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May 25th, 2016:

E-cigarettes no longer considered medicinal products in Sweden

http://www.lexology.com/library/detail.aspx?g=9258ca21-ab20-4384-bcad-2a8d64044143

The Supreme Administrative Court has ruled that e-cigarettes not marketed for smoking cessation purposes should not be classified as medicinal products. This is contrary to the Medical Product Agency’s long-standing position and rulings of the first and second-instance courts. As a result, the EU Tobacco Product Directive (2014/40/EU) rules for e-cigarettes will apply to e-cigarettes in Sweden from May 20 2016, when the directive must be implemented in national legislation.

Facts

The Medical Product Agency had ordered a company to stop selling e-cigarettes with nicotine-containing liquids. The agency argued that the products had a high nicotine content, which is a pharmacologically active substance with an established medical use, primarily for smoking cessation.

The distributor argued that the e-cigarettes in question did not have a sufficiently strong pharmacological effect on the body’s functions to be classified as a medicinal product. Even if the e-cigarettes did have such an effect, they had no health benefits. The distributor claimed that it sold the e-cigarettes purely as a recreational product, with no claims that they were beneficial to health.

Both the first and second-instance courts dismissed the distributor’s arguments and held that e-cigarettes and nicotine-containing liquids should be classified as medicinal products. The appeal court stated that the manufacturers’ and distributors’ perceptions of the products’ use could not be considered decisive. The products were held to have scientifically documented pharmacological characteristics insofar as the active substance nicotine can be used to treat tobacco addiction, which results in nicotine cravings and withdrawal symptoms. This qualified as a beneficial health effect. The fact that the e-cigarettes were not used exclusively as medicinal products did not change this assessment and they were thus classified as medicinal products. The appeal court held that the Tobacco Product Directive does not prevent a member state from classifying e-cigarettes as medicinal products.

Decision

The Supreme Administrative Court held that all characteristics of a product must be considered when deciding on that product’s classification, including:
• the way it is used;
• how it is distributed;
• how well known it is among consumers; and
• the risks which may be involved with use.

It is not sufficient that a product has a pharmacological effect on the body’s functions. Referring to EU case law, the court stated that in order to be classified as a medicinal product, the product, if used as intended, must be capable of appreciably restoring, correcting or modifying physiological functions in human beings. The mere fact that the active substance affects the body’s functions is insufficient for it to be defined as a medicinal product.

The court did not consider that the Medical Product Agency’s scientific reports conclusively highlighted the effects that e-cigarettes had on smoking cessation and therefore did not demonstrate any e-cigarette health benefits (one of the prerequisites for medicinal product classification). Further, in its assessment of how e-cigarettes are distributed and used, the court referred to a report from the European Commission which showed that only 2% of Swedish respondents used e-cigarettes to stop smoking and that they did not consider the product to have any long-term effects on their smoking.

The court also noted that the e-cigarette distributor in this case had stated that the e-cigarettes were developed as a healthier, recreational alternative to normal tobacco cigarettes. They were designed to mimic traditional cigarettes and simulated cigarette smoke through their vapour. The addition of various aromas made product use pleasant. The products were not sold with any particular instructions on how the user should cut down on smoking or nicotine addiction.

The court therefore found that e-cigarettes were not medicinal products.

Comment

The Swedish market for e-cigarettes has until now been almost non-existent. However, this is likely to change following this decision. The judgment focused on the actual use of the products on the market and how they are marketed. Considering that no e-cigarettes are currently registered as medicinal products in Sweden, and that sales of non-registered e-cigarettes were virtually non-existent pending this decision, the Swedish respondents’ answers in the commission’s report to which the court referred should be reasonably affected. The court considered that because the way that these products are used and distributed will likely change following this decision, that classification of the product could also change.

The Supreme Administrative Court decision is something of a surprise in light of the lower-court decisions and agency case law. While the legislature in the ongoing implementation of the Tobacco Product Directive had mentioned that it would await the outcome of the judgment, it is likely that this particular outcome was not anticipated. This means that the directive’s rules for e-cigarettes will have to be put quickly into place in Swedish national law.

The judgment may also open up the possibility of introducing other smokeless nicotine products that would have been previously classified as medicinal products. It is uncertain whether the fact that e-cigarettes imitate tobacco cigarettes in terms of shape and vapour was decisive for the decision, and whether such anti-smoking products as lozenges or sprays could be considered general products. These questions remain unanswered.

