World No Tobacco Day 2014 is coming up

Every year, on 31 May, the World Health Organization (WHO) and partners everywhere mark World No Tobacco Day, highlighting the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption. Tobacco use is the single most preventable cause of death globally and is currently responsible for 10 percent of adult deaths worldwide.

For World No Tobacco Day 2014, the WHO is calling on countries to raise taxes on tobacco.

Under the WHO Framework Convention on Tobacco Control (FCTC), countries should implement tax and price policies on tobacco products as a way to reduce tobacco consumption. Research shows that higher taxes are especially effective in reducing tobacco use among lower-income groups and in preventing young people from starting to smoke. A tax increase that increases tobacco prices by 10 percent decreases tobacco consumption by about four percent in high-income countries and by up to eight percent in most low- and middle-income countries.

Furthermore, increasing excise taxes on tobacco is considered to be the most cost-effective tobacco control measure. The World Health Report 2010 indicated that a 50 percent increase in tobacco excise taxes would generate a little more than US$ 1.4 billion in additional funds in 22 low-income countries. If allocated to health, government health spending in these countries could increase by up to 50 percent.

Learn more about World No Tobacco Day 2014.

Tobacco imagery on prime time TV in the United Kingdom

Smoking and other tobacco content are common in films marketed to children and young people, but television has the potential to reach far larger audiences than films alone. A British study has found that up to 12 percent of television programming in the United Kingdom, particularly feature films and reality TV, contain tobacco use, predominantly cigarette smoking.

Specific tobacco brand appearances were rare and sometimes occurred in historical footage, but arose predominantly from images of point-of-sale displays broadcast in news and other factual reporting, and in fictional soap opera and other drama.

Tobacco occurred with similar frequency before as after 9:00 p.m., the UK watershed for programs suitable for youth. The estimated number of incidences of exposure of the audience younger than 18 years for any tobacco, actual tobacco use and tobacco branding were 59 million, 16 million and 3 million, respectively on average per week.

“More stringent controls on tobacco in prime time television…have the potential to reduce the uptake of youth smoking in the UK,” the study concluded.

Citation:
1. Lyons A, McNeill A, Britton J. Tobacco imagery on prime time UK television. Tobacco Control 2014; 23: 257-263 (open access)

Smoking down in the U.S.

The proportion of adults in the United States who smoke declined from 20.9 percent in 2005 to 18.1 percent in 2012, according to data from the 2012 National Health Interview Survey.

The smoking rate in 2012 was significantly higher among males (20.5 percent) than females (15.8 percent) and among persons aged 18–24 years (17.3 percent), 25–44 years (21.6 percent), and 45–64 years (19.5 percent) than among those aged 65 years or older (8.9 percent).

The decline in smoking is encouraging and likely reflects the success of tobacco control efforts across the country, according to researchers. For example: the 2009 Family Smoking Prevention and Tobacco Control Act granted the Food and Drug Administration the authority to regulate the manufacture, distribution, and marketing of tobacco products; the 2009 Children’s Health Insurance Program Reauthorization Act raised the federal tax rate for cigarettes from $0.39 to $1.01 per pack; and the 2010 Patient Protection and Affordable Care Act provided expanded coverage for evidence-based smoking-cessation treatments. Also, in 2012 the Center for Disease Control and Prevention (CDC) debuted Tips from Former Smokers (TIPS), the first federally funded, nationwide, paid-media tobacco education campaign in the United States. During the campaign, calls to the quitline portal 1-800-QUIT-NOW increased 132 percent, and the number of unique visitors to a smoking cessation website (www.smokefree.gov) increased 428 percent. An estimated 1.6 million quit attempts were attributable to the campaign.

Additionally, smoking prevalence was:

• highest among adults of multiple races (26.1 percent) and lowest among Asians (10.7 percent);
• highest among persons with a graduate education development certificate (41.9 percent) and lowest among those with a graduate (5.9 percent) or undergraduate (9.1 percent) degree;
• higher among persons living below the poverty level (27.9 percent) than those living at or above this level (17 percent); and
• higher among people living in the South (19.7 percent) and Midwest (20.6 percent) than those in the West (14.2 percent) and Northeast (16.5 percent).

Citation:
1. Agaku IT, King BA, Dube SR. Current Cigarette Smoking Among Adults—United States, 2005–2012. Morbidity and Mortality Weekly Report 2014; 63(02): 29-34. (open access)

Three years of tobacco control progress averts smoking-related deaths

Between 2007 and 2010, 41 countries and territories implemented tobacco control policies that will collectively result in 15 million fewer smokers and prevent nearly 7.5 million smoking-related deaths globally by 2050, according to a World Health Organization (WHO) study.

