Beware! Today’s cigarettes more dangerous than 50 years ago

Beware! Today’s cigarettes more dangerous than 50 years ago

The latest  US Surgeon General’s Report released in 2014 states: “today’s cigarette smokers – both men and women – have a much higher risk of lung cancer and chronic obstructive pulmonary disease (COPD) than smokers in 1964, despite smoking fewer cigarettes.” 

The report further establishes that the increased risk of lung cancer is the result of tobacco industry changes to the design and composition of cigarettes.

The Surgeon General relied on evidence from large epidemiological studies which demonstrate that there has been a progressive increase in lung cancer and COPD among smokers in the United States between 1959 and 2010. 

The Surgeon General found that, between 1959 and 2010, the risk of lung cancer to smokers increased tenfold for women and doubled for men. The risk increased despite the fact that the prevalence of smoking and the number of cigarettes consumed per smoker decreased over the same time period.

Moreover, the epidemiological evidence demonstrates that the increased rates of lung cancer have only occurred in smokers; there has been no comparable increase for non-smokers. This disparity leaves no doubt that the increase is directly linked to cigarette smoking and points to changes in the cigarette as the likely cause.

Tobacco specific nitrosamines (TSNA) are potent carcinogens. Changes in cigarette design over the last 50 years have dramatically increased TSNA levels in American cigarettes. 

“The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have not reduced overall disease risk among smokers and may have hindered prevention and cessation efforts.” What is new is the emerging recognition that the very design change that lowered machine tar and nicotine ratings has in all likelihood increased the risk of smoking-related disease.

After an exhaustive trial and the presentation of a massive amount of evidence, US District Court Judge Gladys Kessler found, and the US Court of Appeals for the DC Circuit upheld, that the companies have known for decades that there is no health benefit from smoking low-tar or low nicotine cigarettes as opposed to conventional, full-flavored cigarettes; that the machine test method for measuring tar and nicotine was unreliable for measuring the amount of tar and nicotine a smoker would absorb in part because it did not take into account addiction and the phenomenon of smoker compensation; and that smokers were concerned and anxious about the health effects of smoking and chose light cigarettes because they relied on the health claims that the companies falsely made for light cigarettes as a reason for not quitting.

Despite this knowledge, the companies extensively − and successfully − marketed and promoted their low-tar and light cigarettes in ways that led consumers to believe they were less harmful alternatives to full-flavor cigarettes.

As a result of this evidence, the 2009 Tobacco Control Act prohibited the use of descriptors such as “light,” “smooth,” or “mild” for cigarettes sold in the United States beginning in 2010. 

The same prohibition is included in the WHO Framework Convention on Tobacco Control, a global treaty that has been ratified by 178 nations. Despite this prohibition, cigarette manufacturers continue to market such cigarettes and communicate the same misleading messages by color-coding their packs. Thus, products incorporating the same cigarette design elements responsible for increasing the risk of lung cancer to smokers remain dominant in the marketplace.

The Surgeon General helps to answer a critical question:

Why does tobacco use remain such an enormous public health problem?

Prior reports have highlighted the role of tobacco marketing, especially in causing kids to start and continue using tobacco. The tobacco industry continues to spend huge sums – $8.8 billion a year, or $1 million every hour – to market its products, according to the latest data from the Federal Trade Commission.

What was not known until recently is the public health impact of design changes the tobacco industry has made to the cigarette itself.

The latest Surgeon General’s report concludes that over the past 50 years, tobacco manufacturers have designed and marketed ever more sophisticated products that are highly effective at creating and sustaining addiction to nicotine, more appealing to new youth smokers and more harmful. They took a deadly and addictive product and made it worse, putting smokers at even greater risk of addiction, disease and death.

This report describes the key ways in which tobacco companies design and manipulates their products to attract new youth smokers, create and sustain addiction, mislead consumers to think that they are reducing their risk of disease and make it more difficult for users to quit. It also found, the design changes during the past 50 years to make cigarettes even more dangerous.

This report is based on an extensive review of scientific studies and tobacco industry documents made public as a result of litigation against the industry. It also draws on the conclusions of Surgeon General’s reports and the 2006 Final Opinion of U.S. District Court Judge Gladys Kessler, who in U.S. v. Philip Morris, Inc., found the major cigarette manufacturers had violated civil racketeering laws by deceiving the American people about the addictiveness and health risks of their products.

This evidence makes clear those tobacco products – and cigarettes in particular – are highly engineered to expand the appeal of these products and facilitate the consumption and addiction to nicotine, a highly addictive drug. Tobacco companies also know that almost all new smokers begin their addiction as children and that smoking is distasteful for new smokers, so they carefully design the product to appeal to this important market. The companies have spent huge sums to research the design of their products and ensure they achieve these goals, even if the impact of these changes also makes the product more dangerous.

Addictiveness of cigarettes

Independent evidence and the tobacco industry’s own documents make clear that the tobacco companies have used design features and chemical additives in the manufacturing process in ways that increase the impact of nicotine, the addictive agent in tobacco products. Some of the ways the addictiveness of cigarettes has been increased include:

• Increasing nicotine levels

• Adding ammonia or ammonia compounds, which increase the speed at which nicotine is delivered to the brain

• Adding sugars, which increase the addictive effects of nicotine and make it easier to inhale tobacco smoke.

Judge Kessler concluded in her final opinion, “Defendants have designed their cigarettes to precisely control nicotine delivery levels and provide doses of nicotine sufficient to create and sustain addiction.”

“The and contents of tobacco products make them more attractive and addictive than ever before. Cigarettes today deliver nicotine more quickly from the lungs to the heart and

brain. While nicotine is the key chemical compound that causes and sustains the powerful addicting effects of cigarettes, other ingredients and design features make them even more attractive and more addictive.”