For further information on this topic please contact Jonas Löfgren or Annie Kabala at Advokatfirman Lindahl KB by telephone (+46 8 527 70 800) or email (jonas.lofgren@lindahl.se or annie.kabala@lindahl.se). The Advokatfirman Lindahl KB website can be accessed at www.lindahl.se.

E-cigarettes CAN cause lung damage, warn Manchester scientists

A study by the University of Manchester carried out at Wythenshawe hospital says the vapour can cause similar conditions to traditional cigarettes

http://www.manchestereveningnews.co.uk/news/greater-manchester-news/e-cigarettes-can-cause-lung-11384841

Tens of thousands of electronic cigarette users are at risk of chronic lung disease, according to a new study by scientists from the University of Manchester .

Experts say that using e-cigs or “vaping” can cause the same debilitating conditions as smoking normal cigarettes.

They claim the study, which is the first of its kind, shows that chemicals found in the e-cig vapour have been known to lead to conditions such as Chronic Obstructive Pulmonary Disease.

Dr Andrew Higham from The University of Manchester says it contains formaldehyde and acrolein – similar to traditional cigarettes – which could be harmful if taken over the long term.

In research published in the open access journal Respiratory Research, Dr Higham examined the effect of e-cig exposure on human white blood cells taken from 10 non-smokers.

The study was funded by the North West Lung Centre, which is based at the University Hospital of South Manchester NHS Foundation Trust (UHSM).

It was carried out at Wythenshawe hospital , and the University’s Manchester Institute of Biotechnology, where three brands of e-cigarette were investigated.

Scientists noticed a raised activity of the white blood cells following exposure to the vapour, similar to that observed in the presence of traditional cigarettes.

It is also a characteristic of the debilitating lung condition Chronic Obstructive Pulmonary Disease, an illness commonly found in smokers.

The University’s research is expected to fuel the debate on the safety of e-cigarettes.

Dr Higham says the results raise concerns over the safety of e-cig use.

He said: “Our research shows quite clearly that there are risks associated with long-term use of these devices in terms of pulmonary inflammation.

“There has been a lot of public discussion on e-cigarettes. But we think that the public needs to be aware of the potential harm these devices may cause which will empower users to make informed decisions.”

There are an estimated three million users of electronic cigarettes in the UK.

They are often used as an alternative to traditional cigarettes to avoid the unwanted health effects.

Why Altria Group, Philip Morris International, and Reynolds American Are Up More Than 10% in 2016

All three tobacco stocks have done well this year. Find out why.

http://www.fool.com/investing/2016/05/25/why-altria-group-philip-morris-international-and-r.aspx

tobacco-stocks

Altria keeps powering ahead

Altria has gained almost 11% so far in 2016, and part of what distinguishes it from its two tobacco peers is the breadth of its business. Under its corporate umbrella, Altria not only has its key Philip Morris USA tobacco business but also its smokeless tobacco unit, its wine business, and a minority interest in beer giant SABMiller. Smokeable products are the bread and butter for Altria’s success, but its other businesses help diversify its exposure to some extent and also offer new avenues for potential growth.

For instance, the pending deal for SABMiller to get acquired by Anheuser-Busch InBev will give Altria a substantial stake in the acquiring company, with its percentage share being smaller but with Anheuser-Busch being a much larger enterprise.

In addition, Altria has worked on maximizing its profitability. Moves like controlling costs with a $300 million productivity initiative and shoring up its balance sheet to get an improved bond rating are measures that can boost the bottom line and make Altria shares rise even more.

Philip Morris International fights international headwinds

Philip Morris International is the winner of the three stocks, rising nearly 14% so far this year. What makes the gains more impressive is that the company has had to deal with plenty of challenges in its internationally focused business. Downward pressure from weak foreign currencies has stunted Philip Morris International’s earnings growth, and a recent adverse decision from a U.K. court upholding plain packaging regulations extended a trend that has caught on across the world.

So far, pricing power and brand loyalty have been enough to sustain Philip Morris through tough times as it outperforms many of its global peers. Longer-term, Philip Morris is especially confident that its efforts to build a franchise based on reduced-risk products like its iQOS heat-not-burn tobacco system will produce growth to replace any loss in the traditional cigarette business.