These findings demonstrate the magnitude of the actions already taken by countries and underscore the potential for millions of additional lives to be saved with continued adoption of MPOWER policies. To assist countries with implementing Framework Convention on Tobacco Control (FCTC) obligations, in 2008 the WHO introduced the MPOWER package of evidence-based tobacco control measures. The MPOWER package includes: Monitoring tobacco use and tobacco control policies; Protecting people from the dangers of tobacco smoke; Offering help to quit tobacco; Warning the public about the dangers of tobacco; Enforcing bans on tobacco advertising, promotion and sponsorship; and Raising tobacco taxes. The goal of the MPOWER package is to reduce smoking-attributable deaths, which are projected to rise to 8.3 million annually by 2030.

The largest number of smoking-related deaths was averted as a result of increased cigarette taxes (3.5 million), smoke-free air laws (2.5 million), health warnings (700,000), cessation treatments (380,000), and bans on tobacco marketing (306,000).

“It is imperative that the public health community continue to advocate for MPOWER policies of the highest level,” the study concluded.

Citation:
1. Levy DT, Ellis JA, Mays D, Huang A-T. Smoking-related deaths averted due to three years of policy progress. Bulletin of the World Health Organization 2013; 91:509-518. (open access)

Plain cigarette packs may reduce smoking appeal

Plain packaging and removal of descriptors on cigarette packs may reduce the appeal of smoking for teens and young adults, and consequently reduce the likelihood of smoking, according to a study of young women aged 16-26 years in Brazil.

Study participants were asked to rate three types of cigarette packages (standard branded, plain packaging, and plain packaging with no descriptors, e.g., flavors). Branded cigarette packs were rated as significantly more appealing, better tasting and smoother than plain packs and were associated with greater style and sophistication.

Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes.

Citation:
1. White CM, Hammond D, Thrasher JF, Fong GT. The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study. BMC Public Health 2012; 12: 737. (open access)

Poor Pakistani women unaware of smoking-related health effects

Most women living in urban slums in Pakistan are aware that smoking harms women’s and children’s health, however, a new study reports that few of these women knew about specific smoking-related health effects.

Around one-third of women in the study knew that smoking can cause lung disease, but only seven percent knew that smoking could lead to heart disease. Few knew that smoking could lead to female-related health effects such as: low birth weight (seven percent); congenital abnormalities (five percent); pregnancy loss, still birth and preterm labor (less than one percent); and infertility and osteoporosis (zero percent). Only 20 percent understood the harmful effects of secondhand smoke on their children.

The study also found that the women’s limited health knowledge was largely due to illiteracy and lower levels of education.

“Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on women’s health,” the study concluded.

Citation:
1. Bhanji S, Andrades M, Taj F, Khuwaja AK. Factors related to knowledge and perception of women about smoking: a cross sectional study from a developing country. BMC Women’s Health 2011; 11: 16 (open access)

Tobacconomics: Report on the tobacco industry’s misleading economic arguments

The tobacco industry uses pseudo economic arguments to divert attention away from the health consequences of smoking to block new health regulations and ultimately protect its revenues, according to Tobacconomics, a report produced by Action on Smoking and Health.

The report debunks claims that support the three major pro-tobacco arguments developed by the industry and its lobbyists, which are recycled again and again for each new policy intervention: standing up for small businesses and defending workers’ jobs; raising the alarm about counterfeit and smuggled tobacco; and denying the effectiveness of tobacco control policies.

Citation:
1. Action on Smoking and Health. Tobacconomics: How Big Tobacco Uses Dodgy Data to ‘Throw Sand in the Gears’ of Global Health Policy. London, UK: ASH, 2011.

Arguments against the adult-rating of movies with smoking scenes

In the United States and elsewhere, a growing number of medical and public health agencies are calling for movies with smoking scenes to be adult rated. They believe that such ratings would significantly reduce the exposure of youth to smoking scenes in movies, which they argue directly cause the uptake of smoking. An essay published in PLoS Medicine presents four arguments against such proposals.

Argument 1: Studies purporting to demonstrate a link between exposure to smoking in movies and smoking uptake do not control for the possible influence of other factors such as alcohol or recreational drug portrayal, violence, coarse language and sexual content, and their relationship with subsequent smoking.

Argument 2: Claims for attributable uptake of smoking said to be caused by movie smoking exposure are crudely reductionist, ignoring widespread exposure to smoking scenes elsewhere.

Argument 3: Adult classification is a highly inefficient way of preventing youth exposure to adult-rated content because kids find ways to access this content anyway, especially via the internet.

Argument 4: There are concerns about the assumption that advocates for any cause should feel it reasonable that the state should regulate (censor) cultural products like movies, books, art and theater in the service of their issue.