Maximizing appeal

In addition to controlling the addictive properties of their products, tobacco companies also manipulate their products in ways that attract new smokers and increase the likelihood that they will become regular smokers. By altering the taste, smell and other sensory attributes of their products, tobacco manufacturers make it easier for new users – the vast majority of whom are kids – to start and continue smoking. 

Since the nicotine can make tobacco smoke harsh and difficult to smoke, manufacturers use chemical additives to alter the taste and smoothness of tobacco use in ways that make tobacco products more appealing to the young, novice smoker;

• Levulinic acid reduces the harshness of nicotine and makes the smoke feel smoother and less irritating.

• Flavorings, such as chocolate and liquorices, boost the sweetness of tobacco, mask the harshness of the smoke and make tobacco products more appealing to young people.

• Bronchodilators expand the lungs’ airways, making it easier for tobacco smoke to pass into the lungs.

• Menthol cools and numbs the throat to reduce throat irritation and makes the smoke feel smoother.

Design changes

The report identified two specific changes as the most likely reason for the increased risk of developing lung cancer:

• An increase in the levels of highly carcinogenic tobacco-specific nitrosamines in US cigarettes – This report linked this increase to tobacco blends used in US cigarettes compared to cigarettes sold in Australia and Canada as well as the curing process now being used. 

• Introduction of ventilation holes in cigarette filters that caused smokers to inhale more frequently and vigorously which makes drawing of carcinogens in the smoke more deeply into the lungs.

Tobacco manufacturers have conducted extensive research on ammonia technology and its effect on nicotine. Through complex chemical reactions, ammonia compounds can produce smoothing effects that make the naturally harsh and burning smoke of the tobacco leaf more readily inhalable. But ammonia compounds do much more to help control the nicotine dosing and generate increased levels of freebase nicotine to cause addiction.

Philip Morris was the first tobacco manufacturer to discover that adding ammonia or ammonia-based compounds during the manufacturing process alters the chemical composition of nicotine and smoothes the smoke. Ammonia compounds increase the pH or the alkalinity of smoke and convert the nicotine molecules into a form often referred to as “freebase” nicotine.

Freebase nicotine is more readily absorbed by the smoker, offering a faster and more intense fix of nicotine, and the smoother smoke can be more easily inhaled deeply into the lung. It is more addictive and reaches the brain speedily.

“Freebase version of Marlboro cigarettes was one of the greatest triumphs in the history of modern drug design and one reason the brand became the world’s most popular cigarette.”

Ammonia compounds are among the most frequently used additives, by volume, in the tobacco industry. In her final opinion, Judge Kessler of the US found that the cigarette companies were “well aware of the particular chemical characteristics and effects of free nicotine, and undertook efforts to exploit these features.”

Ammonia technology, not just the Marlboro Man, played a pivotal role in turning Marlboro from a relatively marginal brand in the 1960s and early 1970s into the world’s best-selling cigarette. After Marlboro was introduced with higher pH and increased levels of “free” nicotine, sales for the cigarette brand rose sharply and have remained at high levels for decades.

The tobacco industry devoted significant resources to reverse engineering the chemistry of Marlboro cigarettes to discover what was behind their popularity. Other tobacco manufacturers eventually discovered the role that ammonia played in catapulting Marlboro to the top. By the end of the 1980s, five of the six big tobacco companies were using ammonia technology.

Acetaldehyde

Sugars like glucose, fructose and sucrose are naturally present in tobacco leaf, but tobacco companies have also added sugars to their products in substantial quantities. For some cigarettes, including Marlboro, sugar is the main constituent after tobacco. When sugars are burned in cigarettes, they form the addiction-enhancing, cancer-causing chemical acetaldehyde. While only minor amounts of acetaldehyde are absorbed into the bloodstream, acetaldehyde is believed to interact with nicotine to enhance nicotine’s addictive effects by making receptors in the brain more receptive to nicotine. In fact, animal research conducted by Philip Morris demonstrated a synergistic interaction between nicotine and acetaldehyde – rats pressed the lever more for the combination of nicotine and acetaldehyde than for either substance by itself.

Tobacco companies also add sugars to their products to neutralize tobacco’s harsh taste and make the smoke seem milder and easier to inhale. By making cigarettes more palatable to first time users, sugars ultimately increase the risk for addiction because they encourage initiation. 

Researchers have concluded that sugars and how they are manipulated in tobacco also significantly contribute to the adverse health effects of smoking.

Tobacco companies not only manipulate the addictive properties of their products, but also the product in ways that both attract starter smokers and enhance the likelihood that they will become regular smokers. 

Many brands are designed to appeal to specific target groups, like youth, women and African Americans. By altering the taste, smell and other sensory attributes, tobacco manufacturers are able to make it easier to start smoking and create a better experience for the smoker.

Tobacco manufacturers have exploited the distinct sensory preferences among various demographic groups by tailoring products specifically to these preferences.

Decisions regarding product manufacture and design have been made following intensive research on how to make the product appealing to non-smokers, experimenters and specific subgroups. For example, research suggests that women are most attracted to flavors such as coconut and spearmint and products with a fresh aftertaste and pleasant aroma. As a result, companies have created products with these characteristics.

Tobacco industry documents indicate the companies are aware that attracting new young customers is the key to their survival, and they have designed products that appeal to this important market. Tobacco companies have admitted in their own internal documents that, if they don’t capture new users by the age of 21, it is very unlikely that they ever will. Indeed, 90 percent of adult smokers began smoking at or before the age of 18.

Tobacco Companies Use all sort of tactics

Tobacco Companies Use All Sorts of Tactics

Speaking at the inauguration of the World Conference on Tobacco or Health (WOTCH), held at the ADNEC, in Abu Dhabi, on March 17   2015, the Chief of the World Health Organization, Dr. Margaret Chan welcomed steps taken by several countries, led by Australia, to introduce plain packaging for cigarettes. She called for similar action by other nations.

