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December, 2016:

Public Health England enlists children in campaign to emphasise smoking heart risk

A campaign launched today by Public Health England centres around NHS doctor and kids TV star Dr Ranj Singh working with children to encourage adults to stop

Smokefree Health Harms launches today through a PR push across various media, and Facebook content.

The Facebook video content features Dr Singh working with primary school children to create images about the damage that smoking does to the heart and arteries.

These images are in the form of cigarette packets (below). Smokefree Health Harms launches as new rules come into force at the start of 2017 meaning that all cigarettes sold in the UK will be in unbranded standard packs that feature graphic image health warnings.

Dr Singh said: “We know that many people quit smoking for their family, and this film shows just how passionately children want to protect the health of smokers and want to help them quit.”

PHE’s campaign focuses on the fact that smoking increases the risk of heart disease by 24%, and doubles the risk of a heart attack or stroke, as well as highlighting that 45 people a day die of cardiovascular disease.

The campaign will direct people to support including an app, email, text and help in person from local stop smoking services.

As with other recent PHE campaigns, such as the One You diabetes and healthy living campaign launched on Monday. Creative agencies involved are M&C Saatchi, Ogilvy & Mather and 23red, with MEC handling media and Freud Communications for PR.

Visceral ads showing the impact of smoking on the body will continue to be shown in areas where there are higher rates of smoking.

Hard-hitting campaign warns of the dangers of smoking

Health experts are warning that smokers are at a dramatically higher risk of heart disease and having a stroke.

Research released by Public Health England shows 45 people every day die from cardiovascular disease linked to smoking.

Despite recent campaigns, a sixth of people in the West Country still smoke.

15.5% People in the South West are smokers
25% Greater risk of heart disease for smokers
2x Risk of heart attack or a stroke for smokers

Public Health England has started a hard-hitting campaign to coincide with the first year when all cigarettes sold in the UK will be in standard packs with all attractive branding removed.

The packs, which will be mandatory from May, feature graphic picture and text health warnings, several of which illustrate how smoking causes cardiovascular disease and death.

Smoking is the biggest cause of premature death in England, accounting for almost 78,000 deaths a year.

For every death caused by smoking approximately 20 smokers suffer from a smoking-related illness.

However, you can change this. Stopping smoking will have a dramatic positive impact on your health and the health of those around you, especially children, and is the single best health decision you can make this new year.


Public Health England has found that the two biggest motivators for smokers to quit are for their health and their families.

It has released a short film featuring children’s TV doctor Dr Ranj Singh working with primary school children to create their own messages about the dangers of smoking.

But the NHS says there is hope – if you give up now.

We know smoking causes serious illnesses and death, but we also know that quitting will eventually lead to a much reduced risk of heart disease and stroke.

The Health Harms campaign will feature a lot of dramatic images of the damage tobacco smoking will cause; if that inspires anyone to quit there is a lot of local help available to them to break the habit.


Brand Loyalty Low Among Teen E-Cig Users

Half of surveyed users did not know which brand they used

Half of teens who use e-cigarettes reported vaping no particular brand, and about a third reported using e-cigarette devices for substances other than nicotine, according to an analysis of recent survey data by researchers from the CDC.

The most commonly reported e-cigarette used by the middle school and high school students participating in the 2015 National Youth Tobacco Survey (NYTS) was the heavily promoted brand ‘blu’, manufactured by Fontem Ventures-Imperial Brands (formerly Imperial Tobacco Group).

Roughly one in four surveyed teen e-cigarette users (26.4%) reported using that brand, while 12.2% reported using the next most popular brand, ‘VUSE’, manufactured by R.J. Reynolds.

The survey results were reported Thursday in the CDC’s Morbidity and Mortality Weekly Report.

“Electronic cigarettes are now the most commonly used tobacco product among U.S. youths; in 2015, 5.3% of middle school students and 16% of high school students reported using e-cigarettes in the past 30 days,” CDC researcher Tushar Singh, MD, PhD, and colleagues wrote, adding that not much has been known about the brands preferred by teens and the substances used in e-cigarette devices.

