ASH Daily News for 27 May 2008

The last gasp: Health Secretary signals new smoking curbs

Cigarettes will be banned from public display in shops and vending machines are to be scrapped under dramatic new plans designed to curb smoking among young people. Packets of 10 cigarettes will also be outlawed under proposals to be published later this week by the Health Secretary, Alan Johnson.

A consultation paper includes plans to force cigarettes to be kept "under the counter" out of public view, Mr Johnson said. His comments came as he praised moves by the Scottish government to ban cigarettes on display north of the border. "I think they're right to do that and we're considering that as well," said the Health Secretary.

It represents a further dramatic step in a decade-long campaign to curb the consumption of tobacco products. That has been seen as an infringement of individual rights and civil liberties for some time but anti-smoking campaigners have welcomed each move as a step towards dramatically improving the nation's health.

Yesterday, Mr Johnson indicated that the Government would not simply stop with the ban on smoking in public places that was introduced last summer. "Younger people are more influence by advertising," he said. "Two hundred thousand kids under 16 start smoking every year and their chances of a premature death from smoking are three times higher than if they had started smoking in their twenties."

A series of constraints on cigarette advertising have come into place over the past two decades, seeing it stripped from billboards, magazine pages and sporting events. Now the final strongholds of cigarette branding and marketing, the shops where they are sold, are in the firing line. And the minister also pointed out that banning vending machines, where there was no control over the age of the purchaser, had already happened in other European countries. He said they had enjoyed "startling results".

He went on to target the 10-pack. "I started smoking very young and you could get 10 Woodbines and you could get threepenny singles. Well they have taken threepenny singles away but whether you should still be able to buy 10 cigarettes or whether you should insist you can only buy 20 is an issue we need to look very closely at."

The move, which was backed by anti-smoking groups yesterday, would represent the latest in a series of drastic curbs on smoking designed to reduce the 114,000 deaths each year from smoking-related diseases. Ministers are anxious to cut the number of teenage smokers, with figures showing that more than 80 per cent of adult smokers started in their teens. But pro-smoking groups accused the Government of an "Orwellian" drive to force people to act "in a government-approved way". Retailers also attacked the plans, saying they would cost them thousands of pounds.

The latest crackdown on cigarette sales mirrors Wednesday's decision by the Scottish government to impose a ban. Smoking in public places was banned in Scotland two years ago, and became illegal in England last July. Cigarette advertising outside shop display units was banned in 2002. Government figures show that the proportion of smokers in Britain fell from 28 per cent in 1999 to 25 per cent in 2005. Ministers aim to cut that figure to 21 per cent by 2010. However, the habit is most prevalent among the 20- to 24-year-old age group.

Yesterday, Action on Smoking and Health, the anti-smoking pressure group, welcomed the latest move. Its director, Deborah Arnott, said: "The Government is to be congratulated for launching this ambitious consultation on a comprehensive new strategy to drive down smoking so soon after successfully implementing 'smoke free' legislation. We welcome the focus on protecting children, as two thirds of all smokers start smoking before they reach the age of 18, significantly increasing their risk of dying from cancer.

"Smoking is still by far the major cause of preventable death and disease, exacerbating health inequalities and killing more people each year than alcohol, obesity, road accidents and illegal drugs put together. Reducing smoking, especially among the most disadvantaged in society, continues to be the number one priority if we are to significantly improve public health."

But the pro-smoking group Forest attacked the proposed ban and claimed the move would herald attempts to tighten restrictions on alcohol and food. The group's spokesman, Neil Rafferty, said: "It is really disingenuous to say that a point of sale ban is all about children. We are not aware of any evidence that it cuts youth smoking. What this is really about is making smokers feel bad about themselves, feel immoral or feel like they are buying pornography. It's about trying to get the rest of society to shame them. If you talk about 10-packs, if a teenager can buy two 10-packs a week they can buy one pack of 20. If people are trying to cut down or give up then banning 10 packs denies them that choice. This is all about de-normalising smoking, which is an Orwellian phrase."

The Liberal Democrat health spokesman, Norman Lamb, said: "It is vital that the Government cracks down on underage smoking and access to cigarettes for youngsters. Vending machines are the key outlet which must be controlled and it's taken too long to address the issue. However, any measures taken must be evidence-based." He added, "There is a risk that Labour's addiction to headline-grabbing could lead to measures that are gimmicky, contradictory and would fail to prevent sales to underage smokers." A spokesman for the British Retail Consortium, which represents all levels of retailers, added: "We think this will make no difference at all to people taking up smoking or the habits of existing smokers but it will impose costs of thousands of pounds to pay for shopfitting."

Source: The Independent, 26 May 2008 (also reported in The Daily Mail and The Mirror)
Link: http://tiny.cc/CwrQ0

Childhood passive smoking disease risk

Passive smoking makes children more likely to catch serious diseases, according to a new study. Youngsters who were around smokers were almost 50% more likely to have to go to hospital for an infectious disease before the age of eight. One in three children who were within three metres of smoke in their early years ended up in hospital.