“Tobacco companies use all sorts of tactics including funding political parties, individual politicians to work for them… There is nothing they would not exploit to undermine the governments’ resolve and determination to protect their own people,” Chan stated.

Edouard Tursan d’Espaignet, the WHO coordinator of comprehensive information systems for tobacco control, said, “The industry has lobbies, has very strong powerful friends, and these people can interfere in the right working of the government. That’s why we’re here to defy and eradicate it.” 

Addressing the tobacco control advocates, on March 18, 2015 at the Bloomberg Awards ceremony at the WOTCH Conference, in Abu Dhabi, Michael R. Bloomberg and Bill Gates announced the launch of the Anti-Tobacco Trade Litigation Fund, a new joint effort to combat the tobacco industry’s use of international trade agreements to threaten and prevent countries from passing strong tobacco-control laws. Backed by Bloomberg Philanthropies and the Bill & Melinda Gates Foundation, the new support for low and middle-income countries is the most recent element in a comprehensive strategy to reduce tobacco use globally. Tobacco will claim 1 billion lives in this century unless urgent action is taken.

“We are at a critical moment in the global effort to reduce tobacco use, because the significant gains we have seen are at risk of being undermined by the tobacco industry’s use of trade agreements and litigation,” said Michael R. Bloomberg. “We will stand with nations as they work to protect their populations against the deadly health effects of tobacco use.”

Since 2010, Uruguay has been fighting a legal challenge by Philip Morris International against the country’s graphic health warnings on tobacco products with support from Bloomberg Philanthropies and international tobacco control advocates. Australia is currently fending off both a World Trade Organization (WTO) challenge and a legal challenge by Philip Morris International against its national law that requires cigarette packs to be sold in drab colors with only the graphic health warnings – a tobacco control policy referred to as “plain packaging”. 

Numerous additional countries have been threatened by the tobacco industry, a tactic that can lead to delays by governments in passing and implementing the best-practice tobacco control laws called for in the Framework Convention on Tobacco Control (FCTC) – the world’s first health treaty that has been adopted by more than 180 countries globally.

In addition to supporting countries facing suit before international trade tribunals, the Anti-Tobacco Trade Litigation Fund includes:

1)     Technical assistance in legislative drafting and documentation to avoid legal challenges and potential trade disputes from the passage of tobacco-control laws

2)     Support of global best practices in tobacco control and coordinated efforts to document industry wrongdoing

3)     Litigation support to low- and middle-income countries to help defend laws in the form of financial support and access to high quality legal assistance

4)     Communications support to educate and inform the public about the industry challenges to tobacco control policy and abuse of the trade system

5)     Assistance in accessing knowledgeable tobacco control experts and mobilizing support among the global public health community to help countries defend against tobacco industry litigation

6)     Creation of a network of senior lawyers, experienced in trade litigation to support countries

 Washington, DC–based Campaign for Tobacco-Free Kids will administer the fund, coordinating resources including funding, technical assistance, media attention, and support from the global public health community to help countries stand against the tobacco industry when threatened with trade litigation.

 “This timely support from Bloomberg Philanthropies and the Bill and Melinda Gates Foundation will encourage low- and middle-income countries under attack from tobacco companies to fight back,” said Matthew L. Myers, President of Campaign for Tobacco-Free Kids. “The Campaign for Tobacco-Free Kids looks forward to leveraging this support to ensure that comprehensive assistance is provided to countries whose sovereign right to protect public health is threatened by tobacco companies inappropriately manipulating trade agreements.”

The Campaign for Tobacco-Free Kids (CTFK) is leading force in the fight to reduce tobacco use and its deadly toll in the United States and around the world. The CTFK’s vision is a future free of the death and disease caused by tobacco. The CTFK works to save lives by advocating for public policies that prevent kids from smoking, help smokers quit and protect everyone from secondhand smoke.

The Bloomberg Initiative to Reduce Tobacco Use aims to cut global use of tobacco by supporting low and middle-income countries to implement proven tobacco control policies as outlined in the Framework Convention on Tobacco Control (FCTC), such as creating smoke-free public places, banning tobacco advertising, increasing tax on tobacco products and increasing public awareness. Bloomberg Philanthropies has committed $600 million since 2007 to combat tobacco use worldwide. More than one billion people are now protected with smoke-free legislation and other effective tobacco control policies.

Bloomberg Philanthropies’ mission is to ensure better, longer lives for the greatest number of people. 

In the meantime at the closing ceremony of the WOTCH held on March 21, 2015, the countries were urged to take steps to reduce the consumption of tobacco which it said was a leading cause of disease and death worldwide.

In its final declaration, the 16th World Conference on Tobacco OR Health in Abu Dhabi also called for wider implementation of World Health Organization (WHO) guidelines for cutting smoking rates and reducing the burden of non-communicable diseases.

The five-day conference, which declared that all tobacco products are harmful, said they “pose an especially heavy burden on low- and middle-income countries and should be de-normalized worldwide.”

It insisted that tobacco use, in all its forms, is a major contributor to the occurrence of non-communicable disease (NCDs), such as cancer, cardiovascular disease, diabetes and respiratory diseases.

Organizers warned that tobacco causes one in six of all NCD deaths and that almost half of current tobacco users will eventually die of tobacco-related disease.

And despite a decline in the number of smokers in many countries, more needs to be done to curb tobacco use to meet the global target of a 30 percent reduction in consumption by 2025.

According to the WHO, one person dies every six seconds due to tobacco -- nearly six million people each year. It warns that unless urgent action is taken, the annual toll could rise to eight million by 2030.

The WHO says NCDs kill 35 million people annually, of whom 80 percent are in low- and middle-income countries.

The WHO framework convention on tobacco sets out guidelines on steps governments can take, including punitive tax measures; bans on tobacco advertising, promotion and sponsorship; the creation of smoke-free work and public spaces, prominent health warnings on tobacco packages and combatting illicit trade.

