PQ: Consultation on tobacco control

John Baron (Whip, Whips; Billericay, Conservative): To ask the Secretary of State for Health when he will respond to the consultation on proposals for the next steps in (a) tobacco control and (b) the further regulation of tobacco products.

Dawn Primarolo (Minister of State (Public Health), Department of Health; Bristol South, Labour): The Department has received nearly 100,000 responses to the "Consultation on the future of tobacco control". A summary of consultation responses will be made available on the Department's website before the end of 2008. The Government have committed to developing a new national tobacco control strategy to build on the achievements made since the publication of the "Smoking Kills" White Paper in 1998. The "Consultation on the future of tobacco control" is the first stage in developing this new strategy. A publication date for the new strategy will be announced in due course.

Source: Hansard Source 09/10/08 – Column 771W
 

Study supports smoking cessation programme after heart attack

BACKGROUND: Smoking cessation after myocardial infarction (MI) is an important goal for secondary prevention of mortality. Whether new initiatives to promote cessation improve patients' quit rates after MI is unknown. 

METHODS: The Prospective Registry Evaluating Outcomes After Myocardial Infarction Events and Recovery (PREMIER) enrolled 2498 patients with MI from 19 US centers between January 2003 and June 2004. Smoking behavior was assessed by self-report during hospitalization and 6 months after an MI. Extensive sociodemographic, comorbidity, psychosocial, disease severity, and treatment data were collected by interview and medical record abstraction. Hierarchical multivariable logistic regression models with random site effects were constructed to predict smoking cessation 6 months after admission, with a focus on the presence of an inpatient smoking cessation program as a hospital-level covariate.

RESULTS: Among 834 patients who smoked at the time of MI hospitalization, 639 were interviewed and reported their smoking habits 6 months post-MI (77%). Of these, 297 were not smoking at 6 months (46%). The odds of smoking cessation were greater among those receiving discharge recommendations for cardiac rehabilitation (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.17-2.75) and being treated at a facility that offered an inpatient smoking cessation program (OR, 1.71; 95% CI, 1.03-2.83). However, medical chart–based individual smoking cessation counseling did not predict smoking cessation rates (OR, 0.80; 95% CI, 0.51-1.25). Patients with depressive symptoms during the MI hospitalization were less likely to quit smoking (OR, 0.57; 95% CI, 0.36-0.90).

CONCLUSIONS: While individual smoking cessation counseling was not associated with smoking cessation post-MI, hospital-based smoking cessation programs, as well as referral to cardiac rehabilitation, were strongly associated with increased smoking cessation rates. Such programs appear to be underutilized in current clinical practice and may be a valuable structural measure of health care quality. Moreover, smoking cessation programs should likely incorporate screening for and treating depressive disorders.

Author Affiliations: Department of Medicine, Divisions of General Medicine (Drs Dawood, Hamid, and Parashar) and Cardiology (Dr Vaccarino), Emory University School of Medicine, Atlanta, Georgia; and Mid America Heart Institute, Kansas City, Missouri (Ms Reid and Dr Spertus).

Source: Predictors of Smoking Cessation After a Myocardial Infarction, Nazeera Dawood, MD, MPH; Viola Vaccarino, MD, PhD; Kimberly J. Reid, MS; John A. Spertus, MD, MPH; Nesruddin Hamid, MD; Susmita Parashar, MD, MPH, MS; for the PREMIER Registry Investigators
Link: http://archinte.ama-assn.org/cgi/content/short/168/18/1961

Japan Tobacco starts petition against cigarette tax increase

Japan Tobacco Inc., the world's third largest publicly traded cigarette maker, will enlist customers in a campaign to stop the government from raising cigarette taxes. 

Consumers opposed to the proposal to increase retail cigarette prices by as much as threefold should fill in a petition at tobacco retailers, by mobile phone or on the Internet, the Tokyo based company, which is 50 percent owned by the government, said.

