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December 1st, 2013:

How would plain packaging and pictorial warning impact on smoking reduction, cessation and initiation?


The European Commission has proposed a review of the directive on tobacco products on labeling and packaging of tobacco products by introducing warning text with pictorial warning that occupies 75% of the cigarette packages. The aim of the survey was to assess the impact of plain packaging and pictorial warning in smoking reduction, cessation and initiation among a sample of adult. The cross-sectional study was conducted in Rome between September and November 2012. The questionnaires administered were 227, with a response rate of 82.4%. 35.8% (No. 67) of the respondents considered the image of the gangrene the most effective in communicating smoking-related damages, followed by the image on lung cancer (No. 60; 32.1%). Distinguishing between smokers and non-smokers (both former and never smokers), the picture on lung cancer was the most effective for smokers (No. 22; 38.6%); if cigarette packages have pictorial warnings like the ones shown, more than half (No. 33; 57.9%) of smokers would change brand; 66.7% (No. 38) of them would feel uncomfortable in showing the package. Comparing the 3 packagings, classic packaging, plain packaging with textual warning, and plain packaging with both textual and pictorial warning, the majority of people declared that the third is the most effective in preventing smoking initiation (No. 169; 90.9%), in motivating to quit (No. 158; 84.9%), and in changing smoking habits (No. 149; 80.5%). The survey, although its small sample size and being not representative of all strata of Italian population, shows that the plain packaging with pictorial warning is the most convincing in the three outcomes considered.

Pictorial health warnings on cigarette packs and the impact on women



To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women.


Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette.


Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warnings than women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03).


Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.

WP: Snuffing out a tobacco exemption in Trans-Pacific Partnership trade deal

from the editorial board of the Washington Post:

Tobacco sickens and, eventually, can kill if consumed as intended. Every country, the United States included, should be taking every effective step to prevent smoking.

The costs and benefits of free trade are clear, but, as recent presidents, Republican and Democratic, have recognized, the long-term gains to society outweigh the short-term losses to particular groups. Thus, the United States has wisely pursued pacts to expand free trade with partners around the world.

What to do, however, when free trade and tobacco control seem to be in tension? The question arises in the context of the Trans-Pacific Partnership (TPP), a proposed trade agreement that would link the United States, Canada, Mexico, Japan, Australia, South Korea, Vietnam and five other countries as never before — spurring global growth and bolstering the United States geopolitically.

Initially, the Obama administration favored a TPP provision exempting individual nations’ tobacco regulations — such as those banning advertising or requiring warning labels — from legal attack as “non-tariff barriers” to the free flow of goods. The idea was that, when it comes to controlling a uniquely dangerous product, there’s no such thing as “protectionism.”

Alas, the United States softened its position at a public meeting of TPP negotiators last month. The new proposal simply specifies that tobacco is included in an existing exemption for policies necessary to protect human life or health, and requires governments to consult before challenging each other’s tobacco rules.

While better than the status quo, in that it might constrain governments from going to bat for domestic tobacco producers, this suggestion would leave tobacco companies free to mount legal challenges to various nations’ policies.

The office of U.S. Trade Representative Michael Froman explained the new stance reflected “consultations with Congress and with a wide range of American stakeholders” — a polite reference to pushback from farm-state legislators, farm lobbies and other interest groups that feared a tobacco exception would expand to a health-related excuse for protectionism against many other products.

A tobacco field in the Pleasant View community of Horry County, South Carolina. (Reuters/Randall Hill)

Though Asian countries have, in the past, discriminated against U.S. beef on trumped-up health grounds, U.S. agriculture’s fears this time are overblown. Tobacco is unique, and everyone knows it. Surely that can be enshrined in an enforceable agreement — which would be easier if all “stakeholders” worked toward an effective compromise instead of attacking Mr. Froman’s attempt as insufficiently protective of U.S. interests, as business interests continue to do.

Tom Bollyky of the Council on Foreign Relations suggests that the office of the trade representative could formally reassure U.S. businesses that supporting tobacco control in the TPP cannot serve as precedent under other circumstances. It could also make an exemption from legal challenge for tobacco-control measures applicable only to those measures that treat domestic and imported products equally. All concerned should strive for a TPP that addresses legitimate concerns of U.S. business — but reflects the unique dangers of smoking both here and abroad.

17 Sep 2013

Tobacco Displays at the Point of Sale

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Jakarta Post: Indonesia to accede to tobacco treaty before 2014

from Nadya Natahadibrata of the Jakarta Post:

Health Minister Nafsiah Mboi said that Indonesia would finally accede to the Framework Convention on Tobacco Control (FCTC) before the end of this year, a major step in the fight against prevalent smoking addiction.

“The treaty accession will be completed through a presidential decree. The President has agreed [to accede to the treaty]. God willing we will accede to the treaty before the end of the year,” Nafsiah said.

As previously reported Nafsiah said that three ministries, namely the Trade Ministry, Industry Ministry and the Manpower and Transmigration Ministry, had previously rejected the accession, and added that it would hurt tobacco farmers and reduce the state’s income in tobacco excise, which had a big contribution to the state budget.

“All three ministries have agreed to accede to the treaty. They have agreed that the accession is solely aimed at protecting the public,” Nafsiah told reporters on the sidelines of the closing ceremony of National Health Day on Friday.

According to Nafsiah, the government is currently drafting the text to be submitted to the Foreign Ministry before being signed by President Susilo Bambang Yudhoyono.