Reynolds American rides post-merger enthusiasm

Reynolds American has risen 11% in 2016, and the ongoing success of its acquisition of Lorillard continues to power the company forward. The integration of the Newport brand has gone well, and that has made the company an even stronger No. 2 challenger to Altria in the domestic tobacco market. The company has described the Lorillard merger as being “transformational” to its business. Newport in particular is responsible for 14% market share in the domestic tobacco market, coming close to matching the combined brand power of traditional Reynolds American brands Camel and Pall Mall.

Yet one of the biggest victories for Reynolds American has come from the super-premium market, where Natural American Spirit has been a surprisingly strong performer.

By tapping into demand for higher-quality products, Reynolds American has created a franchise that could rival long-established brands at its competitors for years to come.

Tobacco stocks in general have performed quite well in 2016. As long as they can manage to keep growing earnings despite the challenges they face, tobacco giants are likely to deliver solid share-price performance and dividend income to their investors.

Dan Caplinger has no position in any stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.

HOW TO REPORT A SMOKING OFFENSE IN HONG KONG

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Health Ministry rapped over tobacco plain packaging plans

http://www.thestar.com.my/news/nation/2016/05/25/health-ministry-rapped-over-tobacco-plain-packaging-plans/

KUALA LUMPUR: A DAP lawmaker has criticised the Health Ministry for backtracking on its plans to implement plain packaging for tobacco products.

Klang MP Charles Santiago said the ministry had previously announced plans to introduce generic packaging for tobacco products to reduce brand recognition and consumption.

“The ministry’s director of disease control division Dr Chong Chee Keong said this on Feb 24.

“He even suggested that standardised colours and fonts be used in the packaging in stages,” Santiago told a press conference in Parliament lobby Wednesday.

He said the statements suggested that the ministry had an implementation plan and strategy for plain packaging.

Santiago noted that Health Minister Datuk Seri Dr S. Subramaniam had said in a parliamentary response on Monday that the ministry had to undertake public consultations before implementing plain packaging.

“This clearly shows that the Government has backed off from its original position and reversed the plain packaging policy,” he said.

Santiago said the Government should not buckle under pressure from the tobacco industry and stressed that the ministry should acknowledge the opinions of health groups.

“The tobacco industry and lobby groups have cautioned the Government that introducing plain packaging would violate international trade laws.

“It is unacceptable that the ministry chooses to ignore the opinions of health groups and instead listen to business corporations,” he said.

He urged the ministry to keep to its plan and implement plain packaging ahead of the World Health Organisation’s Tobacco Day.

The ministry has yet to respond on the issue.

GUEST VIEW: Raising tobacco age to 21 is way to keep children healthy

http://www.mrt.com/health_and_wellness/stories/article_5a492902-21f5-11e6-88d1-47dfec285776.html

Smoking-related illnesses are the equivalent of a modern-day plague. Smoking harms nearly every organ in our bodies; it hurts innocent people who inhale it second-hand; it puts the unborn at risk.

“It’s incredible the suffering we see directly related to tobacco: people losing their voice boxes, their jaws, their tongues, and people being mutilated by surgeries and chemo that we have to perform to cure these cancers,” Dr. Erich Sturgis, a medical oncologist at M.D. Anderson told us. Each year in Texas, smoking-related illnesses lead to more than $2.2 billion in health-care costs and lost productivity, and more than 2,000 deaths.

The difference between smoking-related illnesses and almost every other health scourge visited on mankind is that we have the tools to end it. Although our state and our nation lack the political will to ban tobacco, we can help more people live longer, healthier lives by raising the minimum age for cigarettes to 21.

Virtually all adult smokers started by age 21. Delaying the initiation of smoking reduces the likelihood that someone will become a lifelong smoker.

Right now, more than two-thirds of 10th grade students and nearly half of eighth-grade students say it’s easy to get a cigarette, according to M.D. Anderson’s EndTobacco initiative. Given the stakes for these kids’ health, that level of access is acute. Many head- and neck-related cancers tied to smoking don’t show up until patients are in their mid-60s, a fate that is impossible for teens to comprehend.

By raising the minimum age to 21 for the sale of tobacco products, lawmakers could, over time, reduce the use of tobacco products by one-third in 18-to-20-year-old Texans, according to a report prepared by the Texas Comptroller’s Office. The impact would be direct: Reducing the number of teens who start smoking would slow the rate at which tobacco companies replace those who die of smoking-related diseases with new customers.

