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June 1st, 2016:

In all US regions, broad support for increasing legal age of tobacco sales

Although the United States’ current political environment is rancorous, a national survey has found strong support in all regions of the United States for raising the legal age of tobacco sales.

Researchers from the University of North Carolina at Chapel Hill and East Carolina University report in the American Journal of Preventive Medicine that in all nine regions of the country, a majority of adults supported increasing the minimum legal age for tobacco product sales. They also found the most support for increasing the minimum age to 21 rather than to 20 or 19.

“With these findings, policy makers and public health advocates can move forward knowing that people in their states support raising the minimum legal age for selling tobacco products, and that this is an issue that is not viewed as partisan,” said Adam O. Goldstein, MD, MPH, a University of North Carolina Lineberger Comprehensive Cancer Center member and a professor in the UNC School of Medicine Department of Family Medicine. “It seems to cross political lines, and it is one policy measure that the majority of those surveyed can agree on.”

The study comes as two states have recently moved to increase the legal age of tobacco sales to 21. Hawaii became the first U.S. state to make the change Jan. 1, and California followed suit earlier this year. Already, a number of counties and cities, including New York City, have increased the minimum legal age.

“With the strong support indicated in our data, I think we will continue to see strong momentum,” Goldstein said. “It appears likely that increasingly, lawmakers are going to be interested in doing this.”

According to a National Academy of Medicine report in 2015, increasing the legal age for purchasing tobacco products would likely lower health care costs, and would prevent or delay young adults from starting smoking. The U.S. Food and Drug Administration-sponsored report predicted that raising the legal age to 21 nationally would result in a 12 percent reduction in smoking prevalence.

“By restricting tobacco use to people 21 and older, the compelling evidence is that you have less people who end up using it. They don’t end up taking up smoking and tobacco,” Goldstein said. “And if you cut down on adolescents using tobacco, you’ll ultimately cut down on how many adults use tobacco, and then you cut down on tobacco-related diseases like heart disease and cancer.”

In the study, researchers surveyed 4,880 adults aged 18 or older to learn their views on raising the minimum age of tobacco sales to 19, 20 or 21. The telephone survey was offered in both English and Spanish and conducted on land-line and cell phones.

A majority of people surveyed supported raising the minimum age in all regions of the country. Levels of support ranged from 59.6 percent in a seven-state Midwestern region that included Iowa and Kansas to 73.1 percent of residents in a four-state region of the South that included Texas and Louisiana. In the South Atlantic region, which included North Carolina, seven other states, and the District of Columbia, 68.1 percent of people supported an increase.

“Even in regions with historically strong ties to tobacco growing and manufacturing, a strong majority of the public, including smokers, is in favor of raising the minimum legal age of tobacco sales,” said the study’s first author Joseph G. L. Lee, PhD, MPH, an assistant professor in the East Carolina University College of Health & Human Performance. Lee began the study as a doctoral student at the UNC Gillings School of Global Public Health.

Women, non-white adults, Latinos and non-smokers were more supportive of an increase as were those who were over the age of 21.

Although there was no association found between the proportion of voters in a state who voted Republican in the last presidential election and the likelihood that person would be in favor of a higher age of sale for tobacco products, there was an association with a respondent’s level of trust in the government. A person who trusted the government was 8 percent more likely to support an increase in the minimum age.

“What we found was really an overall trend of broad support for this policy,” Goldstein said.

Cancer Research UK widely criticised over scientist pensions invested in tobacco

Cancer Research UK has been the subject of critical articles in a number of newspapers after the pension schemes of scientists they fund were found to be heavily invested in the tobacco industry.

The latest accounts of the UK’s leading provider of academic pensions, the Universities Superannuation Scheme, show that more than £200m was invested by USS in British American Tobacco (BAT) in the year to March 2015.

However while CRUK provides money to fund scientists’ salaries, including pensions, it cannot control where universities invest those pensions.

One anonymous scientist working for CRUK said she was “horrified” to learn that her money was invested in an industry that was causing the disease she was trying to cure.

“This means that, even if only indirectly through our time and labour, Cancer Research UK money is being invested in growing and supporting the tobacco industry,” she told the Guardian.

