CONTENTS:

Tobacco News

Fall in heart attack cases in Wales
CMO Annual Report: Teenage Health; Oesophageal cancer

Parliamentary News

PQ: Tobacco production in the EU
PQ: Cigarette litter

Industry Watch

Gallaher found guilty of price fixing
Japan Tobacco – rise in net profits

Recent Research

Smokefree laws and reductions in heart disease
Smokefree laws do not adversely affect hospitality trade
Alternative forms of tobacco use
Smokeless tobacco use by south Asian youth in the UK

Events and Publications

See List of Events at the end of this bulletin

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Tobacco News

Fall in heart attack cases in Wales

The number of patients suffering a heart attack in Wales has fallen dramatically following the ban on smoking. New figures appear to support claims that the smoking ban would improve the health of the nation.

Across the country as a whole there was a 12.5% fall in the number of patients admitted to hospital with a heart attack between October and December last year, compared to the same period in 2006, before the ban on smoking in enclosed public spaces was introduced in Wales. But some NHS trusts have seen the number of heart attacks fall by up to 40% in the same period.

The Welsh figures follow claims that hospital admissions for heart attacks in Scotland and Ireland fell by 17% and 14% respectively, in the year after bans were introduced in 2006 and 2004 respectively.

Dr Tony Jewell, Wales’ Chief Medical Officer, said: “There is no disputing the devastating effects of smoking on the individual or their family and friends and we welcome these reductions.

“Given the high level of compliance to the legislation in Wales, we are now starting to see similar health benefits such as reduced hospital admissions for heart attacks that has already been seen in Scotland, which introduced its smoke-free legislation a little over two years ago.”

The Welsh figures reveal that between October and December 2007 the number of patients admitted to hospital following a heart attack fell 22% in South East Wales, 6% in North Wales and 5.4% in Mid and West Wales. The overall trend for patients being admitted to hospital with a heart attack is also falling – 22,452 patients were admitted to Welsh hospitals in 2005 but by 2007 this figure was down more than 18% at 18,246.

A year after the ban was introduced in Wales in April 2007, it has been estimated that there has been a 20% increase in the number of people seeking help to quit the habit.

Wales has also been largely compliant with the ban – 107 fixed penalty notices have been issued and there have been 14 prosecutions for either smoking in a public place or failing to prevent smoking in a public place.

Western Mail, 2 July 2008

[See also review by Stan Glantz on this topic in Recent Research section below.]

CMO Annual Report – Teenage Health; Oesophageal cancer

In his latest report on the state of public health, the Chief Medical Officer, Sir Liam Donaldson, has called for a new focus on teenage health. The report, which reviews key health problems and developments over the last year, highlights the unique health needs of teenagers.

Speaking at the launch of his 2007 Annual Report, On the State of Public Health, Sir Liam said:

"Adolescence can be a challenging time. It is a period in which teenagers encounter risks and make hard choices. Young people are exposed to behaviours, opportunities and products that have the capacity to harm their health in the short and long term. In this Report I concentrate on the 'Big Six': smoking, alcohol and drugs, accidents and violence, diet, physical activity and sexual health.

"Habits adopted in the teenage years can form behaviour for a lifetime. For example, adolescent binge drinkers are twice as likely as their peers to be dependent on alcohol or taking illicit drugs by the time they reach 30 years, while someone who starts to smoke aged 15 years is three times more likely to die of smoking-related cancer than someone who starts smoking in their 20s. The effects of poor health in adolescence can last a lifetime, and even shorten it. Keeping teenagers well is a valuable investment for the health of the population in the future."

This year's Report also draws attention to the rising levels of oesophageal cancer, which is the sixth most common cause of cancer deaths in England and Wales and kills 6,000 people a year. England has some of the highest rates of oesophageal cancer in Europe. Over the last 20 years, the rate of new cases in England has gone up by 86% for men and 40% for women, whereas the rate has sharply decreased in other European countries, such as France. The reasons for this are unknown.

In his Report Sir Liam calls for:

- A large scale national research study to investigate the risk factors associated with the rising rate of cancer of the oesophagus.

- Better educational programmes to improve public awareness of the symptoms.

- Research into better diagnostic techniques.

- The Chief Medical Officer to issue a public alert in circumstances where there is an unexplained increase of a serious disease.

Source: Department of Health press release, 14 July 2008 

The Annual Report can be found at www.dh.gov.uk/cmo or http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_086176

Parliamentary News

PQ – Tobacco production in the EU

David Drew: To ask the Secretary of State for Environment, Food and Rural Affairs what assistance the Common Agricultural Policy provides for production of tobacco; and if he will estimate the hectarage given over to the crop in the EU in the latest year for which figures are available.

Jonathan R Shaw (Parliamentary Under-Secretary (Marine, Landscape and Rural Affairs) and Minister for the South East), Department for Environment, Food and Rural Affairs):

In 2007 the CAP provided €335.5 million worth of assistance for tobacco production.

The latest estimates of hectares given over to tobacco production, based on 27 member states' estimated contracts for 2007, is 114,437 hectares.

