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Archive for November, 2015

E-cigarettes and children: advocates walking on both sides of the street?

13 Nov, 15 | by Becky Freeman, Web Editor

Post written by Prof Simon Chapman AO

Follow Simon on Twitter: @simonchapman6

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In a 2014 open letter to the WHO’s director general Margaret Chan signed by 53 researchers, it was argued “Controls on [ecigarette] advertising to nonsmokers, and particularly to young people are certainly justified, but a total ban would have many negative effects, including protection of the cigarette market and implicit support for tobacco companies. It is possible to target advertising at existing smokers where the benefits are potentially huge and the risks minimal.”

Clive Bates who “had a hand” in organising the letter but curiously did not sign it, is a former director of England’s Action on Smoking and Health. In that role, Bates directed and wrote one of the most excoriating critiques ever published of the tobacco industry’s long standing (and still running) denials of its designs on children.

In the October 2000 Danger in the Playground, Bates documented many of the most telling examples of candid industry talk about the vital role of children to the future of tobacco industry profitability. This accompanying powerpoint presentation (also authored by Bates) rubs it in even harder. These revelations were all made in internal tobacco industry documents released through the US Master Settlement Agreement between US state governments the tobacco industry, millions of which are now freely available here.

The tobacco industry’s business model about the importance of youth smoking was never put more succinctly than in this 1984 document from an RJ Reynolds tobacco official: “If younger adults turn away from smoking, the industry will decline, just as a population which does not give birth will eventually dwindle.” (“younger adults” was industry code from the mid 1970s for children and young adults, to be used in all written communications)

In a 2000 press statement at the time of the launch of the publication, Bates said “When you look at what they say privately, and compare it to their public posturing, the whole idea that tobacco companies might be working against teenage smoking is revealed as sinister self-serving public relations.  The more they try to define smoking as only for adults, the more they are saying ‘hey kids, smoking’s for grown-ups’ with a sly nod and a cynical wink.”

Today, Bates runs his own consultancy business and is a leading advocate of ecigarettes. Of 220 tweets he posted between Oct 1 and Nov 1, 80% were about ecigarettes. On a recent blog he wrote that when it comes to ecigarettes “There is little evidence of marketing to children, only assertions that certain ads or brands are designed to appeal to children but with no empirical evidence, and apparently minimal understanding of modern advertising.”

On reading this, I was struck by how far Bates appears to have moved in the 15 years since he wrote Danger in the Playground and so tweeted a juxtaposition of the two quotes above, asking “which Clive Bates to believe?”

Bates replied challenging this apparent inconsistency, arguing that his 2000 statement referred to tobacco companies while his 2015 statement referred to ecigarette companies. He argued that currently, the vaping market is worth 100 times less than the cigarette market and that “nearly all vape customers come from the ranks of existing smokers”, which he said explains why adult smokers are the target market for ecigs.

The same analysis can of course be applied to the current contribution of young smokers to the total cigarette market. For example, an early Australian analysis showed that while in one year the value of the underage market to manufacturers was $AUD18.7million, if 50% of young smokers continued to smoke, they would contribute $AUD112 billion at current prices to the industry across their lifetime.

Bates knows perfectly that tobacco companies understand the importance of smoking uptake by children to their future, but seems to believe that such a thought has never crossed the minds of ecig manufacturers.

In an extraordinary statement, he wrote that “there are good reasons why the e-cigarette companies, even tobacco owned ones, would not target adolescents … demand, reputational, legal and regulatory risk etc … it would be bad business.”

flavour

E-cigarettes contain many child-friendly flavors. Flickr/keoni101

This language only needs to be contrasted with the many counterfactual examples he supplied in his own 2000 publication. Yes, there are many good reasons why designs on kids need to be publicly denied. As one 1973 tobacco document describing a supposed anti-youth smoking initiative put it “This is one of the proposals that we shall initiate to show that we as an industry are doing something about discouraging young people to smoke. This of course is a phony way of showing sincerity as we all well know.”

In much the same way as the tobacco industry has long done, many of those promoting vaping are today trying to walk on both sides of the street on youth vaping. They know the reputational risk of openly saying that they are unconcerned about youth uptake. Whenever data show negligible uptake by youth, this is rapidly megaphoned as self-evidently a good thing. But when data show significant use, they try to spin this as being an entirely positive development where it happens: all children who are now vaping would have been smoking instead, these clairvoyants assure us.

