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ASH News and Events Bulletin - 16-30 June 2010

HEADLINES

EVENTS

  • Asia tobacco farmers fight flavoured cigarette ban call

    Asian tobacco growers are meeting in Indonesia for a two-day summit on the challenges facing the industry.

    It comes after a recent recommendation by the World Health Organization (WHO) to ban ingredients such as clove and other flavours in tobacco products.

    Asian tobacco growers say if the WHO ruling is enforced it could threaten millions of tobacco farmers' jobs.

    Indonesia is the world's largest producer of clove cigarettes and is particularly concerned about the move.

    Tobacco growers from India, Korea, Malaysia, the Philippines, Thailand and Indonesia are taking part in the summit in Jakarta.

    It is the first of its kind and members hope that the Asia Tobacco Forum will prove to be an effective lobby group for their goals.

    Their biggest concern is how to deal with the WHO's recent recommendation to ban flavoured tobacco products.

    According to the association of Asian tobacco growers, the ruling could put an estimated 50 million jobs in the region at risk.

    In Indonesia, most of the tobacco companies out-source the growing of the plant to small farmers, who depend on the industry for their livelihoods.

    Abdus Setiawan, head of the Indonesian Tobacco Farmers' Association, said 93% of the cigarettes made in Indonesia are kretek clove cigarettes.

    "This will mean a loss of jobs, this will mean a problem with the government's poverty alleviation programmes, because a lot of these farmers are depending only on those products," he said.

    In September 2009, the United States banned flavoured cigarettes.

    According to local reports, that move has cost tobacco growers here almost $300m (£202m) in losses.

    Indonesia subsequently filed a formal complaint to the World Trade Organization against the US, saying the ban unfairly targeted Indonesian cigarettes.

    Source: BBC News - 21 June 2010
    Link: http://bit.ly/aObZmS

  • Call to ban smoking in cars carrying children

    Adults should be banned from smoking in their own cars when children are passengers, a leading charity said today.

    The British Lung Foundation said a ban on smoking in cars would be a “natural” progression to the ban on smoking in public places, which came into force in Wales in 2007.

    The calls come amid growing concern about the number of children regularly exposed to passive smoking.

    While the BLF’s calls echo those made by the UK Faculty of Public Health earlier this year, they will undoubtedly attract accusations of nanny-stateism by those opposed to such restrictions on their private space.

    Helena Shovelton, chief executive of the BLF said: “We see this as the next step forward from the smoking ban, which was done pretty much with universal acceptance.

    “But if you are a child in a smoky car you can’t fight for yourself.

    “This is a way on concentrating people’s minds about the impact of passive smoking, because the vast majority of people who smoke in front of their children don’t understand what they are doing.”

    The call for a ban comes after a BLF survey on website mumsnet found 88% of mothers were in favour of the move.

    The survey also found that 13% of smoking parents have smoked in the car with the window open when travelling with their children.

    And the same number thought lighting up near their children had no impact on their health, despite evidence showing the opposite.

    Chris Mulholland, head of the BLF in Wales, said: “Smoking just one cigarette, even with the car window open, creates a greater concentration of second-hand smoke than a whole evening’s smoking in a pub or a bar.

    “A ban on smoking in the car with children would prevent some of the 22,000 new cases each year of asthma, caused as a direct result of passive smoking.

    “This overwhelming evidence and public support can no longer be ignored and as the only UK charity supporting everyone affected by lung disease, we are calling for this legislation.”

    Bans on smoking in cars carrying children are already in place in parts of the US, Australia and in Puerto Rico. In Ontario, Canada, drivers face fines of up to $250 for smoking in cars with children under 16.

    Ms Shovelton suggested the threat of three penalty points for motorists caught smoking in their cars while carrying children, could be sufficient to deter the majority.

    Tanya Buchanan, chief executive of Ash Wales, said: “Breathing in second-hand smoke is known to cause a range of health problems and children are especially vulnerable as they breathe faster than adults as their lungs are still developing. Levels of second-hand smoke in cars can be extremely high – as much as 27 times greater than in a smoker’s home.

    “The call from the BLF to ban smoking in cars carrying children echoes what has already been implemented in other parts of the world. It is possible to successfully implement such a ban.

    “In Wales public support for banning smoking in cars carrying children has been consistently high for the last three years, with support growing from 75% in 2007 to 81% in 2010.”

    Dr Tony Jewell, Wales’ chief medical officer, said: “I welcome the BLF’s efforts to raise awareness of the dangers of smoking and secondhand smoke.

    “This complements our work to discourage people from starting to smoke and to provide help and support for smokers to quit.

    “We will be developing a Tobacco Control Strategy and as part of this, a group with expertise in tobacco control will look at the issue of children and young people’s exposure to tobacco smoke in private cars and will advise the Assembly Government on a way forward.”

    Simon Clark of smokers’ rights group Forest, said: “We don’t condone smoking in cars with children but we think introducing legislation to ban it would be a like using a sledgehammer to crack a nut.