Take the law raising the minimum drinking age to 21. Although it didn’t eliminate underage drinking, the change is credited with having spared almost 22,000 lives between 1975 and 2002, according to the National Highway Traffic Safety Administration.

More than 145 localities including New York City, Chicago, Boston and Cleveland have adopted this commonsense approach, according to the Campaign for Tobacco-Free Kids, a nonprofit advocacy group. Hawaii was the first state to raise the minimum smoking age, and this month California became the second.

Opponents of the law point out that because 18-year-olds can vote, serve in the military and drive, it’s ludicrous for them not to be able to buy cigarettes. Left out of the argument is this salient fact: Nicotine is an addictive substance.

Neuroscience suggests that most people don’t achieve full physiological maturity until the age of 25 and that immature brains are particularly vulnerable to the effects of nicotine use. About 3 out of 4 teen smokers end up hooked even if they intend to quit after a few years. Moreover, exposure to nicotine may have lasting, adverse consequences on brain development.

There’s a still more pernicious reason that can help explain why this common-sense law hasn’t been adopted in Texas. Raising the minimum age would have a negative impact on tax revenues, with an estimated $40 million loss in 2016. But that’s a drop in the bucket compared to the longterm costs of smoking, not to mention to loss of life and suffering it engenders. For the good of young Texans, our Legislature must disregard short-term losses and adopt this farsighted policy.

Tobacco control laws are popular with voters. Nearly three-quarters of adults surveyed supported changing the age to 21, according to a 2015 paper by researchers at the U.S. Centers for Disease Control and Prevention, including 7 out of 10 smokers.

It’s said that youth is wasted on the young. It’s true that often teens don’t have the experience or maturity to appreciate the gift of life. But our older and wiser lawmakers should. With the next session of the Legislature just around the corner, where is the courageous lawmaker who cares enough about Texas youth to stand up to Big Tobacco and to sponsor a bill to raise the legal age for cigarettes to 21?

More than half of EU citizens questioned now think e-cigarettes are harmful

http://www.sciencecodex.com/more_than_half_of_eu_citizens_questioned_now_think_ecigarettes_are_harmful-183102

More than half of Europeans now think that e-cigarettes are harmful–a proportion that has nearly doubled in two years–show the latest results of a European Union (EU)-wide survey, published online in the journal Tobacco Control.

Yet use of these devices across member states has continued to surge within the same timeframe, the findings show.

The researchers analysed responses to two Eurobarometer for Tobacco surveys carried out in early 2012 and late 2014, on the perceptions and use of e-cigarettes, among a representative sample of adults (15+ years) from 27 EU member states, excluding Croatia.

In all, just under 27,000 people in both years answered questions on frequency of use; reasons for use; perception of harms; current tobacco use; and provided information on age, sex, educational attainment, and household financial security.

The proportion of people who said they had ever tried an e-cigarette rose from 7.2% in 2012 to 11.6% in 2014 across member states, although this figure varied widely by country, ranging from 5.7% of respondents in Portugal to 21.3% in France, for example.

And in Malta, survey respondents were more than five times as likely to say they had tried an e-cigarette in 2014 as they were in 2012.

Furthermore, in 2014, around one in seven people who said they had ever tried an e-cigarette defined themselves as a current user of these devices, indicating that they had shifted from experimentation to use, say the researchers. But once again, this varied by country, ranging from 1.7% in Slovenia to 28.9% in Portugal.

Current smokers were 23 times more likely to say that they had ever tried an e-cigarette while ex-smokers were more than 6.5 times as likely to have done so.

Being in the age range 18-24, living in a town/city, and being more highly educated were also linked to increased odds of ever having tried an e-cigarette.

Those who defined themselves as current vapers were more likely to be older. And they were nearly three times as likely to say they had started vaping because they thought e-cigarettes could help them quit smoking, and more than twice as likely to say they had done so to get round smoking bans.

The attractiveness of e-cigarettes had no bearing on the decision to become a regular vaper, the responses showed.

But despite the rising overall popularity of e-cigarettes, the proportion of those who felt these devices posed a health risk nearly doubled between 2012 and 2014.

In 2012, around one in four people (just over 27%) believed them to pose a health risk. By 2014 this figure had risen to more than 51.5%.

Yet again, this figure varied widely, from just over 31% of respondents in Hungary to just over 78% in The Netherlands. The UK had one of the lowest proportions of citizens who thought e-cigarettes were harmful.

