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November, 2016:

What will it take to get China’s 350 million smokers to quit? Public bans, tax hikes on the cards

Promised smoking ban welcome but Margaret Chan urges city mayors to also curb tobacco marketing

China has not done enough to control smoking even though the mainland authorities plan to put a smoking ban into effect within this year, said World Health Organisation Director-General Margaret Chan.

“Tobacco control is very close to my heart and a very important subject for the World Health Organisation,” Chan said at a meeting on the sidelines of the 9th Global Conference on Health Promotion in Shanghai. “The WHO’s member states have developed and adopted the WHO framework convention on tobacco control.”

The world’s largest tobacco market, with 350 million smokers, China has not yet passed a national law to ban smoking in public places. Of more than 600 cities across the country, only 18 have passed their own smoking control regulations.

“I used to say to Chinese officials that you have done well but not enough and there is room for further improvement,” Chan said. “I look forward to seeing the progress of China’s national tobacco control law.”

Mao Qunan, spokesman for the National Health and Family Planning Commission, China’s health authority, said a national law is expected to go into effect within this year.

Chan said she encouraged dozens of mainland city mayors who were attending the conference to introduce regulatory or fiscal measures to prevent the marketing of tobacco products and to stop tobacco sponsorships of sports events.

Mao said the biggest obstacle in the legislation was that the public did not have adequate awareness of the dangers from smoking.

“The Chinese government is beefing up an awareness campaign on smoking control, making laws and reforming the tobacco tax and price system to honour our commitment to the WHO’s framework convention on smoking control,” he said.

The mainland’s tax reform on tobacco products, which began seven years ago, has met strong resistance from tobacco producers and cigarettes sold on the mainland are still among the cheapest in the world, Wu Yiqun, a Beijing-based smoking control campaigner, told the Economic Observer.

The official said that health promotion work, such as smoking control, needed multisector collaboration. “Without support and involvement from other departments, many of our tasks can’t be achieved,” he said.

A Shanghai Declaration on Health Promotion was released at the conference, urging governments across the world to integrate health into their sustainable development agenda.

For a long time, the mainland has been lacklustre in global health rankings for allocating only 5-6 per cent of its gross domestic product to health services. Premier Li Keqiang, in his keynote speech at the conference on Monday, said China’s spending on health services has been increasing year by year over the past few years. He did not give specific figures.

“We will put health in a strategic position and regard it as a priority task. In our development mindset, we should prioritise health and emphasise health goals in our economic and social planning,” Li said. “Public policies should favour health goals and fiscal spending should guarantee the development of health-related causes.”

Nationwide public smoking ban expected by year’s end

A nationwide ban on smoking in public places circulated as a draft two years ago and building upon curbs in nearly 20 Chinese cities is expected to become law by the end of 2016, the Shanghai Daily reported.

Smoking would be prohibited at indoor public venues, on public transportation and outdoors in areas where schools and youth facilities are present, the newspaper said, citing a draft. Smoking in stadiums also would be banned. Mao Qun’an, a senior spokesperson with the National Health and Family Planning Commission, reportedly said the regulation was making its way through the legislative process and would be issued by the end of the year.

A few clarifications about our e-cigeratte study

In the Organic Analytic Laboratory at DRI our main specialty is sampling and detailed chemical analysis of organic air pollutants. Our team has more than 20 years of experience in this area.

E-cigarette research is new for us, but involves similar sampling and analytical techniques. Having seen advertisements for e-cigarettes that claimed they are safe because liquids contain only FDA approved ingredients, we decided to apply our expertise to see what is in e-cigarette vapors. This resulted in publication of the first set of results concerning the role of flavorings in aldehyde formation during vaping.

Following the publication of our paper, we received a lot of attention from media, the blogosphere, and individual vapers. This shows the importance of the problem and we are pleased to have made a contribution to the ongoing discussion of the pros and cons of vaping.

While the news coverage was generally accurate, we noticed some misunderstanding and misrepresentation of the study, especially in comment sections of media articles and on some blogs. For example, we were amazed to see some commenters suggesting that our study was sponsored by the tobacco industry. This is completely untrue. This was an internally funded study. None of us, nor the Desert Research Institute has any connection to the tobacco industry.

A recent blog post by Dr. Farsalinos was also brought to my attention. In his post, Dr. Farsalinos states that our “results contradict previous research on aldehyde emissions” and he makes other assertions that I would like to address here in more detail. By making this statement, Dr. Farsalinos revealed that (a) he is not up-to-date with the current literature, and (b) has not read our paper carefully, because we explicitly compare our results to other studies.

