Impact of smokefree law on admissions to hospital for heart attack in Scotland

BACKGROUND Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both. 

METHODS Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million.

RESULTS Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684 — a 17% reduction (95% confidence interval, 16 to 18) — as compared with a 4% reduction in England (which had no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test).

CONCLUSIONS The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.

Source: Pell, JP et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. NEJM 2008; 359: 482-491
Link: http://content.nejm.org/cgi/content/short/359/5/482

Tobacco firms pay $1-billion in fines, settlement

Two of Canada's big three tobacco companies have agreed to pay a total of more than $1-billion in fines and settlement costs, ending an eight-year tussle over the cross-border smuggling of contraband cigarettes that were shipped to the United States but then smuggled back and resold in Canada. 

Imposed under the federal Excise Act, the fines are believed to be the largest ever levied in Canada. As part of an agreed statement of facts read out in a Toronto courtroom packed with lawyers and investigators, Rothmans Benson Hedges Inc. was fined $100-million. Simultaneously in Montreal, Imperial Tobacco Canada Ltd (a BAT subsidiary) agreed to pay a $200-million fine.

In addition, the two companies will pay a total of $815-million in civil damages to the federal government and to the Ontario and Quebec provincial governments. The companies both pleaded guilty to “aiding persons to sell and be in possession of tobacco manufactured in Canada that was not packed and was not stamped in conformity with the Excise Act.”

The charges involved the shipment of contraband, tax-free tobacco in Canada to locations in the United States and near the Canada-U.S. border between 1989 and 1994. From there, the tobacco moved in a circular route, and was distributed to smugglers who brought it back into Canada where it was resold on the streets and in convenience stores.

As to why, “This was done with the intention of maintaining RBH's share of the Canadian tobacco market,” Crown attorney Graeme Cameron told the Toronto hearing.

Outside court, RBH defence lawyer Glenn Hainey said he was content with the outcome, which he said ended “the uncertainty and burden that would have continued if the matter had not been resolved...The companies look forward to seeing significant enforcement action to curtail the current contraband problem, which doesn't involved any products that RBH manufactures.”

Toronto-based RBH is 40 per cent owned by Philip Morris International, and in large part, the agreements unveiled yesterday mirror a similar, out-of-court deal reached in 2004 between the European Commission and Philip Morris, manufacturer of Marlboro cigarettes.

European Union regulators had for years complained that countries with low tobacco taxes, notably in Eastern Europe, were being flooded with an oversupply of Philip Morris cigarettes. The aim was to encourage the smuggling of cigarettes to such high-tax nations as Germany and Italy, the EU said.

Philip Morris denied that allegation, but after years of legal skirmishing nonetheless agreed to pay the Commission more than $1-billion that would be used to combat cigarette smuggling.

The accord included no admission of wrong-doing by Philip Morris. Nor was the $1-billion described as a fine. Rather, it was called a “voluntary payment.”

Thursday's settlement turns the page in a cross-border cigarette-smuggling industry dating back to the late 1980s, surfacing most prominently on the Mohawk Akwsasne reserve, near Cornwall, Ont., which straddles the U.S.-Canadian border.

The federal government's first effort to crimp the trade came in February, 1992, when it briefly imposed an $8-per-carton export tax. Under pressure from the tobacco industry, however, the measure was repealed four months later,

And so two years later, in 1994, Ottawa took the opposite tack by slashing taxes on domestically sold cigarettes by about $25 a carton, in a bid to make their sale more profitable and reduce the incentive to ship them south.

The tobacco companies were pleased, but health groups and foes of tobacco were dismayed, estimating that along with promoting the use of tobacco, the tax cuts cost Ottawa more than $10-billion in lost revenue over the next five years.

Since then federal and provincial tobacco taxes have been steadily climbing back up, reviving the contraband among a shrinking population of tobacco-users that now comprises fewer than 20 per cent of Canadians aged 15 or more.

The difference these days, however, is that in Ontario and Quebec at least, the bulk of black-market cigarettes being sold on Canadian streets are being manufactured on native reserves, police say, notably Akwesasne, near Cornwall, Ont., and the Six Nations reserve near Brantford, an hour's drive west of Toronto.

Source: The Globe and Mail, 1 August 2008

Dose response risk of stroke for young female smokers

New research suggests that the risk of stroke for a young woman smoker is directly related to the number of cigarettes she smokes. 

While smoking has been clearly established as increasing the risk of stroke, "there is not a lot of data out there on the actual dose response," said Dr. John Cole, the study's corresponding author and an assistant professor of neurology at the University of Maryland School of Medicine in Baltimore.