The study on the Tobacco Control website, followed 7,402 children born in Hong Kong in April and May 1997. Researchers recorded their experiences for eight years. The effects of smoking were even more severe for children with a low birth weight, the study found. Those exposed to tobacco smoke were 75% more likely to need treatment for diseases such as meningococcal and respiratory illnesses.

The study's authors from the University of Hong Kong, say passive smoking can weaken the immune system and cause respiratory problems. The report says: "An excess risk of severe morbidity from both respiratory and other infections for all infants exposed to second hand smoke suggests that such exposure, as well as acting via direct contact with the respiratory tract, may also affect the immune system."

Source: Yahoo News, 26 May 2008
Link: http://tiny.cc/7o2Y9

Youth protect hearts by promoting smoke-free policy

Some of the world's leading cardiologists have urged peers at their biennial world congress to recognise the full extent of the dangers of tobacco, in relation to heart disease and stroke. They are allying themselves with youth to help combat tobacco use and other lifestyle factors that threaten global health. 

Dr Valentin Fuster, Past President of the World Heart Federation, points out why cardiologists must work closely with youth as they fight the alarming increase in cardiovascular disease worldwide: "The unhealthy lifestyles that lead to cardiovascular disease often begin in childhood and adolescence, so prevention of heart disease must begin here. Children as young as ten reflect the health habits of their family, peers and social environment, and current research indicates that eating and exercise habits consolidate at this age and stay with children for life. Youth also have a leading role to play in helping change the policies, practices, perceptions and habits that will shape global health in the coming generations," said Dr Fuster.

The World Heart Federation Colombia Model Youth Project, funded by philanthropists Julio Mario and Beatriz Santo Domingo, intervenes to prevent cardiovascular disease during the critical periods of early childhood and adolescence: through a partnership with Sesame Workshop's Plaza Sésamo 'Healthy Habits for Life' initiative. It uses multi-media to encourage preschoolers and their caregivers to practice healthy eating, sleeping and exercise habits and overall healthy lifestyles, and through its youth advocacy activities it stimulates Latin American youths' involvement in smoke-free activism.

"Smoking has long been recognized as a major risk factor for cardiovascular disease, but mounting evidence on the effects of second-hand smoke on the cardiovascular system makes promotion of smoke-free policy an even higher priority," said Joachin Barnoya, Research Assistant Professor, Department of Surgery, Washington University, St Louis. "Passive smoking increases the risk of heart disease by up to 30 per cent in non-smokers , which is why we have to not only encourage smoking cessation but also to support smoke-free environments. Smoke-free policy is a resounding priority for those who care about heart health. Healthcare professionals, and particularly those specialising in heart disease and stroke, should be advising patients to call for smoke-free environments at home and at work and to put smoke-free policy high on the health advocacy agenda."

Over the past two years, the World Heart Federation has worked to help its members develop youth activities aiming to reduce cardiovascular risk. The Colombia Model Youth project has enabled the World Heart Federation and Colombian Society of Cardiology to help youth groups get active in tobacco control for the first time. In the project's regional component the World Heart Federation works with the InterAmerican Heart Foundation to support youth projects in Argentina and Uruguay and build a network of youth for a smoke-free Latin America. Youth in the network are involved in advocacy and research supporting smoke-free policy, and the Colombia Model Youth project has helped them enlist more youth and youth groups in their efforts. At the recent regional tobacco control conference in Rio de Janeiro, the youth in this network wrote the 'Declaration of Latin American and Caribbean Youth in Favour of Tobacco-Free Lives.'

World Heart Federation youth advocacy activities were initiated at the first Global Youth Meet on Health in India in November 2006. Hosted by the Indian youth organization HRIDAY-SHAN, the meeting gathered more than 160 youth health activists from 35 countries. World Heart Federation member organizations organized youth teams from Argentina, Belgium, Colombia, Indonesia, Georgia, Mexico, Pakistan Singapore, South Africa, Uruguay. Participants launched the Youth for Health movement to promote health-promoting policy globally, and made plans of action for activities at national level. "Tobacco use often begins in adolescence," said Professor Srinath Reddy Executive Director of HRIDAY-SHAN and Chairman of the World Heart Federation's Foundations Advisory Board. "And the industry knows it: marketing often targets youth and these efforts are intensifying in developing countries."

Eduardo Bianco, a cardiologist who helped found the new tobacco research centre in Uruguay, has worked with youth to design RESPIRA URUGUAY, an innovative interactive exhibit on the effects of tobacco. "We realized that adults telling youth not to smoke just doesn't work," he said. We have to approach youth through youth." Veronica Schoj, of InterAmerican Heart Foundation, who has done extensive research on youth tobacco use, agrees: "Saying to youth that they cannot smoke at school, but that it is all right for the teachers to do it in the teacher's lounge, never worked. Now we try to work together with them to change the whole environment that threatens adults and youth, smokers and non-smokers alike. Through action they learn much more."

Youth advocates will be manning the Youth Booth stand throughout the World Congress of Cardiology (booth 258, blue pavilion). Photography and images are available from the Congress press office and on YouTube.

