Kathryn Barnsley, University of Tasmania

The island state of Tasmania off the south coast of Australia has a population of around 500,000 and has high smoking rates, and lower socio-economic status, compared to other states in Australia.

Over the past fifteen years Tasmania has implemented a range of legislative reforms designed to reduce tobacco use. At the point of sale, graphic health warnings must be displayed and products must be out of sight. The tobacco industry has been prevented from making misleading statements about the health of tobacco products and about legislation. Smoking is banned in gaming areas, nightclubs (2005) and pubs (2006). Fruit flavoured cigarettes are illegal and smoking in cars where children are present is banned.  Fines in each case are substantial and laws have been enforced.

In May 2012, Professor Jon Berrick, a co-author of a proposal for a smoke free generation visited Tasmania and met with Tasmania’s Minister for Health and Human Services Michelle O’Byrne, SmokeFree Tasmania and University of Tasmania researchers who have been exploring the potential benefits of cigarette engineering. The subsequent publicity inspired a member of the Legislative Council, the Upper House of Parliament, Hon Ivan Dean to put together a set of proposals to move Tasmania forwards in eradicating tobacco use in the long term. Mr Dean, a former police officer and former Mayor of Launceston (a regional centre) had previously campaigned for outdoor smoking bans in his municipality.

On 21 August 2012 Hon Ivan Dean, incorporating a number of these ideas, moved the following motion in the Tasmanian Parliament, which was carried unanimously and supported by the members of both the Labor and Greens parties that are in Government:

“That the Legislative Council calls on the Government to initiate and promote measures,  including if necessary further legislative measures, to restrict access to tobacco products and reduce smoking and the harmful effects of smoking by

(1) Supporting a tobacco free generation of children born this century in Tasmania;

(2) Banning flavourings, additives and filter ventilation (including menthol) in tobacco products sold in Tasmania;

(3) Progressively reducing the availability of tobacco products in Tasmania;

(4) Requiring the Education Department to implement evidence-based, monitored and evaluated anti-tobacco education and smoking cessation programs in all government schools on an ongoing basis.”

The Education Department should switch from a punitive approach to smoking to one that focuses more positively on cessation support for students. The proposal forecasts a reduction in retail outlets or other mechanisms for reducing availability. As Tasmania already has a licensing system, and effective enforcement for retail sales, this can be tackled.

The great novelty of Mr Dean’s proposal is that it incorporates two key elements that have been proposed as elements of planning for a tobacco end-game. These are mandated product modification to make cigarettes less addictive and/or palatable and the birth-date bases proscription of tobacco purchase and use that would forever prohibit the sale of cigarettes to anyone born after the year 2000.

The proposal does not have the status of law but is an exceptionally influential instrument. The Legislative Council is the most powerful Upper House in Australia. The Governments cannot pass legislation, including budgets, without its support.

The government supported the concept and the Minister has already referred the matter to the Children’s Commissioner for a report. The next steps will most probably be the production of an Options or Discussion paper followed by community consultation prior to drafting legislation.

Watch a report by Al Jazeera here.

Nathan Cowie, Centre for Tobacco Control Research, University of Auckland.

12 September 2012

Stub It Out is a free game developed for Apple’s iPad by a small multidisciplinary team at the University of Auckland in New Zealand.  The game was released on the App Store last month.  The game is designed to be a resource complementing the WERO package – an attractive, culturally salient group stop smoking competition designed for Maori and Pacific Island smokers – priority groups for smoking cessation in New Zealand.

We wanted to create a resource that was innovative, attractive and engaging, not just another boring leaflet or booklet that people will look at once before discarding.  The gameplay is simple and fun, yet challenging.  Tobacco products sail across the screen and the player ‘taps’ them to stub them out.  The cigarette butts fall to the ground where they smoulder and emit smoke (making gameplay harder) until they are swept away with a ‘swipe’ gesture.  Cessation products also feature in the game and act as power-ups, temporarily slowing down the gameplay to make it easier to stub out the cigarettes and sweep away the butts.

We expect that this game could help smokers in a number of ways – as a distraction, a stress release, keeping hands busy, and by increasing awareness of cessation treatments.  Ideally the game would be used as an adjunct to behavioural support and or pharmacotherapy.

