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ASH News and Events Bulletin - 1-15 March 2008

Tobacco News

New Border Agency to tackle tobacco smuggling

The inflation-only rise in tobacco tax announced this week will not be enough to make a dramatic impact on smoking rates but other measures announced in the Budget were welcomed by ASH. Specifically, the Chancellor’s decision to maintain the reduced VAT on nicotine replacement therapy is encouraging, as was the announcement of a new strategy to deal with tobacco smuggling.

A new body – the UK Borders Agency – is to be set up to integrate the work of HMRC with the Borders and Immigration Agency and UK Visas in order to “enhance the Government's strategy to combat excise fraud”.

The new anti-smuggling strategy is to be developed and published by the UKBA by the time of the Pre-Budget Report this year (usually November). It will specify how the UKBA will aim to improve both detection and deterrence by, for example:

using the range of data sources available to the new Agency to improve targeting of high risk freight movements (particularly from within the EU);
exploiting the expanded reach of the UKBA at all points of entry/exit, e.g. to tackle tobacco smuggling at regional airports;
working with postal and fast parcel couriers to curb the increasing use of those services by smugglers squeezed from other routes; and
building on the experience in the visa and immigration areas by improving links with the international transport community to work with them to prevent misuse of their services by tobacco smugglers.

HM Treasury press notices, 12 March 2008
http://www.hm-treasury.gov.uk/budget/budget_08/press_notices/bud_bud08_press03.cfm

No Smoking Day

Data released in advance of this year’s No Smoking Day revealed that about a quarter (23%) of all smokers have cut down since the introduction of smokefree legislation and millions more planned to quit. The study showed that almost one in five smokers – 2.25 million people - planned to stop on No Smoking Day (12 March), with the ban proving to be a key factor in triggering quit attempts. This represents the biggest mass participation in the annual event for many years.

No Smoking Day press release, 11 March 2007

Parliamentary News

Criminal Justice Bill - Licensing of tobacco retailers

A proposed amendment to raise the threshold before action is taken against retailers breaking the law on tobacco sales to minors, and to reduce the penalty for offences, has been withdrawn. The bill has now completed the House of Lords committee stage. The Report Days will be on the 26th March and 2nd April 2008.

In response to a persuasive speech by Lord Faulkner, The Department of Health has agreed to a review of the measures after two years.

House of Lords Hansard
http://www.publications.parliament.uk/pa/ld200708/ldhansrd/text/80312-0006.htm

Industry Watch

Marlboro snus compared to Swedish snus

Questions have been raised by researchers about the composition of the recently launched Marlboro snus in the US, namely that it has a much lower level of nicotine compared to snus produced in Sweden.

Swedish snus is a medium/high nicotine delivery, low-nitrosamine moist smokeless tobacco product that has been estimated to be at least 90% less harmful than smoked tobacco. More men use snus than smoke cigarettes in Sweden, and a quarter of male former smokers quit by switching to snus.

Leading multinational cigarette manufacturers have begun test-marketing snus-like products in the United States and other countries. The version of Philip Morris Marlboro snus currently being marketed in the United States differs from Swedish snus in many ways; it has lower moisture content and pH, but most puzzling is its very low nicotine delivery. Philip Morris, the market-leader in United States cigarette sales, may have designed the product so that it does not satisfy nicotine cravings and fails to enable smokers to switch.

Researchers compared and contrasted Swedish snus and Marlboro snus, and speculated as to why Philip Morris may have intentionally designed a product that delivers very low levels of nicotine. They recommend that Philip Morris cease using the term snus to refer to dry tobacco products with low nicotine delivery, so that the term be reserved for moist, low-toxin, medium/high nicotine delivery smokeless tobacco products that are qualitatively similar to the leading brands in Sweden.

Foulds, J and Furberg, H. Is low-nicotine Marlboro snus really snus?

Harm Reduction Journal 2008, 5:9doi:10.1186/1477-7517-5-9
Published:27 February 2008

http://www.harmreductionjournal.com/content/5/1/9/abstract
http://www.harmreductionjournal.com/content/pdf/1477-7517-5-9.pdf

Imperial Tobacco rolls out CSR report

Imperial Tobacco, the world’s fourth largest cigarette company, has published its fifth annual corporate responsibility (CR) review.

This year, the review endeavours to answer the question: ‘What does it take to build a responsible business?’

The review gives a general overview of Imperial Tobacco’s commitment and approach to CR and of its performance during the 2007 financial year. It also sets out five priorities for the next five years:

better carbon management;
product portfolio balance;
supplier sustainability;
empowering local management to better engage in corporate responsibility; and,
further increasing transparency in how the group adheres to its policies.

Environmental Finance News, 6 March 2008
http://www.environmental-finance.com/onlinews/0306imp.html

Recent Research

Misperceptions about NRT may hinder quit attempts

Leading researchers in the field of smoking cessation are gathering at the annual meeting of the Society for Research on Nicotine and Tobacco (SRNT) to present the latest research on smoking cessation, including a new study revealing smokers' misperceptions about cessation treatments.