The treaty has been signed by 180 countries but implementation “has fallen short of objectives,” and the conference urged global cooperation to fully implement it.

The conference called for all countries to have ratified the treaty by 2018, at as well as for at least 30 countries to have adopted plain packaging and at least 100 requiring graphic warnings covering more than 50 percent of cigarette packets.

And it said that at least 15 additional countries should introduce a 70 percent hike in taxes on the retail price of tobacco products.

It also supported an initiative to be voted by parliament in the Australian state of Tasmania Tuesday to ban tobacco sales to all those born this century, to achieve a “tobacco-free generation.”

WHO - Framework Convention celebrates 10 years!

The WHO-Framework Convention on Tobacco Control (WHO-FCTC) recently celebrated its 10th anniversary, a milestone marking a decade of action to curb the global-tobacco epidemic and promote public health. The Convention is the first international treaty negotiated under the WHO’s auspices, and has become one of the fastest endorsed by the United Nations to date, with 180 Parties, covering 90 percent of the world’s population. 

In its 10 years of existence, the World Health Organization’s Framework Convention on Tobacco Control (FCTC) has succeeded in keeping tobacco control high on the global agenda, while saving lives and improving global health.

By implementing FCTC compliant legislation, many Parties have seen significant declines in their current smoking prevalence. Thus Turkey and Uruguay smoking prevalence declined by 22 percent and 25 percent respectively, in 10 years.

As regards to progress made Article wise, with regard to Article 5, Parties have made significant progress in adopting new tobacco control legislation and action plans, and establishing multi-sectoral bodies to coordinate national tobacco control efforts.

Article 5.2  -  Eighty  percent of the Parties have strengthened their existing or adopted new tobacco control legislation after ratifying the Convention. 

Article 5.3  - An increasing number of Parties are taking steps through laws or by other means to prevent tobacco industry interference, such as preventing the industry from participating in the development of legislation or sponsoring sporting events.

Article 6 - Many Parties have increased taxes to decrease tobacco consumption. The average price of a packet of cigarettes has increased by almost 150 percent in the past five years around the world. More than 40 Parties use tobacco tax earmarking to support public health and tobacco control programmes.

Article 8 - In 2005, only 5 Parties had imposed a complete ban of smoking in all public places, workplaces and public transport. As at 31 December 2014,  48 Parties had adopted legislation towards this end, an almost 10-fold increase 

since 2005.

Many Parties have introduced smoking bans in indoor public places, such as restaurants, cafés and other workplaces. More and more Parties are also banning smoking in outdoor areas, like beaches, bus stops, public parks, playgrounds and markets. To increase the protection of children, some Parties have prohibited smoking in private cars carrying children.

Article 9 -  Some Parties have banned additives in tobacco products, such as menthol, sugar and flavourings, which are all designed to make the taste of tobacco products more attractive. 

Another important development in this area is the establishment of new standards for reduced ignition propensity cigarettes, which have been shown to reduce deaths caused by smoking-related fires.

Article 11 - In 2005, only 6 Parties required large (more than 50 percent) and rotating pictorial health warnings; most countries only had text warnings. At the end of 2014, 43 Parties request warnings with the same characteristics, a more than 7-fold increase since 2005.

Many Parties require large graphic health warnings on all tobacco packaging, some of them after overcoming legal challenges posed by the tobacco industry. Plain packaging of tobacco products (with no branding, colours, imagery, corporate logos or trademarks) is another area to which Parties are paying more attention.

Article 13  - In addition to banning traditional forms of advertising (e.g. print media and billboards), several Parties have banned the display of tobacco products at points of sale. Instead, tobacco products are stored in non-transparent, locked containers.

Article 14 - Quit lines have traditionally been used to assist tobacco users, and operate in almost one quarter of the State Parties. New and innovative approaches to tobacco cessation are proving effective, including cell-phone text messaging, Internet-based behavioural support and Smartphone applications.

Article 16 - The legal age to buy tobacco products has been set or increased in several Parties to 21 or 20 years of age in recent years.

Article 17 and 18 - More and more countries are successfully promoting alternatives to tobacco growing. Replacement crops include bamboo, beans, corn, cane, fruits, safflower and soy.

 “The WHO Framework Convention stands out as the single most powerful preventive instrument available to public health,” says Dr Margaret Chan, Director-General of the World Health Organization. “We know it works. It averts addiction to a deadly product. It saves lives. Implementation of its provisions brings both an immediate and longer-term reduction in diseases and premature deaths. Increasingly fierce opposition from the tobacco industry is further evidence of how well this treaty works.” 

Dr. Margaret Chan states that there are three main challenges. The first being  ‘tobacco control fatigue’ which need to be overcome by relighting  public and political will to implement tough control measures.  

The second challenge is failing to implement the most effective measures. Though tobacco taxes do the most to reduce demand, the measure is least implemented. 

The Parties to the convention have mentioned that countering tobacco industry measures is the biggest challenge. Since the battle to control tobacco moves into the courts, the industry is using trade and investment agreements to legally challenge government actions. 

Threats of lengthy and costly litigation are being used to intimidate governments that are trying to do the right thing for their people. This is the third challenge.

Tobacco companies are profiling themselves to governments as partners in combating illicit trade in tobacco products.  Tobacco industry is complicit in this trade.  Dr. Chan urged all Parties to ratify the Protocol to eliminate illicit trade in tobacco products. She said that only six countries have ratified the Protocol to eliminate illicit trade in tobacco products, so far. 

