Statement from Georges C. Benjamin MD, FACP, FACEP (EP), Executive Director, American Public Health Association

The American Public Health Association applauds the U.S. House of Representatives for today passing the Family Smoking and Tobacco Control Act with an overwhelming bipartisan majority. The legislation aims to protect the health of Americans, particularly children, by giving the Food and Drug Administration (FDA) the authority to regulate tobacco products.

For decades the tobacco companies have marketed their deadly products to our children, deceived consumers about the harm their products cause, and failed to take any meaningful action to make their products less harmful or less addictive. Today’s passage of this tobacco control legislation provides an opportunity to finally end the special protection enjoyed by the tobacco industry and protect our children and the nation’s health instead.

The legislation meets the high standard established by the public health community for tobacco regulation and will give the FDA authority to effectively regulate the manufacturing, marketing, labeling, distribution and sale of tobacco products.

APHA calls on members of the Senate to follow the lead of their House colleagues and quickly vote in support of this important legislation. With so much at stake, we cannot afford to wait any longer to take action to protect the health of our children and our nation.

American Public Health Association

The National Institute for Health and Clinical Excellence (NICE) has issued new public health guidance on mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people.

Delaying or preventing the uptake of smoking can have a major effect on both short and long term health. Most adult smokers started smoking before they were 18 years old. Children and young people who smoke are two to six times more susceptible to coughs, increased phlegm and wheezing than their non-smoking peers. Smoking can also impair the growth of their lungs and is a cause of asthma-related symptoms in childhood and adolescence.

This guidance is aimed at those who have a responsibility or a role in improving health and wellbeing of children and young people under 18. This includes those working in the NHS, local authorities, voluntary and community sectors, as well as the private sector, in particular the retail industry and mass-media services.

Mass media

Recommendations are aimed at organisers and planners of national, regional and local mass-media campaigns, as well as local and regional commissioners and planners responsible for improving the health and wellbeing of children and young people under 18. The recommendations include:

- the development of national, regional or local mass media campaigns which are developed in partnership with national, regional and local government and nongovernmental organisations, the NHS, children and young people, media professionals, healthcare professionals, public relations agencies and local anti-tobacco activists.

- Use a range of strategies as part of any campaign to reduce the attractiveness of tobacco. This may include writing articles, producing posters, brochures and other materials to promote the campaign

- Convey well researched messages that:

– elicit a strong, negative emotional reaction while providing sources of further information and support
– use personal testimonials that children and young people can relate to
– empower children and young people to refuse offers of cigarettes

Point of sales

- National government should support enforcement of existing legislation by:

– encouraging national organisations and local authorities to provide education and training programmes for trading standards officers
– encouraging and providing all local authorities with support to enforce legislation and undertake regular audits

- Local authorities and trading standards bodies should ensure retailers are aware of legislation prohibiting under-age tobacco sales and providing training and guidance on how to avoid illegal sales.

Andrew Dillon, NICE Chief Executive and Executive Lead for the guideline said: “Smoking is still the main cause of preventable disease and premature death in England and treating smoking-related diseases costs the NHS an estimated ￡1.5 billion a year. We have already published three sets of public health guidance on smoking cessation, but our remit in this case was to look at how to approach children and young people specifically. These recommendations have been developed to complement existing activities, with the aim of supporting a comprehensive tobacco control strategy.”

Professor Catherine Law, Chair of the Public Health Interventions Advisory Committee (PHIAC) at NICE and Professor of Public Health and Epidemiology, UCL Institute of Child Health said: “Mass media campaigns are an effective approach in delaying uptake of smoking amongst children and young people. This delay can have a major effect on long term health. Children who smoke become addicted to nicotine very quickly and research shows the earlier you start smoking the harder it is to give up in later life. If starting is delayed or prevented there is the potential to reduce the number of early deaths attributed to smoking and improve health throughout life.”

Professor Simon Capewell, PHIAC member at NICE and Chair of Clinical Epidemiology, University of Liverpool said: “We know that around two-thirds of people who have smoked took up the habit before the age of 18 and because the risk of disease is related to the length of time a person has smoked, they face an even greater-than-average risk of developing lung cancer or heart disease. The recommendations on mass media campaigns in this guidance will help children and young people understand the health consequences of smoking and support them in refusing cigarettes.”

