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December, 2013:

When health policy and empirical evidence collide: the case of cigarette package warning labels and economic consumer surplus


In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost “pleasure” smokers experience when they stop smoking; this is quantified as lost “consumer surplus.” Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health.

The Standard: Activists push for 100% tax on tobacco

from Qi Luo, reporting for the Standard:

Anti-smoking lobbyists are urging the government to increase the tobacco tax to at least 75 percent immediately and to 100 percent by the next fiscal year.

The Council on Smoking and Health said the current tax accounts for between 65 and 68 percent of the retail price, which is below the 70 percent recommended by the World Health Organization.

Based on past experiences when tax was raised in the territory, the council estimates that the prevalence of smoking will further drop from 10.7 percent to single digits after one to two years from when the 100 percent tax hike takes effect.

“The tobacco tax was hiked by 50percent and 41.5 percent in 2009 and 2011, respectively. As a result, the incidence of smoking dropped from 12 percent in 2009 to 10.7 percent in 2012,” executive director Vienna Lai Wai-yin said. “A high tobacco tax will push smokers to quit or reduce tobacco consumption, as well as prevent those who plan to start smoking, especially youngsters.”

Lam Tai-hing, professor in the University of Hong Kong’s School of Public Health, said about one in two smokers die of diseases related to their habit.

“We are saving lives. The sooner, the better,” he said.

The tax on an average pack of cigarettes, sold for HK$52 over the counter, is HK$34.

If the proposal to hike the tax to 100percent is accepted by the financial secretary, the retail price for a pack of cigarettes will increase to HK$84. A survey by the School of Public Health found that a majority – 63.5 percent – of the 2,401 respondents supported an increase in tobacco tax.

Nearly one-third of ex-smokers who quit after 2011 agreed that the tobacco tax increase that year made them more determined to quit,” Lam said.

More than 31.4 percent of current smokers reduced their daily consumption after the 2011 tax increase.

The council also called for more resources for tobacco control.

Chairwoman Lisa Lau Man-man said: “COSH wants more smoke-free education and other tobacco control measures, including combating smuggling and enforcement of smoking offenses.”

20 Nov 2013

SCMP: Customs seize HK$1.7m worth of illegal cigarettes hidden in fake water heaters

from Clifford Lo of the SCMP:

Customs officers confiscated more than HK$1.7 million worth contraband cigarettes hidden in fake electric water heaters on Friday.

The consignment – the second such seizure in three months – was discovered after officers followed a cross-boundary lorry to a logistic centre in Sheung Shui at about 11am.

The 34-year-old driver was arrested while unloading the goods from the lorry. The vehicle, which arrived from Shenzhen, was registered as carrying metal and nylon products and ceramic tiles.

In the first 10 months of this year, customs have intercepted 22 big smuggling attempts involving at least 500,000 illegal cigarettes in each case. (SCMP)


SCMP Letters: Primary students can get across anti-smoking message to parents

Letter from Heidi Lau, executive director, Life Education Activity Programme, published in the SCMP:

Life Education Activity Programme (LEAP) concurs with the undersecretary for food and health, Professor Sophia Chan Siu-chee, in advocating that it is important to stop adults around children from smoking in order to prevent children from picking up the habit (“More young children trying smoking according to new survey”, November 9).

Research has shown that children are likely to imitate their parents’ behaviour – healthy and unhealthy. It is said that compared to young people who have not seen their parents drunk, teenagers who have are more than twice as likely to get themselves drunk in a typical month. And those teens who get drunk regularly are three times more likely to use cannabis and smoke cigarettes.

To help kids build self-esteem and stay away from drugs, including cigarettes and alcohol, parents can do many things, and most important of all is to be a good role model for their children.

LEAP, founded in 1994, is the leading drug prevention education organisation in Hong Kong, helping young people establish a healthy lifestyle and become aware of the dangers of drugs and substance abuse. Since 2011, LEAP has been working with the Tobacco Control Office, which has helped enable LEAP to offer its well-established smoking prevention programmes to our primary and secondary students for free.

LEAP’s anti-smoking programmes aim at increasing students’ understanding of the dangers of smoking and the marketing strategies of tobacco companies, as well as helping them develop effective skills to deal with peer pressure.

Professor Chan also acknowledged that children “are very powerful. Many people quit smoking for their children, and a lot of elderly smokers quit for their grandchildren.”

Recognising how children could influence their parents or families, primary students participating in LEAP’s smoking prevention programmes are invited to bring the anti-smoking message home and spread it further to their families and friends.

The feedback from parents has been very positive – more than 80 per cent of the parents expressed willingness to establish a smoke-free family – proving that children could also be very powerful in affecting family habits.

LEAP is one of the several agencies in Hong Kong that offers preventive education to young people and their families. We are encouraged by the drop in the smoking population and would like to applaud the Tobacco Control Office’s plan to continue to strengthen its educational and promotion efforts on the tobacco control front.

18 Nov 2013

Scoop NZ: Quitting tobacco would reduce poverty

from a press release by New Zealand’s Smokefree Coalition, printed in Scoop:

This New Year’s increase will be the second of four tobacco tax increases taking effect each 1 January, in a Government initiative to bring the cost of the average pack of cigarettes to more than $20 by 2016.

Members of the Smokefree Coalition hope the increase in price brought about by taxation will nudge New Zealanders that still smoke, to give up.