During the past decade, the WHO FCTC has enabled Parties to make many significant achievements in tobacco control, including the following: 

• Eighty percent of countries have strengthened their tobacco control legislation since becoming Parties; 

• The cost of a packet of cigarettes has, on average, increased by 150 percent among Parties; 

• There has been a great increase in the use of graphic health warnings – such warnings cover 75–85 percent of cigarette packages in many countries and plain packaging initiatives are increasing; 

• Many countries have banned smoking in indoor and outdoor public spaces, which has helped to ensure that smoking is no longer seen as socially acceptable; 

• Some Parties have set the explicit goal of becoming “tobacco free” (with less than 5 percent prevalence of tobacco use), including Finland, Ireland and New Zealand, and the Pacific Island countries. Full implementation of the WHO-FCTC would support global commitments to achieving a 25 percent reduction in premature deaths from non-communicable diseases by 2025, including a 30 percent reduction in the prevalence of tobacco use in persons aged 15 years and over. 

The use of new products like electronic nicotine delivery systems, and of existing products, like water pipes, in new settings is gaining in popularity. 

One in every ten cigarettes and many other tobacco products consumed in the world are illegal.

This is another issue that remains high on the WHO-FCTC’s agenda is the illicit tobacco trade, which accounts for one in every 10 cigarettes and many other tobacco products consumed globally. The trade is driven by numerous players, ranging from criminal networks to the tobacco industry. To respond to this challenge, the Protocol to Eliminate Illicit Trade in Tobacco Products was adopted in November 2012, although it requires 34 more Parties to become international law. The Protocol is a new international treaty open to all Parties to the WHO-FCTC, and aims to tackle smuggling and other kinds of illicit trade, which are a grave danger to public health. The issue has been chosen as the theme for WHO’s World No Tobacco Day campaign in 2015. 

The growth in the use of new products, such as electronic nicotine delivery systems, and of existing products in new settings, such as water pipes, is alarming. Addressing new and emerging tobacco products will be vital to the success of future tobacco control efforts.

FCTC treaty recommends:

Raising tobacco taxes to reduce consumption

Article Six of the Framework Convention on Tobacco Control (FCTC) of the World Health Organization requires that Parties to the treaty consider tax policies and price polices as a part of their overall national health policy and recommends that governments raise tobacco taxes to reduce tobacco consumption as far as possible.

Treaty *Considers tax, price policies *Raising tobacco taxes *Using media to educate public *Introducing tobacco control policies

Tobacco *Leading cause of preventable death *Kills 5.4 m people annually *Over 80 percent of tobacco deaths in developing world *Estimated to kill one billion this year

The most direct and effective method for reducing tobacco consumption is to increase the price of tobacco products through tax increases. Higher tobacco prices encourage cessation among existing tobacco users, prevent initiation among potential users (non-smoking youth), and reduce the quantity of tobacco consumed among continuing users.

Higher taxes are particularly effective in reducing tobacco use among vulnerable populations, such as youth, pregnant women, and low-income smokers.

Reducing tobacco use

An increase in tobacco taxes by 10 percent decreases tobacco consumption by four percent in high-income countries and by about eight percent in low- and middle-income countries. Tobacco taxes are one of the single most effective ways of reducing tobacco use, with studies showing that a price increase of 10 percent would reduce the number of smokers by 42 million worldwide and save 10 million lives (overall consumption by four percent and youth smoking by seven percent).

Similarly, tax increases directly benefit governments through increased revenues. Every nation and sub-national entity that has significantly increased its tobacco tax has enjoyed substantial increases in revenue, even while reducing smoking. Tax increases that raise real price of cigarettes by 10 percent worldwide would increase revenues on average by about seven percent.

Preventable death

The World Bank recommends setting tobacco taxes to between two-thirds to four-fifths of retail price. Few low-and middle-income countries achieve this level of taxation, and most can significantly increase their tax levels.

The findings of a study published recently by the American Journal of Public Health provides important new evidence that cigarette tax increases and mass media public education campaigns can significantly reduce smoking.

The study adds to the overwhelming body of evidence that these solutions work and should encourage governments to take urgent actions to protect the health of their citizens from tobacco use, the world's leading cause of preventable death.

The study, conducted by a team of Australian researchers, examined the impact of several tobacco control policies on adult smoking rates in Australia over a 10 year period. The study found that government action can effectively reduce tobacco use.

The key findings are as follows:

?? Higher cigarette prices resulting from tax increases led to rapid reductions in adult smoking rates, even when controlling for other factors. According to the study, increases in the cost of a pack of cigarettes created measurable declines in smoking rates.

?? Well-funded and sustained tobacco control media campaigns significantly reduced smoking rates. The study concludes that media campaigns must be adequately funded to ensure sufficient exposure to the public and must be sustained over time.

The results of the study demonstrate that raising the price of tobacco by increasing tobacco taxes will reduce in smoking, but an even greater impact can be achieved by using some of the revenue from the tobacco tax to fund a sustained media campaign.

These proven measures are a part of a package of six cost-effective solutions for reducing tobacco use, called the MPOWER package that the World Health Organization has recommended every nation to implement.

??Monitor tobacco use and assess the impact of tobacco prevention and cessation efforts.

?? Protect everyone from secondhand smoke with laws that require smoke-free workplaces and public places.

?? Offer help to every tobacco user to quit.

?? Warn and effectively educate every person about the dangers of tobacco use with strong, pictorial health warnings and hard-hitting, sustained media campaigns.

?? Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorships and on the use of misleading terms such as 'light' and 'low-tar,' and

?? Raise the price of tobacco products by significantly increasing tobacco taxes.

Additionally the WHO has found that consumer mass media campaigns are effective in educating the public on the dangers of smoking, countering the tobacco industry's marketing and promotional tactics and reducing tobacco use.

According to the WHO, tobacco use is the leading cause of preventable death in the world today which will kill one billion people worldwide this century unless nations act now to save lives. Tobacco use already kills 5.4 million people a year and the epidemic is worsening, especially in the developing world where more than 80 percent of tobacco-caused deaths will occur in the coming decades. However, this epidemic is entirely preventable if nations urgently implement proven solutions.