Hansard Column 1072W, 3 July 2008

Greg Knight: To ask the Secretary of State for Environment, Food and Rural Affairs what discussions he has had with his European counterparts on the continuance of subsidies for European tobacco crops.

Jonathan R Shaw: Agreement was reached at the Council of Ministers in April 2004 for the successful reform of the EU tobacco regime.

The reform introduced decoupling into the tobacco sector, which means that the direct link between production and support is broken. This will apply progressively until 2010 when direct support for tobacco production will cease altogether.

Hansard Column 1073-4W, 03 July 2008
http://tinyurl.com/646v6t

PQ: Cigarette litter

David Drew: To ask the Secretary of State for Environment, Food and Rural Affairs if he will bring forward proposals to make cigarette manufacturers responsible for the costs of removing cigarette butts from public places.

Jonathan R Shaw: Local authorities have a duty under section 89 of the Environmental Protection Act 1990 to keep land clear of all forms of litter and refuse. Decisions on taxation are for my right hon. Friend the Chancellor of the Exchequer.

Hansard Column 1083W, 03 July 2008
http://tinyurl.com/6jden7

Industry Watch

Gallaher found guilty of price fixing

Cigarette maker Gallaher and retailers including Asda and Somerfield have been fined over £173m following a price-fixing investigation by the Office of Fair Trading.

A large proportion - £93m - will be paid by Gallaher, whose brands include Benson & Hedge and Silk Cut.

The fines follow a five-year investigation into price setting and the passing of sensitive information in the UK tobacco industry between 2000 and 2003.

The OFT said the size of the fines would be reduced to £132.3m if the companies, which had applied to the watchdog for leniency, continued to support the investigation.

The size of Gallaher's fine, disclosed by its owner, Japan Tobacco, is based on the company benefiting from the leniency reduction.

The other retailers fined were First Quench, One Stop Stores and TM Retail. Sainsbury's, the first company to apply for leniency, has escaped without a fine.

The OFT - which expects to close its case early next year - said the investigation into Co-Op, Imperial Tobacco, Morrisons, Safeway, Shell and Tesco was continuing

Daily Telegraph, 11 July 2008
http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2008/07/12/cntobacco112.xml

Japan Tobacco – rise in net profits

Japan Tobacco Inc has reported a 13.3% rise in net profits during 2007. The weaker business in Japan was offset by the acquisition of UK-based Gallaher Group. Overseas businesses doubled its operating profit to 205.3bn yen, with focus directed at expanding markets in eastern Europe, Russia, Ukraine and Kazakhstan.

Within its domestic market, Japan Tobacco spokeswoman Yukiko Seto said that the company was attempting to move consumers towards higher-cost value added products and that if this tactic did not reduce JT’s costs, then it would consider raising prices.

Tobacco International June 2008 

Recent Research

Impact of smoke-free laws on hospital admissions for heart attack

On the first anniversary of the ban on public smoking in England, a report shows that smoke-free laws worldwide reduce admissions by almost one fifth (Preventive Medicine 2008 Jun 18; doi: 10.1016/j.ypmed.2008.06.007).

This meta-analysis of published studies shows that the effects were immediate. "The fact that many studies from so many locations around the world provide consistent findings of a substantial drop in acute myocardial infarction associated with the implementation of smoke-free laws increases the confidence that . . . smoke-free policies have immediate and substantial benefits in terms of reducing acute myocardial infarctions," says the author, Stanton Glantz, professor of medicine at the University of California.

The analysis is based on eight studies published since 2004, when the first report of such a drop was reported for the town of Helena, Montana.

The results of the analysis show a pooled estimate of an immediate 19% (95% confidence interval 14% to 24%) reduction to admission rates associated with the laws.

The report says that the fact that the studies from Italy and Ireland showed smaller drops in admissions than in US locations may reflect lower levels of compliance with the law. It says that in Italy and Ireland implementation of the law was associated with a reduction in levels of secondhand smoke exposure of 64% and 69%, compared with an 84% reduction in the United States.

The analysis does not include two studies for which confidence intervals are not available—a small study of Monroe County, Indiana, which found a significant drop in admissions, and a study of Scotland presented at a conference, which reported a 17% drop but which has not yet been published.

BMJ 2008;337:a597
http://www.bmj.com/cgi/content/full/337/jun30_1/a597

Glantz, S.A. Meta-analysis of the effects of smokefree laws on acute myocardial infarction: An update. Preventive Medicine
http://www.sciencedirect.com/science/journal/00917435

Smokefree laws do not adversely affect hospitality trade

A new study by experts in California and France demonstrates that restrictions on smoking do not affect the business activity of the restaurant and bar industry.

In an article published in The Lancet, the researchers also said that although a reduction in lung cancer as a result of such policies is plausible, evidence to support such a health benefit will only become apparent in the future.

Dr John Pierce, from the University of California and Dr María León, from the International Agency for Cancer Research’s tobacco and cancer team, assessed 11 proposals relating to effects of smoke-free policies and graded them into three categories.

