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January 29th, 2008:

Tobacco Control Programs Reduce Number of Smokers

New CDC Study: Well-Funded Tobacco Control Programs Can Reduce Number of Smokers by Millions

Statement of William V. Corr, Executive Director, Campaign for Tobacco-Free Kids – 29th Jan 2008

Washington, D.C. – As state legislatures across the country convene their 2008 sessions, an important new study provides powerful evidence of the direct relationship between increased funding for state tobacco prevention and cessation programs and declines in adult smoking.

The study, being published in the February 2008 issue of the American Journal of Public Health, examined state tobacco prevention and cessation funding levels from 1995 to 2003 and found that the more states spent on these programs, the larger the declines they achieved in adult smoking, even when controlling for other factors such as increased tobacco prices. The researchers also calculated that if every state had funded their programs at the levels recommended by the U.S. Centers for Disease Control (CDC) during that period, there would have been between 2.2 million and 7.1 million fewer smokers in the United States by 2003. The Campaign for Tobacco-Free Kids estimates that such smoking declines would have saved between 700,000 and 2.2 million lives as well as between $20 billion and $67 billion in health care costs.

The new study was conducted by researchers at the CDC and RTI International, an independent nonprofit research institute based in Research Triangle Park, N.C. The study adds to earlier research, using similar methods, which demonstrated the same type of relationship between program spending and youth smoking declines. These studies, along with reviews by the Institute of Medicine of the National Academies of Sciences, the President’s Cancer Panel and numerous other experts demonstrate conclusively that state tobacco prevention and cessation programs work to prevent kids from smoking and help adults quit, thereby saving lives and health care dollars.

This overwhelming evidence that state tobacco prevention and cessation programs work and deliver so many health and financial benefits leaves elected leaders with no excuse for failing to fund such programs in every state at CDC-recommended levels. The decision should be an easy one:

* The problem is huge and warrants urgent action. Tobacco use is the leading preventable cause of death in the U.S, resulting in 400,000 premature deaths and costing the nation nearly $100 billion in health care bills each year.

* We know the solution works. Comprehensive, well-funded state tobacco prevention and cessation programs are highly effective, especially when combined with higher tobacco taxes and smoke-free workplace laws.

* States have the revenue. The states will collect about $25 billion this year in revenue from the tobacco settlement and tobacco taxes. It would take just 15 percent of this revenue for each state to fund a tobacco prevention and cessation program at the CDC’s new recommended levels. Right now, the states are spending less than 3 percent.

* The public supports it. Poll after poll shows that Americans strongly believe tobacco settlement and tax dollars should be spent on tobacco prevention.

States with well-funded programs have reported strong success. Washington state, with a well-funded tobacco prevention and cessation program, has reduced adult smoking by 24 percent since it launched the program in 1999. Washington’s dramatic decline in adult smoking translates to more than 230,000 fewer smokers in the state, saving about $2.1 billion in future health care costs

Despite the overwhelming evidence that state tobacco prevention and cessation programs are highly effective when they are funded appropriately, only three states currently fund these programs at even the minimum level recommended by the CDC. This is part of the reason that declines in both youth and adult smoking in the United States have stalled in recent years. With the tobacco companies spending more $13.4 billion per year marketing their deadly products, it is imperative that state leaders act now to fund programs that we know work to prevent kids from smoking and help smokers quit.

The CDC recently updated its recommendations to the states for funding and implementing tobacco prevention and cessation programs, taking into account new scientific evidence, state experiences and cost factors such as inflation and population increases since last issuing its recommendations in 1999 (see CDC’s Best Practices for Comprehensive Tobacco Control Programs – 2007). The new study should spur state legislatures and governors to heed the CDC’s call for greater investment in programs proven to reduce smoking, save lives, and save money.

Cigarette Modification the Ultimate Public Health Nightmare

Cigarette Smoking and the Church’s “Pro-Life” Position

By Elizabeth M. Whelan, Sc.D., M.P.H. – American Council on Science and Health

This week’s announcement by Philip Morris that it plans a “global blitz” to dramatically increase the number of cigarette smokers around the world represents the ultimate public health nightmare.