The cigarette companies have opposed tobacco tax increases by arguing that raising cigarette prices would not reduce adult or youth smoking. But the internal documents of tobacco industry disclosed in the tobacco lawsuits, show that they know very well that raising cigarette prices is one of the most effective ways to prevent and reduce smoking, especially among children.

Young-adult smokers

Economic research confirms that cigarette tax increases reduce smoking. Numerous economic studies in peer-reviewed journals have documented that cigarette tax or price increases reduce both adult and underage smoking. The general consensus is that every 10 percent increase in the real price of cigarettes reduces overall cigarette consumption by approximately three to five percent, reduces the number of young-adult smokers by 3.5 percent and reduces the number of children who smoke by six or seven percent.

Research studies have also found that cigarette price and tax increases work even more effectively to reduce smoking among males and lower-income smokers. A cigarette tax increase that raises prices by ten percent will reduce smoking among pregnant women by seven percent, preventing thousands of spontaneous abortions and still-born births and saving tens of thousands of newborns from suffering from smoking-affected births and related health consequences.

Raising cigarette taxes reduces smoking especially among children which is known to tobacco industry. Higher taxes on smokeless tobacco reduce its use, particularly among young males; and increasing cigar prices through tax increases reduce adult and youth cigar smoking. It is also proved that cigarette price increases not only reduce youth smoking, but also reduce both the number of children who smoke marijuana and the amount of marijuana consumed by continuing users. By reducing smoking levels, cigarette tax increases reduce secondhand smoke exposure among nonsmokers, especially children and pregnant women.

In every single state that has significantly raised its cigarette tax rate, pack sales have gone down sharply. While some of the decline in pack sales comes from interstate smuggling and from smokers going to other lower-tax states to buy their cigarettes, reduced consumption from smokers quitting and cutting back plays a more powerful role. As shown in more detail, below, nationwide data - which counts both legal in-state purchases and the vast majority of packs purchased through cross-border, Internet, or smuggled sales shows that overall packs sales go down as state cigarette tax increases push up the average national price.

There is evidence which shows that state cigarette tax increases are prompting many smokers to quit or cutback. The Expert Conclusions on Cigarette Prices and Smoking Levels in its 2007 report, Ending the Tobacco Problem: A Blueprint for the Nation, the National Academy of Sciences' Institute of Medicine recommends raising cigarette taxes in states with low rates and indexing them to inflation, to reduce cigarette consumption and to provide money for tobacco control. The report states, "Tobacco excise tax revenues pose a potential funding stream for state tobacco control programs".

'Setting aside about one-third of the per-capita proceeds from tobacco excise taxes would help states fund programs at the level' suggested in The President's Cancer Panel's 2007 report, Promoting Healthy Lifestyles; advised increasing state tobacco taxes, stating, " Increases in tobacco excise taxes, which are passed along to consumers in the form of higher tobacco product prices, have proven highly effective in reducing tobacco use by promoting cessation among current users, discouraging relapse among former users, preventing initiation among potential users and reducing consumption among those who continue to use tobacco. These revenues also provide crucial dollars needed to fund anti-tobacco efforts."

The 2000 US Surgeon General's Report, Reducing Tobacco Use, found that raising tobacco-product prices decreases the prevalence of tobacco use, particularly among kids and young adults, and that tobacco tax increases produce "substantial long-term improvements in health." From its review of existing research, the report concluded that raising tobacco taxes is one of the most effective tobacco prevention and control strategies.

The Wall Street tobacco industry analysts have long recognized the powerful role of increasing cigarette taxes and rising cigarette prices play in reducing U.S. smoking levels. For example, the December 1998 "Sensitivity Analysis on Cigarette Price Elasticity" by Credit Suisse First Boston Corporation settled on a 'conservative' estimate that cigarette consumption will decline by four percent for every 10 percent increase in price.

The National Academy of Sciences' Institute of Medicine, in its 1998 report, Taking Action to Reduce Tobacco Use, concluded that "the single most direct and reliable method for reducing consumption is to increase the price of tobacco products, thus encouraging the cessation and reducing the level of initiation of tobacco use."

Today is World No Tobacco Day – 31st May

The theme for this year is Stop Tobacco Industry Interference. The primary goal of tobacco control is to prevent tobacco-caused diseases and death. In the hierarchy of objectives for reaching this goal, preventing the uptake of tobacco use and assisting tobacco users in ceasing use of all forms of tobacco rank highest.

Similarly, efforts designed to reduce exposure to second-hand smoke or the third-hand smoke are most effective when smoking is prohibited in public areas.

In the same way WHO states that introducing of pictorial health warnings on tobacco products is vital in reducing the consumption of cigarettes.

Although the industry sometimes makes expedient public statements to the contrary, it routinely seeks to maximize uptake of tobacco use, do all that is possible to ensure that tobacco users continue to be consumers and prevent the erosion of smoking opportunities by restrictions known to reduce smoking frequency and promote cessation. Thus, when tobacco control succeeds, the tobacco industry fails.

People employed by the tobacco industry have fiduciary responsibilities to their shareholders or government owners to take all legal steps possible to maximize profits. It is therefore entirely predictable that the tobacco industry does what it can to ensure that effective tobacco control policies fail.

“It is horrific to think that an industry known for its dirty tricks and dirty laundry could be allowed to trump what is clearly in the public’s best interests. Big Tobacco can afford to hire the best lawyers and PR firms that money can buy. Big money can speak louder than any moral, ethical or public health argument and can trample even the most damning scientific evidence. I urge all these countries to stand firm together, do not bow to pressure... we must never allow the tobacco industry to get the upper hand.”

-Dr. Margaret Chan, Director General of the World Health Organization

In the usual public health model of communicable disease control, the tobacco industry has been described as the principal ‘vector’ of tobacco-caused diseases. When making efforts to understand the chain of transmission and death in communicable diseases, comprehensive tobacco control requires that public health authorities monitor and counteract the efforts of the tobacco industry to promote tobacco use and to undermine tobacco control.