The analytic sample of the 2015 NYTS included 4,021 students who reported ever using e-cigarettes, “even once or twice.” Respondents were asked what brands of e-cigarettes they had used, with eight specific brands listed, and whether they had ever used an e-cigarette device for vaping a substance other than nicotine.

Data were weighted to account for the complex survey design and to adjust for nonresponse. Prevalence estimates were also reported for the type of e-cigarette ever used, brands, and whether e-cigarettes were used for substances other than nicotine.

A total of 13.5% of sixth through eighth graders and 37.7% of ninth through 12th graders reported ever-use of e-cigarettes.

Among the adolescents reporting ever having used an e-cigarette, 14.5% used only disposable e-cigarettes, 53.4% used only rechargeable/refillable e-cigarettes, and 32.1% used both types.

Half of the student respondents (50.7%, representing 3.18 million teens) did not know the brand of the e-cigarette they had used.

Use of e-cigarettes for a substance other than nicotine was similar among middle school (33.7%) and high school (32.2%) users, and it was higher among males than females (37.3% of high school male e-cigarette users versus 26.2% of high school female respondents).

In a separate survey of high school age e-cigarette users in Connecticut, reported last year in Pediatrics, 18% of respondents reported using cannabis in an e-cigarette device.

“In the present analysis, it is unknown whether students who had used an e-cigarette for a non-nicotine substance had also used an e-cigarette for nicotine, which might underestimate nicotine use,” Singh and colleagues wrote.

“Nicotine content in e-cigarettes is of public health concern because exposure to nicotine is the main cause of tobacco product dependence, and nicotine exposure during adolescence, a critical period for brain development, can cause addiction, can harm brain development, and could lead to sustained tobacco product use among youths.”

Study limitations cited by the researchers included the self-reported nature of the survey, the limited number of specific e-cigarette brands included in the survey, and the lack of data on which substances other than nicotine were being used.

The researchers concluded that increased monitoring of product types, brands, and ingredients preferred by adolescent e-cigarette users is warranted, “to guide measures to prevent and reduce use of e-cigarettes among youths.”

Saudi Arabia to impose 100 percent value added tax on tobacco

Saudi Arabia’s decision to impose 100 percent value added tax (VAT) on tobacco and its products will bring down the number of smokers in the country, said Dr. Mohammed Yamani, chairman of the board of directors of Naqa, an NGO that helps smokers kick the habit.

“The move is a positive and important step toward combating the unhealthy habit,” he told Okaz/Saudi Gazette.

Saudi Arabia has one of the world’s highest rates of smokers as 14 percent of its teenagers and seven percent of its women smoke.

“Smoking habit among young Saudis aged 18 and below has increased with their rate reaching 13 to 14 percent. The figure is close to the study conducted by the World Health Organization,” Yamani said.

He said the VAT on tobacco and its products would be imposed in the second quarter of 2017 as part of the government’s efforts to achieve fiscal balance.

“Cigarette prices in the Kingdom and other Gulf states are still low compared to other countries,” he pointed out.

Yamani, who has been working to combat smoking during the past several years, emphasized the need to bring price of a cigarette packet to SR35-SR40. “VAT will be imposed on import cost. So the price of a cigarette packet will not reach double of the present price,” he explained.

He wanted the Kingdom to increase taxes on cigarettes to bring prices to international level. He said low prices have contributed to increasing the number of smokers in the Gulf region, especially among teenagers and people having low income.

“The increase in cigarette price will not prevent people from smoking but bring down the number of smokers,” Yamani said citing studies conducted in advanced countries.
He said the executive bylaw for preventing smoking in public places will be published shortly.

“The Cabinet has already passed the law and the health minister has told us two weeks ago that the law will be implemented within a few days,” he added.