    “To introduce legislation that needs to be enforced seems to be a gross over-reaction.”

    A petition calling for a ban can be signed at www.lunguk.org

    Source: Wales Online - 16 June 2010
    Link: http://bit.ly/ajW6hG

  • China: Government tobacco control policies have instant impact on motivating young people to stop smoking

    Government-enacted tobacco control policies significantly increase the number of young people seeking advice to quit smoking according new data presented at the World Congress of Cardiology (WCC) Scientific Sessions in Beijing, China.

    The introduction of smoke-free legislation in Hong Kong in 2007 stimulated a 27.7 per cent increase in the number of calls to a Youth Quitline and a 27.5 per cent increase in the number of people completing counseling. Moreover, the tax rise in 2009 increased the number of telephone calls by 144 per cent and case counseling increased by 111 per cent in the short term.

    "These data demonstrate that government policy decisions do motivate the youth of Hong Kong to seek advice to quit smoking," said Dr David Wong, Biostatistician, School of Nursing, The University of Hong Kong. "The Government and healthcare professionals should capitalize on this key insight to promote smoking cessation to young smokers."

    This study analyzed the number of calls received from young smokers (aged between 12 and 25 and who had smoked at least one cigarette in the past month) 12 weeks before and after the announcement of each tobacco control policy announced by the Hong Kong government. (September 2006 to March 2007 and January 2009 to June 2009).

    Smoking is a leading risk factor for cardiovascular disease and smoking cessation at an early age would largely reduce the risk of coronary heart disease and stroke. It is, however, difficult for young smokers to quit by themselves. Despite the fact that psycho-behavioral counseling can increase the chances of successfully quitting less that 3 per cent of 'youths' have indicated that they would use such a service.  

    Source: MediLexicon - 18 June 2010
    Link: http://bit.ly/bLLvCG

  • Do smokers use more prescription painkillers?

    Smokers may use more prescription opioid painkillers than non-smokers, according to a study from Norway.

    The findings suggest, the researchers say, that doctors should ask patients about their smoking habits before prescribing opioids for pain that is not related to cancer.

    While use of powerful opioid painkillers for non-cancer pain has risen sharply in many parts of the world, the use of these drugs is controversial, largely because of their addictive potential. Certain factors -- for example, a history of alcohol or drug abuse -- can increase a person's likelihood of abusing prescribed opioids.

    There's also evidence that a person's smoking habits could influence their opioid use, Dr. Svetlana Skurtveit of the Norwegian Institute of Public Health in Oslo and her colleagues note in the Annals of Epidemiology.

    To investigate, they looked at nearly 13,000 men and almost 16,000 women 30 to 75 years old who participated in health surveys between 2000 and 2002. None had been prescribed opioids at the time of study enrollment. During follow-up, lasting from 2004 to 2007, 1.5 percent of the study participants received 12 or more opioid prescriptions.

    People who smoked at least 10 cigarettes a day at the study's outset were three times as likely as never-smokers to have been prescribed opiates at least 12 times during follow-up, the researchers found, while people who smoked one to nine cigarettes daily were at nearly double the risk of having multiple opioid prescriptions. The risk for people who used to smoke 10 or more cigarettes a day, but had quit, was roughly doubled.

    It is important to note, the researchers say, that people who receive at least a dozen opioid prescriptions over the course of four years are not necessarily abusing the drugs or addicted to them.

    Nonetheless, the current study suggests that being dependent on nicotine may predict more frequent use of opioids, they say.

    "There is ample evidence from experimental studies that nicotine and opioids modulate each other's effects," Skurtveit and her colleagues add, while smoking can also influence pain perception.

    Based on their findings, they suggest that doctors might want to "screen for smoking habits before starting pain treatment with opioids."

    Source: Reuters - 17 June 2010
    Link: http://bit.ly/a4LO9b

  • FDA acts to prevent Philip Morris from evading new ban on promoting cigarettes as 'light' or 'low-tar'

    The U.S. Food and Drug Administration today took strong, quick action against Philip Morris USA to prevent the tobacco company from evading the new ban on promoting cigarettes as "light," "mild" or "low-tar" that takes effect on June 22. The ban on these deceptive terms is a key provision of the new federal law giving the FDA authority to regulate tobacco products. It seeks to end a decades-long tobacco industry fraud that has falsely promoted some cigarette brands as less harmful and sought to discourage smokers from quitting.

    According to a letter the FDA sent to Philip Morris today, the company has attached "onserts" to its Marlboro Lights packs that state, "Your Marlboro Lights pack is changing. But your cigarette stays the same. In the future, ask for 'Marlboro in the gold pack.'"

    The FDA letter states, "FDA is concerned that the statements included in the onserts attached to the individual packs of Marlboro Lights may perpetuate the mistaken beliefs associated with your "light" cigarettes when marketed as Marlboro in the gold pack. By stating that only the packaging is changing, but the cigarettes will stay the same, the onsert suggests that Marlboro in the gold pack will have the same characteristics as Marlboro Lights, including any mistaken attributes associated with the "light" cigarettes."