The promotional activities of the industry are directly responsible for the spread of tobacco use, especially among young people and women and in developing countries, who are the latest targets of tobacco industry marketing. Scrutinizing, countering and eliminating their activities will decrease the disease burden of tobacco use.

The WHO Tobacco Free Initiative (TFI) monitors and draws global attention to the activities and practices of the tobacco industry.

Some of the strategies that the tobacco industry uses to undermine tobacco control policies and activities in the world are;

• Intelligence gathering to monitor opponents and social trends in order to anticipate future challenges.

• Public relations to mould public opinion, using the media to promote positions favorable to the industry.

• Political funding to use campaign contributions to win votes and legislative favours from politicians.

• Lobbying to make deals and influence political processes.

• Consultancy to recruit allegedly independent experts who are critical of tobacco control measures.

• Funding research, including universities to create doubt about evidence of the health effects of tobacco use.

• Smokers’ rights groups to create an impression of spontaneous, grassroots public support.

• Creating alliances and front groups to mobilize farmers, retailers, advertising agencies, the hospitality industry, grassroots and anti-tax groups with a view to influencing legislation.

• Intimidation to use legal and economic power as a means of harassing and frightening opponents who support tobacco control.

• Philanthropy to buy friends and social respectability from arts, sports, humanitarian and cultural groups.

• ‘Corporate social responsibility’ to promote voluntary measures as an effective way to address tobacco control and create an illusion of being a ‘changed’ company and to establish partnerships with health interests.

• Youth smoking prevention and retailer education programmes to appear to be on the side of efforts to prevent children from smoking and to depict smoking as an adult choice.

• Litigation to challenge laws and intimidate tobacco industry opponents.

• Smuggling to undermine tobacco excise tax policies and marketing and trade restrictions and thereby increase profits.

• International treaties and other international instruments to use trade agreements to force entry into closed markets and to challenge the legality of proposed tobacco control legislation.

• Joint manufacturing and licensing agreements and voluntary policy agreements with governments to form joint ventures with state monopolies and subsequently pressurize governments to privatize monopolies.

• Pre-emption to overrule local or state government by removing its power to act.

According to WHO, attempts by the tobacco industry to influence policy and programmes reach beyond health to social issues, education and the environment.

The Preamble of the WHO Framework Convention on Tobacco Control recognized the Parties’ “need to be alert to any efforts by the tobacco industry to undermine tobacco control efforts and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts”.

Use of the guidelines for implementation of Article 5.3 of the Convention will have an overarching impact on countries’ tobacco control policies and on implementation of the Convention, because the guidelines recognize that tobacco industry interference, including that from the State-owned tobacco industry, cuts across a number of tobacco control policy areas, as stated in the Preamble of the Convention, articles referring to specific tobacco control policies and the Rules of Procedure of the Conference of the Parties to the WHO Framework Convention on Tobacco Control.

The purpose of these guidelines is to ensure that efforts to protect tobacco control from commercial and other vested interests of the tobacco industry are comprehensive and effective. Parties should implement measures in all branches of government that may have an interest in, or the capacity to, affect public health policies with respect to tobacco control. The guidelines draw on the best available scientific evidence and the experience of Parties in addressing tobacco industry interference.

The guidelines apply to persons, bodies or entities that contribute to, or could contribute to, the formulation, implementation, administration or enforcement of those policies and are applicable to government officials, representatives and employees of any national, state, provincial, municipal, local or other public or semi/quasi-public institution or body within the jurisdiction of a Party, and to any person acting on their behalf. Any government branch (executive, legislative and judiciary) responsible for setting and implementing tobacco control policies and for protecting those policies against tobacco industry interests should be accountable.

The tobacco industry produces and promotes a product that has been proven scientifically to be addictive, to cause disease and death and to give rise to a variety of social ills, including increased poverty. Therefore, Parties should protect the formulation and implementation of public health policies for tobacco control from the tobacco industry to the greatest extent possible.

Parties, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent.

Any preferential treatment of the tobacco industry would be in conflict with tobacco control policy. The Parties should raise awareness about the addictive and harmful nature of tobacco products and about tobacco industry interference with tobacco control policies.

The Parties should establish measures to limit interactions with the tobacco industry and ensure the transparency of those interactions that occur. They should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products, when interactions with the tobacco industry are necessary, they should be conducted in public, for example through public hearings, public notice of interactions, disclosure of records of such interactions to the public.

The tobacco industry should not be a partner in any initiative linked to setting or implementing public health policies, given that its interests are in direct conflict with the goals of public health.

Parties should not accept, support or endorse partnerships and non-binding or non-enforceable agreements as well as any voluntary arrangement with the tobacco industry or any entity or person working to further its interests.

Parties should not accept, support or endorse the tobacco industry organizing, promoting, participating in, or performing, youth, public education or any initiatives that are directly or indirectly related to tobacco control.

Any voluntary code of conduct or instrument drafted by the tobacco industry that is offered as a substitute for legally enforceable tobacco control measures should not be accepted, supported or endorsed.

Any offer for assistance or proposed tobacco control legislation or policy drafted by or in collaboration with the tobacco industry should not be accepted, supported or endorsed.

Clear rules regarding conflicts of interest for government officials and employees working in tobacco control are important means for protecting such policies from interference by the tobacco industry.

Payments, gifts and services, monetary or in-kind, and research funding offered by the tobacco industry to government institutions, officials or employees can create conflicts of interest. Conflicting interests are created even if a promise of favorable consideration is not given in exchange, as the potential exists for personal interest to influence official responsibilities as recognized in the International Code of Conduct for Public Officials adopted by the United Nations General Assembly and by several governmental and regional economic integration organizations.