Dr Marewa Glover, Director of the Centre for Tobacco Control Research, came across this article by Canadian researchers, who had placed virtual cigarettes in a 3D virtual reality environment for participants to reach out and ‘crush’. Participants in the control condition entered the same virtual reality environment for the same duration, but instead of crushing virtual cigarettes they were to ‘grasp’ virtual balls. Though the mechanism is unknown, their results suggest that crushing virtual cigarettes in a virtual reality environment reduces nicotine dependence and encouraged retention of smokers in their psychosocial treatment programme.

Dr Glover, being a recent convert to the iPad, saw the potential of such an approach and set about designing the game Stub It Out to be part of the new media component (other components being website and an iOS app) of the WERO group stop smoking competition, which is being tested as an intervention to enable mass quitting as part of a programme of research to inform the rapid reduction of smoking prevalence in New Zealand.

Developing the game was a collaborative process. Dr Glover had been playing different games on the iPad and observing her 7 year old daughter playing games too. Debra Warren, a software developer from the National Institute of Health Innovation joined our team along with myself, Laura Wilson (graphic design), and Timi Hawea, a student from the Music and Audio Institute of New Zealand who created the background score and sound effects. As the development of the game progressed we tested it with our neighbours in the office and made adjustments accordingly. Eventually, on 22 August 2012 the game was released on the App Store and we started promoting it on Facebook, Twitter and any opportunity that presented itself.

Response to the game has been very positive so far and we intend to develop a version for the iPhone, and then for the Android operating system, so that we can maximise the potential audiences. We also plan to be able to customise the game so that it is salient to smokers in other parts of the world – Stub It Out India (if adapted) would feature localised backdrops and tobacco products that are available locally such as gutka and bidi, in addition to cigarettes and cigars.

A small sub study is currently in the design stages to evaluate if playing Stub It Out compared to a control iPad game has an effect of tobacco cravings.

Get Stub It Out on your iPad now:

Judith Mackay, World Lung Foundation

28 August 2012

The pioneer of tobacco control in China has died at the age of 93. In 1984, Doctor Weng Xin Zhi published the first national adult smoking survey, the landmark study awakening the Chinese government to the enormity of the tobacco problem. It was also published in English, a shrewd move to engage the world in the problem of smoking in China. He was the first in China to grasp that the tobacco epidemic would never be solved in the corridors of hospitals and clinics, but in the corridors of power and government. He optimistically concluded that the study would change views on smoking and establish a new social norm, and the study even included detailed suggestions such as less smoking in movies and TV.

Dr Weng attended the 1985 Washington DC “First international summit of smoking control leaders,” the first time that China joined the growing group of global tobacco control advocates. It was at that meeting the realisation dawned that the issues of tobacco control were virtually identical around the world, whether the governments were democracies, kingdoms or communist; the harmfulness of tobacco, the obstacles and the action that needed to be taken, were the same. Dr Weng, representing China, personified that message to colleagues in the West.

In 1987, Dr Weng led a team of Chinese colleagues, helped by a small number of foreign specialists, in the drafting of China’s first tobacco control law, which was implemented in 1992. The topic was so sensitive that the first planning meeting had to be held outside Beijing, in Tianjin. The law contained the core elements of advertising bans, smoke-free areas, packet warnings, health education, tar reduction (from some very high levels). The law might seem mild by today’s standards, but it was a giant leap forward for China. It established the harmfulness of tobacco – a principle that would drive all future tobacco control legislation.

He was academically honoured for his work in several fields of health. But his main legacy will be as the pioneer in China’s tobacco-control campaign. He was the executive vice president of the Chinese Association on Smoking and Health in 1991-1998 and was principal investigator of WHO Collaborating Centre for Tobacco or Health from 1986. He was the first Chinese awarded the WHO Smoking and Health Commemorative Medal in 1989.

Dr Weng was a dedicated and unassuming man, and was deeply moved by the toll of disease, disability and death from smoking he saw in China, and which he rightly predicted would increase substantially in the future. No-one has equaled his contribution in saving the lives of Chinese from the diseases of tobacco.