“The average pack-a-day smoker stands to save more than $7000 a year if they give up smoking,” said Dr Kyle Perrin, Medical Director for the Asthma Foundation.

“Tobacco is part of the reason some New Zealanders are falling into poverty. We hope the price increase will help them make the smart decision, to save their money for the more important things in life.”

Smoking prevalence increases with increasing deprivation and is three times more common amongst people of low socioeconomic status. People from deprived areas are four times more likely to die from smoking. Among the members of the Smokefree Coalition there is concern that smokers from lower socio-economic backgrounds tend to pay the price and let some of the basic necessities slide. In response to this, there is a concerted push by cessation service providers such as Quitline, Smokechange, Aukati Kai Papa and Pacific Quit Services, to promote nicotine replacement therapy and coaching to quit in lower socio-demographic communities.

“There is free and accessible help to quit and if adults in a family do quit they will have more money to spend on their children,” Paula Snowden, Chief Executive of Quitline, said.

“Smoking is highly addictive and quitting is hard when you are under stress, but it can be done and thousands do quit successfully, with help and support, every year. A smokefree family have more money and better health.”

Tax increases are the most effective measure to stimulate people to quit, according to a recent Lancet report, and New Zealand’s own prevalence monitoring. Smokefree Coalition urge New Zealanders that still smoke to engage with their services for a greater chance of successfully quitting, for the good of their children and for the good of our country.

“Our services improve a person’s chances of quitting successfully by 5 times than if they made the attempt cold turkey. We hope we’re inundated with callers this January,” said Snowden.

In 2011 the Government agreed to the goal of New Zealand becoming essentially Smokefree by 2025. The current smoking prevalence rate in New Zealand is 15 percent.


Review of the PMI funded ‘Project Star’ report

Download (PDF, 1.25MB)

HK Dept of Health: Thematic Household Survey on Pattern of Smoking

The statistics quoted from the SCMP editorial on the previous post are taken from the Thematic Household Survey on Pattern of Smoking, released by the Hong Kong Department of Health. While the overall number of smokers have decreased, as the editorial points out, the worrying trend is the increase in youth (or underage) smoking and the number of smokers in the female population.

SCMP: Time to crusade for a smoke-free city

from the SCMP editorial:

Hong Kong’s anti-smoking report card is a cause both for relief and concern. The good news is that the number of people who light up has dropped to an all-time low. The bad news is that more young children may be taking up the habit. Kindergartens are the new battleground in publicity campaigns. The situation is far from reassuring.

According to the Tobacco Control Office, 0.3 per cent of the Primary Four to Six pupils surveyed had smoked a cigarette in the past 30 days, up from 0.2 per cent two years ago. The percentage may seem negligible. But that more than 4,000 primary-school children had smoked – nearly half of them before the age of seven – should set the alarm bells ringing. The health risks associated with tobacco have been well recognised. If smoking is taking root as early as childhood, the problem among future generations may worsen.

Our crusade against smoking has come a long way over the past three decades. The decrease in the smoking population – from 23.3 per cent in 1982 to 10.7 per cent last year – owes much to our effective strategies, which include high tobacco duty, a ban on smoking indoors and tight advertising restrictions. They have been instrumental in helping Hong Kong to achieve the lowest ratio of smokers in the Asia-Pacific region. But we should stay alert to the emerging trends of under-age smoking. There is no room for complacency.

In the long run, Hong Kong stands a chance of being declared smoke-free – when the smoking population drops to just 5 per cent. While we are not far off, this can only be achieved with a more targeted approach. There are still 645,000 smokers. More than 60 per cent have never tried to quit. The percentage of those who have no intention of doing so is even higher, at 85 per cent. Officials admit that encouraging smokers to kick the habit is not easy. A more proactive approach is needed to get the message across. Moving towards a smoke-free society should be our next target. Existing measures should be reviewed to help us move forward.

12 Nov 2013

Guardian: Cigarettes could get plain packaging by 2015 after (UK) government U-turn

from Denis Campbell and Patrick Wintour of the Guardian:

Cigarettes could be sold only in plain packets after a government U-turn on a major public health policy that previously appeared to have been dropped.

In a surprise move the coalition is set to give ministers the power to introduce the policy, although actual implementation will be subject to an evidence review.

The latest volte face came after a cross party group of peers tabled amendments to the children and families bill that would have introduced standardised packaging.

The group, led by Lord Faulkner, were confident of winning the vote in the Lords since they had prestigious medical support in the Lords for the measure.

The evidence review, which will be led by Sir Cyril Chantler, a distinguished doctor, academic and NHS administrator, will report by the end of March.

Subject to its findings, plain packaging could be in force before the 2015 general election.


ITV: Plain packets ruling a ‘victory for public health’

from ITV news:

The chief executive of health charity Action on Smoking and Health (Ash) said the decision to introduce plain packaging is a “victory for public health” and hailed the “positive impact” of the move in Australia, which introduced standardised packaging almost a year ago.

This decision is a victory for public health, for common sense and for future generations who will as a result be protected from glitzy, colourful and misleading tobacco packaging.

The Government should be given due credit for being willing to listen to Parliament and to the experts and change its mind.

We understand the need for a review of the evidence and we are pleased that this will be carried out with the necessary speed to ensure that it reports early in the Spring.

– Deborah Arnott, Ash chief executive

28 Nov 2013