The industry’s insidious strategies to modify cigarettes to meet changing cultural and social needs will add to the allure of this inherently dangerous product: the soon-to-be-launched “Marlboro Intense” will allow smokers to cope with indoor smoking bans by taking quick, deep puffs of a shorter but more potent cigarette during a quick outdoor break, while innovative clove-infused cigarettes will suit the taste of smokers in Southeastern Asia. The end results will be hundreds of millions of new cigarette addicts and the inevitable surge in the full spectrum of devastating cigarette-related diseases. Not only will the increase in smoking lead to soaring numbers of premature deaths, but the economies of these countries will suffer devastating losses due as large portions of their workforce are incapacitated and demand smoking-related medical care.

Altria brags that by spinning off Philip Morris International, the newly-independent company will be outside of the reach of most regulatory efforts and threats of legal liability. It considers itself autonomous, responsible to no one at all.

Where is the outrage at this brazen campaign that will cause the deaths of millions of people in the next several decades?

Where, for example, is the voice of the Roman Catholic Church, which is apparently so committed to a “pro-life” position? Why are they not deeply concerned about the lives of the millions who will soon die from this now-intensified Philip Morris sales blitz?


To say that the Roman Catholic Church’s stance on the public and personal health implications of cigarette smoking has been dismal would be an understatement. The Church has been largely mute on the subject, more concerned with the moral depravity of alcohol and illicit drug use than smoking. Indeed back in the 1950s, when the avalanche of data on smoking and disease began to hit the medical journals, the cigarette companies were terrified that the Catholic Church might make a pronouncement about smoking’s imperiling of human life and health.

But the Church did not. Of course, the tobacco folks had a real scare back in 1957 when Pope Pius XII suggested that the Jesuit order give up smoking. There were only 33,000 Jesuits in the world at that point, so the industry was not afraid of losing lots of priest-customers. But they did worry that the Pope might eventually ask the question, as a magazine headline once put it: “When Is a Cig a Sin?” — and, worse yet, that the answer might be “always.”

So the spin doctors in the industry worked on the Pope’s Jesuit statement and came up with this: an industry rep wrote in the United States Tobacco Journal, “the Jesuits have a way of life that is traditionally stricter than other segments of the clergy or laity in general.” What the Pope was really saying, the industry argued, was that cigarette smoke is good fun and pleasurable, and the only reason Jesuits should not smoke is that they are supposed to reject human gratification. Thus smoking is fine for everyone else!


Some twenty years ago, while preparing a book on the history of the cigarette in America (A Smoking Gun: How the Tobacco Industry Gets Away With Murder, Stickley, 1984), I wrote to the Cardinal of New York and asked him why the Church had no pronouncements on cigarettes, the leading cause of premature death — a clear threat to the value of life. The letter I received back was scathing, calling me stupid and naive, arguing that I had obviously not traveled outside the U.S. much and seen poverty and hunger — otherwise, I would not be worrying about something as trivial as cigarette smoking.

As a public health professional, I do not consider 485,000 premature deaths annually in the United States to be “trivial.” And I am outraged to see the ongoing marketing of cigarettes here in our country. But the recently-announced move by Philip Morris to addict hundreds of millions more people in Africa, China, Korea, Russia, and beyond is nothing short of appalling. As this international massacre continues — indeed, intensifies — is silence by the Church compatible with a pro-life commitment, or is it just sheer hypocrisy?

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health

Selling Cigarettes To Minors

SCMP – 29th January

All of us understand the seriousness of selling cigarettes to minors. But how can this problem be solved?

A law does exist which makes it illegal to sell cigarettes to minors and it must be enforced and the appropriate punishment be meted out.

Even though a law was introduced last year which banned smoking in most public spaces, smoking is still a problem among Hong Kong’s youth and there does not appear to be any sign of improvement.

One way, therefore, in which we may be able to curb the habit is to punish vendors who sell cigarettes to minors.

It is a bit like littering. If someone is caught and prosecuted for littering in the street, they are less likely to litter again. Similarly with vendors, they may think twice about selling cigarettes to a minor if they have been prosecuted in court.

Although that is a short-term solution to the problem, it could prove effective.

The government should also be looking at more deep-rooted solutions.

Sandy Cheung, Sau Mau Ping

Cut In Tobacco Tax Would Be Death Warrant For Young People

Updated on Jan 29, 2008 – scmp

Philip Bowring (“Sharing the spoils”, January 23) advocates a cut in tobacco tax, “another impost that most hurts lower-income earners who are generally more frequent smokers”. Does Bowring realise cutting tax will sign the death warrants of our youth? The tax on tobacco, which has not increased here since 1999, should be tripled immediately. This will save lives.