The Kingdom has widened the scope of public places where smoking is not allowed and it includes prayer places, schools and restaurants. It’s the longest article of the law.

He said VAT would be imposed on harmful materials beginning from the second quarter of next year. The Saudi finance minister has already signed a resolution taken by the GCC Supreme Council to impose 50 percent tax on beverages and 100 percent tax on tobacco and its products.

Teens are vaping more than ever, and not just nicotine

The latest report from the CDC digs into teens’ relationship with ecigarettes

Vaping is more popular with teens than ever, with more than one-third of high school students reporting having tried e-cigarettes. And teens aren’t always using e-cigs for nicotine, according to a new US Centers for Disease Control and Prevention report that dug into teen vaping behavior.

To evaluate e-cig use, the CDC and the US Food and Drug Administration poured through surveys filled out by 17,000 middle and high school students across the US in 2015. About 38 percent of high school students and 13 percent of middle school students reported that they’ve tried e-cigarettes.

That could be an underestimate, too, since the students were reporting their own behavior, and surveys based on self-reports are known to be unreliable.

The CDC is interested in vaping is because we still don’t know exactly how using e-cigarettes could affect a teen’s development. A medical group in the UK lauded e-cigs as useful tools to help current smokers quit, but the CDC said in a statement there’s no evidence that they work. What’s more, e-cig use during adolescence could kickstart an addiction, and the US Surgeon General Vivek Murthy warns that nicotine in any form is unsafe for teenagers. Still, more than 3 million teens used e-cigs in 2015, a tenfold increase over four years that Murthy called a public health crisis. But to stop it, the CDC has to understand it better.

In today’s report, one-third of e-cigarette users reported using their devices for something other than nicotine. This was more common for male white and Hispanic students than non-Hispanic black students. The survey didn’t get into what exactly the students were using their vape pens for, if not nicotine. But other studies point to pot as the most likely substance.

More than half of the e-cig users stuck to reusable electronic cigarettes — the ones you can refill with new liquid nicotine cartridges — as opposed to the disposable kind.

Although most of the students didn’t know what brand they were using, the ones who did used blu and VUSE most frequently.

Both of these brands are owned by big tobacco companies, and are among the most heavily advertised. Millions of teens are exposed to ads for ecigarettes online and in stores. These ads take a leaf out of big-tobacco’s book, promising independence and sex appeal to manipulate people into buying. And they work: more exposure to e-cig advertisements corresponds with more e-cig use in young adults, according to previous CDC research.

The CDC has repeatedly called for restricting e-cig marketing, but they have no control over advertisements. But regulation of the devices is growing; just this year, the FDA ruled that e-cigarettes and vape pens fall under the regulatory umbrella of tobacco products, which means the agency can ban sales to people under 18. We’ll see if the numbers of teenage users drop when the CDC analyzes the data from 2016.

Cigarette Graphic Warning Labels Are Not Created Equal

Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers’ Quit Intentions Relative to Text-only Warnings

Abigail T. Evans, Ph.D. Ellen Peters, Ph.D. Abigail Shoben, Ph.D. Louise Meilleur, MS Elizabeth G. Klein, Ph.D. Mary Kate Tompkins, MS Daniel Romer, Ph.D. Martin Tusler, MS



Cigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.


Nationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over two weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling.


Participants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = .21; bTeen = .27, p’s<.004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -.18; bTeen = -.22, p’s<.018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult =.66; bTeen = .85, p’s<.001) and greater quit intentions among adults (bAdult = 1.00, p<.001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions.


Warning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions vs. text-only warnings.


This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions vs. text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions vs. text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers’ risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.

