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Archive for April, 2013

Kosovo: new tobacco control law introduces world’s strongest protection against tobacco industry interference

29 Apr, 13 | by Marita Hefler, News Editor

Kosovo has surged ahead in tobacco control with the introduction of a comprehensive tobacco control law. Notable among the range of measures is the strongest protections against tobacco industry interference in the world, based on Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC). The measures, which will apply to the whole of government and be enforced by the national Anti-Corruption Agency, include:

  • No unnecessary interactions between government and tobacco industry.
  • Full transparency for necessary interactions.
  • Prohibition on government partnership with, or support of, the tobacco industry.
  • Prohibition on contributions from tobacco industry to government, to government officials, and to political parties.
  • Strong tobacco-related conflict of interest provisions

The country already had a weak tobacco control law which was passed in 2007, but had been struggling to enforce it. With female smoking prevalence of 44% – the second highest in the world – and 47% of youth having tried smoking before turning 18, the new law is a welcome measure. Other provisions in the law are:

  • 100% smoke-free indoor public places, work places, and public transportation, as well as specified outdoor areas, with some very minor exceptions.
  • Comprehensive bans on tobacco advertising, promotion, and sponsorship, including a ban on retail tobacco product displays.
  • Graphic health warnings on both sides of the pack.
  • Ban on misleading packaging, including descriptors such as ‘light’ and ‘low’.
  • Prohibition on sales to and by minors.
  • Ban on sales in health, education, and athletic facilities.
  • Granting power to the Ministry of Health authority to ban ingredients.
  • Constituents and emissions limits with reporting requirements for manufacturers.
  • Cessation and education measures, include 45 minutes each month of mandatory programming on public radio and television.

Open Access Supplement on Tobacco Control End Games

17 Apr, 13 | by Becky Freeman, Web Editor

A fully open access supplement of Tobacco Control is now available. With 20 articles contributed by 27 authors it is rich with ideas and possibilities.


Dr Kenneth Warner sets the scene for this themed supplement:

In this supplement, some of the world’s most brilliant tobacco control scholars, strategists and activists, including those who originated the principal endgame concepts, offer a wide range of observations pertinent to contemplating the endgame. With other colleagues, these authors gathered together in Ann Arbor, Michigan, last June at a workshop hosted by the University of Michigan School of Public Health to contemplate the very notion of an endgame and to debate the merits of the various endgame proposals brought to light to date. The workshop was sponsored by grants from the American Legacy Foundation and the Robert Wood Johnson Foundation, who also sponsored the development and distribution of this supplement. On behalf of the workshop organisers and participants and the supplement authors, I express our deep gratitude to these visionary organisations for their willingness to encourage thinking outside the box.

The papers published in this volume are not the proceedings of the workshop, although they certainly reflect both the subject matter covered and the diversity of issues and perspectives that characterised the lively proceedings.

The goal of the workshop—and indeed the goal of this supplement—was never to produce a consensus on any of the challenging questions that pervade the subject of the tobacco endgame; it is far too early to do so. Rather, as one participant put it, the intent of the workshop was to serve as ‘an intellectual ice-breaker’ for the field of endgame studies. We hope this supplement will play a similar role for the broader tobacco control community, opening up the debate, enlisting a wider array of tobacco control and public health professionals, and thereby hastening the determination of answers to the challenging questions. While we struggle today with often widely divergent perspectives and beliefs, we all share the same vision of the final words to this story: ‘The end’.


“If it’s not cancer, I’ll give up smoking”

16 Apr, 13 | by Marita Hefler, News Editor

"I promise you, I will do everything I can to make sure you did not die in vain. I will tell the world your story, and the story of other people killed by tobacco. I will challenge the tobacco industry, the tobacco lobbyists, and the politicians who listen to them."

Replacement smokers are the lifeblood of the tobacco industry. What’s it like to treat the victims of this insidious industry? In this powerful TEDx talk, pulmonologists Pauline Dekker and Wanda de Kanter show the heartbreaking, but all too typical, journey of a lung cancer patient, explode the idea of freedom of choice, and highlight the tactics of selling death.


The marketing of e-cigarettes: a UK snapshot

6 Apr, 13 | by Marita Hefler, News Editor

Marisa de Andrade & Gerard Hastings

Institute for Social Marketing; University of Stirling

Editor’s note: The United Kingdom’s health regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), is currently considering how to regulate ecigarettes. Given that marketing of these e-cigarettes is of particular concern, Marisa de Andrade and Gerard Hastings were commissioned by Cancer Research UK to conduct a rapid review of current practices and emerging trends. Here they provide highlights from the review.


Multiple brands of e-cigarettes are being widely marketed, both online and in conventional media, as safer, ‘healthier’ and cheaper alternatives to smoking that can be used either to quit, or for dual use in places where smoking is not allowed – thereby enabling smokers to ‘take back their freedom’.

The products come in various flavours, colours and innovative packaging and have been endorsed by celebrity doctors and actors as well as fictional cartoon characters; presented as ‘must-have’ accessories; linked to charities; featured in various television programmes and films and been pictured in the hands of celebrities.  The ads frequently use images of young, attractive men and women and, in one case, sponsor a 19 year old British Touring Car professional racing driver.  Much imaginative use is made of online marketing – including social networking platforms; online consumer forums and internet-affiliate schemes which turn users into sellers.

The advertising regulator – the Advertising Standards Authority – is struggling to tackle this plethora of marketing communication. It has taken steps to remove claims on e-cigarette websites suggesting that the products are harmless (this remains unproven), and is monitoring television advertising – which cannot, for instance, make reference to the act of smoking.  However, the regulatory challenges are significant.

