacco in any form and increase labor enforcement efforts to make sure government inspectors check for workers’ safety, especially on small tobacco farms where children might be in danger.

In our meetings with government officials, we have heard many times that the tobacco industry is powerful in Indonesia, and that it is difficult to achieve policy changes the industry opposes. Surely eliminating child labor in tobacco farming is an issue tobacco companies also want to address.

The UN Guiding Principles on Business and Human Rights make clear that companies have responsibilities for addressing human rights abuses in their supply chains. We shared our findings with the largest tobacco companies operating in Indonesia—Djarum, Gudang Garam, Philip Morris International (which owns Sampoerna), British American Tobacco (which owns Bentoel), and others. The large multinational tobacco companies have policies to prevent children from doing the most dangerous tasks on tobacco farms, but their policies are not strong enough, and they should do more to monitor for child labor when they buy Indonesian tobacco on the open market through traders.

The largest Indonesian companies—Djarum and Gudang Garam—do not appear to be taking any steps to prevent or address child labor in their supply chains. They have never responded to our many requests for information and meetings, and they do not make any information publicly available about their child labor policies.

These companies should not be profiting off the backs of Indonesian child workers.

Two months from now, the next tobacco-growing season will be underway, and children will be heading to the fields again. The controversy around the draft tobacco bill likely will not be resolved by then. But with decisive action, the Jokowi administration and tobacco companies could take steps to protect children from dangerous work in tobacco fields. Their futures depend on it.

Tobacco Smoke Ups Rhinitis Rates in Asian Children

Tobacco smoke is associated with pediatric rhinitis among Asian children, according to cohort study findings presented at the 2017 AAAAI Annual Meeting

“This Asian cohort demonstrates supportive evidence for positive association of tobacco smoke exposure with rhinitis, while the effect is mainly confirmed to non-allergic rhinitis and more pronounced in adolescents than in young children, highlighting the need for raising public health awareness about the detremental effects of tobacco smoke exposure on children’s respiratory health,” reported lead study author Hui-Ju Tsai, MPH, PhD, of the National Health Research Institutes in Miaoli, Taiwan, and coauthors.

Prior research demonstrated that tobacco smoke exposure harms respiratory health but few population studies have employed cotinine as an exposure biomarker, Dr. Tsai said. And so, the research team set out to examine tobacco smoke exposure and allergic disease among Asian children.

This population based study included a total of 1,315 children aged 5–18 years, who were assessed using questionnaire instruments, and allergen-specific immunoglobulin E, and serum cotinine concentrations as biomarkers of tobacco smoke exposure.

“Serum cotinine levels were positively associated with rhinitis ever (adjusted odds ratio [AOR] 2.95, 95% CI: 1.15–7.60) and current rhinitis (AOR 2.71, 95% CI: 1.07–6.89), while the association for physician-diagnosed rhinitis approached significance (AOR 2.26, 95% CI: 0.88–5.83 [not significant]),” they reported.

No association was found for asthma or eczema, they noted. When data were stratified by patient age groups, these associations were significant only for children at least 10 years old (rhinitis ever AOR 3.34; 95% CI: 1.05–10.61; current rhinitis AOR 4.23; 95% CI: 1.28–13.97). For patient less than 10 years old, no significant association was detected.

“Stratified analyses demonstrated significant association of serum cotinine levels with current rhinitis among children without allergic sensitization (AOR 6.76, 95% CI: 1.21–37.74), but not among those with allergic sensitization,” they noted.

Campaign Art: What’s the real cost of smoking?

People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

The real cost of smoking is high, especially high on your health. According to the World Health Organization (WHO), tobacco kills around 6 million people each year, out of which 600,000 are the results of non-smokers being exposed to second-hand smoke. The cost of smoking is also high on the global economy, as smoking burdens global health systems, hinders economic development, and deprives families of financial resources that could have been spent on education, food, shelter, or other needs.

Tobacco use is the world’s leading underlying cause of preventable death. It contributes to a great number of non-communicable diseases (NCDs), which account for 63% of all deaths. Prevention of tobacco use can significantly decrease the number of preventable deaths worldwide, encourage economic development, reduce poverty, encourage healthy lifestyle choices and support Sustainable Development Goals.

In order to prevent and reduce youth tobacco use, in February 2014 the U.S. Food and Drug Administration (FDA) put forward a national public education campaign titled “The Real Cost.” The following video is a part of this campaign:

It is no surprise that tobacco is made of extremely toxic materials. But did you know that “Tobacco smoke contains more than 7000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer?” Here are some of the chemicals contained in tobacco smoke:


What are the global actors doing about this issue?

Many of the international organizations, government agencies, civil society organizations, private sector, communities, and private citizens raising awareness about the negative effects of smoking, funding programs to decrease global tobacco use, and promoting smoke-free lifestyles. Many of them also agree that tobacco tax increases are the single most effective policy to reduce tobacco use. Tobacco tax increases reduce consumption and promote quitting, they are inexpensive to implement, and they are especially effective in reducing tobacco use by vulnerable populations. (Tobacco use is increasingly concentrated in populations with the lowest income and socioeconomic status, and explains a large proportion of socioeconomic disparities in health.)

In the fight against tobacco use, the World Bank Group (WBG) is making its mark. Fully aligned with the WBG’s twin goals of ending poverty by 2030, and boosting shared prosperity, global tobacco control has become a development priority for WBG. Since 1991 the WBG’s policy has been not to lend, invest in, or guarantee investments or loans for tobacco production, processing, or marketing. WBG’s Tobacco Control Program assists selected countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and controlling illicit trade on tobacco.

Global tobacco control

Download (PDF, 7.46MB)

Parliament adopts Standardised packaging to save lives and prevent suffering

Members of Parliament voted in favour of standardised packaging of tobacco products despite intense lobbying by the tobacco industry to sway politicians against the measure.

The snowball that was set in motion in Australia in 2012 rolled through Norway today. An overwhelming majority of Parliament endorsed recommendations formulated on 1 December 2016 by the parliamentary Standing Committee on Health and Care Services. The measure will be introduced at the same time as the EU Tobacco Products Directive measures on packaging and labelling.

Tobacco advertising is deadly. It seeks to addict people to a product that kills almost half of its long-term users. Today, Norway becomes one of the first countries in the world to introduce standardised cigarette packs and the first country to standardise smokeless tobacco boxes. Smokeless tobacco use increased dramatically among young people in Norway during the last decade. The new measure will contribute to ensure that children and young people never start with tobacco and thus avoid tobacco-related suffering and death.

Anne Lise Ryel, Secretary General of the Norwegian Cancer Society said: “Norwegian politicians have taken a historic step forward to reduce the consequences of tobacco advertising. Advertising works, especially with children. Norway was the first country in the world to introduce bans on all traditional forms of advertising of tobacco products. Ever since, cigarette packs have become mini billboards for tobacco industry marketing. With this morning’s event, the tobacco industry loses its last vehicle to lure children into addiction, disease and possibly death. This is truly a ground-breaking public health reform, and a landmark day for the cancer cause”.

The Norwegian Cancer Society congratulated Minister of Health and Care Services Bent Høie for his leadership in support of the measure in the face of persistent pressure and campaigning from the tobacco industry.