Mr Dale Robinson, PHIAC member at NICE and Corporate Manager - Health & Environmental Services at South Cambridgeshire District Council said: “As well as looking at mass media interventions, this guidance also makes particular recommendations for places that young people buy cigarettes. These recommendations include the national government working with agencies to ensure that retailers, including publicans, are aware of legislation on under-age tobacco sales, including the fact that it covers vending machines. The guidance also advises local agencies to work together to identify areas where under-age tobacco sales are a particular problem and then offer practical advice to retailers on how to avoid selling cigarettes to children.”

Notes

The mass-media and point-of-sales measures to prevent the uptake of smoking by children and young people guidance is available at: http://www.nice.org.uk/PH014

Children and young people refer to those under the age of 18.

Mass-media interventions use a range of methods to communicate a message. This can include local, regional or national television, radio and newspapers, and leaflets and booklets. It can also include new media. In this document, ‘new media’ refers to communication via the Internet or mobile phone. On the Internet, it can involve anything from real-time streaming of information and podcasts, to discussions with experts and the use of social networking sites. (An example of real-time streaming of information is the ‘breaking news’ text that appears along the bottom of the screen during some TV news programmes.) The aim of mass-media interventions is to reach large numbers of people without being reliant on face-to-face contact.

Point-of-sales interventions take place at the point where tobacco could be sold. Primarily, they aim to deter shopkeepers from making illegal sales.

Related NICE public health guidance includes:

- Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. http://www.nice.org.uk/PH010
- Behaviour change at population, community and individual levels. http://www.nice.org.uk/PH006
- Workplace health promotion: how to help employees to stop smoking. http://www.nice.org.uk/PHI005
- Brief interventions and referral for smoking cessation in primary care and other settings. http://www.nice.org.uk/PHI001

About NICE

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

NICE produces guidance in three areas of health:

- Public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

- Health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

- Clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

National Institute for Health and Clinical Excellence

The Navajo Nation Council on Friday voted 42-27 to ban smoking and chewing tobacco in public places on the reservation, the AP/Arizona Daily Star reports. The ban does not include tobacco used in ceremonies on the reservation, located on portions of Arizona, New Mexico and Utah.

The tribe’s Division of Health would oversee compliance with the ban and issue fines of $100 for the first violation, $200 for the second and $500 for the third. Increasing hours of community service also would be an option for violators of the ban.

Navajo Nation President Joe Shirley has 10 days to sign or veto the legislation. Thomas Walker, sponsor of the tobacco ban legislation, said that Shirley has not made a direct commitment to sign it, though two years ago Shirley made a tobacco-free proclamation of his own.

Walker added, “I think the council made a wise decision that puts the health and well-being of the people first.” Patricia Nez Henderson, vice president of the Blackhill Center for American Indian Health, said that the ban could help discourage young tribal members from starting to smoke as well as help others who want to stop smoking and protect nonsmokers from secondhand smoke.

The Navajo Nation Gaming Enterprise opposes the tobacco ban, saying that it could put the tribe’s first casino at a disadvantage because competitors still would permit smoking. The casino is expected to open later this year (Major Holmes, AP/Arizona Daily Star, 7/28).

NPR’s “Morning Edition” on Monday reported on the ban (Herz, “Morning Edition,” NPR, 7/28).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Quitting is on the minds of young smokers well before full-blown addiction sets in, according to a new study from Canada.

“Kids begin to think about quitting very soon after their first puffs,” said lead author Jennifer O’Loughlin, a researcher with the department of social and preventive medicine at the University of Montreal.

The study, which appears in the September issue of the American Journal of Public Health, identified a paradox: Novice smokers, who seem to begin experimenting at the age of 12, continue to escalate their tobacco use while at the same time making several unsuccessful attempts to stop.

During the five-year study, 319 Montreal teenagers filled out questionnaires on their smoking habits every three months. The researchers found that the first serious attempt to quit smoking came just two and a half months after the first puff.

The smoking habit progressed rapidly, with teens taking about nine months to develop a monthly smoking habit, and almost two years to need daily nicotine hits.

As cravings, withdrawal symptoms and tolerance grew, novice smokers began to lose confidence in their ability to quit. After two years, many had discovered that breaking the habit was not so easy. In the course of the study, more than 70 percent of the teens wanted to quit, but only 19 percent actually managed to stop smoking for at least a year.

“There was evidence to suggest that kids who smoke do want to quit, but the fact that there were so many serious quit attempts two months after initiation is eye opening,” said Geri Dino, director of the Prevention Research Center in the Department of Community Medicine at West Virginia University. Another interesting finding, she said, was that four years after taking up smoking, 32 percent were still unaware of how hard it is to quit: “It’s taking these kids a while to realize this is a tough thing.” Dino had no affiliation with the study.