Source: Medical News Today, 26 May 2008
Link: http://tiny.cc/3Z9ub

How legislation took the puff out of tobacco advertising

"I smoke 'em cos my name's on them," a chubby character called Reg cheerily told us of his Regal cigarettes from billboards in the early Nineties, covering up the last two letters on the label. At a time when smoking was far less politicised, Reg was encouraging us all to indulge in a little bit of brand loyalty. That was the argument of the multinational corporations behind the adverts. They weren't encouraging people to smoke – especially not young people – merely advising those who already puffed as to where they might maximise their pleasure.

At the time it seemed perfectly reasonable: smoking advertisements seemed to be in the same category as those for alcohol. Only medics and hard-core campaigners appeared to get upset about them. In fact, smoking was associated with some of the most memorable advertising campaigns of the past two decades – not least that featuring Reg.

Remember Marlboro man? That iconic John Wayne-alike, whose cowboy hat and rugged complexion came into their own when he dragged – slowly, thoughtfully – on a Marlboro Red? He was a man of his time. Horses would gallop incessantly in the background, whipping up a dust storm. "Come to where the flavour is," said the gravel-voiced narrator. "Come to Marlboro Country."

Peter Stuyvesant cigarettes featured jet-setting super-rich playboys in sporty scenarios draped with drop-dead gorgeous babes sharing a Stuyvesant on a beach or over a game of roulette. Other famous campaigns included the slogans "Happiness is a cigar called Hamlet" and "You're never alone with a Strand." And yet we shall never see the likes again. First they vanished from TV screens, then billboards, and then magazines. Then came the ban on actually smoking in public places: first in Scotland and Northern Ireland, then in the rest of the UK.

Now politicians north of the border appear to be leading the way again. It only seems a matter of time now before cigarette branding is removed even from the shops that sell them. To be aware of tobacco branding, it appears you will soon have to go into a shop and ask for the hidden product. Rarely in the history of marketing has there been such an abrupt turnaround in public perception. The speed of the transformation, from cool and cultured to ugly and unacceptable, has been remarkable. How did we get here?

An early foray came in 1999. Tessa Jowell, then health minister, brought forward legislation to ban all billboards, newspaper, and cigarette promotions – two years before the rest of Europe. An EU directive thrashed out in 1997 had planned to phase out advertising by 2001, but New Labour wanted to stay ahead of the pack. The Houses of Parliament, which until 2001 sold its own-label brand of cigarettes, then pushed through the Tobacco Advertising and Promotion Act 2002, most of which came into effect in February of the following year. In July 2003, sponsorship of sporting events was also banned. As a result Formula One, which had for years been a high-octane, hours-long advert for smoking, featuring billboards moving at 200 miles per hour, was pacified and censored.

In May 2004 a few specific adverts were targeted and outlawed. In December 2004 all large adverts in shops, pubs, and clubs were similarly expunged. The Health Secretary's latest plans suggest that all forms of cigarette promotion might finally be stubbed out.

Source: The Independent, 26 May 2008
Link: http://tiny.cc/lHAGN

Legislation update: Smoking ban

Is there a human right to smoke in your own home? That was essentially the question the High Court was asked to answer this month in a case brought by high-security mental health patients at Rampton hospital. As everyone now knows, a wide-scale smoking ban in public is in force, introduced by the Health Act 2006. However, there were also regulations that introduced exemptions in certain areas. The private rooms of patients at Rampton are excluded until July 1 this year. After that the NHS has decided to introduce a total ban at the hospital. Other high-security hospitals have already introduced a total ban.

The claimants in the case relied on ministerial statements that it was not the intention of the Government to prevent people from smoking in their own homes. It was argued that as the average stay of a patient at Rampton is more than eight years, it was right to see the hospital as the home of patients. The court was prepared to accept the argument. However, that was just about all that the court did accept.

The claimants had to show that their right to respect for private life and home was being interfered with by the ban, so as to bring them within article 8 of the European Convention of Human Rights. The court accepted that the scope of the right in article 8 is a wide and diffuse one and difficult to define. However, the judges said that they were not persuaded that article 8 “imposes a general obligation on those responsible for the care of detained people to make arrangements enabling them to smoke”.

They went on to say that “whether it is put in terms of moral integrity, identity or personal autonomy, no general right for mental patients to smoke, or general obligation to permit smoking, arises”. That was really the end of the argument, but the court went on to consider other aspects of the case as well. There was no convincing evidence presented to suggest that giving up smoking would worsen the condition of mental patients. The policy of banning smoking for general health reasons was a legitimate one for the Government and the health service to pursue. Arguments about the sanctity of personal liberty based on the philosophy of J.S. Mill were rejected.

It was also noted that prisoners will continue to be entitled to smoke in prisons, but the court was doubtful as to whether the claimants could say that they were being discriminated against on the basis of their status as detained mental patients. So it looks as though the patients at Rampton will be stubbing out at the end of next month. However, an appeal is planned with hopes that the Court of Appeal will be able to consider the case before the total ban comes into place.

Source: The Times, 27 May 2008
Link: http://tiny.cc/3YLh5