EU Comes Up With A Plan To Prevent Illicit Cigarette Trade

A draft report commissioned by the EU has stated a Europe-wide system should be developed to track cigarettes , which should be run by the industry together with independent third parties, according to the Financial Times. This new program should be up and running by May 2019 in order to prevent the smuggling and counterfeiting of cigarettes, which costs €10 billion a year, according to the European Commission. As per the new laws, European Union countries must ensure that all tobacco packets are “marked with a unique identifier,” as well as a security stamp, so that the packet can be tracked from the factory to the shop floor. The Commission is yet to decide whether the tracking and tracing program should be implemented by the tobacco industry itself, or if it should be given to a third party.

While the commission says that the tobacco companies must work with numerous third parties to implement this system, the tobacco industry has maintained that it should be allowed to run the system by itself, arguing that external influence would cause disruption. Meanwhile, anti-tobacco groups have asserted the need for outside help to tackle this problem, given past allegations that some tobacco groups have benefited as a result of smuggling of, and illicit trade in, cigarettes. This recommendation comes after the ending of a $1.25 billion tracing deal between the EU and Philip Morris International ( PM ) this year, which was agreed in 2004, following criticism by lawmakers.

What Are Illicit Cigarettes?

Illicit cigarettes enter or are sold in a market in violation of certain rules and regulations, such as without payment of import duties, excise tax, or VAT. Such products can be genuine products manufactured by a official tobacco company, and sold without payment of applicable taxes, or else counterfeit cigarettes, made without the consent of the trademark owner. A number of regulatory measures and actions have been taken up by the government in response to this. Such trade harms governments, consumers, and manufacturers. According to World Health Organization (WHO) estimates, the illegal, unregulated black market in cigarettes amounts to 11% of the global consumption. Tobacco manufacturers themselves have taken a series of measures to ensure their brands are protected and consumers receive genuine products.

How Bad Is The Situation?

Counterfeit and Contraband (C&C) cigarettes declined by 6% in 2015 in the EU, over the previous year. This was against a backdrop of improved economic conditions and increased measures undertaken to counter the illicit trade activities. According to the Economic Intelligence Unit, personal disposable income rose at an average of 2.6% in 2015 across all EU member states. This may have prompted consumers to increase the consumption of Legal Domestic Sales (LDS). Furthermore, after a rise in tobacco taxes to meet the minimum EU excise requirements in a number of countries in 2014, 2015 was a year of more stable prices, which contributed to the decline in the sales of C&C cigarettes; prices rose by three percentage points less in 2015 than in 2014.


However, C&C still accounts for close to 10% of the total consumption, with high consumption in countries such as Greece, Norway, UK, and Ireland, which have the highest prices within Europe. In Eastern EU, high levels of C&C were seen in those regions bordering non-EU countries, where average prices tended to be four times lower. France was noted to have the largest volume of C&C, though it did not have the highest level as a proportion of consumption.


The major source of C&C are non-EU countries, with Belarus being the largest contributor, followed by Ukraine, Algeria, and Russia. The volume of counterfeit cigarettes continued to decline from EU countries, accounting for just 12.2% of the total in 2015.


Illicit Whites (IW), which are cigarettes manufactured legally in one country, but which are smuggled across borders, accounted for over a third of C&C, of which 5.3 billion cigarettes has Belarusian labeling. These have grown as a proportion of total C&C from 7.8 billion in 2009, to 18.8 billion in 2015. Further, counterfeit cigarettes increased 28% during 2015, but remain less than 9% of the illicit consumption in Europe.


During 2015, Philip Morris reported revenue, net of excise, from its EU segment of $8.07 billion. If we consider the rate of illicit trade in EU to be 10%, this would amount to over $800 million in lost revenue for the company. In May, the company pledged $100 million to fund projects to confront this problem. The company has come up with a new initiative – PMI IMPACT – to combat illicit trade practices. Besides expending the aforementioned sum, the initiative will also raise funds from public and non-governmental organizations. Given the large amount of lost revenue annually for Philip Morris from just the EU region, this is definitely a move that would be beneficial to the company.