    The FDA is correctly demanding that the company turn over all market research it has conducted or possesses on how consumers react to changes in the Marlboro Lights package, including their perceptions about the new gold packs. This will give the FDA the information it needs to take additional enforcement action if Philip Morris does not pull the onserts. Under the law, tobacco companies may not use any marketing that explicitly or implicitly suggests a cigarette brand is less harmful than others.

    In addition to the onserts, Philip Morris and other tobacco companies are using lighter-colored packaging for light brands and switched to terms such as "gold" and "silver" to replace "light" and "ultra-light" to circumvent the ban.

    We applaud the FDA's action as a crucial first step toward keeping the tobacco industry from continuing the "light" and "low-tar" deception. We call on Philip Morris to go beyond the actions called for by the FDA and immediately stop using these onserts. In fact, all tobacco companies and retailers should cease any activity that communicates to consumers that "light" or "low-tar" brands are still available. Any activity that misleads consumers into believing that certain cigarettes are safer and discourages smokers from quitting is harmful to public health.

    The FDA letter to Philip Morris can be found on the FDA site here.
     

    Source: PRNewswire - 17 June 2010
    Link: http://bit.ly/dqz2Zz

  • Illicit cigarette trade funds terrorism and organized crime

    There is clear and convincing evidence that large sums are being siphoned from the multi-billion dollar revenues from the global cigarette smuggling trade into the pockets of terrorist networks and international organized crime.

    A United Nations Security Council investigative body, the Group of Experts, has reported that millions of dollars in illicit tobacco revenues are reaching al-Qaeda, the Taliban and other terrorist organizations, and is financing Congolese rebels for the recruitment of child soldiers, mass rape and murders.

    The World Health Organization's Framework Convention on Tobacco Control has determined that 600 billion counterfeited and smuggled cigarettes cross national borders annually. This represents USD $50 billion in lost proceeds affecting nations throughout the world. The most recent edition of the authoritative Tobacco Atlas, released by the American Cancer Society and World Lung Foundation also concluded: "Cigarettes are the world's most widely smuggled legal consumer product."

    Despite disturbing trends in many other nations, the Ukraine, with a population of 45 million, and with porous borders, has an extremely low rate of 1.7% of its total market in contraband tobacco. The Ukraine utilizes the EDAPS Tax Stamp System to control the illicit sales of products and EDAPS is now offering comparable systems to other nations.

    "Our hologram technology and enforcement methodology with our Track & Trace System, enables government agencies to not only substantially increase their revenues from the sale of excisable products but to dramatically block illegal uses that often fund transnational criminal and terrorist activities," said Alexander Vassiliev, Chairman of EDAPS.

    Since 9-11, the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives has reported that smugglers with ties to terrorist groups were acquiring millions of dollars from illegal cigarette sales and funneling the cash to al-Qaeda and the Taliban. At the same time, the booming black markets are fueling not only terrorist groups but dozens of organized crime gangs, who find the big profits and low risk hard to resist, according to the latest study by the Center for Public Integrity.

    The first large-scale cigarette trafficking case tied to terrorism was prosecuted in North Carolina in 2002. A federal jury in Charlotte convicted Mohamad Hammoud, 28, of violating a ban on providing material support to terrorist groups by funneling profits from a multimillion-dollar cigarette-smuggling operation to them. Prosecutors were able to prove that huge profits from the venture were sent to high-ranking terrorist leaders.

    "This is a major priority for us," Michael Bouchard, assistant director of the ATF told the Washington Post. "The deeper we dig into these cases, the more ties to terrorism we're discovering."

    A Congressional study prepared by the U.S. House Committee on Homeland Security -- "How Cigarette Smuggling is Funding our Enemies Abroad" -- concluded, "Recent law enforcement investigations have directly linked those involved in illicit tobacco trade to infamous terrorist organizations."

    A report by the International Consortium of Investigative Journalists -- "Tobacco Underground" -- charts the paths of smugglers working for the Taliban and others. The report explains how the multibillion-dollar business fuels organized crime, robs governments of tax money and spurs addiction.

    As the Twelfth United Nations Congress on Crime Prevention and Criminal Justice concluded at their meeting in Brazil last month, "Organized crime and terrorism pose greater threats to international peace and security than ever before."

    "We are confident that our EDAPS Tax Stamp System can substantially contribute to global efforts to cut off essential funds from those engaged in a wide range of transnational crime and terrorism," Vassiliev concluded.

    Source: Sys-con - 18 June 2010
    Link: http://bit.ly/bcF19O

  • JTI steps up efforts to block smoke ban extension

    Japan Tobacco International (JTI) has joined forces with the Save Our Pubs & Clubs campaign to highlight the danger of an extension to the smoking ban.

    JTI is supporting the Best Creative Outdoor Area award in the Morning Advertiser’s Great British Pub Awards 2010 to highlight best practice making the most of external areas to accommodate customers, including displaced smokers — and to spotlight the threat of a ban extension.