Aldehyde Concentrations

Our paper states (from the top of the right column of page four): “For example, maximal formaldehyde emissions observed in this study are approximately 2−7 times lower than the steady-state emissions measured by Sleiman et al.,9 who reported values ranging from 13000 to 48200 ng/mg. In terms of emissions per puff, our formaldehyde data [0.12−50 μg/puff (Table S3)] are comparable to values of 0.05−50 μg/puff reported by Gillman et al.6 and 30−100 μg/puff reported by Sleiman et al.9”

Yes, the highest observed concentrations in our study, which seem to have caused disbelief in some such as Dr. Farsalinos, are actually several times lower than those reported in another recent study (Sleiman et al.). In Sleiman et al., it is reported that the first few puffs significantly underestimate aldehyde emissions as the coil temperature needs time to come to steady state. Most if not all of the previous studies that reported low aldehyde concentrations did not include warm-up puffs. This is also discussed in our paper.

Flavoring Compounds

Our study also clearly states – “our results do not suggest that PG or VG produces no aldehydes, but that flavoring compounds are responsible for the main part of the emitted toxic aldehydes. Nondetects for unflavored liquids reported in this study are likely due to the small number of puffs that we have used in our measurements. By collecting more puffs per measurement, we could have quantified emissions for unflavored liquids. This quantification, however, is of minor consequence, as the flavored liquids produce significantly more aldehydes than unflavored ones do” (top of the left column on page 5).

We are not contesting the contribution of PG/VG to aldehyde formation. Our point is that flavorings cause significantly higher emissions.

The standard excuse (written about here – of a “dry-puff” to explain aldehyde emissions cannot be applied to our study.

There is only one peer-reviewed paper that asserts that high aldehyde concentrations are due to dry puffs only and that these cause aversion in users. That paper was reviewed in just 11 days and methodological problems have been identified by other researchers – see an review by Shihadeh et al. here

As was discussed above, the evidence is mounting that aldehyde levels in e-cigarette vapors could be dangerously high.


While we do agree with Dr. Farsalinos that the strength of science lies in reproducibility of experimental results and we wish anyone success in reproducing our study, we strongly believe that science requires impartiality and an open mind. Statements such as “I should note that it is impossible to convincingly identify something that went wrong in this study” are derogatory and assume that our study is wrong.

We would also suggest Dr. Farsalinos reproduce studies by Sleiman et al., Gillman et al., and Jensen et al.

It should be also noted that aldehydes and their DNPH adducts are chemically unstable. Experience and outmost care are required to obtain accurate results.

While we are not interested in proving or disproving Dr. Farsalinos’ dry puff study, we have collected some preliminary data that contradicts conclusions of that study regarding high aldehyde levels causing an “unpleasant” sensation during vaping.

We are collecting data for secondary aldehyde exposure associated with vaping. To estimate secondary emissions, we collected exhaled breath from three research volunteers, who were asked to vape as they normally do in a real-life scenario. The results are shown in the unpublished graph below (DO NOT CITE).

The levels are comparable to what we have measured per puff. One volunteer produced higher concentrations, because a different device was used. None of our volunteers complained about anything unpleasant during their vaping.


We continue working on characterizing other pollutants in e-cigarette vapors and have data collaborating the effect of flavoring additives we reported in the ES&T.

Stay tuned for more exciting results and important research findings from our team!

– Andrey Khylstov, Ph.D

Facebook could help lower Indigenous smoking rates, Northern Territory health researchers say

Indigenous people have the highest rates of smoking in the country, but researchers in the Top End believe Facebook could be the most effective way of helping them quit.

Aboriginal people living in remote communities smoke at three times the rate of other Australians, according to research fellow Marita Hefler from the Menzies School of Health Research in Darwin.

Preliminary research into the role of Facebook in helping smokers to quit has found that although the living situations of Indigenous Australians differs widely across the Northern Territory, even those who lack food or clothing may still own a smartphone.

“We know that Aboriginal people use social media at very high rates; it’s been taken up even in remote communities, particularly where people have limited communication through other means,” Ms Hefler said.

Researchers believe Indigenous people use Facebook at higher rates than the overall population, making it one of the most effective ways to reach out.

“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,” Ms Hefler said.

Early findings show that when friends and family talk about quitting smoking on social media, it has a greater effect than traditional hardline anti-smoking ads.

“The people in your Facebook networks influence you the most,” Ms Hefler said.