The campaign comes as the maker of Camel and Mild Seven cigarettes battles higher tobacco prices, a falling smoking rate and controls on vending-machine purchases that account for more than half its $31.4 billion in domestic tobacco sales. Lawmakers in June proposed raising taxes on cigarettes, which sell for less than a third of the U.K. price, to fund rising welfare costs.

Higher taxes could quicken a decline in cigarette sales in Japan, where the percentage of men who smoke has fallen by half over the past 40 years to about 40 percent because of an increase in health consciousness. Japan Tobacco's operating income from cigarette sales in the country slid 9.4 percent to 222 billion yen ($2.1 billion) in the 12 months through March.

Japan Tobacco said it will submit its petition to the government after the campaign, which the company plans to end in December, in time for the Japanese government's internal discussions on proposed taxes.

Source: Bloomberg, 01 October 2008
Link: http://tinyurl.com/3kcz5v

Smoking Costing NHS £2.7 billion a Year

New Report Calls for Action to Protect Young People and Curb Tobacco Marketing

The annual cost of smoking to the NHS in England has soared from £1.7 billion a year in 1998 to £2.7 billion this year. The figures are included in a major new report, ‘Beyond Smoking Kills' published by Action on Smoking and Health (ASH), in collaboration with the British Heart Foundation, Cancer Research UK and endorsed by over 100 health and welfare organisations. The cost of smoking to the NHS would have risen even more – to more than £3 billion a year - if Government action, health education and changing social attitudes had not led over the last decade to a fall in the total number of smokers from nearly 12 million to just over 9 million.

The report also finds that tobacco manufacturers are misleading smokers and young people about the safety of cigarettes and calls for radical new legal steps to protect young people from inheriting the smoking habit and to curb tobacco marketing. The Government is now considering what action to take in a new Health Bill, to be included in the Queen’s Speech in December.

“Beyond Smoking Kills” calls on the Government to introduce a comprehensive tobacco control strategy which could help a further 4.5 million smokers to quit by 2015 by:
• Requiring plain packaging for all tobacco products
• Prohibiting the display of tobacco products in shops
• Clamping down on smuggling
• Giving smokers access to safer non-tobacco alternatives to smoking

New research from the University of Nottingham, also published in the report, shows that tobacco branding and packaging sends misleading ‘smoke signals’ to young people. Although it has been illegal for manufacturers to use trademarks, text or any sign to suggest that one tobacco product is less harmful than another since 2003, this research shows that products bearing the word ‘smooth’ or using lighter coloured branding mislead young people into thinking that these products are less harmful to their health.

The research also reveals that young people are between 3 and 4 times less likely to pick a plain pack as a branded one if they were trying smoking for the first time, supporting calls for plain packaging and countering industry claims that plain packs would be more attractive to young people.

One in seven fifteen year olds regularly smokes and two thirds (66%) of regular smokers start before they are 18. Strategies to reduce the attractiveness of smoking and reduce accessibility of cigarettes would have a dramatic influence on take up rates of smoking among young people.

Tackling the stark health inequalities caused by smoking and smoking related disease is also a focus of Beyond Smoking Kills. Smoking rates in the wealthiest parts of England can be as low as 12% and in the most deprived wards as high as 52%. Tackling tobacco smuggling is particularly important as the report reveals that less well off smokers are much more likely to buy cheap illicit tobacco.

The report recognises the great progress made with tobacco control in the ten years since the Government published its last tobacco strategy “Smoking Kills” in 1998. However, it concludes that much more needs to be done to protect children and reduce inequalities caused by England’s largest cause of preventable death.

Chair of the Editorial Board Peter Kellner said:

“There is a terrible gap in life expectancy between the richest and poorest in British society. Smoking is by far the biggest single factor, accounting for half the difference. A child born today who never smokes will live, on average, ten years longer than a child who takes up smoking. The younger a smoker starts, the harder it is for them to quit.

Our report sets out a comprehensive strategy for Government action to protect children from exposure to smoke and smoking, to support smokers to quit and to help smokers who are not yet ready to quit to reduce the harm they cause themselves. Smoking remains the greatest public health problem in our society – but we now have a great opportunity to stop the next generation from inheriting this lethal habit.”