    Launched last year with the support of TV chef and publican Antony Worrall Thompson and MPs from the three main parties, the Save Our Pubs & Clubs campaign is a coalition of groups and individuals who believe that the public smoking ban introduced in Scotland in 2006 and the rest of the United Kingdom in 2007 is excessive and should be amended to allow separate smoking rooms.

    Campaign director Simon Clark said: “By supporting this award we aim to show our commitment to publicans who go that extra mile to accommodate all their customers, including smokers, throughout the year.

    “Although we want the smoking ban amended to allow separate smoking rooms, we also want to highlight the fact that the ban could be extended to doorways and beer gardens with exclusion zones around many public buildings, including pubs and bars.

    “Supporting the Great British Pub Awards gives us the opportunity to highlight this very real threat that could have serious repercussions for publicans and their customers.”

    Jonathan Yajima, JTI’s Head of Horeca and Vending, said: "Our aim to help licensees improve the profitability of their business and accommodate all their customers, including the 10.5 million smokers in the UK.

    “Therefore we are delighted to support both the Best Creative Outdoor Area award at the Morning Advertiser’s Great British Pub Awards 2010 and the Save Our Pubs & Clubs campaign.”

    The Great British Pub Awards 2010 take place on Thursday September 9 at The Hilton, Park Lane, London.

    Source: Morning Advertiser 17 Juney 2010
    Link: http://bit.ly/9NzSd4

  • New Zealand: Smoking initiatives will save lives, says industry whistleblower

    New Zealand needs to "close the noose'' on a duplicitous and resourceful tobacco industry pedalling an addictive and lethal product, says the man who blew the whistle on the industry nearly 20 years ago.

    Jeffrey Wigand, the former head of research at tobacco company Brown & Williamson, a subsidiary of BAT, and portrayed by Russell Crowe in the movie The Insider, spoke to the Maori Affairs select committee inquiry into tobacco today.

    The committee is investigating ways to make New Zealand smokefree by 2020.

    British American Tobacco NZ, the major tobacco company in this country, told the committee earlier this year it did not know how much it spent on marketing and denied a strategy of targeting Maori and Maori youth.

    But Dr Wigand said he did not believe that was an honest account.

    Tobacco companies added hundreds of additives to cigarettes, and not just sugar as the industry maintained, and the assertion there were no marketing plans was "absolute nonsense", he said.

    Tobacco representative should return to the select committee and testify under oath that they only add sugar and don't have marketing strategies, he said.

    "See if you get the same story.''

    Dr Wigand, an expert in additives to make cigarettes more potent and taste better, addiction process and cigarette design, said his moral compass was challenged while working for the industry for four years and three months.

    Cigarettes were an "elegant form of a drug delivery device'' which only had one purpose; to addict someone and introduce them to between 4000 and 8000 poisons that could not legally be buried, he said.

    The industry exercised a "deliberate and conscious daily distortion of the truth", where information that could save lives was controlled.

    It deliberately targeted groups such as ethnic groups, women and children, he said.

    "I know the Maori population suffers more than any other population, with about a 50 percent smoking rate and the associated morbidity and mortality.''

    In the US and Canada, native Americans, African Americans and Hispanics and the concept of thinness for women were targeted with different packaging and branding - such as Uptowns, Cool, Capri and Virginia Super Slims, he said.

    They were peddling the concept of thinness to target women.

    "Hook 'em young, hook 'em for life'' was the industry's mantra, he said, citing Project 16, a BAT initiative looking at how to get children smoking, focusing on those aged 16 and below - making them feel older, sexier and thinner through smoking.

    He advocated regulation for the full disclosure of the addictive chemicals and additives added to tobacco.

    Nationalising the tobacco industry was not out of the question.

    New Zealand, like Bhutan had done, could control the supply of tobacco through its borders. Most tobacco came here from Australia.

    He admitted people could smoke homegrown tobacco - but it was the additives that made it palatable. Smoking raw tobacco was an unpleasant "retching'' experience, Dr Wigand said.

    He did not believed banning tobacco altogether was realistic but controlling what came into the country was more practical.

    "If you truly want to have New Zealand, by 2020, tobacco free, you have to make this a hostile environment for the tobacco industry and you do that by regulating.''

    Allowing the industry to regulate itself was "like giving the fox the ability to build the chicken coop", he said.

    "They will not voluntarily do anything, anything, whether it is morally right, saves lives at the expense of profit. If you really want to have a tobacco-free society, then you are going to have to do some things that are pretty harsh.

    "When used as intended, it kills.''

    He said the committee's initiative was very important.

    "Your initiatives will save lives, more so your initiative, your actions, they will save lives. If you can reduce in the Maori population, pregnant women that smoke, you will be saving an enormous future.''