Monitoring implementation of Article 5.3 of the Convention and of these guidelines is essential for ensuring the introduction and implementation of efficient tobacco control policies. This should also involve monitoring the tobacco industry, for which existing models and resources should be used, such as the database on tobacco industry monitoring of the WHO Tobacco Free Initiative.

Nongovernmental organizations and other members of civil society not affiliated with the tobacco industry could play an essential role in monitoring the activities of the tobacco industry.

International cooperation is essential and vital for making progress in preventing interference by the tobacco industry with the formulation of public health policies on tobacco control.

The Framework Convention on Tobacco Control (FCTC) required Parties to the treaty to implement the regulation on warnings, to cover at least 50% of the pack with pictorial health warnings highlighting the harm of smoking.

Though Sri Lanka is a Party to the treaty, which ratified the FCTC in 2003 as the First Asian country, the country is now four years behind the prescribed schedule. Throughout the world the industry has been involved in interfering in health policy matters to delay very important tobacco control policies. Thus industry interference in policy matters related to health matters should never be allowed.

Therefore we request the government to expedite the implementation process of the regulation of Pictorial Health Warnings on Tobacco products and save the 20,000 untimely deaths occurring in Sri Lanka every year!

- Asian Tribune

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Worldwide call for larger pictorial health warnings

by Manjari Peiris

The FCTC Article 11 guidelines recognise that the effectiveness of health warnings increases with size - A larger size means that warnings are more visible, more important, and have more impact. A larger size allows for bigger and better pictures, a larger font size and/or additional information, including cessation information.

A larger size makes it more difficult for the branded promotional part of the package to distract the consumer’s attention away from the warning. That larger sizes are more effective is confirmed by the considered decisions of governments worldwide where the trend is very much to increase warning size.

All the Parties to the international tobacco control treaty of the World Health Organisation (WHO) - Framework Convention on Tobacco Control (FCTC) should have been implemented the treaty’s Article 11 - which is Pictorial Health Warnings on tobacco products within three years after the FCTC comes into force for that Party.

Sri Lanka ratified the treaty in 2003 and the FCTC came into force in 2005. Pictorial Health Warning regulation is one of the five key policies of WHO to reduce tobacco consumption - MPOWER.

Pictorial health warnings (PHW) on tobacco products constitute the most cost-effective tool for educating smokers and non smokers alike about the health risks of tobacco use. In many countries, more smokers report getting information about the health risks of smoking from warning labels than any other source. PHWs also provide high awareness to non-smokers, including children of the danger of tobacco smoking.

Theories in social and health psychology, supported by empirical studies, have demonstrated the superiority of using pictures and imagery over text-only messages in health communication. Article 11 also has a provision regarding emission information elsewhere on the package, with the Article 11 Guidelines providing that qualitative information should be used without tar and nicotine ISO yield numbers. Article 11 requires Parties to ensure that the industry’s use of the package is not “false, misleading, deceptive or likely to create an erroneous impression” - accordingly a growing number of countries have prohibited “light”, “mild” and other misleading descriptors.

Health warnings on packages of tobacco products are a highly cost-effective means of health communication. Package warnings reach every smoker (and consumers of other tobacco products) every day.

Guidelines

Warnings are always working - 24 hours per day, seven days per week. A pack a day smoker would take his or her pack out 20 times per day, 7,300 times per year. Warnings are also seen by those around the consumers, such as family, friends and co workers.

Consumers are entitled to be fully informed of the many health effects of tobacco products, and the package is the best way to do that. Studies show that consumers, including children, underestimate the health effects, in low, middle and high income countries. The tobacco industry highly opposes larger, picture warnings as a way to protect their sales volumes.

The FCTC Article 11 guidelines recognise that the effectiveness of health warnings increases with size - A larger size means that warnings are more visible, more important, and have more impact. A larger size allows for bigger and better pictures, a larger font size and/or additional information, including cessation information.

A larger size makes it more difficult for the branded promotional part of the package to distract the consumer’s attention away from the warning. That larger sizes are more effective is confirmed by the considered decisions of governments worldwide where the trend is very much to increase warning size.

A picture really does say a thousand words. Pictures are especially important for individuals who are illiterate or who have low literacy, an aspect especially important in many countries. Pictures are also important to immigrants, temporary workers as well as individuals from minority language groups who may not yet be able to read the national language.

Impact

The feasibility of implementing picture warnings has been demonstrated in a larger number countries/jurisdictions.To ensure better visibility and impact, picture warnings should be placed on both the front and back of the package (not just one of these), and should be placed at the top of the front/back, not the bottom, as provided in the Article 11 guidelines.

Australia which has the largest warnings in the world has also implemented plain packaging to prohibit tobacco company colours, logos, and design elements on the brand part of the package.

Plain packaging prohibits brand colours, logos and design elements on packages and requires that packages only come in a standard shape and format. Under plain packaging, health warnings should continue to appear, but the brand portion of the package has the same colour (e.g. brown) for all brands. The brand name is allowed on packages, but only in a standard location, colour (e.g. black), front style and size. Plain packaging would curb the industry’s use of the package as a promotional vehicle, would increase the effectiveness of package warnings, would curb package deception, and would decrease tobacco use.

Article 11 and the Article 13 guidelines under the FCTC recommend that Parties consider implementing plain packaging.

The deadly health consequences of tobacco consumption are well known the world over, and the tobacco industry resists every move by governments to protect their people from tobacco addiction. It understands the power of pictorial health warnings and uses all its clout globally to delay countries from implementing this tried and tested deterrent. The recent Cigarette Pack Health Warnings International Status Report, places Sri Lanka in 3rd place for the largest health warnings among 198 countries.

Sri Lanka warnings will cover 80 percent of the front and 80 percent of the back, which is far ahead of many developed countries, and reinforces the country’s commitment to the health and welfare of its people.