“In the past, anti-smoking advertising has relied heavily on having a captive audience; we know that smokers don’t like the content they are seeing, but they can’t get away. Now with the advent of Facebook, all you have to do is swipe and the message is gone.”

Cigarettes more popular than fruit in outback stores

Customers in remote Australia spent roughly four and a half times more on cigarettes than fruit and vegetables in 2015-16, said Stephen Bradley, chairman of Outback Stores, a government-owned company which manages 37 businesses in some of the remotest parts of the country.

An incentive program run by Outback Stores to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales, but Mr. Bradley admits more needs to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” he said.

The Federal Government is aiming to close the gap between Indigenous and non-Indigenous life expectancy within a generation.

Indigenous deaths caused by heart disease and strokes have been dropping but on average Indigenous people are still dying 10 years younger than non-Indigenous Australians.

“Smoking in Aboriginal communities looks quite different to what it does in the rest of Australia,” Ms Hefler said.

“There’s historical reasons why the smoking rate is higher: it’s tied up in inter-generational trauma, and we also know the stolen generations are more likely to smoke.”

Using Facebook to quit

After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

Ms Lowah has been a smoker for more than half her life and agrees the tough traditional anti-smoking ads are too easy to ignore.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,” she said.

The preliminary research findings from Menzies have been welcomed by NT Territory Labor MP Chansey Paech, whose central Australian electorate of Namatjira has a high Indigenous population.

“Both the Territory and Federal Governments have made significant contributions over the last several years to reduce the rates of smoking, so I’m looking forward to reading the report and seeing what the recommendations are, and hopefully reducing the smoking rate in the Northern Territory, which we know is too high,” he said.

Tobacco Industry And Front Groups Pump Up Their Propaganda For COP7

Over the past year, governments across the globe have continued to make new agreements with the tobacco industry, as shown above. However there is a ray of hope from Namibia, which is choosing to grow more food crops.

The tobacco industry is very angry that the Conference of the Parties (COP) is using Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect the policy-making process from industry interference.

The industry has hijacked the “public space” of the COP. FCTC Parties have responded in recent sessions by not allowing participation from the “public”, which is dominated by industry representatives. For COP7, FCA is recommending Parties adopt pre-screening processes for the public and for the media. (Presently, media is in the category public).

The industry has gone on the offensive: conducting an international campaign to attack and discredit the COP and the World Health Organization (WHO) about lack of transparency. Industry representatives have written angry letters to both the COP and WHO and published many statements in the media criticizing the COP’s lack of ‘transparency’, which strikes a chord with broader society.

The industry throws a tantrum whenever it does not get its way, and has no qualms in criticising the 180 governments that are FCTC Parties. In one statement, a representative of Japan Tobacco International (JTI) said the industry wants to see change, (read, “we want to influence the COP”), and that it needs to “keep raising our voice about these censorship practices”.

Since the tobacco industry has no credibility to criticise the COP and tobacco control, it has recruited front groups, think tanks and sympathetic individuals to sing from its song sheet.

The Institute of Economic Affairs (IEA) is one such close ally. It advises the industry to talk more about “due process and fairness and less about the specifics of tobacco policy in drawing attention to this issue”.

According to the IEA, “With regard to [Article] 5.3 and COP, the industry needs to find allies amongst groups who take an interest in transparency, openness and constitutional structures. Such groups needn’t be sympathetic to the regulatory agenda of the industry; indeed they may even be antagonistic to the industry and tobacco products in general. That needn’t matter—the issue here is about the manner in which policy is developed and created, not the exact content of the policy.”

Another industry funded group, the International Tax and Investment Centre (ITIC), has stepped up its efforts to protect industry interests ever since the FCTC Secretariat issued a Note Verbal in 2014 about its activities. Earlier this year, an ITIC consultant, Gary Johns, wrote to several civil society groups involved in tobacco control taking issue with the critiques they had done on the ITIC’s skewed research. In a 36-page letter he sent to the Southeast Asia Tobacco Control Alliance (SEATCA) earlier this year Johns wrote, “vested interests are not the problem – debate behind closed doors is”.

The letter was riddled with false accusations against SEATCA, mischaracterizations of fact and law, disparaging comments about the WHO, the Framework Convention Secretariat and FCTC Parties. SEATCA published an open letter in response.

In September, Johns, a former Australian Labor Minister, released a publication attacking WHO for not conducting its business in “transparent fashion and in public view.” The tobacco industry publicized his report in the Tobacco Reporter.