Nevertheless, almost a third of all respondents (29%) said they didn’t know whether e-cigarettes were harmful, which indicates prevailing levels of uncertainty about their safety, suggest the researchers.

They point out that as their study was cross-sectional, meaning that data were collected from each participant at a single point in time, caution should be applied to any assumptions about causal relationships.

Variations in responses may be partly explained by the differing rates of smoking across EU member states as current and former smokers were much more likely to have tried e-cigarettes, they say.

Other factors, such as the way in which e-cigarettes are advertised and/or promoted as a smoking cessation aid, and their affordability, are also likely to have a role, they add.

“A better understanding of the population-level use and impact of e-cigarettes within the EU is needed, especially of the potential impact on smoke-free laws, smoking initiation and cessation,” they conclude.

E-cigarette users risking ‘dangerous levels’ of lung inflammation

https://inews.co.uk/essentials/news/health/electronic-cigarette-users-risking-dangerous-levels-lung-inflammation/

Thousands of electronic cigarette users are risking dangerous levels of lung inflammation because of chemicals in the vapour they inhale, a new study has found.

Dr Andrew Higham from the University of Manchester says the vapour inhaled by e-smokers contains formaldehyde and acrolein – chemicals also found in traditional cigarettes – which could be harmful long term.

The university says its study, which used three brands of e-cigarettes to examine the effects of vaping on white blood cells taken from 10 non-smokers, is the first of its kind and will “empower” Britain’s estimated three million “vapers” to make “informed decisions” about whether to keep using them.

Last year, Public Health England urged Britain’s eight million cigarette smokers to start vaping after a government-backed report found that e-cigarettes were 20 times less harmful than tobacco.

But Dr Higham said: “Our research shows quite clearly that there are risks associated with long-term use of these devices in terms of pulmonary inflammation.

“There has been a lot of public discussion on e-cigarettes, but we think that the public needs to be aware of the potential harm these devices may cause, which will empower users to make informed decisions.”

The publication of the research comes a day after researchers at Imperial College London warned that people are still taking a ”bet“ by using the electronic devices and the long-term health risks were still unknown.

The Manchester study was funded by and conducted at the North West Lung Centre at the University Hospital of South Manchester – a world leading treatment and research centre for lung disease – and at the university’s Institute of Biotechnology.

It found that raised white blood cell activity in response to e-cigarette exposure was similar to that observed in smokers of traditional cigarettes and was characteristic of the debilitating lung condition Chronic Obstructive Pulmonary Disease.

Vaping is on the rise

The research is set to fuel the debate on e-cigarette safety. Separate figures show the proportion of people in Britain who have tried an e-cigarette increased from 8.9 per cent to 15.5 per cent between 2012 and 2014.

Most were smokers, but the number of non-smokers using electronic devices rose from 0.8 per cent to 2.1 per cent in the same period.

The Welsh Government this week dropped plans to enforce a ban on the use of e-cigarettes in a number of public places in Wales.

The electronic cigarette industry points to a separate report by the Tobacco Advisory Group of the Royal College of Physicians, which was published last month.

That report says: ”Some of the carcinogens, oxidants and other toxins present in tobacco smoke have also been detected in e-cigarette vapour, raising the possibility that long-term use of e-cigarettes may increase the risk of lung cancer, COPD, cardiovascular and other smoking-related diseases.

“However, the magnitude of such risks is likely to be substantially lower than those of smoking and extremely low in absolute terms.”

Less harmful than tobacco

Tom Pruen, chief scientific officer for the Electronic Cigarette Industry Trade Association, said: “A large number of studies on cell cultures have been done and they indicate that the vapour from e-cigarettes is much less harmful than smoke.

”A recent study which constantly exposed cells to e-cigarette vapour for eight weeks found some changes, but exposure to cigarette smoke under the same conditions killed so many of the cells in 24 hours that the experiment could not be run for longer.

“While vaping e-cigarettes is going to carry some small risk, it is without doubt much safer than continuing to smoke.”

Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said: “While e-cigarettes are not 100 per cent safe, the crucial point is that they carry a fraction of the risk of smoking.

Harmful chemicals found in tobacco smoke are either completely absent in e-cigarette vapour or, if present, are much lower than in tobacco smoke.

“However smokers increasingly believe vaping is as dangerous as smoking and this mistaken belief may be discouraging some smokers from switching. The best thing a smoker can do is to quit completely, now and forever.”