O’Loughlin said the study shows that there are milestones in the process of becoming addicted to tobacco. Understanding the steps that lead to addiction could uncover critical periods when kids might be most open to education and support.

“I think there’s a narrow window of opportunity in there before full-blown addiction that we’re not taking into account in our prevention and cessation interventions aimed at kids,” O’Loughlin said.

The Canadian Cancer Society funded the study.

The American Journal of Public Health is the monthly journal of the American Public Health Association. Visit http://www.apha.org for more information. Complimentary online access to the journal is available to credentialed members of the media.

O’Loughlin J, et al. Milestones in the process of cessation among novice adolescent smokers. Am J Public Health 98(9), 2008.

Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
http://www.hbns.org

Face it: we all have our price. Still, despite prizes ranging from lottery tickets to cash payments, quit-smoking contests do not help people kick the habit in the end, according to a new systematic review of studies.

None of the 17 studies, which involved roughly 6,300 participants, demonstrated significantly higher long-term quit rates for smokers offered incentives, despite some creative approaches.

In one study, participants were encouraged to toss their cigarettes down the toilet and rewarded with one lottery ticket per day. Another offered payments of $10 per month and participation in a monthly worksite lottery. Yet another offered cash prizes ranging from $100 to $250, along with certificates of recognition.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Studies occurred in the United States, Canada, the United Kingdom and Australia. Workplaces and clinics were common settings for the competitions.

“In my view, none of them was effective,” said review co-author Kate Cahill at the University of Oxford. “One of our main conclusions was that if incentives work at all, they only work while they’re in place; if you revisit those quitters 12 or 24 months down the line, they [smokers offered incentives] were generally no more successful” than counterparts not offered incentives.

One-year cessation rates for participants in one study were 22 percent more than double that of those not offered incentives. However, by the one-year evaluation, the quit rate for participants was much closer to that of non-participants. In addition, the difference between participants and the group not offered incentives “had become non-significant at the two-year follow up,” the reviewers found.

Offering incentives is a tricky business. “An effective incentive should be large enough to attract smokers motivated to try and quit, but not so attractive that the desire to win outweighs the seriousness of the quit attempt,” the reviewers say.

In a 1994 paper, which was not part of the Cochrane review, an Australian researcher described how one smoking-cessation competition offered a $30,000 car as a grand prize.

By polling entrants after the contest, researchers “found that 34 percent were either ex-smokers or never-smokers who had entered the contest solely in order to win the prize, confident that they could confirm their smoke-free status with a breath sample.” Cahill recalled. “I think it’s a perfectly valid approach to reward people for entering a smoking cessation program … but the risk of deception rises with the scale of the cessation rewards.”

In a landmark announcement in 1964, the U.S. Surgeon General linked smoking and cancer. Census records show that as of the next year, 42 percent of all adults were “current” smokers. By 2007, after years of public awareness and education campaigns, roughly 21 percent identified themselves as current smokers. That dramatic decrease will be counted as one of the public health successes of the 20th century, said Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Interventions.

However, the pool of smokers including younger people is dynamic and health officials still struggle to eliminate tobacco use with limited resources. Fiore said that the cessation contests in the review clearly did not offer a big bang for the buck. However, he added, “Maybe some of these programs have collateral benefit, in that they encourage people who may not have thought about quitting to quit.”

There is no one unequivocal way to eliminate all tobacco use. Efforts hinge on prescription drug treatments, counseling and 1-800-QuitNow telephone lines. “Smokers are extraordinarily diverse as individuals,” Fiore said. “There is never going to be a one size fits all.”

If it were easy, it would have happened by now, researchers say. “We have an enormous number quitting every year. There are not a lot of smokers who say ‘I smoke and I love it,’” Fiore said. It is more common, he said, to encounter smokers who feel ‘hooked,’ who feel trapped by a disease, who feel discouraged in dealing with a powerful drug of dependence.”

Public health officials continue a barrage of efforts including contests. Earlier this summer, a Scottish Health Board announced a three-month incentive plan in Dundee, Cahill said. Smokers who pass a weekly breath test will get the equivalent of about $24 each time in the form of grocery credit. Winners cannot use the money for alcohol or tobacco.