Another industry front group, the International Tobacco Growers Association (ITGA), which routinely rounds up its members to rabble rouse at COP sessions, has stepped up its misinformation campaign. ITGA’s Indian member Federation of All India Farmer Associations (FAIFA) has been applying pressure on the Indian government to allow its members to the COP using arguments of “principles of transparency and equity”

ITGA’s president has also claimed that the FCTC had banned dozens of officials representing tobacco-growing countries from participating in COP7.

A similar statement was made by a new NGO representative cum journalist, who claimed, “The policy of banning delegates having associations with tobacco production is said to be so broad that it will almost certainly prohibit finance ministers, economic development secretaries, public health officials, and even presidents and prime ministers …”

In September, ITGA members from North and South America, India, Europe, Africa, and Indonesia were in New Delhi for a two-day seminar to prepare their protests for COP7.

The ITGA claims COP decisions are being made “only by health officials and activists”. This is simply not true. Government delegations have included officials from non-health departments, such as ministries of agriculture, industry and trade, as official COP records show (Table 1).

In 2008, FCTC Parties adopted Article 5.3 guidelines. They include recommendations 4.9 and 8.3, which explicitly state that Parties should not nominate any person employed by the tobacco industry, or any entity working to further the industry’s interests, to serve on delegations to COP or other FCTC meetings, nor should any representatives of state-owned tobacco industries be included on government delegations.

WHO Chief Calls for Multisectoral Collaboration in Global Health Advocacy

“Tobacco use kills around 6 million people each year. That’s a fact. Health literacy must extend from the personal to the political and policy levels,” said Margaret Chan, the director-general of WHO, in her keynote address at the 9th Global Conference on Health Promotion.

From November 21 to 24, World Health Organization officials, health ministers and health city mayors, totaling more than 1,180 health sector personnel from 126 countries and regions, will gather in Shanghai to discuss global health promotion and equity.

The conference, led by WHO, rotates host cities every three to four years. This year’s event is the first one to be held in China, the country with the world’s biggest population and thus the toughest challenge when it comes to health.

Describing the combination of legislative and fiscal measures as “among the most effective interventions,” Chan called for intersectional efforts at both the national and municipal levels to reshape people’s environments and lifestyle choices.

“Today’s complex health challenges can no longer be addressed by the health sector acting alone. Curbing the rise of antimicrobial resistance requires policy support from agriculture. Access to clean energy fuels economic growth, but it also reduces millions of deaths from respiratory and cardiovascular disease associated with air pollution,” Chan said.

Citing success in Australia, the U.K. and France, the director-general called on more countries to carry out Plain Packaging, a tobacco control measure headed by the WHO Framework Convention on Tobacco Control.

“In October, WHO urged governments to introduce taxes on sugar-sweetened beverages to reduce their significant contribution to obesity, diabetes and dental decay,” she added.

Chan also urged governments to accept responsibility for protecting children from obesity, and for assisting the poor in accessing healthy foods.

E-cigarettes raise teens’ risk of persistent cough and wheeze, study finds

Teenagers who use e-cigarettes have twice the risk of respiratory symptoms such as persistent cough, bronchitis, and wheeze as those who have never used the devices, a large US study has found.1

Use of e-cigarettes among teenagers is increasing dramatically, and public health experts are concerned that these devices may increase cigarette smoking. But there has been limited information on the effect of chronic e-cigarette use on respiratory health.

Researchers analysed responses to a questionnaire from 2086 teenagers aged 16 to 18 years who were taking part in the ongoing Southern California Children’s Health study, to investigate the long term effects of air pollution on respiratory health in young people. Respondents to the 2014 questionnaire were asked about use of e-cigarettes and chronic cough, phlegm, bronchitis, and wheeze in the previous 12 months.

The results showed that the risk of bronchitic symptoms was twice as high in teenagers who said that they were currently using e-cigarettes as in those who had never tried them (odds ratio 2.02 (95% confidence interval 1.42 to 2.88)).

Risk of bronchitis symptoms rose with frequency of current use, from a two thirds higher risk in teenagers who used e-cigarettes for 1-2 days in the previous month (odds ratio 1.66 (1.02 to 2.68)) to two and a half times the risk in those using them on three or more days (odds ratio 2.52 (1.56 to 4.08)), when compared with never users.