1) The purpose of these analyses is to help readers focus on a few important things. We hope such lean communication sparks thinking, and encourages readers to comment and ask questions on the comment section, or email

2) Figures mentioned are approximate values to help our readers remember the key concepts more intuitively. For precise figures, please refer to our complete analysis for Philip Morris International .


China to Ban Smoking in Public By the End of the Year

Smokers in China should find a new habit in 2017 as the country is set to implement a stricter nationwide cigarette smoking ban by the year’s end. The country’s National Health and Family Planning Commission and a senior government official introduced the regulation to control smoking in public areas at the Global Conference on Health Promotion in Shanghai on Tuesday, Shanghaiist reported. In a statement, the commission’s publicity head Mao Qun’an announced that “smoking harms health has become a global consensus.” The legislation drafted will make it illegal to smoke in all indoor public venues, public transport, and even workplaces. Outdoor spaces, like hospitals, primary schools, kindergartens, tourist sites, and stadiums will also be off limits to smoking. A fine of up to 500 yuan (US$72) will be imposed for every person who violates the new rule, while businesses which fail to comply will risk having their operating license revoked plus a fine of up to 30,000 yuan (US$4,320).

According to the Chinese Association on Tobacco Control, China is home to around 316 million smokers in the country. The country, which produces the world’s largest supply of cigarettes, has yet to enforce the WHO-endorsed graphic packaging to local tobacco companies. Other factors seen as the cause for such rampant cigarette use is the lack of information drive tackling the harm it causes. The price of cigarettes in the country also remains cheap with some brands priced for just 10 RMB ($1.60) per pack. In 2011, the Chinese government attempted a similar legislation but failed to effectively enforce it. The commission is hoping to improve its implementation this time around.

B130m in contraband medicine and cigarettes seized

The Customs Department has seized more than 130 million baht worth of medicine and foreign cigarettes as part of a concerted effort to crack down on smuggled, counterfeit and unpaid tax products.

Some 120 million baht in medicine was seized, along with another 12 million baht in smuggled cigarettes, director-general Kulit Sombatsiri said in a statement.

The medicine had been produced in India and flown to Singapore before being delivered to Thailand by ship.

Over 2 million pills of sildenafil soft gel capsules and other medicines were seized by the Customs Department as they were shipped to Thailand without licences, he said.

He added that the importers had made false declarations in terms of type, volume and weight, which breached sections 99 and 27 of the Customs Act.

Only companies that have received licences from the Food and Drug Administration can import sildenafil, taken to treat erectile dysfunction, to Thailand.

Mr Kulit said 6.32 million cigarettes were also smuggled into Thailand without evidence of customs and excise tax duty payment, violating Section 27 and 27 (bi) of the Customs Act.

The illegal cigarette packages were sealed with tax stamps from China, where they had been manufactured.

If the cigarettes had not been seized, they might have been sold on the market immediately, said Mr Kulit.

The statement said the Customs Department will continue to tighten inspections to catch imported goods on which tax payments have been avoided, in accordance with the policies of the department’s director-general.

In the last fiscal year, ending Sept 30, 2016, the Customs Department managed 113 raids on those who had smuggled cigarettes worth 11.6 million baht, according to Customs Department data.

Customs officials arrested 43 people each in October and November and seized cigarettes worth 5.36 million baht and 4.54 million, respectively.

The number of nabbed cigarette smugglers in December declined to 27 and the value of contraband also fell to 1.69 million baht.

Earlier this month, the Customs Department ordered Bestlin Group, which was contracted by the Bangkok Mass Transit Authority to procure natural gas vehicles, to pay 370 million baht to retrieve the first lot of 100 vehicles, after the company was found to have improperly imported the buses and declared the import tax on them.

The buses were imported from China to Malaysia by sea before being shipped to Thailand.

The company had manipulated the import process to make the buses appear as though they had been made in and imported from Malaysia.

Bestlin was attempting to reap a tax exemption from the Asean’s free-trade agreement.