“The idea that we all have our pension invested in British American Tobacco is outrageous.

“All the work of this institute is done under the guidance of Cancer Research UK, and we are, quite rightly, regularly reviewed to ensure that [charity] money is being spent effectively and efficiently in the global fight against cancer.

“How can this possibly be in line with the fact that most of us will retire comfortably on money earned from tobacco investments?”

Yesterday, Alison Cox, director of cancer prevention for CRUK, told Civil Society News the charity was making efforts to encourage pension schemes to end investment in tobacco.

“Tobacco is responsible for one in four cancer deaths. To help make it easier for organisations’ pension schemes to opt out of tobacco shares, we’re now funding the UK arm of Tobacco Free Portfolios to encourage investment funds to end investment in tobacco. AXA’s move earlier this week to withdraw billions in investment from the tobacco industry shows what can be done,” she said.

“Pensions are complex and what we want to see is a clearer choice for people, no matter where they are employed, to have easy options of not investing in tobacco.”

This morning, USS told Civil Society News it was an “active and responsible shareowner” – an approach its “trustees believe will protect and enhance the long-tern value of the fund”.

“In order to ensure appropriate diversification we invest in a wide range of companies and assets,” a spokeswoman for the organisation said.

“We have a significant in-house Responsible Investment team and work with the companies in which we invest to improve ethical, environmental and governance standards, in the best financial interest of our members and beneficiaries.

“In recent times, this has included engaging with tobacco companies on marketing approaches and regulations around e-cigarettes. The trustees keep the approach under review,” she said.

Cigarette brands owned by British American Tobacco include Lucky Strike, Pall Mall and Benson & Hedges.

Nigeria: World No Tobacco Day – Researchers Say Cigarette Promotes Bacteria, Reduces Immunity

As the world yesterday marked this year’s World No Tobacco Day, researchers have found that cigarette smoke and its components infiltrate bacteria in the body and reduce the immunity.

This is coming as the World Health Organisation, WHO, said moves to introduce plain packaging of tobacco products can save lives by reducing demand for tobacco products.

The researchers from the University of Louisville School of Dentistry researchers led by David A. Scott, found that Cigarette smoke and its components promote biofilm formation by several pathogens including Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumonia and Pseudomonas aeruginosa, report scientists.

In the findings released on this year’s World No Tobacco Day, the researchers who explored how cigarettes lead to infiltration of bacteria in the body said the mouth is the dirtiest parts of the body and smoking makes it worse.

According to them, puffing cigarettes can increase the likelihood that certain bacteria like Porphyromonas gingivalis will not only set up camp but will build a fortified city in the mouth and fight against the immune system.

Scott and his team identified how tobacco smoke, composed of thousands of chemical components, stating that tobacco smoke is an environmental stressor and promotes bacteria colonization and immune invasion.

Scott explained that Biofilms are composed of numerous microbial communities often made up of complex, interacting and co-existing multispecies structures. Bacteria can form biofilms on most surfaces including teeth, heart valves and the respiratory tract.

“Once a pathogen establishes itself within a biofilm, it can be difficult to eradicate as biofilms provide a physical barrier against the host immune response, can be impermeable to antibiotics and act as a reservoir for persistent infection,” Scott added.

“Furthermore, biofilms allow for the transfer of genetic material among the bacterial community and this can lead to antibiotic resistance and the propagation of other virulence factors that promote infection.”

In a related development, the World Health Organisation, WHO, has said that the moves to introduce plain (standardized) packaging of tobacco products can save lives by reducing demand for tobacco products.

In a statement to mark this year’s World no Tobacco Day, WHO Director-General Dr Margaret Chan explained that “Plain packaging reduces the attractiveness of tobacco products. It kills the glamour, which is appropriate for a product that kills people.

“It restricts tobacco advertising and promotion. It limits misleading packaging and labelling. And it increases the effectiveness of health warnings.”

The theme of this year’s World No Tobacco Day – Get ready for plain packaging – highlights the new trend in global efforts to control tobacco products, which kill almost six million people annually.