And the risk of respiratory symptoms was 85% higher in teenagers who said that they had used e-cigarettes than in those who had never used them (odds ratio 1.85 (1.37 to 2.49)). This increased risk remained even after adjustment for relevant potential confounding factors. Associations were slightly reduced when data were adjusted for lifetime number of cigarettes smoked and secondhand smoke exposure. But the risk of bronchitic symptoms among past e-cigarette users remained higher after adjustment for relevant potential confounders and was also seen among those who had never smoked cigarettes (odds ratio 1.70 (1.11 to 2.59)).

Just under a 10th (9.6% (201)) of the adolescents who responded to the survey were current users of e-cigarettes, having used them at least once in the previous 30 days.

An eighth (14.4%) were past users, reporting that they had used e-cigarettes previously but not in the past month. And three quarters (76%) said that they had never used e-cigarettes.

“E-cigarettes are known to deliver chemicals toxic to the lungs, including oxidant metals, glycerol vapour, diketone flavouring compounds, and nicotine,” said the study’s lead author, Rob McConnell, professor of preventive medicine at the Keck School of Medicine at the University of Southern California, Los Angeles.

He noted, “The Food and Drug Administration recently banned the sale of e-cigarettes to children under 18 years of age, and California just prohibited sale to young adults under 21.

“Our results suggest that these regulations and an environment that discourages the initiation of any tobacco product may reduce the burden of chronic respiratory symptoms in youth.” He added that further studies were needed to better understand the long term effects of e-cigarette use.

1 McConnell R, Barrington-Trimis JL, Wang K, et al. Electronic-cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med 2016; doi:10.1164/rccm.201604-0804OC.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

Early childhood household smoke exposure predicts later delinquency and dropout risk at age 12

Results of a new study led by Professor Linda Pagani of the University of Montreal’s School of Psycho-Education show that the more children are exposed to household tobacco smoke in early childhood, the greater their risk of adopting antisocial behavior toward others, engaging in proactive and reactive aggression, having conduct problems at school, and dropping out at age 12.

“Young children have little control over their exposure to household tobacco smoke, which is considered toxic to the brain at a time when its development is exponential,” said Pagani.

“The detection of early environmental factors that influence later child well-being represents an important target for individual and community health. Parents who smoke near where their children live and play often inadvertently expose them to second and third hand smoke. It was already known that environmental smoke places children at risk of short- and long-term health problems. However, now for the first time, we have compelling evidence which suggests other dangers to developing brain systems that govern behavioural decisions, social and emotional life, and cognitive functioning,” she added.

Pagani, her graduate student François Lévesque-Seck, and fellow Professors Isabelle Archambault and Michel Janosz, came to their conclusions after examining data from a longitudinal birth cohort of Quebec boys and girls born in 1997 and 1998. The Quebec Longitudinal Study of Child Development is a public database administered and coordinated by the Institut de la statistique du Québec. Every year, parents of 1,035 children from the longitudinal study reported whether anyone smoked at home when their children were aged 1.5 to 7.5 years. At age 12, their children self-reported their antisocial behaviour and academic characteristics. Overall, 60 percent of families reported never being exposed to tobacco smoke, while 27 percent reported intermittent exposure, and 13 percent reported chronic exposure. Pagani’s team then analyzed the data to identify whether there was a significant link between early household smoke exposure and later signs of child deviance. This was done while eliminating the influence of numerous confounding factors such as exposure to tobacco smoke, drugs, and alcohol during pregnancy, and other parental and family characteristics that could have explained the observed link between early household smoke and later child deviance.

“Our goal was to eliminate any pre-existing conditions of the children or families that could shed a different light on our results or serve as alternative explanations,” said the researcher.

Animal studies have suggested that exposure to tobacco smoke is toxic to the developing brain at a time when it is most vulnerable to environment input. Abnormal brain development can result from chronic or transient exposure to toxic chemicals and gases in second hand tobacco smoke. These compounds eventually solidify and create third hand smoke. Antisocial behavior is characterized by proactive intent to harm others, lack prosocial feelings, and violate social norms. Such behaviors include aggression, criminal offenses, theft, refusal to comply with authority, and destruction of property. In later childhood, antisocial behavior is often associated with academic problems, as highlighted in the study. Deviance and dropout risk are costly to society as a whole.

“These long-term associations should encourage policy-makers and public health professionals to raise awareness among parents about the developmental risks of second hand smoke exposure. In addition, schools could incorporate this knowledge into curricula at all grade levels in an effort to prevent further exposure to neurotoxins,” she concluded.