Cahill K, Perera R. Competitions and incentives for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
http://www.hbns.org

Today, the California Governor’s office announced that anti-smoking public service announcements (PSAs) developed by the state will be included in youth-rated DVD movies from several major Hollywood studios. The American Legacy Foundation(R), a national public health foundation dedicated to reducing tobacco use in the U.S., applauds the state of California for joining in the nationwide effort to educate youth on the dangers of tobacco use. Moreover, as young people continue to be exposed to tobacco images on screen and on television, the effort to reach them in this way is critical.

More than half of youth-rated movies contain smoking, and research shows these images can influence 200,000 new youth smokers a year. As a result, the foundation and a host of national health organizations - including the American Heart Association, American Medical Association, American Lung Association and more - have long supported including anti-smoking PSAs before movies with smoking, along with other smoke-free movies policies.

The foundation is delighted that the California Department of Health, a well-respected leader in state tobacco control has joined this important life-saving initiative. Over the past few years, Legacy has worked closely with state Attorneys General around the country to include PSAs from our award-winning truth(R) youth smoking prevention campaign in DVDs, for both youth- and R-rated movies. The Weinstein Company was an early leader in this effort and has since included truth(R) spots in about two dozen films. The Walt Disney Company (Miramax and Buena Vista studios) and Time Warner (Warner Bros.) have also placed these important and highly effective ads from truth(R) in DVDs.

“Putting ads in more movies is a positive step to curb the negative effect that movie smoking has on youth starting to smoke,” said Cheryl G. Healton, Dr. P.H., President and CEO of the foundation. “We believe more can, and must, be done by the industry. The most important way to reduce youth exposure to smoking in movies is take it completely out of youth-rated films.”

Rigorous evaluation shows that truth(R) was responsible for 22 percent of the overall decline in smoking rates in the campaign’s first two years (2000-2002) and 300,000 fewer smokers in 2002. The campaign is stronger than ever, creatively reaching youth in innovative ways that we never would have imagined 10 years ago. It engages youth through television, print and online ads, social media all over the Internet, and now movies through DVDs and theaters.

While we in public health and tobacco control have seen positive progress in our collective efforts to end the tobacco epidemic, a recent report from the Centers for Disease Control and Prevention shows us that, although youth smoking is currently at the lowest level in the past 30 years, the recent substantial declines seen between 1997-2003 leveled off between 2003-2007. To beat the number one preventable cause of death we will have to use every tool in our arsenal - including community level tobacco control programs and science-based counter-advertising mass media campaigns like truth(R), and PSAs in movies, among other things.

The American Legacy Foundation(R) is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the foundation develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The foundation’s programs include truth(R), a national youth smoking prevention campaign that has been cited as contributing to significant declines in youth smoking; EX(R), an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; research initiatives exploring the causes, consequences and approaches to reducing tobacco use; and a nationally-renowned program of outreach to priority populations. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry. Visit http://www.americanlegacy.org.

American Legacy Foundation
http://www.americanlegacy.org

U.S. Senator Frank R. Lautenberg (D-NJ) has issued the following statement in response to the Federal Trade Commission’s (FTC) announcement that it will seek to end the ability of cigarette companies to use deceptive tar and nicotine claims. Lautenberg is the leader of Congressional efforts to end the tobacco companies use of the “FTC Method” of measuring tar and nicotine:

“For years, Big Tobacco has relied on the FTC’s flawed testing method to mislead smokers into thinking these cigarettes deliver less tar and nicotine. In reality, some so-called ‘light’ and ‘low-tar’ cigarettes can actually be more harmful for smokers. Tobacco companies should not be able to hide behind the federal government to deceptively market their deadly products. Smokers deserve to know the truth and today’s action will help make sure they get it.”

Sens. Lautenberg and Olympia Snowe (R-ME) are the authors of S. 2685, a bill to prohibit the cigarette companies of using the so-called “FTC method” for measuring tar and nicotine. The bill was approved by the Senate Commerce Committee and is currently awaiting action on the Senate floor.

In November, Lautenberg chaired a Senate Commerce Committee hearing to examine the accuracy of the FTC tar and nicotine cigarette rating system, and the marketing claims of tobacco companies based on these ratings. During the hearing, the New Jersey Senator uncovered a lengthy history of false and deceptive cigarette ratings and marketing methods used by the tobacco industry.