The study's findings indicate smokers dramatically underestimate the safety and efficacy of nicotine replacement therapy (NRT) products for quitting smoking, which may lead to less use of proven smoking cessation therapy that has been proven to double a smoker's chances of quitting. Presentation findings were based on a study of 900 men and women adult smokers in the U.S.

Seventy-six percent of smokers wrongly believe or do not know whether NRT is more addictive than cigarettes. Additionally, 68 percent of smokers wrongly answered or do not know that NRT products are as dangerous as cigarettes. Less than three percent of respondents answered all questions about treatment correctly, demonstrating the enormous need for further education.

The good news is that even if smokers held these misperceptions, about half of them stated they would be more likely to consider NRT if they were shown scientific evidence that proves its safety.

"Cessation treatments like nicotine replacement therapy have been proven to greatly increase the chances of successfully quitting," said Dr. Donna Vallone, Senior Vice President, Research and Evaluation American Legacy Foundation. "The research findings only reinforce the point that treatments for cessation are underutilized thereby jeopardizing successful attempts at quitting. More needs to be done to educate smokers."

The majority of smokers try to quit "cold turkey," yet only 3-5 percent of smokers who quit cold turkey are successful long-term. Tools for cessation such as NRT products are among the first-line treatments recommended for all smokers and when used as directed, can significantly increase a smoker's chances of quitting versus cold turkey and remaining smoke-free long-term (6 months and longer). Over 100 clinical trials involving over 35,000 participants and extensive consumer use over more than 20 years have proven the safety and efficacy of NRT when used as directed.

Earthtimes, March 3, 2008
SRNT Annual Meeting

Does snus pose a ‘gateway’ problem?

As smoking rates decline in Sweden, the use of snus, a moist snuff, is rising among both men and women. Researchers investigated whether snus use among young people provided a ‘gateway’ by inviting them into experimentation and eventual transition to cigarette smoking.

Based on annual surveys of 2,983 adolescents in Sweden, researchers found that snus use was 4 to 10 times more prevalent among boys than girls. They also found:
65% of those who used any tobacco and reported which they used first had begun by smoking; 11.2% started with snus, and 19.3% had started using both the same year.
Those who had started with both had significantly higher risk of becoming regular tobacco users.
No significant difference was found , either in regular tobacco use or the amount used, between those who started with only one of the other.
Girls who started as smokers had a higher risk of becoming regular tobacco users; that was not true for boys.

The authors conclude that early age of tobacco use is an important predictor of future use, regardless of which came first – cigarettes or snus. They calculate that “at most 6% of the final smoking prevalence in this cohort could theoretically be attributable to a ‘gateway’ effect of snus but warn that even though the effect is small, introducing vulnerable individuals to a recreational drug that has high potential for addiction should be regarded as a serious public health problem.

What’s new in Nicotine and Tobacco Research. Feb 2008

Original study: Galanti, M et al. The development of tobacco use in adolescence among “snus starters” and “cigarette starters”: An analysis of the Swedish “BROMS” cohort. Nicotine and Tobacco Research. 2008; 10: 315-323

Informing smokers of their lung age and likelihood of quitting

A study was undertaken to evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking. Participants were 561 current smokers aged over 35 in five general practices in Hertfordshire, England.

All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.

The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.

Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at £280 (Eur366, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.

The authors conclude that telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.

Parkes, G et al. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ doi:10.1136/bmj.39503.582396.25 (published 6 March 2008)

http://www.bmj.com/cgi/content/full/bmj.39503.582396.25v1

Related BMJ editorial:
Spirometry with pictorial feedback on lung age, not just raw data, improves quit rates
http://www.bmj.com/cgi/content/full/bmj.39506.386759.80v1

Events and Publications

Events

1-2 April 2008 – 16th UKPHA Annual Public Health Forum
Venue: Liverpool.. See: www.ukphaconference.org.uk for more details.

28-29 April 2008 - A Call To Action: Successful Tobacco Control for the Future
Conference organised by ASH Wales. http://www.smoking-conference-wales.org.uk/

16-18 June – SCTRP three-day course, Central London
This Course is the development of the traditional 'Maudsley Training'. It focuses on treatment methods validated by research. It also covers aspects of the smoking cessation field useful for policy-makers and public health practitioners.
Contact Janice Rossabi, SCTRP Course Secretary at sctrp@yahoo.co.uk

30 June – 1 July 2008 – UK National Smoking Cessation Conference (UKNSCC)
Venue: Hilton Birmingham Metropole Hotel
The world’s largest gathering of smoking cessation practitioners, researchers and policy makers.
Abstract deadline: 14 April 2008. See www.uknscc.org for more information.

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