Source: ASH Press Release, 07 October 2008
Link:  http://www.ash.org.uk/ash_eyhkq96u.htm

Cost-effectiveness of smoking cessation to prevent age-related macular degeneration

Abstract

BACKGROUND: Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk.

METHODS: We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving
1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year.

RESULTS: If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective.

CONCLUSIONS: Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.

Source: Cost-effectiveness of smoking cessation to prevent age-related macular degeneration, Susan F. Hurley , Jane P. Matthews and Robyn H. Guymer
Link: http://www.resource-allocation.com/content/6/1/18

Electronic cigarettes spark health row

Health campaigners have called for detailed research to be carried out into the health implications of electronic cigarettes, whose popularity has been boosted by the introduction of the smoking ban last year. 

The artificial cigarettes, which use cartridges to deliver a nicotine hit which is inhaled in a mist, can be smoked indoors. Some retailers are selling almost 2,000 of the £40 kits every month.

But health groups say that electronic cigarettes have yet to undergo the rigorous testing to which other nicotine products are subjected. Deborah Arnott, director of Action on Smoking and Health (ASH), said: "At the moment we don't know enough about this product. The electronic cigarettes fall into a regulatory gap and they haven't been clinically tested."

The World Health Organisation (WHO) also expressed concern about the products. "If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework," said Douglas Bettcher, director of WHO's Tobacco Free Initiative.

Jason Cropper, managing director of the Electronic Cigarette Company, said: "It's a healthier way of smoking. You don't get any of the stuff that's in regular tobacco."

"It's better if people aren't using nicotine in any form, but they're an alternative to using a tobacco-based product and my opinion is they're massively less harmful. I bet my life they're a hundred times healthier than using a tobacco-based cigarette."

Cropper said that testing had been done on his electronic cigarettes, adding: "Apart from the nicotine, the samples tested appear to be free from other harmful toxins." He added: "I believe this product is a lifesaver. Ultimately it will become the nicotine replacement therapy of choice."

Source: The Guardian, 09 October 2008
Link: http://tinyurl.com/3t643o

PQ: Tobacco and young people

David Ruffley (Shadow Minister, Home Affairs; Bury St Edmunds, Conservative): To ask the Secretary of State for the Home Department how many (a) confectioners and tobacconists and (b) other retailers have been found to be selling tobacco products to those under the age of 16 years in each year since 1997; how many offences of selling tobacco products to those under the age of 16 years have been recorded in each such year; how many (i) fines and (ii) cautions were issued in respect of such offences in each year; and what the average fine imposed was in each year.

Vernon Coaker (Parliamentary Under-Secretary, Home Office; Gedling, Labour): Information on the number of recorded offences of retailers selling tobacco products to those aged under 16 years is not collected centrally. This is a summary offence and is not included in the police recorded crime statistics. Statistics on the number of police cautions issued, the number of fines imposed and the average fines have been provided by the Ministry of Justice and are given in the table for 1997-2006. No information is collected centrally to distinguish between confectioners, tobacconists and other retailers.

Source: Hansard Source 06/10/2008 - Column 151W

R.J. Reynolds test marketing dissolvable tobacco products

US Tobacco Company R.J. Reynolds Tobacco is to expand the US smokeless category next year by distributing Camel Snus and introducing in test markets dissolvable alternatives to cigarettes called Camel Sticks, Camel Orbs and Camel Strips. 

The new products, grouped under the Camel Dissolvables banner, are smokeless and spit-free; they are made from finely milled tobacco and held together with food grade binders. The products will launch in the first quarter in Columbus, Ohio, Portland, Oregon, and Indianapolis. The Camel Dissolvables Sticks can be placed in the mouth like a toothpick or broken into a piece that is placed between the upper lip and gum, where it dissolves after 10 minutes. RJR recommends the same usage for Orbs, which is a pellet that lasts about 15 minutes, and Strips, which dissolve after about 3 minutes.