Cole and his colleagues interviewed 466 women who had had a stroke, and also 604 women who hadn't. All were between the ages of 15 and 49, and were either smokers, non-smokers or former smokers.

Any smoking at all doubles the risk of stroke, the study found. The risk was 2.2 times greater for women smoking one to 10 cigarettes a day, 4.3 times greater for those smoking 21 to 39 cigarettes a day, and 9.1 times greater for those smoking two packs a day or more, compared to nonsmokers.

The study also demonstrated the benefit of quitting smoking. Stroke risk declined as early as 30 days after a woman gave up smoking and returned to normal in about two years.

"Stopping is the best thing to do, but cutting back will also reduce the risk," Cole said.

Smoking raises the risk not only of stroke but also of heart disease by damaging blood vessels and making blood clots more likely, Cole said.

"Cigarettes, among other tobacco products, are the only products that when used as directed are still guaranteed to do harm," said Dr. David A. Meyerson, director of cardiology consultative services at Johns Hopkins University Bayview Medical Center, and a spokesman for the American Heart Association.

"There are four major reasons why," Meyerson added. "Smoking disrupts the cells lining the blood vessels. It increases blood fibrogen levels, which makes blood more likely to clot. It increases the stickiness of platelets, the cells that form blood clots, and it also decreases the body's natural clot-dissolving mechanism."

The new study is valuable "because of its size and its ethnic diversity," he said. "We see broadly how it applies to all young women."

Cole said a similar study on young men is planned.

Source: Health Day, 15 Aug 2008
Bhat, VM. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke. 2008. Published online before print August 14, 2008, doi: 10.1161/STROKEAHA.107.510073
Link: http://stroke.ahajournals.org/

Japan Tobacco to introduce face recognition software in vending machines

With a legal purchasing age of 20 and a total of 570,000 vending machines in Japan, the vending industry is now turning to optical recognition software of facial features to determine age, and thus allow the continued use of vending machines selling cigarettes to adults. A spokesman for the vending machine manufacturer Fujitake Co said: “A customer using a vending machines first looks into an attached digital camera which then identifies facial characteristics such as wrinkles surrounding the eyes, bone structure and skin sags. This is then automatically compared to a data base containing facial data of 100,00 people to determine the person’s age. With face recognition… the problem of minors borrowing identification cards to purchase cigarettes will also be avoided.” The Japanese government has already sanctioned an age-identifying smart card called taspo which reads a person’s age from driving licences.

Source: World Tobacco, July 2008
 

EU Health Commissioner declines to meet tobacco industry

Health Commissioner Androulla Vassiliou has declared that she will not meet anyone wishing to promote the interests of the tobacco industry. Speaking at a seminar organised by the Smoke Free Partnership at the European Parliament on 15 July Ms Vassiliou said: “As Commissioner for Health, I am ready to commit today not to accept any invitation coming from the tobacco industry or those working to further its interests during the time I hold this office.” She added that she hoped future Health Commissioners would take a similar stance. 

Ms Vassiliou referred to tobacco and the promotion of tobacco as a historical mistake and affirmed Europe’s “duty to remedy the historical error by using all the means at our disposal”. The Commissioner affirmed the European Commission’s key role in the implementation of the WHO Framework Convention on Tobacco Control (FCTC) and expressed hope that the next Conference of the Parties would adopt a comprehensive ban on tobacco advertising, promotion and sponsorship, adding that the Commission will be “pressing hard for” such an outcome. 

Source: New Europe, 20-26 July 2008
Link: www.neurope.eu

SHS exposure in hospitality sector after smokefree law in England

Abstract

BACKGROUND: To monitor and disseminate the short-term effects of the English Smoke-free legislation on air quality and employee exposure in businesses of the hospitality industry. 

METHODS: Indoor particle concentrations and salivary cotinine levels were measured in businesses in the hospitality sector and non-smoking employees one month before and after the implementation of the legislation. Results were immediately released to the media to announce the improvements in air quality and employee exposure to the wider public.

RESULTS: Measurements were collected in 49 businesses and from 75 non-smoking individuals. Indoor PM(2.5) concentrations decreased by 95% from 217 microg/m(3) at baseline to 11 microg/m(3) at follow-up (P < 0.001). Salivary cotinine in employees was reduced by 75%, from 3.6 ng/ml at baseline to 0.9 ng/ml at follow-up (P < 0.001). The findings were presented to the public through press releases and interviews and were cited in over 20 media articles.