An excise tax increase is proven worldwide to be the most effective fiscal health care method of preventing youth tobacco use. It lowers the levels of adult smoking significantly.

The New York tax on a packet of cigarettes, is HK$28, in Britain it is HK$62, in Hong Kong HK$16.

Hong Kong, as an SAR of China, is bound to comply with the directive of the Framework Convention on Tobacco Control, which mandates signatories increase tobacco taxes forthwith and regularly. Ratified signatories must acknowledge FCTC is grounded in fundamental human rights. Guidelines should affirm the right to effective protection from exposure to tobacco smoke is implicit in the fundamental right of all persons to life, a healthy environment and enjoyment of the highest attainable standard of health. To underscore effective protection of health requires the creation of 100 per cent smoke-free environments. Providing just ventilation and designated smoking rooms is not acceptable.

This duty of care to protect against this epidemic is implicit in the right to life recognised by the Universal Declaration of Human Rights; the fundamental right of all persons to enjoy the highest attainable health standard as recognised in the Constitution of the World Health Organisation, International Covenant on Economic, Social and Cultural Rights, and other international legal instruments. Parties’ obligations to protect their citizens from exposure to tobacco smoke flow from the citizens’ universal rights as recognised in numerous other international instruments.

Clear the Air urges any parent who cares for the welfare of their children to e-mail the financial secretary at urging him to adopt a stringent increase on tobacco tax.

James Middleton, Clear the Air

Philip Morris Readies Aggressive Global Push

Division Spinoff Enables Blitz of New Products; High-Tar Smokes in AsiaBy VANESSA O’CONNELL – January 29, 2008; Page A1 – The Wall Street Journal

LAUSANNE, Switzerland — Sitting in his office overlooking Lake Geneva, Philip Morris International Chief Executive André Calantzopoulos takes a long drag from an unusually short cigarette. Called Marlboro Intense, the product has been shrunk down by about a half inch, and offers smokers seven potent puffs apiece, versus the average of eight or so milder draws.

The idea behind Intense is to appeal to customers who, due to indoor smoking bans, want to dash outside for a quick nicotine hit but don’t always finish a full-size cigarette. Pointing to his lit Intense, the CEO says there are “possibly 50 markets that are interested in deploying it.”

Marlboro Intense is likely to be part of an aggressive blitz of new smoking products PMI will roll out around the globe once the company — now a unit of New York-based Altria Group Inc. — becomes a standalone entity. That change will be set into motion tomorrow, when the Altria board is expected to approve a long-awaited decision to split PMI from Philip Morris USA. The move would free the tobacco giant’s international operations of legal and public-relations headaches in the U.S. that have hindered its growth.

The separate entity, for example, would be exempt from U.S. tobacco regulations and out of reach of American litigators. Importantly, its practices would no longer be constrained by American public opinion, paving the way for broad product experimentation.

By as early as March, PMI could be operating as an independent company — the third most profitable consumer goods concern in the world after Procter & Gamble Co. and Nestlé SA. The move will make it easier for the tobacco behemoth to market an array of new smoking concepts, each targeted to different foreign populations, who, collectively are expected to smoke 5.2 trillion cigarettes this year.

Among the new products in test phase is a hand-held electronic smoking device called the Heatbar, which emits less smoke than a regular cigarette. Another is Marlboro Wides — an extra-thick cigarette whose package flips open from one side. To appeal to customers in some emerging markets, the company is making sweet-smelling cigarettes that contain tobacco, cloves and flavoring — with twice the tar and nicotine levels of a conventional U.S. cigarette.

While smoking rates in developed countries have slowly declined, they have shot up dramatically in some developing counties, where PMI is a major player. These include Pakistan (up 42% since 2001), Ukraine (up 36%) and Argentina (up 18%).

Some antitobacco types are sounding alarm bells that an independent PMI will be a corporation which, from a practical viewpoint, is stateless and answers to no one. “There is a fear that after the spinoff, PMI will become even less accountable than it is today,” says Richard Daynard, a professor of law at Northeastern University, who worked as a consultant on class actions against tobacco companies.