Expat fee, subsidy cuts: What’s in Saudi fiscal balance document

An “excise tax on harmful products” — including a 50 per cent tax on soft drinks and a 100 per cent tax on tobacco and energy drinks — will be implemented from the second quarter of 2017. — Bloomberg News’s-in-Saudi-fiscal-balance-document

Riyadh: Saudi Arabia followed a historic budget announcement last week with an 84-page document outlining how the Arab world’s largest economy plans to balance its budget by 2020. The document includes plans to curtail capital spending, raise new revenue and stimulate the private sector.

Following are highlights of what caught our attention:

Capital expenditure:

Authorities reviewed projects with a total cost of SR490 billion ($131 billion) under the five civilian ministries with the highest capital spending. Of the total, SR270 billion had already been spent and the revision identified potential savings of SR100 billion.

The next phase will see the government examining capital spending at 13 entities with a total cost of about SR1.18 trillion. To control the costs of projects, the government is creating a strategic procurement unit.

Subsidy reforms:

Additional subsidy cuts will involve a steady change in energy and water prices from 2017 to 2020. This is expected to help the kingdom save SR209 billion annually by 2020.

The government is looking to increase prices of local retail fuel by linking them to benchmark oil prices or to the average of gasoline and diesel fuel prices on the international market. Prices will change according to fluctuations in the international market and they will be revised periodically.

In 2016, a reduction in fuel and electricity subsidies saved the state between SR27 and SR29 billion despite a halt to a planned water subsidy reduction. The kingdom sees gross saving from the reforms reaching SR59 billion in 2017, SR107 billion in 2018 and SR142 billion in 2019, the document says.

The partial reduction of subsidies has also helped slow the growth in energy consumption to 1.7 per cent in the first half of 2016 from 3.5 per cent in the same period a year earlier.

Taxes and fees:

The government plans to introduce a slew of taxes and fees, raising additional revenue of SR42 billion in 2017 and SR152 billion by 2020. In 2017, Saudi Arabia will introduce an unprecedented “expat levy” on foreign workers with dependents.

The fee will start at SR100 per month in July and rise each year to reach SR400 a month in July 2020, according to the document. It is unclear whether the fee will be assessed for each dependent.

The government will also raise the monthly fees paid by employers that have more foreign workers than Saudis. It will no longer waive the fee for businesses have fewer expats than nationals, instead charging them a “discounted rate.”

An “excise tax on harmful products” — including a 50 per cent tax on soft drinks and a 100 per cent tax on tobacco and energy drinks — will be implemented from the second quarter of 2017. A 5 per cent value-added tax will be imposed in the first quarter of 2018. The government is studying taxes on sugary drinks and snacks.

Authorities will also impose “luxury tariffs” from the first quarter of 2018, the document says, without elaboration.

Private-sector stimulus package:

In the document, authorities acknowledge that confidence in the economy has declined, private sector employment has dropped and real consumption per capita is falling. To counter that, officials on Thursday announced a stimulus package for the private sector worth SR200 billion ($53.3 billion) until 2020.

The fund will provide “attractive investment capital to support the private sector,” the document says. It will be directed to raising the efficiency of industries with high energy and water usage. The package may be extended beyond 2020.

There are also plans to ease rules governing foreign ownership of companies and land, increase the mobility of foreign workers and deregulate industries like tourism and entertainment to reduce barriers to growth, the document says.

Outlook for the economy, decision making:

Overall, the newly-announced measures will increase private investment, consumption and growth over the next four years, the document predicts. The government foresees a slight rise in unemployment in 2018 followed by declines in 2019 and 2020.

Inflation is seen accelerating each year as new measures are introduced.

The kingdom pledges that there will be “no additional financial impositions’ by the government on its citizens or private sector” beyond what’s already mentioned in this document.

There will be no further removal of subsidies There will be no income tax imposed on citizens There will be no corporate income tax There will be a grace period between policy announcements and action There will be no delay in contractor payments. The government will pay within 60 days of “due dates.” There will be no retroactive decision-making.