CONCLUSION: The project demonstrates the positive effects of the English Smoke-free legislation on air quality and second-hand smoke exposure in the hospitality industry sector. We believe that quick and positive feedback to the public on the effects of smoking restrictions is essential when introducing public health legislation such as the Smoke-free legislation.

Source: Gotz NK et al. Changes in air quality and second-hand smoke exposure in hospitality sector businesses after introduction of the English Smoke-free legislation. J Public Health 2008 [Epub ahead of print]
Link: http://jpubhealth.oxfordjournals.org/cgi/content/abstract/fdn062v1  

EU to require fire-safe, self-extinguishing cigarettes by 2011

All cigarettes sold in Europe by 2011 will be required to be "fire-safe" brands that automatically go out if not puffed on for a minute, the European Commission said. 

European standard-setters are working on rules to mandate self-extinguishing cigarettes to prevent accidental fires, following as many as 37 U.S. states and Canada, commission spokesman Ton van Lierop said.

Data from 16 European countries show that careless use of cigarettes such as smoking in bed caused 11,000 fires annually between 2005 and 2007, killing 520 people and injuring 1,600.

"We think that by 2011 at the latest, these cigarettes will be on the market," Van Lierop told reporters today in Brussels. He challenged contentions by tobacco companies that fireproofing would drive up cigarette prices.

The standard method of fireproofing is to wrap a cigarette in additional layers of thickened paper to slow the burning process, leading the cigarette to go out on its own if not smoked for about 60 seconds, the commission said.

Cigarette makers chafe at the added regulation. Alison Cooper, a director of Imperial Tobacco Group Plc, told analysts in March that the term "fire-safe" is "misleading" and asked whether the idea would yield "a real benefit."

The European Committee for Standardization has begun work on the technical specifications for the safer cigarettes, after the European Union's 27 governments gave the go-ahead in November, Van Lierop said.

Discarded cigarettes are also a leading cause of forest fires, the commission said.

Source: Bloomberg, August 6, 2008
 

Bar workers’ perceptions of behaviour change since smokefree law in Scotland

Abstract

BACKGROUND: "Smoke-Free" legislation prohibiting smoking in all enclosed public places was introduced in March 2006. This qualitative study presents insights from bar workers about their observations of the changing social bar environment, changing patrons' behaviours and challenges bar workers have faced in managing smoke-free legislation. 

METHODS: Twelve in-depth interviews were conducted between November 2006 and January 2007 with a purposively-selected sample of bar workers, identified from a larger quantitative study evaluating the impact of the legislation in Scotland [the Bar Workers' Health and Environmental Tobacco Smoke Exposure project (BHET SE)].

RESULTS: Bar workers all spoke of the improvements the legislation had brought to their working lives and the greater comfort it appeared to offer patrons. Bar workers reported that patrons were generally quick to accept and comply with the new law, and that families had become a greater feature of pub life since the legislation. However, they expressed concerns that older men seemed to have had most difficulty adjusting to the legislation and lack of knowledge about the best practices they should adopt in order to reduce the risks of unattended drinks being spiked and of anti-social behaviour associated with patrons moving outside to smoke.

CONCLUSION: Smoke-free legislation is changing the social context of smoking in Scotland. Further research to assess the impact the legislation is having on older male smokers and on the incidence of drink spiking would be useful. More specifically, bar workers would benefit from guidance on how to manage issues arising from patrons moving outside to smoke.

Source: Hilton S, Cameron J, MacLean A, Petticrew M. Observations from behind the bar: changing patrons' behaviours in response to smoke-free legislation in Scotland. BMC Public Health. 2008 Jul 14;8:238.
Link: http://www.biomedcentral.com/1471-2458/8/238  
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2475535&blobtype=pdf
 

EU tobacco tax harmonisation plans

The European Commission has finalised proposals to increase and harmonise tobacco taxes across the European Union to cut cigarette smuggling and help reduce smoking in general. The Commissioner for Taxation and Customs Union, Laszio Kovacs said the proposals “support the EU policy to cut tobacco consumption and narrow the differences in price levels of tobacco products within the EU”. If adopted, the proposals will also help reduce the illicit trade and cross-border shopping which undermine the health objectives of Member States that impose high taxes to deter smoking. Under the plan, the minimum percentage of excise duty applied to cigarettes would rise from the present 57% to 63% by 2014. The Commission estimates that up to 20% of cigarettes consumed in some countries come from other member states where the price is lower. 

The Commission proposal, which must be approved unanimously by all Member States, also aims to reduce the difference in price between hand-rolled and manufactured cigarettes.

Source: New Europe, 20-26 July 2008
Link: www.neurope.eu