To mark World No Tobacco Day, WHO is launching a new guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure.

Question Of The Day: Flavored Tobacco

The White House deleted language in a recently introduced tobacco regulation that would have removed flavored e-cigarettes from the market until they had been authorized by the food and drug administration.

Critics said science shows flavored products appeal to young children and encourage smoking. However, advocates say e-cigarette flavors are effective in helping adults quit traditional tobacco use.

18 NEWS asked viewers, what is more important, preventing tobacco exposure to children or helping adults kick their addictions?

Jill added, “With this logic, I guess hard lemonade, fruity wine coolers and hard cider drinks are all targeting children too.. give me a break.”

Seth said, “This isn’t tobacco by any means and it comes with zero nicotine if you so choose. Within a day of getting mine I stopped smoking and haven’t turned back. It was literally that easy.”

Corey wrote, “I started Vaping 4 years ago when I quit smoking, It was a very effective tool in helping me doing so. I believe it’s more import to eliminate smoking as a whole! Kids will do what they see adults do, so if we eliminate smoking by vaping, why not? In time Vaping goes away quicker than smoking.”

Paul added,”Vaping is likely better for adults than smoking cigarettes, but I can’t agree that the various flavors themselves are specifically helpful. And definitely young children are more apt to use sweetly flavored vapes.”

All eyes on iQOS

After a promising test-marketing phase, Philip Morris International’s iQOS is moving into additional markets.

By Stefanie Rossel

In the not too distant future, the Marlboro Man had better bring his power bank to the campfire—at least that’s what Andre Calantzopoulos, CEO of Philip Morris International (PMI), recently seemed to suggest. At the Consumer Analyst Conference Group of New York, in February, he said that it was his company’s stated ambition to convince all adult smokers who intend to continue smoking to switch to reduced-risk products (RRPs) “as soon as possible.”

He went on elaborate on iQOS, the company’s most prominent alternative to combustible cigarettes. Introduced in 2014, iQOS is a heat-not-burn (HnB) product consisting of a rechargeable, pen-like device into which a short, cigarette-like tobacco product, called a HeatStick, is inserted and heated to create a tobacco-flavored nicotine aerosol. No combustion takes place, and the product is heated to a temperature of less than 350 degrees Celsius (662 degrees Fahrenheit).

“For the first time in history, we have products with the real potential to both accelerate harm reduction and grow our business,” Calantzopoulos commented. He said he was confident that PMI’s range of RRPs could achieve a market share, net of cannibalization, of between 3 to 5 percent of the global cigarette market by 2020, with the incremental volume of 30 to 50 billion units generating a potential additional margin of between $720 million and $1.2 billion per year. One of the prerequisites, he added, was that regulators and anti-tobacco groups embraced the principle of harm reduction and implemented appropriate frameworks and unambiguous communication that would “drastically accelerate” current smoker adoption of RRPs and further foster innovation in this area.

Analysts share Calantzopoulos’ optimism, as the device not only mimics the smoking ritual but also provides real tobacco taste—something that has thus far proved difficult to achieve with e-liquid. James Bushnell, an analyst at Exane BNP Paribas, said iQOS was “the closest yet that the industry has got to the holy grail of a commercially successful ‘safe’ cigarette.” Wells Fargo Securities analyst Bonnie Herzog forecasts the device to achieve a volume of 5.3 billion sticks this year, which represents 0.6 percent of PMI’s total cigarette and HeatStick volume. By 2025, she estimated, iQOS will account for 366.9 billion sticks, excluding the U.S., or 35.9 percent of the company’s combined combustible and HeatSticks volume. Including the U.S., she predicted that as many as 420.1 billion HeatSticks could be sold per year by 2025. PMI’s new HnB technology, she said, could displace up to 30 percent of the combustible cigarette industry in developed markets by 2025 and had “the potential to change the trajectory of smoking.”

