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ASH News and Events Bulletin - 1-15 May 2008

Tobacco News

Half of Europe's workforce remain unprotected from secondhand smoke at work

Less than a third of the European Union's Member States have introduced fully comprehensive smokefree legislation, three years after the world's first public health treaty on tobacco control - the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) - introduced the need for protecting employees from the dangerous effects of secondhand smoke.

To date, only nine of the 25 EU Member States that have signed and ratified the WHO treaty have so far introduced comprehensive smokefree legislation - leaving over half of Europe's workforce exposed to secondhand smoke.

Comprehensive smokefree legislation has been introduced in Estonia, Finland, France, Ireland, Italy, Malta, Slovenia, Sweden and the UK.

Jean-Luc Eiselé, Executive Director at the European Respiratory Society said: "The scientific evidence is clear: secondhand smoke kills. Only comprehensive smoke free legislation fully protects workers from the detrimental effects of second hand smoke. We congratulate those countries that have taken the steps necessary to become smokefree, but all workers in the EU should have the same level of protection"

'Spotlight on the FCTC' , a report prepared by the Smokefree Partnership, highlights how the European Commission, European Parliament and EU Member States have met, or in some cases failed to meet, their obligations to tackle second hand smoke, according to Article 8 of the convention.

The booklet also draws attention to the fact the European Parliament failed to maintain its own comprehensive smoking ban, which was introduced in January 2007, and lasted 43 days before being revoked by the governing body of MEPs. A ruling by the European Ombudsman found that the Parliament was failing to protect the health of its staff.

A 2007 Parliamentary report led by MEP Karl Heinz Florenz in response to a Commission Green Paper on a smokefree Europe, states that 'only a full smoking ban in all enclosed workplaces, including catering and drinking establishments, and all public buildings and transport, can protect the health of employees and non smokers'. The report also called on the Parliament's Bureau, in the light of its duty to set an example, to implement a full smoking ban in all parts of the Parliament - but no action has yet been taken.

MEP Gerard Onesta said: "The alarming decision by the European Parliament to scrap its own smokefree rules highlights a dangerous disregard some MEP's have for the health of those workers affected. Their original commitment to a smokefree European Parliament showed they understood the dangers of secondhand smoke. They urgently need to lead by example and reverse this disastrous setback for the future of a healthy Europe."

The 'Spotlight on the FCTC' is a series of briefing papers on the FCTC and EU's associated obligations prepared by the Smokefree Partnership.

http://www.smokefreepartnership.eu

Medical News Today, 18 April 2008

ECJ: German case against tobacco advertising Directive fails

The European Court of Justice (ECJ) has rejected the case brought by Germany against the tobacco advertising Directive. Germany had contested the legal basis of the Directive. In rejecting the case, the ECJ was following the recommendation made by the Advocate General in June. The German government had originally claimed that the European Commission was surpassing its competence with the EU-wide ban on tobacco advertising.

Source: Abendzeitung, 24 April 2008

http://www.abendzeitung.de/nachrichten/24034

Parliamentary News

Banning orders for retailers who break the law on sale of tobacco to minors

The Criminal Justice and Immigration Bill which includes the provision of banning orders for retailers who persistently sell tobacco to persons under the age of 18, has received Royal Assent. It will come into force on 1 April 2009.

Criminal Justice and Immigration Bill

PQ Illnesses from passive smoking

Richard Benyon: To ask the Secretary of State for Health whether his Department has collated the number of cases of illnesses caused by the effects of passive smoking since the implementation of the smoking ban in 2007.

Dawn Primarolo (Minister of State (Public Health): We have commissioned research on the health impacts of the smokefree legislation in England. However, early assessments are that this legislation is proving to be effective in significantly reducing levels of second hand smoke in enclosed public places and workplaces.

Research from Scotland has reported a range of benefits since smokefree legislation was introduced there, including dramatic improvements in air quality in pubs, improved health, reduced tobacco consumption and no increase in the amount of smoking in the home.

Hansard – 08/05/08 Column 1177W
Hansard Source

Industry Watch

BAT Canadian subsidiary to test market snus in Ottawa

Imperial Tobacco Canada has announced that the Canadian capital will be the next focus for its snus test market. Imperial launched its first snus test in Edmonton (Alberta) in September 2007. Imperial’s CEO Benjamin Kemball said: “The health risks associated with smoking tobacco products are well understood, the prices are high and restrictions are strict, yet about five million adults in Canada smoke. Imperial Tobacco Canada believes that it is the right thing to provide people [with] products that are potentially less harmful than smoking.”

The tobacco company said it would offer the test marketing results to Health Canada with which it is hoping to work regarding a regulatory framework for snus.