Mr. Calantzopoulos, 51 years old, says such concerns are a “misconception.” He notes that regulatory regimes in Europe, for instance, are harsher than in the U.S., where the most severe restrictions were created in a late 1990s settlement of antitobacco lawsuits by the states.

The World Health Organization’s Framework Convention on Tobacco Control, an international public-health treaty, has 152 participating countries, including China, Brazil and Pakistan. While it has led to greater regulation in many of the world’s markets, countries such as Indonesia and Russia haven’t signed on.

Given the fast-changing legislative climate around the globe, “manufacturers are needing to spot potential first, act rapidly on a national level rather than on a regional level,” says Zora Milenkovic, head tobacco analyst for the research firm Euromonitor International.

Moving Headquarters

Mr. Calantzopoulos, a former automotive engineer and PMI’s CEO for the past six years, will become president of PMI, reporting to Louis Camilleri, the current chief of Altria. Mr. Camilleri will depart Altria and relocate to Switzerland to run the independent, publicly-traded international tobacco business. Altria, which plans to move its headquarters to Richmond, Va., will consist of the company’s domestic tobacco businesses and a 28.6% stake in United Kingdom-based brewer SABMiller.

PMI stands to rank as the world’s largest nongovernment tobacco company, with sales volume totaling more than four times that of its U.S. sibling. In 2006, PMI had revenue of $48.26 billion, compared with $18.47 billion at Philip Morris USA.

Mr. Camilleri has argued that the breakup will lead to a “renewed” focus at PMI. Ahead of the restructuring, Mr. Calantzopoulos has simplified PMI’s decision making to quicken the introduction of new products. Local managers have the “power to decide” which new ideas might have legs in a particular region, he says.

PMI is also streamlining manufacturing. By this fall, it will halt imports of about 57 billion cigarettes annually from its U.S. sister company. Instead, it will begin to get its entire supply internationally, primarily from its own 42 manufacturing centers, the largest of which are in Holland, Russia, Germany, Turkey and Ukraine.

One of PMI’s immediate goals is to harness the huge potential of China’s smoking population, as well as some of that country’s own brands.

After more than three years of negotiations with the Chinese government, PMI is expected this year to begin marketing three home-grown brands. The smokes — selected from hundreds of varieties produced by state-run China National Tobacco Corp. — will be sold in Central Europe, Eastern Europe and Latin America, according to PMI.

The launch is slated for sometime in the next six months. It is part of a December 2005 deal in which Philip Morris agreed to market Chinese brands internationally in exchange for the right to produce its own Marlboro brand at state-owned factories. At the moment, Philip Morris is limited to importing its cigarettes for sale in China and is restricted by stringent quotas.Lighting Up

China National Tobacco, based in Beijing, declined to comment.

With some 350 million smokers, China has 50 million more cigarette buyers than the U.S. has people, according to Euromonitor. Its booming tobacco industry, which the government says generates around $30 billion in tax revenue in 2005, is a pillar of the economy.

China and PMI, says Mr. Calantzopoulos, spent the past year figuring out which of China’s top brands might have the greatest potential for sales abroad.

“The objective is not to sell Chinese brands to the Chinese immigrants. That’s not difficult,” says Mr. Calantzopoulos. “But what we want and they want is to adapt these products in a way that they become appealing” to foreigners.

Chinese smokers, for instance, prefer the stronger taste of full-tar cigarettes, while most Europeans and Latin Americans favor lower-tar cigarettes with blends of different tobacco leaves. Another concern: The packaging of Chinese brands tends to be “flashy,” says Mr. Calantzopoulos.

One of the three brands to be sold abroad is called RGD and is manufactured by Wuhan Cigarette Factory of Wuhan city of Hubei province. It’s a milder version of an existing Chinese brand called Red Gold Dragon. In preliminary marketing materials, China National Tobacco touted it as being “carefully formulated” with Chinese and non-Chinese tobacco leaves, “and flavored by fragrance extracted from the unique natural plants from Central China.” PMI says the positioning has changed, but declines to be more specific.

Many of PMI’s other new products are intended to strengthen and broaden the world’s leading Marlboro brand, whose sales volumes outside the U.S. slid by 0.53% from 2001 to 2006. “It’s in pretty good shape, but we can do much more with the brand,” Mr. Calantzopoulos says.