Researchers raise concerns over e-cig safety

Thousands of electronic cigarette users are risking dangerous levels of lung inflammation, the first study of its kind has revealed.

http://medicalxpress.com/news/2016-05-e-cig-safety.html

Dr Andrew Higham from The University of Manchester says the vapour which e-smokers inhale contains formaldehyde and acrolein—similar to traditional cigarettes—which could be harmful if taken over the long term.

In research published in the open access journal Respiratory Research, Dr Higham examined the effect of e-cig exposure on human white blood cells taken from 10 non-smokers

The research was funded by the North West Lung Centre, which is based at the University Hospital of South Manchester NHS Foundation Trust (UHSM). The research was conducted at UHSM’s Wythenshawe hospital, and the University’s Manchester Institute of Biotechnology, where three brands of e-Cigarette were investigated.

The raised activity of neutrophils in response to e-Cigarette exposure is similar to that observed in the presence of traditional cigarettes and is a characteristic of the debilitating lung condition Chronic Obstructive Pulmonary Disease, an illness found in traditional smokers.

The research will fuel the debate on the safety of e-Cigarettes: this week, for example, the Welsh Government dropped a ban on the use of e-cigarettes in enclosed public spaces.

There are an estimated 3 million users of electronic cigarettes in the UK. E-Cigarettes are often used to avoid the unwanted effects of traditional cigarettes, such as causing pulmonary inflammation.

However the results raise concerns over the safety of e-cig use.

Dr Higham said: “Our research shows quite clearly that there are risks associated with long-term use of these devices in terms of pulmonary inflammation.

“There has been a lot of public discussion on e-Cigarettes. But we think that the public needs to be aware of the potential harm these devices may cause which will empower users to make informed decisions.”

Indonesia: Child Tobacco Workers Suffer as Firms Profit

Exposed to Harmful Nicotine, Pesticides

https://www.hrw.org/news/2016/05/25/indonesia-child-tobacco-workers-suffer-firms-profit

A young girl ties tobacco leaves onto sticks to prepare them for curing in East Lombok, West Nusa Tenggara. © 2015 Marcus Bleasdale for Human Rights Watch

A young girl ties tobacco leaves onto sticks to prepare them for curing in East Lombok, West Nusa Tenggara.
© 2015 Marcus Bleasdale for Human Rights Watch

(Jakarta) – Thousands of children in Indonesia, some just 8 years old, are working in hazardous conditions on tobacco farms, Human Rights Watch said in a report released today. Indonesian and multinational tobacco companies buy tobacco grown in Indonesia, but none do enough to ensure that children are not doing hazardous work on farms in their supply chains.

The 119-page report, “‘The Harvest is in My Blood’: Hazardous Child Labor in Tobacco Farming in Indonesia,” documents how child tobacco workers are exposed to nicotine, handle toxic chemicals, use sharp tools, lift heavy loads, and work in extreme heat. The work could have lasting consequences for their health and development.

Companies should ban suppliers from using children for work that involves direct contact with tobacco, and the Indonesian government should regulate the industry to hold them accountable.

“Tobacco companies are making money off the backs and the health of Indonesian child workers,” said Margaret Wurth, children’s rights researcher at Human Rights Watch and co-author of the report. “Tobacco companies shouldn’t contribute to the use of hazardous child labor through their supply chains.”

Indonesia is the world’s fifth-largest tobacco producer, with more than 500,000 tobacco farms. The International Labour Organization (ILO) estimates that more than 1.5 million children, ages 10 to 17, work in agriculture in Indonesia. Human Rights Watch could not find any official estimates of the number of children working in tobacco farming.

Human Rights Watch conducted field research for the report in four Indonesian provinces, including the three responsible for almost 90 percent of the country’s annual tobacco production: East Java, Central Java, and West Nusa Tenggara. The report is based on interviews with 227 people, including 132 child tobacco workers, ages 8 to 17.

Most started working by age 12 throughout the growing season on small plots of land farmed by their families or neighbors.

Half the children interviewed reported nausea, vomiting, headaches, or dizziness, all symptoms consistent with acute nicotine poisoning from absorbing nicotine through their skin. The long-term effects have not been studied, but research on smoking suggests that nicotine exposure during childhood and adolescence may affect brain development.