Tobacco Reporter, March 2008

Recent Research

Brief advice boosts quit rates

An updated Cochrane review has confirmed previous findings, namely that brief advice given by doctors to patients who smoke can increase the chances of the patient successfully quitting.

“Assuming an unassisted quit rate of 2 to 3 percent, a brief advice intervention can increase quitting by a further 1 to 3 percent,” said lead reviewer Lindsay Stead.

The reviewers looked at of 41 studies of more than 31,000 smokers.

“To a non-clinician, these results may seem underwhelming, but [they] are really quite significant when you consider how many people who smoke see a physician every year — about 80 percent — and how many more of them would quit if all doctors advised them to do so at every visit,” said Dr Abigail Halperin, a physician-researcher specializing in prevention and treatment of tobacco-related diseases at the University of Washington.

The reviewers looked at studies conducted between 1972 and 2007. When they pooled data from 17 trials of brief advice compared to no advice, they found significant increases in quit rates among the group that received some form of counselling from a physician.

Efforts did not have to be lengthy or complicated: The researchers found no statistical difference between intensive and minimal endeavours. However, the studies did not select study participants based on motivation to quit smoking, which might have affected the findings on intensive interventions.

“Cessation interventions are typically highly cost-effective, so even a very small improvement in effect from intensifying the intervention could well be cost-effective,” said Stead.

“I suspect the barrier to providing intensive interventions to all comers — including smokers who were initially resistant to the idea of a quit attempt — would be that physicians would be hard to persuade it was effective,” Stead said.

Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 2.

http://www.mrw.interscience.wiley.com/

Reasons for not using smoking cessation aids

A German study investigated why so few smokers used clinically proven aids to stopping smoking.

BACKGROUND: Few smokers use effective smoking cessation aids when trying to stop smoking. Little is known why available aids are used insufficiently. A study therefore investigated the reasons for not using proven aids and examined related demographic, smoking behaviour, and motivational variables.

METHODS: Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used stop smoking aids and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use.

RESULTS: The most common reasons given for non-use of aids were:
belief in being able to quit on one's own (55.2%),
the belief that help is not necessary (40.1%), and
the belief that smoking does not constitute a big problem in one's life (36.5%).

One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much.

CONCLUSIONS: The main reasons for non-use of stop smoking aids are: being overly self-confident and the perception that aids are not helpful. Future interventions to increase the use of cessation aids should address these reasons in all smokers.

Gross B. Reasons for not using smoking cessation aids. BMC Public Health. 2008 Apr 22;8(1):129 [Epub ahead of print]

http://www.biomedcentral.com/1471-2458/8/129
http://www.biomedcentral.com/content/pdf/1471-2458-8-129.pdf

Note: Full text PDF freely available from link immediately above.

Peer-led intervention to prevent youth smoking

Schools in many countries undertake programmes for smoking prevention but systematic reviews have shown mixed evidence of their effectiveness. Most peer-led approaches have been classroom-based, and rigorous assessments are scarce. A study was undertaken to assess the effectiveness of a peer-led intervention that aimed to prevent smoking uptake in secondary schools.

The study comprised a cluster randomised controlled trial of 10730 pupils aged 12-13 in 59 schools in England and Wales. Twenty-nine schools (5372 students) were randomly assigned to the control group to continue their usual smoking education and 30 (5358 students) to the intervention group. The intervention – ASSIST (A Stop Smoking in Schools Trial) consisted of training influential students to act as peer supporters during informal interactions outside the classroom to encourage their peers not to smoke. Follow up was immediately after the intervention and at 1 and 2 years.

The authors found that the odds ratio of being a smoker in the intervention group compared with control schools was 0.75 immediately following the intervention (n=9349 students), 0.77 at 1-year follow up and 0.85 at 2-year follow up. The results suggest that, if implemented on a population basis, the ASSIST programme could lead to a reduction in adolescent smoking prevalence of public health importance.

In an accompanying editorial, Robin Mermelstein, while welcoming the rigour of the study, notes that other social influence factors may have an equal, if not greater, effect on youth smoking than peers. For instance, he notes that siblings remain an “untapped resource” for the extension of prevention programmes.

Campbell, R. An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. The Lancet 2008; 371:1595-1602.
http://www.thelancet.com/journals/lancet/article/PIIS0140673608606923/abstract

Mermelstein, R. Moving tobacco prevention outside the classroom. The Lancet 2008; 371: 1556-1557
http://www.thelancet.com/journals/lancet/article/PIIS0140673608606686/fulltext

Events and Publications

Events

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.
See www.uknscc.org for more information.

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

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