    Source: Otago Daily Times - 23 June 2010
    Link: http://bit.ly/bxLNw0

  • Smokeless Tobacco Damages DNA And Key Enzymes - New Evidence

    Far from having adverse effects limited to the mouth, smokeless tobacco affects the normal function of a key family of enzymes found in almost every organ in the body, according to the first report on the topic in ACS' monthly journal Chemical Research in Toxicology. The enzymes play important roles in production of hormones, including the sex hormones estrogen and testosterone; production of cholesterol and vitamin D; and help the body breakdown prescription drugs and potentially toxic substances. Smokeless tobacco also damages genetic material in the liver, kidney and lungs.

    Krishan Khanduja and colleagues note widespread recognition of smokeless tobacco's harmful effects on the mouth, which include an increased risk of gum disease and oral cancer. The potential carcinogens and other chemicals in chewing tobacco and other smokeless products are absorbed into the blood and travel throughout the body. However, scientists have little information on smokeless tobacco's effects on other parts of the body. To fill that knowledge gap, the scientists evaluated changes in enzymes and genetic material in laboratory rats using extracts of smokeless tobacco.

    In addition to damage to the genetic material DNA, they found that smokeless tobacco extracts alter the function of the so-called CYP-450 family of enzymes. "These products are used around the world but are most common in Northern Africa, Southeast Asia, and the Mediterranean region," the report says. "Most of the users seem to be unaware of the harmful health effects and, therefore, use smokeless tobacco to 'treat' toothaches, headaches, and stomachaches. This false impression only promotes tobacco use among youth. The use of smokeless tobacco and its new products is increasing not only among men but also among children, teenagers, women, and immigrants of South Asian origin and medical and dental students."

    Article: "Involvement of Various Molecular Events in Cellular Injury Induced by Smokeless Tobacco"  

    Source: MediLexicon - 17 June 2010
    Link: http://bit.ly/aRo95H

  • Smoking and consumption of fruit and vegetables

    Abstract

    Objectives: As smoking and unhealthy diet are more prevalent in lower socioeconomic groups, this study aims at exploring whether associations between smoking and fruit and vegetable consumption are confounded by socioeconomic conditions or if smoking is independently associated with consumption.

    Methods: Cross-sectional analyses of 4,814 middle-aged participants from the Heinz Nixdorf recall study, a population-based cohort study in Germany. Fruit and vegetable consumption was assessed by a food frequency questionnaire. Education and income were used as indicators for socioeconomic groups. Logistic regression models were run to estimate odds ratios for consumption by smoking status.

    Results: Smoking is associated with poor consumption of fruits and raw vegetables/salad in both genders, and with poor consumption of boiled vegetables and fruit/vegetable juice in men. Importantly, poor consumption is related to smoking independently of people's socioeconomic conditions.

    Conclusion: The findings imply that smokers in all socioeconomic groups are at higher risk for unhealthy intake of fruits and vegetables. Public health interventions targeted to smokers should include dietary instructions.

    Muff, C. et al., Is the co-occurrence of smoking and poor consumption of fruits and vegetables confounded by socioeconomic conditions?, International Journal of Public Health, 2010, 10.1007/s00038-010-0152-5

    Source: SpringerLink - 04 June 2010
    Link: http://bit.ly/d9Ffeu

  • Smoking motives in movies are important for understanding adolescent smoking: A preliminary investigation

    Abstract

    Introduction: Exposure to smoking in movies is strongly associated with smoking uptake and maintenance among adolescents. However, little is known about what features of movies (e.g., the context for smoking or motives for a character smoking) moderate the association between exposure to movie smoking and adolescent smoking. This laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive is associated with the desire to smoke differently than smoking that is portrayed as having no clear motive.

    Methods: A sample of 77 middle school students (mean age of 12.8 years, 62% male, 60% Caucasian) viewed movie clips that portrayed smoking as helping to facilitate social interaction, to relax, to appear rebellious, or as having no clear motive. After exposure to each clip, participants rated their desire to smoke.

    Results: Exposure to clips where smoking was portrayed as helping characters to relax was associated with a significantly stronger desire to smoke compared with clips where the motive for smoking was unclear. Desire to smoke was similar for clips where no motive was clear, social smoking clips, and rebellious smoking clips.

    Discussion: These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking.

    Shadel, WG. et al., Smoking motives in movies are important for understanding adolescent smoking: A preliminary investigation, Nicotine & Tobacco Research Advance Access published online on June 24, 2010

    Source: Oxford Journals - 24 June 2010
    Link: http://bit.ly/bTOZ6r

  • The smoking gun: working to eliminate tobacco smoke exposure

    Background

    The 1972 US Surgeon General’s Report on smoking reported the first systematic examination of the impact of smoking on indoor environments. The report noted the lack of exposure data, concluding that the contribution to human disease of tobacco smoke components (e.g., particulate matter (PM) and oxides of nitrogen) was not well known.

    By the early 1980s, evidence of the health consequences of secondhand smoke (SHS) exposure was mounting. The literature suffered, however, from limited data characterizing the extent of SHS exposure. The recent report of the Surgeon General on the health consequences of involuntary smoking relied heavily on the growing body of literature describing exposure to PM, nicotine, nitrosamines, and other tobacco compounds associated with SHS exposure.