Thirteen-year-old “Ayu” said she vomits every year while harvesting tobacco on farms in her village near Garut, West Java: “I was throwing up when I was so tired from harvesting and carrying the [tobacco] leaf. I threw up so many times.”

Many child tobacco workers said they mixed and applied pesticides and other chemicals. Pesticide exposure has been associated with long-term and chronic health effects, including respiratory problems, cancer, depression, neurologic deficits, and reproductive health problems. “Argo,” a 15-year-old worker in Pamekasan, East Java, said he felt suddenly ill when applying a pesticide to his family’s farm: “Once I was vomiting. It was when it was planting time, and I didn’t use the mask, and the smell was so strong, I started throwing up.” Some children were also exposed to pesticides when other workers applied chemicals in the fields where they were working, or in nearby fields.

© 2015 Marcus Bleasdale for Human Rights Watch

© 2015 Marcus Bleasdale for Human Rights Watch

Few of the children interviewed, or their parents, understood the health risks or were trained on safety measures. The Indonesian government should carry out a massive education campaign to promote awareness of the health risks to children of work in tobacco farming, Human Rights Watch said.

Most of the children interviewed worked outside of school hours, but Human Rights Watch found that work in tobacco farming interfered with schooling for some children. “Sari,” 14, from Magelang, Central Java, said she dreamed of becoming a nurse, but she stopped attending school after sixth grade to help support her family.

The largest companies operating in Indonesia include three Indonesian tobacco product manufacturers – PT Djarum, PT Gudang Garam Tbk, and PT Nojorono Tobacco International – and two companies owned by multinational tobacco companies – PT Bentoel Internasional Investama, owned by British American Tobacco, and PT Hanjaya Mandala Sampoerna Tbk, owned by Philip Morris International. Other Indonesian and multinational companies also purchase tobacco grown in Indonesia.

Human Rights Watch shared its findings with 13 companies, and 10 responded. None of the four Indonesian companies provided a detailed or comprehensive response, and the largest two, Djarum and Gudang Garam, did not respond despite repeated attempts to reach them.

Since 2013, Human Rights Watch has met and corresponded with representatives of several multinational tobacco companies regarding their child labor policies and practices. Human Rights Watch previously documented work by children on United States tobacco farms, and urged tobacco companies to take concrete steps to eliminate hazardous child labor in their supply chains globally. Some have adopted new protections for child workers, but none have policies sufficient to ensure that all children in their supply chains are protected.

Under human rights norms, tobacco companies have a responsibility to ensure that the tobacco they purchase was not produced with hazardous child labor, Human Rights Watch said.

indonesia-supply-chain-graphic

Most tobacco in Indonesia is bought and sold on the open market through traders and intermediaries, with the tobacco often passing through many hands before purchase by national or multinational companies. However, some farmers are under contract with individual companies.

The multinational companies that responded to Human Rights Watch prioritize direct contracting in their supply chains. Yet all also purchase tobacco on the open market, and none trace where open market tobacco was produced, and under what conditions.

Human Rights Watch could not find any evidence that the Indonesian companies take steps to prevent child labor in their supply chains, and they did not correspond in detail or meet with Human Rights Watch.

“When tobacco companies don’t even know where the tobacco they purchase has come from, there’s no way they can ensure children haven’t put their health at risk to produce it,” Wurth said.

Under Indonesian law, 15 is the minimum age for work, and children ages 13 to 15 may only do light work that does not interfere with their schooling or harm their health and safety. Children under 18 are prohibited from doing hazardous work, including in environments with harmful chemical substances. Any work involving direct contact with tobacco should be considered prohibited under this provision, due to the risk of nicotine exposure, Human Rights Watch said.

Indonesia has come under international scrutiny for failing to protect children from the dangers of smoking. Though Indonesian law prohibits the sale of tobacco products to children, nearly 4 million children, ages 10 to 14, become smokers each year, and at least 239,000 children under 10 have started smoking. More than 40 million Indonesian children under 15 are exposed to secondhand smoke.

Indonesia is one of only a few countries that has not signed or ratified the World Health Organization’s Framework Convention on Tobacco Control, a global public health treaty aimed at protecting the population from the consequences of tobacco consumption and exposure to tobacco smoke. Indonesia should sign and ratify the treaty without delay, Human Rights Watch said.

“The government should do much more to protect children from the dangers of tobacco consumption,” Wurth said. “But Indonesia’s child tobacco workers are hidden victims, and they urgently need protection too.”