Sufficient evidence means that the association was judged to be “causal”; a lesser classification of “strong” suggested that the association is consistent and the third category applied to proposals where there was insufficient data to come to a conclusion.

They found there is sufficient evidence for claims that smoke-free policies substantially decrease second-hand smoke exposure; that smoke-free workplaces decrease cigarette consumption; that smoke-free policies do not decrease the business activity of the restaurant and bar industry; that introduction of smoke-free policies decreases respiratory symptoms in workers; that voluntary smoke-free home policies decrease children’s second hand smoke-exposure; and that smoke-free home policies decrease adult smoking.

There was strong evidence for claims that smoking bans decrease heart disease morbidity; and that smoke-free home policies lead to a reduction in smoking among teenagers.

The authors said: “Implementation of such policies can have a broader population effect of increasing smoke-free environments.

“Not only do these policies achieve their aim of protecting the health of non-smokers by decreasing exposure to second-hand smoke, they also have many effects on smoking behaviour, which compound the expected health benefits.”

Western Mail, 2 July 2008

Pierce, JP & Leon ME. Effectiveness of smoke-free policies.
Lancet Oncology 2008; 9:614-615

http://www.thelancet.com/

Alternative forms of tobacco use

Abstract

BACKGROUND: A review of the available scientific literature concerning forms of tobacco use other than regular cigarettes, cigars and pipes, the nature of such products, prevalence data and trends, health effects, regulatory issues and preventive measures.

RESULTS: Narghile (water pipe), bidis, kreteks and other forms of oral tobacco are traditionally used in many low-income countries, and some of these are currently spreading to the Western countries. They are all linked to negative effects similar to, and often greater than, those associated with common cigarette smoking. Various potentially reduced exposure products (PREPs), including snus, targeted at smokers aware of the health risks of regular cigarettes, have recently been developed by the tobacco industry. Their pathogenic potential varies widely and is not fully known; it is in any case greater than that of pure nicotine forms (such as medicinal nicotine). Their use as cigarette substitutes should not be considered even by inveterate smokers who are unable or unwilling to quit nicotine before further independent evaluation and control.

CONCLUSIONS: There is no such thing as a safe tobacco product. Like cigarettes, alternative forms of tobacco use need regulatory measures that are adapted to local situations and supplemented by preventive measures within the World Health Organization's Framework Convention for Tobacco Control.

Prignot, J.J.; Sasco, A.J.; Poulet, E.; Gupta, P.C.; Aditama, T.Y.
The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 7, July 2008 , pp. 718-727(10)

Smokeless tobacco use by south Asian youth in the UK

The problem of the easy availability and increasing use of smokeless tobacco products by young people of south Asian origin in the UK needs to be urgently addressed, according to researchers writing in The Lancet. Although legislation exists to control use of these products by minors, it is often flouted. The authors argue that young people who regularly use these products are at increased risk of oropharangeal cancers. They cite research in Banglasdeshi young people aged 12-18 in east London which found high levels of regular use of paan, for both the tobacco and tobacco-free forms. Only a third of these young people knew of the association between tobacco-containing paan and cancer. The authors note that carcinogenic smokeless tobacco products are commonly sold in the UK without health warnings. They urge Trading Standards Officers to enforce the legislation prohibiting the sale of tobacco products to persons under the age of 18 and to clamp down on products sold illegally without health warnings. Failure to act, they argue, could lead to the habit spreading to other groups outside the Asian community, as has happened with the use of hookahs, for example.

Panesar S, Gatrade R and Sheikh A. Smokeless tobacco use by south Asian youth in the UK. The Lancet 2008; 372: 97-98.

www.thelancet.com

Events and Publications

Events

1-4 October – 11th European Health Forum Gastein: Theme - Values in Health: from vision to reality
Venue: Bad Hofgastein, Salzburg, Austria
Details: www.ehfg.org

2 October 2008 – BASSP 2nd conference
The British Association for Stop Smoking Practitioners (BASSP) – 2nd Conference
The focus for this one day event will be smoking and mental health and how to collect and analyse data from your service.
Venue: Manchester University
Details: Contact Louise Preston for more details about contributing to the conference: lapreston@ntlworld.com or visit website: www.brit-thoracic.org.uk/bassp.

4-8 October 2008 – European Respiratory Society Annual Congress
Details: info@ersnet.org

27-29 October - SCTRP three-day course, Central London
Contact Janice Rossabi, SCTRP Course Secretary at sctrp@yahoo.co.uk

5 December - Annual Update and Supervision Day
The annual Update and Supervision Day is the opportunity for graduates of the SCTRP Courses to ‘calibrate’ their clinical practice and share information in this fast-developing field. The programme consists of talks on new developments in treatment theory and practice, practical sessions on treatment details, and discussions of participants’ experience. As well as supervision and troubleshooting sessions, the Update provides an opportunity for networking among 100 clinicians and service co-ordinators.
For further details please contact Janice Rossabi, SCTRP Course Secretary at sctrp@yahoo.co.uk

2009
8-12 March - World Conference on Tobacco and Health
Venue: Mumbai, India
Details: www.14wctoh.org