    SHS exposure is most commonly assessed by measuring PM and nicotine in the air. Measuring PM for this purpose began in the early 1980s, and determining vapor-phase nicotine concentrations dates back to landmark studies in the late 1980s. Biomonitoring offers important insights into internal dose by integrating multiple exposure sources and can thus provide information about exposure in different environments (e.g., home, work, and transportation). Cotinine—the principal metabolite of nicotine—in biological samples (e.g., serum) is the biomarker that is used most often to assess short-term and ongoing SHS exposure.

    Impact and implications for exposure science

    Measurements of airborne nicotine and PM in public places have contributed to the development and implementation of smoke-free legislation around the world by documenting the magnitude and extent of SHS exposure. While SHS concentrations range widely across locations and countries, elevated concentrations are consistently found in restaurants, bars, and casinos, raising major concerns about the health of the patrons and the employees in those environments. For example, SHS assessments have provided key evidence indicating that separate nonsmoking sections in public places are insufficient to protect nonsmokers from SHS exposure, and that such exposure is a significant occupational health problem for nonsmokers in workplaces that allow smoking. Overall, these and other studies have clearly documented that comprehensive smoke-free legislation is urgently needed to protect all people, including workers in the hospitality industry.

    The World Health Organization Framework Convention on Tobacco Control (FCTC), developed in response to the globalization of the tobacco epidemic, entered into force in 2005. Article 8 requires signatories to adopt legislative measures to protect the population from exposure to tobacco smoke in all indoor public places and workplaces. According to Article 8, protection from tobacco smoke is grounded in fundamental human rights and freedoms.

    In response to the FCTC, many countries and subnational entities are enacting comprehensive smoke-free laws that ban smoking in indoor public places. For example, in the United States and Canada, many states and provinces have passed comprehensive smoke-free legislation. Despite these successes, the World Health Organization estimated in 2009 that only 5% of the world’s population was covered by comprehensive smoke-free laws. In the United States, it was estimated that 41% of the population was covered by comprehensive laws as of April 2010.

    The FCTC also indicated that smoke-free legislation should be monitored and evaluated for compliance. Although questionnaires and observation are useful tools for evaluating the implementation of smoke-free laws, airborne nicotine, PM, and other tobacco markers have the advantage of allowing precise, objective measures of SHS exposure at a reasonable cost.

    Exposure measurement and biomonitoring have played a critical role in implementation and compliance with tobacco control efforts. First, they provide baseline measures in critical locations, including both public and private places, as well as overall levels of SHS exposure in the nonsmoking population. Detecting SHS is a powerful argument in support of comprehensive smoke-free initiatives because it has been firmly established that there are no safe levels of SHS exposure. Second, they provide unquestionable evidence that some approaches to eliminating SHS exposure, such as mechanic ventilation systems and separated areas for smokers and nonsmokers, are ineffective. Third, they allow for comparisons between places where smoking is allowed and those that are comprehensively smoke-free. Similarly, biomonitoring allows for comparison of SHS exposure for individuals working or living in places where smoking is allowed with that for similar individuals working or living in comprehensively smoke-free places. Studies have shown dramatically higher SHS exposures in locations where smoking is allowed as well as in individuals spending time in those environments.

    The fourth role of exposure measurement and biomonitoring is for dissemination and advocacy campaigns to audiences such as the media, policy makers, medical and public health providers, and the public at large. In most countries where SHS exposure assessments have been conducted, this information has been presented to legislative bodies debating tobacco control legislation. Local evidence of tobacco smoke exposure provides a powerful tool for policy development. Finally, SHS exposure data are critical to evaluate the implementation of tobacco control programs. For instance, in the United States, serum cotinine levels declined 70% from the late 1980s to the early 2000s, providing evidence of the impact of tobacco control measures implemented during the 1990s. These evaluations also identify opportunities for improvement. For example, serum cotinine data clearly showed that additional tobacco control efforts are needed among young children and black populations in the United States.

    Assessment of SHS exposure has afforded a key evidence base needed to establish the associated risks, to drive policy efforts worldwide aimed at banning smoking in public places, and to assess compliance with smoking bans.

    Source: Nature - June 2010
    Link: http://bit.ly/cNHNan

  • USA: FDA demands Philip Morris marketing documents

    U.S. regulators demanded on Thursday that cigarette maker Philip Morris turn over all market research material on Marlboro Lights, citing concern over an advertisement for the brand.

    In a letter to Philip Morris parent company Altria Group, Inc (MO.N), the U.S. Food and Drug Administration said it was concerned about advertisements, or "onserts," attached to packs of Marlboro Lights.

    A U.S. ban on promoting cigarettes as "light," "mild" or "low" takes effect on Tuesday. The ban is a key provision of a new federal law that gives the FDA authority to regulate tobacco products.

    "By stating that only the packaging is changing, but the cigarettes will stay the same, the onsert suggests that Marlboro in the gold pack will have the same characteristics as Marlboro Lights, including any mistaken attributes associated with the 'light' cigarettes," the FDA letter read.