The three forms of smokeless tobacco will be packed in plastic, child-resistant packaging. Strips will come in Fresh mint flavor and Sticks in Mellow; Orbs will be available in both flavors. Camel Dissolvables deliver between 0.6 to 3.1 milligrams of nicotine, while cigarette smokers typically inhale about 1 mg per cigarette.

The smokeless category has been a magnet for cigarette makers with sales averaging 5% to 7% annually. Although there is a growing body of literature contending that smokeless tobacco is less harmful than smoking cigarettes, a 2007 study by the American Cancer Society found that male smokers who switched to smokeless had higher death rates than men who quit or never smoked. Camel Dissolvables will not be positioned as a smoking cessation or reduced risk product, according to the company.

"The consumer should be aware of the information available about the potential risks of each tobacco product. There are none that are safe and there are none that are without risks," said RJR rep David Howard.

In addition to introducing the new dissolvable alternatives, RJR will expand distribution for Camel Snus (pronounced snooze) by offering retailers countertop and under the counter refrigerator units to keep the product cold.

In 2006, Reynolds American acquired Conwood, the second largest maker of smokeless products in the U.S. Philip Morris USA's smokeless products include Marlboro Snus and Marlboro Snuff. Altria, Philip Morris' parent company, expects to close by January on its purchase of UST, the holding company for U.S. Smokeless Tobacco, the largest smokeless product company and maker of Skoal and Copenhagen.

Source: Mike Beirne, Brandweek, 09 October 2008
Link: http://www.brandweek.com/bw/content_display/news-and-features/packaged-goods/e3i3a362ca17e5cae63154356af5abae6d1

PQ: Tobacco smuggling

Frank Field (Birkenhead, Labour): To ask the Secretary of State for the Home Department what steps her Department is taking to constrain illicit trade in tobacco; and what plans she has to review these measures.

Stephen Timms (Financial Secretary, HM Treasury; East Ham, Labour): Since the publication of the tackling tobacco smuggling strategy in 2000, over 15 billion illicit cigarettes and over 1,000 tonnes of hand rolling tobacco (HRT) have been seized. Many organised criminal gangs have been broken up and thousands of individuals have been successfully prosecuted. As a result of the success of the strategy, the size of the illicit market for cigarettes was reduced over the five years to 2005-06 from 21 per cent. to 13 per cent. In the 2008 Budget, the Government announced that the new UK Border Agency, which has assumed responsibility for Customs detection work at the border, would be developing a strategy for enhancing detection of tobacco products.

Source: Hansard Source 09/10/2008 – Colum 578W
 

Smoking prevalence in a north-west town following the introduction of smoke-free England

Abstract 

BACKGROUND: In July 2007, legislation banning smoking in public places was introduced in England. This study investigates the impact of this legislation on smoking in Bury.

METHODS: A postal survey was undertaken before the implementation of the legislation. The survey was repeated 3 months after the smoking ban. Smoking prevalence was then compared. Participants were randomly selected using the PCT database of people registered with general practitioners. In the baseline and second survey, 3500 questionnaires were sent to participants. In the baseline survey 59.5% responded. In the second survey 56.3% responded.

RESULTS: Results were standardized to age and gender bands from Bury's population. The baseline survey found that the standardized prevalence of smoking before the ban was 22.4% and after it was 22.6%. The proportion of smokers reporting that on average they smoked 20 cigarettes a day or greater fell from 27.6 to 21.8% (P = 0.044).

CONCLUSIONS: The study found that in Bury the smoking ban did not have a substantial impact on smoking prevalence but had an impact on the proportion of heavy smokers. The measurement of smoking prevalence before the change in legislation can be used to assess its long-term impact on smoking habits in Bury.

Source: J Public Health (Oxf). 2008 Sep 23. [Epub ahead of print], Elton PJ, Campbell P.
Link: http://jpubhealth.oxfordjournals.org/cgi/content/abstract/fdn077v1