The authors of the essay, Simon Chapman and Matthew C. Farrelly, point out that “efforts should be applauded to expose and outlaw paid tobacco industry product placement in film—which is unarguably a form of advertising—as well as efforts to raise awareness within the film and television industries about the ways that gratuitous depiction of smoking can assist in normalizing smoking.”

Citation:
1. Chapman S, Farrelly MC. Four arguments against the adult-rating of movies with smoking scenes. PLoS Medicine 2011; 8(8): e1001078. (open access)

Tobacco Control: Menthol cigarettes

The May 2011 supplement issue of Tobacco Control is focused on menthol cigarettes. All eight research papers are available open access.

Below are short summaries and links to each research paper.

1. Lee YO, Glantz SA. Menthol: putting the pieces together. Tobacco Control 2011; 20: ii1-ii7.
Information from tobacco industry documents consistently demonstrates that menthol facilitates and increases smoking and reduces quit smoking rates.

2. Anderson SJ, McCandless PM, Klausner K, et al. Tobacco documents research methodology. Tobacco Control 2011; 20: ii8-ii11.
This paper demonstrates the methodology used in researching tobacco documents.

3. Klausner K. Menthol cigarettes and smoking initiation: a tobacco industry perspective. Tobacco Control 2011; 20: ii12-ii19.
Menthol is a prominent design feature used by cigarette manufacturers to attract and retain new, younger smokers who perceive menthol cigarettes as less harsh and easier to smoke.

4. Anderson SJ. Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tobacco Control 2011; 20: ii20-ii28.
Tobacco marketing emphasizing menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find ‘regular’ cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit.

5. Yerger VB. Menthol’s potential effects on nicotine dependence: a tobacco industry perspective. Tobacco Control 2011; 20: ii29-ii36.
The tobacco industry knows that menthol overrides the harsh taste of tobacco and interacts with nicotine to produce tobacco products that are easier to smoke, thereby making it easier to expose smokers, especially those who are new, to the addictive power of nicotine.

6. Yerger VB, McCandless PM. Menthol sensory qualities and smoking topography: a review of tobacco industry documents. Tobacco Control 2011; 20: ii37-ii43.
If menthol in cigarettes was banned, new/experimental smokers might choose not to smoke rather than experience the harshness of tobacco smoke and the irritating qualities of nicotine. Similarly, established menthol smokers might choose to quit if faced with an unpleasant smoking alternative.

7. Salgado MV, Glantz SA. Direct disease-inducing effects of menthol through the eyes of tobacco companies. Tobacco Control 2011; 20: ii44-ii48.
The tobacco industry conducted little research on the potential disease-inducing effects of menthol and did not pursue studies that suggested adverse effects.

8. Anderson SJ. Menthol cigarettes and smoking cessation behaviour: a review of tobacco industry documents. Tobacco Control 2011; 20: ii49-ii56.
Menthol’s cooling and anesthetic effects that mask the short-term negative effects of smoking such as throat pain, burning and cough and the perception that menthol cigarettes are more socially acceptable provide a false assurance that would otherwise motivate smokers to quit.

Tobacco industry added appetite-suppressant substances to cigarettes, study says

Following the 1998 “Master Settlement Agreement” between the tobacco industry and 46 U.S. states, U.S. tobacco companies made their internal documents available on the internet. Research into these documents indicates that, in the past, tobacco companies enhanced the effects of smoking on appetite and weight by adding appetite-suppressant agents into cigarettes.

During the 1960s, tobacco giant Phillip Morris put a substance containing tartaric acid into its cigarettes in order to reduce smokers’ appetite. This substance was also added to British American Tobacco cigarettes, although researchers did not find at which date, and if it is still the case. The substance 2-acetylpyridine is also claimed as an appetite-reducing molecule and is one of the tobacco additives disclosed on many past lists of cigarette ingredients.

These are important findings in the fight against tobacco addiction because most smokers want to stop smoking, but the fear of weight gain sometimes outweighs the perception of potential health benefits associated with quitting smoking, particularly in women.

According to the study first published in April 2011 in the European Journal of Public Health, the findings may help smokers and the health care community to understand at least partially why cigarette smoking is producing the effect of reducing appetite, and could explain in part why smokers weigh in general less than non-smokers.

“Although little is known in the medical literature about the anti-appetite effect of the above cited substances, we can make the hypothesis that the weight gain following smoking cessation could be a ‘rebound effect’ of discontinuation of the daily consumption of an anti-appetite substance through cigarette smoking, as it is known for the use of other anti-appetite substances,” the study said.

Citation:
1. Gonseth S, Jacot-Sadowski I, Diethelm PA, et al. The tobacco industry’s past role in weight control related to smoking. European Journal of Public Health, published online 7 April 2011. (open access)