    Altria must submit by July 30 all materials related to the marketing or sale of Marlboro Lights, including themes, creative recommendations and dissemination strategies, the FDA said.

    Altria spokesman Bill Phelps said, "We received the letter today and we're reviewing it and we will respond."

    The anti-smoking group Campaign for Tobacco-Free Kids said the FDA action would prevent Philip Morris from evading the ban.

    "This will give the FDA the information it needs to take additional enforcement action if Philip Morris does not pull the onserts," the group said in a statement.

    Source: Reuters - 17 June 2010
    Link: http://bit.ly/9taCkd

  • USA: Puffing in public housing poses serious health risks to tenants

    In an effort to protect children from harmful tobacco smoke exposure, health and medical professionals are pushing for a ban on smoking in public housing in a report appearing in this week's New England Journal of Medicine.

    "Research shows that those living in multiple-unit housing are being exposed to toxins from tobacco smoke," says Jonathan Winickoff, MD, MPH, lead author and pediatrician at MassGeneral Hospital for Children (MGHfC). "Even if you are not a smoker and don't smoke inside of your own apartment, if you have a neighbor who is smoking inside of his, the entire building is contaminated."

    Over 7 million people are served by public housing in the U.S., with 4 in 10 units occupied by families with children. On July 17, 2009, the U.S. Department of Housing and Urban Development (HUD) issued a memorandum that strongly encouraged local Public Housing Authorities (PHAs) to implement no-smoking policies in some or all of their public housing units. While surveys indicate that 4 in 5 nonsmokers prefer smoke-free building policies, and many private landlords throughout the country have made their housing units smoke-free, only about 4% of PHAs have banned smoking in the units they manage. The article gives specific guidance on policy options for PHAs and HUD to protect all residents from tobacco smoke exposure and clarifies that there are no legal barriers to banning smoking in public housing. "HUD has taken an important step," says coauthor Michelle Mello , J.D., Ph.D. of the Harvard School of Public Health, "but it could do more to prod lagging PHAs to take action."

    The National Toxicology Program has identified more than 250 poisonous gases, chemicals, and metals in tobacco smoke, 11 of which are class A carcinogens. Numerous epidemiologic studies show that exposure to tobacco smoke can cause lung cancer and cardiac disease in nonsmokers, and the Surgeon General's report on involuntary smoking concluded that there is no safe level of exposure. Even brief exposures to tobacco smoke can adversely affect nonsmokers, especially children, who experience increased rates and severity of asthma and other respiratory illnesses, as well as higher risk of sudden infant death syndrome.

    Smoking in a single unit within a multiunit residential building puts other residents of the building at risk. Tobacco smoke can move along air ducts, through cracks in the walls and floors, through elevator shafts, and along plumbing and electrical lines to affect units on other floors. Mitigation measures like fans and air filters are not effective in preventing exposure. High levels of tobacco toxins can persist in the indoor environment long after the period of active smoking - a phenomenon known as third-hand smoke. Tobacco toxins from smoke are deposited on indoor surfaces and reemitted in the air over a period of days to years, and are found on rugs, furniture, clothing, and floors - all surfaces that children crawl and play on.

    While it is clear that second and third hand smoke are inimical to the health of nonsmokers in multiple housing units, there are challenges facing public housing authorities, landlords and nonsmokers. Any addiction is difficult to overcome and a ban would put pressure on tenants addicted to nicotine, and could raise concern over how to deal with tenants who continued to smoke inside their building.

    "Any no-smoking policies within PHAs would need to be accompanied by clear instructions on how residents can access evidence-based smoking-cessation resources," says coauthor Mark Gottlieb, J.D., Executive Director of the Public Health Advocacy Institute at Northeastern University School of Law. Currently most state Medicaid programs do not cover comprehensive tobacco-dependence treatments, a situation that may change with an increased emphasis on tobacco control in healthcare reform. However, right now, free smoking cessation services are available in all 50 states though the quitline.

    "Rather than prohibiting smokers from inhabiting public housing units, prohibiting the act of smoking on the premises would minimize the ethical concerns relating to a smoking ban," says Mello. "This type of policy would encourage smokers to quit, since only those who continued to smoke on the premises would be required to move out."

    Creating and maintaining smoke-free living space that encourages smoking cessation not only provides a healthy environment for children as they grow, it discourages them from picking up the habit. "When children see smoking in and around their homes, it normalizes the behavior for them," says Mello. "Research shows that no-smoking policies in the home lead to lower smoking initiation rates by teens." Americans living below the poverty level are 1.6 times more likely to smoke; adopting a smoke-free policy in public housing units encourages inhabitants to "fight back" against the intense tobacco marketing that exists in low-income neighborhoods.

    "As we move forward and further explore public housing policy, it is important to remember that the status quo is not acceptable for America's children," says Winickoff. "Each child deserves a healthy start, and we can help provide this by encouraging smoke-free home environments."  