Fresh approach

Whether the analysts have looked into the correct crystal ball remains to be seen. The introduction of iQOS followed a series of hapless launches of other HnB products, among them R.J. Reynolds’ Premier (1988), Eclipse (1994) and, most recently, Revo (2014), for which marketing support was discontinued after five months of test-marketing in Wisconsin, USA, last year. Philip Morris had its Accord (1998) and Heatbar (2007). Most of these products failed because of poor consumer reception. During the recent TMA conference in Williamsburg, Virginia, USA, one speaker derided his company’s first HnB product as “smelling like a fart and tasting like shit.”

IQOS is different from its predecessors in many aspects. For starters, it is backed by significant investment. In 2014 PMI built a €500 million (then $680 million) new factory near Bologna, Italy, to produce the tobacco components of its HnB products. Altogether, the company has invested $2 billion in its RRP product portfolio over the past decade. Furthermore, iQOS features a slimmer, lighter design and new technology. Importantly, it offers an improved taste and sensorial and ritual experience over former HnB devices, according to PMI. At the same time, iQOS appears to deliver on its promise to reduce output of harmful and potentially harmful constituents (HPHCs). According to comprehensive studies carried out by a 300-strong scientific team dedicated to PMI’s novel product portfolio, the aerosol generated by iQOS contains on average 90 percent less of all classes of HPHCs compared with the smoke of the standard reference cigarette. Further studies showed that the product does not negatively affect indoor air quality. Toward the end of 2016, PMI intends to submit a modified-risk tobacco product application to the U.S. Food and Drug Administration.

Into the world

First launched in Japan and Italy, iQOS is currently being test-marketed in selected cities in seven countries, among them Switzerland, Russia, Romania, Portugal and Ukraine. PMI plans to introduce the device to another 13 markets globally by the end of the year.

At the Goldman Sachs Global Staples Forum in May, PMI Chief Financial Officer Jacek Olczak said that in its main test market Japan, iQOS had by now achieved a full conversion rate of 60 percent from combustible cigarettes. Sales figures look promising, too: According to PMI’s 2015 annual report, the device generated an “off-take” share of 2.4 percent in Tokyo and 1.6 percent in the expansion areas outside Tokyo; the weekly off-take share was reported to be growing. PMI said it had to postpone the national rollout date for iQOS in Japan to mid-April, citing potential supply shortages due to the popularity of the device.

While iQOS is not the only product currently competing in this segment—in November 2015, British American Tobacco started to test-market Glo iFuse in Romania, and in January 2016, Japan Tobacco launched Ploom Tech in its home market—PMI’s timing may have been just right: The device enters the market as the initially phenomenal growth rate of vapor has ebbed, and some smokers who had switched to e-cigarettes have returned to combustibles. According to Euromonitor International, vapor sales have decelerated considerably; the research company has cut the category’s forecast five-year compounded annual growth rate of 114 percent to 57 percent.

In addition to being a “first mover” with regard to commercialization and clinical trials, PMI also benefits from its ability to leverage the ubiquitous Marlboro brand globally. Except for Russia, where HeatSticks are sold under the Parliament brand, iQOS is offered with Marlboro HeatSticks.

To ensure communication with potential users of their new device also in highly restricted marketing environments, PMI has created specialized points of sale—dedicated flagship stores the company calls “iQOS embassies,” which are reminiscent of Nespresso shops. It also uses grass-roots marketing and an e-commerce platform for distribution.

IQOS is one of four RRP platforms PMI is currently developing and the first of two HnB platforms; the other one—for the time known as Platform 2—uses a pressed carbon heat source that, once ignited, heats the tobacco to generate a nicotine-containing aerosol. Platform 2 has been designed to resemble a cigarette as closely as possible, the company says, and is scheduled for an initial city test still this year. At the end of 2015, the device passed a four-week whole-offer test in Romania, where it led to 60 percent of smokers using the device predominantly.

Platform 3 is an inhaler more similar to the current e-cigarettes. Using acquired technology, it creates an aerosol of nicotine salt formed by the chemical reaction of nicotine with a weak organic acid. Product development was also progressing for Platform 3, PMI said. The company expects to conduct a city test for the device in early 2017.

Flavoring Chemicals in E-Cigarettes

Download (PDF, 247KB)

Plain tobacco packaging likely early next year


Here’s how cigarette packs could soon look – a standard package with gruesome warning image.