Lautenberg is one of the Senate’s leaders when it comes to fighting Big tobacco and protecting Americans from the dangers of smoking. He wrote the law that banned smoking on airplanes, which helped trigger a broader smoke-free revolution. Lautenberg is also the author of a law that ban smoking in buildings that house Federally-funded facilities that serve children.

http://www.lautenberg.senate.gov/

On the first anniversary of England’s smokefree law, public support for smokefree environments is still rising [1] and surveys show that most people are in favour of even stronger measures to reduce smoking and to protect children from secondhand smoke [2]. The law has also resulted in a fall in sales of cigarettes [3] and more people than ever are giving up smoking. [4]

Last week, the Office for National Statistics revealed that eighty per cent of Britons agreed with the ban on smoking in public places, with 61% strongly in favour, while a YouGov poll commissioned by ASH found similar levels of support with 63% strongly supporting the measure.

The YouGov survey also revealed that in England:

- 77% of adults support a ban on smoking in cars carrying children under the age of 18
- 85% of adults want retailers who are convicted of selling tobacco illegally to children to be banned from selling tobacco products
- 59% support the banning of tobacco products being displayed in shops
- 65% support the prohibition of sales of tobacco from vending machines.

The Government is currently considering action to restrict or remove the display of tobacco products in shops, as well as requiring retailers to sell them from under the counter, and a possible ban on cigarette vending machines.

The ASH research shows a majority of people are in favour of these policies but for the following measures more than three out of four want more action:

- Easier access to quitting medications, such as nicotine gum and patches (82%);
- Licences for tobacco vendors, which should be removed if they are caught selling to underage smokers; (87%)
- A crackdown on tobacco smuggling (75%).

Deborah Arnott, Director of the health campaigning charity ASH, said:

“The smokefree legislation has been a fantastic success and is hugely popular.

But what it also shows is a hunger for more action: the smokefree law is not an end in itself but has proven to be a catalyst for further controls on tobacco. There is still a lot more that needs to be done. In particular the Government should focus on measures to shield children from tobacco industry marketing while parents and carers can do much more to protect children from exposure to secondhand smoke in the home and car.

“We should celebrate achievements so far but cannot afford to be complacent. With nine million people in England still hooked on tobacco, we must re-galvanize our efforts to substantially reduce current rates of smoking and to protect children from smoking.”

Notes and links:

[1] Smoking related behaviour and attitudes 2007. ONS, 2008.

[2] YouGov poll. Key findings of the survey are available here.

Total sample size was 3,329 adults. Fieldwork was undertaken between 20th - 25th February 2008. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18 ). The study was a collaboration between ASH, ASH Scotland and ASH Wales. The sample size for the England data was 1056.

[3] A report by industry analysts AC Nielsen in Jan 2008 recorded a drop in cigarette sales of 3.9% for the 12 months from Jan 2007 to Jan 2008 (compared to 2% decline in 2007).

[4] The research found that the decline in smoking prevalence for the 9 months prior to the smoking ban was 1.6% whereas in the 9 months after July it rose to 5.5%. Researchers estimate that this means at least 400,000 people quit smoking as a result of the ban.

Source: The Smoking Toolkit Study. This is a monthly series of national household surveys with smokers and recent ex-smokers being followed up for six months. Data collection began in October 2007. The study is currently funded by Cancer Research UK, McNeil, Pfizer and GlaxoSmithKline. The fieldwork is undertaken by the British Market Research Bureau (BRMB).

ASH

First Anniversary of England’s smokefree law shows public ready to accept even stronger tobacco control measures

On the first anniversary of England’s smokefree law, public support for smokefree environments is still rising [1] and surveys show that most people are in favour of even stronger measures to reduce smoking and to protect children from secondhand smoke [2]. The law has also resulted in a fall in sales of cigarettes [3] and more people than ever are giving up smoking. [4]

Last week, the Office for National Statistics revealed that eighty per cent of Britons agreed with the ban on smoking in public places, with 61% strongly in favour, while a YouGov poll commissioned by ASH found similar levels of support with 63% strongly supporting the measure.

The YouGov survey also revealed that in England:

- 77% of adults support a ban on smoking in cars carrying children under the age of 18
- 85% of adults want retailers who are convicted of selling tobacco illegally to children to be banned from selling tobacco products
- 59% support the banning of tobacco products being displayed in shops
- 65% support the prohibition of sales of tobacco from vending machines.

The Government is currently considering action to restrict or remove the display of tobacco products in shops, as well as requiring retailers to sell them from under the counter, and a possible ban on cigarette vending machines.

The ASH research shows a majority of people are in favour of these policies but for the following measures more than three out of four want more action:

- Easier access to quitting medications, such as nicotine gum and patches (82%);
- Licences for tobacco vendors, which should be removed if they are caught selling to underage smokers; (87%)
- A crackdown on tobacco smuggling (75%).

Deborah Arnott, Director of the health campaigning charity ASH, said:

“The smokefree legislation has been a fantastic success and is hugely popular.
But what it also shows is a hunger for more action: the smokefree law is not an end in itself but has proven to be a catalyst for further controls on tobacco. There is still a lot more that needs to be done. In particular the Government should focus on measures to shield children from tobacco industry marketing while parents and carers can do much more to protect children from exposure to secondhand smoke in the home and car.

“We should celebrate achievements so far but cannot afford to be complacent. With nine million people in England still hooked on tobacco, we must re-galvanize our efforts to substantially reduce current rates of smoking and to protect children from smoking.”

[1] Smoking related behaviour and attitudes 2007. ONS, 2008. http://www.statistics.gov.uk/pdfdir/smoke0608.pdf

[2] YouGov poll. Key findings of the survey are available here.

Total sample size was 3,329 adults. Fieldwork was undertaken between 20th - 25th February 2008. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+). The study was a collaboration between ASH, ASH Scotland and ASH Wales. The sample size for the England data was 1056.

[3] A report by industry analysts AC Nielsen in Jan 2008 recorded a drop in cigarette sales of 3.9% for the 12 months from Jan 2007 to Jan 2008 (compared to 2% decline in 2007).

[4] The research found that the decline in smoking prevalence for the 9 months prior to the smoking ban was 1.6% whereas in the 9 months after July it rose to 5.5%. Researchers estimate that this means at least 400,000 people quit smoking as a result of the ban. Source: The Smoking Toolkit Study. This is a monthly series of national household surveys with smokers and recent ex-smokers being followed up for six months. Data collection began in October 2007. The study is currently funded by Cancer Research UK, McNeil, Pfizer and GlaxoSmithKline. The fieldwork is undertaken by the British Market Research Bureau (BRMB).

h ASH ttp://www.ash.org.uk

The Australian Medical Association cannot believe that QANTAS has made a decision to sell in-flight duty-free cigarettes on international routes.

The AMA understands that QANTAS has instructed its staff to ensure that cigarettes are ‘displayed prominently on top’ of the in-flight duty-free cart to ‘ensure our customers are aware of the duty-free products onboard’ and to ‘boost sales’.

AMA President, Dr Rosanna Capolingua, has labelled QANTAS’ apparent actions a retrograde step that encouraged smoking and was inconsistent with government and community efforts to address the causes of preventable chronic disease.

The AMA will be writing to QANTAS to urge the airline to reverse any decision to sell tobacco products on its flights.

Dr Capolingua expressed particular concern about the message QANTAS may be sending to children and young people.

“QANTAS could be positioning cigarettes as a normal consumer product and a standard part of the in-flight experience, like items from the drinks trolley. Tobacco products are not like other items. They are inherently harmful,” she said.

“It is strange that an airline that prides itself on an international reputation for safety could be pushing packs of poison to its customers.”

Dr Capolingua said there was no safe level of tobacco use - which is why the sale, display and promotion of tobacco products are subject to strict restrictions everywhere, it seems, except in airports and on board aircraft.

“If media reports are correct, the airline is exploiting a major legislative loophole which allows duty-free tobacco to be exempt from government restrictions on how tobacco products are displayed and sold. There is no justification for the continued sale of duty-free tobacco, and particularly not in this manner,” she said.

Health groups had received complaints from QANTAS staff concerned about having to sell tobacco as part of their jobs, as well as the increased risk of smoking in aircraft toilets when passengers are provided with cigarettes.

The AMA has been calling for an end to duty-free tobacco sales for years and has also supported calls by previous Federal Governments for Australia to take the lead in negotiating an end to international agreements that have allowed the continuation of duty-free tobacco sales.

“The AMA believes the issue of duty-free tobacco should now be considered by the Preventative Health Task Force as part of its focus on tobacco as a contributor to preventable illness,” Dr Capolingua said.

The total costs of tobacco use to Australia were estimated to be $31.5 billion (2004/05), and the cost of revenue lost to the Government from duty-free to

bacco sales was estimated to be between $11.2 million (1992) and $25 million (2002-03). Smoking remains the single largest cause of preventable death and disease in Australia. It is responsible for around 16,000 Australian deaths every year. Treating diseases and conditions caused by smoking takes up nearly 1.5 million hospital patient bed-days a year.

Australian Medical Association(AMA)http://www.ama.com.au