    Source: MediLexicon - 17 June 2010
    Link: http://bit.ly/d2gpUe

  • Validation of The Health Improvement Network (THIN) primary care database for monitoring prescriptions for smoking cessation medications

    Abstract

    Purpose: Evaluation of tobacco policy requires high quality and timely data on smoking cessation behaviour in the general population and in relevant target groups. Electronic primary care databases have the potential to provide a valuable source of data due to their size and continuity, and the availability of demographic and socioeconomic data. We therefore sought to investigate whether The Health Improvement Network (THIN) prescribing data are complete and can therefore be used to monitor trends in the prescribing of smoking cessation medications.

    Methods: The THIN smoking cessation medication prescriptions data for England were compared with smoking cessation medication dispensing data from NHS Prescription Services for January 2004 to December 2005.

    Results: Throughout the period the rates of prescribing and dispensing were very similar, both for nicotine replacement therapy (NRT) and bupropion combined, and for each type of medication alone. For NRT, dispensing exceeded recorded GP prescribing by 5.5% during the study period. For bupropion, prescribing exceeded dispensing by 5%.

    Conclusions: THIN prescribing and national dispensing data are highly comparable. THIN prescribing data could potentially be used to monitor longitudinal trends in prescribing for smoking cessation medications.

    Langley TE, et al., Validation of The Health Improvement Network (THIN) primary care database for monitoring prescriptions for smoking cessation medications, Pharmacoepidemiol Drug Safety. 2010 May 4;19(6):586-590. [Epub ahead of print]

    Source: Interscience - 4 May 2010
    Link: http://bit.ly/cN9hOp

Events

  • National CVD Prevention meeting

    Putting Prevention First – The Professional Challenges

    The conference will discuss the challenges professional face in delivering CVD prevention through NHS Primary Care Trusts and Cardiac and Stroke Networks.

    Professor Roger Boyle and Elizabeth Lynam from the Department of Health will provide an update on the national agenda, new results from the National Audit of Cardiac Rehabilitation, and the development of a new NHS Commissioning Pack for Cardiac Rehabilitation.

    In primary prevention the principles of CVD risk assessment will be discussed, and there will be a guest lecture by Professor Guy de Backer on new risk markers for clinical practice.

    Date: 01 July 2010
    Venue: Imperial College London
    Contact: www.imperial.ac.uk/cpd/puttingpreventionfirst

  • 4th Latin American Conference on Lung Cancer (LALCA 2010)

    The event will be a time for lung cancer professional from Latin America and around the world to share the most up-to-date information regarding the science and advances in the treatment of lung cancer. International and national speakers will participate in the Scientific Program and their presentations will provide a platform to discuss the latest developments in basic science and clinical treatment.
     

    Date: 28 July 2010
    Contact: www.lalca2010.org

  • Personalisation and peer support – the mental health education and training agenda

    This conference – the 10th annual event of its kind – will explore the mental health education and training agenda for both personalisation and peer support. This will be done through:

    • Presentations on the key themes of personalisation and peer support

    • Workshops concentrating on examples of education and training initiatives in relation to personalisation and peer support.

    Date: 08 September 2010
    Venue: ORT House Conference Centre, London NW1
    Contact: www.pavpub.com/pavpub/conferences/showfull.asp?Conference=%20190

  • Health in Europe - Ready for the Future?

    Leading experts from business and industry, science and academia, patient organisations/NGOs as well as numerous prominent decision makers in health policy present new ideas and use the EHFG as a platform for the exchange of experiences and opinions at the international level.

    Date: 06 October 2010
    Venue: Gastein, Austria
    Contact: www.ehfg.org

  • Smoke Free Futures: Tobacco Control Conference 2010

    Smoke Free Futures is a two day tobacco control conference that asks what are the next steps we need to be taking to secure tobacco free futures for our children and how do we help the 70% of smokers who say they wish to quit more effectively in the here and now.

    Confirmed workshops and presentations at the Conference include:

    • No Smoking Day – Be the first to find out about NSD 2011
    • Young Tobacco Control Campaigners Tell their Stories
    • Understanding the Framework Convention on Tobacco Control (FCTC) and the Framework Convention Alliance
    • Evaluation of the Ireland Point of Sale Legislation
    • Development of a Tobacco Control Strategy for Wales

    Conference participants will have the opportunity to learn from the successes and challenges faced by successful tobacco control practitioners at this highly interactive conference.

    Date: 11 October 2010
    Venue: Mercure Holland House Hotel Cardiff, Wales
    Contact: www.smoking-conference-wales.org.uk

  • SCTRP Annual Update and Supervision Day

    The annual opportunity for SCTRP graduates to troubleshoot existing practice, update on research, and interact with over 100 practitioners.

    Tutors: P Hajek, R West, G Sutherland, H McRobbie and members of their teams.

    Cost: £235 (£200 plus VAT) Early Bird rate prior to course

    Availability: 100+

    Date: 03 December 2010
    Venue: Park Crescent Conference Centre, 229 Great Portland Street, London W1
    Contact: Janice Rossabi on +44 0208 347 0556 or sctrp@yahoo.co.uk