Early efforts to regulate tobacco advertising showed how difficult it is to control the content of imagery-rich appeals; thus the fact that smoking cannot be directly mentioned does not mean that it is not being indirectly invoked using pictures or associations.  Even with the best intentions, transgressions slip through the net; for example many e-cigarettes are being promoted as smoking cessation aids although they are not currently licensed for this in the UK.  Furthermore, online publicity presents particular difficulties – websites can be set up outside UK jurisdiction, for instance, and website age protection remains rudimentary.  The potential appeal of ecigarettes to the young is a particular concern, with at least one baseline study suggesting that younger, non-minority smokers with higher incomes have a high awareness of these products.

These developments have recently taken a more sinister turn because the tobacco industry has acquired large stakes in the e-cigarettes business.  As a corporation, a tobacco company’s overriding objective is to maximise profits. It is possible that this could be benefit public health by enabling them to diversify away from burned tobacco products, and so hasten the move to smokefree.  However, given the market size and dominance of burned tobacco, it seems more likely that these acquisitions will be used to bolster the status quo by normalising nicotine use, providing control of the recreational (and possibly pharmaceutical) gateways to it and turning a potential competitor into a product range (or even brand) extension.

The rapid review pinpoints two key areas of e-cigarettes which urgently need more research. Firstly, we have to know much more about public, and especially young people’s (including smokers and non-smokers), response to ecigarettes and the related marketing. To what extent are these developments modelling, reinforcing, or in any way promoting smoking? Secondly, it is vital that we learn much more about the tobacco industry’s intent. The current swathe of ecigarette marketing in the UK is chillingly reminiscent of the early days of tobacco advertising; this past experience suggests there is good reason to be deeply concerned.

Smoking in Japan: Deadly social norms behind a ‘warm-hearted’ story

4 Apr, 13 | by Marita Hefler, News Editor

Akihiro Nishi, Tetsutaro Matayoshi, Takahiro Shimizu, Masako Kinkozan, Ichiro Kawachi

At the end of January, a local newspaper company in Okinawa, Japan, Ryukyu Shimpo, published an opinion letter from a young reader, entitled “Cool Big Brother”.

The author, a first-year elementary school girl (aged 6 or 7) related a warm-hearted story of an affectionate granddaughter (herself) and a convenience store clerk (big brother). In the letter, she recounted how she had decided to prepare a surprise gift for her grandfather, who loves smoking. She went to the local convenience store and asked the store clerk to give her as many packs of cigarettes as her pocket money could buy. He convinced the girl that her grandfather would be just as pleased with the gift of one packet, and gave back her change. The girl concluded her letter with praise for him: “that big brother was really cool”.

The letter created considerable controversy, even among health professionals, with opinion divided along the lines of health concerns versus ‘excessive’ anti-smoking attitudes. Within a week, the newspaper company realised that the letter was a forgery and retracted it. The newspaper’s failure to spot the forgery came to light only after the local elementary school – which the girl supposedly attended – reported that no student with her name was enrolled there. The true author of the letter remains a mystery.

The case raises some interesting observations about smoking and social norms in Japan. It is illegal for under-age youth to purchase tobacco, and store clerks selling tobacco to minors can lose their jobs. Nobody at the editorial desk of the newspaper seems to have caught this, or the troubling consequences of a six year old child being able to purchase cigarettes. Indeed, the newspaper company decided to run this story as a heart-warming tale of a young girl’s love for her grandfather, ignoring the fact that cigarettes are a gift with deadly consequences.

It would appear that the social acceptance of smoking as an unremarkable norm in Japan meant the newspaper expected readers would enjoy the letter as an uncomplicated and touching story. These enduring social norms will continue to pose a challenge in progress toward lowering the high prevalence of smoking in Japanese society, and point to the need for health professionals to more effectively communicate the negative impacts of smoking on both individuals and society.

Author affiliations:

Akihiro Nishi, Masako Kinkozan and Ichiro Kawachi: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

Tetsutaro Matayoshi: Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan

Takahiro Shimizu: Chibana Clinic, Okinawa, Japan

Masako Kinkozan: Osaka Head Office, The Asahi Shimbun, Osaka, Japan


2 Apr, 13 | by Marita Hefler, News Editor

Senegal has launched its first national mass media campaign about the harms of tobacco. Developed by the Ministry of Health and Social Action and World Lung Foundation, the campaign graphically depicts the tar that collects inside an average smoker’s lungs. It is hoped that the campaign will empower citizens with new knowledge, and also spur advocacy and government policies to protect citizens from tobacco.

Called ‘Sponge,’ the campaign will air on TV, radio, outdoor venues and SMS for eight weeks.  It was tested rigorously in Senegal, and is based on campaigns previously aired in Australia, China, India, Mauritius, Russia, the United States, and several other countries. Currently, three percent of all male deaths in Senegal can be attributed to tobacco use; a number set to skyrocket as the tobacco industry increases its efforts to addict more people to its products.

Across Africa, tobacco industry activity is booming. Women in Africa, who have a relatively low smoking prevalence compared to other regions of the world and are therefore seen as a growth market, are aggressively targeted by the industry. Initiation among young people is also a concern; according to The Tobacco Atlas, almost 20% of youth in Senegal report having an item with a tobacco logo on it, with even higher percentages in Chad (30%), Niger (30%) and Mauritania (28%). This data suggest young people are being subjected to aggressive marketing to addict a new generation of users.

The campaign television ad (in French) can be viewed from the World Lung Foundation website.

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