The packaging was revealed at a smokefree event on Wellington’s waterfront and could be rolled out early next year.

The prop design at the event is not the final design – the Government will now consult on plain packaging, including design for packs.

Associate Health Minister Peseta Sam Lotu-Iiga has released draft regulations and a consultation document which aims to standardise the look of cigarette packs.

“The design and appearance of cigarette packets are powerful marketing tools for vendors. The Government is proposing to use the standard brown-green packaging which is similar to what is used in Australia,” Mr Lotu-Iiga said.

“We’re proposing that mandatory health warnings will cover at least 75 per cent of the front of the packs and all tobacco imagery will be removed. Brand names will be allowed but regulations will standardise how and where the printing is.”

Plain packaging is likely to be in place early next year – but officials need better information before deciding if e-cigarettes can be made legal, Prime Minister John Key says.

Tax on tobacco will be significantly hiked and the Government will forge ahead with plain packaging, despite a legal risk backed by tobacco giants.

“Nothing kills you with greater predictability than smoking,” Mr Key said of the plain-packaging change.

“It will take some time before you actually see it on the shelves [plain packaging]. My expectation would be early next year.”

Certain tobacco researchers are urging the removal of restrictions on buying e-cigarettes containing nicotine.

Nicotine patches and gum can be bought, but nicotine e-cigarette liquid must be bought from overseas. Other countries, like the UK, allow the products to be sold in supermarkets and dairies.

However, there are fears young people could use the devices. Mr Key said he had received advice on the usefulness of e-cigarettes and vaping.

“The advice I’m getting so far is that there may be a role for e-cigarettes in terms of people transitioning away from smoking. But I think the health impacts are very unknown at this point. So there is some concern, at least by officials, that there may be long-term health impacts.

“We don’t have enough good data at this point to make a call on that. In the short term, people certainly are using them to transition. That might be a helpful way of weaning off cigarettes, but long-term we’ll need to get better advice and data.”

Maori Party co-leader Marama Fox told the smokefree gathering that politicians should lead by example and make the Parliamentary precinct smokefree.

That led to a crack from Labour MP Rino Tirikatene, who tweeted that the Maori Party and their “mates” National were “slowly turning Aotearoa into a kuia state”.

Labour leader Andrew Little said he needed better information before making a call on whether e-cigarettes should be made available. Plain packaging was supported by Labour.

New Zealand had been keeping an eye on the outcome of legal challenges against Australia’s plain packaging, one from tobacco firm Philip Morris and another from tobacco-producing countries via the World Trade Organisation (WTO).

Australia won the case against Philip Morris in December.

The WTO challenge is ongoing, but Mr Key has said he received advice late last year that the Government was on a “firm footing” to progress plain packaging because several other countries, including the UK and Ireland, had introduced it.

These countries did not face a challenge under the WTO.

The Trans Pacific Partnership (TPP), signed on February 4, also allows tobacco-control measures, so New Zealand could advance anti-smoking policies without risking a legal challenge.

A pack of 20 cigarettes will increase from about $20 now to around $30 in 2020 after hefty excise increases were announced as part of last week’s Budget.

The tax on tobacco will rise by 10 per cent on January 1 each year for the next four years.

That is expected to bring in an extra $425 million in tax over that period.

It will affect the about 15 per cent of adult New Zealanders who smoke each day – about 550,000 people.

That rate increases to 35 per cent for Maori, and 22 per cent for Pacific people.

The tax hikes are part of measures designed to make New Zealand smoke-free by 2025, a key goal of the Maori Party.

Asked if that was realistic, Mr Key said his confidence was increasing, as there was increasing momentum behind the smokefree movement.

World No Tobacco Day

Combating tobacco: The youth taking control

Every year, World No Tobacco Day is observed on May 31 to draw attention to the paradoxes surrounding tobacco.

There is now wider agreement that there is a tremendous price to pay for cigarette consumption: respiratory troubles, lives and productivity lost from smoking-attributable diseases, or all the money spent. It is a burden that more and more countries are not willing to carry anymore. Except Indonesia.