High Nicotine, High Tar

Recent Marlboro launches include Marlboro Mix 9, a high-nicotine, high-tar cigarette introduced in Indonesia last July. PMI is poised to export the clove-infused Mix 9 to other Southeast Asian markets as soon as this year. Another iteration of the iconic brand, the Marlboro Filter Plus, is being sold in South Korea, Russia, Kazakhstan and Ukraine. It touts a special filter comprised of carbon, cellulose acetate and tobacco that claims to lower the tar level while giving smokers a smoother taste. The short but strong Marlboro Intense, which the CEO lit up in his office, is newly available in Turkey.

A more unusual product, the Heatbar, has a different objective: preparing for the onslaught of smoking bans in some mature markets. But it’s risky — requiring consumers to embrace an odd-looking product that is as far from a Marlboro as a cigarette can be.

Heatbar smokers insert specially-designed cigarettes into the device, a plastic holder resembling an electric toothbrush. They place their lips on the cigarette but when they inhale, the device heats up the cigarette, delivering a flavored aerosol, without causing any tobacco to burn. PMI says Heatbar releases 90% less smoke into the atmosphere than a traditional cigarette. Smokers can either rent or buy the device, which is powered by a rechargeable battery.

The gadget’s prospects are uncertain. Philip Morris USA struck out with a similar product in the late 1990s. Known as the Accord, it was pulled from U.S. store shelves after a test market run in Richmond, Va., failed to generate interest.

In late 2006 PMI opened an intimate wine and coffee bar, Heatbar Tasting Room, to drum up interest in its latest version. One night in late October, business at the Zurich lounge was so slow that nobody showed up over the course of an hour and a half. A lone employee, trained to teach customers the merits of Heatbar, blamed the chilly weather. But surrounding pubs and restaurants were packed with smokers.

PMI shuttered the bar last month, taking down its prominent displays of the device in a range of colors, and of packs of cigarettes that go with it. But late last year, PMI convinced two independent Zurich bars to carry the product. The idea, says a spokesman, is to test Heatbar in pubs and other places where smokers would naturally tend to gather. In December it took Heatbar to Australia, opening another PMI-owned store, New Movement Tobacconist, in Melbourne.

Mr. Calantzopoulos says the device is in the midst of an upgrade that’s easier to use and provides a better taste.

Meanwhile, PMI has shown prototypes of the technology to regulators in Australia, New Zealand and the U.K., among other countries with tough antismoking policies. The idea, says Mr. Calantzopoulos is to engage them in early discussion about any future marketing restrictions on so-called reduced-risk cigarettes.

“It gives us some access to regulators,” he says. “If you don’t have a concrete product out in the market, it is very difficult for regulators to focus” on the issues.

Seeking Attention

At times PMI says it will also launch new products specifically to draw attention to paradoxical regulatory or tax policies.

Internationally, 62% of the average retail price of a cigarette is attributable to taxes, versus roughly 50% in the U.S., according to PMI data. But in certain countries in Europe and elsewhere, tax rates on roll-your-own tobacco products are one-third to one-half the rates on cigarettes, the CEO notes.

That explains PMI’s launch of TBS (“Tobacco Block System”) in Germany, where roll-your-own tobacco is taxed at significantly lower rates.

Smokers use the system — which includes a foot-long machine and compressed blocks of tobacco — to assemble their own cigarettes. After inserting empty paper sleeves into the side of the device, a dose of tobacco shoots inside the shell to create a cigarette.

PMI says it hopes the unusual tobacco kits can expand its market share so it can apply more pressure on the German government to close the disparity in tobacco tax rates.

Future products in the PMI pipeline will feature unusual packaging, a response to limits on cigarette advertising imposed by the WHO antitobacco treaty. Marketing restrictions are a particular challenge to PMI. Roughly half of its cigarettes, and all those bearing the Marlboro name, are so-called “premium” brands at the top end of the price spectrum in their local markets. That makes PMI highly vulnerable to competition from cheaper local smokes.

Without traditional advertising, “your product and your packaging become the key conveyor of what the brand stands for,” Mr. Calantzopoulos says, noting that there’s always an opportunity for gaining market share.

Fancier packs are intended to lure smokers into paying a premium for the company’s brands. One example is the Marlboro Filter Plus, which Mr. Calantzopoulos thinks might work in as many as 50 additional markets. The top third of its pack slides straight up, and then backwards — a sleek design similar to a cellphone.