In the USA today data from the US National Youth Tobacco Survey show that while cigarette smoking continues to fall in US teenagers, e-cigarette use has been dramatically increasing since 2011 and is now way ahead of cigarette smoking: there are now some 50% more middle and high school kids vaping than are smoking, with an estimated 340,000 vaping on more than 20 days each month. Advertising like this, and 3 year old birthday party favourite flavours like these which Bates thinks should be allowed, are plainly intended to beguile teenagers.

A recent systematic review in the Lancet of nicotine and psychosis concluded that “Daily tobacco use is associated with increased risk of psychosis and an earlier age at onset of psychotic illness. The possibility of a causal link between tobacco use and psychosis merits further examination.” It set out important arguments about why the “self-medication” hypothesis about nicotine (promoted by the tobacco industry) deserves reassessment against one where nicotine might be causative in psychosis. Such serious considerations demand that trite dismissals of nicotine as being as benign as “like drinking coffee or something” be condemned.

Clive Bates and others who signed his letter might like to comment on how “it is possible to target [ecigarette] advertising at existing smokers”; how many of these allegedly “adult targeted” ads would never attract the interest of non-smoking teens; and where parents can buy one of the miraculous magic filters that let such advertising through to smokers but somehow render it invisible or uninteresting to young non-smokers.

Nepal: report card on progress in tobacco control

2 Nov, 15 | by Marita Hefler, News Editor

Dr Pranil Man Singh Pradhan                                      

Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur

It has been four years since the Tobacco Product Control and Regulatory Bill was passed in Nepal and significant progress has been made since then. The decision by the Nepalese government to increase the surface area of all tobacco packaging with graphic warnings against tobacco from 75% to 90% was commended globally. Despite stronger legislation, implementation has been slow. More is needed to reduce the growing burden of Non Communicable Diseases (NCDs) in the country.

Nepal has made significant progress towards tobacco control in the last decade. It became a signatory to the WHO Framework Convention on Tobacco Control (FCTC) in 2003, and ratified it in 2006. In what was regarded as the landmark in the nation’s campaign against tobacco, the Constituent Assembly approved the Tobacco Product Control and Regulatory Bill 2010 on April 11, 2011. Major features of the new law included a complete ban on smoking in public places, workplaces and public transportation. It also banned the sale of individual cigarettes, prohibited unlicensed vendors from selling tobacco products, deemed tobacco sales to minors (under 18 years of age) and pregnant women as offenses, and required tobacco companies to cover 75% of cigarette and other tobacco product packaging space with pictorial health warnings. It also introduced a health tax on tobacco products, and a total ban on tobacco advertisements, promotion and sponsorship in any form. The law supported the provision of punishments and penalties for violation of these new regulations.

Recently Nepal took another significant step by increasing the surface area of all tobacco packaging with graphic warnings to 90% of the pack. Pictorial health warnings are a particularly important deterrent against smoking among people with low literacy and younger generation. The legislation was due to be implemented by all the tobacco companies in Nepal from May 2015, and would mean Nepal has the strongest tobacco warnings after Australia, where plain packaging legislation has been in place since 2012. In recognition of this achievement, the Ministry of Health and Population of Nepal was awarded the 2015 Bloomberg Philanthropies Award for Global Tobacco Control at the 16th World Conference on Tobacco or Health held in Abu Dhabi, U.A.E. in March 2015.

However, Nepal has been lagging behind on implementation. Research in different regions of Nepal among adolescents has shown that two-thirds of adolescent smokers consume tobacco in public places such as restaurants, and nearly 75% of adolescent smoker students were found to purchase tobacco directly from shops. The majority of adolescents surveyed have seen other people smoking in public places (67.4%) and were unaware of any penalty or punishment given to them (48.8%).

The clear violations identified by these small scale studies raise the question of how effectively the anti-tobacco law is really being implemented. Another issue of concern is the rising prevalence of female tobacco use in Nepal, and the fact that Nepal has the highest female smoking prevalence among nine Southeast Asian countries.

Most high income countries have been able to combat the tobacco epidemic with strict regulations. Nepal is well on the way, aiming for a 25% reduction in the relative mortality from NCDs by 2025 (the 25 by 25 goal). Effective implementation of the anti-tobacco law is urgently needed to ensure this is achieved.

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