Cigarettes are everywhere here. You just need to look around wherever you’re standing to see people blowing cigarette smoke, or flicking ashes to the ground.

Myriad cigarette ads practically line the streets. It is “normal” to smoke. We are in fact the world’s third-worst cigarette smoking country — and smokers here are getting younger.

Three out of 10 smokers are aged between 15 and 30, and most smoke their first cigarette before they turn 19, according to the national 2013 Basic Health Survey (Riskesdas).

Production of cigarettes is being strongly pushed, with the Industry Ministry targeting a whopping 421.1 billion cigarettes for production this year through its tobacco production roadmap.

Combined with lax regulations on cigarette marketing and advertisements, it’s no wonder that Indonesia has a rampant smoking problem, an old problem getting younger as it is increasingly noticeable among youths.

Remember that unsettling viral video of the smoking baby, already addicted at the age of 2. The impact on young people goes much deeper than smoking itself even.

The global NGO Human Rights Watch recently released a report on the thousands of children in Indonesia that work on tobacco farms with hazardous conditions, their lives being endangered by acute nicotine poisoning and harmful pesticides.

Thus, we cannot just rely on the government’s efforts, which are lukewarm at best. Apart from policies like Law No. 109/2012 regulating materials that contain addictive substances in tobacco products, and the Health Minister’s Decree No. 28/2013 concerning pictorial health warnings and health information, there has been neither much breakthrough nor serious commitment on strengthening tobacco control.

Thus, the government no longer functions as a controlling and regulating organization for society.

Therefore, civil society actors have strived to become influential over policy. The youth, in particular, have done so in ways unimaginable in earlier times. They are steering the tobacco control reform to break out of the lethargic mode it is stuck in.

There’s no sense in waiting for a stronger, better effort on tobacco control. If this problem persists, there will be little chance for young people to maximize their potential and be productive, which will lead to a disastrous waste of the anticipated demographic bonus.

It’s simple — there are currently 65 million people classified as youth, and more than a quarter of them are smokers, so in the next 30 to 40 years they face a high probability of contracting non-communicable diseases attributed to tobacco.

There is hope though. Young people today are not staying silent and doing nothing. In fact, the Global Youth Tobacco Survey of school-aged young people, revealed that three out of four students agreed that tobacco smoke was dangerous and that smoking should be prohibited in public spaces.

This awareness marks a rise in young voices, such as those of millennials, who are conscious of their ability to create social movements, and fight for causes.

There are many initiatives started by young people that aim to reduce the negative impact of tobacco, such as Penggerak Nusantara (Archipelago Movers) who promote peer education among students on the impacts of tobacco.

There is also Smoke Free Agents, an initiative that encourages students to demand their right to tobacco-free spaces and identify violations of tobacco control regulations in their schools and neighborhoods.

All these initiatives aim to inspire and empower young people to make informed decisions regarding smoking. This also demonstrates a shift from a top-down and hierarchical cascade of information to one that is peer driven.

Social norms can change, including the normalization of cigarette smoking. There is of course the factor of power relations that underlies tobacco control. But youth leaders have the power to influence not only their peers, but important policies as well.

It might be a hefty challenge, but focusing prevention efforts relentlessly on young people will be the key to achieving not only a tobacco-free World No Tobacco Day, but a tobacco-free generation.

Anindita Sitepu is a health psychologist and Olivia Herlinda is a pharmacist and health policy observer. Both work for the Center for Indonesia’s Strategic Development Initiatives.

Consultation on plain packaging

Health Canada will accept public input until 31 August on the government’s plan to introduce plain packaging for tobacco products, the ministry said.

Uniform packaging would require a standard colour and font on the portion of the package not devoted to health warnings, the ministry said. Canada also recently announced a ban on menthol cigarettes.

“I don’t believe tobacco companies should be allowed to build brand loyalty with children, for a product that could kill them.” said Health Minister Jane Philpott. “Research shows that plain packaging of tobacco products is an effective way to deter people from starting to smoke and will bolster our efforts to reduce tobacco use.”

Plain-pack comments may be submitted online. More information is available at: