Scientists consider Cigarette Use will be eliminated completely by 2050

Prominent public health scientists admit that landmark Tobacco Control Act approved last year by the U.S. Congress has not only given the U.S. Food and Drug Administration the authority to regulate tobacco products, but is also a major step to eliminating cigarette smoking across the country within 30-40 years.
Such findings were established by the University of Wisconsin-Madison research group led by Michael Fiore and Timothy Baker. The research is published in online issue of Journal of Clinical Medicine. During the research, the scientists analyzed the major landmarks in reducing tobacco usage across the nation and developed their strategy to crack down cigarette smoking within a couple of decades. The scientists also analyzed the information collected by Wisconsin Department of Public Health from 1960 to 2007.
Timothy Baker, leading researcher admitted that numerous experts confirmed that the level of smoking is declining, and though the rate of the drop is not very considerable if comparing the last two decades, yet, the rate is huge in comparison with that registered in the 1960s, before the landmark report of the Surgeon General about the dangers of tobacco consumption.
In conformity with the stats provided by the Centers for Disease Control and Prevention nationwide adult smoking rates have been dropping 0.5 percentage points annually from 43% reported in 1965 down to 21.1% last year. These figures prove that the overall drop has been very considerable, and the efforts in the struggle with cigarette smoking have paid off.
According to the scientists, previous victories of the national efforts to crack down tobacco consumption include:
• Adoption of strict bans on smoking in public places
• Continuous rises in tobacco excise taxes with corresponding price increases
• Severe restrictions on marketing of tobacco products
• Placing larger and stronger health warning on packages of tobacco products.
• Implementing measures banning tobacco sales to adolescents
• Carrying out nationwide awareness-rising campaigns
• Invention of various nicotine-replacement therapies.
Timothy Baker stated that the findings underline the astonishing success in reducing tobacco consumption during the past decades; however, the achieved success should not mitigate responsibility and willingness to continue struggling with tobacco use in order to eliminate the habit completely in the nearest future.
The scientist added that when all the introduced and proposed strategies of eliminating smoking would be implemented, tobacco consumption would go into history in several decades.
The research is partly dedicated to the methods that should be approved throughout the USA in order to accelerate the decline in smoking rates. The following methods were mentioned in the research:
• Requiring all the states to adopt bans on smoking in public places.
• Raising excise taxes on tobacco products by 100 percent.
• Obliging cigarette makers to stop placing nicotine in their brands.
• Rising public awareness about the dangers of tobacco use
• Performing nationwide anti-smoking campaigns.
• Giving free nicotine-replacement therapies to every smoker willing to get rid of his habit.
Concluding the research, scientists urged lawmakers to regulate tobacco industry more strictly, ban menthol flavor in tobacco products and implement plain packaging bill.

World No Smoking Day

To smoke is to breathe in smoke through cigarettes, cigars, pipes and to let it out again. Those who inhale smoke are called tobacco free daysmokers and those who smoke tobacco regularly are called heavy smokers or chain smokers. Smoking is not a must like food and drink. However, many people are addicted to smoking to such an extent that they say that they can live for days without food and drink but not without a smoke. There is a limit to the quantity of food and drink that a human being can consume because after a while the consumer loses his appetite but in the case of smoking there is no limit, There are smokers who light cigarettes, cigars or beedi one after the other and those who have the pipe always in the mouth .Such persons are called chain smokers.
Unfortunately many people in countries in every corner of the world have got into the habit of smoking. Young people get into this habit by imitating their elders including their parents and other senior members in the family, associates and friends. At later stages most of those who are addicted to smoke realize the ill – effects of smoking but once they start smoking it is hard to break the habit. This is the very reason why smoking is sometimes referred as the most difficult drug to give up.
Smoking and drug addiction
Although smoking does not belong to the category of hard drugs it brings extremely harmful effects in the long run.
Nicotine can be physiological, psychological or both. People who are physically dependent on nicotine find that their bodies have become used to function when nicotine is present and many of them experience withdrawal symptoms when they reduce their nicotine intake.
Urge to smoke
People who psychologically depend on nicotine may find that they feel an urge to smoke when they are in specific surroundings such as pubs or liquor shops and in particular situations such as lunch breaks or socials in which friends come together. Research has shown that smoking is associated with different roles meaning for smoker, such as social roles such as enjoyment of the company of friends, emotional roles such as helping themselves to deal with stress and anxiety and providing “companionship” and temporal roles connecting to the flow of events or time in the smokers’ day providing a break from work or activities and relieving boredom.
Harmful effects of smoking on the Human body
The effects of smoking on human health are very serious and in many cases deadly. There are approximately 4,000 chemicals in cigarettes, hundreds of which are toxic or containing poison. The ingredients in cigarettes affect everything from the internal functioning of organs to the efficiency of the body’s immune system.
The effects of cigarette smoking are destructive and widespread. Toxic ingredients in cigarette smoking travel throughout the body causing damage in several ways. Nicotine reaches every part of the body and mixes up even with the breast milk of feeding mothers. Carbon monoxide binds to hemoglobin – the red substance in the blood that carries oxygen. The affected cells are then prevented from carrying the full load of oxygen
Tobacco causes a number of cancers
Carcinogens or substances that cause cancer are contained in tobacco smoke. These substances damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly. The carcinogen benzo (a) pyrene binds to cells in the air – way or the passage from the nose and throat to the lungs, through which one breathes and the major organs of smokers. Further, smoking affects the functioning of the immune system and may increase the risk of respiratory and other infections. Damages caused to smokers are many and numerous.
Oxidative stress
The chemical in the cells that carry generic information gets affected. Antioxidants are produced in the body to repair damaged cells.but smoking is associated with higher levels of chronic inflammation. This is another damaging process that may result in oxidative stress.
Lung cancer
Tobacco smoking contributes to a number of cancers. Tar coats in lungs are like soot in a chimney and causes cancer. A 20- a- day smoker breathes in up to a full cup (210 g) of tar in a year. Lung cancer from smoking is caused by the tar in tobacco smoke. Men who smoke are ten times more likely to die from lung cancer than non smokers
Heart attacks and strokes
The mixture of nicotine and carbon – monoxide in each cigarette one smokes temporarily increases one’s heart rate and blood pressure straining one’s heart and blood vessels. This can cause heart attacks and strokes. It slows one’s blood flow, cuffing oxygen to one’s feet and hands. Heart diseases and strokes are also more common among smokers than non – smokers. Carbon monoxide robs one’s muscles, brain and body tissues of oxygen making one’s whole body and especially one’s heart work harder
Gradual way to die
Thus smoking causes diseases and is a gradual way to die. The strain put on one’s body by smoking often causes years of suffering. Emphysema is an illness that slowly rots one’s lungs. People with emphysema often get bronchitis again and again and suffer lung and heart failure.
Smoking causes fat deposits to narrow and block blood vessels which lead to heart attack.

Withdrawal symptoms

If a person who is dependent on the nicotine in tobacco suddenly stops using it or reduces the amount he or she uses he or she will experience withdrawal symptoms because his or her body has to be readjusted to functioning without drugs.
Symptoms include craving, irritability, agitation, depression and anxiety insomnia or the condition of being unable to sleep, increased appetite and weight gain, restlessness and loss of concentration, headache, coughing and sore throat, aches and pains in the body.
However, most of these are temporary ailments which can be endured by those who possess the will power.
Benefits of giving up smoking
It should be mentioned that life is precious for any human being and good health is necessary for any one to live long. As has been already pointed out smoking is the root cause of a number of ailments such as cancer, T.B. heart diseases etc. and by quitting smoking or stopping the use of tobacco the threat of these health hazards can be avoided.
World No Tobacco day captions refer to the health hazards of smoking. “Tobacco – health warning” in 2009” “Tobacco- deadly in any form or disguise” in 2006, Tobacco kills Don’t be duped” in 2000, “Health services – our window to a tobacco free world” in 1993 are warnings against tobacco.
Economic gains by not smoking
Secondly smokers spend a major part of their income on tobacco. The price of a cigarette is about Rs. 18/ and a person who smokes twenty cigarettes per day burns Rs. 360/+ per day and later in his life he will need more than that amount for medical treatment.
Hence by quitting smoking one can make himself and his family economically sound. The caption for 2004 World No Tobacco “Poverty, a vicious circle” indicates this.
Non smokers affected by smokers in public places
Smokers destroy not only themselves but also the environment. Some persons in the vicinity are affected adversely when someone smokes. Inmates in the house inhale the smoke puffed out by smokers.
When someone smokes in a pub or a public place the others in the crowd inhale the smoke in spite of the fact that they are non-smokers.
These people who suffer due to the smoking of others are referred to as passive smokers. The caption for 1991 and 1992 No Tobacco dDy indicates the ill effects of smoking in public places.
Global attention to tobacco epidemic
A number of states in the World Health Organization created World No Tobacco day in 1987 to draw global attention to the tobacco epidemic and the preventable deaths and diseases it causes.
In 1987 the world Health assembly passed a resolution (WHA 40.38) calling for 07 April, 1988 to be the “World No Smoking Day. In 1988 a resolution (WHAS 42,19) was passed calling for the celebration of World No Tobacco Day, every year on the 31st May.
By Gamini Jayasinghe
Dailymirror, 31 May 2010

The Same Scientists Who Lied About Tobacco Also Lied About Global Warming

If you are a candidate for a stroke or heart attack — or just have fond hopes that your child or grandchild will grow up in a world without a sell-by date — you really should step back from this screen.
I have read many books that infuriated me, and I was glad for the experience. It’s good to get pissed off at injustice, fictional or real, and come away energized, eager to do your small part in correcting whatever wrong the book exposed. But although Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming is brilliantly reported and written with brutal clarity, it has left me with a different reaction — frustration that lobbyists and “experts” have blocked all meaningful steps to avert environment disaster. And will continue to do so, not just until millions are afflicted with skin cancer and the wheat fields are bone dry and the poor are fighting in the streets for water. No. In the very last minute of the very last hour of humanity’s very last day on earth, a scientist on the payroll of an oil or coal company — most likely a scientist who has no expertise in environmental matters and whose scientific contributions ended decades ago — will be saying there’s “still doubt” about global warming.
Naomi Oreskes is a real scientist and historian. She’s Professor of History and Science Studies at the University of California, San Diego; her books include “Plate Tectonics: An Insider’s History of the Modern Theory of the Earth,” cited by Library Journal as one of the best science and technology books of 2002. A few years ago, she tired of the Bush administration’s insistence that “most” scientists disagree with the notion of global warming, so she did what a real scientist does — she read every single piece of science written on the subject to see what “most” scientists said about it.
Not one of them called it a “theory.” Her conclusion:
No scientific conclusion can ever be proven, absolutely, but it is no more a ‘belief’ to say that Earth is heating up than it is to say that continents move, that germs cause disease, that DNA carries hereditary information or that quarks are the basic building blocks of subatomic matter. You can always find someone, somewhere, to disagree, but these conclusions represent our best available science, and therefore our best basis for reasoned action.
Her new book, written with science journalist Erik Conway, is about the absence of reasoned action — and not just when the issue is global warming. The real shocker of this book is that it takes us, in just 274 brisk pages, through seven scientific issues that called for decisive government regulation and didn’t get it, sometimes for decades, because a few scientists sprinkled doubt-dust in the offices of regulators, politicians and journalists. Suddenly the issue had two sides. Better not to do anything until we know more.
Truth in science is a process: research, followed by scientific writing, followed by peer review. In this way, mistakes are corrected, findings refined, validity confirmed. But the interests of scientists on the payroll of, say, R.J. Reynolds Tobacco wasn’t truth. “They were not interested in finding facts,” Oreskes and Conway write. “They were interested in fighting them.”

If you are a candidate for a stroke or heart attack — or just have fond hopes that your child or grandchild will grow up in a world without a sell-by date — you really should step back from this screen.
I have read many books that infuriated me, and I was glad for the experience. It’s good to get pissed off at injustice, fictional or real, and come away energized, eager to do your small part in correcting whatever wrong the book exposed. But although Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming is brilliantly reported and written with brutal clarity, it has left me with a different reaction — frustration that lobbyists and “experts” have blocked all meaningful steps to avert environment disaster. And will continue to do so, not just until millions are afflicted with skin cancer and the wheat fields are bone dry and the poor are fighting in the streets for water. No. In the very last minute of the very last hour of humanity’s very last day on earth, a scientist on the payroll of an oil or coal company — most likely a scientist who has no expertise in environmental matters and whose scientific contributions ended decades ago — will be saying there’s “still doubt” about global warming.
Naomi Oreskes is a real scientist and historian. She’s Professor of History and Science Studies at the University of California, San Diego; her books include “Plate Tectonics: An Insider’s History of the Modern Theory of the Earth,” cited by Library Journal as one of the best science and technology books of 2002. A few years ago, she tired of the Bush administration’s insistence that “most” scientists disagree with the notion of global warming, so she did what a real scientist does — she read every single piece of science written on the subject to see what “most” scientists said about it.
Not one of them called it a “theory.” Her conclusion:
No scientific conclusion can ever be proven, absolutely, but it is no more a ‘belief’ to say that Earth is heating up than it is to say that continents move, that germs cause disease, that DNA carries hereditary information or that quarks are the basic building blocks of subatomic matter. You can always find someone, somewhere, to disagree, but these conclusions represent our best available science, and therefore our best basis for reasoned action.
Her new book, written with science journalist Erik Conway, is about the absence of reasoned action — and not just when the issue is global warming. The real shocker of this book is that it takes us, in just 274 brisk pages, through seven scientific issues that called for decisive government regulation and didn’t get it, sometimes for decades, because a few scientists sprinkled doubt-dust in the offices of regulators, politicians and journalists. Suddenly the issue had two sides. Better not to do anything until we know more.
Truth in science is a process: research, followed by scientific writing, followed by peer review. In this way, mistakes are corrected, findings refined, validity confirmed. But the interests of scientists on the payroll of, say, R.J. Reynolds Tobacco wasn’t truth. “They were not interested in finding facts,” Oreskes and Conway write. “They were interested in fighting them.”
Here’s the absolute stunner — some of the scientists who were on the payroll of tobacco companies turn out to be the very same scientists now working for oil and coal companies to create confusion about global warming.
Why you may ask, would scientists who once had impressive reputations pose as “experts” on topics which they have no history of expertise?
Frederick Seitz and Fred Singer — the most visible of the tobacco-causes-cancer and man-causes-global-warming deniers — were both physicists. Long ago, Seitz helped built the atomic bomb; long ago, Singer developed satellites. Both were politically conservative. Both supported the War in Vietnam and politicians who were obsessed with the Soviet threat. Both were patriots who believed that defending business had something to do with defending freedom. And both were beneficiaries of the strategy that John Hill, Chairman and CEO of the Hill & Knowlton public relations firm, laid out for tobacco executives in 1953: “Scientific doubts should remain.” The way to encourage doubt? Call for “more research” — and fund it.
You can imagine what this did to media coverage in our country. As early as the 1930s, German scientists had shown that cigarettes caused lung cancer. (No one smoked around Hitler.) By the early 1960s, scientists working for American tobacco companies agreed — nicotine was “addictive” and its smoke was “carcinogenic.” But the incessant call for more research and “balanced” journalism kept the smoking controversy alive until 2006, when a federal judge found the tobacco industry guilty under the RICO statute (that is, guilty of a criminal pattern of fraud.) Fifty years of doubt! Impressive.
“The tobacco road would lead through Star Wars, nuclear winter, acid rain and the ozone hole, all the way to global warming,” Oreskes and Conway write. The lay reader may want to read the tobacco stories, skim the middle chapters, and then re-focus on global warming, the subject of the book’s second half. There you can thrill to the argument that the sun is to blame. Revel in the attacks on environmental scientists (they’re all Luddites, and some are probably pinkos). See politics trump science. (The attack on Rachel Carson, who first alerted us to the dangers of DDT, is especially potent. In a novel, Michael Crichton had a character say, “Banning DDT killed more people than Hitler….It was so safe you could eat it.”)
Fifty-six “environmentally skeptical” books were published in the 1990s — and 92% of them were linked to a network of right-wing foundations. As late as 2007, 40% of the American public believed global warming was still a matter of scientific debate. (It’s not just Americans who are now addled. Just today, in the New York Times, I read that “only 26 percent of Britons believe that ‘climate change is happening and is now established as largely manmade,’ down from 41 percent in November 2009. A poll conducted for the German magazine Der Spiegel found that 42 percent of Germans feared global warming, down from 62 percent four years earlier.”)
I’m just dancing on the surface of this book’s revelations. There’s so much more, and it’s all of a piece — as the director of British American Tobacco finally admitted, “A demand for scientific proof is always a formula for inaction and delay, and usually the first reaction of the guilty.”
Well said, as far as it goes. When I finished “Merchants of Doubt,” I felt a little more strongly about that guilt. I try to have compassion for the failings of others, hoping that they might have compassion for my failings, but I have trouble thinking that these scientists and the CEOs who hired them were misguided or confused or even blinded by the incessant need for profit. I now think there really is such a thing as Evil. In their book, Oreskes and Conway do a great public service — they give us their names of the villains and tell us their stories.
The Climate War: True Believers, Power Brokers, and the Fight to Save the Earth, by Eric Pooley, tells somewhat the same story as “Merchants of Doubt,” but it’s written as a political thriller. Here we meet a small army of idealists who labor mightily to draft and pass environmental legislation. They are brilliant, inventive and inspiring.
I’ve worked with Eric Pooley. He’s a great choice for a book like this; I can see him in the portrait of men and women he admires. And, to his credit, he’s fair to the people on the other side of the issue — indeed, as is often the case, the “villains” are more interesting.
But the good guys are up against an adversary so well-funded that it’s hard to understand why they persevere. And the legislative process — unreal! I knew it’s hard to draft a bill and move it through committees and have it emerge as a problem-solver, but I never quite grasped how… political the process is. From here, it looks as if you fight for a yard, lose a yard. And yet these eco-warriors keep at it. After 441 pages, I wanted to weep for them.
Still, I’m glad they keep going. The fix may be in, the denial campaign may have made most of us passive, uncaring victims. But at the very least, the bastards need to know we’re on to them.
By Jesse Kornbluth
May 25, 2010

The impact of tobacco in the European Union

Ahead of the 2010 No Tobacco Day (31 May), the European Commission unveils the results of a Eurobarometer survey which shows that a strong majority of EU citizens support stronger tobacco control measures. For example, three in every four Europeans supports picture health warnings on tobacco packs and smoke free restaurants. The survey also shows, however, that nearly one in every three Europeans still smokes, despite the fact that tobacco kills half of its users. The Commission is planning to launch an open consultation shortly with a view to revising the 2001 Tobacco Products Directive and is stepping up its tobacco control efforts throughout the EU.
1. What is the impact of tobacco on health in the EU?
An estimated 14 million people in the EU27 suffer from the six (1) main disease categories that are associated with smoking, i.e.
Approximately 650 000 EU citizens die prematurely every year because of tobacco.
Smoking affects non-smokers too. According to conservative estimates, 79 000 adults, including 19 000 non-smokers, died in the EU-25 in 2002 because they were exposed to tobacco smoke at home (72 000) and at in their workplace (7 300). It can be assumed that the magnitude of the problem has not changed remarkably during the last years.
2. How widespread is exposure to tobacco smoke in the EU?
In countries with no comprehensive smoke-free regulations, tobacco smoke is present in the majority of public places, most of which are also somebody’s workplace. In the case of children and adolescents, most of the exposure to tobacco smoke comes from parents and occurs in the home.
According to the latest Eurobarometer (May 2010):
* Smoking at home is allowed by 4 in 10 EU citizens (38%). The most permissive Member States are Greece, Spain and Cyprus, where at least 1 in 4 allow smoking everywhere in the house. Finnish and Swedish respondents are the strictest about smoking in their homes, with 95% and 86% respectively not allowing smoking in the home at all.
* 16% of citizens allow smoking in the car all the time and 12% some of the time. This depends on whether they smoke themselves. About two thirds of smokers permit smoking in the car (65%) compared with 13% of non-smokers.
* Of those who visited bars and eating establishments in the past 6 months, 45% recall that people were smoking inside the bar and 30% said the same about an eating establishment.
* A quarter of citizens are exposed to tobacco smoke in the workplace. At work, about 1 in 10 are exposed to tobacco smoke for less than an hour a day, 1 in 20 for between one and five hours per day and the remaining one in 20 for more than 5 hours per day.
3. Is there evidence that smoke-free policies work?
Smoking bans have positive health effects. While the full health benefits may take up to 20-30 years to be realised, the evidence from smoke-free countries is already very encouraging. Indoor air quality improved dramatically after the smoking bans went into effect, with an 83% and an 86% reduction in the concentrations of particulate matter in Irish and Scottish bars, respectively. Better air quality has been mirrored by substantial reductions in the incidence of heart attacks, including a drop of 11% in Ireland and Italy, a 17% drop in Scotland and even greater reductions in some US jurisdictions.
Numerous studies have also shown significant improvement in the respiratory health in hospitality workers as a result of smoke-free laws, ranging from 13 to 50%. Smoke-free policies have also been reported to reduce tobacco consumption and encourage quit attempts among smokers, thus contributing to a reduction in smoking prevalence.
4. What is the EU’s legislation on Tobacco?
The Directive on Tobacco Products (2001) requires manufacturers to put warnings on tobacco products, bans terms such as ‘light’, ‘mild’ or ‘low tar’, forces producers to provide full information on all ingredients and sets maximum limits for tar, nicotine and carbon monoxide in cigarettes.
The Directive on Tobacco Advertising (2003) bans cross-border advertising of tobacco products in printed media, radio and on-line services. It equally bans sponsorship of cross border events. Tobacco advertising and sponsorship on television has already been prohibited since 1989.
The Council Recommendation on smoking prevention (2003) encourages Member States to control all forms of tobacco promotion and sales to minors, as well as to improve awareness and health education.
The Council Recommendation on Smoke Free Environments (2009) calls on Member States to adopt and implement laws to protect citizens from exposure to tobacco smoke in enclosed public places, workplaces and public transport. It also calls for the enhancement of smoke-free laws with supporting measures such as protecting children, encouraging efforts to quit smoking and having pictorial warnings on cigarette packages.

5. What are national smoke-free regulations?

So far, 12 EU Member States provide for comprehensive protection from exposure to tobacco smoke.
Total bans on smoking in all enclosed public places and workplaces, including bars and restaurants, are in place in Ireland, UK and Cyprus. Italy, Malta, Sweden, Latvia, Finland, Slovenia, France, Lithuania and the Netherlands have introduced smoke-free legislation allowing for special enclosed smoking rooms.
However, in the remaining Member States, citizens and workers are still not fully protected from exposure to tobacco smoke in indoor workplaces and public places. Bars and restaurants are a particularly difficult area of regulation.
Partial smoking bans in the hospitality sector are in place in Austria, Bulgaria, Denmark, Greece, Portugal, Romania, Belgium, Luxembourg, Slovakia, Spain and most German Länder
For additional details see: table on implementation of smoke free measures in EU

6. What are the main possible changes in the Tobacco Products Directive that the Commission is analysing?

* Improving consumer information, for example by having bigger and double-sided picture warnings, standard packaging, qualitative information on harmful substances and information on cessation services.
* Introducing a control, restriction or ban, on harmful, addictive and attractive substances in tobacco products.
* Improving mechanisms for reporting and analysing tobacco products by introducing harmonised reporting systems and introducing accompanying fees.
* Examining the current rules on sales of tobacco products, in particular with regard to promotion at the point of sales, vending machines and distance sales.
* Addressing newly emerging products.
7. Will the Commission propose lifting the ban on oral tobacco/snus?
Snus is a smokeless tobacco product. It is a moist snuff which is placed under the lip for extended periods of time. The sale of snus is illegal in the European Union. Sweden is the only country in the EU that is exempt from this ban. The derogation was granted on condition that Sweden shall take all the necessary measures to ensure that snus is not placed on the market in other Member States.
The opinion of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) of February 2008 states that snus is a harmful product. This opinion calls for a very cautious approach; there are currently no plans to lift the ban.

8. What is the EU role in tobacco control at international level?

The EU plays an active role in tobacco control at international level. It was a driving force for the WHO Framework Convention on Tobacco Control (FCTC) which entered into force on 27 February 2005.
The EU is a full Party to the Convention since June 2005, as are 26 of its Member States (all but the Czech Republic).
The implementation of the Convention is a political and legal commitment for its Parties.
The first legally binding protocol under the Convention concerns the illicit trade in tobacco products and is in the final stages of negotiation.
In addition to the Convention itself, guidelines have been developed to facilitate and guide the implementation process. Such guidelines exist for tobacco product labelling, advertising, smoke free environments and protection of public health policies from the interests of tobacco industry.
Currently guidelines are being finalised on tobacco ingredients and their disclosure, on cessation and on awareness raising and education. They are expected to be adopted by the fourth conference of the Parties in November 2010.
Further information, WHO

Remarks to the Tobacco Merchants Association

Let me first thank you for inviting me to take part in your program today.FDA
I am pleased to join you to discuss the implementation of the Family Smoking Prevention and Tobacco Control Act.
It is perhaps fitting that you hear about this historic legislation in a setting like historic Williamsburg.
Let me start by telling you something about myself. Then let’s talk about your products and FDA regulation.
As you heard in my introduction, I have spent the last 30 years working to improve the health of Americans through my work as a physician and through the field of public health.
I trained in and worked in public health well before I became a physician and a researcher.
In graduate public health school, I studied the impact of diseases and behaviors on populations such as tuberculosis in inner cities, schistosmiasis in the Nile delta and lead exposure in infants, as well as tobacco use in the United States.
After receiving my public health degree, I initially worked on Capitol Hill and then continued my work in public health as a member of the Surgeon Generals’ staff in the Ford and then Carter Administrations. I was privileged to work on important public health issues of the day, including clean air, clean water, the health effects of poverty, health manpower issues. Back in 1978, I helped set up the original Office on Smoking and Health in what was then the Department of Health, Education and Welfare.
Later in life, I decided I wanted to become a doctor and went to medical school and completed my internship and residency right at the time when HIV/AIDS was discovered and became a major public health challenge. So in 1987, my medical training started to combine with my public health experience and I went to NIH to train in Infectious Diseases and to conduct AIDS research. I stayed at NIH for about 11 years, during which time I was able to contribute to much of the basic and clinical research that defined HIV and helped test the drugs which we use today to treat people with HIV infection.  During this time, I also continued to be an active clinician both at the NIH and Johns Hopkins.
I left NIH in 1998 to join the leadership team of the largest health care system in the country — the one that delivers care to our nation’s Veterans. I became the head of VA’s HIV/AIDS programs at a time when not many people recognized that VA was and is the largest provider of patient care to people with HIV infection. That was a time when VA began its transformation into a modern integrated health care system which has been proven to deliver the highest quality of care in the Nation. Over time I was asked to take on more responsibility and I became VA’s Chief Public Health Officer in 2006. Among my many responsibilities for our nation’s Veterans was to revitalize the VA’s tobacco cessation programs.
On my watch, Veteran’s tobacco use dropped from 33 to 22 percent.
Again, during this time I continued to practice medicine and became a primary care provider to about 100 Veterans at the Washington, D.C. VA Medical Center.
I love helping deliver medical care to Veterans — there is no group of patients more deserving of the best care we can provide. Let me tell you about one of my patients. I’ll call him Mr. Smith*. I met Mr. Smith in about 1999 and I was his primary care provider. Mr. Smith proudly served in the infantry in Vietnam. He was injured on his 2nd tour of duty, nearly died on the battlefield but was medivac-ed out, and after a long recovery from his wounds, he returned to civilian life.
Vietnam scarred Mr. Smith both physically and mentally. He suffered from PTSD from the horrors of war and his injuries. He began to use drugs and became infected with HIV. His years using drugs also scarred his kidneys so when we first met, Mr. Smith had AIDS, kidney failure — and he was on dialysis.
Mr. Smith entered VA’s drug recovery programs and, because of his determination and the good care he got from VA, he was successfully able to quit using drugs. His HIV infection had hurt his immune system but fortunately, with effective drug treatment, his immune system recovered and his overall health improved.
Despite needing to go to dialysis three times a week Mr. Smith held a job and cared for his family. He was so clinically stable that we began preparing Mr. Smith for a kidney transplant. One of the important criteria to be eligible for transplant is to be drug and tobacco free. He was drug free and although I had encouraged him to quit smoking for many years, the prospect of being free of dialysis gave him even more motivation — so we had been working on helping him quit smoking.
While we prepared to get him on the transplant waiting list, we tried many approaches to help him quit smoking. Mr. Smith was really having a hard time. But he was determined. He told me many times something I have heard over the years from many patients — how much harder it was to quit smoking than it was to quit shooting heroin.
Then around Thanksgiving, he began to lose weight, he developed a cough and a chest X ray showed a mass in his right lung which on biopsy was lung cancer.  Other X-rays showed the lung cancer had spread to his bones.
So, the battlefields of Vietnam didn’t kill him. He came home.
His drug use didn’t kill him – he recovered from that.
His HIV didn’t kill him – his treatments restored his immune system.
His kidney failure didn’t kill him and was being treated.
And Mr. Smith had the possibility of a transplant and a normal life without dialysis.
But for this tough, resilient, determined infantry soldier NONE of that took him out.
Mr. Smith died in January — it was his battle with smoking that finally took out this brave soldier.
So after Commissioner Hamburg asked me to take this job and during the first months I’ve been on the job, I’ve often thought about Mr. Smith and other patients like him. I recognized that this was an opportunity to serve my country by helping to prevent our men, women and children from suffering and dying from tobacco-related disease.
I took this job so there are fewer kids who start to use tobacco. I took this job so fewer families devastated by the early death of a loved one. And I took this job because the public health mandate of the Family Smoking Prevention and Tobacco Control Act is so promising with respect to helping reduce the toll of disease, disability and death caused by tobacco use in this country.
I have been on the job nine months now. I have had a chance to take stock of the status of tobacco use in the United States, and let me give you a quick glimpse of what I see.
I see that more than 400,000 Americans still die unnecessarily each year from diseases related to using tobacco products.
That’s more than all the deaths caused by HIV/AIDS, alcohol use, cocaine use, heroin use, homicides, suicides, motor vehicle crashes, and fires combined.
I see that another 8.6 million Americans have at least one serious illness due to smoking.
I see the 50,000 non-smokers who die each year from exposures attributed to second-hand smoke.
I see that between 20 to 25 percent of American high school students still use tobacco.
I see that 4,000 kids start smoking every single day — and 1,000 of them become regular users.
I see that many of these kids will become addicted before they are old enough to understand the risks and will ultimately die too young from diseases directly linked to their tobacco use — lung disease, heart disease and stroke and cancers of the lung, mouth, larynx, esophagus and bladder.
I also see that these kids who are smokers aren’t rummaging around through mom’s purse looking for a stray cigarette. Many are addicted and have product loyalties as pronounced as any adult.
You’re in the tobacco business — you know these choices don’t happen by accident. Recent data show that 43 percent of youth smokers actually prefer one brand of cigarette, Marlboro. In fact, according to CDC, 81 percent of underage smokers preferred the three most heavily advertised brands: Marlboro, Newport, and Camel.
I also see that even today, many smokers falsely believe that terms like “Light” or “Low Tar” mean that those products are less harmful than full flavored cigarettes. Of course, we know that is not true because no data exists that prove the decades of engineering and marketing of products called ‘light’ ‘low’ and ‘mild’ are safer than any other cigarettes. In fact, it has actually been shown because of smokers’ now-proven misperceptions that those products actually reduce motivation to quit tobacco use and keep people smoking longer.
I also see that as states and communities are enacting more indoor clean air laws and increase taxes particularly on cigarettes, new types of tobacco products are being developed. Some of these new products appear, taste like and may be confused for candy by kids.
I see my job at FDA is to address this enormous toll of confusion, suffering, and death caused by the current state of tobacco use in this country.
And frankly, we have a long way to go.
And if we can’t make significant progress, I have failed in my job.
So now let me turn to what we intend to do with this new law at FDA to protect public health.
As I recently wrote in the New England Journal of Medicine with the FDA’s Commissioner and Principal Deputy, the FDA’s public health approach to tobacco regulation has four key elements:

  • reducing the rate of initiation of tobacco use,
  • educating the public,
  • applying regulatory science to the control of tobacco products, and
  • engaging actively with public health partners and industry.

Reducing Initiation: The most effective way to reduce the harm is to deter use altogether.  Stopping addiction before it starts is a key initial priority for FDA.  FDA’s first efforts will focus on restricting the marketing and illegal sales of tobacco products to youth and setting initial standards for additives that facilitate youth use.
We will do so by implementing requirements of the law which places restrictions on marketing and promotion to kids such as setting a national minimum age of 18 for purchases and a minimum pack size of 20 cigarettes, banning free cigarette samples and restricting free smokeless samples, eliminating the brand-name sponsorship of sporting events and concerts and establishing a national enforcement system with States and Territories to deter underage tobacco purchases.
We will do so by regulation of tobacco products themselves. Effective September 22, 2009, FDA banned cigarettes with fruit, candy, and other characterizing flavors. Congress authorized this ban because of clear evidence that these flavors act to encourage youth experimentation, regular use, and addiction.
FDA is also examining the role of menthol flavoring in tobacco use by young people and its specific impact on racial and ethnic minorities. And FDA also has the authority to act on tobacco products other than cigarettes or smokeless tobacco that may lead to addiction and tobacco use by young people.
Educating the Public: Most Americans know generally that tobacco is harmful, l but few know the key facts of how damaging tobacco is to their own health and the health of those around them.  In the Tobacco Control Act, Congress gave FDA the tools to educate the public about the actual ingredients and constituents in tobacco products and the profound consequences of exposure to them.
The law also requires FDA to enforce truth in advertising. As I said before, even today, many smokers falsely believe that terms like “Light” or “Low Tar” indicate that those products are less harmful than other cigarettes.  To correct false impressions about the safety of these and other tobacco products, the law requires that tobacco products that use the terms “light,” “low,” and “mild,” on labels or in advertising can no longer be manufactured after June 22nd without FDA approval.
In addition, under the new law tobacco manufacturers must submit detailed lists of ingredients and constituents to FDA as well as documents and data regarding their safety. This material will enable FDA to publish lists of potentially harmful constituents in tobacco products and their smoke, as required by the new law.
The law also requires FDA to propose new graphic pack warning labels comprising 50 percent of the front and back of each cigarette pack and box and start a new system of health warnings for smokeless tobacco products.
FDA also has the authority to request information and studies conducted by tobacco manufacturers on any topic.
Applying Regulatory Science: There exists a substantial scientific base for each of the areas in which the FDA has been empowered to act.  FDA will build on this base to guide key decisions in tobacco regulation.
A major area of focus is in the approval of “modified risk” products. We expect companies to seek approval for products that have “fewer carcinogens” or are “less toxic.”   In setting standards for approval of these products, FDA is well aware of the public health calamity of “light” and “low” cigarettes that I have mentioned.
The law says that in reviewing applications regarding “modified risk” products, the FDA must be presented with sufficient data to understand the health impact on users and non-users as well as the appeal to young people, who might begin a lifetime of tobacco use. To assist, FDA may request and tobacco companies must provide this data with their applications as well as conduct strict post-market surveillance to verify that the products are reducing tobacco-related morbidity and mortality.
Importantly, the new law sets new public health product standard for FDA’s tobacco product regulations which is more appropriate than FDA’s traditional, ‘safe and effective’ standard.   One of FDA’s most powerful tools is the setting of product standards across a class of tobacco products to reduce addictiveness or harm.
Let me end with a few words about the relationship between FDA and industry.
We at FDA understand that it is never easy for an industry to submit to new regulation. The tobacco industry poses special challenges, and speaking frankly, the industry has a long history of resistance to government action.
And, you may realistically perceive the Tobacco Control Act as a serious threat to the tobacco industry’s long-term interests.
Yet I realize that successful implementation of this law will require engaging the various components of the tobacco industry directly, fairly, and transparently. The design of effective regulatory measures must be based on an understanding of the industry to be regulated. For example, input from a wide variety of tobacco companies helped us in establishing a system for industry registration and listing of tobacco products and industry feedback is important to improvements we intend to make in those systems.
While we are a new part of FDA, we have already established a Small Business Assistance Office, a Call Center to field questions and a Web site which adds new information almost every day.  We’ve held listening sessions with industry representatives, distributors and others and we are organizing a series of moderated discussions throughout the country over the next 18 months.
And I want you to know that understanding and engaging with the tobacco industry is important.  That is why I am here today.
That’s also why I asked Les Weinstein to join me at this meeting. Les is the Center for Tobacco Products Ombudsman.  His job is to help resolve regulatory confusion and problems so that this law can be implemented fairly.
I also asked some other members of my staff to come here, too. Perhaps they could stand up.  Unlike me, they didn’t come here to give a speech — they came to listen.
When I was preparing for this meeting, I realized that as representatives of different parts of the tobacco industry, you each face a choice of walking one of two paths with FDA.
One path is confrontational, to try to block FDA at every turn in implementing this law.
To those on such a path, I can only point out that FDA regulation of tobacco products is the result of a law which passed overwhelmingly by Congress and signed by the President.  It is the law and the FDA has the authority to bring advisory, administrative,or judicial actions, including, for those who ignore the law issuing warning letters, seizures, injunctions, civil money penalties and criminal prosecutions.
And FDA will not hesitate to take these steps when warranted by the facts.
But there is the other path too.  And that path is based on the recognition that the people of the United States expect us to use this law to protect their families and the public health.
I hope you will see value of helping FDA to understand the tobacco industry, and that you will participate in the regulatory process and then comply with the FDA’s policies to reduce the devastating harm that tobacco causes for millions of American families.
In my career, I have witnessed what happens when we apply science to public health challenges.  In the case of HIV, through the application of science, what was once a uniformly fatal infectious disease is now largely a manageable chronic condition.
It is my hope that tobacco will become another example of how the application of excellence in science will have a major impact on the public health.
Thank you for your attention.
Dr. Lawrence Deyton, Fda.go

New Ordinance Target Cigarettes Marketing

Many years ago Joe Camel was drove away from the public eyesight because he was seen as a way to captivate the attention of especially of minors. Because of Joe Camel most of them started smoking habit.
So, this is the main reason why state government decided to enlarge its anti-smoking legislations, because children are the Future.
For example, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act on June 22 last year. The new legislation gives the Food and Drug Administration (FDA) the power to control the manufacture, trading and even distribution of all smoking products. The main goal of the new regulation is to protect inhabitants’ health and to reduce the use of tobacco by kids and adolescents.
The new bill enforced stricter regulations on marketing tobacco. According to the Lee County Clean Air Coalition’s Emily Carrick, tobacco manufacturers’ ads in teen storehouse or similar announcements can no longer use color, but have to censure to black text on a white background.
The new legislation banned the selling and advertising of non-tobacco units like t-shirts or new items carrying a cigarette or smokeless tobacco brand-name, logo or even selling message.
Appeared also special programs like “Marlboro Miles” and “Camel Cash” after the new anti-smoking law was enforced. The new regulation will not permit items other than cigarettes or smokeless tobacco to be replaced for credits, coupons for to purchase of cigarettes or smokeless tobacco products.
Till now Tobacco Companies were the main sponsorships of athletic, musical, artistic or other social or cultural events.
At least the companies will not be able to display a brand name, logo, symbol, motto, or even recognizable prototype of colors or any other methods to identify their smoking products if they do sponsor an event.
Approximately 450,000 people in the United States died from smoking-related diseases each year, according to the Centers for Disease Control and Prevention. Usually smokers die 14 years earlier than non-smokers.

Differences by Sex in Tobacco Use – Bangladesh, Thailand, and Uruguay

The majority of the world’s 1.3 billion tobacco users are men, but female use is increasing. To examine differences in tobacco use and awareness of tobacco marketing by sex, CDC and health officials in Bangladesh, Thailand, and Uruguay (among the first countries to report results) analyzed 2009 data from a newly instituted survey, the Global Adult Tobacco Survey (GATS). This report summarizes the results of that analysis, which indicated wide variation among the three countries in tobacco use, product types used, and marketing awareness among males and females. In Bangladesh and Thailand, use of smoked tobacco products was far greater among males (44.7% and 45.6%, respectively) than females (1.5% and 3.1%, respectively). In Uruguay, the difference was smaller (30.7% versus 19.8%). Use of smokeless tobacco products in Bangladesh was approximately the same among males (26.4%) and females (27.9%), but females were significantly more likely to use smokeless tobacco in Thailand (6.3% versus 1.3%), and use in Uruguay by either sex was nearly nonexistent. Males in Bangladesh were twice as likely as females to notice cigarette advertising (68.0% versus 29.3%), but the difference between males and females was smaller in Thailand (17.4% versus 14.5%) and Uruguay (49.0% versus 40.0%). In all three countries, awareness of tobacco marketing was more prevalent among females aged 15–24 years than older women. Comprehensive bans on advertising, sponsorship, and promotion of tobacco products, recommended by the World Health Organization (WHO), can reduce per capita cigarette consumption if enforced.
GATS* is a new nationally representative household survey of persons aged ≥15 years, initially conducted during 2008–2009 in 14 countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Bangladesh, Thailand, and Uruguay were among the first countries to report results. The GATS core questionnaire includes detailed questions regarding the demographic characteristics of respondents, their tobacco use, and a wide range of tobacco-related topics (e.g., cessation, secondhand smoke, economics, media, and knowledge, attitudes, and perceptions). In each country, a multistage cluster sample design is used, with the number of households selected proportionate to population size. Households are chosen randomly within a primary sampling unit or secondary sampling unit, and one respondent is selected at random from each selected household to participate in the survey. Interviewers administer the survey in the country’s local language, using handheld electronic data collection devices. Interviews are conducted privately and same-sex interviewers are used in countries where culturally appropriate (e.g., Bangladesh). Response rates and number of participants for the three countries in 2009 were as follows: Bangladesh, 93.6% and 9,629; Thailand, 94.2% and 20,566; and Uruguay, 95.6% and 5,581.
To examine differences in tobacco use by sex, estimates of current tobacco use† in the three countries were analyzed for both smoked tobacco products§ and smokeless tobacco products.¶ To examine differences in tobacco marketing awareness by sex, “yes” responses were analyzed to questions regarding whether participants had noticed advertising, promotion, or sponsorship of cigarettes in the preceding 30 days. Estimates were reported for noticing any cigarette marketing, noticing marketing in stores where cigarettes are sold, and noticing marketing other than in stores where cigarettes are sold.** In Bangladesh, similar questions regarding bidi†† and smokeless tobacco marketing were included in the survey. All estimates were weighted to reflect the noninstitutionalized population aged ≥15 years in each country, accounting for clustered sampling in the variance estimation. Statistical significance of differences in values was determined using a chi-square test, with significance determined at p<0.05.
In all three countries, current tobacco use was higher among males than females, but use of tobacco varied substantially by sex. In Bangladesh, overall smoking prevalence among females (1.5%) was far lower than males (44.7%). However, the prevalence of smokeless tobacco use among females (27.9%) and males (26.4%) was approximately the same. In Thailand, smoking prevalence was much lower among females, compared with males (3.1% versus 45.6%), but smokeless tobacco use was higher among females than males (6.3% versus 1.3%, respectively). In Uruguay, 19.8% of females were current smokers, compared with 30.7% of males, but only one of the 5,581 participants reported using smokeless tobacco.
Regardless of age group or region type smokers (urban or rural), males were more likely to smoke than females in all three countries. Among both males and females, smoking prevalence varied by age group but did not vary greatly by region type. In Bangladesh and Thailand, smokeless tobacco use among both males and females increased with age group, and smokeless tobacco use was higher in rural than urban areas. In each of these countries, the greatest prevalence of smokeless tobacco use was among women aged ≥65 years: 64.1% in Bangladesh and 32.9% in Thailand.
The percentage of females who noticed any cigarette advertising, sponsorship, or promotion in the preceding 30 days was 29.3% in Bangladesh, 14.5% in Thailand, and 40.0% in Uruguay. Among males, the prevalence was 68.0% in Bangladesh, 17.4% in Thailand, and 49.0% in Uruguay. Among females, awareness of cigarette marketing in stores where cigarettes are sold was 22.0% in Bangladesh, 7.6% in Thailand, and 24.0% in Uruguay. In Thailand and Uruguay, little or no difference in awareness of in-store cigarette marketing was observed between males and females; however, in Bangladesh, the prevalence among males (54.8%) was more than double the prevalence among females. Similar patterns by sex were observed for awareness of cigarette marketing other than in stores where cigarettes are sold. The percentage of females who noticed tobacco advertising, sponsorship, or promotion other than in stores where cigarettes are sold was 16.5% in Bangladesh, 8.3% in Thailand, and 31.6% in Uruguay.
In all three countries, awareness of cigarette advertising was greater among females aged 15–24 years than women aged ≥25 years. Similar age differences were observed among males in all three countries. In Bangladesh, awareness of bidi (80.1%) and smokeless tobacco (69.9%) marketing was widespread among females and did not vary by age. In Thailand, for both males and females, those who lived in urban areas were more likely to report exposure to cigarette marketing than those in rural areas. This relationship also was observed among males in Uruguay. In contrast, awareness of both bidi and smokeless tobacco marketing in Bangladesh was more common among males in rural areas than in urban areas.

Editorial Note

This report is the first to compare results among countries that participated in GATS. The findings demonstrate the wide variation in prevalence of tobacco use and types of tobacco used by males and females in Bangladesh, Thailand, and Uruguay and also the widespread exposure to tobacco marketing in these three countries, particularly among persons aged 15-24 years. Although tobacco use surveys have been conducted previously in all three countries, the results from GATS are the first that allow comparison among countries using the same core questionnaire and survey method.
One finding from these surveys is the lower prevalence of current smoking among females in Bangladesh and Thailand compared with males, but the higher prevalence of smokeless tobacco use among females. This reflects the traditional social acceptance of smokeless tobacco use among females in Southeast Asian countries, where older women are more likely to be users. In contrast, in Uruguay, smokeless tobacco use by either sex is virtually nonexistent. Tobacco use in individual countries reflects a complex interaction of personal, familial, cultural, and social factors, including exposure to tobacco industry marketing. For example, in the United States, girls and young women have been shown to be particularly susceptible to beliefs about self-image and weight control, and might be influenced more by female friends and role models who smoke or use tobacco.
GATS survey results like these can be used to better understand comparative patterns of tobacco use among countries, which, in turn, can be used to create more effective control programs and monitor the impact of these programs. GATS was created to enable systematic monitoring of tobacco use by persons aged ≥15 years and key tobacco-control indicators in low- and middle-income countries. Over time, GATS will provide detailed information on a range of tobacco-control topics, including cessation, secondhand smoke, economics, media, and knowledge, attitudes, and perceptions.
The theme of WHO’s World No Tobacco Day 2010 (May 31) is “gender and tobacco with an emphasis on marketing to women.” Tobacco marketing is important to the initiation and maintenance of tobacco use. In all three countries in this report, greater awareness of cigarette marketing was found among females aged 15–24 years than older women, suggesting that tobacco companies might be targeting this age group. Historically, the tobacco industry has taken advantage of increasingly liberalized social attitudes toward women and increased economic empowerment of women to aggressively market and sell its products. In the absence of effective tobacco control policies, this pattern might repeat itself in low- and middle-income countries, resulting in a rise in tobacco use and tobacco-related disease and death.
Globally, each year, the tobacco industry spends tens of billions of dollars on direct and indirect advertising of tobacco products. Comprehensive bans on tobacco advertising, sponsorship, and promotion have been shown to reduce per capita cigarette consumption if adequately enforced. Enforcement of bans on tobacco advertising, sponsorship, and promotion, is a component of WHO’s MPOWER strategy. According to WHO, only 26 countries have implemented comprehensive bans on direct and indirect tobacco advertising, and many do not have high levels of compliance. Bangladesh and Uruguay have a ban on all national television, radio, and print media, and on some, but not all, other forms of direct and/or indirect advertising of tobacco products. In these countries, enforcement is rated as high, but not complete. Thailand has a ban on all direct and indirect advertising, with the level of enforcement rated somewhat lower.§§ The results presented in this report indicate that the lowest prevalence of awareness of cigarette marketing, among both males and females, was found in Thailand, where prohibition of the display of cigarettes packets or logos of tobacco brands at the points of sale was enforced beginning in 2005.
The findings in this report are subject to at least two limitations. First, the prevalence results are based on self-reports. In certain settings, social norms (i.e., unacceptability of women smoking) might result in underreporting. However, this tendency might have been mitigated by using same-sex interviewers and conducting interviews in private settings. Second, regarding the findings on awareness of tobacco marketing, slight variations in the number and type of specific response categories used in each country might limit comparability. For example, Thailand added a category of “pubs/bars” as a site for tobacco marketing to the core GATS questionnaire and removed “public walls.” Uruguay added the category “e-mail” to promotions, and Thailand added a category for the “Internet.” Aside from these differences, the response categories were similar among the three countries.
Continued monitoring will be needed to determine trends in tobacco use and awareness of tobacco marketing and the differences between males and females. Repeated GATS surveys in participating countries will allow the countries to compare results to other countries, track key tobacco control indicators, and monitor progress toward tobacco-control goals.


This report is based, in part, on contributions by R Caixeta, DDS, Pan American Health Organization, and D Sinha, MD, Southeast Asian Regional Office, World Health Organization.

Tobacco Talk: FDA web dialogue on tobacco

WASHINGTON — Retailers were given the opportunity to “share ideas, offer recommendations [and] ask questions” about how the U.S. Food & Drug Administration’s Center for Tobacco Products (CTP) can better communicate with them, during a web dialogue on Wednesday.
By midday, there were 357 retailers, tobacco-control executives and others participating in the dialogue, but the discussion was decidedly one-sided. The CTP mostly thanked participants for their input and promised to take the information under advisement. As Kathleen Quinn, acting director of health communication and direction at the CTP put it, “The purpose of today’s open dialogue was to see what channels and tactics are best to be used to reach retailers. It wasn’t meant to answer detailed questions on the regulations.”
Thomas Briant, executive director of the National Association of Tobacco Outlets Inc. (NATO), participated in the all-day event, and told CSP Daily News, “I think the web conference is somewhat effective for retailers and others to give input to the FDA; however, it does not appear to be very effective in obtaining feedback or answers to question asked of the FDA.”
The discussion particularly looked at rules that limit the sale, distribution and marketing of cigarettes and smokeless tobacco, which become effective on June 22, 2010. Among other things, the regulations:

  • Prohibit the sale of cigarettes or smokeless tobacco to people younger than 18.
  • Prohibit the sale of cigarette packages with fewer than 20 cigarettes.
  • Prohibit the sale of cigarettes and smokeless tobacco in vending machines, self-service displays or other impersonal modes of sales, except in very limited situations.
  • Prohibit free samples of cigarettes and limits distribution of smokeless tobacco products.
  • Prohibit tobacco brand-name sponsorship of any athletic, musical or other social or cultural event, or any team or entry in those events.
  • Prohibit gifts or other items in exchange for buying cigarettes or smokeless tobacco products.
  • Require that audio ads use only words with no music or sound effects.
  • Prohibit the sale or distribution of items, such as hats and t-shirts, with tobacco brands or logos.

The various topics were blanketed under two agenda items, “Help Us Help You—Information You Need” and “Meeting Retailer Needs—Effective Channels and Messages.”
One particular topic, “Sell Through of Cigarette Brands with Descriptors,” drew in the more participants than any other (20 at press time). Briant explained that one of the primary questions being asked is on the ability to sell through, at the wholesale and retail level, cigarette brands with descriptors of “light,” “mild,” or “low.”
“With the June 22nd effective date of the regulation prohibiting such descriptors, the industry needs a reply immediately on whether wholesalers and retailers can sell through their inventories,” he said, “and that response has not been forthcoming from the FDA.”
Briant suggested that beyond the “cut and paste” responses of the web dialogue, the FDA should have had an attorney who “has the authority to answer some of these conversations at the time they’re raised, rather than having to wait for an indeterminate amount of time for an answer or response.”
Briant said another concern was on point-of-sale advertising. A federal district court struck down the ban on color tobacco advertising, which the FDA has now appealed to the U.S. circuit court of appeals. “On that one, because the litigation is ongoing, they can’t answer,” he said.
Additional questions pertained to self-service bays, social media, text messaging, casinos and signage, among other topics. It was not immediately clear when the FDA hopes to have responses to retailer questions and concerns.
“I hope the answers will be forthcoming, because the industry needs to know the answers so we can comply with the law,” Briant said. “We want to be compliant, but we need to know or be provided with accurate information in order to comply.”
Briant said NATO will send its members sometime during the first week of June a memo with the best advice at that point and time of how retailers should comply with the regulations that go into effect June 22.
By Linda Abu-Shalback Zid
CSP, May 27, 2010

WHO warns tobacco firms targeting women and girls

The World Health Organization (WHO) on Thursday urged Asia-Pacific countries to protect women and girls from aggressive efforts tobacco free worldby tobacco firms to induce them to start smoking.
In a statement ahead of World No Tobacco Day on May 31, the WHO’s regional office in Manila warned that smoking among women and girls was increasing in the Asia-Pacific.
It is estimated that more than 8 per cent of girls from 13 to 15, or around 4.5 million, are using tobacco products in the region, the WHO said.
“Starting early results in addiction that later translates to a life of nicotine dependence, poor health and premature death,” warned Shin Young-soo, the WHO’s regional director for the Western Pacific.
Shin said bans on advertising, promotion and sponsorship were needed to protect women and girls from deceptive messages that portray smoking as glamorous or fashionable.
“The truth is, smoking is ugly and harmful to health,” he said.
“Currently, only half of the countries in the Western Pacific have complete bans on advertising.” Shin added that smokers should not be tricked into believing that cigarettes labelled as light or mild are safer or less harmful.
“Misleading cigarette descriptors are meant to conceal the fact that all cigarettes contain 4,000 hazardous chemicals and 60 known carcinogens,” he said. “No cigarette is safe or less harmful.” The WHO also expressed alarm that close to half of all women in the Asia-Pacific are exposed to secondhand smoke in their homes or workplaces.
Secondhand smoke has been classified as a carcinogen in several countries and is known to cause lung cancer, heart disease and respiratory conditions.
But women and girls are sometimes forced to endure secondhand smoke because of cultural and social norms, the WHO said.
“For example, in China, 97 per cent of smokers are men and more than half of all Chinese women of reproductive age are regularly exposed to second-hand smoke,” it said.
A study in Shanghai of 72,000 non-smoking women found that exposure to their husbands’ habit increased their risks of dying from lung cancer, heart disease and stroke by up to 50 per cent.
Manila, Май 27, 2010

Falling into the tobacco trap

In the recent past, Big Tobacco has stepped up its advertising campaigns for a new target group — women. Set against a hot pink quit smokingtag which screams ‘Smoking is Ugly’, the World Health Organisation’s Global Tobacco Epidemic Report 2009 gives the alarming numbers — of the five million who die annually of tobacco abuse, 1.5 million are women.
New targets
But tobacco use among women, globally, is still comparatively low — only 9 per cent to the male 40 per cent. That explains the shift in focus with tobacco’s new gender-specific advertising. For an industry that needs to constantly seek replacement users, this is their biggest opportunity group. “With women”, the report goes on to state, “the industry simply has more room to expand.” But how can tobacco use possibly increase, when the industry has been banned from advertising its products and the government has clamped down on sponsorships of public events by tobacco companies?
Bhavna Mukhopadhyay, Executive Director of the Delhi-based grassroots organisation Voluntary Health Association of India (VHAI) that, among other things, works for tobacco control, explains how tobacco giants circumvent laws to promote their products. Something as harmless as shampoo could be a sneaky way to push a pack of cigarettes at you.
Why? Because they’re both from India’s biggest cigarette manufacturer ITC, or rather Indian Tobacco Company. Such surrogate advertising, where a product’s ad is indirectly used to promote another, is what tobacco companies resort to now. A lot of imagery that surrounds such advertising is directed at women, Bhavna adds. And once a brand ambassador like Deepika Padukone or Kareena Kapoor is raked in, the limelight is inevitable.
Elaborating on celebrity endorsements of tobacco-linked products, Bhavna talks of when Preity Zinta was the face for the Godfrey Phillips Bravery Awards. The awards were instituted by Godfrey Phillips India Ltd., India’s second largest cigarette brand. She argues, “What right does a product that kills numerous people every year have to award bravery?” The ads stopped only after VHAI wrote to the Bollywood star pointing out the irony.
Marketing tactics
But gender-specific advertising can also get a lot more direct. Cigarettes targeting women are usually described as ‘low tar’, ‘fresh’, ‘slim’, or ‘light’. The adjectives though, don’t make the tobacco inside any less harmful. Companies burn billions planning the right promotional strategies to make tobacco sell. Traffic to their websites is encouraged by selling tickets to shows and concerts online. Retail shops use the time-tested product giveaways — like bling phone pouches. Cigarettes become complimentary in pubs, home to the free-spirited girl of today. The ploy is to create a whole new feminine culture that’s centered on the product. So that the modern definition of women’s liberation includes a smoking cigarette held between slender, well-manicured fingers.
Rural reach
Chewed tobacco — not as elitist but equally deadly — is already a health issue with a majority of rural women, particularly in the east and northeast. Small sachets of gutka and paan masala are priced as low as one rupee; which keeps the addiction affordable. Many of these packs feature smiling, happy women. Sometimes, they are also prominently described as ‘kesar yukt’ (with added saffron!). But the statutory warnings are illegible.
When toiletry lines to pretty cell phone covers carry the brand imprints, it’s hard not to miss the emphasis. All this subtle marketing creates false goodwill for the central product — tobacco. So in our minds, smoking becomes a little less evil, which can be lethal, especially when lung cancer has already become the leading killer in women.
Gone up in smoke
Number of tobacco users globally is estimated at 1.2 billion
India is the third largest producer of tobacco in the world.
In India, tobacco use is responsible for half of all cancers in men and a quarter of all cancers in women.
India has the highest rates of oral cancer in the world.
Women who smoke are twice as likely to suffer a heart attack as non-smoking women.
The risk of developing lung cancer is 13 times higher for women smokers.
Smoking is a known cause of cancer of the lung, larynx, mouth, oral cavity, bladder, pancreas, uterus, cervix, kidney, stomach and oesophagus.
Deadly in pink
A recent report by the American tobacco-control organisation, Campaign for Tobacco Free Kids, describes the industry’s new marketing campaigns that project cigarette smoking as “….feminine and fashionable, rather than the harmful and deadly addiction it really is”.
October 2008: Philip Morris USA announced a makeover of its Virginia Slims brand into “purse packs”. Available in mauve and teal and half the size of regular cigarette packs, the sleek “purse packs” resemble packages of cosmetics and fit easily in small purses. Their “Superslims Lights” and “Superslims Ultra Lights” versions continue to (misleadingly) associate smoking with weight control.
January 2007: R.J. Reynolds launched the new version of its Camel cigarettes, Camel No. 9, packaged in shiny black boxes with hot pink and teal borders. The ads carried slogans including “Light and luscious” and “Now available in stiletto”, the latter for a thin version of the cigarette pitched to “the most fashion forward woman”. Promotional giveaways included flavoured lip balm, cell phone jewellery, tiny purses and wristbands, all in hot pink.
Different point of view
The epidemic of tobacco use manifests itself differently among women:
Women’s reasons for smoking often differ from those of men. The tobacco industry dupes many women into believing that smoking is a sign of liberation, and many women wrongly view smoking as a good way of keeping slim.
Women who smoke are more likely than those who do not to experience infertility and delays in conceiving. Maternal smoking during pregnancy increases the risks of premature delivery, stillbirth and newborn death and may cause a reduction in breast milk.
Smoking increases women’s risk for cancer of the cervix. There is a possible link between active smoking and premenopausal breast cancer.
Many tobacco control strategies ignore women who chew tobacco.
Passive smoking
Second-hand smoke is particularly worrisome for women.
In many countries, vastly more men smoke than women, and many of those countries fail to protect non-smokers adequately.
In many countries, women are powerless to protect themselves, and their children, from second-hand smoke.
In China — where the vast majority of adult smokers are men — more than half of women of reproductive age are regularly exposed to second-hand smoke, which puts themselves and their unborn babies at risk.
Feminine marketing
Tobacco industry marketing endangers women
Advertisements falsely link tobacco use with female beauty, empowerment and health. In fact, addiction to tobacco enslaves and disfigures women.
Advertisements lure women with such misleading identifiers as “light” or “ow-tar”. More women than men smoke “light” cigarettes, often in the mistaken belief that “light” means “safer”.
Smoking reduces a woman’s fertility, causes intra-uterine growth retardation, and physical and mental disabilities in children.