“If I put in front of you two packs of cigarettes and asked you to choose, you will choose, based on some criteria,” Mr. Calantzopoulos says, adding: “The whole idea” is to give smokers a reason to choose the PMI-made cigarette — “not one made by somebody else.”

–Nicholas Zamiska in Hong Kong and Gordon Fairclough in Shanghai contributed to this article. 

Pub Landlord Charged in UK re Smoking Ban

First pub landlord charged with refusing to enforce smoking ban hit with £10,000 fine

Last updated at 13:34pm on 29th January 2008 – The Daily Mail UK

The first publican to be convicted after challenging the smoking ban is today facing a £10,000 legal bill.

Nick Hogan, 40, was taken to court after repeatedly flouting rules by letting customers light up in his pubs in Bolton, Greater Manchester. He pleaded not guilty, claiming he had “advised” customers about the ban and left them to decide whether to act on it.

But in the first conviction of its kind a district judge condemned Hogan for “flagrant breaches” of the law. Another landlord, from Blackpool, defied the smoking ban but last year admitted the charges in court. A Gloucestershire landlord who pleaded not guilty to defying the ban was acquitted.

The first person to be caught flouting the smoking ban, 47-year-old Gerard Hart, was spotted lighting up in Hogan’s Barristers pub. Today after Hogan was fined £3,000 plus costs of £7,236 he vowed to fight on against the ban.

He said: “I still believe that this legislation is draconian, and I am sure that the fight against it will go on. This was not just about smoking. It was about people’s rights.

“I’m not pro-smoking, but I am pro-choice. I have respect for the law, but I have no respect for an unfair law. I don’t want to break the law, but I feel I’ve been pushed into it.”

He added: “At the end of the day it’s my pub, not the Government’s. I have been asking for my day in court since the ban was introduced. I want to show that this legislation is unworkable and discriminatory.”

He had already held a “mass light-up” in defiance of the ban on the day it came into force – claiming he “wanted his day in court”. Inspectors found letters on tables saying: “The management and staff of The Swan believe you have the freedom to choose whether or not you wish to smoke. If you choose to smoke, it is entirely your responsibility.”

Hogan later asked the inspectors to leave as they tried to give him a warning that he could face a £2,500 fine if he continued to allow people to smoke inside.

Smokers Kicking Habit After Ban


Nearly 165,000 people in England gave up smoking with the help of the NHS last summer, when lighting up was banned in enclosed public spaces. This is a 28% increase in the number of people successfully using the Stop Smoking Services compared to 2006.

Although these findings only relate to those using the NHS service, they are the first figures on quitting to emerge since the smoking ban was introduced.

The Information Centre for Health and Social Care published the data. It covers the period between April and September of 2007.

2005: 142,188
2006: 128,868
2007: 164,711

While the figures do show a significant increase from 2006, in that year the number of quitters had actually declined from 2005.

They also do not take into account those who quit using other methods outside the NHS, and whether these numbers rose or declined.

However they do tally with other available figures. Cigarette sales in the UK dropped by almost 11% in July 2007 compared with the same month the year before, although it is unclear whether this effect lasted. Smoking was on the decline well before the ban. The latest available figures show the overall prevalence of smoking among the adult population fell to 22% in 2006 – its lowest recorded level.

“It’s great news that so many smokers have been able to quit, preventing serious health problems and complications. It’s not easy to overcome a nicotine addiction so it’s clear that the NHS Stop Smoking Service is providing a vital service,” said Public Health Minister Dawn Primarolo.

“And these figures are confirmation that the £56m we invested into the service last year was money well spent.”

According to the ONS, the drug Champix was the most successful in helping people quit.

The highest success rates were reported by the East Midlands, East of England, South East Coast and South Central Strategic Health Authorities (SHAs), while the North East SHA reported the lowest rate, although the difference was not great.

Quitters were defined as those who, by their own account, were still not smoking four weeks after treatment.

According to public health specialists, perhaps as many as 50% of those will however be smoking again six months later.

Dr Tim Crayford of the Association of Directors of Public Health said this does not detract from the benefits of the service. “Even if some do eventually go back to smoking, the fact that others have permanently quit is what’s important. It remains one of the most cost-effective services the NHS can provide.”