About the study

Professor Linda Pagani, her graduate student François Lévesque-Seck, and Professors Isabelle Archambault and Michel Janosz published the article “Early Childhood Household Smoke Exposure Predicts Later Delinquent Behaviour and Dropout Risk at Age 12″ online in Indoor Air, the official journal of the International Society of Indoor Air Quality and Climate, November 21, 2016. DOI: 10.1111/ina.12353

Linda Pagani, Isabelle Archambault, and Michel Janosz are professors at the School of Psychoeducation and researchers at the FRQSC School Environment Research Group, at the University of Montreal.

British American Tobacco says a minimum excise tax in the Autumn Statement would only fuel the black market

UK smokers face a triple whammy in 2017 ahead of Philip Hammond’s Autumn Statement, a British American Tobacco spokesperson said.

With a duty escalator expected and more limitations to come from the EU’s tobacco products directive, BAT said the minimum excise tax proposed by former chancellor George Osborne should be dropped.

The minimum excise tax is effectively a floor price that would hike the price of value-for-money brands in an effort to encourage smokers to quit rather than switch to cheaper brands.

Will Hill is a spokesperson for BAT who said the company, which has a stake in low cost options, would urge the government not to introduce the proposed tax.

Research for the tobacco company by KPMG also showed the tax could increase activity in illicit trading. The study said British smokers who buy low cost brands are more likely to fall into the black market than to quit smoking.

If set at the wrong level, the research shows the tax could cost the Treasury £1.2bn between 2017 and 2020.

The Treasury lost more than £31bn in tax revenue between 2010 and 2015 due to high taxes on alcohol and tobacco, a report by the TaxPayers’ Alliance said.

The company also said the minimum excise tax would run counter to Theresa May’s assurances of a government that works for the many and not just the privileged few.

Anti-smoking campaigner wins top award

An anti-tobacco campaigner who has played a leading role in reducing the harm caused by cigarettes in Scotland has been honoured by the Scottish Cancer Foundation.

Sheila Duffy, the chief executive of ASH Scotland, is this year’s recipient of Scottish Cancer Foundation prize which recognises individuals who have made an outstanding contribution in the fight against cancer.

Today, smoking rates in Scotland are half what they were in the 1970s and the number of young people taking up the habit is at the lowest level ever recorded. Meanwhile public support has grown for measures to regulate tobacco even further.

Sheila Duffy has been at the heart of these changes for the past 20 years. She played a prominent role in building the case in Scotland for the introduction of a smoking ban in enclosed public places in 2006 – the first part of the UK to introduce such a measure. It has been credited with changing attitudes to smoking and has been described as one of the most important public health changes of the past 100 years.

In addition Ms Duffy has campaigned successfully to move tobacco out of the reach of young people, enhance support for those who want to quit, and remove attractive branding from tobacco packaging which reduces its appeal, particularly to young people.

Professor Bob Steele, Chairman of the Scottish Cancer Foundation said: “Smoking causes or increases the risk of a range of cancers and it has been very pleasing to see the positive reductions that have taken place in tobacco use in Scotland in recent years. Sheila Duffy and the organisation she leads have been instrumental in many of these changes which will free hundreds of thousands of Scots from the fear of contracting tobacco related cancer.

“Her commitment has helped to make Scotland a healthier country and she is a very worthy winner of the Scottish Cancer Foundation prize.”

Ms Duffy said : “I am greatly honoured to receive this award, especially in 2016 as we celebrate ten years of smoke-free indoor spaces. Tobacco is the single biggest preventable cause of cancer, and working to put cigarettes out of sight, out of mind and out of fashion must be a priority going forward.”

“The national ambition is that a child born this year will grow up and reach the age of 18 smoke-free. Achieving this will prevent future cancers, and directly reduce health inequalities.”

The award comes with £10,000 prize money which is to be used to further reduce the burden of cancer in Scotland. Ms Duffy said that ASH Scotland plans to use the money on research to improve the help that can be given to people living in challenging circumstances. The smoking rate for the poorest fifth of the population is still 34%, amongst those with a long-term disability or unemployed it is nearly 50% and among prisoners it is 72%. A third of all tobacco used is by people with mental health issues.

The research will focus on factors that lead people in these groups to smoke and the barriers they face to stopping. It is hoped this will fill gaps in our current knowledge and lead to more effective measures to help them.

The Scottish Cancer Foundation prize is supported by the Grant Simpson Trust which helps organisations involved in the “advancement of health.”

The award to Ms Duffy was presented at the Scotland Against Cancer conference on November 21 at the Royal College of Surgeons of Edinburgh.